bluuebunny/crossref_metadata_2025 huggingface dataset:
Asteroseismic constraints on active latitudes of solar-type stars: HD 173701 has active bands at higher latitudes than the Sun
Authors: Thomas Alexandra E L , Chaplin William J , Davies Guy R , Howe Rachel , Santos Ângela R G , Elsworth Yvonne , Miglio Andrea , Campante Tiago , Cunha Margarida S
Published: March 2019

We present a new method for determining the location of active bands of latitude on solar-type stars, which uses stellar-cycle-induced frequency shifts of detectable solar-like oscillations. When near-surface activity is distributed in a non-homogeneous manner, oscillation modes of different angular degree and azimuthal order will have their frequencies shifted by different amounts. We use this simple concept, coupled to a model for the spatial distribution of the near-surface activity, to develop two methods that use the frequency shifts to infer minimum and maximum latitudes for the active bands. Our methods respond to the range in latitude over which there is significant magnetic flux present, over and above weak basal ephemeral flux levels. We verify that we are able to draw accurate inferences in the solar case, using Sun-as-a-star helioseismic data and artificial data. We then apply our methods to Kepler data on the solar analogue HD 173701, and find that its active bands straddle a much wider range in latitude than do the bands on the Sun.
S-band Polarization All-Sky Survey (S-PASS): survey description and maps
Authors: Carretti E , Haverkorn M , Staveley-Smith L , Bernardi G , Gaensler B M , Kesteven M J , Poppi S , Brown S , Crocker R M , Purcell C , Schnitzler D H F M , Sun X
Published: March 2019

We present the S-Band Polarization All Sky Survey (S-PASS), a survey of polarized radio emission over the southern sky at Dec. <−1° taken with the Parkes radio telescope at 2.3 GHz. The main aim was to observe at a frequency high enough to avoid strong depolarization at intermediate Galactic latitudes (still present at 1.4 GHz) to study Galactic magnetism, but low enough to retain ample signal-to-noise ratio (S/N) at high latitudes for extragalactic and cosmological science. We developed a new scanning strategy based on long azimuth scans and a corresponding map-making procedure to make recovery of the overall mean signal of Stokes Q and U possible, a long-standing problem with polarization observations. We describe the scanning strategy, map-making procedure and validation tests. The overall mean signal is recovered with a precision better than 0.5 per cent. The maps have a mean sensitivity of 0.81 mK on beam-size scales and show clear polarized signals, typically to within a few degrees of the Galactic plane, with ample S/N everywhere (the typical signal in low-emission regions is 13 mK and 98.6 per cent of pixels have S/N > 3). The largest depolarization areas are in the inner Galaxy, associated with the Sagittarius Arm. We have also computed a rotation measure map combining S-PASS with archival data from the Wilkinson Microwave Anisotropy Probe (WMAP) and Planck experiments. A Stokes I map has been generated, with sensitivity limited to the confusion level of 9 mK.
Nietzsche as a Critic of Genealogical Debunking: Making Room for Naturalism without Subversion
Authors: Queloz Matthieu , Cueni Damian
Published: March 2019

This paper argues that Nietzsche is a critic of just the kind of genealogical debunking he is popularly associated with. We begin by showing that interpretations of Nietzsche which see him as engaging in genealogical debunking turn him into an advocate of nihilism, for on his own premises, any truthful genealogical inquiry into our values is going to uncover what most of his contemporaries deem objectionable origins and thus license global genealogical debunking. To escape nihilism and make room for naturalism without indiscriminate subversion, we then argue, Nietzsche targets the way of thinking about values that permits genealogical debunking: far from trying to subvert values simply by uncovering their origins, Nietzsche is actively criticizing genealogical debunking thus understood. Finally, we draw out the consequences of our reading for Nietzsche’s positive vision.
Review of the scientific evidence used for establishing US policies on added sugars
Authors: Trumbo Paula R
Published: March 2019

The 2015 Dietary Guidelines for Americans Advisory Committee has set recommendations to limit added sugars. This action was based on the association between dietary pattern quality scores and chronic disease risk, the results of meta-analyses conducted for the World Health Organization, and data from modeling of dietary patterns for establishing the US Department of Agriculture’s Healthy US-Style Eating Patterns. Recommendations provided by the 2015–2020 Dietary Guidelines for Americans were used by the US Food and Drug Administration to establish, for the first time, the mandatory declaration of added sugars and a Daily Value of added sugars for the Nutrition Facts label. This review provides an overview of the scientific evidence considered by the World Health Organization, the 2015–2020 Dietary Guidelines for Americans, and the US Food and Drug Administration for setting recent polices and regulations on added sugars and highlights important issues and inconsistencies in the evaluations and interpretations of the evidence.
Inequality, survival to adulthood, and the growth drag of pollution
Authors: Schaefer Andreas
Published: March 2019

We theoretically investigate the interrelationship between economic inequality and the exposure to pollutants during the course of economic development. Environmental pollution adversely affects children’s probability of surviving to adulthood, thereby reducing parental expenditures on children’s quality and increasing the number of births necessary to achieve a desired family size. Children’s exposure to environmental pollution is determined by economic inequality because wealthier households live in cleaner areas, which then shapes variations in the level of human capital per child. This is the key mechanism through which environmental conditions impose a growth drag on the economy. Our theory proposes explanations for: (i) the hump-shaped evolution of child mortality ratios between cleaner and more polluted areas during the course of economic development, and (ii) the observed positive correlation between inequality and the concentration of pollutants at the local level.
Active Muscle Trigger Points Are Associated with Pain and Related Disability in Patients with Plantar Heel Pain: A Case–Control Study
Authors: Ortega-Santiago Ricardo , Ríos-León Marta , Martín-Casas Patricia , Fernández-de-las-Peñas César , Plaza-Manzano Gustavo
Published: March 2019

Objective

Pain experienced by patients with plantar heel pain has been associated with fascia thickness. It is possible that referred muscle pain may also be related to symptoms experienced by these patients. Our aim was to systematically investigate if the referred pain elicited by trigger points in the leg and foot musculature reproduces the symptoms in individuals with plantar heel pain and to determine the association of trigger points (TrPs) with pain and related disability.

