bluuebunny/crossref_metadata_2025 huggingface dataset:
Trajectories of Homebound Status in Medicare Beneficiaries Aged 65 and Older
Authors: Xiang Xiaoling , Chen Jieling , Kim MinHee
Published: February 2019

Background and Objectives

The purpose of this study was to examine the trajectories of homebound status in older adults and to investigate the risk factors in shaping the pattern of these trajectories.

Research Design and Methods

The study sample was a nationally representative sample of Medicare beneficiaries aged 65 and older (N = 7,607) from the National Health and Aging Trends Study (Round 1–Round 7). Homebound state was defined as never or rarely went out the home in the last month. Homebound trajectories were identified using an enhanced group-based trajectory modeling that accounted for nonrandom attrition. Multinomial logistic regression was used to examine risk factors of homebound trajectories.

Results

Three trajectory groups were identified: the “never” group (65.5%) remained nonhomebound; the “chronic” group were largely persistently homebound (8.3%); and the “onset” group (26.2%) had a rapid increase in their risk of being homebound over the 7-year period. The following factors increased the relative risk for being on the “onset” and “chronic” versus the “never” trajectory: older age, Hispanic ethnicity, social isolation, past or current smoking, instrumental activities of daily living limitations, probable dementia, and use of a walker or wheelchair. Male sex and living alone were associated with a lower risk of being on the “chronic” trajectory, whereas depression and anxiety symptoms, chronic conditions, and activities of daily living limitations increased the risk.

Discussion and Implications

The progression of homebound status among community-dwelling older adults followed three distinct trajectories over a 7-year period. Addressing social isolation and other risk factors may prevent or delay the progression to homebound state.
Early outcomes and computational fluid dynamic analyses of chimney reconstruction in the Norwood procedure
Authors: Asada Satoshi , Yamagishi Masaaki , Itatani Keiichi , Maeda Yoshinobu , Taniguchi Satoshi , Fujita Shuhei , Hongu Hisayuki , Yaku Hitoshi
Published: February 2019

OBJECTIVES

The ideal configuration of a reconstructed aortic arch in the Norwood procedure for hypoplastic left heart syndrome is still a matter of debate. Chimney reconstruction was developed to avoid postoperative complications and turbulent flow in the aortic arch. This study sought to clarify early outcomes of the procedure and verify its haemodynamic advantages using computational fluid dynamics (CFD).

METHODS

Fourteen consecutive patients with hypoplastic left heart syndrome or a variant who underwent chimney reconstruction in the Norwood procedure between January 2013 and March 2018 were enrolled. Median age and body weight at the time of operation were 2.5 months and 4.1 kg, respectively. Thirteen patients (93.9%) had been palliated with previous bilateral pulmonary artery (PA) banding. In addition, patient-specific CFD models of neoarches based on postoperative computed tomograms from 6 patients were created and the flow profiles analysed.

RESULTS

Survival rates at 1, 3 and 5 years were 76.6%, 67.3% and 67.3%, respectively. No patient developed left PA compression by neoaorta, neoaortic dilation or neoaortic insufficiency. Only 2 patients (14.3%) required surgical intervention for recoarctation. Fontan completion was performed on 5 patients. On CFD analysis, all reconstructed aortic arches showed low energy loss (9.16–14.4 mW/m2) and low wall shear stresses.

CONCLUSIONS

Chimney reconstruction was a feasible technique when homografts were not readily available. CFD analyses underscored the fact that this technique produced excellent flow profiles. Larger studies should be conducted to clarify long-term outcomes.
Preoperative pulmonary function in all comers for cardiac surgery predicts mortality
Authors: Risom Emilie C , Buggeskov Katrine B , Mogensen Ulla B , Sundskard Martin , Mortensen Jann , Ravn Hanne B
Published: February 2019

OBJECTIVES

Although reduced lung function and chronic obstructive pulmonary disease (COPD) is associated with higher risk of death following cardiac surgery, preoperative spirometry is not performed routinely. The aim of this study was to investigate the relationship between preoperative lung function and postoperative complications in all comers for cardiac surgery irrespective of smoking or COPD history.

METHODS

Preoperative spirometry was performed in elective adult cardiac surgery patients. Airflow obstruction was defined as the ratio of forced expiratory volume in 1 s (FEV1)/forced vital capacity ratio below the lower limit of normal (LLN) and reduced forced ventilatory capacity defined as FEV1 <LLN.

RESULTS

A history of COPD was reported by 132 (19%) patients; however, only 74 (56%) had spirometry-verified airflow obstruction. Conversely, 64 (12%) of the 551 patients not reporting a history of COPD had spirometry-verified airflow obstruction. The probability of death was significantly higher in patients with airflow obstruction (8.8% vs 4.5%, P = 0.04) and in patients with a FEV1 <LLN (8.7% vs 3.7%, P = 0.007). In the multivariate analysis were age [hazard ratio (HR) 1.6, 95% confidence interval (CI) 1.0–2.5; P = 0.04], prolonged cardiopulmonary bypass time (HR 1.2, 95% CI 1.02–1.3; P = 0.03), reduced kidney function (HR 2.5, 95% CI 1.2–5.6; P = 0.02) and FEV1 <LLN (HR 2.4, 95% CI 1.1–5.2; P = 0.03) all independently associated with an increased risk of death.

CONCLUSIONS

Preoperative spirometry reclassified 18% of the patients. A reduced FEV1 independently doubled the risk of death. Inclusion of preoperative spirometry in routine screening of cardiac surgical patients may improve risk prediction and identify high-risk patients.

