bluuebunny/crossref_metadata_2025 huggingface dataset:
Retrosigmoid Approach for Trapping and Removal of a Distal Dissecting Superior Cerebellar Artery Aneurysm in a Child
Authors: Ros de San Pedro Javier
Published: October 2018

Objectives To demonstrate the feasibility of the retrosigmoid craniotomy for surgical management of vascular lesions located in the cerebellopontine angle (CPA).

Method A previously healthy 2-year-old boy presented a sudden episode of torticollis to the left while sleeping. This episode was selflimited but it occurred two more times in a 6-day span. Torticollis worsened in the upright position, caused unsteady gait and refusal to walk from the child. The preoperative magnetic resonance imaging (MRI) showed the presence of a round, heterogenous vascular lesion in the left CPA. The lesion clearly enhanced after contrast administration. The preoperative angiography demonstrated the absence of left anterior inferior cerebellar artery anterior inferior cerebellar artery (AICA), being the left superior cerebellar artery (SCA) the supplier of the left lateral cerebellum. A blurred blush on the distal left SCA was compatible with a fusiform aneurysm. A standard retrosigmoid approach was planned for trapping and removal of the aneurysm.

Results Through a left retrosigmoid craniotomy the aneurysm was approached, along with the different neurovascular structures of the CPA. The aneurysm leaned on the VII, VIII nerves complex and the superior petrosal vein, while tightly attached to the lateral cerebellum. Both proximal and distal SCA segments to the aneurysm were dissected, clipped, and divided for a complete trapping. Finally, the aneurysm was completely detached and removed in a whole piece. The patient fully recovered after surgery with no relapse of his symptoms.

Conclusion The retrosigmoid craniotomy is a versatile approach that permits wide exposure of all CPA structures and adequate removal of distal aneurysms located in those cerebellar arteries supplying the lateral cerebellum.

The link to the video can be found at: https://youtu.be/oEVfy4goFYM.
Development of new experimental setup focusing on long-pulse magnetic reconnection by using rotating magnetic field technique
Authors: Yanai R. , Takahata Y. , Inomoto M.
Published: October 2018

A new closed-type experimental setup to achieve a long-pulse magnetic reconnection in weakly ionized plasmas was developed by using a rotating magnetic field (RMF) technique. The experimental setup has a cylindrical vacuum vessel in which two sets of four antennas are equipped to generate RMF which drives steady azimuthal electron current in two torus plasmas. This device provided a quasi-steady magnetic reconnection condition in weakly ionized plasmas with ionization fraction of less than 1%. The proposed experimental setup will extend the research area of laboratory reconnection experiments and be helpful to comprehend the reconnection process in weakly ionized plasmas such as solar chromosphere.
Interchange transport in electron-positron plasmas with ion impurities
Authors: Kendl Alexander
Published: October 2018

Interchange drive and cross-field transport of density filaments in quasi-neutral inhomogeneously magnetized electron-positron plasmas is shown to be strongly reduced by the presence of minority ions. Two mechanisms are identified for the reduction in radial propagation and plasma transport: effective mass related inertia and collisionality dependent Boltzmann spin-up of the filaments. Numerical results are obtained with a three-dimensional full-F multi-species gyrofluid model.
Shoulder pain cost-of-illness in patients referred for public orthopaedic care in Australia
Authors: Marks Darryn , Comans Tracy , Bisset Leanne , Thomas Michael , Scuffham Paul A.
Published: October 2018

