bluuebunny/crossref_metadata_2025 huggingface dataset:
Expertentreffen COPD: Lunge und Herz – ziemlich oft gemeinsam krank!
Authors: Jany B. , Bals R. , Dreher M. , Held M. , Jany L. , Rembert Koczulla A. , Pfeifer M. , Randerath W. , Watz H. , Wilkens H. , Steinkamp G.
Published: September 2019

Pneumologen sollten immer auch an das Herz denken, wenn sie Patienten mit pulmonalen Erkrankungen diagnostizieren und therapieren. Dies gilt besonders für die COPD, aber auch eine ganze Reihe anderer pneumologischer Krankheitsbilder. Auf dem Workshop „Luftschlösser“, der wieder im Februar 2019 in Wiesbaden abgehalten wurde, diskutierten die Teilnehmer die vielfältigen Interaktionen von Lunge und Herz und deren Bedeutung für die Therapie. Ausgehend von pathophysiologischen Überlegungen wurden die psychosozialen Auswirkungen des Kardinalsymptoms Dyspnoe für Patienten sowohl mit Lungen- als auch Herzerkrankungen deutlich. Eine besondere diagnostische und therapeutische Herausforderung liegt im simultanen Auftreten von pulmonalen und kardialen Krankheiten beim individuellen Patienten. So wurde gezeigt, wie häufig die Komorbidität Herzinfarkt bei COPD übersehen wird – und vice versa. Dass auch Asthmatiker häufiger eine koronare Herzerkrankung oder eine Herzinsuffizienz aufweisen, ist im klinischen Alltag nicht immer präsent. Die Überblähung der Lunge beim Emphysem beeinträchtigt die kardiale Funktion auch beim Herzgesunden. Die medikamentöse Verminderung der Überblähung verbessert so die kardiale Funktion. Biomarker helfen bei der Differenzialdiagnose. Ihre Rolle wird in der großen deutschen Kohorte COSYCONET untersucht. Der schwerergradig herzkranke Lungenpatient stellt therapeutisch eine große Herausforderung dar, insbesondere wenn er intensiv- und beatmungspflichtig wird und das Weaning prolongiert verläuft. Ein „klassisches“ Beispiel der Interaktion von Lunge und Herz stellen die Lungengefäßerkrankungen dar. Sowohl bei der pulmonal-arteriellen Hypertonie als auch der chronisch-thromboembolischen pulmonalen Hypertonie vergeht nicht selten eine zu lange Zeit bis zur Diagnosestellung. Die therapeutischen Möglichkeiten haben sich für beide Gruppen von Lungengefäßerkrankungen in den letzten Jahren erheblich verbessert und stellen eine wichtige Aufgabe für Pneumologen dar. Schlafbezogene Atmungsstörungen und die kardiale Funktion stehen in einer Wechselbeziehung, die nach der SERVE-HF-Studie einer besonderen Aufmerksamkeit bedarf. Unstrittig bleibt, dass die obstruktive Schlafapnoe ein unabhängiger Risikofaktor für kardiovaskuläre Erkrankungen ist und leitlinienkonform behandelt werden muss.

Der Workshop zeigte eindrucksvoll die vielfältigen Wechselwirkungen von Herz und respiratorischem System, die zu Problemen in Diagnostik und Therapie führen können. Pneumologische Leitlinien sollten den Aspekt der kardialen Komorbidität stärker in den Fokus nehmen.
Rauchen im Jugendalter in England und Deutschland, 2001 – 2016
Authors: Hanewinkel R. , Isensee B. , Goecke M. , Morgenstern M.
Published: September 2019

Ziel Deskription des Rauchverhaltens Jugendlicher aus England und Deutschland über einen Beobachtungszeitraum von 15 Jahren.

Methode 11 wiederholte Querschnittserhebungen mit insgesamt 107 485 Personen im Alter von 11 bis 15 Jahren wurden zwischen 2001 und 2016 in England und Deutschland durchgeführt. Erfasst wurde a) der relative Anteil Jugendlicher, die jemals in ihrem Leben ein konventionelles Tabakprodukt geraucht hatten, und b) der relative Anteil aktuell rauchender Jugendlicher, d. h. Jugendliche, die „gelegentlich“ bzw. „ständig“ oder „regelmäßig“ rauchten.

Ergebnisse Es zeigte sich im Beobachtungszeitraum eine signifikant stärkere Reduktion des Anteils Jugendlicher mit Raucherfahrung in Deutschland (von 52 % auf 10 %) im Vergleich zu England (von 44 % auf 19 %). Der Anteil aktuell rauchender Jugendlicher fiel im Beobachtungszeitraum in Deutschland um 16 Prozentpunkte auf 3 % und in England um 12 Prozentpunkte auf 7 % (kein signifikanter Unterschied).

Schlussfolgerungen Die Daten liefern einen Hinweis auf einen stärkeren Trend zum Nie-Rauchen in Deutschland im Vergleich zu England und auf einen vergleichbaren Trend zum selteneren aktuellen Rauchen in den beiden Ländern. Kausale Schlussfolgerungen sind aufgrund der Studienanlage nicht möglich.
Akutes respiratorisches Versagen durch Silikon-Injektion
Authors: Eckle V.-S. , Lambiris N. , Grund D. , Vogtmann M. , Ruwwe-Glösenkamp C. , Uhrig A. , Suttorp N. , Witzenrath M. , Müller-Redetzky H.
Published: September 2019