Clinical trial registration number

NCT01614951 (ClinicalTrials.gov).
On the Boundedness of Anti-Canonical Volumes of Singular Fano3-Folds in Characteristicp> 5
Authors: Das Omprokash
Published: February 2019

In this article, we prove the following version of the weak Borisov-Alexeev-Borisov (Weak-BAB) conjecture for $3$-folds in $\operatorname{char} p>5$: fix a set $I\subseteq [0, 1)$ which satisfies the descending chain condition (DCC) and an algebraically closed field $k$ of characteristic $p>5$. Let ${\mathfrak{D}}$ be a collection of klt pairs $(X, \Delta )$ satisfying the following properties: (1) $X$ is a projective $3$-fold, (2) $\Delta $ is an ${\mathbb{R}}$-divisor with coefficients in $I$, (3) $K_X+\Delta \equiv 0$, and (4) $-K_X$ is ample. Then the set $\{\operatorname{vol}_X(-K_X) \ | \ (X, \Delta )\in{\mathfrak{D}}\mbox{ for some }\Delta \}$ is bounded from above.
The Effect of the Free Primary Education Policy on School Enrolment and Relative Grade Attainment in Lesotho†
Authors: Moshoeshoe Ramaele , Ardington Cally , Piraino Patrizio
Published: February 2019

We examine the impact of Lesotho’s Free Primary Education (FPE) programme on enrolment and relative grade attainment. The programme was sequentially implemented by first abolishing school fees in grade one in the year 2000. The timing of the implementation created changes in programme coverage across age groups over time. We employ a difference-in-differences strategy that exploits these variations to identify the effects of the FPE policy. Using data from the 2000 Multiple Indicator Cluster Survey and the 2002 Core Welfare Indicators Questionnaire survey, we find that the FPE policy increased enrolment of primary school-age children by 19.1 percentage points between 1999 and 2002. We also find that the policy had a negative effect on relative grade attainment: post-FPE, children had 0.15 fewer grades per year of age compared to pre-FPE. We do not find evidence of sibling effects.
Female Reproductive System Morphology and the Development of a Physiological Age-Grading System for Bagrada hilaris (Hemiptera: Pentatomidae)
Authors: Grodowitz Michael J , Reed Darcy A , Elliott Brad , Perring Thomas M
Published: February 2019

In this paper, we describe the morphology of the female Bagrada hilaris (Burmeister) reproductive system and develop a physiological age-grading system related to egg production. The female reproductive system is composed of two meroistic and telotrophic ovaries each containing 5–6 tubular ovarioles. The ovarioles unite into the lateral oviduct which combine to form the common oviduct. The ovarioles are composed of two regions; the distal germarium and the tubular vitellarium which contains maturing follicles. Each follicle is surrounded by a layer of cells; the follicular epithelium. As the follicle passes from the ovariole to the lateral oviducts the follicular epithelial cells slough off and accumulate in the base of the ovarioles and are known as follicular relics. The continuum of ovarian development is divided into two categories: nulliparous (‘nonreproducing’) and parous (‘reproducing’). The nulliparous category is characterized by the absence of follicular relics or eggs in the oviducts as opposed to the parous category where follicular relics and, in many cases, eggs occurred in the oviducts. The nulliparous category is divided further into two stages; N1 and N2 based on ovariole differentiation. The parous category is divided into three stages; P1, P2, and P3, based on the quantity and appearance of follicular relics. Females characterized as P3 produced three times more eggs (79.2 eggs ± 5.7) than females characterized as P1 (27.1 eggs ± 6.0).
Genomic, Transcriptomic, Epigenetic, and Immune Profiling of Mucinous Breast Cancer
Authors: Nguyen Bastien , Veys Isabelle , Leduc Sophia , Bareche Yacine , Majjaj Samira , Brown David N , Boeckx Bram , Lambrechts Diether , Sotiriou Christos , Larsimont Denis , Desmedt Christine
Published: February 2019

Although invasive ductal breast cancer (IDC) represents the most common histological type of breast cancer, minor subtypes exist such as mucinous breast cancer (MuBC). MuBC are distinguished by tumor cells floating in extracellular mucin. MuBC patients are generally older and associated with a favorable prognosis. To unravel the molecular architecture of MuBC, we applied low-pass whole-genome sequencing and microscopic evaluation of stromal tumor infiltrating lymphocytes to 30 MuBC from a retrospective institutional cohort. We further analyzed two independent datasets from the International Cancer Genomics Consortium and The Cancer Genome Atlas. Genomic data (n = 26 MuBC, n = 535 estrogen receptor [ER] positive/HER2-negative IDC), methylation data (n = 28 MuBC, n = 529 ER-positive/HER2-negative IDC), and transcriptomic data (n = 27 MuBC, n = 467 ER-positive/HER2-negative IDC) were analyzed. MuBC was characterized by low tumor infiltrating lymphocyte levels (median = 0.0%, average = 3.4%, 95% confidence interval = 1.9% to 4.9%). Compared with IDC, MuBC had a lower genomic instability (P = .01, two-sided Mann-Whitney U test) and a decreased prevalence of PIK3CA mutations (39.7% in IDC vs 6.7% in MuBC, P = .01 in the International Cancer Genomics Consortium; and 34.8% vs 0.0%, P = .02 in The Cancer Genome Atlas, two-sided Fisher’s exact test). Finally, our report identifies aberrant DNA methylation of MUC2 as a possible cause of extracellular production of mucin in MuBC.
Modular Survey Design: Experimental Manipulation of Survey Length and Monetary Incentive Structure
Authors: Peytchev Andy , Peytcheva Emilia , Conzelmann Johnathan G , Wilson Ashley , Wine Jennifer
Published: February 2019

Survey length and monetary incentives are design features that have been found to affect survey participation in opposing ways. Declining response rates make these key design features even more important. However, survey length has received surprisingly little attention, possibly being viewed as a static survey attribute rather than an alterable design feature. In addition, experimental tests of the interaction between survey length and monetary incentives could not be found, despite calls for the need for such research and theories that support such an interaction.

