bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk Stratification for Postoperative Venous Thromboembolism after Endoscopic Sinus Surgery
Authors: Beswick Daniel M. , Vaezeafshar Reza , Ma Yifei , Hwang Peter H. , Nayak Jayakar V. , Patel Zara M.
Published: February 2018

Objectives

Venous thromboembolism (VTE) contributes to significant patient morbidity, yet the incidence of VTE following endoscopic sinus surgery (ESS) is unknown. Quality improvement criteria are prompting increased standardization of perioperative VTE prophylaxis. Risk stratification for VTE may better define best practice measures to balance limiting VTE development with avoiding unnecessary chemoprophylaxis.

Study Design

Retrospective cohort study.

Setting

Tertiary institution.

Subjects and Methods

Adult patients who underwent ESS without perioperative chemoprophylaxis from 2008 to 2016 were evaluated. Identification of VTE was performed via screening diagnosis and procedure codes and clinical records, with subsequent confirmation of true‐positive VTE. Data for individual Caprini scores were abstracted from electronic medical records. The primary outcome was development of VTE within 30 days following ESS relative to the Caprini score.

Results

A total of 2369 ESS cases were evaluated. While initial screening identified multiple potential VTE events, in‐depth medical record review confirmed only 4 true VTE (0.17%). The VTE rate among cases with a Caprini score of <8 (0.09%, 2/2278) was significantly less (P =. 008) than the rate with a score of ≥8 (2.2%, 2/91). Beyond overall score, specific risk factors associated with development of postoperative VTE included stroke, central venous access, sepsis, and inpatient status (all P <. 025), while prior VTE and hypercoagulability were not associated with postoperative VTE (all P >. 5).

Conclusions

In the absence of perioperative chemoprophylaxis, postoperative VTE following ESS is extremely rare, particularly for patients carrying low‐to‐moderate Caprini scores. Risk stratification based on these data can assist in the design of VTE prophylaxis guidelines for ESS patients.
A Systematic Review of the Association between Cigarette Smoke Exposure and Chronic Rhinosinusitis
Authors: Christensen Dallin N. , Franks Zechariah G. , McCrary Hilary C. , Saleh Ahlam A. , Chang Eugene H.
Published: February 2018

Objectives

Cigarette smoking and passive smoke exposure have been associated with chronic rhinosinusitis (CRS). Our goal in this systematic review was to (1) determine if there was a strong correlative effect in large population studies between cigarette smoke exposure and the prevalence of CRS, (2) investigate pathogenic mechanisms of cigarette smoke in the upper airway, and (3) determine if a history of cigarette smoking affects the medical and surgical outcomes of CRS.

Data Sources

MEDLINE, Embase, Cochrane CENTRAL, Web of Science SCI and CPCI‐S, and websites.

Methods

A comprehensive literature review and quantitative meta‐analysis of studies based on the PRISMA protocol and examining the relationship between cigarette smoke exposure and CRS was performed. A search strategy was developed using various terms such as sinusitis, rhinitis, rhinosinusitis, and smoking. The articles were categorized by (1) epidemiology, (2) pathophysiology, and (3) outcomes. Data regarding study design, population/setting, methods, and bias were collected.

Results

The initial search generated 2621 titles/abstracts with 309 articles undergoing secondary review and 112 articles for final review. We determined that there is a strong correlation between active and passive cigarette smoke with the prevalence of CRS. Cigarette smoke challenge to sinonasal epithelia results in the release of inflammatory mediators and altered ciliary beat frequency. Pediatric patients exposed to secondhand smoke appear to have particularly poor outcomes.

Conclusion

There is clear evidence that cigarette smoke is related to CRS, but longitudinal and mechanistic studies are required to determine a causative effect. This information is critical for greater understanding of CRS health outcomes.
Effects of Common Ear Drops on Tympanic Membrane Healing in Rats
Authors: Dirain Carolyn O. , Kosko Brendan , Antonelli Patrick J.
Published: February 2018

Objective

Ciprofloxacin + dexamethasone ear drops have been associated with higher rates of tympanic membrane perforations than ofloxacin. This was thought to be an effect of the steroid; however, ciprofloxacin (sans steroid) has been found to be more toxic to tympanic membrane fibroblasts than ofloxacin in vitro. This study aimed to compare the effect of these agents on tympanic membrane healing in vivo.

Study Design

Controlled animal study.

Setting

Academic research laboratory.

Methods

Perforations were created in 54 rats with a carbon dioxide laser. Rats were randomized to 6 groups (9/group), with 1 ear receiving ofloxacin, ciprofloxacin, dexamethasone, ofloxacin + dexamethasone, ciprofloxacin + dexamethasone, or neomycin, and the contralateral ear receiving saline twice daily for 10 days. Healing was assessed over 40 days.

Results

Ofloxacin did not delay healing relative to saline. All other treatments delayed healing relative to ofloxacin at day 10 (P <. 0001). Dexamethasone and ofloxacin + dexamethasone delayed healing up to day 14 (P <. 0001). Neomycin and ciprofloxacin + dexamethasone further delayed healing up to day 28 (P =. 009) and day 35 (P =. 043), respectively. All eardrums healed by day 10 with ofloxacin, day 20 with ciprofloxacin, day 28 for dexamethasone, and day 35 for ofloxacin + dexamethasone. At day 40, 2 of 9 ciprofloxacin + dexamethasone–treated eardrums had not healed. All saline‐treated eardrums in the ofloxacin, ciprofloxacin, dexamethasone, and ofloxacin + dexamethasone groups were healed by day 14, but this was delayed to day 20 in the ciprofloxacin + dexamethasone group (P =. 007).