Ein 35-jähriger Patient stellte sich mit Fieber, Dyspnoe und Petechien in der Notaufnahme einer Universitätsklinik vor. Im Röntgen-Thorax zeigten sich bipulmonale Infiltrate. 5 Tage zuvor hatte sich der Patient Silikonöl als kosmetischen Laieneingriff subkutan in den Penis injizieren lassen. Bei zunehmender respiratorischer Verschlechterung musste der Patient analgosediert und intubiert werden. Im CT des Thorax und in der Bronchoskopie zeigte sich eine diffuse alveoläre Hämorrhagie. Die Diagnose einer Pneumonitis mit einem schweren akuten respiratorischen Versagen aufgrund eines Silikon-Embolisations-Syndroms wurde gestellt. Neben Bauchlagerung und Lungen-protektiver Beatmung wurde mit einer Kortison-Stoß-Therapie behandelt. Nach 19 intensivstationären Behandlungstagen konnte der Patient auf die Normalstation verlegt werden. In der ambulanten Nachsorge zeigte sich eine altersentsprechende Lungenfunktion.

Fazit Bei Fieber, Atemnot und alveolärer Hämorrhagie sollte im Zusammenhang mit kosmetischen Eingriffen differenzialdiagnostisch an eine Silikon-Pneumonitis gedacht werden. Unter Hochdosis-Kortison-Therapie und Lungen-protektiver Beatmung kann ein schweres respiratorisches Lungenversagen bis zur vollständigen Ausheilung erfolgreich therapiert werden.
Efficient analytical approach to solve system of BVPs associated with fractional obstacle problem
Authors: Rafiq Muhammad , Noor Muhammad Aslam , Tahir Madeeha , Kamran Muhammad , Qureshi Muhammad Amer , Farwa Shabieh
Published: September 2019

The general obstacle framework has found applications in steady state fluid interaction, thin-plate fluid dynamics, study of minimal surfaces, control theory, elasto-statics, etc. The obstacle problem involving the fractional operator indeed appears in many contexts, such as in the analysis of anomalous diffusion, in the quasi-geostrophic flow problem, and in pricing of American options regulated by assets evolving in relation to jump processes; these notable applications in financial mathematics and physics made the obstacle problem very important in recent times. In this work, we present a fractional contact problem in which derivative of fractional order in the sense of Caputo is involved. Using the penalty function method, we degenerate it into a system of fractional boundary value problems with known obstacle. We apply the variational iteration method (VIM) for finding the series solution of these fractional BVPs. In order to ensure the accuracy and convergence of solution, residual errors of the solutions for various values of fractional parameters are plotted. The quite accurate results show that variational iteration method is one of the highly potential and robust method for solving fractional BVPs.
Secondary electron emission characteristics of Al2O3 coatings prepared by atomic layer deposition
Authors: Guo Junjiang , Wang Dan , Xu Yantao , Zhu Xiangping , Wen Kaile , Miao Guanghui , Cao Weiwei , Si JinHai , Lu Min , Guo Haitao
Published: September 2019

Secondary electron emission (SEE) plays a crucial role in the gain performance of devices, such as electron multipliers and microchannel plates (MCPs). Gain performance could be improved by increasing the secondary electron yield (SEY) of device surface. Al2O3 coating is an ideal material for SEE, benefiting from its high SEY. The Al2O3 coating deposited on inner device walls by atomic layer deposition (ALD) can improve the gain performance of devices. In this study, the SEE characteristics of Al2O3 coatings were investigated experimentally. A series of Al2O3 coatings with thicknesses of 1-30 nm were prepared on Si substrate through the ALD method. Then, the SEY of the coatings were quantified as a function of primary electron energy in the range of 100∼1500 eV. Furthermore, an equation describing the true SEY as a function of thickness was established by applying theory of Dionne’s SEE model. This work presents potential approach for controlling the SEE level of Al2O3 coatings through thickness adjustment and is crucial for comprehending the SEE of composite materials.
Design and build MoS2/Au/MoS2 sandwich structure to significantly enhance the photoluminescence
Authors: Zhang Shucheng , Guan Liao , Niu Xinyue , Yao Jiadong , Yan Xiaoyuan , Xing Boran , Yu Ying , Sha Jian , Wang Yewu
Published: September 2019

Usually the bi-layer MoS2 grown directly by chemical vapor deposition or exfoliated by mechanical method has an indirect band gap, which leads to poor optical property. In this work, we design and build the sandwich structure by stacking a bi-layer MoS2 with Au nanoparticles embedded in the adjacent layers. This structure shows a 45-fold enhancement in photoluminescence (PL) compared with the direct grown bi-layer MoS2. More importantly, the as-built bi-layer MoS2 area shows much stronger in the PL intensity than that of the monolayer MoS2 area. This work presents the optimized PL enhancement of this homogeneous MoS2 structure by the surface plasmon resonance (SPR) effect of the Au nanoparticles and the effect of direct bandgap bi-layer MoS2 structures via tuning the interlayer distance between the adjacent MoS2 layers.
Adsorption simulation of methane on coals with different metamorphic grades
Authors: Gao Dameng , Hong Lin , Wang Jiren , Zheng Dan
Published: September 2019

