bluuebunny/crossref_metadata_2025 huggingface dataset:
Gender and Human Development
Authors: Prabhu K. Seeta , Iyer Sandhya S.
Published: June 2019

The chapter presents an intersectional analysis of women’s human development outcomes through the lens of gender and social relations on the one hand, and the nature of public policies implemented on the other. Against the backdrop of women’s movements, this chapter explains women’s marginalization process, wherein critical gaps in the formation of basic capabilities across men and women in the society are identified. Differences in human development outcomes are not only due to differences in access and opportunity freedoms, but also in endowments and entitlements. Thus, real concerns about women’s human development achievements are regarding capability deprivation and inequalities in access to labour markets, social opportunities, political participation, and social protection. It is argued that purely entitlement transfers through state policy will not be able to resolve the issue. The numerous efforts to assess human development outcomes of both women and men in terms of quantitative and qualitative dimensions have been able to capture only some part of this multi-layered phenomenon.
Need for a Shot of Justice
Authors: Mehdi Ali
Published: June 2019

Given the backlash against the politics and practice of social justice, this chapter provides a justification for an engagement with the proactive debate in political philosophy on ‘equalisandum’—what is to be equalized across individuals in a just society—since the publication of John Rawls’ path-breaking work, A Theory of Justice, in 1971. Since injustice faced by children is the biggest blot on the promise of equality of opportunity, it makes a case for anchoring the discussion of equalisandum in the context of child survival, in India. Millions of children continue to lack the opportunity to even survive within the first five years of birth, and India has recorded not only the highest number of child deaths for decades, but also some of the worst forms of injustice. The chapter ends with a brief discussion on why Amartya Sen’s capability metric is preferable vis-à-vis its Rawlsian and resourcist counterparts, both conceptually and contextually.
Constraints on Discretion: Part 1—Directors
Authors: Gerner-Beuerle Carsten , Schillig Michael
Published: June 2019

This chapter discusses two general types of behavioural constraints on managerial decision-making that can be found in most legal systems: the duties of care and loyalty. The former deals with the care, skill, and diligence that a director is expected to employ in managing a company. The latter deals with situations where a director’s interest conflicts with the interests of the company, notably where the director is a shareholder or otherwise involved in a business partner of the company or takes advantage of a business opportunity that could also be of commercial interest to the company.
Veil-piercing
Authors: Gerner-Beuerle Carsten , Schillig Michael
Published: June 2019

This chapter focuses on strategies that, in a broad sense, set the principle of limited liability aside in order to reach (the assets of) the natural or legal persons that benefit from corporate activity. These concepts are complementary to the ex ante strategies discussed in previous chapters. They are ex post in the sense that they will be triggered only if and when the former have failed for some reason. Their aim is to internalize as far as possible the social cost of corporate activity in order to set appropriate incentives for corporate decision-making. The legal concepts under consideration are largely standard based with open textured norms whose application heavily depends on the factual settings in every individual case. Consequently, the challenge is to provide workable criteria and coherent guidance for courts in order to ensure predictability for entrepreneurs and their legal advisers.
Employment Protection, Investment, and Firm Growth
Authors: Bai John (Jianqiu) , Fairhurst Douglas , Serfling Matthew
Published: June 2019

We exploit the adoption of U.S. state-level labor protection laws to study the effect of employment protection on corporate investment rates and sales growth. We find that, following the adoption of these laws, capital expenditures as a percentage of book assets decrease, resulting in slower sales growth. Our findings are consistent with theories predicting that greater employment protection discourages investment by making projects more irreversible. Supporting this channel, following negative cash flow shocks, firms are less likely to downsize operations in states that have adopted these laws but more likely to downsize in states that have not adopted these laws.

Authors have furnished code, data, and an Internet Appendix, which are available on the Oxford University Press Web site next to the link to the final published paper online.
Initial disease severity, cardiovascular events and all-cause mortality among patients with systemic lupus erythematosus
Authors: Li Daniel , Yoshida Kazuki , Feldman Candace H , Speyer Cameron , Barbhaiya Medha , Guan Hongshu , Solomon Daniel H , Everett Brendan M , Costenbader Karen H
Published: June 2019

Objective

SLE is associated with high risks of cardiovascular disease (CVD) and mortality, and has a wide spectrum of presentations. We investigated whether SLE severity at diagnosis was associated with CVD or mortality risk.

Methods

Within Medicaid (2000–10), we identified patients 18–65 years of age with incident SLE. Initial SLE severity was classified—mild, moderate, or severe—during the baseline year prior to the start of follow-up (incident index date) using a published algorithm based on SLE-related medications and diagnoses. Patients were followed from the index date to the first CVD event or death, disenrollment, loss to follow-up or end of follow-up period. Cox and Fine–Gray regression models, adjusted for demographics and comorbidities accounting for the competing risk of death (for CVD), estimated CVD and mortality risks by baseline SLE severity.

Results

Of 15 120 incident SLE patients, 48.7% had mild initial SLE severity, 33.9% moderate and 17.4% severe. Mean (s.d.) follow-up was 3.3 (2.4) years. After multivariable adjustment, CVD subdistribution hazard ratios (HRSD) were higher for initially severe [HRSD 1.64 (95% CI 1.32, 2.04)] and moderate [HRSD 1.19 (95% CI 1.00, 1.41)] SLE vs mild SLE. Mortality HRs were also higher for initially severe [HR 3.11 (95% CI 2.49, 3.89)] and moderate [HR 1.61 (95% CI 1.29, 2.01)] SLE vs mild SLE.