Conclusions

Ototopical quinolones delay rat tympanic membrane healing in a drug‐specific manner, with ciprofloxacin having a greater impact than ofloxacin. This effect is potentiated by steroids.
(R)-fluoxetine enhances cognitive flexibility and hippocampal cell proliferation in mice
Authors: Marwari Subhi , Dawe Gavin S
Published: February 2018

Fluoxetine is a clinically successful antidepressant. It is a racemic mixture of (R) and (S) stereoisomers. In preclinical studies, chronic treatment with fluoxetine (10 mg/kg) had antidepressant effects correlated with increased hippocampal cell proliferation in adult rodents. However, the contribution of the enantiomers of fluoxetine is largely unknown. We investigated the effects of treatment with (R)- and (S)-fluoxetine on cognitive behavioral paradigms and examined cell proliferation in the hippocampus of C57BL/6J female mice. In a behavioral sequencing task using the IntelliCage system in which discriminated spatial patterns of rewarded and never-rewarded corners were reversed serially, (R)-fluoxetine-treated mice showed rapid acquisition of behavioral sequencing (compared with S-fluoxetine) and cognitive flexibility in subsequent reversal stages in intra- and inter-session analysis. (R)-fluoxetine also increased cell proliferation in the hippocampus, in particular in the suprapyramidal blade of the dentate gyrus. (R)-fluoxetine had superior effects to (S)-fluoxetine in elevated plus maze, forced-swim and tail-suspension tests. These results suggest that (R)-fluoxetine, which has been reported to have a shorter half-life than (S)-fluoxetine, has superior antidepressant effects and more consistently improves spatial learning and memory. This profile offers advantages in depression treatment and may also aid management of the neurocognitive impairments associated with depression.
The net social wage in different welfare regimes
Authors: Maniatis Thanasis , Passas Costas
Published: February 2018

This article investigates empirically the net fiscal position of the working class in nine European countries for the 1995–2015 period. This is done through the estimation of the net social wage for wage and salary earners in those countries, characterized by different types of welfare states. The negative net social wage ratio in eight out of nine countries indicates that in advanced capitalism, the state budget redistributes income in such a way that the post-fiscal or true rate of exploitation is higher than the pre-fiscal or apparent one. Adverse economic conditions and ageing of the population have made the net social wage ratio less negative recently, while the accumulation of public debt and the increased obligations for interest payments on this public debt have acted in the opposite direction.
Under the British Roof
Authors: Bogusz Halina , Pękacka-Falkowska Katarzyna , Magowska Anita
Published: February 2018

The article focuses on British contribution to the development of palliative and hospice care in Poland in the 1980s and beyond. It is based on archival research in the hospices in Cracow and Poznan and broad-scoped Polish journals’ review. The social background of the hospice movement in Poland is described. We explore the role of inspiration and help of Dame Cicely Saunders and other British leaders in the transfer of British hospice philosophy and practice of palliative care to the medical community in Poland. This study demonstrates the importance of institutions for the formal exchange of medical information.
Emerging Structures for Social Enterprises Within Nonprofits: An Institutional Logics Perspective
Authors: Fitzgerald Tricia , Shepherd Deborah
Published: February 2018

The development of social enterprise initiatives within nonprofit organizations is a complex activity and the disruptive challenges of accommodating commercial processes within social organizations are often underestimated. This article is based on research that tracks four nonprofit organizations as they endeavor to develop their first social enterprise activities. Using a lens of institutional logics with the emerging empirical findings, six discernible differences are identified between nonprofits and for-profits which usefully inform our understanding of the challenges of accommodating both commercial and social logics. Building upon existing theory, this article offers a typology of structural options for a social enterprise that nonprofits might consider, with illustrative examples from the research findings.
Transient natural convection flow between vertical concentric cylinders heated/cooled asymmetrically
Authors: Jha Basant K , Oni Michael O
Published: February 2018

This paper investigates the impact of asymmetric heating or cooling of cylinder surfaces on transient natural convection flow in between vertical concentric cylinders. The outer surface of inner cylinder is assumed to be heated with temperature greater than the cooled inner surface of the outer cylinder. Closed form expressions are obtained by using the well-known Laplace transform technique to solve the governing partial differential equations in Laplace domain, whereas the Riemann-sum approximation is used to invert to time domain. Results show that the role of buoyancy force distribution parameter is to increase temperature, velocity, skin-friction and volume flow rate for both air and water. Further, reverse flow formation can be controlled by using suitable buoyancy force distribution parameter.
A blended-learning programme regarding professional ethics in physiotherapy students
Authors: Aguilar-Rodríguez Marta , Marques-Sule Elena , Serra-Añó Pilar , Espí-López Gemma Victoria , Dueñas-Moscardó Lirios , Pérez-Alenda Sofía
Published: February 2018

Background:

In the university context, assessing students’ attitude, knowledge and opinions when applying an innovative methodological approach to teach professional ethics becomes fundamental to know if the used approach is enough motivating for students.