In order to study the adsorption capacity of methane on coals with different metamorphic grades and its influencing factors, the new macromolecular structure models of lignite, bituminous coal and anthracite were constructed, and the grand canonical Monte Carlo (GCMC) method was used to simulate the adsorption process of methane in coals. The results show that the adsorption amount of methane is related to the volume of pore formed by macromolecular accumulation. Gas adsorption is mainly caused by van der Waals force. The adsorption amount of methane decreases linearly with the increase of temperature. Water molecules in coal inhibit methane adsorption. The amount of methane adsorbed in coal decreases with moisture content increasing, especially for anthracite. When methane and water are simultaneously isostatically adsorbed, the amount of water is much larger than that of methane, and the amount of methane in micropores is nearly zero. In simulations, we find the construction of the unit cell of coal is critical to the accuracy of the amount of methane. The structure of the supercell represents the grades of metamorphism of coal, which has a great influence on the amount of methane adsorbed in coal. Compared with the metamorphic grade, the temperature has small effect on the amount of methane.
Ferroelectric properties of BaTiO3 thin films co-doped with Mn and Nb
Authors: Phuyal Dibya , Mukherjee Soham , Jana Somnath , Denoel Fernand , Kamalakar M. Venkata , Butorin Sergei M. , Kalaboukhov Alexei , Rensmo Håkan , Karis Olof
Published: September 2019

We report on properties of BaTiO3 thin films where the bandgap is tuned via aliovalent doping of Mn and Nb ions co-doped at the Ti site. The doped films show single-phase tetragonal structure, growing epitaxially with a smooth interface to the substrate. Using piezoforce microscopy, we find that both doped and undoped films exhibit good ferroelectric response. The piezoelectric domain switching in the films was confirmed by measuring local hysteresis of the polarization at several different areas across the thin films, demonstrating a switchable ferroelectric state. The doping of the BaTiO3 also reduces the bandgap of the material from 3.2 eV for BaTiO3 to nearly 2.7 eV for the 7.5% doped sample, suggesting the viability of the films for effective light harvesting in the visible spectrum. The results demonstrate co-doping as an effective strategy for bandgap engineering and a guide for the realization of visible-light applications using its ferroelectric properties.
Evolution of carbides and performance of knives made of aged 8Cr13MoV steel
Authors: Zhang Jie , Li Jing , Shi Chengbin , Li Jihui
Published: September 2019

The dissolution and precipitation behaviours of M7C3 and M23C6 carbides in 8Cr13MoV steel were calculated using Thermo-Calc software. The mechanical properties of carbides were calculated using the Vienna Ab-initio Simulation Package. Results showed that M7C3 carbides were ductile and M23C6 carbides were brittle. High holding temperature provided favourable conditions for M7C3 carbides to precipitate and promoted the dissolution of bulky M23C6 carbides. Two heat treatment sequences were designed. During aging treatment, dispersive rodlike nanoscale M7C3 carbides precipitated from matrix, which improved wear resistance and the retention ability of the cutting edge of knives by 56 and 22%, respectively.
Enhanced biogas production from fecal sludge by iron metal supplementation: iron enriched fertiliser as a byproduct
Authors: Dhungana S , Adhikari B , Shrestha S D , Shrestha B P
Published: September 2019

Iron has strong influence on microbial metabolism and can inhibit activity of microbes in cases of excessive concentrations or of low bioavailability of nutrients. Addition of iron fulfils the deficiency of seven enzymes provided by eight microorganisms. These enzymes are very essential for the microbial activity during anaerobic digestion for enhanced methane production. In this study the anaerobic digestion of fecal sludge was conducted in the presence of iron powder (Fe) as a trace element and the temperature was maintained at mesophilic range i.e. 35°C. For the correction of C: N ratio, co-digestion of fecal sludge and kitchen waste was done. The gas produced was measured by water displacement method. Biogas production from human feces as substrate when supplemented with different concentration of iron powder resulted with improved amount of methane as that from the fecal sludge in the control. Results showed that the production of methane was improved to 53.11 % and 64.74 % in the presence of iron powder, respectively at the dose rate of 0.25 g Fe and 0.5 g Fe per 200 g sludge. The increase in methane yield from Co-digestion was found to be 76.27 % as compared to that of fecal sludge in control.
Hot air drying of coconut residue: shelf life, drying characteristics, and product quality
Authors: Jongyingcharoen J S , Wuttigarn P , Assawarachan R
Published: September 2019

The longest and the shortest shelf lives of coconut residue based on microbial analysis were more than 140 and less than 3 days when varied the moisture content from 0.03 to 0.25 g water/g dry matter, respectively. Drying characteristics and quality of coconut residue were determined at various drying temperatures (50-80˚C) and layer thicknesses (5-10 mm). These drying factors significantly affected drying time, whiteness and oil content of coconut residue. The highest temperature and the smallest thickness resulted in the shortest drying time (70 min). As compared to fresh sample, drying for less than 200 min gave whiter coconut residue and all dried samples had higher oil content.
Immune response declines with age in a wild lizard
Authors: Plasman Melissa , Sandoval-Zapotitla Estela , Torres Roxana
Published: September 2019

The immune system allows animals to survive the constant attacks of pathogens. Although it is essential for survival and fitness, the performance of the immune system can decline with age (a process known as immunosenescence), which may be responsible for the increased mortality of older individuals. Only a few studies have investigated the effect of age on the immune system in reptiles, and no evidence of immunosenescence has yet been reported in lizards. In a wild population of Dickerson’s collared lizards (Crotaphytus dickersonae), we evaluated the effect of age (estimated by skeletochronology) on the male’s immune response to a novel antigen (phytohaemagglutinin). We found a strong negative relationship between immune response and age, the first evidence of immunosenescence in a lizard. Our results show that immunosenescence can occur even in relatively short-lived reptiles and underline the importance of age on performance in fitness-related traits.
Support Needs and Post-Adoption Resources for Adopted Adults: A Systematic Review
Authors: Sánchez-Sandoval Yolanda , Jiménez-Luque Natalia , Melero Sandra , Luque Violeta , Verdugo Laura
Published: September 2019