Conclusion

SLE patients with high initial severity had elevated mortality and CVD events risks compared with those who presented with milder disease. This has implications for clinical care and risk stratification of newly diagnosed SLE patients.
Reversed accounting: legal professionals, families and the gender wealth gap in France
Authors: Bessière Céline
Published: June 2019

This article describes how legal professionals and families contribute to the widening, legitimation and concealment of the gender wealth gap. It is based on ethnographic observation, study of legal files and statistical data on gender wealth inequality in France. Despite formally equal law, family wealth arrangements in moments of estate planning and marital breakdown tend to reproduce gender inequality. The main legal professionals involved are lawyers and notaries. In their interactions with family members, they carry out reversed accounting, a logic of practice in which the result comes first and computation comes after. As families and legal professionals strive to preserve real estate and businesses, or to minimize taxes, they produce inventories, estimations and distributions of assets which disadvantage women, even though shares appear to be formally equal. Female legal professionals, as well as female clients, may endorse this concern, and thus, also unwittingly contribute to the gender wealth gap.
Widespread Epigenetic Changes to the Enhancer Landscape of Mouse Liver Induced by a Specific Xenobiotic Agonist Ligand of the Nuclear Receptor CAR
Authors: Rampersaud Andy , Lodato Nicholas J , Shin Aram , Waxman David J
Published: June 2019

Constitutive androstane receptor (CAR) (Nr1i3), a liver nuclear receptor and xenobiotic sensor, induces drug, steroid, and lipid metabolism and dysregulates genes linked to hepatocellular carcinogenesis, but its impact on the liver epigenome is poorly understood. TCPOBOP (1, 4-bis-[2-(3, 5-dichloropyridyloxy)]benzene), a halogenated xenochemical and highly specific CAR agonist ligand, induces localized chromatin opening or closing at several thousand mouse liver genomic regions, discovered as differential DNase-hypersensitive sites (ΔDHS). Active enhancer and promoter histone marks induced by TCPOBOP were enriched at opening DHS and TCPOBOP-inducible genes. Enrichment of CAR binding and CAR motifs was seen at opening DHS and their inducible drug/lipid metabolism gene targets, and at many constitutively open DHS located nearby. TCPOBOP-responsive cell cycle and DNA replication genes codependent on MET/EGFR signaling for induction were also enriched for CAR binding. A subset of opening DHS and many closing DHS mapping to TCPOBOP-responsive target genes did not bind CAR, indicating an indirect mechanism for their changes in chromatin accessibility. TCPOBOP-responsive DHS were also enriched for induced binding of RXRA, CEBPA, and CEBPB, and for motifs for liver-enriched factors that may contribute to liver-specific transcriptional responses to TCPOBOP exposure. These studies elucidate the enhancer landscape of TCPOBOP-exposed liver and the widespread epigenetic changes that are induced by both direct and indirect mechanisms linked to CAR activation. The global maps of thousands of environmental chemical-induced epigenetic changes described here constitute a rich resource for further research on xenochemical effects on liver chromatin states and the epigenome.
Exploring Recipient Preferences and Allocation Mechanisms in the Distribution of Development Aid
Authors: Shapiro Jeremy
Published: June 2019

This study uses incentive-compatible techniques to obtain valuations of 14 common poverty reduction interventions from (probable) aid recipients. Recipients’ valuations for these interventions are highly heterogeneous both across interventions and across recipients of the same intervention. Valuation for interventions does not correlate with overall poverty or with perceived need for specific interventions, suggesting that targeting individuals with high valuations based on recipient characteristics is difficult. Through simulations, this study assesses how various allocation mechanisms—cash transfers and voting—compare in generating recipient surplus in the allocation of aid. When markets function and constraints on joint private contributions to public goods do not bind, cash transfers generate considerably more recipient surplus than voting. Even when cash transfers cannot enable public goods and some services, they may still outperform voting at very low resource levels. However, as resource levels increase, voting dominates cash transfers from a surplus-maximization perspective.
Evaluation of Medical School Grading Variability in the United States: Are All Honors the Same?
Authors: Westerman Mary E. , Boe Chelsea , Bole Raevti , Turner Norman S. , Rose Steven H. , Gettman Matthew T. , Thompson R. Houston
Published: June 2019

Purpose

The medical student performance evaluation (MSPE) summarizes a residency applicant’s academic performance. Despite attempts to improve standardized clerkship grading, concerns regarding grade inflation and variability at United States medical schools persist. This study’s aim was to describe current patterns of clerkship grading and applicant performance data provided in the MSPE.

Method

The authors evaluated Electronic Residency Application Service data submitted to a single institution for the 2016–2017 Match cycle. Clerkship grading characteristics regarding grading tiers, school rank, location, and size were obtained. Data regarding methods for summative comparisons such as key word utilization were also extracted. Descriptive statistics were generated, and generalized linear modeling was performed.

Results

Data were available for 137/140 (98%) MD-granting U.S. medical schools. Pass/fail grading was most commonly used during the preclinical years (47.4%). A 4-tier system was most common for clerkship grading (31%); however, 19 different grading schemes were identified. A median of 34% of students received the highest clerkship grade (range, 5%–97%). Students attending a top 20 medical school were more likely to receive the highest grade compared with those attending lower-rated schools (40% vs 32%, P < .001). Seventy-three percent of schools ranked students, most commonly using descriptive adjectives. Thirty-two different adjectives were used.

