bluuebunny/crossref_metadata_2025 huggingface dataset:
Haitian Immigrants and Their Descendants Born in the Dominican Republic
Authors: Wooding Bridget
Published: January 2018

There has been a century of Haitian immigration to the neighboring Dominican Republic, initially as seasonal cane cutters. Noteworthy are the manu militari policies and ethnically discriminatory legislation adopted under the Trujillo dictatorship (1930–1961), including the legacy of these under the subsequent mainmise administration of his protégé President Balaguer. The diversification of this migrant labor in recent decades has been accompanied by the struggle between competing ideological factions to revise the obsolete migration legislation at the turn of the 21st century. The ensuing normative bias is detrimental to Haitians and constitutes unwarranted incursions into nationality matters.

Understanding discrimination and anti-Haitianism in the Dominican Republic and how this has been confronted underpin an analysis of current issues. Given the reluctance of political leaders and private-sector interests to address xenophobia and racism affecting Haitians and persons with Haitian ancestry, the role of civil society practitioners has come to the fore. This contestation on the part of civil society is exemplified in the strategic litigation outside and within the country, especially as regards the threat of nationality stripping of Haitian ancestry Dominicans born in the Dominican Republic.

The buildup to the crisis of 2013 stemming from the decision of the Dominican Constitutional Court (CC), La Sentencia (as it became known), which effectively rendered stateless 133,000 Dominicans of Haitian ancestry, is critical to understanding how and why this has happened. It also helps explain the nature of the palliative efforts set in motion by the Dominican authorities to mitigate the effects of the Sentence. Civil society’s response has been characterized by different but interrelated processes mandated by the Sentence and then enacted in twin but different legislation. Both the National Regularization Plan for Foreigners with an Irregular Migration Status (PNRE) and Naturalization Law 169-14 for those persons denationalized in September 2013 are examined.

Finally, taking stock entails examining the prospect of lasting change toward proper integration of Haitian migrants and the recognition of the right for their descendants born in the Dominican Republic to have and to hold Dominican nationality. Heightened judicial engagement is doubtless necessary, but the cultural turn perhaps holds the key to more sustainable gains in compliance with the rights of Haitian migrants and their family members. At most immediate risk is the realization of the acquired citizenship rights of descendants born in country to Haitian immigrants.
The Politics and Culture of Medicine and Disease in Central America
Authors: Carey Jr. David
Published: January 2018

With its diverse ecological zones and varied public health threats that ranged from lowland epidemic to highland endemic diseases, Central America is a challenging place to practice healthcare. In addition to topography and geography, social relations have also influenced the dynamic, contested, and negotiated process of healthcare in developing countries. Adversarial relations among indigenous people, African immigrants and slaves, and the state marked the region’s pasts. After the Spanish conquest established racist structures that favored Hispanic citizens by instituting forced labor mechanisms and limiting access to political, economic, and social power, colonists extracted land and labor from indigenous communities. Although most countries assumed that adopting Hispanic customs would improve the lives of indigenous and Afro-Central Americans, many elites felt such workers’ health was important only insofar as it did not impede their ability to labor.

Characterized by holistic approaches to health that took into account psychological, emotional, and physical well-being, indigenous and other traditional healing practices flourished even after states embraced the fields of bacteriology and parasitology in the late 19th and early 20th centuries. Primarily served by curanderos, midwives, bonesetters, and other traditional healers for generations, some remote rural communities were isolated from schooled medicine and its practitioners. In other rural communities and cities, hybrid healthcare offered patients palatable and efficacious healing options.

As doctors became politicians and states embraced science to modernize their nations, politics and public health became inextricably linked. Often with the assistance of multinational companies and nongovernmental organizations, governments deployed scientific medicine and public health campaigns to undergird assimilationist projects. Based on assumptions that traditional medicine was impotent and indigenous people and African descendants were vectors of disease, public health campaigns often discounted, rejected, or persecuted the healing practices of such peoples. When authorities embraced rather than problematized the confluences of race and health, they enjoyed some success. Yet neither authoritarian nor democratic governments could establish a medical monopoly.
mysteries, Eleusinian
Authors: Graf Fritz
Published: January 2018

The mystery cult of the Eleusinian goddesses Demeter and Persephone was the most important Greek mystery cult. During its very long existence, the Eleusinian Mysteries influenced other cults and attracted and inspired countless ancient humans and gave them better hopes for their afterlife.
The Compositional Semantics of Modification
Authors: Bücking Sebastian
Published: January 2018