Objective The aim of this study was to calculate the societal economic burden of shoulder pain in patients on the orthopaedic waiting list at an Australian public hospital and calculate the cost (from the government’s perspective) of care delivered by the hospital for those patients. Methods A cost-of-illness analysis was undertaken in a cohort of 277 orthopaedic patients on the Gold Coast in Australia. Outcomes included a health care costs and impacts questionnaire, work absenteeism, presenteeism questionnaires (Work Limitations Questionnaire (WLQ) and Work Productivity and Activity Impairment Questionnaire (WPAI)) and hospital care provision over a 2-year period. Results The mean societal cost of healthcare and domestic support was AU$20.72 per day (AU$7563 annually) per patient on the orthopaedic waiting list. When absenteeism and presenteeism were included, the cost per patient who was employed was AU$38.04 per day (AU$13 885 annually) calculated with the WLQ and AU$61.31 per day (AU$22 378 annually) calculated with the WPAI. The mean per-patient cost to government of public hospital care was AU$2622 in Year 1 and AU$3835.78 (s.d. 4961.28) over 2 years. The surgical conversion rate was 22%, and 51% of hospital care cost was attributable to outpatient services. Conclusions Public orthopaedic shoulder waiting lists create a large economic burden for society; few referrals require surgery and just over half the hospital care costs are for out-patient services. New models of care that better manage shoulder pain and identify surgical candidates before orthopaedic referral could reduce this burden. What is known about the topic? Little is known about the cost of shoulder pain in Australia, or the cost of patients referred for public orthopaedic care. What does this paper add? This article quantifies the costs of shoulder pain and the value of lost production from shoulder pain. The time spent waiting for public hospital orthopaedic appointments and the costs associated with waiting demonstrate that the time spent on a waiting list is a key driver of the economic burden. What are the implications for practitioners? Greater resourcing to reduce public orthopaedic shoulder waiting lists may be helpful, but system change is also required. Earlier and more accurate identification of surgical cases could reduce inefficient referrals and improve hospital productivity. Collaboration between clinicians and policy makers is needed to design more economically efficient shoulder care.
The flooding tolerance of two critical habitat-forming wetland shrubs, Leptospermum lanigerum and Melaleuca squarrosa, at different life history stages
Authors: Zacks Georgina , Greet Joe , Walsh Christopher J. , Raulings Elisa
Published: October 2018

Understanding the effect of water regime on the different life history stages of woody wetland plants is essential to managing their persistence. The common and widespread myrtaceous shrub species, Melaleuca squarrosa Donn. ex Sm. and Leptospermum lanigerum (Aiton) Sm., provide habitat for two critically endangered fauna within the Yellingbo Nature Conservation Reserve (south-eastern Australia), but are in decline putatively because of the altered flooding regimes. We, thus, tested the effects of flooding depth and duration on their seed germination and seedling establishment, and seedling growth and survival in two separate glasshouse experiments. We also compared the condition of mature plants of both species at an intermittently flooded (reference) site, and two near permanently flooded (impact) sites. Seeds of both species were able to germinate underwater, but early flooding reduced seedling establishment. Seedling growth of both species was greater in waterlogged than in well drained or inundated conditions, whereas no seedlings of either species survived >8 weeks of submergence. Leptospermum lanigerum seedlings were generally more flood tolerant than were M. squarrosa seedlings. Correspondingly, crown condition of mature M. squarrosa, but not L. lanigerum, was poorer at impact than reference sites. Prolonged flooding in swamp forests is likely to (1) limit woody plant recruitment, because flooding reduces seedling establishment, growth and survival, and (2) be deleterious to the maintenance of less flood-tolerant species (e.g. M. squarrosa). Moist exposed substrate is likely to be best for promoting the recruitment of both study species, and intermittent flooding for maintaining adult M. squarrosa plants.
Corrigendum to: Molecular phylogenetics and taxonomic reanalysis of the family Mithracidae MacLeay (Decapoda : Brachyura : Majoidea)
Authors: Windsor Amanda M. , Felder Darryl L.
Published: October 2018

