bluuebunny/crossref_metadata_2025 huggingface dataset:
Trends in Urgent Care Utilization Following Ankle Fracture Fixation
Authors: Abousayed Mostafa M. , Johnson Christopher K. , Moral Muhammad , Sternbach Sarah , Rosenbaum Andrew J.
Published: October 2018

Background:

The Centers for Medicare and Medicaid services (CMS) have implemented initiatives to improve postdischarge care and reduce unnecessary readmissions. Readmissions within 30 days are frequent and represent an economic burden on both patients and the healthcare system. The aim of this study was to evaluate the frequency and causes for urgent care visits within 30 days of discharge after ankle open reduction and internal fixation (ORIF) and determine factors correlated with such visits.

Methods:

This was a retrospective analysis of prospectively collected data. All patients who underwent ankle ORIF at our institution between July 1, 2016, and June 30, 2017, were included. Patients were identified using Current Procedural Terminology (CPT) codes for ankle ORIF. Patients’ demographics including age, sex, race, body mass index, occupation, insurance payer, and comorbidities were documented.

Results:

Thirty-five patients (10.51%) had urgent care visits within 30 days of discharge. Patients presented at a mean of 11.8 days after the day of surgery. Sixteen patients (45.71%) had cast/splint-related issues, 7 (20%) presented with pain, and 7 (20%) with increased operative site drainage. Univariate analysis demonstrated a statistically significant association between postoperative urgent care visits and patients with diabetes ( P = .03) or underlying psychiatric disorders ( P = .03).

Conclusion:

In this population study of patients undergoing ankle fracture surgery, we found that the rate of urgent care visits within 30 days of discharge exceeded the rate of inpatient readmission. Additionally, patients with diabetes and psychiatric disorders were significantly more likely to present to an urgent care facility postoperatively, potentially accounting for increased expenditures of the healthcare system.

Level of Evidence:

Level III, comparative series.
Complicated Grief and Cortisol Response: An Integrative Review of the Literature
Authors: Mason Tina M. , Duffy Allyson R.
Published: October 2018

BACKGROUND: The loss of a loved one, especially by a caregiver, can be stressful. Grief can affect one emotionally, mentally, behaviorally, spiritually, and physically and affects individuals differently. Complicated grief (CG), especially for a caregiver, can be intense, prolonged, and interfere with normal activities accompanied by destructive thoughts and behaviors. AIM: To synthesize the available research on persons experiencing CG and the effect on cortisol levels. METHODS: A literature search for articles published on CG and cortisol was performed using PubMed, Cochrane Library, PsychINFO, and Web of Science. Search terms included CG, cortisol, and their variants. No date limitations were applied. In accordance with PRISMA, articles were sorted and evaluated against specific inclusion and exclusion criteria. RESULTS: The search yielded 18 articles, of which 5 were included in the review. CONCLUSIONS: Cortisol levels and diurnal patterns are shown to be affected in individuals experiencing CG. With prolonged bereavement and dysregulated cortisol, physical and mental health outcomes may result warranting a need for effective stress reduction therapies for this population.
Non-surgical management of congenital ichthyosis using hyaluronic acid gel injection
Authors: Cicinelli Maria Vittoria , Dave Tarjani Vivek , Madhuri Bejanki Kavya , Tiple Sweety , Naik Milind N
Published: October 2018

Aim:

To test if hyaluronic acid gel injection in the upper eyelid achieves correction of congenital cicatricial ectropion and reduction in lagophthalmos, in preparation for intraocular surgery.

Methods:

This case reports the long-term outcome of hyaluronic acid gel injection in the upper eyelid for the correction of ectropion prior to cataract surgery. One millilitre of hyaluronic acid gel was injected in both the upper eyelids of a child with congenital ichthyosis in the suborbicularis plane, prior to cataract surgery.

Results:

Lagophthalmos reduced by 15 mm in the right eye and 13 mm in the left eye. Subsequently, the child underwent cataract surgery without any complications.

Conclusion:

We demonstrate the long-term outcome of using hyaluronic acid gel injection for successful, non-surgical correction of cicatricial ectropion in ichthyosis.
Transported: New Zealand non-profit organizations, digital platforms and the limitations of metaphor
Authors: Gray F Elizabeth , Hopkins Kane
Published: October 2018

Digital communication has become ubiquitous to the non-profit sector, globally, and non-profit organizations (NPOs) have adopted multiple digital media channels and platforms in attempts to connect with and influence external stakeholders. This article examines how non-profits in New Zealand (NZ) are using metaphoric language around their deployment of digital media channels. Since its inception, digital information technology has been explained in terms of transport metaphors such as information superhighway and digital traffic. These metaphors have become largely invisible. A combination of empirical and interpretative analyses was deployed to examine the metaphorical framework at work in NPO discussions of their digital media engagements. The analysis uncovered rhetoric that valued movement over destination, de-emphasized the stakeholder perspective and narrowly restricted the power to contribute to organizational meaning.
Nanostructure changes in diesel soot during NO2–O2 oxidation under diesel particulate filter-like conditions toward filter regeneration
Authors: Singh Madhu , Srilomsak Mek , Wang Yujun , Hanamura Katsunori , Vander Wal Randy
Published: October 2018