Leverage-salience theory leads to opposing expectations, depending on the relative importance people give to different factors affecting survey participation. Making the survey request in parts, to reduce burden, may increase participation. Yet, it may instead decrease participation relative to the status quo of offering the full incentive for the entire survey if incentives play a larger role than survey length. When factoring both burden and motivation, the results for survey length could likely depend on the structure of monetary incentives. We designed an experiment to test a modularized survey, ending one part of the survey with a request to complete another part. Respondents in the modular survey design were also assigned to proportionate or disproportionate incentives—offering a larger proportion of the incentive for the initial survey request. Surprisingly, the two-part survey request led to not lower but greater nonresponse. There was increased potential for nonresponse bias attributable to nonresponse to the second request, without reduction in item nonresponse and measurement error. Disproportionate allocation of incentives across modules seemed to increase overall participation compared with proportionate allocation. The lack of a beneficial effect of a request for a shorter survey and the results on incentive allocation have important implications for survey practitioners. Furthermore, the inconsistency in findings on survey length requires further research to identify mediating factors.
A Profile of Point of Care Coordinators: Roles, Responsibilities and Attitudes
Authors: Gledhill Tyler R , White Sandra K , Lewis Jamie E , Schmidt Robert L
Published: February 2019

Background

Point of care (POC) testing is rapidly evolving. POC testing is often managed by POC coordinators (POCC), but this role is relatively new and has not been characterized.

Objectives

To characterize the background, responsibilities, and job satisfaction of POCCs.

Methods

Structured interviews were conducted with 15 POCCs. On the basis of these interviews, a 38-item questionnaire was developed and administered as a web-based survey.

Results

The respondents (N = 98) were mostly female (87%) and had a bachelor’s degree (79%). About half the respondents were older than 55 years and were in supervisory positions. Overall, respondents indicated high job satisfaction, but women were significantly less satisfied than men. POCCs were infrequently involved in decisions regarding the implementation of new tests. The number of tests managed by each POCC varied widely (median, 6.0; range, 1–30).

Conclusions

The POCC role is in flux. There is consensus regarding some aspects of the job, but there are significant differences in the way that hospitals organize the POCC function.
Urgent Delivery - Validation and Operational Implementation of Urgent Blood Delivery by Modern High Speed Hospital Pneumatic Tube System to Support Bleeding Emergencies Within a Hospital Massive Transfusion Protocol
Authors: Chay Jason Wai Mun , Kim Ji Hyun , B M Taha Nur Shahirah , Chiew Siew Hong , Chin Kwong Weng , Lim Shu Hong , Ho Liam Pock
Published: February 2019

Background

Timely blood delivery to patients with critical bleeding poses logistic challenges. A modern, high speed hospital pneumatic tube system (PTS) is one solution, but blood units may be subjected to high-speed torque and acceleration/deceleration forces.

Objective

To validate a new PTS system for potential use at our 1,400-bed hospital in Singapore.

Method

Our validation included red blood cells, platelets, thawed plasma, and cryoprecipitate units transported from the blood bank for a distance of 820 meters (PTS track), at a velocity of 3–6 meters per second. Transit time, temperature, bag integrity, and blood quality were assessed visually and through analytical testing on pre- and post-PTS specimens.

Results

Blood units arrived physically intact in less than 8 minutes. The temperature for each was within the acceptable range. Comparative testing of pre-PTS and post-PTS specimens showed no significant difference in physical quality and analyzed parameters (P> .05).

Conclusions

High speed PTS transportation of blood components has satisfactory fidelity and speed, without significant impact on quality. As a result, we incorporated PTS blood delivery into the hospital massive-transfusion protocol and successfully operationalized that new system.
Analysis of mystical concepts in Khaghani’s Divan
Authors: Yin Ming-Ming , Mahmoudi Mohammad Reza , Abbasalizadeh Ali
Published: February 2019

Text analysis provides an exciting approach for extracting knowledge from text data. Recently, text analysis has been applied in many research fields. In this study, it was demonstrated that how text analysis can be applied to literary researches. All the lines of Khaghani’s Divan have been considered using different text analysis methods. Then the accuracy of the applied methods is compared.
Comparing immunochromatography with latex antigen agglutination testing for the diagnosis of cryptococcosis in cats, dogs and koalas
Authors: Krockenberger Mark B , Marschner Caroline , Martin Patricia , Reppas George , Halliday Catriona , Schmertmann Laura J , Harvey Andrea M , Malik Richard
Published: February 2019