Modification is a combinatorial semantic operation between a modifier and a modifiee. Take, for example, vegetarian soup: the attributive adjective vegetarian modifies the nominal modifiee soup and thus constrains the range of potential referents of the complex expression to soups that are vegetarian. Similarly, in Ben is preparing a soup in the camper, the adverbial in the camper modifies the preparation by locating it. Notably, modifiers can have fairly drastic effects; in fake stove, the attribute fake induces that the complex expression singles out objects that seem to be stoves, but are not. Intuitively, modifiers contribute additional information that is not explicitly called for by the target the modifier relates to. Speaking in terms of logic, this roughly says that modification is an endotypical operation; that is, it does not change the arity, or logical type, of the modified target constituent. Speaking in terms of syntax, this predicts that modifiers are typically adjuncts and thus do not change the syntactic distribution of their respective target; therefore, modifiers can be easily iterated (see, for instance, spicy vegetarian soup or Ben prepared a soup in the camper yesterday). This initial characterization sets modification apart from other combinatorial operations such as argument satisfaction and quantification: combining a soup with prepare satisfies an argument slot of the verbal head and thus reduces its arity (see, for instance, *prepare a soup a quiche). Quantification as, for example, in the combination of the quantifier every with the noun soup, maps a nominal property onto a quantifying expression with a different distribution (see, for instance, *a every soup). Their comparatively loose connection to their hosts renders modifiers a flexible, though certainly not random, means within combinatorial meaning constitution. The foundational question is how to work their being endotypical into a full-fledged compositional analysis. On the one hand, modifiers can be considered endotypical functors by virtue of their lexical endowment; for instance, vegetarian would be born a higher-ordered function from predicates to predicates. On the other hand, modification can be considered a rule-based operation; for instance, vegetarian would denote a simple predicate from entities to truth-values that receives its modifying endotypical function only by virtue of a separate modification rule. In order to assess this and related controversies empirically, research on modification pays particular attention to interface questions such as the following: how do structural conditions and the modifying function conspire in establishing complex interpretations? What roles do ontological information and fine-grained conceptual knowledge play in the course of concept combination?
Screening Substance Use and Misuse Among Middle and High School Students
Authors: Steiker Lori K. Holleran
Published: January 2018

This article provides an overview of screening adolescents for substance use, misuse, and substance use disorders. It covers the practical and empirical considerations when working with youth around issues of drugs and alcohol. Four reliable and valid screening tools are discussed: Alcohol Use Disorders Identification Test (AUDIT), CRAFFT, Rutgers Alcohol Problem Index (RAPI), and Problem-Oriented Screening Instrument for Teenagers (POSIT). The tools and techniques are drawn from evidence-based theoretical frames and practices, including close attention to the recent adolescent (Screening, Brief Intervention, Referral, and Treatment (SBIRT) resources.
Monasticism: A Very Short Introduction
Authors: Davis Stephen J.
Published: January 2018

Monasticism is a social and religious phenomenon that originated in antiquity, which remains relevant in the 21st century. Monasticism: A Very Short Introduction discusses the history of monasticism from the earliest evidence for it, and the different types that have developed. It considers where monasteries are located around the world, and how their settings impact the everyday life and worldview of the monks and nuns who dwell in them. Exploring how monastic communities are organized, this VSI also looks at how all aspects of life are regimented. Finally, it discusses what the stories about saints communicate about monastic identity and ethics, and considers what place there is for monasticism in the modern world.
Lakes: A Very Short Introduction
Authors: Vincent Warwick F.
Published: January 2018

From the mysterious depths of Lake Vostok, Antarctica, to tropical floodplain lakes, inland seas, hydro-reservoirs, and numerous waterbodies in our local environment, lakes encompass a huge diversity of shapes, sizes, depths, colours, and even salinities. Lakes are important, unique ecosystems, providing us with drinking water and food. Lakes: A Very Short Introduction introduces lake science (‘limnology’), discussing the importance of sustaining these complex ecosystems; and the impact on lake biodiversity of features such as climate, seasons, salinity, and sedimentation. It traces the origins of lake science from François Forel’s seminal work on Lake Geneva to modern approaches, such as environmental sensors, satellite observations, stable isotope analysis, and DNA-based technologies.
The History of Physics: A Very Short Introduction
Authors: Heilbron J. L.
Published: January 2018

How does today’s physics—highly professionalized; inextricably linked to government and industry—link back to its origins as a liberal art in ancient Greece? The History of Physics: A Very Short Introduction tells the 2,500-year story, exploring the changing place and purpose of physics in different cultures; highlighting the implications for humankind’s self-understanding. It introduces Islamic astronomers and mathematicians calculating the Earth’s size; medieval scholar-theologians investigating light; Galileo, Copernicus, Kepler, and Newton, measuring, and trying to explain, the universe. It visits: the House of Wisdom in 9th-century Baghdad; Europe’s first universities; the courts of the Renaissance; the Scientific Revolution and 18th-century academies; and the increasingly specialized world of 20th‒21st-century science.
Use of GPS tracking collars and accelerometers for rangeland livestock production research1
Authors: Bailey Derek W , Trotter Mark G , Knight Colt W , Thomas Milt G
Published: January 2018

Over the last 20 yr, global positioning system (GPS) collars have greatly enhanced livestock grazing behavior research. Practices designed to improve livestock grazing distribution can now be accurately and cost effectively monitored with GPS tracking. For example, cattle use of feed supplement placed in areas far from water and on steep slopes can be measured with GPS tracking and corresponding impacts on distribution patterns estimated. Ongoing research has identified genetic markers that are associated with cattle spatial movement patterns. If the results can be validated, genetic selection for grazing distribution may become feasible. Tracking collars have become easier to develop and construct, making them significantly less expensive, which will likely increase their use in livestock grazing management research. Some research questions can be designed so that dependent variables are measured by spatial movements of livestock, and in such cases, GPS tracking is a practical tool for conducting studies on extensive and rugged rangeland pastures. Similarly, accelerometers are changing our ability to monitor livestock behavior. Today, accelerometers are sensitive and can record movements at fine temporal scales for periods of weeks to months. The combination of GPS tracking and accelerometers appears to be useful tools for identifying changes in livestock behavior that are associated with livestock diseases and other welfare concerns. Recent technological advancements may make real-time or near real-time tracking on rangelands feasible and cost-effective. This would allow development of applications that could remotely monitor livestock well-being on extensive rangeland and notify ranchers when animals require treatment or other management.
Evaluation of the contribution of tenderness, juiciness, and flavor to the overall consumer beef eating experience1
Authors: O’Quinn Travis G , Legako J F , Brooks J C , Miller Mark F
Published: January 2018