Research objective:

To assess the effect of a blended-learning model, based on professional ethics and related to clinical practices, on physiotherapy students’ attitude, knowledge and opinions towards learning professional ethics.

Research design and participants:

A simple-blind clinical trial was performed (NLM identifier NCT03241693) (control group, n = 64; experimental group, n = 65). Both groups followed clinical practices for 8 months. Control group performed a public exposition of a clinical case about professional ethics. By contrast, an 8-month blended-learning programme regarding professional ethics was worked out for experimental group. An online syllabus and online activities were elaborated, while face-to-face active participation techniques were performed to discuss ethical issues. Students’ attitudes, knowledge and opinions towards learning professional ethics were assessed.

Ethical considerations:

The study was approved by the University Ethic Committee of Human Research and followed the ethical principles according to the Declaration of Helsinki.

Findings:

After the programme, attitudes and knowledge towards learning professional ethics of experimental group students significantly improved, while no differences were observed in control group. Moreover, opinions reported an adequate extension of themes and temporization, importance of clinical practices and interest of topics. Case study method and role playing were considered as the most helpful techniques.

Conclusion:

The blended-learning programme proposed, based on professional ethics and related to clinical practices, improves physiotherapy students’ attitudes, knowledge and opinions towards learning professional ethics.
Practice insights on patient care—management overview for chemoradiation toxic mucositis—guidelines, guideline-supported therapies and high potency polymerized cross-linked sucralfate (ProThelial)
Authors: McCullough Ricky W
Published: February 2018

Aim

To offer a practice insight for the management of chemoradiation toxic mucositis.

Method

Review chemoradiation toxic mucositis, its pathobiology and breadth of symptom presentation. Review mucositis guidelines and guideline-supported anti-mucositis therapies. Offer guidance on guidelines and an abbreviated review of high potency cross-linked sucralfate for management of chemoradiation toxic mucositis.

Result

There are six major mucositis guidelines but only one that is current and regularly updated. Guidelines from the Multinational Association Supportive Cancer Care suggest 14 interventions gleaned from controlled trials, 12 of which are off-label uses of therapies that offer statistically significant but incrementally beneficial outcomes. Several evidence-based limitations of guidelines are discussed. Data on high potency polymerized cross-linked sucralfate confirming complete prevention and rapid (2–3 days) elimination, sustained throughout cancer treatment is verified as high quality evidence in accordance to standards adopted by Agency for Healthcare Research and Quality. A 96–97% reduction in mucositis duration qualifies as a positive Glasziou treatment effect, which is discussed as an additional measure of evidence-based medicine.

Conclusion

Statistically significant but fractional treatment effects of guideline-supported interventions are not likely to substantially alter the course of mucositis when it occurs nor completely prevent its onset. Complete prevention and rapid sustained elimination should be the goal, therefore high potency polymerized cross-linked sucralfate may be useful. Where guidelines fail, institution-based protocols led by oncology pharmacists could succeed. In an effort to eliminate toxic mucositis, enhance compliance to chemoradiation regimens, and improve survival, such protocols for practice may verify pharmacoeconomic benefits, if any, in using high potency polymerized cross-linked sucralfate to manage toxic mucositis.
Real-World Data on Health-Related Quality of Life Assessment in Patients With Breast Cancer Receiving Subcutaneous Trastuzumab
Authors: Syrios John , Pappa Evelina , Volakakis Nikolaos , Grivas Anastasios , Alafis John , Manioudaki Sofia , Tzouda Vasiliki , Korogiannos Athanasios , Rapti Cleopatra , Koufopoulos Nektarios , Nikolaidou Adamantia , Kanavou Eleftheria , Alexopoulos Athanasios , Koumarianou Anna
Published: February 2018

Purpose:

Trastuzumab, a humanized anti-human epidermal growth factor receptor 2 (anti-HER2) antibody delivered intravenously, has revolutionized the treatment of patients with breast cancer overexpressing HER2 protein. Recently, a newer subcutaneous formulation was shown to have comparable efficacy to the initial intravenous trastuzumab. In this study, we aimed to evaluate the impact of subcutaneous trastuzumab on the health-related quality of life (HRQoL) of patients diagnosed with early or metastatic HER2-overexpressing breast cancer.

Methods:

Patients were provided with the EORTC QLQ-C30 (European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire-Core 30) and the BR-23 questionnaires. The scoring of questionnaires and patient’s sociodemographic and clinicopathologic characteristics were recorded and analyzed by descriptive and correlation statistics employing t test and 2-way analysis of variance.