Although the point-of-care cryptococcal antigen lateral flow assay (LFA) has revolutionized the diagnosis of cryptococcosis in human patients, to date there has been no large-scale examination of this test in animals. We therefore assessed the LFA in cats, dogs and koalas suspected of having cryptococcosis. In sum, 528 serum specimens (129 from cats, 108 from dogs, 291 from koalas) were tested using the LFA and one of two commercially available latex cryptococcal antigen agglutination test (LCAT) kits. The LCAT is a proven and well-accepted method in veterinary patients and therefore taken as the “gold standard” against which the LFA was compared. The LFA achieved a sensitivity of 92%, 100%, and 98% in cats, dogs, and koalas, respectively, with corresponding negative predictive values of 94%, 100%, and 98%. The specificity of the LFA was 81%, 84%, and 62% for cats, dogs, and koalas, respectively, with corresponding positive predictive values of 76%, 48%, and 69%. These findings suggest the most appropriate role for the LFA is as a screening test to rule out a diagnosis of cryptococcosis in cats, dogs, and koalas. Point-of-care accessibility makes it equally suited for use in the field and as a cage-side test in veterinary hospitals. The suboptimal specificity of the LFA makes it less suited to definitive confirmation of cryptococcosis in animals; therefore, all LFA-positive test results should be confirmed by LCAT testing. The discrepancy between these observations and the high specificity of the LFA in humans may reflect differences in the host-pathogen interactions amongst the species.
Clinical and microbiological characteristics of paracoccidioidomycosis in patients with AIDS in Buenos Aires, Argentina
Authors: Messina F , Romero M , Benchetrit A , Marin E , Arechavala A , Depardo R , Negroni R , Santiso G
Published: February 2019

Paracoccidioidomycosis (Pm) is a systemic disease, endemic in the American continent. There are two different clinical forms, the infant-juvenile or subacute form (PmS) and the chronic adult form (PmC). The human immunodeficiency virus (HIV) associated paracoccidioidomycosis (PmHIV) shares characteristics with both of the previously mentioned forms. The objective of this work was to describe the epidemiological, clinical and laboratory features of the PmHIV and to compare them with the ones of PmS and the PmC. A retrospective analysis of 119 patients with paracoccidioidomycosis was performed. Ninety four suffered the chronic form, 11 the subacute one and 14 were coinfected with HIV. Patients with PmHIV presented a CD4+ T lymphocytes median of 70.5 cells/μl, 71.4% had fever, 64.3% had a miliary pattern on the chest radiography, 64.3% had hepatosplenomegaly, 64.3% had mucosal lesions and 50% had skin lesions. One patient died during his hospitalization. The clinical presentation of Pm in patients with HIV resembled the subacute form with fever, hepatomegaly and skin lesions. However, they also tended to present mucosal lesions, positive serology for Pm and pulmonary parenchyma lesions as usually seen in PmC (9/14 PmHIV patients had overlapping features, while 4/14 PmHIV patients clinically resembled PmS and 1/14 PmC). The incidence of Pm has not changed with the burden of AIDS as it has happened with other fungal infections but it appears clinically different from the classic clinical forms of the disease.
Serendipitous discoveries of kilonovae in the LSST main survey: maximizing detections of sub-threshold gravitational wave events
Authors: Setzer Christian N , Biswas Rahul , Peiris Hiranya V , Rosswog Stephan , Korobkin Oleg , Wollaeger Ryan T ,   (The LSST Dark Energy Science Collaboration)
Published: February 2019

We investigate the ability of the Large Synoptic Survey Telescope (LSST) to discover kilonovae (kNe) from binary neutron star (BNS) and neutron star–black hole (NSBH) mergers, focusing on serendipitous detections in the Wide-Fast-Deep (WFD) survey. We simulate observations of kNe with proposed LSST survey strategies, focusing on cadence choices that are compatible with the broader LSST cosmology programme. If all kNe are identical to GW170817, we find the baseline survey strategy will yield 58 kNe over the survey lifetime. If we instead assume a representative population model of BNS kNe, we expect to detect only 27 kNe. However, we find the choice of survey strategy significantly impacts these numbers and can increase them to 254 and 82 kNe over the survey lifetime, respectively. This improvement arises from an increased cadence of observations between different filters with respect to the baseline. We then consider the detectability of these BNS mergers by the Advanced LIGO/Virgo (ALV) detector network. If the optimal survey strategy is adopted, 202 of the GW170817-like kNe and 56 of the BNS population model kNe are detected with LSST but are below the threshold for detection by the ALV network. This represents, for both models, an increase by a factor greater than 4.5 in the number of detected sub-threshold events over the baseline strategy. These sub-threshold events would provide an opportunity to conduct electromagnetic-triggered searches for signals in gravitational-wave data and assess selection effects in measurements of the Hubble constant from standard sirens, e.g. viewing angle effects.
Initial Emergency Room Triage of Acute Ischemic Stroke
Authors: Waqas Muhammad , Vakharia Kunal , Munich Stephan A , Morrison John F , Mokin Maxim , Levy Elad I , Siddiqui Adnan H
Published: February 2019

Early recognition and differentiation of acute ischemic stroke from intracranial hemorrhage and stroke mimics and the identification of large vessel occlusion (LVO) are critical to the appropriate management of stroke patients. In this review, we discuss the current evidence and practices surrounding safe and efficient triage in the emergency room. As the indications of stroke intervention are evolving to further improve stroke care, focus has begun to revolve around recognition of LVO and provision of endovascular thrombectomy with or without the administration of tissue plasminogen activator. Systems of stroke care are being organized to achieve this goal without delay. Clinical history is important in determining time of onset or last known well time, but, alone or along with an examination, it cannot reliably predict an LVO or exclude intracranial hemorrhage and stroke mimics. The choice of imaging is influenced mainly by the duration of symptoms. On the basis of recent trials, patients presenting after the 6-h therapeutic window can be considered for endovascular thrombectomy if the computed tomographic or magnetic resonance perfusion imaging shows favorable findings. The Society of NeuroInterventional Surgery has established time metrics for each step of triage and initial management. Hospitals are required to develop multidisciplinary stroke teams and emergency protocols to meet these goals. There also needs to be coordination of the emergency medical services with the emergency facility of an appropriate stroke center (a primary stroke center, comprehensive stroke care center, or a thrombectomy-capable stroke center).
Functional Outcomes After Revascularization Procedures in Patients With Hemorrhagic Moyamoya Disease
Authors: Abhinav Kumar , Furtado Sunil V , Nielsen Troels H , Iyer Aditya , Gooderham Peter A , Teo Mario , Lee Justin , Han Summer S , Steinberg Gary K
Published: February 2019