Methods

A case–control study was conducted. Thirty-five individuals with unilateral chronic plantar heel pain and 35 matched comparable healthy controls participated. An assessor blinded to the subject’s condition explored TrPs in the flexor hallucis brevis, adductor hallucis, quadratus plantae, and internal gastrocnemius. Pain and related disability were assessed with a numerical pain rating scale (0–10), the Foot Function Index, and the Foot Health Status Questionnaire.

Results

The number of TrPs for each patient with plantar heel pain was 4 ± 3 (2.5 ± 2 active TrPs, 1.5 ± 1.8 latent TrPs). Healthy controls only had latent TrPs (mean = 1 ± 1). Active TrPs in the quadratus plantae (N = 20, 62.5%), and flexor hallucis brevis (N = 19, 59%) were the most prevalent in patients with plantar heel pain. A greater number of active, but not latent, TrPs was associated with higher foot pain variables (0.413 < rs < 0.561, P < 0.01), higher impact of foot pain (0.350 < rs < 0.473, P < 0.05) and worse related disability (–0.447 < rs < –0.35456, P < 0.05).

Conclusions

The referred pain elicited by active TrPs in the foot muscles reproduced the symptoms in patients with plantar heel pain. A greater number of active TrPs was associated with higher pain and related disability in patients with plantar heel pain.
Lessons from a publicly funded tier 2 healthy weight programme in Cornwall, UK
Authors: Williams A J , Barter T , Sharpe R A
Published: March 2019

Background

The UK has one of the highest prevalence rates of obesity worldwide. Public health departments have a duty to provide some obesity treatment and prevention services. With evidence of effective programmes lacking, we investigate lessons learned from a healthy weight programme in Cornwall, UK.

Methods

Data from the 12-week multi-component adult healthy weight management programme were obtained for 2012–2016. Descriptive statistics and statistical tests were used to describe participants’ demographics, health status and anthropometric measures to explore the enrolment and retention of the programme as well as the impact.

Results

A total of 1872 adults were referred into the programme. Overall, 646 completed the programme and, 48.8% achieved the programme’s aim of a >3% reduction in weight. Those who completed and met the programme aim tended to have had healthier outcomes at baseline.

Conclusions

For those who engage with the programme the impact can be meaningful. However, <1% of the population of Cornwall with overweight or obesity enroled in the programme, and those who benefitted most might have been in least need. Providing services that meet the needs of the population is challenging when a variety of services is needed, and the evidence base is poor.
Assessing the prevalence of alcohol consumption in early pregnancy using blood biomarker analysis: a consistent pattern across north-east England?
Authors: Howlett Helen , Mackenzie Shonag , Gray William K , Rankin Judith , Nixon Leanne , Brown Nigel W
Published: March 2019

Background

We previously investigated the prevalence of alcohol consumption in early pregnancy in Northumbria Healthcare NHS Foundation Trust, a locality of north-east England. The prevalence was 1.4% based on blood sample biomarker analysis using carbohydrate deficient transferrin (CDT) and 3.5% for gamma-glutamyltransferase (GGT).

Aims

To supplement this research by investigating the prevalence of alcohol use using identical methods in a different locality of the same region.

Methods

Six-hundred random blood samples taken at the antenatal booking appointment were anonymously analysed for the presence of CDT, a validated marker of chronic alcohol exposure (normalizing 2–3 weeks from abstinence) and GGT, a liver enzyme elevated for up to 8 weeks after alcohol exposure.

Results

The North Tees and Hartlepool NHS Foundation Trust data revealed a CDT prevalence rate of 1.7% (95% CI: 0.7–2.9) and GGT prevalence rate of 4.2% (95% CI: 2.6–5.9). However, these measures are not sensitive to low levels of alcohol; and no overlapping cases were identified or a significant correlation demonstrated between CDT or GGT.

Discussion

These data support our earlier work. Prevalence rates according to CDT and GGT analysis were similar in both areas, suggesting similar patterns of sustained alcohol use in pregnancy across the region.
Spontaneous pneumothorax in cocaine users
Authors: Ciriaco P , Rossetti F , Carretta A , Sant’Angelo M , Arrigoni G , Negri G
Published: March 2019

Background

Pneumothorax is one of the respiratory toxic effects of cocaine inhalation. The literature counts several cases, some associated to other respiratory conditions such as pneumomediastinum, haemoptysis and others not requiring surgical treatment.

Aim

We present a series of nonHIV cocaine-inhaler subjects who underwent video-assisted thoracoscopic surgery (VATS) for isolated spontaneous pneumothorax.

Design

Nine subjects, with a mean age of 24 ± 4 years, admitting cocaine inhalation, developed spontaneous pneumothorax and underwent 10 surgical treatments by means of VATS, at our Institution.