The objectives of this study were to evaluate the contribution of tenderness, juiciness, and flavor to the overall consumer beef eating experience and to evaluate the risk of overall palatability failure due to the unacceptable level of one or more of these traits. Data from 11 previously conducted studies representing a wide range of treatments and levels of eating quality that included more than 1,500 beef samples and 1,800 consumers were compiled and analyzed for this study. Results of a multivariate regression indicated that tenderness, flavor, and juiciness accounted for 43.4%, 49.4%, and 7.4%, respectively, of overall palatability (P < 0.05; R2 > 0.99). Additionally, the odds of a steak being rated unacceptable overall when tenderness, juiciness, or flavor were rated unacceptable were 2.2 to 1 (69%), 1.9 to 1 (66%), and 3.3 to 1 (77%), respectively. This indicated overall palatability was 7.2, 6.5, and 12.3 times more likely to be rated unacceptable if tenderness, juiciness, or flavor, respectively, was also rated unacceptable. Additionally, the percentage of samples rated acceptable for each palatability trait increased (P < 0.05) as quality grade increased. More than 88% of USDA Prime samples were rated acceptable for each palatability trait, whereas only 74.8–77.3% of USDA Select samples were rated acceptable for each palatability trait. Marbling score accounted for 14–16% of the variation (P < 0.01) in consumer palatability scores for each trait and intramuscular fat percentage accounted for 17–21% of the variation in each trait (P < 0.01). Logistic equation models for the predicted probability of an acceptable rating for each palatability trait based on intramuscular fat percentage accounted for only a minimal amount of variation (P < 0.01; R2 ≤ 0.09). Results of this study indicate the relative contribution of tenderness, juiciness, and flavor to overall beef palatability. They provide evidence that the failure of even a single palatability trait dramatically increases the likelihood of overall palatability failure, indicating that no single palatability trait is most important, as beef palatability is dependent upon the acceptance of all three traits: tenderness, juiciness, and flavor.
Fifty Years Since the Discovery of PKA
Authors: Taylor Susan S. , Kim Choel W. , Cheng Cecilia Y. , Kannan Natarajan , Sastri Mira , Eggers Christopher W. , Wu Jian
Published: January 2018

In 1968, after Sutherland's discovery of cAMP, Krebs discovered cAMP‐dependent Protein Kinase (PKA), thus establishing the major paradigm for cAMP signaling in mammalian cells. The protein kinases, one of the largest gene families, are associated with many diseases, and PKA serves as a prototype for general protein kinase structure and function. While the structure of PKA first defined the conserved protein kinase fold, the recent solution of inhibited complexes of the catalytic (C) and regulatory (R) subunits have defined not only the molecular basis for inhibition but also the mechanisms for activation by cAMP. In addition, they show the dramatic flexibility that is embedded within the R‐subunit as it releases cAMP and wraps itself around the large lobe of the C‐subunit. In contrast, the C‐subunit functions as a stable scaffold that binds to many proteins. In addition to the R‐subunit isoforms and PKI, the C‐subunit docks to other proteins such as the A Kinase Interacting Protein (AKIP‐1), which contributes to its nuclear localization. The R‐ and C‐subunits do not typically exist as isolated entities in the cell but instead are part of large complexes assembled in part through A Kinase Anchoring Proteins (AKAPs). Localization and trafficking are an essential part of kinase function, and the challenge for the next decade will be to understand how these large PKA‐mediated signaling complexes assemble and integrate highly regulated functional responses. It is a challenge that requires the concerted integration of structural biology, cell biology, pharmacology and physiology.

(Funded by grants from the NIH to SST and fellowships from the American Cancer Society to CK and CWE, and NIH Training Grant GM08326 to CYC.)
Laughter Is the Best Medicine: Teaching to Teach Using Standardized Patients
Authors: Kaylor Sara K. , Strickland Haley P. , Sartain Andrea F.
Published: January 2018

This article describes an innovative approach to patient teaching using standardized patients, humor, and therapeutic communication. The strategy was designed for baccalaureate students enrolled in a fundamentals nursing course. Students, divided into small groups, were assigned a patient education topic to provide to the standardized patient. Student and faculty feedback indicated positive responses to this instructional strategy. Utilization of this learner-centered teaching environment to promote therapeutic communication during a complex patient-teaching scenario was found to be beneficial for novice nursing students.
Effects of Ambient Temperature and Forced-air Warming on Intraoperative Core Temperature
Authors: Pei Lijian , Huang Yuguang , Xu Yiyao , Zheng Yongchang , Sang Xinting , Zhou Xiaoyun , Li Shanqing , Mao Guangmei , Mascha Edward J. , Sessler Daniel I.
Published: January 2018

Background

The effect of ambient temperature, with and without active warming, on intraoperative core temperature remains poorly characterized. The authors determined the effect of ambient temperature on core temperature changes with and without forced-air warming.