Mithracid crabs comprise a primarily subtidal reef- and rubble-dwelling group inhabiting both tropical and subtropical seas. Despite their relative ubiquity in many hard-substrate environments, there has been little consensus about their phylogenetic relationships or whether their group rank should be that of subfamily or family. We have used a combined molecular dataset of two nuclear (18S, H3) and three mitochondrial (12S, 16S, COI) genes to build a preliminary molecular phylogeny of Majoidea in order to examine the membership of Mithracidae. We then built a second molecular phylogeny based on three mitochondrial genes to assess the internal composition of the family, and conducted comparative morphological examinations of genera and species that resolved in unexpected positions on the phylogram. Four genera are designated under new or resurrected names on the basis of molecular and morphological characters, while memberships of several other existing genera are modified. Following review of molecular and morphological characters, the genera Coelocerus, Cyclocoeloma, Cyphocarcinus, Leptopisa, Micippa, Picrocerodes, Stenocionops and Tiarinia are provisionally excluded from Mithracidae s.s., while Hemus and Pitho are included in it. A key to genera of Mithracidae is provided.
A revision of eastern Australian land snails placed in Nitor Gude (Helicarionidae, Stylommatophora)
Authors: Hyman Isabel T. , Köhler Frank
Published: October 2018

Nitor Gude, 1911 is a genus of helicarionid land snails currently comprising eight species ranging from southern New South Wales to northern Queensland. We comprehensively revise the taxonomy of this group based on comparative morphology and on mitochondrial genes cytochrome c oxidase subunit I and 16S rRNA, provide a new generic diagnosis, revise species descriptions and describe four new species. Two species, ‘N.’ reisi Stanisic, 2010 from northern Queensland and ‘N.’ whitneyae Stnaisic, 2010 from mid-eastern Queensland, are removed from Nitor. Revised species descriptions are given for N. subrugatus (Reeve, 1852), N. medioximus Iredale, 1941, N. circumcinctus (Cox, 1868), N. wiangariensis Hyman, 2007 and N. pudibundus (Cox, 1868); N. helmsianus Iredale, 1941 (previously considered a synonym of N. subrugatus) is reinstated; and new species N. glenugie, N. sheai, N. benjamini and N. pipinna are described. Helix graftonensis Cox, 1864 is synonymised with N. subrugatus. We demonstrate that Nitor is closely related to Lord Howe Island taxa Epiglypta Pilsbry, 1893, Gudeoconcha Iredale, 1944, Howearion Iredale, 1944 and Parmellops Iredale, 1944; the five genera are united by a combination of characters including the presence of a distinct vagina, a slender epiphallic flagellum forming a simple spermatophore and an epiphallic caecum with terminal attachment of the penial retractor muscle.
Comparing continual task learning in minds and machines
Authors: Flesch Timo , Balaguer Jan , Dekker Ronald , Nili Hamed , Summerfield Christopher
Published: October 2018

Significance

Humans learn to perform many different tasks over the lifespan, such as speaking both French and Spanish. The brain has to represent task information without mutual interference. In machine learning, this “continual learning” is a major unsolved challenge. Here, we studied the patterns of errors made by humans and state-of-the-art neural networks while they learned new tasks from scratch and without instruction. Humans, but not machines, seem to benefit from training regimes that blocked one task at a time, especially when they had a prior bias to represent stimuli in a way that encouraged task separation. Machines trained to exhibit the same prior bias suffered less interference between tasks, suggesting new avenues for solving continual learning in artificial systems.
Effect of concentration on the structure of isothermally-annealed CuZr metallic glasses
Authors: Yue X. X. , Liu C. T. , Pan S. Y. , Inoue A. , Liaw P. K. , Fan C.
Published: October 2018

To clarify the influence of isothermal annealing on CuxZr100-x ( x = 36, 44, 50, 56, and 64) metallic glasses, the annealing process was conducted using molecular dynamics (MD) simulation. The local structure is analysed by means of the radial distribution functions, Voronoi tessellation and the nearest-neighbour correlation index, Cij. The results show that Cu-centered < 0 0 12 0 > and Zr-centered < 0 0 12 4 > dramatically increases after an isothermal annealing treatment and presents a strong tendency of being the nearest neighbour with each other, as the Cu concentration is over 50%. These two kinds of clusters are formed the Cu2Zr Laves phase which can be directly observed in the Cu-rich glasses.
‘Framing social policy and populism in a changing European context’
Authors: Ketola Markus , Nordensvard Johan
Published: October 2018

