bluuebunny/crossref_metadata_2025 huggingface dataset:
Adaptation in Acute Kidney Injury
Authors: Jaipaul Navin
Published: February 2019

It is well established that patients who develop acute kidney injury (AKI) are at increased risk for progression to chronic kidney disease (CKD). However, by the time AKI is clinically recognized, a sequence of events with potential to repair the injury or propagate further damage to the renal parenchyma is already initiated. The outcome of the repair process depends on adaptive and maladaptive influences at the cellular level. Progression to CKD after AKI is the result of imbalance in favor of maladaptive repair, which culminates in the development of interstitial fibrosis. Various biochemical pathways are implicated in this process and may lend themselves to potential therapeutic targets for intervention in the transition from AKI to CKD. Emerging methods, including injury-specific biomarkers for the earlier detection of subclinical disease, show promise for use in combination with clinical factors and functional markers to stratify patient risk for CKD progression after AKI.
Cholesterol Crystal Embolism
Authors: Meyrier Alain
Published: February 2019

Cholesterol crystal embolism (CCE) is a frequent complication of aortic atherosclerotic plaques triggered by vascular radiology, vascular surgery, and/or anticoagulation. Crystals lodge in small arteries and induce early thrombosis followed by delayed, definitive obstruction by endarteritis. Lower limb cutaneous involvement with livedo reticularis and blue/purple toes along with blood eosinophilia are common features of diagnostic interest. Massive CCE leads to early oligoanuria and often death from multivisceral compromise. In subacute forms, clinical manifestation of kidney injury may be delayed by several weeks following the triggering event. The chronic subset can be easily mistaken for nephrosclerosis. Cutaneous, retinal, and muscle involvement allow diagnosis without resort to kidney biopsy in about 80% of cases. Treatment of acute/subacute forms of renal insufficiency consists of stopping anticoagulation and forbidding any new triggering procedure along with supportive measures including dialysis, parenteral nutrition, corticosteroids, and statins. About 40% of survivors do not recover renal function and remain on dialysis.
Recurrence of Primary Glomerular Diseases Post Kidney Transplantation
Authors: Manllo-Dieck John , Alachkar Nada
Published: February 2019

Glomerulonephritis (GN) is a common cause of end stage renal disease (ESRD), just behind diabetes and hypertension. Primary glomerular diseases may recur after transplant, or in some instances may present de novo. At times is difficult to differentiate between recurrence and de novo, due to misdiagnosis of the primary cause of ESRD and lack of tissue diagnosis prior to transplantation. All GNs can recur after transplantation, incidence and impact on allograft survival depends on the primary disease and immunosuppression being used. Close monitoring of patients with known GN is key, since early diagnosis and rapid intervention are crucial for allograft survival.
Pediatric Pain
Authors: O’Brien Juliana H. , Root Maggie C.
Published: February 2019

Children and infants experience pain as a serious complication of disease and injury, but only recently have clinicians come to understand how children experience pain. Exposure to painful injury is associated with psychological consequences in infants and children, including posttraumatic stress symptoms, neurodevelopmental issues, increased anxiety, and cortical dysfunction in childhood. In seriously ill infants, pain may be associated with increased morbidity and mortality; in older children, untreated pain can lead to decreased functioning, social isolation, sleep disorders, and mood changes. Prevention and relief of pain for this vulnerable population is essential. Pain assessment and management in infants and children require that palliative care nurses understand the developmental stages of childhood. This chapter provides a recommended approach to pain assessment and pain management in children. It outlines age-specific and developmentally appropriate pain assessment tools. It describes commonly observed pain behaviors in verbal and nonverbal children. It highlights the management differences between acute pain, neuropathic pain, and chronic pain. It details a combined nonpharmacologic and pharmacologic (including weight-based dosing) approach for pain management.
Identity and the psychological consequences of recognition
Authors: Rashed Mohammed Abouelleil
Published: February 2019

This chapter, “Identity and the psychological consequences of recognition,” offers an overview of contemporary ideas about identity and authenticity with a focus on the work of Charles Taylor. It addresses the problem of essentialism as it applies to identity and the self, and discusses the relation between social and individual identity. It examines the motivation underlying the struggle for recognition, and the distinction between genuine and ideological recognition. The chapter also explores the psychological consequences of recognition and misrecognition through a critical review of key writings by Axel Honneth. It continues the overall aim of the second part of this book, which is to construct a theory for the politics of identity and recognition that can enable us to respond to Mad activism’s demand for recognition.
Ten principles to strengthen prognosis research
Authors: Riley Richard D , Snell Kym IE , Moons Karel GM , Debray Thomas PA
Published: February 2019

This chapter provides a set of ten principles for ensuring high-quality prognosis research. There are three general principles for strengthening prognosis research: the need for study registration and protocols, use of reporting guidelines, and importance of replication and validation studies. The seven other principles concern study analysis and presentation: use of estimation and confidence intervals rather than statistical hypothesis testing; use of interaction estimates when analysing subgroups; avoidance of categorization of continuous predictor and outcome variables; multiple imputation of missing values; adjustment of new prognostic factor estimates for established factors; avoidance of univariable estimates for predictor selection when developing prognostic models; use of penalization techniques within prognostic model development to reduce overfitting and overly extreme predictions for new individuals; and use of competing risk models in frail populations.
Low Revision Rates at 10 years for Metal on Metal Hip Implants in a Military Population
Authors: Slaven Sean E , Richards John T , Wade Sean M , Saxena Sameer K , Vanier Alan T , Cody John P
Published: February 2019

Introduction

Prior to being largely abandoned due to unacceptably high failure rates and the adverse physiologic reactions to metal ions, metal-on-metal (MoM) total hip arthroplasty (THA) and hip resurfacing (HR) were in widespread use throughout the USA, and the potential benefit of decreased volumetric wear rates made it of particular interest to those who serve a young active population, such as military surgeons. The aim of our study was to determine the revision rate of metal on metal hip implants performed at our military institution and obtain current patient reported outcomes from this cohort.