Methods

In this unblinded three-by-two factorial trial, 292 adults were randomized to ambient temperatures 19°, 21°, or 23°C, and to passive insulation or forced-air warming. The primary outcome was core temperature change between 1 and 3 h after induction. Linear mixed-effects models assessed the effects of ambient temperature, warming method, and their interaction.

Results

A 1°C increase in ambient temperature attenuated the negative slope of core temperature change 1 to 3 h after anesthesia induction by 0.03 (98.3% CI, 0.01 to 0.06) °Ccore/(h.°Cambient) (P < 0.001), for patients who received passive insulation, but not for those warmed with forced-air (–0.01 [98.3% CI, –0.03 to 0.01] °Ccore/[h.°Cambient]; P = 0.40). Final core temperature at the end of surgery increased 0.13°C (98.3% CI, 0.07 to 0.20; P < 0.01) per degree increase in ambient temperature with passive insulation, but was unaffected by ambient temperature during forced-air warming (0.02 [98.3% CI, –0.04 to 0.09] °Ccore/°Cambient; P = 0.40). After an average of 3.4 h of surgery, core temperature was 36.3° ± 0.5°C in each of the forced-air groups, and ranged from 35.6° to 36.1°C in passively insulated patients.

Conclusions

Ambient intraoperative temperature has a negligible effect on core temperature when patients are warmed with forced air. The effect is larger when patients are passively insulated, but the magnitude remains small. Ambient temperature can thus be set to comfortable levels for staff in patients who are actively warmed.
Antifungal Susceptibility and Clinical Outcome in Neonatal Candidiasis
Authors: Autmizguine Julie , Tan Sylvia , Cohen-Wolkowiez Michael , Cotten C. Michael , Wiederhold Nathan , Goldberg Ronald N. , Adams-Chapman Ira , Stoll Barbara J. , Smith P. Brian , Benjamin Daniel K.
Published: January 2018

Background:

Invasive candidiasis is an important cause of sepsis in extremely low birth weight infants (ELBW, < 1000 g), is often fatal, and frequently results in neurodevelopmental impairment (NDI) among survivors. We sought to assess the antifungal minimum inhibitory concentration (MIC) distribution for Candida in ELBW infants and evaluate the association between antifungal resistance and death or NDI.

Methods:

This was a secondary analysis of a National Institute of Child Health and Human Development Neonatal Research Network study. MIC values were determined for fluconazole, amphotericin B and micafungin. NDI was assessed at 18–22 months adjusted age using the Bayley Scales of Infant Development. An infant was defined as having a resistant Candida isolate if ≥ 1 positive cultures from normally sterile sites (blood, cerebrospinal fluid, or urine) were resistant to ≥ 1 antifungal agent. In addition to resistance status, we categorized fungal isolates according to MIC values (low and high). The association between death/NDI and MIC level was determined using logistic regression, controlling for gestational age and Bayley Scales of Infant Development (II or III).

Results:

Among 137 ELBW infants with IC, MICs were determined for 308 isolates from 110 (80%) infants. Three Candida isolates from 3 infants were resistant to fluconazole. None were resistant to amphotericin B or micafungin. No significant difference in death, NDI, or death/NDI between groups with low and high MICs was observed.

Conclusions:

Antifungal resistance was rare among infecting Candida isolates, and MIC level was not associated with increased risk of death or NDI in this cohort of ELBW infants.
Orally active Epac inhibitor reverses mechanical allodynia and loss of intraepidermal nerve fibers in a mouse model of chemotherapy-induced peripheral neuropathy
Authors: Singhmar Pooja , Huo XiaoJiao , Li Yan , Dougherty Patrick M. , Mei Fang , Cheng Xiaodong , Heijnen Cobi J. , Kavelaars Annemieke
Published: January 2018

Chemotherapy-induced peripheral neuropathy (CIPN) is a major side effect of cancer treatment that significantly compromises quality of life of cancer patients and survivors. Identification of targets for pharmacological intervention to prevent or reverse CIPN is needed. We investigated exchange protein regulated by cAMP (Epac) as a potential target. Epacs are cAMP-binding proteins known to play a pivotal role in mechanical allodynia induced by nerve injury and inflammation. We demonstrate that global Epac1-knockout (Epac1−/−) male and female mice are protected against paclitaxel-induced mechanical allodynia. In addition, spinal cord astrocyte activation and intraepidermal nerve fiber (IENF) loss are significantly reduced in Epac1−/− mice as compared to wild-type mice. Moreover, Epac1−/− mice do not develop the paclitaxel-induced deficits in mitochondrial bioenergetics in the sciatic nerve that are a hallmark of CIPN. Notably, mice with cell-specific deletion of Epac1 in Nav1.8-positive neurons (N-Epac1−/−) also show reduced paclitaxel-induced mechanical allodynia, astrocyte activation, and IENF loss, indicating that CIPN develops downstream of Epac1 activation in nociceptors. The Epac-inhibitor ESI-09 reversed established paclitaxel-induced mechanical allodynia in wild-type mice even when dosing started 10 days after completion of paclitaxel treatment. In addition, oral administration of ESI-09 suppressed spinal cord astrocyte activation in the spinal cord and protected against IENF loss. Ex vivo, ESI-09 blocked paclitaxel-induced abnormal spontaneous discharges in dorsal root ganglion neurons. Collectively, these findings implicate Epac1 in nociceptors as a novel target for treatment of CIPN. This is clinically relevant because ESI-09 has the potential to reverse a debilitating and long-lasting side effect of cancer treatment.
Lateralized kappa opioid receptor signaling from the amygdala central nucleus promotes stress-induced functional pain
Authors: Nation Kelsey M. , De Felice Milena , Hernandez Pablo I. , Dodick David W. , Neugebauer Volker , Navratilova Edita , Porreca Frank
Published: January 2018