BACKGROUND

Poor natural history of hemorrhagic Moyamoya disease (MMD) is related to high rehemorrhage rates between 32% and 61%. Postrevascularization, rehemorrhage rates reportedly decrease to 12% to 17%.

OBJECTIVE

To evaluate long-term functional outcomes and rehemorrhage rates of hemorrhagic MMD patients treated with surgical revascularization and examine these in relation to clinical and radiological factors.

METHODS

Patients treated surgically for hemorrhagic MMD over a 26-yr period were identified. Modified Rankin scale (mRS) was used to assess clinical status at presentation and functional outcomes. Multivariable regression analyses were performed to evaluate the risk factors associated with rehemorrhage rates and functional outcomes.

RESULTS

A total of 104 patients (mean age: 38.04 yr) were identified. The mean mRS score at baseline was 1.3. Of 172 revascularized hemispheres, 157 (91.3%) were direct superficial temporal artery (STA)-middle cerebral artery (MCA) bypasses and the rest indirect. Over the mean follow-up of 61.4 mo, 8 of 104 patients (7.7%) experienced rehemorrhage with rehemorrhage rate per person-years of 1.9%. A total of 4 patients died with 1 related to rehemorrhage. At the last follow-up, mean mRS score improved to 1.1. No significant risk factors were identified in relation to the rehemorrhage rates (P < .05). The patients’ initial mRS score was positively associated with mRS scores at the final follow-up (P < .001). STA-MCA direct bypass was associated with better performance status (P = .033).

CONCLUSION

Rehemorrhage rate following surgical revascularization of the hemorrhagic MMD patients at 7.7% is lower compared with much higher natural history rates. Surgical revascularization improved patients' performance status. These outcomes support performing revascularization procedure with a preference for direct STA-MCA bypasses.
Management of Subdural Hematohygromas in Abusive Head Trauma
Authors: Nguyen Vincent N , Wallace David , Ajmera Sonia , Akinduro Oluwatomi , Smith Lydia J , Giles Kim , Vaughn Brandy , Klimo Paul
Published: February 2019

BACKGROUND

The optimal management of nonacute subdural fluid collections in infantile abusive head trauma (AHT) remains controversial.

OBJECTIVE

To review the outcomes and costs of the various treatments for symptomatic subdural fluid collections in children with AHT at a single center.

METHODS

Our AHT database was queried to identify children requiring any intervention for hematohygromas. Demographic, hospital course, radiologic, cost, readmission, and follow-up information were collected.

RESULTS

From January 2009 to March 2018, the authors identified 318 children with AHT, of whom 210 (66%) had a subdural collection of any type (blood or cerebrospinal fluid). A total of 50 required some form of intervention specifically for chronic hematohygromas. The initial management consisted of transfontanelle percutaneous aspiration (n = 31), burr holes with (n = 12) or without (n = 3) external subdural drainage, and mini-craniotomy (n = 4). Of those who were initially managed with 1 or more needle aspiration, 23 (74%) required further intervention—12 subduroperitoneal shunts and 11 nonshunt procedures. No patient who underwent burr holes/external drainage required further intervention (n = 16). Overall, the average number of interventions needed in these 50 children for definitive treatment was 1.8 (range, 1-4). A total of 15 children ultimately required a subduroperitoneal shunt. Complications (infectious, hemorrhagic, and thrombotic) were significant and occurred in all treatment groups except burr holes without drainage (n = 3). The average hospital charge for the entire cohort was $166 300.25 (range, $19 126-$739 248).

CONCLUSION

Based on our experience to date, burr hole with controlled external subdural drainage is an effective and preferred treatment for traumatic hematohygromas; complications and need for additional intervention is low.
Prevalence and severity of sleep difficulty in patients with a CNS cancer receiving palliative care in Australia
Authors: Jeon Megan S , Dhillon Haryana M , Descallar Joseph , Lam Lawrence , Allingham Samuel , Koh Eng-Siew , Currow David C , Agar Meera R
Published: February 2019

Background

The literature describing the incidence of sleep difficulty in CNS cancers is very limited, with exploration of a sleep difficulty symptom trajectory particularly sparse in people with advanced disease. We aimed to establish the prevalence and longitudinal trajectory of sleep difficulty in populations with CNS cancers receiving palliative care nationally, and to identify clinically modifiable predictors of sleep difficulty.

Methods

A consecutive cohort of 2406 patients with CNS cancers receiving palliative care from sites participating in the Australian national Palliative Care Outcomes Collaboration were evaluated longitudinally on patient-reported sleep difficulty from point-of-care data collection, comorbid symptoms, and clinician-rated problems. Multilevel models were used to analyze patient-reported sleep difficulty.