Materials and Methods

We conducted a retrospective review of patients who underwent MoM total hip arthroplasty (THA) or hip resurfacing (HR) at our institution from 2006 to 2012. Revision status and component type were determined, and patients were contacted to obtain current HOOS JR scores.

Results

We identified 103 THAs in 88 patients and 38 HRs in 33 patients, with mean follow up of 10.2 years. Average age at time of surgery was 48 years, and 85% of the patients were male. The mean HOOS JR score in the THA and HR groups were 84.9 ± 17.6 and 75.8 ± 24.9, respectively (p = 0.38), and were not significantly lower in those who were revised. Two THA revisions occurred for metallosis and one for aseptic loosening of the femoral component. One HR revision occurred for breach of the anterior femoral neck, and one occurred for heterotopicossification.

Conclusions

Revision rates of MoM THA and HR in this young, predominantly male population were 2.9% and 5.3%, respectively, and patients maintained generally good hip-specific outcomes.
Acute Left M1 Stroke With Critical Left Internal Carotid Artery Stenosis: Video Case
Authors: Bonney Phillip A , Singh Parampreet , Mack William J
Published: February 2019

We present the case of a 68-yr-old woman who presented with an acute left middle cerebral artery syndrome. Noninvasive angiography obtained 13 h after last known well time demonstrated both left M1-segment middle cerebral artery (MCA) occlusion and near-complete occlusion of the left internal carotid artery (ICA) just distal to the carotid bifurcation. Intervention was offered given the sizeable mismatch demonstrated by computed tomography (CT) perfusion imaging. After administering loading doses of aspirin and clopidogrel, we initially performed carotid angioplasty and stenting to open the internal carotid artery, which was otherwise impassible. Subsequently, thrombectomy of the M1 occlusion was performed with direct aspiration. Postprocedural imaging demonstrated preservation of the at-risk brain parenchyma. The patient demonstrated significant improvement in strength and speech after the procedure, and she was discharged to an inpatient rehabilitation center for further treatment. The patient and her family gave consent for this report.
Municipal Councillors in Parliament, a Handicap for Legislative Activism? Parliamentary Productivity of Dual Mandate-Holders in the Belgian Federal Assembly between 1995 and 2014
Authors: Van de Voorde Nicolas
Published: February 2019

Traditionally, scholars have always assumed that exercising a local political mandate as a national legislator intrinsically interferes with the intra parliamentary output. Despite the intuitive presumption that dual mandate-holders lack sufficient time to fulfil both mandates adequately, empirical support remains scarce and contradictory. Existing research has almost exclusively focused on problematic small samples in the French national assembly, failed to disentangle the generic phenomenon based on the nature of the local function and the context it is being exercised in, and neglected to embed their work in the legislative literature. This contribution aims to cover these shortcomings and assesses whether representatives with a dual mandate are less productive in the Belgian federal parliament during five legislatures between 1995 and 2014. The evidence shows that only mayors from large municipalities are less preoccupied with formal parliamentary endeavours, which refines the traditional pessimistic premise that cumul des mandats unambiguously cripples parliamentary activism and instead opens up the possibility for a more optimistic perspective.
An energetic high-velocity compact cloud: CO−0.31+0.11
Authors: Takekawa Shunya , Oka Tomoharu , Tokuyama Sekito , Tanabe Kyosuke , Iwata Yuhei , Tsujimoto Shiho , Nomura Mariko , Shibuya Yukihiro
Published: February 2019

We have discovered an energetic high-velocity compact cloud CO$\, -0.31+$0.11 in the central molecular zone of our Galaxy. CO$\, -0.31+$0.11 is located at a projected distance of ∼45 pc from the Galactic nucleus Sgr A*. It is characterized by its compact spatial appearance (d ≃ 4 pc), extremely broad velocity width (ΔV > 100 km s−1), and high CO J = 3–2/J = 1–0 intensity ratio. The total gas mass and kinetic energy are estimated as approximately $10^{4}\, M_{\odot }$ and 1051 erg, respectively. Two expanding bubble-like structures are found in our HCN J = 1–0 map obtained with the Nobeyama Radio Observatory 45 m telescope. In the longitude–velocity maps, CO$\, -0.31+$0.11 exhibits an asymmetric V shape. This kinematical structure can be well fitted by Keplerian motion on an eccentric orbit around a point mass of $2\times 10^{5}\, M_\odot$. The enhanced CO J = 3–2/J = 1–0 ratio is possibly attributed to the tidal compression during the pericenter passage. The model suggests that a huge mass is packed within a radius of r < 0.1 pc. The huge mass, compactness, and absence of luminous stellar counterparts may correspond to a signature of an intermediate-mass black hole (IMBH) inside. We propose a formation scenario of CO$\, -0.31+$0.11 in which a compact cloud has gravitationally interacted with an IMBH and a bipolar molecular outflow was driven by the past activity of the putative IMBH.
Development Through the Lens of a Perception-Action-Cognition Connection: Recognizing the Need for a Paradigm Shift in Clinical Reasoning
Authors: Rahlin Mary , Barnett Joyce , Becker Elaine , Fregosi Charlene M
Published: February 2019