Development of the regeneration process on diesel particulate filters requires a better understanding of soot oxidation phenomena, especially its relation to soot nanostructure. Nitrogen dioxide (NO2) is known to play an essential role in passive regeneration by oxidizing soot at low temperatures, especially in the presence of oxygen (O2) in the exhaust. However, change in soot nanostructure due to oxidation by NO2–O2 mixtures has not received much attention. This work focuses on nanostructure evolution during passive regeneration of the diesel particulate filter by oxidation of soot at normal exhaust gas temperatures (300°C–400°C). High-resolution transmission electron microscopy of partially oxidized model carbons (R250, M1300, arc-generated soot) and diesel soot under NO2–O2 mixtures is used to investigate physical changes in nanostructure correlating with the material’s behavior during oxidation. Microscopy reveals the changing nanostructure of model carbons during oxidation while fringe analysis of the images points to the differences in the structural metrics of fringe length and tortuosity of the resultant structures. The variation in oxidation rates highlights the inter-dependence of the material’s reactivity with its structure. NO2 preferentially oxidizes edge-site carbon, promotes surface oxidation by altering the particle’s burning mode with increased overall reactivity of NO2+O2 resulting in inhibition of internal burning, typically observed by O2 at exhaust gas temperatures.
Analysing sport data with clusters of opposite preferences
Authors: Simone Rosaria , Iannario Maria
Published: October 2018

In the analysis of questionnaire-based evaluation of sport preferences, measurements of sport participation, opinions on social implications such as resurgence of racism, violence in stadiums and doping, the need arises to establish connections among motivations, subjects’ characteristics and responses. In this setting, the article deals with a selection of statistical models suitable to analyse sport rating data in which clusters of opposite responses are observed. Specifically, a two-component mixture of inverse hypergeometric (MIHG) distributions will be introduced and tested against competing models in order to yield a multifold interpretation of results. The ultimate comparative analysis will consider discrete models with a specific focus on those accounting for both uncertainty and feeling of self-evaluation in presence of inflation at the extreme categories. After a brief review of the methods, the proposal will be discussed both on ranking and rating data on the basis of two surveys on sport preferences and on measurements of sport activity: the identification of clusters of respondents with opposite choices will be investigated also in terms of covariates by comparing fitting performances of the selected models. The conclusions and insights offered by the study can be exploited to design plans of action for some specific policy or marketing strategy.
Selective generation of ultrasonic guided waves in a bi-dimensional waveguide
Authors: Serey Valentin , Quaegebeur Nicolas , Micheau Philippe , Masson Patrice , Castaings Michel , Renier Mathieu
Published: October 2018

Non-destructive testing and structural health monitoring systems based on ultrasonic guided waves propagation are particularly used in civil engineering or aerospace applications. Guided waves are commonly employed as they propagate through large distances and can inspect the entire cross-section of the structure. In order to optimize the sensitivity to a specific damage type, it is often preferable to generate a carefully selected pure mode. Although single-mode generation has been achieved for Lamb waves in infinite plate-like structures, such generation is much harder in a rectangular bar since less conventional modes propagate in finite cross-section waveguides. This article presents a general methodology for mode selective generation in a finite cross-section waveguide, using multiple transducers. Obtaining modal identification through conventional spatial Fourier transform on a longitudinal scan has proven to be inconvenient for waveguides with a two-dimensional cross-section. An alternative technique is proposed, consisting in the decomposition over the modal basis of the three displacement components measured across the bar width at the bar surface. The methodology is applied to the single-mode generation within an aluminum bar instrumented with eight piezoelectric transducers bonded to the surface. The modal basis is obtained with a semi-analytical finite element method. Numerical simulations and experiments using a three-dimensional laser Doppler vibrometer are conducted in order to validate the methodology.
Anatomical Predictors of Endoleaks or Migration After Endovascular Aneurysm Sealing
Authors: van Noort Kim , Boersen Johannes T. , Zoethout Aleksandra C. , Schuurmann Richte C. L. , Heyligers Jan M. M. , Reijnen Michel M. P. J. , Zeebregts Clark J. , Slump Cornelis H. , de Vries Jean-Paul P. M. ,   on behalf of the DEVASS (Dutch Endovascular Aneurysm Sealing Study) Group
Published: October 2018