The response of diffuse noxious inhibitory controls (DNIC) is often decreased, or lost, in stress-related functional pain syndromes. Because the dynorphin/kappa opioid receptor (KOR) pathway is activated by stress, we determined its role in DNIC using a model of stress-induced functional pain. Male, Sprague-Dawley rats were primed for 7 days with systemic morphine resulting in opioid-induced hyperalgesia. Fourteen days after priming, when hyperalgesia was resolved, rats were exposed to environmental stress and DNIC was evaluated by measuring hind paw response threshold to noxious pressure (test stimulus) after capsaicin injection in the forepaw (conditioning stimulus). Morphine priming without stress did not alter DNIC. However, stress produced a loss of DNIC in morphine-primed rats in both hind paws that was abolished by systemic administration of the KOR antagonist, nor-binaltorphimine (nor-BNI). Microinjection of nor-BNI into the right, but not left, central nucleus of the amygdala (CeA) prevented the loss of DNIC in morphine-primed rats. Diffuse noxious inhibitory controls were not modulated by bilateral nor-BNI in the rostral ventromedial medulla. Stress increased dynorphin content in both the left and right CeA of primed rats, reaching significance only in the right CeA; no change was observed in the rostral ventromedial medulla or hypothalamus. Although morphine priming alone is not sufficient to influence DNIC, it establishes a state of latent sensitization that amplifies the consequences of stress. After priming, stress-induced dynorphin/KOR signaling from the right CeA inhibits DNIC in both hind paws, likely reflecting enhanced descending facilitation that masks descending inhibition. Kappa opioid receptor antagonists may provide a new therapeutic strategy for stress-related functional pain disorders.
Modification Patterns of Urinary Albumin Correlates With Serum Albumin and Outcome in Severe Alcoholic Hepatitis
Authors: Das Sukanta , Hussain Md. Shabir , Maras Jaswinder S. , Kumar Jitendra , Shasthry Saggere M. , Nayak Suman , Arora Vinod , Vijayaraghavan Rajan , Sharma Shvetank , Maiwall Rakhi , Sarin Shiv K.
Published: January 2018

Background and Aims:

Albumin modifications and deranged functions are well documented in serum of severe alcoholic hepatitis (SAH). We investigated whether urinary albumin (u-Alb) can serve as surrogate marker of circulatory albumin phenotype, functionality, and could predict outcome in SAH patients.

Patients and Methods:

Baseline serum and urine samples from 100 SAH, 20 alcoholic cirrhosis, and 20 healthy controls were subjected to u-Alb, ischemia modified albumin (IMA), IMA to albumin ratio (IMAr), advanced oxidation protein products, advanced glycation end-products, albumin-binding capacity determination. In addition, SAH urinary samples were also analyzed at day 4 and day 7 to predict nonresponse to corticosteroid therapy.

Results:

Urine and serum levels of IMA, advanced oxidation protein products and advanced glycation end-products were higher (P<0.05) in SAH versus alcoholic cirrhosis and healthy controls. IMAr was low in urine but high in serum of SAH (P<0.05). Albumin-binding capacity was lower (P<0.05) in both urinary and serum albumin of SAH. Urinary and serum albumin parameters showed direct correlation, whereas IMAr showed inverse correlation (cc>0.2, P<0.05). Baseline u-Alb level was significantly higher in SAH, and was correlated directly with corticosteroid treatment outcome and 12-month mortality in SAH. Baseline u-Alb showed an area under the receivers operating curve analysis of 0.7 and a hazard ratio of 1.23 for prediction of 12-month mortality in SAH. Baseline u-Alb level >9.0 mg/dL was associated with reduced 12-month survival in SAH (log rank <0.01).

Conclusions:

u-Alb modifications are reflective of serum albumin modifications. Further baseline u-Alb levels could be exploited to predict steroid response and mortality in SAH patients.
Diurnal Intraocular Pressure Fluctuations with Self-tonometry in Glaucoma Patients and Suspects: A Clinical Trial
Authors: Huang Jessie , Katalinic Paula , Kalloniatis Michael , Hennessy Michael P. , Zangerl Barbara
Published: January 2018

SIGNIFICANCE

This article shows that self-tonometry can provide robust measures of diurnal intraocular pressure (IOP) and also detect changes to IOP in response to treatment within a short period of monitoring. These advances in IOP monitoring may contribute to improved management of glaucoma patients and suspects.

PURPOSE

The aim of this study was to prospectively investigate the utility of rebound self-tonometry performed over several weeks for detecting diurnal IOP fluctuations in glaucoma patients and suspects and also initial response to topical treatment in glaucoma patients.