Clinical assessment of movement and posture guides the decision-making process in designing interventions for infants and children with movement disorders. Clinical reasoning is influenced by the therapist's understanding of developmental processes. The views of development grounded in perception-action, dynamic systems, and neuronal group selection theories are well recognized in current literature and supported by a large body of research. Based on the available evidence, intervention must be task-specific, repetitive, and highly salient to the child. Furthermore, it must honor spontaneous exploration and active problem-solving, enhance the child's ability to perceive environmental affordances, and target optimal variability and adaptability of movement and posture. However, a neuromaturational approach to developmental assessment and intervention that relies on “teaching” motor milestones and emphasizes the importance of correcting movement patterns in infants and children developing atypically is still prevalent in the clinic. This perspective paper will: (1) examine evidence in support of a paradigm shift from neuromaturational views toward bringing the concepts of grounded cognition, variability, complexity, and adaptability to the forefront of clinical reasoning; and (2) introduce the Perception-Action Approach as a method of assessment and intervention that may serve as an agent of such a shift by augmenting knowledge translation for the clinician.
What does digitalization hold for the creation of real-world evidence?
Authors: Pisaniello Huai Leng , Dixon William Gregory
Published: February 2019

Health-related information is increasingly being collected and stored digitally. These data, either structured or unstructured, are becoming the ubiquitous assets that might enable us to comprehensively map out a patient’s health journey from an asymptomatic state of wellness to disease onset and its trajectory. These new data could provide rich real-world evidence for better clinical care and research, if they can be accessed, linked and analyzed—all of which are possible. In this review, these opportunities will be explored through a case vignette of a patient with OA, followed by discussion on how this digitalized real-world evidence could best be utilized, as well as the challenges of data access, quality and maintaining public trust.
Moderate nutrient restriction of beef heifers alters expression of genes associated with tissue metabolism, accretion, and function in fetal liver, muscle, and cerebrum by day 50 of gestation1
Authors: Crouse Matthew S , Caton Joel S , Cushman Robert A , McLean Kyle J , Dahlen Carl R , Borowicz Pawel P , Reynolds Lawrence P , Ward Alison K
Published: February 2019

We hypothesized that a moderate maternal nutrient restriction during the first 50 d of gestation in beef heifers would affect transcript abundance of genes associated with tissue metabolism, accretion, and function in fetal liver, muscle, and cerebrum. Angus-cross heifers were estrus synchronized and assigned at breeding to one of two dietary treatments (CON- 100% of nutrient requirements to gain 0.45 kg/d; RES- 60% of CON). At day 50 of gestation, 14 heifers were ovariohysterectomized, and fetal liver, muscle, and cerebrum were collected. Transcriptome analysis via RNA-seq was conducted on the Illumina HiSeq 2500 platform using 50-bp paired-end reads at a depth of 2 × 10.4M reads/sample. Bioinformatic analysis was performed using the Tuxedo Suite and ontological analysis with DAVID 6.8. For fetal liver, muscle, and cerebrum, a total of 548, 317, and 151 genes, respectively (P < 0.01) were differentially expressed, of which 201, 144, and 28 genes, respectively were false discovery rate protected (FDR; q < 0.10). Differentially expressed genes were screened for fit into functional categories of pathways or ontologies associated with known impacts on tissue metabolism, accretion, and function. In fetal liver, five functional categories of interest (n = 125 genes) were affected by nutritional treatment: metabolic pathways, protein kinase, nucleosome core, mRNA splicing, and complement/coagulation cascades, of which 105 genes were upregulated in RES. In fetal muscle, three functional categories of interest (n = 106 genes) were affected by nutritional treatment: skeletal muscle, embryogenesis, and signaling cascades, of which 64 genes were upregulated in RES. In fetal cerebrum, three functional categories of interest (n = 60 genes) were affected by nutritional treatment: hippocampus and neurogenesis, metal-binding, and cytoskeleton, of which 58 genes were upregulated in RES. These results demonstrate that a moderate maternal nutrient restriction during the first 50 d of gestation in beef heifers alters transcript abundance of genes potentially impacting tissue metabolism, accretion, and function in fetal liver, muscle, and cerebrum. Furthermore, these results indicate that affected categories are tissue-specific and moderate maternal nutrient restriction generally increases expression of genes in fetuses from RES fed dams. Finally, these data lay the foundation upon which further research that identifies phenotypic responses to changes in these pathways may be elucidated.
Benefit of Higher Maximum Force Output on Listening Effort in Bone-Anchored Hearing System Users: A Pupillometry Study
Authors: Bianchi Federica , Wendt Dorothea , Wassard Christina , Maas Patrick , Lunner Thomas , Rosenbom Tove , Holmberg Marcus
Published: February 2019

Objectives:

The aim of this study was to compare listening effort, as estimated via pupillary response, during a speech-in-noise test in bone-anchored hearing system (BAHS) users wearing three different sound processors. The three processors, Ponto Pro (PP), Ponto 3 (P3), and Ponto 3 SuperPower (P3SP), differ in terms of maximum force output (MFO) and MFO algorithm. The hypothesis was that listeners would allocate lower listening effort with the P3SP than with the PP, as a consequence of a higher MFO and, hence, fewer saturation artifacts in the signal.