Purpose: To identify preoperative anatomical aortic characteristics that predict seal failures after endovascular aneurysm sealing (EVAS) and compare the incidence of events experienced by patients treated within vs outside the instructions for use (IFU). Methods: Of 355 patients treated with the Nellix EndoVascular Aneurysm Sealing System (generation 3SQ+) at 3 high-volume centers from March 2013 to December 2015, 94 patients were excluded, leaving 261 patients (mean age 76±8 years; 229 men) for regression analysis. Of these, 83 (31.8%) suffered one or more of the following events: distal migration ⩾5 mm of one or both stent frames, any endoleak, and/or aneurysm growth >5 mm. Anatomical characteristics were determined on preoperative computed tomography (CT) scans. Patients were divided into 3 groups: treated within the original IFU (n=166), outside the original IFU (n=95), and within the 2016 revised IFU (n=46). Categorical data are presented as the median (interquartile range Q1, Q3). Results: Neck diameter was significantly larger in the any-event cohort vs the control cohort [23.7 mm (21.7, 26.3) vs 23.0 mm (20.9, 25.2) mm, p=0.022]. Neck length was significantly shorter in the any-event cohort [15.0 mm (10.0, 22.5) vs 19.0 mm (10.0, 21.8), p=0.006]. Maximum abdominal aortic aneurysm (AAA) diameter and the ratio between the maximum AAA diameter and lumen diameter in the any-event group were significantly larger than the control group (p=0.041 and p=0.002, respectively). Regression analysis showed aortic neck diameter (p=0.006), neck length (p=0.001), and the diameter ratio (p=0.011) as significant predictors of any event. In the comparison of events to IFU status, 52 (31.3%) of 166 patients in the inside the original IFU group suffered an event compared to 13 (28.3%) of 46 patients inside the 2016 IFU group (p=0.690). Conclusion: Large neck diameter, short aortic neck length, and the ratio between the maximum AAA and lumen diameters are preoperative anatomical predictors of the occurrence of migration (⩾5 mm), any endoleak, and/or aneurysm growth (>5 mm) after EVAS. Even under the refined 2016 IFU, more than a quarter of patients suffered from an event. Improvements in the device seem to be necessary before this technique can be implemented on a large scale in endovascular AAA repair.
Promoting Physical and Psychological Rehabilitation Activities and Evaluating Potential Links Among Cancer-Related Fatigue, Fear of Recurrence, Quality of Life, and Physiological Indicators in Cancer Survivors
Authors: Lee Yi-Hua , Lai Gi-Ming , Lee De-Chih , Tsai Lai Lee-Jang , Chang Yuan-Ping
Published: October 2018

Objectives: Cancer-related fatigue and fear of recurrence (FOR) are the most common symptoms in cancer survivors and severely affect quality of life (QOL). This study aims to promote and evaluate the effectiveness of physical and psychological rehabilitation activities for cancer survivors. Methods: A longitudinal study with an interventional research design was conducted. A total of 80 participants were randomly assigned to experimental groups E1 (Qigong exercise [QE]) or E2 (stress management [SM]) or the control group. The E1 and E2 groups received QE and SM, respectively, as interventions once a week for 12 weeks, and effects were assessed. Cancer-related fatigue, FOR, QOL, and heart rate variability (HRV) were evaluated at baseline (T0), after 12 weeks (T1), and at the 3-month follow-up (T2). Results: QE and SM effectively strengthened the physical and psychological functions of cancer survivors at the T1 phase. Although differences in FOR and QOL were not statistically significant, the scores were decreased and increased, respectively. Although the effects during the T2 phase were not as significant as those during T1, the score progress was maintained. The effects on HRV were significantly different among the E1, E2, and control groups at T1, which shows that the performance of both experimental groups was better than that of the control group. Conclusions: Physical and psychological rehabilitation activities should be practiced periodically and should be led by professional staff. Long-term educational resources and care should also be provided. HRV can be used to efficiently monitor the status of the mind-body balance and is a more suitable index than questionnaires for physical and psychological function evaluation in cancer survivors.
Symptoms of Posttraumatic Stress Disorder and Associated Risk Factors in Patients With Lung Cancer: A Longitudinal Observational Study
Authors: Ni Jun , Feng Jian , Denehy Linda , Wu Yi , Xu Liqin , Granger Catherine L.
Published: October 2018

Purpose. This study aimed to measure symptoms of posttraumatic stress disorder (PTSD) in Chinese patients following a new diagnosis of lung cancer. Secondary aims were to explore factors at diagnosis that may predict PTSD symptoms at 6 months. Methods. This was a prospective longitudinal observational study that included 93 patients with newly diagnosed lung cancer. PTSD symptomology was assessed using the PTSD Checklist Civilian Version (PCL-C) and health-related quality of life (HRQoL) was assessed with the European Organisation for the Research and Treatment of Cancer questionnaire. Measures were completed at diagnosis and 6 months. Results. No patient had PTSD at baseline or 6 months as measured by a score of ⩾50 in the PCL-C. However, at diagnosis, 44% of patients had “mild” symptoms of PTSD. At 6 months, 64% of patients had “mild” and 8% had “moderate” PTSD symptoms. PTSD symptom scores significantly worsened over 6 months (mean difference [95% CI] = 7.2 [5.4 to 9.0]). Six months after diagnosis, higher PTSD scores were seen in people who at diagnosis were younger ( P = .003), had a lower smoking pack history ( P = .012), displayed less sedentary behavior ( P < .005), or initially had worse cancer symptoms, including fatigue ( P = .001) and poorer HRQoL ( P = .004). Conclusions. Mild PTSD symptoms are common in patients with lung cancer 6 months after treatment; however, a full diagnosis of PTSD is uncommon. Screening for PTSD symptoms may be considered for at-risk patients with newly diagnosed lung cancer.
Whole Blood Selenium Levels and Selenium Supplementation in Patients Treated in a Family Doctor Practice in Golßen (State of Brandenburg, Germany): A Laboratory Study
Authors: Muecke Ralph , Waldschock Knut , Schomburg Lutz , Micke Oliver , Buentzel Jens , Kisters Klaus , Adamietz Irenaeus A. , Huebner Jutta
Published: October 2018