Results:

A total of 163 patients agreed to participate in the study. About 90 of 163 patients (55.21%) received subcutaneous trastuzumab and 21 patients intravenous trastuzumab (12.88%). A control group of 52 HER2+ patients received chemotherapy without trastuzumab (31.90%). Patients receiving subcutaneous trastuzumab were older and of more advanced disease stage compared with those receiving chemotherapy (58.5 vs 51 years, 39.8% vs 28.8% advanced disease). In univariate analysis, subcutaneous trastuzumab was associated with less nausea and vomiting ( P = .002) but worse cognitive function ( P = .013) and dyspnea ( P = .042). Patients who have received >8 cycles of subcutaneous trastuzumab reported less diarrhea ( P = .049) and systemic therapy side effects ( P = .015). Multivariate analysis showed that patients without comorbidity receiving subcutaneous trastuzumab had less treatment side effects, less upset by hair loss, and higher emotional functioning. Of note, mastectomy and subcutaneous trastuzumab were associated with improved role functioning ( P = .021). In metastatic disease, no negative impact of subcutaneous trastuzumab on HRQoL was found.

Conclusions:

The administration of subcutaneous trastuzumab improved certain symptoms and did not adversely affect most of the assessed functional scales. Particularly, in the metastatic setting, subcutaneous trastuzumab had no negative impact on HRQoL.
Optimization of a two-mass vibration-based electromagnetic energy harvester using simulated annealing method
Authors: Chiu Min-Chie , Chang Ying-Chun , Yeh Long-Jyi , Chung Chiu-Hung
Published: February 2018

In this paper, a theoretical mathematical model in conjunction with an electrical generation model is examined. Using a simulated algorithm, the optimal design of a two-mass energy harvester that finds the maximal electrical power will be assessed. Before the optimal design is performed, the influence of the electrical power with respect to design parameters such as the magnet’s height, the diameter, the stiffness of the lower springs, the stiffness of the upper springs, the revolution of the lower coil, the revolution of the upper coil, the diameter of the coil’s wire, and the electrical resistance of the loading will be analyzed. Results reveal that the design parameters play essential roles in maximizing electrical power. The two mode shapes of the two-mass energy harvester also occur at the targeted forcing frequencies. The electrical power is optimally extracted at the two primary forcing frequencies, i.e. 12 and 30 Hz. Moreover, it is obvious that the induced electrical power of the two-mass energy harvester will be superior to that of the one-mass energy harvester.
Exploring Characteristics and Health Care Utilization Trends Among Individuals Who Fall in the Health Insurance Assistance Gap in a Medicaid Nonexpansion State
Authors: Edward Jean , Mir Nageen , Monti Denise , Shacham Enbal , Politi Mary C.
Published: February 2018

States that did not expand Medicaid under the Affordable Care Act (ACA) in the United States have seen a growth in the number of individuals who fall in the assistance gap, defined as having incomes above the Medicaid eligibility limit (≥44% of the federal poverty level) but below the lower limit (<100%) to be eligible for tax credits for premium subsidies or cost-sharing reductions in the marketplace. The purpose of this article is to present findings from a secondary data analysis examining the characteristics of those who fell in the assistance gap ( n = 166) in Missouri, a Medicaid nonexpansion state, by comparing them with those who did not fall in the assistance gap ( n = 157). Participants completed online demographic questionnaires and self-reported measures of health and insurance status, health literacy, numeracy, and health insurance literacy. A select group completed a 1-year follow-up survey about health insurance enrollment and health care utilization. Compared with the nonassistance gap group, individuals in the assistance gap were more likely to have lower levels of education, have at least one chronic condition, be uninsured at baseline, and be seeking health care coverage for additional dependents. Individuals in the assistance gap had significantly lower annual incomes and higher annual premiums when compared with the nonassistance gap group and were less likely to be insured through the marketplace or other private insurance at the 1-year follow-up. Findings provide several practice and policy implications for expanding health insurance coverage, reducing costs, and improving access to care for underserved populations.
Optimal strategy for target protection with a defender in the pursuit-evasion scenario
Authors: Sun Qilong , Qi Naiming , Huo Mingying
Published: February 2018

The conflict among three players, an attacker, a defender, and a target, in the pursuit-evasion strategy context is investigated. The problem is derived for a defender launching from the target with the assumption that the guidance laws of the attacker and defender are linear in form. During the endgame, the target lures the attacker close to the defender based on the attacker’s reaction to the target. Two kinds of optimal guidance laws for protecting the target from the attacker are presented first. Showing that the two kinds of guidance laws are flawed, a new optimal guidance law is subsequently derived. Considering that the players’ control efforts are bounded by reality, the relevant parameters corresponding to the optimal guidance laws also need to be analyzed. For adversaries obeying first-order dynamics, the performance of the guidance laws is simulated for different parameters, and under reasonable parameter choices, the simulation results show that the new optimal guidance law can enable the target to assist the defender in effectively intercepting the attacker.
European Society of Cardiology Council for Cardiology Practice worldwide survey of transcatheter aortic valve implantation beliefs and practices
Authors: Asteggiano Riccardo , Bramlage Peter , Richter Dimitrios J
Published: February 2018

Background

Transcatheter aortic valve implantation (TAVI) continues to gain popularity in the management of patients with severe aortic stenosis (SAS). Distribution of resources to maximise appropriate use remains a priority.

Design & methods

To determine the current perceptions and behaviours regarding SAS patient management, an 18-point multiple-choice questionnaire was distributed to European Society of Cardiology (ESC) Council for Cardiology Practice (CCP) e-journal and/or electronic newsletter subscribers. Respondents to all questions were considered. Sub-analyses based on respondent age, practice setting and geographical location were performed.