Results

Previous pneumothorax occurred in six cases episodes ranged from 0 to 5 (mean 1.6 ± 1.6). Chest computed tomography (CT) scan showed abnormalities in seven cases. All subjects underwent lung apicectomy, apical pleurectomy and mechanical pleurodesis. Seven subjects had also bullectomy. In all cases the visceral pleura was partially covered by fibrinous exudate. Histology of the lung showed small foreign body granulomatous inflammation in fibrotic and/or emphysematous pulmonary parenchyma. Relapse of pneumothorax occurred in one subject at 60 days and it was surgically treated. Mean follow-up was 150 ± 38 months (range 120–239). All subjects are now well, with no evidence of pneumothorax.

Conclusions

Spontaneous pneumothorax in cocaine-inhaler subjects is a reality of which physicians need to be aware. Chest CT scan might not reveal abnormalities. Macroscopically the lung might presents bullae and/or peculiar visceral pleura. Foreign body granulomas observed in the specimens suggest that the particulate component of inhaled substances can injure the lung. Surgical treatment of the bullous disease and mechanical pleurodesis can provide a long-term follow-up without relapse of pneumothorax.
Social entrepreneurship as field encroachment: how a neoliberal social movement constructed a new field
Authors: Spicer Jason , Kay Tamara , Ganz Marshall
Published: March 2019

In explaining the emergence of new strategic action fields, in which social movements’ and organizations’ logic, rules and strategies are forged, inter-field dynamics remain under-explored. The case of Social Enterprise and Entrepreneurship (SEE) shows how new fields can emerge through field encroachment, whereby shifts among overlapping fields create structural opportunities for the ascendency of new fields, which may adapt logics borrowed from adjacent fields to construct legitimacy. SEE leveraged the 1980s’ shift between first-order market and state fields to encroach on the political strategies of community organizing, birthing a neoliberal social movement to create a new field addressing social problems using market-based, profit-motivated approaches. With its borrowed veneer of justice, SEE rapidly developed a high academic and public profile over just three decades, despite little evidence its approach to solving social problems works. In encroaching on proven political strategies for solving social problems, it may further undermine democratic practices.
Photobiomodulation Therapy for Wound Care: A Potent, Noninvasive, Photoceutical Approach
Authors: Mosca Rodrigo Crespo , Ong Adrian A. , Albasha Omar , Bass Kathryn , Arany Praveen
Published: March 2019

GENERAL PURPOSE:

To provide background and examine evidence for the therapeutic application of light energy treatments for wound healing.

TARGET AUDIENCE:

This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.

LEARNING OBJECTIVES/OUTCOMES:

After completing this continuing education activity, you should be better able to:

1. Explain the basics of lasers, light-emitting diodes, and light-tissue interactions as they apply to photobiomodulation therapy.

2. Summarize the results of the authors’ literature review of the evidence regarding the therapeutic applications of photobiomodulation treatments for wound healing.

OBJECTIVE:

To provide background and examine evidence for the therapeutic applications of light energy treatments for wound healing.

METHODS:

A search was performed in PubMed for peer-reviewed scientific articles published in the last 5 years using the search terms “photobiomodulation therapy” and “low-level laser therapy,” and these terms combined with “wound,” using a “human species” filter. This search yielded 218 articles on photobiomodulation therapy or low-level laser therapy and wounds. Of these, only articles on in vivo wound care using light treatments were specifically included in this review (n = 11).

RESULTS:

The wound healing effects of low-dose laser treatments were first described over 50 years ago. Various doses ranging from 0.1 to 10 J/cm2 and wavelengths ranging from 405 to 1,000 nm appear to provide therapeutic benefits for a broad range of chronic wounds. A range of light energy sources from LEDs to lasers have been used and have specific advantages and limitations. There is a lack of consensus on standardized treatment parameters such as wavelengths, dose, and therapeutic outcomes in the reviewed studies, preventing direct comparison and clinical protocol recommendation. An expert opinion based on ongoing research studies and reported literature is offered.

CONCLUSIONS:

Noninvasive, economical, and multipurpose light devices are an attractive tool for wound management. However, there is an urgent need in the wound care community to develop optimal clinical protocols for use based on well-designed, rigorous clinical research studies.
Medical Adhesive-Related Skin Injuries and Associated Risk Factors in a Pediatric Intensive Care Unit
Authors: Wang Dan , Xu Hongzhen , Chen Shuohui , Lou Xiaofang , Tan Jiafei , Xu Ying
Published: March 2019

OBJECTIVE:

To investigate the prevalence of medical adhesive-related skin injuries (MARSIs) and associated risk factors in a pediatric ICU (PICU).

METHODS:

A cross-sectional design was adopted in the PICU of a university-based children’s hospital in eastern China. A total of 232 patients were enrolled, and 611 person-days were analyzed.

MAIN OUTCOME MEASURES:

Researchers assessed all patients daily for 2 weeks. The use of adhesives and prevalence of MARSIs were recorded. The patients’ clinical data were also collected. The prevalence of MARSIs was calculated daily, and the risk factors were examined statistically.

MAIN RESULTS:

The MARSI prevalence ranged from 23.53% to 54.17% (mean, 37.15%). Multivariate analysis identified being female, age 2 years or younger, hospital stays longer than 5 days, infection, edema, and surgery as independent risk factors. Prevalence by product ranged from 19 to 53 per 1,000 product-days with a mean of 34 MARSIs per 1,000 product-days. The major MARSI types were epidermal stripping and skin tear. The face was the most common MARSI site, and tracheal intubation was the most common inciting condition. Implicated products were acrylate tapes with elastic cloth backings.