Introduction: The supply of selenium (Se) varies widely in Germany. Therefore, a laboratory study was conducted in patients treated at a family doctor practice in Brandenburg, Germany, to determine whether there is a general Se deficiency in this area; specifically, whether Se concentrations differ with age, sex, or presence of cancer. Moreover, we tested the effects of a Se supplementation on whole blood Se levels (WBSL). Methods: In 2006, WBSL were analyzed in 871 patients (496 females, 375 males, median age: 67 years). Of these, 143 (78 females, 65 males) had cancer and were in an aftercare situation. From 2006 to 2012, 317 patients (76 with tumors, 241 without tumors) received continuous Se supplementation with sodium selenite (300 µg per day) and annual WBSL measurements. WBSL were compared by Student’s t test for paired and independent samples. Results: The initial WBSL of all patients was 97.2 ± 20.7 µg/L (mean ± SD). WBSL did not differ with regard to age or sex, but patients with cancer had the lowest WBSL. Se supplementation increased mean WBSL in both patients with (to 128.5 µg/L) and without (to 119.52 µg/L) cancer ( P < .001). Discussion: Patients with cancer displayed significantly lower WBSL than patients without cancer, indicating a negative effect of tumors on Se uptake, absorption, or metabolism. Significant influences of age or sex were not observed. Selenite supplementation efficiently improved WBSL to concentrations considered necessary for health benefits.
Research on modeling and simulation in overshadowing influence of coastal building on vessel traffic service radar
Authors: Gan Lang-xiong , Yu Fen-fen , Zheng Yuan-zhou , Zhou Chun-hui , Gao Jun-jie , Cheng Xiao-dong
Published: October 2018

The reflection characteristics of radar waves in coastal high-rise buildings form a certain shielding area, which makes it difficult for vessel traffic service to control the ship dynamic situation in sheltered waters. To study the overshadowing influence of coastal buildings on the vessel traffic service radar, an expression model of shielding area is established based on the structure characteristics of buildings and the relative height of radar. Then, the coordinate system is established, and the range and height of the shelter area are calculated, according to the geometric relation. Based on the theory of radar electromagnetic wave diffraction, the target height is calculated. Finally, taking the prince’s Bay Cruise Terminal Building on the radar Shekou radar as an example, the shielding area and height are calculated and visualized by the numerical calculation model and verified by real vessel test and observation. The building with a height of 60 m has covered 973,090 m2 of sheltered area for Shekou radar. The results can be used not only to analyze the influence of buildings on existing vessel traffic service radar stations but also to provide an important reference for site selection of vessel traffic service radar stations.
A simple new method for identifying performance characteristics associated with success in elite tennis
Authors: Fitzpatrick Anna , Stone Joseph A , Choppin Simon , Kelley John
Published: October 2018

Performance analysis and identifying performance characteristics associated with success are of great importance to players and coaches in any sport. However, while large amounts of data are available within elite tennis, very few players employ an analyst or attempt to exploit the data to enhance their performance; this is partly attributable to the considerable time and complex techniques required to interpret these large datasets. Using data from the 2016 and 2017 French Open tournaments, we tested the agreement between the results of a simple new method for identifying important performance characteristics (the Percentage of matches in which the Winner Outscored the Loser, PWOL) and the results of two standard statistical methods to establish the validity of the simple method. Spearman’s rank-order correlations between the results of the three methods demonstrated excellent agreement, with all methods identifying the same three performance characteristics ( points won of 0–4 rally length, baseline points won and first serve points won) as strongly associated with success. Consequently, we propose that the PWOL method is valid for identifying performance characteristics associated with success in tennis, and is therefore a suitable alternative to more complex statistical methods, as it is simpler to calculate, interpret and contextualise.
Biomarkers in the diagnosis of pleural diseases: a 2018 update
Authors: Porcel José M.
Published: October 2018

The use of biomarkers on pleural fluid (PF) specimens may assist the decision-making process and enhance clinical diagnostic pathways. Three paradigmatic examples are heart failure, tuberculosis and, particularly, malignancy. An elevated PF concentration of the amino-terminal fragment of probrain natriuretic peptide (>1500 pg/ml) is a hallmark of acute decompensated heart failure. Adenosine deaminase, interferon-γ and interleukin-27 are three valuable biomarkers for diagnosing tuberculous pleurisy, yet only the first has been firmly established in clinical practice. Diagnostic PF biomarkers for malignancy can be classified as soluble-protein based, immunocytochemical and nucleic-acid based. Soluble markers (e.g. carcinoembryonic antigen (CEA), carbohydrate antigen 15–3, mesothelin) are only indicative of cancer, but not confirmatory. Immunocytochemical studies on PF cell blocks allow: (a) to distinguish mesothelioma from reactive mesothelial proliferations (e.g. loss of BAP1 nuclear expression, complemented by the demonstration of p16 deletion using fluorescence in situ hybridization, indicate mesothelioma); (b) to separate mesothelioma from adenocarcinoma (e.g. calretinin, CK 5/6, WT-1 and D2-40 are markers of mesothelioma, whereas CEA, EPCAM, TTF-1, napsin A, and claudin 4 are markers of carcinoma); and (c) to reveal tumor origin in pleural metastases of an unknown primary site (e.g. TTF-1 and napsin A for lung adenocarcinoma, p40 for squamous lung cancer, GATA3 and mammaglobin for breast cancer, or synaptophysin and chromogranin A for neuroendocrine tumors). Finally, PF may provide an adequate sample for analysis of molecular markers to guide patients with non-small cell lung cancer to appropriate targeted therapies. Molecular testing must include, at least, mutations of epidermal growth-factor receptor and BRAF V600E, translocations of rat osteosarcoma and anaplastic lymphoma kinase, and expression of programmed death ligand 1.
Assessment of oxygen-uptake efficiency slope in healthy children and children with heart disease: Generation of appropriate reference values for the OUES variable
Authors: Hossri Carlos AC , Souza Isabela PM Alves de , de Oliveira Joana ST , Mastrocola Luiz E
Published: October 2018