Post-adoption services provide guidance to adoptive families concerning common and specific circumstances. Despite adoption is a lifelong experience, most of the post-adoption resources are oriented towards children, adolescents and their adoptive parents. However, it is also necessary to focus on the demands and interventions with adult adoptees. The aim of this article is to review adult adoptees’ demands for post-adoption resources, applicants’ characteristics and resources offered to them. A systematic search was conducted in several databases, finding forty studies that fulfilled the selection criteria (about adults, domestic/international adoptions and published between 2005 and 2018). The included studies showed mainly three needs: contact with birth family, ethnic identity and birth culture, and psychological support. Additionally, adoptees who demand post-adoption resources are a heterogeneous group. This review collects structured programmes focused on different topics: search for origins, attachment development and professionals’ training in adoption. In addition, we also found some specific post-adoption services and other tools, such as support groups or cultural events. Finally, adoptees also have access to other resources that are not specifically for them, such as mental health services. The scarce existence of evidence-based interventions is an important weakness in this work. Recommendations for future research and practice are included.
Lack of Sez6 Family Proteins Impairs Motor Functions, Short-Term Memory, and Cognitive Flexibility and Alters Dendritic Spine Properties
Authors: Nash Amelia , Aumann Timothy D , Pigoni Martina , Lichtenthaler Stefan F , Takeshima Hiroshi , Munro Kathryn M , Gunnersen Jenny M
Published: September 2019

Seizure-related gene 6 (Sez6), Sez6-Like (Sez6L), and Sez6-Like 2 (Sez6L2) comprise a family of homologous proteins widely expressed throughout the brain that have been linked to neurodevelopmental and psychiatric disorders. Here, we use Sez6 triple knockout (TKO) mice, which lack all three Sez6 family proteins, to demonstrate that Sez6 family proteins regulate dendritic spine structure and cognitive functions, motor learning, and maintenance of motor functions across the lifespan. Compared to WT controls, we found that Sez6 TKO mice had impaired motor learning and their motor coordination was negatively affected from 6 weeks old and declined more rapidly as they aged. Sez6 TKO mice had reduced spine density in the hippocampus and dendritic spines were shifted to more immature morphologies in the somatosensory cortex. Cognitive testing revealed that they had enhanced stress responsiveness, impaired working, and spatial short-term memory but intact spatial long-term memory in the Morris water maze albeit accompanied by a reversal deficit. Our study demonstrates that the lack of Sez6 family proteins results in phenotypes commonly associated with neuropsychiatric disorders making it likely that Sez6 family proteins contribute to the complex etiologies of these disorders.
The Territorial Constitution and the Brexit Process
Authors: Tierney Stephen
Published: September 2019

This article assesses the United Kingdom’s rapidly evolving territorial constitution through the register of federal theory. While not arguing that the UK is federal or ought to be described as federal, the article contends that federalism is a useful prism through which to assess how well the UK’s constitution accommodates autonomy on the one hand and the efficacy of union, which is the essential complement of pluralism, on the other. It then proceeds to assess the Brexit process in light of existing imbalances in the UK’s territorial arrangements. The way in which Parliament has paved the way for the United Kingdom’s withdrawal from the EU is widely considered to be deeply unpropitious for devolution. However, upon further analysis of the legal changes and internal political commitments that have been designed to facilitate Brexit, it would appear that a more balanced set of constitutional arrangements may be emerging which could in fact bolster and further embed the United Kingdom’s territorial constitutional commitments.
Efficacy of Medical Operations and Layout Planning Onboard Nontraditional US Navy Vessels at High Seas
Authors: Lindemann Cameron , Hoang Tuan , Pierce Eric , Franciose Reginald , Pena Mathew , Wilson Tina , Bass Cameron , Shattuck Nita L , LaPorta Anthony J
Published: September 2019

Introduction: Attempting to expedite delivery of care to wounded war fighters, this study aimed to quantify the ability of medical and surgical teams to perform lifesaving damage control and resuscitation procedures aboard nontraditional US Navy Vessels on high seas. Specifically, it looked at the ability of the teams to perform procedures in shipboard operating and emergency rooms by analyzing motion of personnel during the procedures. Methods: One hundred and twelve damage control and resuscitation procedures were performed during a voyage of the US Naval Ship Brunswick in transit from Norfolk, Virginia, to San Diego, California. The ability of personnel to perform these procedures was quantified by the use of motion link analysis designed to track the movement of each participant as they completed their assigned tasks. Results: The link analysis showed no significant change in the number of movements of participants from the beginning to the end of the study. However, there was a learning effect observed during the study, with teams completing tasks faster at the end of the study than at the beginning. Conclusion: This shows that the working conditions aboard the US Naval Ship Brunswick were satisfactory for the assigned tasks, indicating that these medical operations may be feasible aboard nontraditional US Navy vessels.
Carbapenems vs β-Lactam Monotherapy or Combination Therapy for the Treatment of Complicated Intra-abdominal Infections: Systematic Review and Meta-analysis of Randomized Controlled Trials
Authors: Li Yan , Chen Lingyuan , Jiang Junsong , Li Xianshu , Huang Tianguo , Liang Xueyan
Published: September 2019

Background

Complicated intra-abdominal infections (cIAIs) result in significant morbidity, mortality, and cost. Carbapenem-resistant sepsis has increased dramatically in the last decade, resulting in infections that are difficult to treat and associated with high mortality rates. To prevent further antibacterial resistance, it is necessary to use carbapenem selectively. The objective of this study was to compare the effectiveness and safety of carbapenems vs alternative β-lactam monotherapy or combination therapy for the treatment of cIAIs.