Results

Reporting of mild to severe sleep difficulties ranged from 10% to 43%. Sleep scores fluctuated greatly over the course of palliative care. While improvement in patients’ clinical status was associated with less sleep difficulty, the relationship was not clear when patients deteriorated. Worsening of sleep difficulty was associated with higher psychological distress (P < .0001), greater breathing problems (P < .05) and pain (P < .05), and higher functional status (P < .001) at the beginning of care.

Conclusions

Sleep difficulty is prevalent but fluctuates widely in patients with CNS cancers receiving palliative care. A better-tailored sleep symptom assessment may be needed for this patient population. Early interventions targeting psychological distress, breathing symptoms, and pain for more functional patients should be explored to see whether it reduces sleep difficulties late in life.
A molecular line survey toward the nearby galaxies NGC 1068, NGC 253, and IC 342 at 3 mm with the Nobeyama 45 m radio telescope: The data
Authors: Takano Shuro , Nakajima Taku , Kohno Kotaro
Published: February 2019

We present observational data of a molecular line survey toward the nearby galaxies NGC 1068, NGC 253, and IC 342 at wavelengths of 3 mm (∼85–116 GHz) obtained with the Nobeyama 45 m radio telescope. Regarding IC 342, a line survey with high spectral resolution in the 3 mm region was reported for the first time. NGC 1068 is a nearby gas-rich galaxy with X-rays from an active galactic nucleus (AGN), and NGC 253 and IC 342 are nearby gas-rich galaxies with prototypical starbursts. These galaxies are useful for studying the impacts of X-rays and ultraviolet radiation on molecular abundances. The survey was carried out with a resulting rms noise level of a few mK ($T\rm {_A^*}$). As a result we could obtain almost complete data of these galaxies in the 3 mm region: we detected 19–23 molecular species, depending on the galaxies, including several new detections (e.g., cyclic-C3H2 in IC 342). We found that the intensities of HCN, CN, and HC3N relative to 13CO are significantly strong in NGC 1068 compared with those in NGC 253 and IC 342. On the other hand, CH3CCH was not detected in NGC 1068. We obtained these results with the narrow beam (${15{^{\prime\prime}_{.}}2}$–${19{^{\prime\prime}_{.}}1}$) of the 45 m telescope, among single-dish telescopes, and in particular selectively observed molecular gas close to the circumnuclear disk (CND) in NGC 1068. The present line intensities in NGC 1068 were compared with those obtained with the IRAM 30 m radio telescope already reported. As a result, the intensity ratio of each line was found to have information on the spatial distribution. Our observations revealed the line intensities and stringent constraints on the upper limit for the three galaxies with such a narrow beam; consequently, the present data will be a basis for further observations with high spatial resolution.
A possible model for the long-term flares of Sgr A*
Authors: Okuda Toru , Singh Chandra B , Das Santabrata , Aktar Ramiz , Nandi Anuj , Dal Pino Elisabete M de Gouveia
Published: February 2019

We examine the effects of magnetic field on low angular momentum flows with standing shock around black holes in two dimensions. The magnetic field brings change in behavior and location of the shock which results in regularly or chaotically oscillating phenomena of the flow. Adopting fiducial parameters like specific angular momentum, specific energy, and magnetic field strength for the flow around Sgr A*, we find that the shock moves back and forth in the range 60–$170\, R_{\rm g}$, irregularly recurring with a time-scale of ∼ 5 d with an accompanying, more rapid, small modulation with a period of 25 hr without fading, where Rg is the Schwarzschild radius. The time-variability associated with the two different periods is attributed to the oscillating outer strong shock, together with another rapidly oscillating inner weak shock. As a consequence of the variable shock location, the luminosities vary roughly by more than a factor of 3. The time-dependent behaviors of the flow are well compatible with luminous flares with a frequency of ∼ one per day and bright flares occurring every ∼ 5–10 d in the latest observations by Chandra, Swift, and XMM-Newton monitoring of Sgr A*.
CO Multi-line Imaging of Nearby Galaxies (COMING). III. Dynamical effect on molecular gas density and star formation in the barred spiral galaxy NGC 4303
Authors: Yajima Yoshiyuki , Sorai Kazuo , Kuno Nario , Muraoka Kazuyuki , Miyamoto Yusuke , Kaneko Hiroyuki , Nakanishi Hiroyuki , Nakai Naomasa , Tanaka Takahiro , Sato Yuya , Salak Dragan , Morokuma-Matsui Kana , Matsumoto Naoko , Pan Hsi-An , Noma Yuto , Takeuchi Tsutomu T , Yoda Moe , Kuroda Mayu , Yasuda Atsushi , Oi Nagisa , Shibata Shugo , Seta Masumichi , Watanabe Yoshimasa , Kita Shoichiro , Komatsuzaki Ryusei , Kajikawa Ayumi , Yashima Yu
Published: February 2019