METHODS

Forty patients were recruited following glaucoma-specific examination. Subsequent to successful training with the iCare HOME tonometer, patients were instructed to measure IOP, in a sitting position, four times a day over 4 to 6 weeks. Date, time, laterality, and IOP downloaded from the tonometer and clinical examination data, including applanation IOP and corneal thickness, were analyzed. A user satisfaction survey was also administered at study completion. t Test and analysis of variance were used to compare groups and IOP across days. Pearson correlation was used to compare measurements to Goldmann applanation tonometry and IOP measurements from the first day/s to the overall mean IOP.

RESULTS

Twenty-seven patients (18 suspects and 9 glaucoma patients) completed data collection. Patients self-measured IOP on 118 (±29) occasions for 40 (±7.4) days. Two dominant patterns of fluctuation were revealed: peak IOP upon awakening (n = 11) and at midday (n = 13). Diurnal IOP measured in the first 7 days showed strong correlation to diurnal IOP across the entire study period (r
2 = 0.82, P < .0001). Within 24 hours of treatment commencement (latanoprost 0.005% ophthalmic solution), IOP reduced from 23.9 (±5.2) to 16.1 (±2.6) mmHg. Overall, patients rated the instrument as easy to use, although difficulties with correct alignment were expressed.

CONCLUSIONS

Rebound self-tonometry demonstrated utility for measuring diurnal IOP fluctuations in most patients, hence enhancing management of patient with or at risk of developing glaucoma.
Can Corneal Biomechanical Properties Explain Difference in Tonometric Measurement in Normal Eyes?
Authors: Dey Ashim , David Rathini Lilian , Asokan Rashima , George Ronnie
Published: January 2018

SIGNIFICANCE

Corneal biomechanical parameters can affect intraocular pressure (IOP) measurements by different tonometers compared with Goldmann applanation tonometer. This study implies that corneal hysteresis (CH) and corneal resistance factor (CRF) better explain variability in IOP measurements.

PURPOSE

The aim of this study was to evaluate the effect of corneal properties on the difference in IOP measured by the Ocular Response Analyzer (ORA), Rebound Tonometer (RBT), Dynamic Contour Tonometer (DCT), and Tono-Pen from the Goldmann applanation tonometer (GAT).

METHODS

An observational study was done on healthy participants in a tertiary eye care center. Corneal curvature was measured with a manual keratometer prior to IOP measurements. Intraocular pressure was measured by a single trained examiner with ORA, RBT, DCT, GAT, and Tono-Pen. CH and CRF were measured using the ORA. Central corneal thickness was measured using the ultrasonic pachymeter. Only the right eye was included for analysis. One-way analysis of variance was performed to compare variables, Bland-Altman plots to assess agreement, and regression analyses to study associated factors.

RESULTS

We included 82 eyes of 82 participants with a mean age of 40.9 (14.3) years. Mean ± SD DCT IOP (15.22 ± 1.98) mmHg was significantly higher than GAT IOP (13.73 ± 2.42) (P= .01) and ORA Goldmann correlated IOP (13.66 ± 3.16) (P= .003). The limits of agreement between GAT and other tonometers measurements ranged between −5.0 and 2.1 mmHg. With multiple linear regression analyses, CH and CRF were found to be associated with the measured IOP differences between GAT and ORA (corneal compensated IOP and Goldmann correlated IOP) (P< .001) and DCT (P= .014, <.001) whereas differences between GAT and RBT measurements were independently explained by corneal curvature (P= .035) and central corneal thickness (P= .045).

CONCLUSIONS

There was good agreement between GAT and other tonometers, but was not good enough for them to be used interchangeably. A combination of CH and CRF may better explain the variability between GAT and tonometers.
Conceptual Considerations for Payment Bundling in Breast Reconstruction
Authors: Sheckter Clifford C. , Razdan Shantanu N. , Disa Joseph J. , Mehrara Babak J. , Matros Evan
Published: January 2018

Rising health care costs and quality demands have driven both the Centers for Medicare and Medicaid Services and the private sector to seek innovations in health system design by placing institutions at financial risk. Novel care models, such as bundled reimbursement, aim to boost value though quality improvement and cost reduction. The Center for Medicare and Medicaid Innovation is leading the charge in this area with multiple pilots and mandates, including Comprehensive Care for Joint Replacement. Other high-cost and high-volume procedures could be considered for bundling in the future, including breast reconstruction. In this article, conceptual considerations surrounding bundling of breast reconstruction are discussed.
Orthognathic Surgery and Rhinoplasty: Simultaneous or Staged?
Authors: Sun Alexander H. , Steinbacher Derek M.
Published: January 2018

Background:

Orthognathic surgery can significantly impact the nasolabial envelope, and at times requires an adjunctive rhinoplasty. The purpose of this study was to evaluate nasal morphology in orthognathic patients, focusing on predictive variables, and the need for and timing of definitive rhinoplasty. Based on these data, an algorithm for the implementation of adjunctive rhinoplasty is proposed.

Methods:

A review of cases over a 3-year period was completed. Information regarding demographic, diagnostic, and operative details; nasal morphology; and use of rhinoplasty was compiled. Three-dimensional images were used to quantify anatomical variables.