Background

Oxygen-uptake efficiency slope (OUES) is an objective measure of functional capacity that does not require a maximal effort but is considerably dependent on anthropometric variables and requires the generation of an appropriate reference value in children. This study aimed to establish normal reference values for OUES/kg in children with and without congenital heart diseases. Besides that, reference values are presented secondarily for OUES per body surface area (OUES/BSA).

Design

Cross-sectional.

Methods

Six hundred and seventy-six children and adolescents performed a maximal cardiopulmonary exercise test (305 healthy controls and 371 individuals with congenital heart defect), between four and 21 years old (481 males and 195 females, with a mean age of 12 years).

Results

The OUES reference value for the classification of children and adolescents with normal functional capacity (>80% of predicted maximum oxygen uptake) was 34.63 (sensitivity 77% and specificity 83%, p < 0.05). Regarding the body surface area, considering healthy patients and those with heart disease, the cutoff value of the OUES/BSA was 1151 with sensitivity of 79% and specificity of 79%.

Conclusions

OUES/kg may be an important marker tool in the differentiation between preserved or abnormal functional capacity in children and adolescents with and without congenital heart disease, even at the submaximal level of exercise.
Exercise physiology in pulmonary hypertension patients with and without congenital heart disease
Authors: Righini Francesca M , Apostolo Anna , Heck Pinar B , Farina Stefania , Hager Alfred , Correale Michele , Badagliacca Roberto , Barbieri Simone , Sciomer Susanna , Agostoni Piergiuseppe
Published: October 2018

Background

Cardiopulmonary exercise testing allows the assessment of integrative cardiopulmonary response to exercise.

Aims

The aim of the study was to better understand the exercise physiology in pulmonary arterial hypertension related to adult congenital heart disease compared to non-adult congenital heart disease patients by means of cardiopulmonary exercise testing parameters.

Methods

The present is a multicentre retrospective study which includes pulmonary hypertension group 1 and group 4 patients. All subjects underwent full clinical and instrumental evaluation, including cardiopulmonary exercise testing and right heart catheterization.

Results

One hundred and sixty-seven pulmonary hypertension patients (93 women and 74 men, 57 adult congenital heart disease and 110 non-adult congenital heart disease) were enrolled. Adult congenital heart disease patients had higher pulmonary pressure (mean pulmonary arterial pressure: 59.8 ± 19.5 mmHg vs 44.6 ± 16.5 mmHg, p < 0.001) and lower pulmonary blood flow (pulmonary blood flow: 3.3 (2.1–4.3) l/min vs 4.5 (3.8–5.4) l/min, p < 0.001). At cardiopulmonary exercise testing they had lower peak oxygen uptake/kg (12.8 ± 3.8 ml/kg/min vs 15.5 ± 4.2 ml/kg/min, p < 0.001) and higher ventilation/carbon dioxide elimination slope (53.2 (43.3–64.8) vs 44.0 (34.6–51.6), p < 0.001). When patients were paired for gender and peak oxygen uptake ( ± 1 ml/kg/min), obtaining 44 pairs, adult congenital heart disease patients had higher pulmonary pressure (mean pulmonary arterial pressure: 58.4 ± 20.2 mmHg vs 42.8 ± 16.8 mmHg, p < 0.001) and ventilation/carbon dioxide elimination slope (51.2 (43.4–63.6) vs 44.9 (35.4–55.1), p = 0.033).

Conclusions

In pulmonary arterial hypertension-adult congenital heart disease patients, pulmonary pressure and ventilation/carbon dioxide elimination slope are higher compared to non-adult congenital heart disease pulmonary hypertension patients, while pulmonary blood flow and peak oxygen uptake are lower. After matching patients for gender and peak oxygen uptake, pulmonary pressure and ventilation/carbon dioxide elimination remain higher in adult congenital heart disease patients suggesting that the long-term adaptation to high pulmonary pressure, hypoxia and low pulmonary blood flow, as well as a persisting shunt has, at least partially, preserved exercise performance of pulmonary arterial hypertension-adult congenital heart disease patients.
Surgical treatment of non-tuberculous mycobacterial lymphadenitis in children: Our experience and a narrative review
Authors: Torretta Sara , Gaffuri Michele , Ibba Tullio , Capaccio Pasquale , Marchisio Paola , Maruca Antonella , Bosis Samantha , Pignataro Lorenzo
Published: October 2018