Design:

Pupil dilations were recorded in 21 BAHS users with a conductive or mixed hearing loss, during a speech-in-noise test performed at positive signal-to-noise ratios (SNRs), where the speech and noise levels were individually adjusted to lead to 95% correct intelligibility with the PP. The listeners had to listen to a sentence in noise, retain it for 3 seconds and then repeat it, while an eye-tracking camera recorded their pupil dilation. The three sound processors were tested in random order with a single-blinded experimental design. Two conditions were performed at the same SNR: Condition 1, where the speech level was designed to saturate the PP but not the P3SP, and condition 2, where the overall sound level was decreased relative to condition 1 to reduce saturation artifacts.

Results:

The P3SP led to higher speech intelligibility than the PP in both conditions, while the performance with the P3 did not differ from the performance with the PP and the P3SP. Pupil dilations were analyzed in terms of both peak pupil dilation (PPD) and overall pupil dilation via growth curve analysis (GCA). In condition 1, a significantly lower PPD, indicating a decrease in listening effort, was obtained with the P3SP relative to the PP. The PPD obtained with the P3 did not differ from the PPD obtained with the other two sound processors. In condition 2, no difference in PPD was observed across the three processors. The GCA revealed that the overall pupil dilation was significantly lower, in both conditions, with both the P3SP and the P3 relative to the PP, and, in condition 1, also with the P3SP relative to the P3.

Conclusions:

The overall effort to process a moderate to loud speech signal was significantly reduced by using a sound processor with a higher MFO (P3SP and P3), as a consequence of fewer saturation artifacts. These findings suggest that sound processors with a higher MFO may help BAHS users in their everyday listening scenarios, in particular in noisy environments, by improving sound quality and, thus, decreasing the amount of cognitive resources utilized to process incoming speech sounds.
Physician-Centered Outcomes for Skin Cancer Treatment: A Single-Day Modified Delphi Process to Assess the Importance of Themes in Skin Cancer Management
Authors: Rossi Anthony M. , Sobanko Joseph , Lawrence Naomi , Bordeaux Jeremy , Cartee Todd , Armbrecht Eric S. , Behera Anit , Baum Christian L. , Alam Murad , Maher Ian A.
Published: February 2019

BACKGROUND

Success in skin cancer treatment is determined through outcome measurement. Patients and physicians may prioritize different outcomes of care, and identification of such may enhance patient-centered care.

OBJECTIVE

To identify gaps between patient and physician attitudes toward skin cancer outcomes.

MATERIALS AND METHODS

A single-day, 21-patient, modified, in-person Delphi process to solicit and rate the importance of skin cancer–related outcomes was conducted. Twelve masked dermatologic surgeons rated patient-generated outcomes in a 2-round modified Delphi process. Each item was rated on a 1 to 9 scale (1, least important; 9, most important) using the Qualtrics web platform (Qualtrics, Provo, UT). Results of the physician ratings were compared with the patient ratings.

RESULTS

A list of 53 skin cancer treatment–related themes and outcomes was generated. Eight items were ranked by physicians as “very high” (>80% importance), 5 as “high” (>70% importance), 19 as intermediate, and 21 as low. The physician and patient panels' ratings were concordant for 56% of items, whereas 7 outcome items showed a 2-category discordance.

CONCLUSION

Physicians and patients were concordant regarding skin cancer treatment on multiple spheres. Areas of discordance include patient fear of unknown future risk, recurrence, or empowering patients to make treatment choices, and may be areas of continued improvement for delivery of patient-centered care.
Jowl Reduction With Deoxycholic Acid
Authors: Montes José Raúl , Santos Elizabeth , Chillar Annirudha
Published: February 2019

BACKGROUND

The study proposes a novel protocol for targeting the jowls using deoxycholic acid (DCA) injections, with emphasis on safety and feasibility of the procedure.

METHODS

This prospective study was conducted at a cosmetic practice between June 2016 and May 2017. Twelve consecutive patients seeking reduction/improvement in mild/moderate jowl fat were injected with DCA subcutaneously in a predefined circular area 1.0 cm above the mandibular border. Treatment response was assessed using physician-evaluated Global Aesthetic Improvement Scale (GAIS) and Subject GAIS.

RESULTS

Twelve patients (11 women and 1 man) with mild (n = 8) or moderate (n = 4) jowls were treated. After the first treatment, GAIS responses for 24 jowls showed 5 jowls with vast improvement, 15 with moderate improvement, and 4 with no change. After the second session for 5 jowls in 3 patients, GAIS responses showed vast improvement in 4 jowls and moderate improvement in 1. Adverse events included induration (n = 4), bruising (n = 6), numbness (n = 2), pain (n = 5), redness (n = 3), edema (n = 9), and dysphagia (n = 1).