CONCLUSIONS:

Researchers concluded that MARSI is common in the PICU. Skin stripping and skin tear were the most common types, and the face was the most vulnerable site for MARSI, typically attributable to the cloth tape used to affix tracheal intubation. Careful attention should be paid to children with identified risk factors (females, age 2 years or younger, longer hospital stays, edema, infection, or surgery).
Preeclampsia and future stroke risk in women
Authors: Davis Melissa , Sanders Bethany
Published: March 2019

Preeclampsia is a complication of pregnancy that affects approximately 4% of pregnancies. Preeclampsia is defined as new-onset hypertension after 20 weeks gestation often accompanied by new-onset proteinuria. Women who experience preeclampsia during pregnancy are at an increased risk for hypertension and stroke later in life. Healthcare providers should screen women appropriately to minimize risk.
Nebulized Amikacin and Fosfomycin for Severe Pseudomonas aeruginosa Pneumonia: An Experimental Study*
Authors: Li Bassi Gianluigi , Motos Ana , Fernandez-Barat Laia , Aguilera Xiol Eli , Chiurazzi Chiara , Senussi Tarek , Saco Maria A. , Fuster Carla , Carbonara Marco , Bobi Joaquim , Amaro Rosanel , De Rosa Francesca , Comaru Talitha , Yang Hua , Ranzani Otavio T. , Marti Joan-Daniel , Rinaudo Mariano , Comino Trinidad Oscar , Rigol Montserrat , Bringué Josep , Ramirez Jose , Nicolau David P. , Pelosi Paolo , Antonelli Massimo , Blasi Francesco , Artigas Antonio , Montgomery A. Bruce , Torres Antoni
Published: March 2019

Objectives:

Latest trials failed to confirm merits of nebulized amikacin for critically ill patients with nosocomial pneumonia. We studied various nebulized and IV antibiotic regimens in a porcine model of severe Pseudomonas aeruginosa pneumonia, resistant to amikacin, fosfomycin, and susceptible to meropenem.

Design:

Prospective randomized animal study.

Setting:

Animal Research, University of Barcelona, Spain.

Subjects:

Thirty female pigs.

Interventions:

The animals were randomized to receive nebulized saline solution (CONTROL); nebulized amikacin every 6 hours; nebulized fosfomycin every 6 hours; IV meropenem alone every 8 hours; nebulized amikacin and fosfomycin every 6 hours; amikacin and fosfomycin every 6 hours, with IV meropenem every 8 hours. Nebulization was performed through a vibrating mesh nebulizer. The primary outcome was lung tissue bacterial concentration. Secondary outcomes were tracheal secretions P. aeruginosa concentration, clinical variables, lung histology, and development of meropenem resistance.

Measurements and Main Results:

We included five animals into each group. Lung P. aeruginosa burden varied among groups (p < 0.001). In particular, IV meropenem and amikacin and fosfomycin + IV meropenem groups presented lower P. aeruginosa concentrations versus amikacin and fosfomycin, amikacin, CONTROL, and fosfomycin groups (p < 0.05), without significant difference between these two groups undergoing IV meropenem treatment. The sole use of nebulized antibiotics resulted in dense P. aeruginosa accumulation at the edges of the interlobular septa. Amikacin, amikacin and fosfomycin, and amikacin and fosfomycin + IV meropenem effectively reduced P. aeruginosa in tracheal secretions (p < 0.001). Pathognomonic clinical variables of respiratory infection did not differ among groups. Resistance to meropenem increased in IV meropenem group versus amikacin and fosfomycin + meropenem (p = 0.004).

Conclusions:

Our findings corroborate that amikacin and fosfomycin alone efficiently reduced P. aeruginosa in tracheal secretions, with negligible effects in pulmonary tissue. Combination of amikacin and fosfomycin with IV meropenem does not increase antipseudomonal pulmonary tissue activity, but it does reduce development of meropenem-resistant P. aeruginosa, in comparison with the sole use of IV meropenem. Our findings imply potential merits for preemptive use of nebulized antibiotics in order to reduce resistance to IV meropenem.
High-Flow Oxygen Therapy After Noninvasive Ventilation Interruption in Patients Recovering From Hypercapnic Acute Respiratory Failure: A Physiological Crossover Trial
Authors: Longhini Federico , Pisani Lara , Lungu Ramona , Comellini Vittoria , Bruni Andrea , Garofalo Eugenio , Laura Vega Maria , Cammarota Gianmaria , Nava Stefano , Navalesi Paolo
Published: March 2019

Objectives:

Assessing gas exchange, diaphragm function, respiratory rate, and patient comfort during high-flow oxygen therapy and standard oxygen at the time of noninvasive ventilation discontinuation.

Design:

Randomized crossover physiologic study.

Setting:

Two ICUs.

Patients:

Thirty chronic obstructive pulmonary disease patients with hypercapnic acute respiratory failure receiving noninvasive ventilation greater than 24 hours.

Interventions:

All patients underwent five 30-minute trials, the first, third, and fifth trial in noninvasive ventilation, whereas the second and fourth were randomly conducted with either standard oxygen and high-flow oxygen therapy.