This themed section focuses on the political and social policy discourses of resurgent welfare chauvinism and identity politics in contemporary Europe. The populist radical right, in particular, has utilised these discourses to great effect, reframing social policy and social citizenship through a heady mix of arguments evoking the nation state and ethnicity, often contemporaneously. Although the explanations for the outcome of the referendum on the withdrawal of the United Kingdom from the European Union, or Brexit, cannot be distilled to any single issue or cause, it is also impossible to deny the relevance of social policy to the outcome. For example, vote choice in the referendum was influenced by factors such as education levels and levels of labour market vulnerability (Hobolt, 2016), ultimately dovetailing with the well-known thesis about globalisation's ‘winners’ and ‘losers’ (Kitschelt & McGann, 1995; Mudde, 2007; Rydgren, 2007; Kriesi et al., 2012) and the structural failures of post-industrial economies to stop growing inequality.
UNC Perceived Message Effectiveness: Validation of a Brief Scale
Authors: Baig Sabeeh A , Noar Seth M , Gottfredson Nisha C , Boynton Marcella H , Ribisl Kurt M , Brewer Noel T
Published: October 2018

Background

Interventionists commonly identify promising messages for health communication efforts based on audience members’ ratings of perceived message effectiveness (PME).

Purpose

We sought to validate a new PME measure that improved on existing scales by focusing on the behavior and respondent, being brief, and having strong psychometric properties.

Methods

Participants were a national convenience sample of 999 adults and national probability samples of 1,692 adults and 869 adolescents recruited in 2015. Smokers and nonsmokers rated up to six brief messages about the chemicals in cigarette smoke on two PME scales. The first was the new three-item University of North Carolina (UNC) PME Scale that assessed effects perceptions. The second was an established six-item PME scale that assessed message perceptions. We examined the UNC PME Scale’s psychometric properties and compared both scales using item factor analysis.

Results

The UNC PME Scale measured the same construct across multiple chemical messages (all factor loadings ≥ 0.86). It exhibited high reliability (>0.85) over very low to moderate levels of PME (z = −2.5 to 0.2), a range that is useful for identifying more promising messages. Samples of adults and adolescents showed a similar pattern of results. As expected, the UNC PME Scale was strongly positively correlated with message perceptions (r = .84). It also exhibited strong psychometric properties among participants regardless of education, reactance, sex, and smoking status.

Discussion

The UNC PME Scale reliably and validly measured PME among adults and adolescents from diverse groups. This brief scale may be used to efficiently evaluate candidate antismoking messages and may be suitable for adaptation to other health risk behaviors.
Subdistribution hazard models for competing risks in discrete time
Authors: Berger Moritz , Schmid Matthias , Welchowski Thomas , Schmitz-Valckenberg Steffen , Beyersmann Jan
Published: October 2018

A popular modeling approach for competing risks analysis in longitudinal studies is the proportional subdistribution hazards model by Fine and Gray (1999. A proportional hazards model for the subdistribution of a competing risk. Journal of the American Statistical Association94, 496–509). This model is widely used for the analysis of continuous event times in clinical and epidemiological studies. However, it does not apply when event times are measured on a discrete time scale, which is a likely scenario when events occur between pairs of consecutive points in time (e.g., between two follow-up visits of an epidemiological study) and when the exact lengths of the continuous time spans are not known. To adapt the Fine and Gray approach to this situation, we propose a technique for modeling subdistribution hazards in discrete time. Our method, which results in consistent and asymptotically normal estimators of the model parameters, is based on a weighted ML estimation scheme for binary regression. We illustrate the modeling approach by an analysis of nosocomial pneumonia in patients treated in hospitals.
Continuity and Discontinuity in Human Cortical Development and Change From Embryonic Stages to Old Age
Authors: Fjell Anders M , Chen Chi-Hua , Sederevicius Donatas , Sneve Markus H , Grydeland Håkon , Krogsrud Stine K , Amlien Inge , Ferschmann Lia , Ness Hedda , Folvik Line , Beck Dani , Mowinckel Athanasia M , Tamnes Christian K , Westerhausen René , Håberg Asta K , Dale Anders M , Walhovd Kristine B
Published: October 2018