CONCLUSION

Results of this early experience showed that DCA injections were safe and effective for nonsurgical jowl reduction.
Effect of 2 Novel Sustained-release Drug Release Systems on Bleb Fibrosis: An In Vivo Trabeculectomy Study in a Rabbit Model
Authors: Swann Forrest B. , Singh Sujata , Blake Diane , John Vijay , Le Crystal , Fullerton Mitchell , Margo Curtis , Zhang Ze , Muddasani Nishika , Wall Jennifer , Satija Celine , Greenberg Erin , Mancera Norberto , Zurakowski David , Ayyala Ramesh S.
Published: February 2019

Precis:

Rabbit model studies suggested better morphology blebs with equal intraocular pressure (IOP) efficacy as a standard mitomycin C (MMC) trabeculectomy using a novel slow-release drug delivery antifibrotic system delivering small quantities of MMC and 5-fluorouracil (5-FU).

Purpose:

To evaluate 2 different concentrations of biodegradable poly(lactic-co-glycolic acid) (PLGA) system with 5-FU and MMC (ElutiGLASS) for their ability to reduce fibrosis and compare the results with standard trabeculectomy with MMC in a rabbit model.

Materials and Methods:

New Zealand albino rabbits (19) were divided into 3 groups (A, B, C) and standard trabeculectomy operation was performed in the right eye of each rabbit.

Group (A) had trabeculectomy with MMC (0.4 mg/mL) applied using a Weck cell sponge; (B) trabeculectomy with slow-release ElutiGLASS (0.23 mg, 5-FU/0.33 μg MMC released over 23 to 30 d); (C) trabeculectomy with rapid release ElutiGLASS (0.45 mg of 5-FU/0.65 μg MMC, released over 5 to 7 d). The rabbits were followed for 3 months before euthanasia.

Results:

Bleb morphology, vascularity, and fibrosis were less pronounced in groups B and C when compared with group A at 3 months. Group B appears to have a lower and more diffuse bleb appearance compared with the other 2 groups with honeycomb appearance on both clinical examination and ultrasound biomicroscopy imaging with higher percentage of maintained bleb space (83%), less fibrosis than group A while maintaining the same low inflammation score as the other 2 groups on histology. At 3 months, the PLGA polymer had completely disappeared in all rabbits. There were no statistical differences in the degree of IOP reduction or histologic inflammation, among the 3 groups.

Conclusions:

We successfully created a sustained-release antifibrotic drug delivery system that delivered known dosage of the drugs at doses that are significantly lower than the current standard, and resulted in less fibrosis while maintaining a healthy bleb and equal reduction of IOP.

Translational Relevance:

These results are supportive of the antifibrotic effect of the slow-release drug delivery system used in conjunction with trabeculectomy, thus paving the way for human pilot studies to improve and simplify existing surgical techniques for filtering surgeries in glaucoma.
Role of motor and cognitive tasks in gait of individuals with mild cognitive impairment
Authors: Goyal Nikita , Luna Geraldine , Curuk Etem , Aruin Alexander S.
Published: February 2019

Older adults with mild cognitive impairment (MCI) experience difficulties with memory and task execution. Walking while performing a secondary task could affect gait of individuals with MCI and increase fall risk. The aim of the study was to investigate gait in individuals with MCI performing motor and cognitive secondary tasks. Eight individuals with MCI and eight age-matched healthy older adults walked over the GAITRite walkway under three different conditions: with no secondary task, while carrying a glass of water in their dominant hand (motor task), and while reciting alphabet [cognitive task (CT)]. Gait velocity, cadence, step length, and stride length were calculated. With no secondary task individuals with MCI as compared with the healthy older adults walked slower (P < 0.001) and with shorter step and stride length. When a secondary task was added, gait performance of the individuals with MCI deteriorated even more. The largest decline in gait was seen during the performance of the CT as compared with motor task (P < 0.001). The outcome provides a basis for future studies of the effect of the secondary motor task and CT in the identification of MCI as well as in planning rehabilitation interventions.
The Louisiana Wellness Centers Program for HIV/STD Prevention Among Gay and Bisexual Men and Transgender Persons
Authors: Burgess Samuel , Beltrami John , Kearns Laura , Gruber DeAnn
Published: February 2019

Context:

During the conduct of the described demonstration project (2012-2015), the Centers for Disease Control and Prevention funding standard for HIV testing was 1.0% newly diagnosed positivity in non-health care settings. For linkage to HIV medical care, the National HIV/AIDS Strategy goal was 85%, and the funding standard was 80% (the Centers for Disease Control and Prevention and National HIV/AIDS Strategy had no other quantified goals/standards relevant to the project).

Objective:

To determine aggregate quantitative results of HIV/STD testing and engagement in HIV care.

Design:

Information sources used for this case study analysis included the Louisiana Department of Health funding application, progress and final reports submitted to the Centers for Disease Control and Prevention, and records of communications between these agencies.

Setting:

Six community-based Wellness Centers throughout Louisiana.

Participants:

Gay and bisexual men and transgender persons.

Main Outcome Measures:

New HIV/STD diagnoses from testing, linkage to HIV care, and reengagement in HIV medical care.

Results:

The percentage of persons who were newly diagnosed with HIV was 1.4% (44/3214). Of the newly diagnosed persons, 91% (40/44) were linked to HIV medical care. Of persons who were identified as out of care, 83% (5/6) were reengaged in HIV medical care. STD testing results showed that 9.0% (294/3251) of the syphilis tests were positive, and 8.3% (803/9719) of the chlamydia/gonorrhea tests were positive. The pharyngeal chlamydia/gonorrhea positivity was 7.6% (256/3375); the rectal chlamydia/gonorrhea positivity was 13% (374/2948); and the urine chlamydia/gonorrhea positivity was 5.1% (173/3396).