Results

Of 1245 full respondents, 41.5% were aged ≥ 51 years, 22.7% were aged 41–50 years and 35.8% were aged ≤ 40 years. The majority were located in Europe (77.5%), followed by Asia/Oceania (11.6%), America (7.6%) and Africa (3.4%). In-hospital and out-of-hospital cardiologists accounted for 57.4% of and 28.5% of the sample, respectively, with the remainder being general practitioners/other. The majority of respondents (70.1%) claimed to diagnose between one and five cases of SAS per month. Free access to TAVI was reported by 41.2%, being less common for those aged ≤ 40 years (32.7%; p < 0.001), those located in Asia/Oceania, America and Africa (20.1%, 18.1% and 2.4%, respectively; p < 0.01 in each case) and in-hospital compared to out-of-hospital cardiologists (35.7% vs. 54.5%, respectively; p < 0.001). The most common reason for not referring a patient for an aortic valve intervention was assessment that the patient was high risk/non-operable (55.5%), followed by short life expectancy (30.5%). The most common reason for referring a patient for TAVI over surgical replacement was surgical risk score (56.9%). The most commonly perceived main complication of TAVI was stroke (28.9%), while the most frequently selected main benefit was improvement in quality of life (37.2%). A high proportion (82.5%) of respondents believed that TAVI is/may become a viable option for lower-risk SAS patients in future.

Conclusion

The population of potential TAVI is significant worldwide, with key barriers to referral being access limitations and poor physician education. Strategies to minimise these factors are paramount.
Case‐finding in primary care for coeliac disease: Accuracy and cost‐effectiveness of a rapid point‐of‐care test
Authors: Esteve Maria , Rosinach Mercè , Llordés Montserrat , Calpe Judit , Montserrat Glòria , Pujals Mar , Cela Abel , Carrasco Anna , Ibarra Montserrat , Ruiz-Ramirez Pablo , Tristán Eva , Arau Beatriz , Ferrer Carme , Mariné Meritxell , Ribes Josepa , Fernández-Bañares Fernando
Published: February 2018

Background

An on‐site, rapid, fingertip, whole‐blood point‐of‐care test (POCT) is attractive for active case‐finding of coeliac disease (CD) in primary care because of its simplicity.

Aim

The aim of this article is to assess the usefulness and cost‐effectiveness of adult case‐finding using a POCT based on deamidated gliadin peptide antibodies (IgA/IgG‐DGP) in primary care for CD diagnosis.

Methods

A case‐finding study for CD was conducted by using an easy‐to‐use, on‐site, whole‐blood for IgA/IgG‐DGP‐based fingertip POCT compared with tTG2 in 350 individuals. Sample size was calculated based on 0.28% prevalence in the reference population. Duodenal biopsies for histology, intraepithelial lymphocytes and in situ deposition of tTG2 were obtained if tTG2 and/or POCT were positive. Accuracy and cost‐effectiveness of strategies using serology or POCT were calculated.

Results

Prevalence of CD was 1.14% (95% CI, 0.3–3.4), almost double what was previously observed. Four patients were diagnosed with CD. tTG2 was positive in three (0.85%) and POCT in 29 (8.2%). Sensitivity of POCT for CD was 100%, specificity 93%, PPV 14%, and NPV 100%. POCT followed by duodenal biopsy was the most cost‐effective approach in our setting (standard diagnosis: €13,033/case; POCT + duodenal biopsy: €7360/case).

Conclusions

A negative POCT allows ruling out CD in primary care, making it suitable for case‐finding. POCT strategy was the most cost effective.
Management of Elbow Dislocations in the National Football League
Authors: Chang Edward S. , Bishop Meghan E. , Dodson Christopher C. , Deluca Peter F. , Ciccotti Michael G. , Cohen Steven B. , Ramsey Matthew L.
Published: February 2018

Background:

Although much literature exists regarding the treatment and management of elbow dislocations in the general population, little information is available regarding management in the athletic population. Furthermore, no literature is available regarding the postinjury treatment and timing of return to play in the contact or professional athlete.

Purpose:

To review the clinical course of elbow dislocations in professional football players and determine the timing of return to full participation.

Study Design:

Case series; Level of evidence, 4.

Methods:

All National Football League (NFL) athletes with elbow dislocations from 2000 through 2011 who returned to play during the season were identified from the NFL Injury Surveillance System (NFL ISS). Roster position, player activity, use of external bracing, and clinical course were reviewed. Mean number of days lost until full return to play was determined for players with elbow dislocations who returned in the same season.

Results:

From 2000 to 2011, a total of 62 elbow dislocations out of 35,324 injuries were recorded (0.17%); 40 (64.5%) dislocations occurred in defensive players, 12 (19.4%) were in offensive players; and 10 (16.1%) were during special teams play. Over half of the injuries (33/62, 53.2%) were sustained while tackling, and 4 (6.5%) patients required surgery. A total of 47 (75.8%) players who sustained this injury were able to return in the same season. For this group, the mean number of days lost in players treated conservatively (45/47) was 25.1 days (median, 23.0 days; range, 0.0-118 days), while that for players treated operatively (2/47) was 46.5 days (median, 46.5 days; range, 29-64 days). Mean return to play based on player position was 25.8 days for defensive players (n = 28; median, 21.5 days; range, 3.0-118 days), 24.1 days for offensive players (n = 11; median, 19 days; range, 2.0-59 days), and 25.6 days for special teams players (n = 8; median, 25.5 days; range, 0-44 days).