Measurements and Main Results:

Diaphragm displacement and thickening fraction were determined by sonographic evaluation at the end of each trial. Arterial blood gases, respiratory rate, and patient comfort were also assessed. Paco
2 (p = 0.153) and pH (p = 0.114) were not different among trials, while Pao
2 was greater in noninvasive ventilation than with both standard oxygen (p ≤ 0.005) and high-flow oxygen therapy (p ≤ 0.001). The diaphragm displacement was no different among trials (p = 0.875), while its thickening fraction was greater with standard oxygen, compared with high-flow oxygen therapy and all noninvasive ventilation trials (p < 0.001 for all comparisons), without differences between high-flow oxygen therapy and noninvasive ventilation. Respiratory rate also increased with standard oxygen, compared with both high-flow oxygen therapy (p < 0.001) and noninvasive ventilation (p < 0.01). High-flow oxygen therapy improved comfort, compared with standard oxygen (p = 0.004) and noninvasive ventilation (p < 0.001).

Conclusions:

At the time of noninvasive ventilation interruption, Paco
2 and diaphragm displacement remained unchanged regardless of the modality of oxygen administration. However, although standard oxygen resulted in a remarkable increase in diaphragm thickening fraction, high-flow oxygen therapy allowed maintaining it unchanged, while improving patient comfort.
Transfusion-Associated Circulatory Overload in ICUs: A Scoping Review of Incidence, Risk Factors, and Outcomes*
Authors: De Cloedt Lise , Savy Nadia , Gauvin France , Taylor Stephen , Lacroix Jacques , Emeriaud Guillaume
Published: March 2019

Transfusion-associated circulatory overload is the most frequent serious adverse transfusion reaction, with an incidence close to 1% of transfused patients in the general adult population. Patients in ICUs are probably more at risk of transfusion-associated circulatory overload as they are more frequently transfused and associated with more comorbidities. However, the epidemiology of transfusion-associated circulatory overload in ICU is not well characterized, leading to a risk of underdiagnosis.

Objectives:

We conducted a scoping review to describe the incidence, risk factors, and outcomes of transfusion-associated circulatory overload in PICU and adult ICU.

Data Sources:

PubMed, Ovid Medline, Ovid All EBM Reviews, Ovid Embase, and EBSCO CINAHL COMPLETE.

Study Selection:

Two reviewers independently screened each article for inclusion criteria. Studies were eligible if they reported data on incidence, risk factors, or outcomes of transfusion-associated circulatory overload in at least 10 ICU patients.

Data Synthesis:

Among 5,926 studies identified, nine were included. Five studies were prospective, and four were retrospective. The definition of transfusion-associated circulatory overload varied among studies. The pooled incidence of transfusion-associated circulatory overload was of 5.5% (95% CI, 2.6–9.4%) in adult ICUs (four studies, 2,252 patients, high heterogeneity). In PICUs, two studies (345 patients) reported 0 cases, and a third study (136 patients) reported variable incidences between 1.5% and 76%, depending on diagnostic criteria. Risk factors for transfusion-associated circulatory overload included positive fluid balance, the number and type of products transfused, rate of transfusion, and cardiovascular and renal comorbidities. Transfusion-associated circulatory overload was associated with increased ICU and hospital lengths of stay, whereas the association with mortality was not consistent.

Conclusions:

Transfusion-associated circulatory overload is frequent in ICU patients and is associated with adverse outcomes. The lack of a pediatric-adjusted definition of transfusion-associated circulatory overload may lead to a risk of underdiagnosis of this condition in PICUs. Further research is warranted to improve the knowledge of transfusion-associated circulatory overload and the safety of transfusion in ICU patients.
Lack of association of metastasis-associated lung adenocarcinoma transcript 1 variants with melanoma skin cancer risk
Authors: Orlandi Elisa , Zanot Chiara , Poli Albino , Nicolis Morena , Rodolfo Monica , Turco Alberto , Sangalli Antonella , Gomez-Lira Macarena
Published: March 2019

The long noncoding RNA (lncRNA) metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) has been implicated in melanoma. Polymorphisms in MALAT1 may play a vital role in the progress of melanoma by its regulative function. However, potential genetic variants in MALAT1 affecting the risk of melanoma onset have not been explored. In this study, two single nucleotide polymorphisms (rs3200401 and rs619586) in MALAT1 were selected for genotyping of 334 melanoma patients and 291 cancer-free controls in an Italian population. The results showed that MALAT1 rs3200401 and rs619586 were not associated with melanoma risk. A further breakdown analysis by sex stratification also indicated a lack of association between these polymorphisms and melanoma. In addition, we tested 450 bp of the proximal 5´ flanking region of the gene for the presence of polymorphisms that could be associated with melanoma risk and found no variants in 96 melanoma patients. In conclusion, our results suggest that there is no contribution of MALAT1 rs3200401 and rs619586 polymorphisms or polymorphisms in the core promoter that could be associated with the risk of melanoma skin cancer in this specific study setting. Further validation will be required in larger studies involving different settings/larger populations in order to reach conclusive results.
Being and Doing
Authors: Mahoney Glenna
Published: March 2019

Doing, that is, working and achieving accomplishments, is a strong Western value. Alternatively, being is about focusing on relationships and the moment. In a weeklong service-learning experience that included manual labor, cultural immersion activities, relationship building, and daily prayer and reflection, an educator was able to help nursing students discover the importance of being, while offering service. Stories and sharing helped to achieve the goal of moving students to a deeper understanding of the Bible's call to solidarity and justice.
Organ Preservation Among Patients With Clinically Node-Positive Rectal Cancer: Is It Really More Dangerous?
Authors: Habr-Gama Angelita , São Julião Guilherme Pagin , Vailati Bruna Borba , Fernandez Laura M. , Ortega Cinthia D. , Figueiredo Nuno , Gama-Rodrigues Joaquim , Perez Rodrigo Oliva
Published: March 2019

BACKGROUND:

Select patients with complete clinical response to chemoradiation have been managed without radical surgery. The presence of radiologic evidence of nodal metastases at baseline could be a risk factor for local tumor regrowth, more advanced stage at the time of recurrence, and worse distant metastases-free survival.