Conclusions

There is significant institutional variation in clinical grading practices and MSPE data. For core clerkships where most students received the highest grade, the ability to distinguish between applicants diminishes. A standardized approach to reporting clinical performance may allow for better comparison of residency applicants.
Mortality Rates of Humerus Fractures in the Elderly: Does Surgical Treatment Matter?
Authors: Lander Sarah T. , Mahmood Bilal , Maceroli Michael A. , Byrd Jonathan , Elfar John C. , Ketz John P. , Nikkel Lucas E.
Published: June 2019

Introduction:

Multiple studies have shown the impact of hip fractures on geriatric mortality. Few evaluate mortality after proximal humerus (PH) or distal humerus (DH) fractures, and fewer determine differences in mortality based on management. We aim to evaluate a statewide cohort of elderly patients with PH or DH fractures to evaluate mortality, length of stay, discharge data, readmission, and differences based on management.

Methods:

The New York Statewide Planning and Research Cooperative System database was used to identify patients 60 years and older admitted with a PH or DH fracture. Patient demographics, including age, gender, sex, race, weight, and insurance status, along with comorbid conditions using the Charlson Comorbidity Index, were determined. Seven-day, 30-day, and 1-year mortality was determined for operative and nonoperative cohorts. Logistic regression determined the competing risk of mortality when controlling for patient demographics, comorbid conditions, and treatment.

Results:

Forty-two thousand five hundred eleven PH and 7654 DH fractures were evaluated. PH fractures had higher mortality than DH. Nonoperative treatment occurred in 76.2% of PH fractures and 53% of DH fractures. There were more comorbid conditions, longer length of stay, and higher mortality at 7 days, 30 days, and 1 year in patients treated nonoperatively. After controlling for patient demographics and comorbid conditions, there was no difference in mortality between PH and DH fractures, but operative treatment for either PH or DH was associated with lower mortality at all time points.

Discussion:

Fewer PH than DH fractures were treated operatively. Operative treatment was associated with improved survival in patients hospitalized with PH or DH fracture even after controlling for patient demographic and comorbid factors.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Functional Outcomes After Muscle-Sparing Fixation of Flail Chest Injuries
Authors: Taylor Benjamin C. , Fowler Terry Ty , Reddy Hemant , Galos David K. , Wetzel Robert
Published: June 2019

Objectives:

To present outcomes in a multicenter review of a large number of flail chest patients.

Design:

Retrospective case series.

Setting:

One urban Level I and 1 urban Level II trauma center.

Patients/Participants:

Fifty-two adult patients who underwent treatment of their flail chest injury with locking plate and screw constructs through muscle-sparing approaches, followed for a minimum of 1 year postoperatively.

Results:

All patients went on to successful union, with complication rates in line with recent published norms. Periscapular strength returned to greater than 90% of the noninjured side by 3 months postoperatively and to within a mean of 95% of the noninjured side by 6 months postoperatively. Glenohumeral range of motion similarly improved over this same interval.

Conclusions:

Use of anatomically designed modern locking plate and screw fixation constructs with muscle-sparing approaches results in efficient return to function and restoration of shoulder function and strength as compared with the noninjured shoulder.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Long-term Outcome of Selective Thoracic Fusion Using Rod Derotation and Direct Vertebral Rotation in the Treatment of Thoracic Adolescent Idiopathic Scoliosis
Authors: Chang Dong-Gune , Suk Se-Il , Kim Jin-Hyok , Song Kwang-Sup , Suh Seung-Woo , Kim Soo-Yeon , Kim Gang-Un , Yang Jae Hyuk , Lee Jung-Hee
Published: June 2019

Study Design:

This was a retrospective comparative study.

Objective:

To evaluate long-term outcomes of selective thoracic fusion (STF) using both rod derotation (RD) and direct vertebral rotation (DVR) with pedicle screw instrumentation (PSI) in the treatment of thoracic adolescent idiopathic scoliosis (AIS) with a minimum 10-year follow-up.

Summary of Background Data:

Postoperative compensation and maintenance of the unfused lumbar curve after STF is very important factor for the satisfactory results in the treatment of thoracic AIS.

Patients and Methods:

Sixty-five patients with thoracic AIS treated with STF from the neutral vertebra (NV) to NV or NV-1 with RD and DVR were retrospectively analyzed with a minimum 10-year follow-up. Patients were divided into 2 groups: satisfactory (n=52) and unsatisfactory groups (n=13). Unsatisfactory results were defined as an adding-on, a lowest instrumented vertebra (LIV) tilt of >10 degrees, or coronal balance >15 mm.

Results:

No significant differences were observed in the main thoracic curve between the satisfactory and unsatisfactory groups postoperatively (P=0.218) and at the last follow-up (P=0.636). Significant improvements of LIV tilt and disk angle were observed in both groups, but these improvements deteriorated during the follow-up period in the unsatisfactory group. Significant differences of apical vertebra (AV) and end vertebra (EV) were observed postoperatively (AV: P=0.001, EV: P=0.001) and at the last follow-up (AV: P<0.000, EV: P<0.000) between the 2 groups.