Methods

The PubMed, Embase, Medline (via Ovid SP), and Cochrane library databases were systematically searched. We included randomized controlled trials (RCTs) comparing carbapenems vs alternative β-lactam monotherapy or combination therapy for the treatment of cIAIs.

Results

Twenty-two studies involving 7720 participants were included in the analysis. There were no differences in clinical treatment success (odds ratio [OR], 0.86; 95% confidence interval [CI], 0.71–1.05; I2 = 35%), microbiological treatment success (OR, 0.88; 95% CI, 0.71–1.09; I2 = 25%), adverse events (OR, 0.98; 95% CI, 0.87–1.09; I2 = 17%), or mortality (OR, 0.96; 95% CI, 0.68–1.35; I2 = 7%). Patients

treated with imipenem were more likely to experience clinical or microbiological failure than those treated with alternative β-lactam monotherapy or combination therapy.

Conclusions

No differences in clinical outcomes were observed between carbapenems and noncarbapenem β-lactams in cIAIs. Patients treated with imipenem were more likely to experience clinical or microbiological failure than those treated with alternative β-lactam monotherapy or combination therapy.
Risk factors, awareness of disease and use of medications in a deprived population: differences between indigent natives and undocumented migrants in Italy
Authors: Fiorini Gianfrancesco , Cerri Cesare , Magri Flavia , Chiovato Luca , Croce Laura , Rigamonti Antonello E , Sartorio Alessandro , Cella Silvano G
Published: September 2019

Background

Undocumented migrants experience many health problems; a comparison with a suitable control group of natives living in the same socio-economic conditions is still lacking.

Methods

Demographic data and data on risk factors, chronic conditions and dietary habits were obtained for 6933 adults (2950 Italians and 3983 undocumented migrants) receiving medical assistance from 40 non-governmental organizations all over the country.

Results

Attributed to the fact that these were unselected groups, differences were found in their demographic features, the main ones being their marital status (singles: 50.5% among Italians and 42.8% among migrants; P < 0.001). Smokers were more frequent among Italians (45.3% versus 42.7% P = 0.03); the same happened with hypertension (40.5% versus 34.5% P < 0.001). Migrants were more often overweight (44.1% versus 40.5% P < 0.001) and reporting a chronic condition (20.2% versus 14.4% P < 0.001). Among those on medications (n = 1354), Italians were fewer (n = 425) and on different medications. Differences emerged also in dietary habits.

Conclusions

Differences in health conditions exist between native-borns and undocumented migrants, not because of a bias related to socio-economic conditions. Further studies are needed to design sustainable health policies and tailored prevention plans.
Mergers, Innovation, and Entry-Exit Dynamics: Consolidation of the Hard Disk Drive Industry, 1996–2016
Authors: Igami Mitsuru , Uetake Kosuke
Published: September 2019

How far should an industry be allowed to consolidate when competition and innovation are endogenous? We develop a stochastically alternating-move game of dynamic oligopoly and estimate it using data from the hard disk drive industry, in which a dozen global players consolidated into only three in the last 20 years. We find plateau-shaped equilibrium relationships between competition and innovation, with heterogeneity across time and productivity. Our counterfactual simulations suggest the current rule-of-thumb policy, which stops mergers when three or fewer firms exist, strikes approximately the right balance between pro-competitive effects and value-destruction side effects in this dynamic welfare trade-off.
Behçet disease
Authors: Lee Debra
Published: September 2019

Behçet disease (BD) is a rare yet complicated chronic inflammatory condition related to vasculitis that may present with multiorgan involvement. BD has a number of potential clinical presentations, with painful oral and genital lesions being the most common. Outcomes of BD range from recurring, painful, transient rashes to life-threatening episodes. Primary care NPs are in a key position to develop suspicion for BD based on clinical presentation of combined manifestations. This article uses a case study to explore the diagnosis of BD.
The Flatfoot Through a Pinhole: Do It Percutaneously!
Authors: Cody Elizabeth A. , Younger Alastair , Cerrato Rebecca A. , Johnson A. Holly
Published: September 2019

Surgical treatment of adult-acquired flatfoot deformity typically requires multiple soft tissue and bony procedures, many of which can be effectively performed with minimally invasive surgery techniques. Use of minimal skin incisions helps limit the morbidity of surgery, reducing postoperative pain and the incidence of wound complications. This chapter will focus primarily on the bony procedures which can be accomplished through minimally invasive surgery, including the medializing calcaneal osteotomy and the first tarsometatarsal fusion.

Level of Evidence: Diagnostic Level V. See Instructions for Authors for a complete description of levels of evidence.
A randomized, double-blind, crossover intervention study of traffic-related air pollution and airway inflammation in healthy adults
Authors: Han Bin , Zhang Nan , Zhao Ruojie , Zhang Liwen , Xu Jia , Yang Wen , Bai Zhipeng , Vedal Sverre
Published: September 2019

Background:

Traffic-related air pollution (TRAP) may increase the risk of respiratory disease. The components of TRAP that are responsible for its respiratory toxicity are largely unknown. The objective was to identify the component(s) of TRAP that cause airways inflammation using fractional exhaled nitric oxide (FENO) and randomized interventions.

Methods:

A randomized, double-blind, crossover intervention study was conducted in which 39 healthy university students spent 2 hours next to a busy road. During exposure, participants wore either a powered air-purifying respirator (PAPR) or an N95 facemask. PAPRs were fitted with a fine particle (PM2.5) filter, a PM2.5 and volatile organic carbon (VOC) filter, or a sham filter, and were blinded to filter type. The four interventions (three PAPR filters and N95) were assigned randomly for each participant and separated by at least 1 week. FENO was measured before and immediately after each roadside exposure, and at 1, 2, 4, and 6 hours after exposure.