We present the results of $^{12}\textrm{C}$$\textrm{O}$(J = 1–0) and $^{13}\textrm{C}$$\textrm{O}$(J = 1–0) simultaneous mappings toward the nearby barred spiral galaxy NGC 4303 as part of the CO Multi-line Imaging of Nearby Galaxies (COMING) project. Barred spiral galaxies often show lower star-formation efficiency (SFE) in their bar region compared to the spiral arms. In this paper, we examine the relation between the SFEs and the volume densities of molecular gas n(H2) in the eight different regions within the galactic disk with $\textrm{C}$$\textrm{O}$ data combined with archival far-ultraviolet and 24 μm data. We confirmed that SFE in the bar region is lower by 39% than that in the spiral arms. Moreover, velocity-alignment stacking analysis was performed for the spectra in the individual regions. Integrated intensity ratios of $^{12}\textrm{C}$$\textrm{O}$ to $^{13}\textrm{C}$$\textrm{O}$ (R12/13) ranging from 10 to 17 were the results of this stacking. Fixing a kinetic temperature of molecular gas, $n(\rm {H_2})$ was derived from R12/13 via non-local thermodynamic equilibrium (non-LTE) analysis. The density n(H2) in the bar is lower by 31%–37% than that in the arms and there is a rather tight positive correlation between SFEs and n(H2), with a correlation coefficient of ∼0.8. Furthermore, we found a dependence of $n(\rm {H}_2)$ on the velocity dispersion of inter-molecular clouds (ΔV/sin i). Specifically, n(H2) increases as ΔV/sin i increases when ΔV/sin i < 100 km s−1. On the other hand, n(H2) decreases as ΔV/sin i increases when ΔV/sin i > 100 km s−1. These relations indicate that the variations of SFE could be caused by the volume densities of molecular gas, and the volume densities could be governed by the dynamical influence such as cloud–cloud collisions, shear, and enhanced inner-cloud turbulence.
An X-ray spectroscopic search for dark matter and unidentified line signatures in the Perseus cluster with Hitomi
Authors: Tamura Takayuki , Fabian Andrew C , Gandhi Poshak , Gu Liyi , Kamada Ayuki , Kitayama Tetsu , Loewenstein Michael , Maeda Yoshitomo , Matsushita Kyoko , McCammon Dan , Mitsuda Kazuhisa , Nakashima Shinya , Porter Scott , Pinto Ciro , Sato Kosuke , Tombesi Francesco , Yamasaki Noriko Y
Published: February 2019

The reported detection of a 3.5 keV emission signal in the Perseus cluster core by Bulbul et al. (2014, ApJ, 789, 13) was ruled out at high confidence in analysis conducted by Aharonian et al. (2017, ApJ, 837, L15) of X-ray spectra at 5 eV energy resolution obtained with the Hitomi observatory Soft X-ray Spectrometer (SXS). Using the same data, we search the full 2–12 keV SXS energy band for previously unidentified emission and absorption features. No significant unidentified line emission or absorption is found. Line flux upper limits (1σ per resolution element) vary with photon energy and assumed intrinsic width, decreasing from ∼100 at 2 keV to <10 photons cm−2 s−1 sr−1 over most of the 5–10 keV energy range for a Gaussian line with Doppler broadening of 640 km s−1. Limits for narrower and broader lines have a similar energy dependence and are systematically smaller and larger, respectively. These line flux limits are used to constrain the decay rate of hypothetical dark matter candidates. For the sterile neutrino decay rate, we place new constraints over the mass range of 4–24 keV with mass resolution better than any previous X-ray analysis. Additionally, the accuracy of relevant thermal spectral models and atomic data are evaluated. The Perseus cluster spectra may be described by a composite of multi-temperature thermal and active galactic nuclei (AGN) power-law continua. Superposed on these, a few line emission signals possibly originating from unmodeled atomic processes (including Si xiv and Fe xxv) are marginally detected and tabulated. Comparisons with previous X-ray upper limits and future prospects for dark matter searches using high-energy resolution spectroscopy are discussed.
The Effectiveness of Autologous Platelet-Rich Plasma for Osteoarthritis of the Hip: A Retrospective Analysis
Authors: Singh Jaspal Ricky , Haffey Paul , Valimahomed Ali , Gellhorn Alfred C
Published: February 2019

Background

Platelet-rich plasma (PRP) is a minimally invasive treatment option to reduce pain and promote tissue healing. At the time this study was performed, there was limited published literature analyzing outcomes for patients treated with PRP for hip osteoarthritis.

Methods

Thirty-six patients aged 49–85 (66.0 ± 12.1) years with chronic hip pain who met inclusion criteria underwent image-guided intra-articular hip PRP injection. Outcomes were measured at baseline, two weeks, three months, and up to six months using the visual analog scale (VAS) for pain and the Hip Disability and Osteoarthritis Outcome Score (HOOS). The proportion of responders, as defined by a ≥50% reduction in VAS pain score, was assessed at three and six months.

Results

At two weeks, there was a significant improvement (P < 0.05) of function in two HOOS subscales: Symptoms and Activities of Daily Living. There was a significant improvement in all HOOS categories at six months. A significant improvement in VAS was observed at six months (baseline VAS = 6.9 ± 0.7 &→ 4.3 ± 1.8, 95% confidence interval = 2.0 to 3.2, P < 0.05). Sixty-seven percent (24/36) of the patients reported a ≥50% improvement in pain at three months; 58% (21/36) reported a ≥50% improvement in pain at six months. Stratification by Kellgren-Lawrence grades revealed that 86% and 82% of the KL grades 1 and 2 were responders at six months, respectively.

Conclusions

In patients with mild/moderate hip osteoarthritis, PRP may provide pain relief and functional improvement for up to six months.
Partisanship, Polling, and the Affordable Care Act
Authors: Brodie Mollyann , Hamel Elizabeth C , Kirzinger Ashley , Dijulio Bianca
Published: February 2019

In an age of increasing political polarization, the Affordable Care Act (ACA) stands out as one of the most politically divisive pieces of legislation in recent history. Unlike previous laws making changes to the US health care system, public views of the ACA did not improve measurably as people gained experience with the program, but remained deeply divided on a partisan basis in the more than eight years since its passage. In this article, we examine how the complexity of the law, lack of understanding by the public, and elite partisan messaging have contributed to this enduring partisan divide, and discuss what the future may hold for the measurement of public opinion on major health care legislation.
A re-evaluation of teenage sunbed use following the introduction of banning legislation for under 18-year-olds
Authors: Menzies S , Daly S , O’Connor R , Kelly A , Fitzgerald M , Bourke J , McKenna D B
Published: February 2019

Background

There is little information on the effectiveness of introducing age restriction legislation alone to reduce the rate of sunbed usage by teenagers. Prior to the Public Health (Sunbed) Act of 2014 prohibiting the use of sunbeds in under 18-year-olds in Ireland we reported the rate of sunbed use at 7.5%.