Conclusions:

STF using RD and DVR can achieve satisfactory deformity correction for thoracic AIS with satisfactory compensatory lumbar curve that was maintained over long-term follow-up. Progression of unfused lumbar curve closely related with LIV tilt and disk angle showing insufficient DVR. Therefore, STF with sufficient DVR required to achieve satisfactory deformity correction and prevent a distal adding-on phenomenon in the treatment of thoracic AIS.
Hand Hygiene Compliance in the ICU: A Systematic Review
Authors: Lambe Kathryn Ann , Lydon Sinéad , Madden Caoimhe , Vellinga Akke , Hehir Aoife , Walsh Mary , O’Connor Paul
Published: June 2019

Objectives:

To synthesize the literature describing compliance with World Health Organization hand hygiene guidelines in ICUs, to evaluate the quality of extant research, and to examine differences in compliance levels across geographical regions, ICU types, and healthcare worker groups, observation methods, and moments (indications) of hand hygiene.

Data Sources:

Electronic searches were conducted in August 2018 using Medline, CINAHL, PsycInfo, Embase, and Web of Science. Reference lists of included studies and related review articles were also screened.

Study Selection:

English-language, peer-reviewed studies measuring hand hygiene compliance by healthcare workers in an ICU setting using direct observation guided by the World Health Organization’s “Five Moments for Hand Hygiene,” published since 2009, were included.

Data Extraction:

Information was extracted on study location, research design, type of ICU, healthcare workers, measurement procedures, and compliance levels.

Data Synthesis:

Sixty-one studies were included. Most were conducted in high-income countries (60.7%) and in adult ICUs (85.2%). Mean hand hygiene compliance was 59.6%. Compliance levels appeared to differ by geographic region (high-income countries 64.5%, low-income countries 9.1%), type of ICU (neonatal 67.0%, pediatric 41.2%, adult 58.2%), and type of healthcare worker (nursing staff 43.4%, physicians 32.6%, other staff 53.8%).

Conclusions:

Mean hand hygiene compliance appears notably lower than international targets. The data collated may offer useful indicators for those evaluating, and seeking to improve, hand hygiene compliance in ICUs internationally.
Management of Peripheral Venoarterial Extracorporeal Membrane Oxygenation in Cardiogenic Shock
Authors: Keller Steven P.
Published: June 2019

Objectives:

Cardiogenic shock is a highly morbid condition in which inadequate end-organ perfusion leads to death if untreated. Peripheral venoarterial extracorporeal membrane oxygenation is increasingly used to restore systemic perfusion despite limited understanding of how to optimally titrate support. This review provides insights into the physiologic basis of extracorporeal membrane oxygenation support and presents an approach to extracorporeal membrane oxygenation management in the cardiogenic shock patient.

Data Sources, Study Selection, and Data Extraction:

Data were obtained from a PubMed search of the most recent medical literature identified from MeSH terms: extracorporeal membrane oxygenation, cardiogenic shock, percutaneous mechanical circulatory support, and heart failure. Articles included original articles, case reports, and review articles.

Data Synthesis:

Current evidence detailing the use of extracorporeal membrane oxygenation to support patients in cardiogenic shock is limited to isolated case reports and single institution case series focused on patient outcomes but lacking in detailed approaches to extracorporeal membrane oxygenation management. Unlike medical therapy, in which dosages are either prescribed or carefully titrated to specific variables, extracorporeal membrane oxygenation is a mechanical support therapy requiring ongoing titration but without widely accepted variables to guide treatment. Similar to mechanical ventilation, extracorporeal membrane oxygenation can provide substantial benefit or induce significant harm. The widespread use and present lack of data to guide extracorporeal membrane oxygenation support demands that intensivists adopt a physiologically-based approach to management of the cardiogenic shock patient on extracorporeal membrane oxygenation.

Conclusions:

Extracorporeal membrane oxygenation is a powerful mechanical circulatory support modality capable of rapidly restoring systemic perfusion yet lacking in defined approaches to management. Adopting a management approach based physiologic principles provides a basis for care.
Fourier Analysis of Corneal Irregular Astigmatism After Small Incision Lenticule Extraction and Comparison to Femtosecond Laser-Assisted Laser In Situ Keratomileusis
Authors: Sideroudi Haris , Sekundo Walter , Kozobolis Vassilios , Messerschmidt-Roth Anke , Lazaridis Apostolos
Published: June 2019

Purpose:

Evaluation of spherical component (SC), regular astigmatism (RA), and irregular astigmatism (IA, ie, Asymmetry and Irregularities) 3 years after small incision lenticule extraction (SMILE) and comparison to femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK).

Methods:

Thirty-two eyes of 21 patients who underwent SMILE for myopia and astigmatism were compared with 32 eyes of 21 patients treated with FS-LASIK. Scheimpflug images were obtained preoperatively and 3 years postoperatively. Fourier analysis of keratometric-derived parameters (SC, RA, Asymmetry, and Irregularities) of the anterior, posterior, and total cornea were evaluated at 4 concentric rings (ring 1, 2 mm diameter; ring 2, 4 mm; ring 3, 6 mm; ring 4, 8 mm) and over the entire 8-mm zone.

Results:

After FS-LASIK, over the 8-mm zone, the RA and IA of the anterior cornea increased significantly (P ≤ 0.002), whereas SMILE induced an insignificant increase in RA and Asymmetry (P ≥ 0.276) and a decrease in Irregularities (P = 0.770). At the 8-mm zone of the posterior cornea, the Irregularities increased significantly (P = 0.027) after FS-LASIK, whereas SMILE induced no significant changes in the examined variables (P ≥ 0.347). RA and IA of the total cornea increased significantly after FS-LASIK (P ≤ 0.001), whereas SMILE induced an insignificant increase in RA and Asymmetry (P ≥ 0.092) and a significant decrease in Irregularities (P < 0.001). FS-LASIK induced a greater decrease in SC of the total cornea at ring 4 (P = 0.009).