OBJECTIVE:

The purpose of this study was to compare the outcomes of patients with baseline node-positive and node-negative cancer after neoadjuvant chemoradiation and complete clinical response managed nonoperatively.

DESIGN:

This was a retrospective review of consecutive patients with nonmetastatic distal rectal cancer undergoing neoadjuvant chemoradiation.

PATIENTS:

Consecutive patients with clinical and radiologic evidence of complete clinical response at 8 to 10 weeks were managed nonoperatively and enrolled in a strict follow-up program (watch and wait). Patients with incomplete clinical response or tumor regrowth after initial complete clinical response were referred to surgery.

MAIN OUTCOMES MEASURES:

Surgery-free and distant metastases-free survival were compared between patients according to nodal status at baseline.

RESULTS:

A total of 117 patients with node-positive and 218 with node-negative cancer at baseline were reviewed. Overall, 62 (53.0%; node positive) and 135 (61.9%; node negative) achieved a complete clinical response and were managed nonoperatively (p = 0.13). Patients with baseline node-positive cancer had similar rates of pathologic nodal metastases at the time of recurrence. Five-year surgery-free (39.7% vs 46.8%; p = 0.2) and distant metastases–free survival (77.5% vs 80.5%; p = 0.49) were similar between baseline node-positive and node-negative patients.

LIMITATIONS:

This was a retrospective study with a small sample size and possible inaccurate nodal staging.

CONCLUSIONS:

Patients with rectal cancer with node-positive cancer at baseline who develop a complete clinical response after neoadjuvant chemoradiation are not at increased risk for local tumor regrowth or development of more advanced disease at the time of recurrence. These patients seem to be safe candidates for organ-preserving strategies after achieving complete clinical response. See Video Abstract at http://links.lww.com/DCR/A902.
Glaucoma Patient Knowledge, Perceptions, and Predispositions for Telemedicine
Authors: Rhodes Lindsay A. , Huisingh Carrie E. , McGwin Gerald , Girkin Christopher A. , Owsley Cynthia
Published: March 2019

Purpose:

The purpose was to identify factors associated with older glaucoma patients’ knowledge of, perceptions of, and predispositions for telemedicine use.

Materials and Methods:

Established patients age 60 years and above with a diagnosis of primary open-angle glaucoma, glaucoma suspect, or ocular hypertension followed by a glaucoma fellowship-trained ophthalmologist were enrolled in the study at an academic, urban, tertiary referral eye clinic. Enrolled patients were administered a Life Space Questionnaire (LSQ), scored 0 to 9, and Preferences for Telemedicine Questionnaire (PTQ), a Likert scale validated tool. χ2 testing analyzed PTQ responses by age, race, education, employment status, LSQ score, and distance traveled from home address to clinic. A Mann-Whitney U test was used to compare PTQ responses by visual field index and visual acuity for the better and worse eye.

Results:

Of 110 patients enrolled, 71% of patients agreed or were neutral to receiving telediagnosis and 74% of patients agreed or were neutral to receiving teleintervention. Patients aged 60 to 69 years compared with those 70 and above had significantly greater knowledge about types of telemedicine: telediagnosis (53% vs. 31%, P=0.02), teleintervention (49% vs. 24%, P=0.006), teletriage (80% vs. 47%, P=0.0004), and telemonitoring (55% vs. 27%, P=0.003). Patients of European descent had significantly more knowledge about teletriage compared with those of non-European descent (72% vs. 53%, P=0.04). Patients with more education (>high school) compared with those with less education (≤high school) had more knowledge about telemedicine (39% vs. 16%, P=0.007) and all the uses of it: telediagnosis (61% vs. 45%, P<0.001), teleintervention (54% vs. 14%, P<0.001), teletriage (86% vs. 35%, P<0.001), and telemonitoring (59% vs. 18%, P=0.001). Patients with a LSQ score ≥6, meaning they traveled a greater distance from home in the previous 3 days, displayed significantly more knowledge about telediagnosis (49% vs. 25%, P=0.02), teleintervention (43% vs. 19%, P=0.01), and telemonitoring (47% vs. 25%, P=0.03) than those with an LSQ<6. Responses to the PTQ were not significantly different by distance traveled.