Results:

With the sham PAPR filter, the mean postexposure FENO increased an average of 2.3 ppb (±4.4) compared with the pre-exposure level. Similar increases in FENO were seen with both the PM2.5 PAPR filter and the N95 mask, but no increase was seen with the combination PM2.5 and VOC PAPR filter.

Conclusions:

Because PAPR filters do not filter inorganic gases (e.g., NO2 or carbon monoxide), it is concluded that the VOC component of TRAP rather than either the particulate matter or the inorganic gases component is responsible for the airway inflammation caused by TRAP exposure.
Linking the GAD-7 and PHQ-9 to the TBI-QOL Anxiety and Depression Item Banks
Authors: Boulton Aaron J. , Tyner Callie E. , Choi Seung W. , Sander Angelle M. , Heinemann Allen W. , Bushnik Tamara , Chiaravalloti Nancy , Sherer Mark , Kisala Pamela A. , Tulsky David S.
Published: September 2019

Objective:

To link scores on commonly used measures of anxiety (7-item Generalized Anxiety Disorder Scale; GAD-7) and depression (9-item Patient Health Questionnaire; PHQ-9) to the Traumatic Brain Injury Quality of Life (TBI-QOL) measurement system.

Setting:

5 Traumatic Brain Injury Model Systems.

Participants:

A total of 385 individuals with traumatic brain injury (TBI) (31% complicated mild; 14% moderate; and 54% severe).

Design:

Observational cohort.

Main Measures:

GAD-7, PHQ-9, TBI-QOL Anxiety v1.0 and TBI-QOL Depression v1.0.

Results:

Item response theory–based linking methods were used to create crosswalk tables that convert scores on the GAD-7 to the TBI-QOL Anxiety metric and scores on the PHQ-9 to the TBI-QOL Depression metric. Comparisons between actual and crosswalked scores suggest that the linkages were successful and are appropriate for group-level analysis. Linking functions closely mirror crosswalks between the GAD-7/PHQ-9 and the Patient-Reported Outcomes Measurement Information System (PROMIS), suggesting that general population linkages are similar to those from a TBI sample.

Conclusion:

Researchers and clinicians can use the crosswalk tables to transform scores on the GAD-7 and the PHQ-9 to the TBI-QOL metric for group-level analyses.
Cerebrospinal Fluid Leak From the Orbital Roof During Orbital Exenteration
Authors: Curragh David S. , Valentine Rowan , Selva Dinesh
Published: September 2019

Cerebrospinal fluid leaks are rarely encountered by orbital surgeons, but can occur during dacryocystorhinostomy, orbital decompression, orbital exenteration, and enucleation. The authors present a case of cerebrospinal fluid leak from an injury to the orbital roof during orbital exenteration with the use of monopolar cautery. This was repaired with multilayer closure. Surgeons performing orbital exenteration must be aware of the possibility of this complication when using monopolar electrocautery to transect the orbital contents at the apex during an exenteration.

Injury to the orbital roof with monopolar cautery during orbital exenteration can result in cerebrospinal fluid leak, and orbital surgeons must be aware of the possibility of its occurrence.
Implementation of Evidence-Based Recommendations for Preventive Services in the Veterans Health Administration
Authors: Ngo-Metzger Quyen A. , Mabry-Hernandez Iris R. , Kim Jane , Adsul Prajakta , Higginbotham Laura B. , Hoffman-Hogg Lori , Smith Mark W. , Doherty Julia
Published: September 2019

Introduction:

The Veterans Health Administration (VHA) is the largest integrated health care system in the United States. To date, there has been scant research on how VHA adopts clinical preventive services guidelines and how U.S. Preventive Services Task Force recommendations factor into the process.

Methods:

Researchers conducted semistructured interviews with eight VHA leaders to examine how they adopt, disseminate, and measure adherence to recommendations. Interviews were recorded, transcribed, and aggregated into a database to enable sorting and synthesis. Themes were identified across the key informant interviews.

Results:

The development of VHA clinical prevention guidelines is coordinated by the National Center for Health Promotion and Disease Prevention. A VHA Advisory Committee discusses and votes to approve or disapprove each guideline. Several factors can impact the ability of a veterans affairs medical center to implement a guideline, such as local system capacity and priorities for quality improvement. Methods to promote implementation include electronic reminders, educational events, and a robust performance measurement system.

Conclusions:

Provision of evidence-based clinical preventive services is an important part of VHA's effort to provide high-quality care for Veterans. Recent achievements in lung cancer, colorectal cancer, and Hepatitis C screening highlight VHA's successful approach to implementation of preventive services guidance.
Specialized Pilonidal Care
Authors: Delshad Hajar R.
Published: September 2019

Introduction

In March 2014, a specialized Pilonidal Care Clinic was started at Boston Children's Hospital to standardize care; evaluate predictors of pilonidal treatment success/failure; decrease morbidity; and improve outcomes, including recurrences and quality of life.

Methods

A staging system for pilonidal disease was developed. Patients were treated with shaving and improved hygiene until inflammation and drainage subsided, then underwent pit-picking under local anesthesia and/or laser epilation, and followed for recurrences.

Results

In bivariate analysis, mild disease severity, longer duration of care in Pilonidal Care Clinic, undergoing pit-picking procedure, and female gender were statistically significant predictors of treatment success. Using multivariate regression analysis, we found that laser epilation independently led to statistically significant disease resolution. To date, the provider team (physician, physician assistant, and registered nurse) have performed >400 laser procedures without a single adverse event—establishing laser epilation as a safe, easy, and effective procedure to utilize in the treatment of pilonidal disease. Analyzing the initial 58 patients who underwent pit picking, only six patients required intraoperative treatment. Of patients with complete follow-up (n = 51), 47 (92%) were symptom- and recurrence-free for an average of 5 months without requiring narcotics or experiencing postoperative morbidity.