Conclusions:

FS-LASIK resulted in a greater increase in RA and Irregularities and greater flattening of the midperiphery of the anterior and total cornea compared with SMILE. The posterior cornea remained unaffected after SMILE, whereas more Irregularities were induced after FS-LASIK over the 8-mm zone.
Long-term Prognosis of Tuberculosis Infection and Disease in Swedish Children
Authors: Bennet Rutger , Jonsson Jerker , Nejat Sahar , Olsson-Åkefeldt Selma , Eriksson Margareta
Published: June 2019

Background:

Reports of the outcome of treatment of tuberculosis (TB) disease and infection (TBI) in children are scarce. Since 2010, we routinely use interferon-gamma release assays in addition to clinical history for the exclusion of TBI, although the safety of this approach has been questioned. We present the frequency of recurrent TB or progression to TB after treatment for TB disease or TB infection, respectively, and progression to disease in children considered TB uninfected at our pediatric TB clinic.

Methods:

We included 4707 patients from 1990 to 2017. At the initial assessment, 96 (2.0%) had previously received TB treatment, 253 (5.4%) had TB disease, 1625 (35%) had TBI and 2733 (58%) children were considered uninfected. Patients were passively followed at our clinic, at the adult TB clinics in Stockholm and at the Swedish national TB registry.

Results:

During a median follow-up time of 8.4 years, we found 36 cases of TB disease, with true relapses in 3/243 (1.2%) successfully treated TB patients. Preventive treatment of TBI reduced the risk of progression to TB by 85%, from 4.3% (15/349) to 0.6% (8/1262). In children considered uninfected, the risk of later developing TB was 0.07% (2/2733).

Conclusions:

The effectiveness of TB management was acceptable. Our routine procedures for the exclusion of TBI appear safe.
Invasive Pneumococcal Infections in Children with Nephrotic Syndrome in Bangladesh
Authors: Malaker Roly , Saha Senjuti , Hanif Mohammed , Ahmed ASMNU , Saha Shampa , Hasanuzzaman Md. , Khondakar Tarannum , Islam Maksuda , Baqui Abdullah H. , Santosham Mathuram , Darmstadt Gary L. , Whitney Cynthia G. , Saha Samir K.
Published: June 2019

Introduction:

Children with nephrotic syndrome are susceptible to invasive bacterial infections. In this study, we aimed to: (1) determine the pathogens associated with infections in children with nephrotic syndrome and (2) describe antimicrobial susceptibility and serotype distribution of Streptococcus pneumoniae to guide evidence-based treatment and prevention policies.

Methods:

From June 2013 to March 2015, we collected blood and/or ascitic fluid from children hospitalized with nephrotic syndrome and suspected bacterial disease in the largest pediatric hospital of Bangladesh. We cultured all samples and performed polymerase chain reaction (PCR) and immunochromatographic test on ascitic fluid for detection of S. pneumoniae. Pneumococcal isolates were tested for antibiotic susceptibility using disc diffusion and serotyped using Quellung reaction and PCR.

Results:

We identified 1342 children hospitalized with nephrotic syndrome. Among them, 608 children had suspected bacterial disease from whom blood and/or ascitic fluid were collected. A pathogen was identified in 8% (48/608) of cases, 94% (45/48) of which were S. pneumoniae. Most (73%, 33/45) pneumococcal infections were identified through culture of blood and ascitic fluid and 27% (12/45) through immunochromatographic test and PCR of ascitic fluid. In total, 24 different pneumococcal serotypes were detected; 51% are covered by PCV10 (+6A), 53% by PCV13 and 60% by PPSV23. All pneumococcal isolates were susceptible to penicillin.

Conclusions:

Because S. pneumoniae was the primary cause of invasive infections, pneumococcal vaccines may be considered as a preventive intervention in children with nephrotic syndrome. Additionally, penicillin can be used to prevent and treat pneumococcal infections in children with nephrotic syndrome in Bangladesh.
Migraine understood as a sensory threshold disease
Authors: Peng Kuan-Po , May Arne
Published: June 2019

Migraine encompasses a broader spectrum of sensory symptoms than just headache. These “other” symptoms, eg, sensory phobias, cognitive and mood changes, allodynia, and many others indicate an altered sensitivity to sensory input which can be measured, in principle, by quantifying sensory threshold changes longitudinally over time. Photophobia, for example, can be quantified by investigating the discomfort thresholds towards the luminance of light. The aim of this review is to look into how thresholds change in patients with migraine. We performed a PubMed search up to June 2018 targeting all peer-reviewed articles evaluating the changes in threshold, sensory phobia, or sensitivity in patients with migraine. Migraineurs, in general, exhibit lower sensory thresholds compared with healthy controls. These threshold changes seem to follow the different phases during a migraine cycle. In general, thresholds reach a nadir when the headache starts (the ictal phase), rise after the headache ends, and then gradually descend towards the next attack. The sensory modality of measurement—mechanical, thermal, or nociceptive—and the location of measurement—trigeminal vs somatic dermatome—also influence the sensory threshold. Functional imaging studies provide evidence that the hypothalamo-thalamo-brainstem network may be the driving force behind the periodic threshold changes. In summary, there is evidence in the literature that migraine could be understood as a periodic sensory dysregulation originating from the brain. Nevertheless, the interstudy discrepancy is still high due to different study designs and a lack of focus on distinct migraine phases. Further well-designed and harmonized studies with an emphasis on the cyclic changes still need to be conducted.
Drug-Drug Interaction Checker
Authors: Ali Walaa Hashim , Ahmed Shahd Bakri Sed , Abdalaziz Abdalaziz Mustafa , Elshafie Marwa Ibrahim , A. Mohammed Haj Ali
Published: June 2019