Non-tuberculous mycobacterial lymphadenitis (NTML) accounts for about 95% of the cases of head-and-neck mycobacterial lymphadenitis, and its prevalence has been increasing in the Western world. The diagnostic work-up can be challenging, and differential diagnoses such as tuberculous and suppurative lymphadenitis need to be considered. It may, therefore, not be diagnosed until the disease is in a late stage, by which time it becomes locally destructive and is characterized by a chronically discharging sinus. The treatment options include a medical approach, a wait-and-see policy, and surgery, with the last being considered the treatment of choice despite the high risk of iatrogenic nerve lesions. The aim of this article is to provide an overview of pediatric, head-and-neck NTML based on the literature and our own experience, with particular emphasis on the impact and limitations of surgery.
Assessment and Early Management of Pain in Hip Fractures: The Impact of Paracetamol
Authors: Dixon Ján , Ashton Fiona , Baker Paul , Charlton Karl , Bates Charlotte , Eardley William
Published: October 2018

Introduction:

As the number of patients sustaining hip fractures increases, interventions aimed at improving patient comfort and reducing complication burden acquire increased importance. Frailty, cognitive impairment, and difficulty in assessing pain control characterize this population. In order to inform future care, a review of pain assessment and the use of preoperative intravenous paracetamol (IVP) is presented.

Materials and Methods:

Systematic review of preoperative IVP administration in patients presenting with a hip fracture.

Results:

Intravenous paracetamol is effective in the early management of pain control in the hip fracture population. There is a considerable decrease in use of breakthrough pain medications when compared with other pain relief modalities. Additionally, IVP reduces the incidence of opioid-induced complications, reduces length of stay, and lowers mean pain scores. Another significant finding of this study is the poor administration of all analgesics to patients with hip fracture with up to 72% receiving no prehospital analgesia.

Discussion:

The potential benefits of IVP as routine in the early management of hip fracture-related pain are clear. Studies of direct comparison between analgesia regimes to inform optimum bundles of analgesic care are sparse. This study highlights the need for properly constructed pathway-driven comparator studies of contemporary analgesia regimes, with IVP as a central feature to optimize pain control and minimize analgesia-related morbidity in this vulnerable population.
Characterizing the Effects of Symbolic and Racial Threat on Charge Modifications in the Juvenile Court
Authors: Lowery Patrick G.
Published: October 2018

African Americans have long been overrepresented in juvenile justice, starting at arrest and all the way through to confinement. Importantly, some scholars argue examining “back-end” processes of juvenile justice and exploring the utility of different theoretical frameworks may aid in explaining African American overrepresentation. Drawing on two similar theoretical explanations, symbolic and racial threat, this study examines whether disparities are explained better by perceived threats to the dominant group norms and values, as well as between-group inequalities (symbolic threat) or Black encroachment into the political and economic resources of the dominant (White) group (racial threat). Notably, this study explores the effects of symbolic and racial threat on reduced and dropped charges within one states’ juvenile court. Hierarchical generalized linear models are utilized to analyze official Department of Juvenile Justice files, which were supplemented with American Community Survey data. Results indicated strong support for the symbolic threat perspective but fail to support the tenants of racial threat. Implications of these findings and future directions for research were discussed.
An Investigation Into the Relationship Between Iranian EFL High- and Low-Proficient Learners and Their Learning Styles
Authors: Derakhshan Ali , Shakki Farzaneh
Published: October 2018

It is also hypothesized that proficiency level may have a voice with respect to learning styles. Therefore, to throw light on this issue, the present investigation targeted the relationship between Iranian English as a Foreign Language (EFL) learners’ learning styles and their levels of proficiency at Golestan University, Gorgan, Iran. To this end, 120 EFL learners majoring in Teaching English as a Foreign Language (TEFL) and English Literature were randomly selected based on the Rubrics of Common European Framework of Reference (A1-C2) to participate in this study. They were then divided into low-proficient (A2-B1) and high-proficient (B2-C1) learners. The instruments used in this study were an International English Language Testing System (IELTS) Mock exam through which the participants’ levels of proficiency were determined and Reid’s Perceptual Learning Style Questionnaire to identify learners’ perceptual learning style preferences. The questionnaire enclosed 30 statements allocated to each modality based on a five point Likert scale, ranging from strongly agree to strongly disagree. The results of independent samples t-test and Spearman correlation coefficient revealed that there existed some significant relationships between students’ learning style preferences and levels of proficiency. It was found that learners with high levels of proficiency favored Kinesthetic and Tactile learning styles more than other preferences, namely, Auditory, Visual, Group, and Individual learning style preferences. In addition, the low-level students were much inclined toward Visual and Group styles. Regarding the necessity of understanding learners’ different styles, the implications of the study are discussed to consider the importance of individual differences.
Investigating Gold Investment as an Inflationary Hedge
Authors: Singh Narinder Pal , Joshi Navneet
Published: October 2018