Conclusions:

The demonstration project was successful. The results were used to discontinue funding for a less effective HIV screening program, continue demonstration project activities with other funds, and make policy changes so that extragenital screening for chlamydia/gonorrhea is now the standard at Louisiana clinics that serve gay and bisexual men and transgender persons.
Hyaluronic Acid–Povidone-Iodine Compound Facilitates Diabetic Wound Healing in a Streptozotocin-Induced Diabetes Rodent Model
Authors: Chen Rong-Fu , Wang Chun-Ting , Chen Yu-Hua , Chien Ching-Ming , Lin Sin-Daw , Lai Chung-Sheng , Wang Ching-Jen , Kuo Yur-Ren
Published: February 2019

Background:

This study investigated whether a hyaluronic acid–povidone-iodine compound can enhance diabetic wound healing.

Methods:

A dorsal skin defect (6 × 5 cm) in a streptozotocin-induced diabetes rodent model was used. Seventy male Wistar rats were divided into seven groups: I, normal control; II, diabetic control, no treatment; III, diabetic rats, lower molecular weight (100 kDa) hyaluronic acid; IV, rats, higher molecular weight (1000 kDa) hyaluronic acid; V, rats, 0.1% povidone-iodine; VI, rats, lower molecular weight hyaluronic acid plus povidone-iodine; and VII, rats, higher molecular weight hyaluronic acid plus povidone-iodine. Histologic examination was performed with hematoxylin and eosin staining. CD45, Ki-67, prolyl 4-hydroxylase, and vascular endothelial growth factor were evaluated with immunohistochemical staining.

Results:

Compared with the control, higher molecular weight hyaluronic acid plus povidone-iodine–treated rats had significantly reduced wound area (p < 0.001). Higher molecular weight hyaluronic acid plus povidone-iodine increased wound healing time when compared with higher molecular weight hyaluronic acid, povidone-iodine, or lower molecular weight hyaluronic acid plus povidone-iodine. Histology revealed significantly increased neovessels and suppressed inflammatory response in the higher molecular weight hyaluronic acid plus povidone-iodine group when compared with the control group. Immunohistochemical staining revealed significantly increased Ki67, prolyl 4-hydroxylase, and vascular endothelial growth factor expression, and suppressed CD45 expression in the higher molecular weight hyaluronic acid plus povidone-iodine group when compared with the other groups.

Conclusion:

Higher molecular weight hyaluronic acid plus povidone-iodine complex dressing significantly facilitated diabetic wound healing via increasing neovascularization and tissue regeneration and suppressing a proinflammatory response.
Reshaping the Oversized Waist through Oblique Flankplasty with Lipoabdominoplasty
Authors: Hurwitz Dennis J. , Beidas Omar , Wright Lauren
Published: February 2019

Background:

Designed in response to the failure of circumferential lower body lifts to deepen waists, oblique flankplasty with lipoabdominoplasty aesthetically reshapes not only the waist, but also the hips, buttocks, and upper lateral thighs with minimal morbidity.

Methods:

The oblique flankplasty with lipoabdominoplasty technique was standardized, with 5 of 56 cases presented. Operative records on the lower torso from March of 2000 to January of 2018 yielded 30 initial oblique flankplasty with lipoabdominoplasty cases and hundreds of lower body lifts. A subset of randomly selected lower body lift and flank liposuction operations yielded 91 cases. Through SurveyMonkey, the authors and 16 unbiased observers graded flank and global deformity using the Pittsburgh Rating and novel posterior trunk aesthetics scales.

Results:

The oblique flankplasty with lipoabdominoplasty deepened and smoothly transitioned waists. Medial rotation of the lateral buttocks over the posterior iliac spine retained lateral fullness and established hip prominence. Central buttock laxity was corrected without intergluteal cleft lengthening. The immediate result persisted, satisfying high patient expectations. There were three minor complications and three nonexcisional revisions, with no unscheduled hospital admissions. The mean flank deformity for all cases was 1.93 was by chi-square analysis, which was significantly more than 0.88 for postoperative deformity (p < 0.001). Subgroup analysis of each procedure group showed a significant reduction in deformity. Comparing flankplasty with lower body lift, oblique flankplasty with lipoabdominoplasty had slightly greater flank deformity and far greater reduction in deformity and overall aesthetic improvement.

Conclusions:

For grade 2 and 3 flank deformities, oblique flankplasty with lipoabdominoplasty provides a tighter skinned lower torso with gender-appropriate curvatures, including a deeper and more smoothly transitioned waist than lower body lift, leading to uniform patient satisfaction. There was minimal secondary deformity or complications.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Maintaining Updated Patient’s Medication Records: Introduction of an Order-on-Behalf Service by Pharmacists
Authors: Chen Chunliang , Hie Szu Liang , Ng Ai Shing
Published: February 2019

Introduction

Accurate medication records are integral to healthcare, especially for obstetrics and gynecology and pediatric patients. When pharmacists perform verbal interventions with prescribers, these were often not updated in the patients’ medication records. To address this issue, the order-on-behalf (OOB) service by pharmacists was implemented in late November 2015, with the aim of providing timely updates of patients’ medication records. The impact of service will be evaluated in this article.