Conclusions:

Knowledge of telemedicine was variable but between one third and one half of patients had favorable attitudes toward using telemedicine for glaucoma care.
Classification System for Heart Sounds Based on Random Forests
Authors: Esmail Mohammed Yagoub , Ahmed Doaa Hayder , Eltayeb Megdi
Published: March 2019

In the last century, cardiovascular illnesses are the first death cause in developed countries. For this reason, many efforts have been made in order to develop sophisticated techniques for the early diagnoses of cardiac disorders. The Phonocardiogram (PCG) signals contain very useful information about the condition of the heart. By analyzing these signals, early detection and diagnosis of heart diseases can be done. It is also very useful in the case of infants, where ECG recording and other techniques are difficult to implement. In this study, a classification method is proposed to classify normal and abnormal heart sound signals using random forests algorithm. The proposed framework was applied to a database of 100 heart sound signals which collected from the web site, firstly all the signals were processed using the wavelet technique to eliminate the noise from the signal, features were extracted from the enhanced signals and the most significant features was selected using the RFs. Finally the random forests classifier was used to perform the classification process. The system achieved 93.24% accuracy in distinguishing between normal and abnormal heart sound signals.
“Everyone Needs a Breath of Fresh Air”
Authors: Petersen Anne Berit , Sarna Linda , Rezk-Hanna Mary , Wells Marjorie , Nohavova Iveta , Bialous Stella
Published: March 2019

Background

Europe continues to have among the highest worldwide prevalence of adult smoking (28%) and the highest among females (19%). Nurses’ rates of smoking in the region are comparable or higher than the general female population. Nurses who smoke are less likely to intervene with patients who smoke; therefore, supporting nurses’ efforts to quit is critical to promoting nurses’ well-being and strengthening the profession’s impact on prevention of tobacco-induced diseases.

Objective

The aim of this study was to explore nurses’ perceptions of hospital workplace factors that influence nurses’ smoking and quitting behaviors in Central and Eastern Europe.

Methods

Each country had a project director involved in the recruitment of participants and the translation of instruments. Using a moderator guide, focus groups (N = 9) about smoking and quitting were conducted in 5 countries (Czech Republic, Hungary, Romania, Slovakia, Slovenia) among 82 nurses who self-reported as current or former smokers. Recorded transcripts were translated and analyzed using content analysis methods.

Results

The majority of nurses were female (94%) and currently smoking (65%). Four major themes were identified that describe workplace factors influencing nurses’ smoking behaviors and efforts to quit: (1) taking breaks, (2) effect of smoking on patient interactions, (3) perceived collegial support for quitting, and (4) impact of workplace policies.

Conclusions

Workplace factors influence nurses smoking and quitting behaviors.

Implications for Practice

Changes in healthcare systems and policies are needed to support nurses’ quit efforts. Additional education is needed to ensure that nurses understand issues related to smoking and interactions with patients.
Fractionated Irradiation in Photobiomodulation Therapy of Ankle Sprain
Authors: Calin Mihaela Antonina , Badila Adrian , Hristea Adriana , Manea Dragos , Savastru Roxana , Nica Adriana Sarah
Published: March 2019

Objective

The aim of this study was to test whether fractionated irradiation in photobiomodulation therapy enhances short-term recovery in patients with moderate severity ankle sprain.

Design

Nineteen patients were randomly assigned to one of two groups: one group receiving photobiomodulation therapy combined with the standard rest, icing, compression, and elevation treatment, or a group receiving only standard treatment. Group 1 patients were irradiated using a laser system (635 nm, 15 mW) according to a double-fractionated irradiation scheme consisting of two sessions (4.5 and 9 J/cm2) separated by a 30-min time interval. Short-term outcomes (reflectance, pain, and clinical outcomes) were assessed at baseline, 10 days, and 6 wks after treatment.

Results

Reflectance data analysis showed significant changes in group 1 (P = 0.027). There was also an ankle function score improvement more in group 1 than in group 2, with a significant short-term effect (P = 0.011) but without significant long-term effects (P = 0.178). Compared with group 2, group 1 had an immediate effect on pain reduction, but no long-term effect (P = 0.074).

Conclusions

Combined with standard treatment, fractionated irradiation photobiomodulation therapy has been shown to have favorable short-term effects on the recovery of patients with ankle sprains, but its long-term effects should be improved.
Clinicopathologic Characteristics and Predictors Affecting Survival Outcome of Eyelid Malignancy
Authors: Aryasit Orapan , Preechawai Passorn , Hajeewaming Nimastika
Published: March 2019

The aim of this study was to determine the clinicopathologic characteristics and evaluate the prognostic factors in eyelid malignancies. This was a retrospective, comparative, case series of 70 patients with eyelid malignancies. The mean age at diagnosis was 72.0 years (range 30.5–93.0 years) with 64.3% female. The 2 most common histologic types were basal cell carcinoma (BCC) followed by sebaceous gland carcinoma (SGC). In total, 47.1% of the malignancies were located in the lower eyelid and the majority of tumor (T) category was T1. The authors assessed the disease-specific survival rates of 64 surgical patients using Kaplan Meier curves. Univariate and multivariate analyses identified the predictors associated with disease-specific survival. Of the 64 surgical patients, 4 had regional nodal metastasis (2 SGC, 1 squamous cell carcinoma [SCC], and 1 adenocarcinoma) and distant metastasis at diagnosis was in 3 patients (2 SGC and 1 malignant melanoma [MM]). Six patients died of disease during follow-up. The 5-year disease-specific survival in BCC, SCC, and SGC were 100%, 100%, and 64.8%, respectively. The predictive factors affecting worse disease-specific survival on multivariate models were T4 category (adjusted hazard ratio [aHR] 14.15, P = 0.022) and tumor recurrence (aHR 6.84, P = 0.045). In conclusion, BCC was the most common eyelid malignancy in southern Thailand followed by SGC. In this study, T4 category and tumor recurrence were the most important prognostic factors in eyelid malignancies.
Definitive Radiation Therapy Versus Postoperative Radiation Therapy for Patients With Maxillary Sinus Cancer Invading the Upper Jaw
Authors: Wang Fang , Ren Ming , Wu Jianjun , Zhang Caifeng
Published: March 2019