Conclusion:

Elbow dislocations comprise less than a half of a percent of all injuries sustained in the NFL. Most injuries occur during the act of tackling, with the majority of injured athletes playing a defensive position. Players treated nonoperatively missed a mean of 25.1 days, whereas those managed operatively missed a mean of 46.5 days.
Active Choice Intervention Increases Advance Directive Completion: A Randomized Trial
Authors: Josephs Michael , Bayard Dominique , Gabler Nicole B. , Cooney Elizabeth , Halpern Scott D.
Published: February 2018

Background. Many people recognize the potential benefits of advance directives (ADs), yet few actually complete them. It is unknown whether an active choice intervention influences AD completion. Methods. New employees were randomized to an active choice intervention (n = 642) or usual care (n = 637). The active choice intervention asked employees to complete an AD, confirm prior AD completion, or fill out a declination form. In usual care, participants could complete an AD, confirm prior completion, or skip the task. We used multivariable logistic regression to assess the relationship between the intervention arm and both AD completion online and the return of a signed AD by mail, as well as assess interactions between intervention group and age, gender, race, and clinical degree status. Results. Participants assigned to the active choice intervention more commonly completed ADs online (35.1% v. 20.4%, P < 0.001) (odds ratio [OR] = 2.10; 95% confidence interval [CI] = 1.63–2.71; number needed to treat = 6.8) and returned signed ADs by mail (7.8% v. 3.9%, P = 0.003; number needed to treat = 25.6). The effect of the intervention was significantly greater among men (OR = 4.13; 95% CI = 2.32–7.35) than among women (OR = 1.74; 95% CI = 1.30–2.32) (interaction P value < 0.001). Responses to all eight choices made in the ADs were similar between groups (all P > 0.10). Limitations. A young and healthy participant may not benefit from AD completion as an older or seriously ill patient would. Conclusions. The active choice intervention significantly increased the proportion of participants completing an AD without changing the choices in ADs. This relationship was especially strong among men and may be a useful method to increase AD completion rates without altering choices.
Evaluation of Bivalirudin’s Effect on International Normalized Ratio to Determine an Appropriate Strategy for Transitioning to Warfarin
Authors: Fetea Andrea , Gulbis Brian E. , Hall Andrea C.
Published: February 2018

Background: Direct thrombin inhibitors are recommended in confirmed or suspected heparin-induced thrombocytopenia. False elevation of the international normalized ratio (INR) occurs with these agents making bridging to warfarin challenging. There is limited data regarding bivalirudin’s effect on INR. Objective: To evaluate bivalirudin’s effect on the INR and determine a strategy for transitioning to warfarin. Methods: This was a retrospective observational study. Included patients were >18 years old receiving primary bridging therapy with overlapping bivalirudin and warfarin for at least 72 hours. Patients with administration of alternate anticoagulants during the transition interval or active major bleeding within 48 hours prior to bivalirudin initiation were excluded. The primary endpoint was to determine the effect on INR at first therapeutic activated partial thromboplastin time after bivalirudin initiation and prior to warfarin initiation. Secondary endpoints included change in INR 12 and 24 hours after bivalirudin initiation, change in INR 4 hours after bivalirudin cessation, and incidence of major bleeding or new thrombotic events. Results: Thirty-four patients met study criteria. For the primary endpoint, the change in INR at first therapeutic activated partial thromboplastin time was 0.37 (range = 0.28-0.48), which occurred at 8.4 hours (range = 4.6-14.2; n = 14). INR increased at 12 and 24 hours by a median of 0.55 and 0.5 from baseline, respectively. Median change in INR 4 to 8 hours post-bivalirudin cessation was −0.48. Conclusion: Targeting an INR > 2.5 when bridging to warfarin will account for this false elevation and maintain an INR above 2.0 on bivalirudin discontinuation.
Surgical offloading procedures for diabetic foot ulcers compared to best non‐surgical treatment: a study protocol for a randomized controlled trial
Authors: Finestone Aharon S. , Tamir Eran , Ron Guy , Wiser Itay , Agar Gabriel
Published: February 2018

Background

Diabetic foot ulcers are frequently related to elevated pressure under a bony prominence. Conservative treatment includes offloading with orthopaedic shoes and custom made orthotics or plaster casts. While casting in plaster is usually effective in achieving primary closure of foot ulcers, recurrence rates are high. Minimally invasive surgical offloading that includes correction of foot deformities has good short and long term results. The surgery alleviates the pressure under the bony prominence, thus enabling prompt ulcer healing, negating the patient's dependence on expensive shoes and orthotics, with a lower chance of recurrence. The purpose of this protocol is to compare offloading surgery (percutaneous flexor tenotomy, mini‐invasive floating metatarsal osteotomy or Keller arthroplasty) to non‐surgical treatment for patients with diabetic foot ulcers in a semi‐crossover designed RCT.