Conclusion

Minimally invasive pilonidal care with pit picking and/or laser epilation is an effective, safe, and well-tolerated treatment approach offering lower recurrence rates with minimal morbidity and avoidance of major operations.
Outcomes and Predictive Factors of Electroacoustic Stimulation Rehabilitation in Children With Limited Low-Frequency Hearing
Authors: Nam Gi-Sung , Song Mee Hyun , Choi Jae Young , Jung Jinsei
Published: September 2019

Objective:

To evaluate the clinical feasibility and auditory benefits of hearing rehabilitation using electroacoustic stimulation (EAS) after cochlear implantation (CI) and to identify the predictive factors for successful EAS rehabilitation in children with limited low-frequency hearing.

Study Design:

Retrospective case review.

Setting:

Tertiary referral hospital.

Patients:

Seventeen children (21 ears) under the age of 15 years with residual low-frequency hearing who underwent CI using hearing preservation techniques.

Intervention:

Patients underwent CI using hearing preservation techniques, and the postoperative audiograms were obtained to evaluate the hearing preservation rate. EAS rehabilitation was applied in patients with successful low-frequency hearing preservation.

Outcome Measures:

Improvements in speech perception in both quiet and noise conditions were compared between the EAS mode and the CI-only mode. The predictive factors for successful EAS rehabilitation in children were analyzed.

Results:

Functional low-frequency residual hearing less than or equal to 85 dB at 250 and 500 Hz was achieved postoperatively in six of 21 ears, and successful EAS rehabilitation was possible in nine of 21 ears. Better speech perception scores were observed in quiet conditions using the EAS mode compared with the CI-only mode, although the difference did not reach statistical significance. Significantly, better scores were observed in noise conditions with the EAS mode compared with the CI-only mode. Postoperative low-frequency pure-tone average was the only significant predictive factor of successful EAS rehabilitation.

Conclusion:

CI surgery using hearing preservation techniques with EAS rehabilitation should be performed in children, even in patients with limited residual hearing, to improve auditory outcomes.
Intraoperative Monitoring of Auditory Function During Lateral Skull Base Surgery
Authors: Trecca Eleonora M. C. , Riggs William J. , Hiss Meghan M. , Mattingly Jameson K. , Cassano Michele , Prevedello Daniel M. , Adunka Oliver F.
Published: September 2019

Objective:

We present a unique case of a patient with a jugular foramen tumor with serviceable hearing. This study discusses the audiometric results and intraoperative electrocochleographic (ECochG) findings recorded during tumor removal to illustrate the potential utility of this technique in skull base surgery.

Patients:

A 22-year-old female patient presented with a jugular foramen schwannoma and associated symptoms of right-sided otalgia, mild hearing loss, and blurry vision.

Interventions:

Intraoperative ECochG responses during an infratemporal fossa approach: click and tone burst (1, 2, 4 kHz) stimuli were used and presented at 90 dB nHL.

Main Outcome Measures:

Intraoperative ECochG testing using frequency-specific tone bursts and clicks before and after tumor resection.

Results:

The compound action potential magnitudes, cochlear microphonic, and summation potential were recorded pre- and post-tumor removal. For statistical analysis, a paired t test with significance set at p < 0.05 was used. The compound action potential magnitudes increased at all test frequencies (p < 0.01) while the summation potential and cochlear microphonic remained relatively stable (p > 0.05). Audiometric testing demonstrated an improvement of the preoperative mild right-sided hearing loss after tumor resection (pure-tone average for 0.5, 1, 2, and 4 kHz of 30 dB HL preoperation and 7.5 dB HL after tumor resection).

Conclusions:

Intraoperative ECochG may allow for real-time monitoring during complex skull base surgery.
Colorectal cancer detection by biomarker quantification in noninvasively collected colorectal mucus: preliminary comparison of 24 protein biomarkers
Authors: Loktionov Alexandre , Soubieres Anet , Bandaletova Tatiana , Mathur Jai , Poullis Andrew
Published: September 2019

Objectives

Noninvasive colorectal cancer detection and screening remain global diagnostic challenges because the existing stool tests either lack sensitivity or are complex and expensive. Moreover, colorectal cancer screening uptake is low due to stool sampling inconvenience. We have developed a simple and patient-friendly noninvasive technique for collecting highly informative colorectal mucus. In this study, we aimed to comparatively assess a range of candidate biomarkers in colorectal mucus samples for colorectal cancer detection.

Methods

The study included 17 patients with colorectal cancer and 35 healthy controls, who provided noninvasively collected colorectal mucus samples. Protein biomarker quantification in these samples by enzyme-linked immunosorbent assays allowed comparing diagnostic performances of 24 candidate biomarkers that comprised haemoglobin, d-dimer, M2-pyruvate kinase, carcinoembryonic antigen, C-reactive protein, calprotectin, eosinophil-derived neurotoxin, protein S100A12, tumour necrosis factor α, clusterin, soluble cytokeratin 18, caspase-cleaved cytokeratin 18, citrullinated histone H3, peptidyl arginine deiminase 4, epidermal growth factor, epidermal growth factor receptor, matrix metalloproteinase 9, tissue inhibitor of metalloproteinase 1, periostin, vascular endothelial growth factor A, vascular endothelial growth factor receptor 1, vascular cell adhesion molecule 1, intercellular adhesion molecule 1 and mucin 2. Tested biomarkers were ranked for colorectal cancer detection efficiency using receiver operating characteristic curve analysis.