The human cerebral cortex is highly regionalized, and this feature emerges from morphometric gradients in the cerebral vesicles during embryonic development. We tested if this principle of regionalization could be traced from the embryonic development to the human life span. Data-driven fuzzy clustering was used to identify regions of coordinated longitudinal development of cortical surface area (SA) and thickness (CT) (n = 301, 4–12 years). The principal divide for the developmental SA clusters extended from the inferior–posterior to the superior–anterior cortex, corresponding to the major embryonic morphometric anterior–posterior (AP) gradient. Embryonic factors showing a clear AP gradient were identified, and we found significant differences in gene expression of these factors between the anterior and posterior clusters. Further, each identified developmental SA and CT clusters showed distinguishable life span trajectories in a larger longitudinal dataset (4–88 years, 1633 observations), and the SA and CT clusters showed differential relationships to cognitive functions. This means that regions that developed together in childhood also changed together throughout life, demonstrating continuity in regionalization of cortical changes. The AP divide in SA development also characterized genetic patterning obtained in an adult twin sample. In conclusion, the development of cortical regionalization is a continuous process from the embryonic stage throughout life.
Who Gets Lost, and What Difference Does It Make? Mixed Modes, Nonresponse Follow-up Surveys and the Estimation of Turnout
Authors: Goldberg Andreas C , Sciarini Pascal
Published: October 2018

This article assesses whether—and to what extent—turnout bias in postelection surveys is reduced by adding a short nonresponse follow-up (NRFU) survey to a mixed-mode survey. Specifically, we examine how the NRFU survey influences response propensities across demographic groups and political factors and whether this affects data quality. We use a rich dataset on validated voter turnout data, collected across two different ballots. In addition to the main survey that comprises computer-assisted telephone interviews (CATI) and web respondents, both studies include a short follow-up mail survey for nonrespondents. The results demonstrate that collecting extra information from additional respondents on so-called “central” questions is worth the effort. In both studies, the NRFU survey substantially increases representativeness with respect to sociodemographic and participation variables. In particular, voters and politically active citizens are more accurately represented in the NRFU survey. This tends to result in better estimates of turnout determinants in the final (combined) sample than is seen from CATI/web respondents only. Moreover, the increase in response rate and the decrease in nonresponse bias comes at almost no price in terms of measurement errors. Vote overreporting is only slightly higher in the mail follow-up survey than in the main CATI/web survey.
Probabilistic Tractography to Predict the Position of Cranial Nerves Displaced by Skull Base Tumors: Value for Surgical Strategy Through a Case Series of 62 Patients
Authors: Jacquesson Timothée , Cotton Francois , Attyé Arnaud , Zaouche Sandra , Tringali Stéphane , Bosc Justine , Robinson Philip , Jouanneau Emmanuel , Frindel Carole
Published: October 2018

BACKGROUND

Predicting the displacement of cranial nerves by tumors could make surgery safer and the outcome better. Recent advances in imaging and processing have overcome some of the limits associated with cranial nerve tractography, such as spatial resolution and fiber crossing. Among others, probabilistic algorithms yield to a more accurate depiction of cranial nerve trajectories.

OBJECTIVE

To report how cranial nerve probabilistic tractography can help the surgical strategy in a series of various skull base tumors.

METHODS

After distortion correction and region of interest seeding, a probabilistic tractography algorithm used the constrained spherical deconvolution model and attempted the reconstruction of cranial nerve trajectories in both healthy and displaced conditions.

RESULTS

Sixty-two patients were included and presented: vestibular schwannomas (n = 33); cerebellopontine angle meningiomas (n = 15); arachnoid or epidermoid cysts (n = 6); cavernous sinus and lower nerves schwannomas (n = 4); and other tumors (n = 4). For each patient, at least one ‘displaced’ cranial nerve was not clearly identified on classical anatomical MRI images. All 372 cranial nerves were successfully tracked on each healthy side; among the 175 cranial nerves considered ‘displaced’ by tumors, 152 (87%) were successfully tracked. Among the 127 displaced nerves of operated patients (n = 51), their position was confirmed intraoperatively for 118 (93%) of them. Conditions that led to tractography failure were detailed. On the basis of tractography, the surgical strategy was adjusted for 44 patients (71%).