Methods

One hundred patients with diabetic neuropathy related foot ulcers (tip of toe ulcers, ulcers under metatarsal heads and ulcers under the hallux interphalangeal joint) will be randomized (2:3) to a surgical offloading procedure or best available non‐surgical treatment. Group 1 (surgery) will have surgery within 1 week. Group 2 (controls) will be prescribed an offloading cast applied for up to 12 weeks (based on clinical considerations). Following successful offloading treatment (ulcer closure with complete epithelization) patients will be prescribed orthopaedic shoes and custom made orthotics. If offloading by cast for at least 6 weeks fails, or the ulcer recurs, patients will be offered surgical offloading. Follow‐up will take place till 2 years following randomization. Outcome criteria will be time to healing of the primary ulcer (complete epithelization), time to healing of surgical wound, recurrence of ulcer, time to recurrence and complications.

Discussion

The high recurrence rate of foot ulcers and their dire consequences justify attempts to find better solutions than the non‐surgical options available at present. To promote surgery, RCT level evidence of efficacy is necessary.

Trial registration

Israel MOH_2017–08‐10_000719. NIH: NCT03414216.
APSIC guidelines for disinfection and sterilization of instruments in health care facilities
Authors: Ling Moi Lin , Ching Patricia , Widitaputra Ammar , Stewart Alison , Sirijindadirat Nanthipha , Thu Le Thi Anh
Published: February 2018

Background

The Asia Pacific Society of Infection Control launched its revised Guidelines for Disinfection and Sterilization of Instruments in Health Care Facilities in February 2017. This document describes the guidelines and recommendations for the reprocessing of instruments in healthcare setting. It aims to highlight practical recommendations in a concise format designed to assist healthcare facilities at Asia Pacific region in achieving high standards in sterilization and disinfection.

Method

The guidelines were revised by an appointed workgroup comprising experts in the Asia Pacific region, following reviews of previously published guidelines and recommendations relevant to each section.

Results

It recommends the centralization of reprocessing, training of all staff with annual competency assessment, verification of cleaning, continual monitoring of reprocessing procedures to ensure their quality and a corporate strategy for dealing with single-use and single-patient use medical equipment/devices. Detailed recommendations are also given with respect to reprocessing of endoscopes. Close working with the Infection Prevention & Control department is also recommended where decisions related to reprocessing medical equipment/devices are to be made.

Conclusions

Sterilization facilities should aim for excellence in practices as this is part of patient safety. The guidelines that come with a checklist help service providers identify gaps for improvement to reach this goal.
In vitro activity of ivermectin against Staphylococcus aureus clinical isolates
Authors: Ashraf Shoaib , Chaudhry Umer , Raza Ali , Ghosh Debasri , Zhao Xin
Published: February 2018

Background

Ivermectin is an endectocide against many parasites. Though being a macrocyclic lactone, its activity against bacteria has been less known, possibly due to the fact that micromolar concentrations at tissue levels are required to achieve a therapeutic effect. Among pathogenic bacteria of major medical significance, Staphylococcus aureus cause a number of diseases in a wide variety of hosts including humans and animals. It has been attributed as one of the most pathogenic organisms. The emergence of methicillin resistance has made the treatment of S. aureus even more difficult as it is now resistant to most of the available antibiotics. Thus, search for alternate anti-staphylococcal agents requires immediate attention.

Methods

Twenty-one clinical isolates of S. aureus were isolated from bovine milk collected from Lahore and Faisalabad Pakistan. Different anthelmintics including levamisole, albendazole and ivermectin were tested against S. aureus to determine their minimum inhibitory concentrations. This was followed-up by growth curve analysis, spot assay and time-kill kinetics.

Results

The results showed that ivermectin but not levamisole or albendazole exhibited a potent anti-staphylococcal activity at the concentrations of 6.25 and 12.5 μg/ml against two isolates. Interestingly, one of the isolate was sensitive while the other was resistant to methicillin/cefoxitin.

Conclusions

Our novel findings indicate that ivermectin has an anti-bacterial effect against certain S. aureus isolates. However, to comprehend why ivermectin did not inhibit the growth of all Staphylococci needs further investigation. Nevertheless, we have extended the broad range of known pharmacological effects of ivermectin. As pharmacology and toxicology of ivermectin are well known, its further development as an anti-staphylococcal agent is potentially appealing.
Symbiosis in the microbial world: from ecology to genome evolution
Authors: Raina Jean-Baptiste , Eme Laura , Pollock F. Joseph , Spang Anja , Archibald John M. , Williams Tom A.
Published: February 2018

The concept of symbiosis – defined in 1879 by de Bary as ‘the living together of unlike organisms’ – has a rich and convoluted history in biology. In part, because it questioned the concept of the individual, symbiosis fell largely outside mainstream science and has traditionally received less attention than other research disciplines. This is gradually changing. In nature organisms do not live in isolation but rather interact with, and are impacted by, diverse beings throughout their life histories. Symbiosis is now recognized as a central driver of evolution across the entire tree of life, including, for example, bacterial endosymbionts that provide insects with vital nutrients and the mitochondria that power our own cells. Symbioses between microbes and their multicellular hosts also underpin the ecological success of some of the most productive ecosystems on the planet, including hydrothermal vents and coral reefs. In November 2017, scientists working in fields spanning the life sciences came together at a Company of Biologists’ workshop to discuss the origin, maintenance, and long-term implications of symbiosis from the complementary perspectives of cell biology, ecology, evolution and genomics, taking into account both model and non-model organisms. Here, we provide a brief synthesis of the fruitful discussions that transpired.
Nosema ceranae parasitism impacts olfactory learning and memory and neurochemistry in honey bees (Apis mellifera)
Authors: Gage Stephanie L. , Kramer Catherine , Calle Samantha , Carroll Mark , Heien Michael , DeGrandi-Hoffman Gloria
Published: February 2018