Methods

The OOB records from December 2015 to April 2017 were collected and reviewed. Details collected include patient type, date performed, date of prescription, and details of interventions. Respective pharmacists who entered the orders were approached for further clarifications, where required. This was a process improvement project exempted from review.

Results

A total of 1501 entries (824 for women, 677 for children) were reviewed. Top three medication-related problems identified were inappropriate dosage regimen (845), improper drug selection (185), and therapeutic substitution (226). The most commonly implicated drugs were hormones (28%) and antibiotics (18%) for obstetrics and gynecology–related entries and antibiotics (27%) and antiepileptic drugs (6%) for pediatric-related entries.

Conclusions

The OOB service has updated many patients’ medication records. Having updated records enhances patient safety because it provides the most accurate information for the prescribers at the next patient visit. Review of OOB data identified the most common types of medication-related problems, as well as the patient subtypes involved. This provides a platform for future work to be performed on system optimizations to improve patient safety.
Evaluation of Opioid Prescriptions After Urogynecologic Surgery Within a Large Health Care Organization: How Much Are We Prescribing?
Authors: Buono Kristen , Brueseke Taylor , Wu Jun , Whitcomb Emily
Published: February 2019

Objectives

Data regarding postoperative opioid prescriptions for patients undergoing urogynecologic surgery are sparse. Our objective was to quantify surgeon prescribing patterns for patients undergoing surgery for pelvic organ prolapse or stress urinary incontinence.

Methods

Patients who underwent surgery for pelvic organ prolapse or SUI within a large health care maintenance organization were identified by procedural codes within the electronic medical record. Medical records were reviewed for demographic and clinical data. Our primary objective was to describe initial postoperative morphine milligram equivalent (MME) dosages for patients undergoing various urogynecologic surgeries. Secondary objectives were to evaluate rates of postoperative non-opioid analgesic prescriptions, presence of additional postoperative opioid prescriptions within 90 days of surgery, and to characterize prescribing patterns of surgeons from different specialties.

Results

We evaluated 855 patients undergoing 7 urogynecologic surgeries. There was wide variation in the quantity of MME prescribed to patients undergoing different urogynecologic surgeries, and the mean MME ranged from 137.6 mg after a colpocleisis to 214.1 mg after a laparoscopic uterosacral ligament suspension. Less than two thirds of patients received a postoperative nonsteroidal anti-inflammatory drug (NSAID) prescription, and rates of NSAID prescriptions varied widely between surgeons from different specialties. Thirty-nine (4.6%) patients received an additional postoperative opioid prescription specifically for the indication of persistent postoperative pain.

Conclusions

There is wide variation in the range of MME prescribed postoperatively to patients undergoing common urogynecologic surgeries. Less than two thirds of patients received a postoperative NSAID prescription, which was found to be independently associated with a higher postoperative opioid prescription dose.
Faster, higher, stronger: timely and robust cell fate/identity commitment in stem cell lineages
Authors: Liu Kun , Xu Ke , Song Yan
Published: February 2019

Precise specification of cell fate or identity within stem cell lineages is critical for ensuring correct stem cell lineage progression and tissue homeostasis. Failure to specify cell fate or identity in a timely and robust manner can result in developmental abnormalities and diseases such as cancer. However, the molecular basis of timely cell fate/identity specification is only beginning to be understood. In this review, we discuss key regulatory strategies employed in cell fate specification and highlight recent results revealing how timely and robust cell fate/identity commitment is achieved through transcriptional control.
Microplastics and synthetic particles ingested by deep-sea amphipods in six of the deepest marine ecosystems on Earth
Authors: Jamieson A. J. , Brooks L. S. R. , Reid W. D. K. , Piertney S. B. , Narayanaswamy B. E. , Linley T. D.
Published: February 2019

While there is now an established recognition of microplastic pollution in the oceans, and the detrimental effects this may have on marine animals, the ocean depth at which such contamination is ingested by organisms has still not been established. Here, we detect the presence of ingested microplastics in the hindguts of Lysianassoidea amphipod populations, in six deep ocean trenches from around the Pacific Rim (Japan, Izu-Bonin, Mariana, Kermadec, New Hebrides and the Peru-Chile trenches), at depths ranging from 7000 m to 10 890 m. This illustrates that microplastic contaminants occur in the very deepest reaches of the oceans. Over 72% of individuals examined (65 of 90) contained at least one microparticle. The number of microparticles ingested per individual across all trenches ranged from 1 to 8. The mean and standard error of microparticles varied per trench, from 0.9 ± 0.4 (New Hebrides Trench) to 3.3 ± 0.7 (Mariana Trench). A subsample of microfibres and fragments analysed using FTIR were found to be a collection of plastic and synthetic materials (Nylon, polyethylene, polyamide, polyvinyl alcohol, polyvinylchloride, often with inorganic filler material), semi-synthetic (rayon and lyocell) and natural fibre (ramie). Notwithstanding, this study reports the deepest record of microplastic ingestion, indicating that anthropogenic debris is bioavailable to organisms at some of the deepest locations in the Earth's oceans.
Language structure is influenced by the number of speakers but seemingly not by the proportion of non-native speakers
Authors: Koplenig Alexander
Published: February 2019