Drugs are chemical substances intended for use in the cure, treatment, or prevention of diseases. When different drugs are taken together, a drug-drug interaction can delay, decrease, or enhance absorption of either drug and may cause adverse effects. Therefore, a system that allows the user to easily check drug-drug interaction has been designed. The drug-drug interaction database is integrated into decision support systems to be used in hospitals and pharmacies for clinical evaluation of interactions. The database has been created by using Microsoft Excel sheet that involves 3 sheets representing groups, drugs, and interactions, respectively. The processing of data has been implemented using artificial neural network (nntool). The accuracy and sensitivity were tested by using neural network and found to be 100%. Finally the graphical user interface was implemented to help the user to interface with the system.
Time Out of Play Due to Illness in Major and Minor League Baseball
Authors: Conway Justin J. , Curriero Frank C. , Camp Christopher L. , Toresdahl Brett G. , Coleman Struan , Kinderknecht James J.
Published: June 2019

Objective:

To generate a summative report on the most commonly diagnosed illnesses in Major League Baseball (MLB) and Minor League Baseball (MiLB) athletes with specific attention to their impact based on time out of play.

Design:

Retrospective analysis.

Setting:

Injury and illness data from the MLB Health and Injury Tracking System.

Participants:

All MLB and MiLB athletes active between 2011 and 2016.

Assessment of Risk Factors:

Illnesses were defined as atraumatic medical diagnoses that occurred during the MLB or MiLB season and resulted in at least 1 day out of play.

Main Outcome Measures:

Incidence of illness diagnoses and resulting time out play.

Results:

Eight thousand eight hundred thirty-four illnesses were reported, representing 14.7% of all diagnoses resulting in time out of play. Total days missed (DM) due to illness were 39 614, with a mean of 4.6 (SD 9.9 days) and median 2 DM per diagnosis. The annual incidence of illness per season was 20.3 per 100 athletes. The most common diagnosis was nonspecific viral illness (15.3%), followed by gastroenteritis (13.6%), other gastrointestinal illness (8.3%), influenza (7.0%), and upper respiratory infection (6.2%). Appendicitis (15.2%) and Epstein–Barr virus/cytomegalovirus (9.1%) were the most common season-ending diagnoses.

Conclusions:

Illnesses represent a significant cause of time out of play in MLB and MiLB. Prevention efforts should focus on limiting the spread of communicable viral, respiratory, and gastrointestinal disease among players, as the majority of diagnoses fell into these categories. This work may be used to guide future research into illness treatment and prevention in professional baseball.
Outcome of Cochlear Implantation in Children With Narrow Bony Cochlear Nerve Canal
Authors: Kang Byung Chul , Lee Jee Yeon , Kim Yehree , Park Jun Woo , Kang Woo Seok , Ahn Joong Ho , Park Hong Ju , Chung Jong Woo
Published: June 2019

Objective:

To investigate the diameter of the bony cochlear nerve canal (BCNC) as a prognostic indicator of cochlear implantation (CI) in children.

Study Design:

Retrospective study.

Setting:

Tertiary referral center.

Patients:

Two hundred ninety two prelingual deaf children (323 ears) who received CI before the age of 5 years.

Interventions:

CI in pediatric patients.

Main Outcome and Measures:

Postoperative auditory performance was analyzed according to the diameter of the BCNC using the Mann–Whitney U test. Using the images of temporal bone computed tomography, patients were grouped according to the diameter of the BCNC: narrow (<1.4 mm, Group 1), normal (Group 2), and other anomalies (Group 3).

Results:

Group 1 (10.5%) showed a less significant degree of improvement in category of audiological performance (CAP) score than Groups 2 (57.3%) and 3 (32.2%). Scores obtained from both the open-set monosyllabic words and sentence tests were lower in Group 1 than Groups 2 and 3. Of the patients with narrow BCNC, the CAP score of patient with complete stenosis of BCNC (<0.2 mm) was lower than that of patients with BCNC between 0.2 and 0.8 mm, also 0.8 and 1.4 mm.

Conclusions:

The improvement in auditory performance was limited in children with narrow BCNC and the narrower the BCNC, the more severe the limitation. However, gradual improvement can be expected and even children with narrow BCNC may be candidates for early CI and rehabilitation.
First MRI With New Cochlear Implant With Rotatable Internal Magnet System and Proposal for Standardization of Reporting Magnet-Related Artifact Size
Authors: Cass Nathan D. , Honce Justin M. , O’Dell Alexandra L. , Gubbels Samuel P.
Published: June 2019

Objective:

To report on the first known magnetic resonance imaging (MRI) with a new cochlear implant (CI) with rotatable internal magnet system, to review the literature on MRI in cochlear implantees, and to advocate for standardization of reporting magnet-related artifact size.