Nosema sp. is an internal parasite of the honey bee, Apis mellifera, and one of the leading contributors to colony losses worldwide. This parasite is found in the honey bee midgut, and has profound consequences on the host's physiology. Nosema sp. impairs foraging performance in honey bees, yet, it is unclear whether this parasite affects the bee's neurobiology. In this study, we examine whether Nosema sp. affects odor learning and memory and whether the brains of parasitized bees show differences in amino acids and biogenic amines. We took newly emerged bees and fed them with a Nosema ceranae. At approximate nurse and forager ages, we employed an odor-associative conditioning assay using the proboscis extension reflex and two bioanalytical techniques to measure changes in brain chemistry. We found that nurse-aged bees infected with N. ceranae significantly outperform controls in odor learning and memory—suggestive of precocious foraging, but by forager age, infected bees showed deficits in learning and memory. We also detected significant differences in amino acid concentrations, some of which were age-specific; as well as altered serotonin, octopamine, dopamine, and L-dopa concentrations in the brain of parasitized bees. These findings suggest N. ceranae infection affects honey bee neurobiology and behavioral tasks may be compromised. These results yield new insight into the host—parasite dynamic of honey bees and N. ceranae, as well the neurochemistry of odor learning and memory under normal, and parasitic conditions.
Innovative Synthesis and Functions of Curved π-Conjugated Molecules
Authors: Hiroto Satoru
Published: February 2018

Creation of novel π-conjugated molecules is an important topic. In this account, one idea for creation of π-conjugated molecules by using distorted conformation has been demonstrated. Planarization of distorted molecules enabled synthesis of heteroatom-containing porphyrin derivatives. Furthermore, dearomatization reaction proved effective to construct distorted conformations from planar π-conjugated molecules under mild reaction conditions. According to this protocol, we have succeeded in the synthesis of heteroatom-containing curved π-conjugated molecules, which have never been achieved by conventional protocols. In particular, a nitrogen embedded buckybowl is the first example of a buckybowl with a heteroatom in its central position, exhibiting unique properties due to incorporation of heteroatom with a curved π-surface.
Light and Matter Interaction in Two-Dimensional Atomically Thin Films
Authors: Ulaganathan Rajesh Kumar , Chang Yi-Hsuan , Wang Di-Yan , Li Shao-Sian
Published: February 2018

Atomically thin two-dimensional (2D) materials have been a famous and fascinating material in recent years due to the potential to replace conventional semiconducting bulk electronic materials. To control the performance of 2D materials, many methods have been proposed, including physical and chemical ways, to manipulate the electronic, atomic and microscopic properties. In this work, we would like to present a physical method based on the interactions of 2D materials with light to influence the 2D material properties and device performance. By reviewing some recent published work, we will show how effective the light can be to functionalize 2D materials. The fundamental fluorescence phenomenon and current applications using 2D materials in optoelectronics, such as photodetectors, solar cells and light emitting diodes, to obtain improved device properties will also be discussed.
Health-related Fitness in Preschool Children with and without Motor Delays
Authors: KING-DOWLING SARA , RODRIGUEZ CHRISTINE , MISSIUNA CHERYL , TIMMONS BRIAN W. , CAIRNEY JOHN
Published: February 2018

Purpose

School-age children with developmental coordination disorder (DCD) have poor health-related fitness (HRF), but little is known about when these deficits emerge. The purpose of this study was to determine if 4- and 5-yr-old children who meet the criteria for DCD exhibit poorer HRF compared with typically developing (TD) children, and if this relationship is mediated by vigorous physical activity (VPA) engagement.

Methods

Five hundred and ninety-two children participated (age, 5.0 ± 0.6 yr) from the Coordination and Activity Tracking in CHildren study. Motor skills were assessed using the Movement Assessment Battery for Children-2, with groups defined as having DCD (≤5th percentile), at risk for DCD (6th–16th percentile), and TD (>16th percentile). Measures of body composition included body mass index, waist circumference, and body fat percentage. Musculoskeletal fitness assessments included standing long jump distance, as well as peak and mean power assessed using a 30-s Wingate protocol on a pediatric cycle ergometer. Time to exhaustion on a progressive, treadmill test was used to determine aerobic fitness. Flexibility and VPA were assessed using a sit-and-reach test and 7-d accelerometry, respectively.

Results

Children in the DCD group had the poorest musculoskeletal and aerobic fitness, whereas TD children had the highest. No differences in body composition among groups were found. Daily VPA was similar among groups and did not explain HRF differences.

Conclusions

Preschool children with DCD have decreased anaerobic and aerobic fitness compared with TD children; however, VPA and body composition seem to be less affected by DCD in the early years. Early motor interventions may be able to improve fitness and reduce the risk of hypoactivity and obesity as children with DCD get older.