Maxillectomy following radiation therapy has the strongest local control over maxillary sinus cancer. However, in the advanced stage, complete resection is difficult with adequate margin and has the risk of functional disabilities after surgeries. The objective of the study was to determine the optimal treatment strategy for patients with maxillary sinus cancer invades the upper jaw. A total of 998 histologically confirmed maxillary sinus cancer invades the upper jaw patients were subjected to simple randomization. Patients were subjected to maxillectomy and received 150 mg/m2/wk intra-arterial cisplatin for 4 weeks followed by radiotherapy (PR group, n = 499) or received the same chemotherapy and definitive radiotherapy only (DR group, n = 499). Disease status, overall survival, progression-free survival, and treatment-emergent adverse effects were evaluated in the follow-up period of 5 years. At the end of 5 years of follow-up, both the treatments had the same overall survival (P = 0.066). Demographic characters were independent parameters for the overall survival (P ≥ 0.05 for all). Postoperative radiotherapy had a higher progression-free survival than definitive radiotherapy (P = 0.018). Maxillectomy was useful in the reduction of the evidence of local recurrence of cancer (P = 0.027). Dysphagia, palate fistula, incomprehensible voice, and trismus were reported as treatment-emergent effects in the PR group. Definitive radiation therapy is recommended in maxillary sinus cancer that invades the upper jaw (Level of Evidence: I; research registry 4571 dated November 14, 2012).
American Association for the Surgery of Trauma emergency general surgery guidelines gap analysis
Authors: Schuster Kevin , Davis Kimberly , Hernandez Matthew , Holena Daniel , Salim Ali , Crandall Marie
Published: March 2019

BACKGROUND

Emergency general surgery (EGS) has been rapidly adopted as one of the major components of acute care surgery. Although heterogenous, the most common disease states that comprise EGS often have published guidelines containing recommendations for their diagnosis and management. Not all diseases included within EGS however have published guidelines and existing guidelines may have important gaps in their recommendations. We present a thorough assessment of the existing guidelines for the most common EGS diseases and highlight gaps that will require additional literature review or new research to fill.

METHODS

Literature searches for existing comprehensive guidelines were performed. These guidelines were summarized based on level of supporting evidence and further subcategorized based on American Association for the Surgery of Trauma (AAST) grade of disease. Using these summaries, gaps in the exiting recommendations were then generated and refined through review by at least two authors.

RESULTS

The initial gap analysis focused on diverticulitis, acute pancreatitis, small bowel obstruction and acute cholecystitis. Despite extensive research into each of these disease processes, critical questions regarding diagnosis and management remain to be answered. Gaps were the result of either low quality research or a complete lack of research. The use of the AAST grade of disease established a framework for evaluating these guidelines and grouping the recommendations.

CONCLUSIONS

Despite extensive prior research, EGS diseases have multiple areas where additional research would likely result in improved patient care. Consensus on the most important areas for additional research can be obtained through analysis of gaps in existing guidelines. This gap analysis has the potential to inform efforts around developing a research agenda for EGS.
Timing of tracheostomy placement among children with severe traumatic brain injury: A propensity-matched analysis
Authors: McLaughlin Cory , Darcy David , Park Caron , Lane Christianne J. , Mack Wendy J. , Bliss David W. , Bhalla Anoopindar , Upperman Jeffrey S. , Nathens Avery B. , Burd Randall S. , Jensen Aaron R.
Published: March 2019

BACKGROUND

Early tracheostomy has been associated with shorter hospital stay and fewer complications in adult trauma patients. Guidelines for tracheostomy have not been established for children with severe traumatic brain injury (TBI). The purpose of this study was to (1) define nationwide trends in time to extubation and time to tracheostomy and (2) determine if early tracheostomy is associated with decreased length of stay and fewer complications in children with severe TBI.

METHODS

Records of children (<15 years) with severe TBI (head Abbreviated Injury Severity [AIS] score ≥3) who were mechanically ventilated (>48 hours) were obtained from the National Trauma Data Bank (2007–2015). Outcomes after early (≤14 days) and late (≥15 days) tracheostomy placement were compared using 1:1 propensity score matching to control for potential confounding by indication. Propensity scores were calculated based on age, race, pulse, blood pressure, Glasgow Coma Scale motor score, injury mechanism, associated injury Abbreviated Injury Severity scores, TBI subtype, craniotomy, and intracranial pressure monitor placement.

RESULTS

Among 6,101 children with severe TBI, 5,740 (94%) were extubated or died without tracheostomy, 95% of the time within 18 days. Tracheostomy was performed in 361 children (6%) at a median [interquartile range] of 15 [10, 22] days. Using propensity score matching, we compared 121 matched pairs with early or late tracheostomy. Early tracheostomy was associated with fewer ventilator days (14 [9, 19] vs. 25 [19, 35]), intensive care unit days (19 [14, 25] vs. 31 [24, 43]), and hospital days (26 [19, 41] vs. 39 [31, 54], all p < 0.05). Pneumonia (24% vs. 41%), venous thromboembolism (3% vs. 13%), and decubitus ulcer (4% vs. 13%) occurred less frequently with early tracheostomy (p < 0.05).

CONCLUSIONS

Early tracheostomy is associated with shorter hospital stay and fewer complications among children with severe TBI. Extubation without tracheostomy is rare beyond 18 days after injury.

LEVEL OF EVIDENCE

Prognostic and epidemiological, retrospective comparative study, level III.