Study Design:

Case report and review of literature.

Setting:

Tertiary care hospital.

Results:

A patient with congenital rubella and bilateral profound hearing loss was incidentally found to have a petroclival meningioma. After resection and radiosurgery, she underwent cochlear implantation with the Advanced Bionics HiRes Ultra 3D device (Advanced Bionics LLC, Valencia, CA) with rotatable internal magnet system, due to need for imaging surveillance of residual meningioma. During 1.5 T MRI brain scan without a head wrap, she experienced no adverse events. The images obtained were adequate for visualization of residual tumor. Implant recipients with non-rotatable magnets who undergo MRI, with or without recommended head wrap, may suffer various complications. All images in patients with retained internal magnets are subject to magnet-related artifact, but reports regarding its size are variable and lack detail on how measurements are made.

Conclusions:

MRI in patients with a new CI device with rotatable magnet system may be performed without discomfort or device dislodgement at 1.5 T, even without a head wrap, though external magnet replacement may require multiple attempts due to internal magnet realignment. Despite significant artifact, the structure of interest may still be visualized for accurate diagnosis. Measuring magnet-related artifact size should be standardized by reporting artifact in radii at the image level of maximal signal loss.
The future of apolipoprotein E mimetic peptides in the prevention of cardiovascular disease
Authors: Valanti Eftaxia-Konstantina , Chroni Angeliki , Sanoudou Despina
Published: June 2019

Purpose of review

This review aims to discuss the recent developments in the area of apolipoprotein E (apoE) mimetics and their therapeutic potential for treating cardiovascular disease, the leading cause of mortality worldwide.

Recent findings

Ongoing research efforts target the development of novel therapies that would not only reduce circulating levels of atherogenic lipoproteins, but could also increase high density lipoprotein cholesterol (HDL-C) levels and/or improve HDL function. Among them, synthetic peptides that mimic the structure of natural human apoE, a component of triglyceride-rich lipoproteins and HDL, have been designed and proven to be functionally similar to apoE. In specific, apoE mimetic peptides mediate hepatic clearance of circulating atherogenic lipoproteins, dramatically reduce plasma cholesterol, and lead to attenuation of atherosclerosis development in vivo. These peptides also exhibit pleiotropic antiatherogenic properties, such as macrophage cholesterol efflux capacity, as well as anti-inflammatory and antioxidative functions.

ApoE mimetics are undergoing preclinical and clinical evaluation with promising results to date that render them attractive candidates in cardiovascular disease prevention and treatment.
Improving the Patient Experience Following Total Knee and Total Hip Arthroplasty
Authors: Burley Gwen , Torres Lizbeth , Heligman Jessica
Published: June 2019

Background:

The paradigm shift that has occurred for patients with total hip (THA) and knee (TKA) arthroplasty through enhanced recovery programs underscores the need for redesigning care provision.

Local Problem:

In this hospital, the patient outcomes and experience anticipated from the implementation of enhanced recovery medical protocols were not fully realized.

Methods:

The Practice Development in Nursing and Healthcare model guided this project.

Interventions:

A nurse-led team designed a new care delivery model with patient/family-centered interventions based on the best evidence.

Results:

Outcomes included an increase in discharges of postoperative day 1 or less of 154% THA and 41.8% TKA and an increase in discharge to home by 24.6% THA and 18.7% TKA. In addition, 90-day readmissions were reduced for both patient groups.

Conclusions:

An interprofessional team of clinicians made sustainable improvements in the experience and outcomes for the surgical patients with THA and TKA.
Spindle Cell Tumors With RET Gene Fusions Exhibit a Morphologic Spectrum Akin to Tumors With NTRK Gene Fusions
Authors: Antonescu Cristina R. , Dickson Brendan C. , Swanson David , Zhang Lei , Sung Yun-Shao , Kao Yu-Chien , Chang Wei-Chin , Ran Leili , Pappo Alberto , Bahrami Armita , Chi Ping , Fletcher Christopher D.
Published: June 2019

A major breakthrough in the classification of soft tissue tumors has been the recent identification of NTRK-fusion related neoplasms which are amenable to highly effective targeted therapies. Despite these therapeutic opportunities, diagnostic challenges have emerged in recognizing tumors characterized by protein kinase fusions, as they are associated with a wide morphologic spectrum, variable risk of malignancy and a rather nonspecific immunoprofile. As such, NTRK-related fusions may occur in infantile fibrosarcoma, lipofibromatosis-like neural tumors (LPF-NTs), tumors resembling malignant peripheral nerve sheath tumors, etc. Triggered by an index case resembling LPF-NT but harboring RET gene rearrangement, we investigated our files for cases showing RET gene abnormalities to establish their clinicopathologic features. Tumors were tested with a combination of targeted RNA sequencing and fluorescence in situ hybridization methods. Six cases with RET gene rearrangements were identified, all except 1 occurred in children, including 4 infants. Their morphologic spectrum was quite diverse, but closely reproduced the phenotype of NTRK–fusion-positive tumors, including LPF-NTs (n=3), infantile fibrosarcoma-like tumor (n=2) and malignant peripheral nerve sheath tumor-like (n=1). Three cases showed coexpression of S100 and CD34, whereas the remaining 3 had a nonspecific immunoprofile. The tumors ranged morphologically and clinically from benign to highly malignant. None of the LPF-NT cases recurred, whereas 2 patients with malignant histology had a highly aggressive course with distant metastases to lung and other viscera. By targeted RNA sequencing these tumors harbored RET fusions with an identical break in exon 12, which retains the tyrosine kinase domain in the fusion oncoprotein and involving various gene partners (CLIP2, CCDC6, SPECC1L, MYH10, and NCOA4). Our results suggest that RET fusion-positive neoplasms share a similar phenotypic spectrum with the NTRK-positive tumors, displaying either fibroblastic or neural-like differentiation, and spanning a wide spectrum of clinical behavior. These findings open new avenues for targeted therapy with RET inhibitors currently available in clinical trials.
Does Performance on the American Board of Physical Medicine and Rehabilitation Initial Certification Examinations Predict Future Physician Disciplinary Actions?
Authors: Kinney Carolyn L. , Raddatz Mikaela M. , Sliwa James A. , Clark Gary S. , Robinson Lawrence R.
Published: June 2019