Results

High area under the curve values between 0.943 and 0.768 were observed for haemoglobin, tissue inhibitor of metalloproteinase 1, M2-pyruvate kinase, peptidyl arginine deiminase 4, C-reactive protein, matrix metalloproteinase 9, epidermal growth factor receptor, eosinophil-derived neurotoxin and calprotectin.

Conclusion

Quantification of protein biomarkers in noninvasively collected samples of colorectal mucus certainly allows detecting colorectal cancer. Further clinical evaluation of the optimal biomarkers identified by this study is needed.
Gastric endoscopic submucosal dissection: a systematic review and meta-analysis on risk factors for poor short-term outcomes
Authors: Figueirôa Gonçalo , Pimentel-Nunes Pedro , Dinis-Ribeiro Mário , Libânio Diogo
Published: September 2019

Objective

Endoscopic submucosal dissection (ESD) is now established as the first option to manage early gastric neoplasms, but its efficacy may vary according to diverse factors. We aimed to systematically identify risk factors for poor short-term outcomes of gastric ESD with the purpose to improve patients’ selection and management.

Methods

Three online databases (MEDLINE, ISI Web of Knowledge and Scopus) were searched (last search on June 2018) for poor outcomes of gastric ESD (deep submucosal invasion, piecemeal/incomplete resection, noncurative resection and local recurrence).

Results

One hundred five studies were included referring to 52.126 ESDs. Undifferentiated histology and upper location (vs lower) were associated with submucosal invasion [odds ratio (OR) = 2.42 [95% confidence interval (CI), 1.62–3.61] and OR = 3.20 (1.04–9.86), respectively] and deep submucosal invasion [OR = 2.98 (2.02–4.39) and OR = 2.35 (1.45–3.81), respectively]. Lesion size greater than 30 mm and ulceration were associated with piecemeal resection [OR = 2.78 (1.17–6.60) and OR = 2.76 (1.23, 6.20), respectively]. Lesion size greater than 30 mm, ulceration, upper location and fibrosis were risk factors for incomplete resection [OR = 3.83 (2.68–5.49), OR = 4.06 (1.62–10.16), OR = 3.71 (2.49–5.54) and OR = 4.46 (1.66–11.96), respectively]. A noncurative resection was more often observed for lesions located in the upper third of the stomach [OR = 1.49 (1.24–1.79)], depressed morphology [OR = 1.49 (1.04–2.12)] and those outside standard criteria [OR = 3.56 (2.31–5.48)]. Older age was significantly linked with local recurrence rates [OR = 3.08 (1.13–5.02)].

Conclusion

Several risk factors influence poor efficacy short-term outcomes of gastric ESD that may be used to inform both patients and health providers about the expected efficacy.
Factors Affecting Uncertainty in Women with High-Risk Pregnancies
Authors: Schmuke Ashley D.
Published: September 2019

Objective:

To evaluate the state of the science on uncertainty in high-risk pregnancy and identify factors that influence uncertainty in women diagnosed with a high-risk pregnancy.

Data Sources:

Primary research articles from CINAHL, Ovid, MEDLINE, Scopus, and PsycINFO written in English, without date restrictions.

Study Selection:

Nineteen articles were identified, including 14 qualitative studies and 5 quantitative studies.

Data Extraction:

This integrative review was guided by Whittemore and Knafl's methodology. Studies were graded on level and quality of evidence as per Dearholt, Dang, and Sigma Theta Tau International.

Data Synthesis:

Studies were synthesized by using constant comparative methods according to factors influencing, outcomes of, and management of uncertainty.

Conclusion:

Uncertainty is a prominent theme in women experiencing a high-risk pregnancy. Uncertainty is influenced by various personal, pregnancy-related, demographic, and healthcare-related factors. Findings may offer insight and empathy for healthcare professionals. Nurses who understand significance of uncertainty in adjusting to two conflicting life events have the opportunity to help women in their understanding of a high-risk diagnosis during pregnancy through anticipatory guidance. Future research is needed to explore factors affecting uncertainty and to understand the experience of high-risk pregnancy to develop interventions aimed at mitigating uncertainty in high-risk pregnant women.
The future of oncology pharmacy: European Conference of Oncology Pharmacy 2018
Authors: Meier Klaus , Astier Alain , Boşnak Ahmet Sami , Goněc Roman
Published: September 2019

The way we treat cancer is changing. Scientific and technological advances such as tumour profiling, ‘big data,’ and an increasing number of targeted therapies and combination regimens will result in a paradigm shift away from a ‘one-size-fits-all’ concept toward personalized, on-demand, precision medicine, which will result in smaller, more defined patient populations.

In parallel, the global incidence of cancer is rising, which is placing an increasing strain on medical oncology centres, and driving the evolution of oncology pharmacy. Clinical pharmacists can reduce the pressures on other healthcare resources by taking an increased role in patient care and providing a broader range of services. Pharmacists recognize that technological developments will lead to significant changes in pharmacy services, which will require greater integration with other services within the healthcare system.

Members of the European Society of Oncology Pharmacy (ESOP) met at the 4th European Conference of Oncology Pharmacy (ECOP) meeting in October 2018 for a symposium entitled The Future of Oncology Pharmacy 2025. This review summarizes several topics discussed at the meeting, including the future of medicine, oncology and pharmacy healthcare, provides an update on ESOP activities and presents the ECOP 2018 resolution. This position statement outlines the ESOP perspective on how oncology pharmacy will change over the next decade, and how it will respond to these changes to support oncology pharmacists and achieve better outcomes for patients with cancer.