Results:

Over 589 patients were reviewed during this period. Of these, 163 fulfilled inclusion criteria for this study. The mean age was 23.3 years. In total, 41.7 percent of orthognathic cases underwent adjunctive rhinoplasty. Of these, 82.4 percent were staged and 17.6 percent were simultaneous. The average time between staged procedures was 208 days. When simultaneous, 16.7 percent of the orthognathic procedures had significant maxillary movement (advancement >4 to 5 mm, impaction >2 mm, alar base excisions); in comparison, 92.9 percent of staged cases had significant maxillary movement (p < 0.0001). All patients had self-reported satisfaction with functional and aesthetic results during the follow-up period.

Conclusions:

Nasal and jaw deformities are intricately interlinked. In this series, the authors identified patterns requiring adjunctive rhinoplasty in the setting of orthognathic surgery. The authors present an algorithm to extensively treat the nasomaxillofacial relationship using orthognathic surgery alone, orthognathic surgery in concert with rhinoplasty, or orthognathic surgery followed by staged rhinoplasty.
Whole-Proteome Analysis of Human Craniosynostotic Tissue Suggests a Link between Inflammatory Signaling and Osteoclast Activation in Human Cranial Suture Patency
Authors: Lyon Sarah M. , Mayampurath Anoop , Song Dongzhe , Ye Jixing , Januszyk Michael , Rogers M. Rose , Ralston Ashley , Frim David M. , He Tong-Chuan , Reid Russell R.
Published: January 2018

Background:

The pathophysiology of nonsyndromic craniosynostosis remains poorly understood. The authors seek to understand the cause of this condition with a specific focus on how osteoclasts may contribute to craniosynostosis. Here, the authors characterize proteins differentially expressed in patent and fused cranial sutures by comparing their respective proteomes.

Methods:

Fused and patent suture samples were obtained from craniosynostotic patients undergoing surgery at a single academic medical center. Extracted protein from samples was interrogated using mass spectrometry. Differential protein expression was determined using maximum likelihood-based G-test with a q-value cutoffs of 0.5 after correction for multiple hypothesis testing. Immunolocalization of lead protein candidates was performed to validate proteomic findings. In addition, quantitative polymerase chain reaction analysis of corresponding gene expression of proteins of interest was performed.

Results:

Proteins differentially expressed in patent versus fused sutures included collagen 6A1 (Col6A1), fibromodulin, periostin, aggrecan, adipocyte enhancer-binding protein 1, and osteomodulin (OMD). Maximum likelihood-based G-test suggested that Col6A1, fibromodulin, and adipocyte enhancer-binding protein 1 are highly expressed in patent sutures compared with fused sutures, whereas OMD is up-regulated in fused sutures compared with patent sutures. These results were corroborated by immunohistochemistry. Quantitative polymerase chain reaction data point to an inverse relationship in proteins of interest to RNA transcript levels, in prematurely fused and patent sutures that potentially describes a feedback loop mechanism.

Conclusions:

Proteome analysis validated by immunohistochemistry may provide insight into the mechanism of cranial suture patency and disease from an osteoclast perspective. The authors results suggest a role of inflammatory mediators in nonsyndromic craniosynostosis. Col6A1 may aid in the regulation of suture patency, and OMD may be involved in premature fusion. Additional validation studies are required.
Anatomical Uniqueness of Ear Morphology: A Novel Metrical Approach through Three-Dimensional Superimposition
Authors: Gibelli Daniele , Pucciarelli Valentina , Ferrario Virgilio F. , Dolci Claudia , Sforza Chiarella
Published: January 2018

Uniqueness of ear morphology has been a widely debated issue in cephaloscopy, but past studies used only two-dimensional approaches. In the current investigation, the right and left ears of 10 healthy adults were imaged twice by stereophotogrammetry at the interval of a few seconds. The ear images obtained from the two acquisitions were superimposed both within subject (group of matches) and among subjects (group of mismatches). A point-to-point root mean square distance was calculated between the two three-dimensional models. Differences according to side and group were assessed by two-way analysis of variance. In total, 200 superimpositions were performed. On average, the point-to-point root mean square distance was 0.31 mm in cases of matches and 1.43 mm in cases of mismatches: differences were statistically significant (p < 0.01). Results provided quantitative data for the assessment of uniqueness of ear morphology, highlighting differences based on their three-dimensional morphology.
Conditioned Medium Obtained from Amnion-Derived Mesenchymal Stem Cell Culture Prevents Activation of Keloid Fibroblasts
Authors: Sato Chigusa , Yamamoto Yuhei , Funayama Emi , Furukawa Hiroshi , Oyama Akihiko , Murao Naoki , Hosono Hidetaka , Kawakubo Kazumichi , Sakamoto Naoya , Ohnishi Shunsuke
Published: January 2018

Background:

Mesenchymal stem cells are a valuable cell source in regenerative medicine, and conditioned medium obtained from mesenchymal stem cells reportedly inhibits inflammation. Keloids are characterized by abnormal fibrosis, caused by fibroblasts in response to inflammation. In this study, the authors evaluated whether conditioned medium obtained from amnion-derived mesenchymal stem cells suppressed activation of keloid fibroblasts.

Methods:

Keloid (n = 7), mature (n = 5), and normal (n = 5) fibroblasts were harvested from patients. Fibroblasts were stimulated with transforming growth factor (TGF)-β, and the effects of conditioned medium obtained from amnion-derived mesenchymal stem cells on cell proliferation, activation, and expression of extracellular matrix–related genes were analyzed. The effect of concentrating the conditioned medium by ultrafiltration on fibroblast activation was also analyzed.