Large-scale empirical evidence indicates a fascinating statistical relationship between the estimated number of language users and its linguistic and statistical structure. In this context, the linguistic niche hypothesis argues that this relationship reflects a negative selection against morphological paradigms that are hard to learn for adults, because languages with a large number of speakers are assumed to be typically spoken and learned by greater proportions of adults. In this paper, this conjecture is tested empirically for more than 2000 languages. The results question the idea of the impact of non-native speakers on the grammatical and statistical structure of languages, as it is demonstrated that the relative proportion of non-native speakers does not significantly correlate with either morphological or information-theoretic complexity. While it thus seems that large numbers of adult learners/speakers do not affect the (grammatical or statistical) structure of a language, the results suggest that there is indeed a relationship between the number of speakers and (especially) information-theoretic complexity, i.e. entropy rates. A potential explanation for the observed relationship is discussed.
Generalizability is not optional: insights from a cross-cultural study of social discounting
Authors: Tiokhin Leonid , Hackman Joseph , Munira Shirajum , Jesmin Khaleda , Hruschka Daniel
Published: February 2019

Current scientific reforms focus more on solutions to the problem of reliability (e.g. direct replications) than generalizability. Here, we use a cross-cultural study of social discounting to illustrate the utility of a complementary focus on generalizability across diverse human populations. Social discounting is the tendency to sacrifice more for socially close individuals—a phenomenon replicated across countries and laboratories. Yet, when adapting a typical protocol to low-literacy, resource-scarce settings in Bangladesh and Indonesia, we find no independent effect of social distance on generosity, despite still documenting this effect among US participants. Several reliability and validity checks suggest that methodological issues alone cannot explain this finding. These results illustrate why we must complement replication efforts with investment in strong checks on generalizability. By failing to do so, we risk developing theories of human nature that reliably explain behaviour among only a thin slice of humanity.
Citizen science in Lebanon—a case study for groundwater quality monitoring
Authors: Baalbaki Rima , Ahmad Serine Haidar , Kays Wassim , Talhouk Salma N. , Saliba Najat A. , Al-Hindi Mahmoud
Published: February 2019

Over the past decade, several citizen science projects have been launched, with a smaller subset addressing citizen scientists' involvement in water quality monitoring. Most of these projects were conducted in developed countries and focused on qualitative assessment and measurements of a limited number of water quality parameters. Moreover, data generated by citizen scientists were mainly for monitoring purposes and rarely resulted in remedial measures. In this work, a collaborative citizen science approach involving local citizens and university researchers was applied to assess the groundwater quality in a Lebanese village. Using a mobile laboratory, winter and summer sampling campaigns were conducted and 12 physical, chemical and biological water quality parameters were tested. Results indicated that the data generated by the citizen scientists were comparable with those generated by university researchers for the majority of physical and chemical water quality parameters. However, the bacteriological test results showed a marked difference and may be attributed to the complexity of the testing procedure and quality of testing material. The collaborative and participatory approach resulted in building local capacity and knowledge and in the formation of a locally elected water committee which will be responsible for continuous monitoring of the groundwater resources.
Multi- and instabilities in gas partitioning between nanoporous materials and rubber balloons
Authors: Simon Cory M. , Carraro Carlo
Published: February 2019

In the two-balloon experiment, two rubber balloons are connected and allowed to exchange gas. Owing to the non-monotonic relationship between the radius of the balloon and the pressure of gas inside it, the two-balloon system presents multi- and in-stabilities. Herein, we consider a two-adsorbent system, where two different adsorbents are allowed to exchange gas. We show that, for rigid adsorbents, the thermodynamic equilibrium state is unique. Then, we consider an adsorbent–balloon system, where an adsorbent exchanges gas with a rubber balloon. This system can exhibit multiple states at thermodynamic equilibrium– two (meta)stable and one unstable. The size of the balloon, pressure of gas in the balloon, and partitioning of gas between the adsorbent and the balloon differ among the equilibrium states. Temperature changes and the addition/removal of gas into/from the adsorbent–balloon system can induce catastrophe bifurcations and show hysteresis. Furthermore, the adsorbent–balloon system exhibits a critical temperature where, when approached from below, the discrepancy of balloon size between the two (meta)stable states decreases and, beyond, bistability is impossible. Practically, our findings preclude multiple partitions of adsorbed gas in rigid, mixed-linker or stratified metal-organic frameworks and may inspire new soft actuator and sensor designs.
Rigidity for sticky discs
Authors: Connelly Robert , Gortler Steven J. , Theran Louis
Published: February 2019

We study the combinatorial and rigidity properties of disc packings with generic radii. We show that a packing of
n
discs in the plane with generic radii cannot have more than 2
n
 − 3 pairs of discs in contact. The allowed motions of a packing preserve the disjointness of the disc interiors and tangency between pairs already in contact (modelling a collection of sticky discs). We show that if a packing has generic radii, then the allowed motions are all rigid body motions if and only if the packing has exactly 2
n
 − 3 contacts. Our approach is to study the space of packings with a fixed contact graph. The main technical step is to show that this space is a smooth manifold, which is done via a connection to the Cauchy–Alexandrov stress lemma. Our methods also apply to jamming problems, in which contacts are allowed to break during a motion. We give a simple proof of a finite variant of a recent result of Connelly
et al.
(Connelly
et al
. 2018 (
http://arxiv.org/abs/1702.08442
)) on the number of contacts in a jammed packing of discs with generic radii.