Objectives

The aim of the study was to compare the rate of sunbed usage among Irish teenagers before and after the introduction of banning legislation to determine if it had the desired effect of reducing its rate of use.

Methods

In a cross-sectional survey, students from the same schools as in our previous study completed an anonymous, written questionnaire pertaining to sunbed usage.

Results

In total, 783 questionnaires, from 13 schools across Ireland, were completed. The rate of sunbed use in the current study was 7.2%, compared to 7.5% in the pre-ban study, (P = 0.76). A higher rate of sunbed use was observed in Dublin schools and female public students.

Conclusion

Our study suggests that legislation alone is ineffective at reducing sunbed usage in a teenage population. A multifaceted approach is required that includes enforcement of the legislation together with targeted public education and awareness campaigns using all aspects of the media.
Lymphomas complicating primary Sjögren’s syndrome: from autoimmunity to lymphoma
Authors: Nocturne Gaetane , Pontarini Elena , Bombardieri Michele , Mariette Xavier
Published: February 2019

Lymphoma development is the most serious complication of SS and the main factor impacting on mortality rate in patients with this condition. Lymphomas in SS are most commonly extranodal non-Hodgkin B-cell lymphomas of the mucosa-associated lymphoid tissue and frequently arise in salivary glands that are the target of a chronic inflammatory autoimmune process. Extensive work on lymphomagenesis in SS has established that the progression towards B-cell lymphoma is a multistep process related to local chronic antigenic stimulation of B cells. These neoplastic B cells in SS frequently derived from autoreactive clones, most commonly RF-producing B cells, which undergo uncontrolled proliferation and malignant escape. In this review, we highlight the most important recent findings that have enhanced our understanding of lymphoma development in SS, with particular reference to the close link between autoimmunity and lymphomagenesis. We also discuss how the identification of key factors involved in B-cell malignancies may impact on our ability to identify at early stages patients at increased risk of lymphoma with potential significant repercussions for the clinical management of SS patients. Finally, we identified the most promising areas of current and further research with the potential to provide novel basic and translational discoveries in the field. The questions of finding new biomarkers, developing a validated score for predicting lymphoma occurrence and assessing if a better control of disease activity will decrease the risk of lymphoma in primary SS will be the enthralling questions of the next few years.
The autoantibody response to cyclic citrullinated collagen type II peptides in rheumatoid arthritis
Authors: Liang Bibo , Ge Changrong , Lönnblom Erik , Lin Xiaoyin , Feng Hui , Xiao Lianbo , Bai Jing’an , Ayoglu Burcu , Nilsson Peter , Nandakumar Kutty Selva , Zhao Ming , Holmdahl Rikard
Published: February 2019

Objectives

The detection of anti-citrullinated peptide antibodies (ACPAs) is a serological hallmark of RA. Autoantibodies reactive with collagen type II (CII) are present in RA sera and synovial fluid and are potentially pathogenic. Here, we investigate the prevalence and specificity of the autoantibody responses to defined citrullinated cyclic peptides derived from CII in a China RA cohort.

Methods

Using bead-based multiplex assay, we examined the presence of autoantibodies binding to 54 cyclic 17-mer citrullinated CII peptides, encompassing all citrullinate epitopes in CII, and the corresponding unmodified peptides in 415 RA patients, in addition to 304 patients with OA. Furthermore, the autoantibody responses to a selected set of 10 cyclic citrullinated peptides were also examined in 203 healthy individuals.

Results

Autoantibody responses to cyclic citrullinated CII peptides were higher in RA patients as compared with OA patients or healthy individuals, whereas little or negligible antibody responses to cyclic unmodified CII peptides were observed. Interestingly, several novel citrullinated CII epitopes were identified. Antibodies to these novel citrullinated CII epitopes showed not only substantial overlapping reactivities but also had unique specificities.

Conclusion

We found a high prevalence of autoantibodies against cyclic citrullinated CII in the sera of patients in a China RA cohort. The present study revealed heterogeneous binding patterns against novel citrullinated CII epitopes, which may help to stratify RA patients into different subgroups.
Three dimensions of institutional contention: efficiency, equality and governance in Danish vocational education and training reform
Authors: Carstensen Martin B , Ibsen Christian Lyhne
Published: February 2019

This article develops a new analytical framework to account for institutional change in vocational education and training (VET) systems. Trajectories of institutional change are typically explained using one of two perspectives on institutional contention. First, the Varieties of Capitalism-approach highlights positive efficiency effects from coordination between companies on skill formation. Second, a historical institutionalist approach focuses on positive political feedback effects from the governance of VET institutions. We propose adding a third dimension of institutional contention related to what role VET should play in fostering greater socio-economic equality. Employing this three-dimensional framework enables a more fine-grained analysis of gradual forms of institutional change and greater appreciation of the ways in which political struggles over the configuration of the three dimensions drive institutional reform. The argument is supported by analyzing the trajectory of institutional change in the Danish VET system in the post-war period.