Gold and Indian culture have been sharing an age-old association. India is one of the top two consumers of gold. Gold is the most popular investment avenue because of its ability to provide liquidity. The average monthly price however has grown by 1,588 percent over the whole period from 1979 to 2017 (June). In this article, we intend to investigate gold as an investment to hedge against inflation. The sample period to study the relationship between gold and inflation is 2011–2017 (March). To analyze long-run equilibrium between gold and inflation (consumer price index [CPI]), Johansen’s cointegration approach has been used. The short- and long-run causality between gold and inflation has been studied using vector error correction model (VECM) and Wald test. The results of cointegration indicate that gold and CPI series are cointegrated and bear long-run equilibrium. Both VECM and Wald test results indicate that there is only long-run causality between CPI and gold prices. However, in short run these variables do not show any causality. Thus, we infer that gold investment can be used as hedge against Inflation. The findings of this research have got direct implications for retail investors, portfolio managers, treasury and fund managers, government, and commercial traders.
ERS technical standard on bronchial challenge testing: pathophysiology and methodology of indirect airway challenge testing
Authors: Hallstrand Teal S. , Leuppi Joerg D. , Joos Guy , Hall Graham L. , Carlsen Kai-Håkon , Kaminsky David A. , Coates Allan L. , Cockcroft Donald W. , Culver Bruce H. , Diamant Zuzana , Gauvreau Gail M. , Horvath Ildiko , de Jongh Frans H.C. , Laube Beth L. , Sterk Peter J. , Wanger Jack
Published: October 2018

Recently, this international task force reported the general considerations for bronchial challenge testing and the performance of the methacholine challenge test, a “direct” airway challenge test. Here, the task force provides an updated description of the pathophysiology and the methods to conduct indirect challenge tests. Because indirect challenge tests trigger airway narrowing through the activation of endogenous pathways that are involved in asthma, indirect challenge tests tend to be specific for asthma and reveal much about the biology of asthma, but may be less sensitive than direct tests for the detection of airway hyperresponsiveness. We provide recommendations for the conduct and interpretation of hyperpnoea challenge tests such as dry air exercise challenge and eucapnic voluntary hyperpnoea that provide a single strong stimulus for airway narrowing. This technical standard expands the recommendations to additional indirect tests such as hypertonic saline, mannitol and adenosine challenge that are incremental tests, but still retain characteristics of other indirect challenges. Assessment of airway hyperresponsiveness, with direct and indirect tests, are valuable tools to understand and to monitor airway function and to characterise the underlying asthma phenotype to guide therapy. The tests should be interpreted within the context of the clinical features of asthma.
Can we predict tuberculosis cure? What tools are available?
Authors: Goletti Delia , Lindestam Arlehamn Cecilia S. , Scriba Thomas J. , Anthony Richard , Cirillo Daniela Maria , Alonzi Tonino , Denkinger Claudia M. , Cobelens Frank
Published: October 2018

Antibiotic treatment of tuberculosis takes ≥6 months, putting a major burden on patients and health systems in large parts of the world. Treatment beyond 2 months is needed to prevent tuberculosis relapse by clearing remaining, drug-tolerantMycobacterium tuberculosisbacilli. However, the majority of patients treated for only 2–3 months will cure without relapse and do not need prolonged treatment. Assays that can identify these patients at an early stage of treatment may significantly help reduce the treatment burden, while a test to identify those patients who will fail treatment may help target host-directed therapies.

In this review we summarise the state of the art with regard to discovery of biomarkers that predict relapse-free cure for pulmonary tuberculosis. Positron emission tomography/computed tomography scanning to measure pulmonary inflammation enhances our understanding of “cure”. Several microbiological and immunological markers seem promising; however, they still need a formal validation. In parallel, new research strategies are needed to generate reliable tests.
Sertraline in symptomatic chronic breathlessness: a double blind, randomised trial
Authors: Currow David C. , Ekström Magnus , Louw Sandra , Hill Julie , Fazekas Belinda , Clark Katherine , Davidson Patricia M. , McDonald Christine , Sajkov Dimitar , McCaffrey Nikki , Doogue Matthew , Abernethy Amy P. , Agar Meera
Published: October 2018

Does sertraline provide symptomatic relief for chronic breathlessness in people with advanced disease whose underlying cause(s) are optimally treated?

223 participants with chronic breathlessness (modified Medical Research Council breathlessness scale ≥2) who had optimal treatment of underlying cause(s) were randomised 1:1 to sertraline 25–100 mg (titrated upwards over 9 days) or placebo for 4 weeks. The primary outcome was the proportion who had an improvement in intensity of current breathlessness >15% from baseline on a 100-mm visual analogue scale.

The proportion of people responding to sertraline was similar to placebo for current breathlessness on days 26–28 (OR 1.00, 95% CI 0.71–1.40) and for other measures of breathlessness. Quality of life in the sertraline arm had a higher likelihood of improving than in the placebo arm over the 4 weeks (OR 0.21, 95% CI 0.01–0.41; p=0.044). No differences in performance status, anxiety and depression, or survival were observed. Adverse event rates were similar between arms.

Sertraline does not appear to provide any benefit over placebo in the symptomatic relief of chronic breathlessness in this patient population.
Randomised controlled trials in severe asthma: selection by phenotype or stereotype
Authors: Brown Thomas , Jones Thomas , Gove Kerry , Barber Clair , Elliott Scott , Chauhan Anoop , Howarth Peter
Published: October 2018

Previous publications have highlighted the disparity between research trial populations and those in clinical practice, but it has not been established how this relates to randomised controlled trials (RCTs) of phenotype-targeted biological therapies in severe asthma.

Detailed characterisation data for 342 severe asthma patients within the Wessex Severe Asthma Cohort (WSAC) was compared against comprehensive trial eligibility criteria for published phase IIB and phase III RCTs evaluating biological therapies in severe asthma since 2000.