Objective

The aim of the study was to determine the relationship between performance on the American Board of Physical Medicine and Rehabilitation primary certification examinations and the risk of subsequent disciplinary actions by state medical boards over a physician's career. The hypothesis is that physicians who do not pass either or both of the two initial specialty certification examinations are at higher risk of disciplinary action from a state medical licensing board.

Design

This is a retrospective cohort study that analyzed board certification examination data from all physicians who completed physical medicine and rehabilitation residency between 1968 and 2017.

Results

Matching examination and license data were available for 9889 physical medicine and rehabilitation physicians, who received a total of 547 disciplinary action reports through the Federation of State Medical Boards. The results showed a significant correlation between failing an American Board of Physical Medicine and Rehabilitation certification examination and the risk of subsequent disciplinary action by a state medical board. Failure to pass either the written (Part I) or oral (Part II) examination increased the risk of subsequent disciplinary action by 5.77-fold (P < 0.0001, 95% confidence interval = 4.07–8.18).

Conclusions

Physicians in physical medicine and rehabilitation who do not pass initial certification examinations and become board certified are at higher risk of disciplinary action from a state medical licensing board throughout their careers.
Caring for Patients With Physical Disabilities
Authors: John Janice Thomas , Block Lauren , Stein Adam , Vasile Elizabeth , Barilla-LaBarca Maria-Louise
Published: June 2019

Despite the fact that one fifth of Americans live with disability, caring for these patients is not routinely part of the undergraduate medical student curriculum. An innovative session addressing care of patients with spinal cord injury was developed for medical students and led by physiatrists, faculty experts in communications, and individuals with spinal cord injury. A mixed-method design was used in evaluating students' knowledge, skills, and attitudes following this curriculum. Quantitative evaluation was performed with a written essay question and checklist items from an objective structured clinical examination station. The session was given to 296 students from 2016 to 2018. On the objective structured clinical examination, 94% asked about sexual function, 85% asked about activities of daily living, 77% asked about instrumental activities of daily living, and 47% of students evaluated skin health. Students demonstrated respectful (99%) and nonjudgmental (99%) attitudes with spinal cord injury standardized patients and 91% interacted with the standardized patients caretaker appropriately. Themes emerged from the student survey including the following: the value of having real patients present during the session, exposure to physical medicine and rehabilitation as a specialty, and the advantage of a small group format. This session provided students with tools necessary to care for patients with spinal cord injury.
Incidence of AIDS-Related Kaposi Sarcoma in All 50 United States From 2000 to 2014
Authors: White Donna L. , Oluyomi Abiodun , Royse Kathryn , Dong Yongquan , Nguyen Harrison , Chang Elaine , Richardson Peter , Jiao Li , Garcia Jose M. , Kramer Jennifer R. , Thrift Aaron P. , Chiao Elizabeth
Published: June 2019

Background:

Although declining rates of incident AIDS-related Kaposi sarcoma (KS) have been reported, KS incidence rates have noted race/ethnic, age, and geographic diversity. We performed a comprehensive assessment of recent secular trends in AIDS-related KS incidence in the United States.

Methods:

We identified incident KS diagnosed in men aged 20–54 years (who comprise most AIDS-related KS in the United States) using the US Cancer Statistics registry data. Joinpoint analysis assessed for trends in age-adjusted incidence rates between 2000 and 2014 calculating average annual percentage changes (AAPCs) with 95% confidence intervals. Heat maps were generated to compare age-adjusted HIV incidence rates with KS incidence rates.

Results:

Age-adjusted KS incidence rates nationwide decreased from 1.44/100,000 to 0.95/100,000 between 2000 and 2014. Observed rate changes varied across subgroups; eg, there were significant decreases in 30–44 years (AAPC = −5.4%), particularly in Whites and Blacks, significant increases among 20–29 years (AAPC = 2.7), primarily in Blacks, and stable rates among 45–54 years (AAPC = −0.03). In Southern United States, the incidence rates among Blacks did not significantly change. The states with highest average age-adjusted rates over the study period were Georgia (2.71/100,000), New York (2.16/100,000), California (2.02/100,000), Florida (1.90/100,000), and Texas (1.39/100,000), with significantly decreasing trends over time, except Georgia where rates increased (AAPC = 1.8).

Conclusions:

Although KS incidence rates have decreased nationally, age, racial, and geographic disparities persist, including increasing risk among younger Black men and particularly elevated rates in some southern states and urban areas. Further research is needed to address racial and geographic AIDS-related KS disparities.