Results:

Conditioned medium obtained from amnion-derived mesenchymal stem cells significantly up-regulated proliferation of mature fibroblasts but tended to suppress that of keloid fibroblasts. Conditioned medium obtained from amnion-derived mesenchymal stem cells significantly suppressed the TGF-β–induced up-regulation of α-smooth muscle actin in keloid and normal fibroblasts and collagen I in keloid fibroblasts, but not in mature fibroblasts. The conditioned medium obtained from amnion-derived mesenchymal stem cells concentrated by ultrafiltration and the filtrate significantly suppressed TGF-β–induced α-smooth muscle actin expression.

Conclusion:

Conditioned medium obtained from amnion-derived mesenchymal stem cells prevents proliferation and activation of keloid fibroblasts and is a promising keloid treatment for administration as a topical agent.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, V.
Polyethylene Ear Reconstruction: A State-of-the-Art Surgical Journey
Authors: Reinisch John , Tahiri Youssef
Published: January 2018

Background:

The use of a porous high-density polyethylene implant for ear reconstruction is gradually gaining acceptance because it allows for a pleasing ear reconstruction in young children before they enter school. In response to this growing interest, the authors decided to write an article clarifying in detail all the steps of this challenging procedure. In this article, the authors also answer all the common questions that surgeons have when they come to observe the operation, or when they go back to their respective practices and start performing this procedure.

Methods:

The authors describe in detail the operative steps that allow for a successful ear reconstruction using porous high-density polyethylene. The key parts of this operation are to meticulously harvest a well-vascularized superficial temporoparietal fascia flap and to use appropriate color-matched skin grafts.

Results:

This method allows for a pleasing ear reconstruction with excellent definition, projection, symmetry, and long-term viability.

Conclusion:

The use of porous high-density polyethylene with a thin superficial temporoparietal fascia flap coverage is the authors’ preferred method of ear reconstruction because it can be performed at an earlier age, in a single stage, as an outpatient procedure, and with minimal discomfort and psychological trauma for the patients and parents.
A Library of Logic Models to Explain How Interventions to Reduce Diagnostic Errors Work
Authors: Kletter Maartje , Melendez-Torres G.J. , Lilford Richard , Taylor Celia
Published: January 2018

Objectives

We aimed to create a library of logic models for interventions to reduce diagnostic error. This library can be used by those developing, implementing, or evaluating an intervention to improve patient care, to understand what needs to happen, and in what order, if the intervention is to be effective.

Methods

To create the library, we modified an existing method for generating logic models. The following five ordered activities to include in each model were defined: preintervention; implementation of the intervention; postimplementation, but before the immediate outcome can occur; the immediate outcome (usually behavior change); and postimmediate outcome, but before a reduction in diagnostic errors can occur. We also included reasons for lack of progress through the model. Relevant information was extracted about existing evaluations of interventions to reduce diagnostic error, identified by updating a previous systematic review.

Results

Data were synthesized to create logic models for four types of intervention, addressing five causes of diagnostic error in seven stages in the diagnostic pathway. In total, 46 interventions from 43 studies were included and 24 different logic models were generated.

Conclusions

We used a novel approach to create a freely available library of logic models. The models highlight the importance of attending to what needs to occur before and after intervention delivery if the intervention is to be effective. Our work provides a useful starting point for intervention developers, helps evaluators identify intermediate outcomes, and provides a method to enable others to generate libraries for interventions targeting other errors.
Computed Tomography Images of the Scapula Taken With Reduced Dose Can Yield Segmented Models of Sufficient Accuracy: A Pilot Study
Authors: Herteleer Michiel , Vancleef Sanne , Nijs Stefaan , Vander Sloten Jos
Published: January 2018

Objective

The aim of the study was to investigate the influence of tube current reduction on the segmentation accuracy of the scapula.

Methods

A human cadaver was computed tomography scanned multiple times while reducing tube current amperage. The images were segmented using 2 different segmentation methods (N = 28). Subsequently the scapula was dissected and all soft tissues were removed. An optical laser scan of the dissected scapula was aligned and compared with the segmented meshes of the different computed tomography scans.

Results

The mesh accuracy remained fairly constant with diminishing tube currents. All segmented meshes had a larger volume than the reference mesh (n = 27). The mean 3-dimensional deviation varied between 1.17 mm (max) and −0.759 mm (min) and the total mean (SD) 3-dimensional deviation was −0.45 (0.38) mm. Radiation dosages were reduced from 7.1 to 0.3 mSv.

Conclusions

Computed tomography tube current can be largely reduced without losing the surface segmentation accuracy of segmented scapula meshes.
Role of Scientific Theory in Simulation Education Research
Authors: Pusic Martin V. , Boutis Kathy , McGaghie Willam C.
Published: January 2018

Summary Statement

Scientific theories are consistent explanations about how the world works. They have been shown to be plausible not only from a large amount of independent confirmatory evidence but also because rigorous attempts at falsification have failed. Other desirable features include parsimony, scalability, explanatory, and predictive power. Scientific theories differ from models and laws in the amount of evidence available and/or the degree to which they explain nature. Learning curve theory is a scientific theory with direct applicability to simulation education researchers. In this article, the authors use the example of learning curve theory to illustrate the key features of scientific theories and how they provide a meaningful foundation for simulation-based education research programs.