37 RCTs evaluating 20 biological therapies were identified. Only a median of 9.8% (range 3.5–17.5%) of severe asthma patients were found to be eligible for enrolment in the phase III trials. Stipulations for airflow obstruction, bronchodilator reversibility and smoking history excluded significant numbers of patients. A median of 78.9% (range 73.2–86.6%) of patients with severe eosinophilic asthma would have been excluded from participation in the phase III licensing trials of interleukin (IL)-5/IL-5R targeted therapies.

Despite including only well characterised and optimally treated severe asthmatics under specialist care within the WSAC study, the vast majority were excluded from trial participation by criteria designed to re-confirm diagnostic labels rather than by biomarker criteria that predict the characteristic addressed by the treatment.
RETRACTED ARTICLE: Knockdown of insulin-like growth factor 1
exerts a protective effect on hypoxic injury of aged BM-MSCs: role of
autophagy
Authors: Yang Ming , Wen Tong , Chen Haixu , Deng Jingyu , Yang Chao , Zhang Zheng
Published: October 2018

Background

Treatment with bone marrow mesenchymal stem cells (BM-MSCs) has been
demonstrated to be an excellent cellular-based therapeutic strategy for treating
myocardial infarction (MI). However, most of the patients suffering with MI are
elderly. Hypoxic conditions can cause apoptosis of BM-MSCs, and this type of
apoptosis is more prevalent in aged BM-MSCs. Decreased autophagy is one of the
mechanisms underlying aging. The aim of this study is to uncover whether the
increased hypoxic injury of aged BM-MSCs is due to autophagy and whether reducing
autophagy diminishes the tolerance of hypoxia in aged BM-MSCs.

Methods

Young and aged BM-MSCs were isolated from male young and aged
GFP/Fluc transgenic C57BL/6 mice respectively and then exposed to hypoxia and
serum deprivation (H/SD) injury. The apoptosis level induced by H/SD was measured
by terminal deoxynucleotidy transferase-mediated dUTP nick end-labeling (TUNEL)
assay. Additionally, autophagy was analyzed via transfection with plasmids
encoding green fluorescent protein-microtubule-associated protein lightchain3
(GFP-LC3), and autophagic vacuoles were visualized with transmission electron
microscopy. Meanwhile, protein expression was measured by western blot analysis.
Autophagic activity was manipulated by the administration of IGF-1 (insulin-like
growth factor siRNA) and 3-methyladenine (3MA). Furthermore, young, aged, and the
IGF-1 siRNA-transfected aged BM-MSCs were transplanted to myocardial infarcted
adult C57BL/6 mice respectively. In vivo longitudinal in vivo bioluminescence
imaging (BLI) of transplanted BM-MSCs was performed to monitor the survival of
transplanted BM-MSCs in each groups.

Results

Aged BM-MSCs exhibited a higher rate of apoptosis compared with
young BM-MSCs under hypoxic conditions. Additionally, the level of autophagy was
lower in aged BM-MSCs compared with young BM-MSCs under normoxic and hypoxic
conditions. Meanwhile, hypoxia decreased the activity of the protein kinase B
(Akt) and mammalian target of rapamycin (mTOR) signaling pathway in young and aged
BM-MSCs, but aged BM-MSCs exhibited a relatively stronger Akt/mTOR activity
compared with young BM-MSCs. In addition, IGF-1 knockdown significantly decreased
the level of apoptosis in aged BM-MSCs under normoxic and hypoxic conditions.
IGF-1 knockdown also decreased the activity of the Akt/mTOR signaling pathway and
increased the level of autophagy in aged BM-MSCs under hypoxic condition.
Furthermore, IGF-1 knockdown protected aged BM-MSCs from hypoxic injury by
increasing the level of autophagy, thereby promoting the survival of aged BM-MSCs
after myocardial infarction transplantation.

Conclusion

This study demonstrates that reducing autophagy decreases the
hypoxia tolerance of aged BM-MSCs. Maintaining optimal levels of autophagy may
serve as a new strategy in treating MI by BM-MSC transplantation in aged
patients.
Mental health in medical, dentistry and veterinary students: cross-sectional online survey
Authors: Knipe Duleeka , Maughan Chloe , Gilbert John , Dymock David , Moran Paul , Gunnell David
Published: October 2018

Background

The mental health of university students, especially medical students, is of growing concern in the UK.

Aim

To estimate the prevalence of mental disorder in health sciences students and investigate help-seeking behaviour.

Method

An online survey from one English university (n= 1139; 53% response rate) collected data on depression (using the nine-item Patient Health Questionnaire), anxiety (seven-item Generalised Anxiety Disorder Assessment), alcohol use (Alcohol Use Disorders Identification Test), self-harm and well-being, as well as help seeking.

Results

A quarter of the students reported symptoms of moderate/severe depression and 27% reported symptoms of moderate/severe anxiety. Only 21% of students with symptoms of severe depression had sought professional help; the main reason for not seeking help was fear of documentation on academic records.

Conclusions

The study highlights the extent of mental health problems faced by health science students. Barriers to help seeking due to concerns about fitness-to-practise procedures urgently need to be addressed to ensure that this population of students can access help in a timely fashion.

Declaration of interest

None.