CONCLUSION

This study reports a cranial nerve probabilistic tractography pipeline that can: predict the position of most cranial nerves displaced by skull base tumors, help the surgical strategy, and thus be a pertinent tool for future routine clinical application.
Volatility and growth: a not so straightforward relationship
Authors: Bakas Dimitrios , Chortareas Georgios , Magkonis Georgios
Published: October 2018

Conflicting theoretical models and diverse empirical evidence characterize research analysing the relationship between business cycle volatility and economic growth. While the average reported effect of volatility on growth is negative, the empirical estimates vary substantially across studies. We identify the factors that explain this heterogeneity in estimates by conducting a meta-analysis. Our evidence suggests that researchers’ choices regarding the measure of volatility, the control set of the estimated equation, the estimation methods, and the data characteristics can all explain the differences in the reported estimates. Finally, the literature is found to be free of publication bias.
High entropy and evidence for a merger in the low surface brightness cluster Abell 2399
Authors: Mitsuishi Ikuyuki , Babazaki Yasunori , Ota Naomi , Sasaki Shin , Böhringer Hans , Chon Gayoung , Pratt Gabriel W
Published: October 2018

We present results of the X-ray analyses of the nearby cluster of galaxies Abell 2399 ($z$ = 0.058) using the XMM–Newton and Suzaku satellites. This cluster is classified as a low surface brightness (LSB) cluster. It has a bimodal structure in X-rays, and the X-ray-emission peaks are significantly offset from the peaks in gas temperature. By de-projecting the annular spectra, the temperature and electron density in the central r < 0.1 r200 region are measured to be 3.6 keV and 1.4 × 10−3 cm−3, respectively. This yields a very high gas entropy, ∼300 keV cm2, in the central region, comparable to the values observed in other LSB clusters. The scaled entropy of Abell 2399 is the highest among the REXCESS cluster sample. The spatial distribution of the member galaxies exhibits multiple substructures, the locations of which are significantly different from those in the X-ray image. We discovered a clear discontinuity in the X-ray brightness and temperature distributions in the western gas clump, which provides evidence of the presence of a cold front. Therefore, our results strongly suggest that A2399 has experienced a merger and that the high central entropy originates from the merger activity.
20-year assessment of metastatic latency and subsequent time to death after proton therapy for uveal melanomas
Authors: Bellocq David , Roy Pascal , Kodjikian Laurent , Mathis Thibaud , Nguyen Anh-Minh , Herault Joël , Rivoire Michel , Négrier Sylvie , Thariat Juliette , Grange Jean-Daniel
Published: October 2018

The aim of this study was to evaluate metastatic latency and survival after the occurrence of metastases in patients with choroidal/ciliary body melanoma treated with proton therapy. This was a retrospective cohort study. All consecutive patients with choroidal/ciliary body melanoma treated with proton therapy between 1991 and 2010 were included. Overall survival, specific survival (SS), local recurrence-free interval, and metastasis-free interval (MFI) were calculated. There were 508 patients. The mean follow-up was 239.4 months. Overall survival and SS rates were 57.2 and 67.6% at 10 years. Pre-equatorial tumor location, advanced tumor stage, and initial exudative retinal detachment were associated independently with SS. Thirty-three percent of the patients (n = 169) had metastases. Local recurrence-free interval and MFI were 91.3 and 65.7% at 10 years, respectively. MFI was shorter in pre-equatorial, large tumors, and/or tumors with exudative retinal detachment. After the occurrence of metastases, the median survival time was 1.25 years and survival probabilities were 62.1% at 1 year, 26.0% at 2 years, and 6.0% at 5 years. Except for age, none of the baseline clinical factors was associated with survival after metastasis occurrence. SS after metastasis occurrence was longer for metastasis occurring more than 10 years after tumor diagnosis (P =0.010). Death after metastasis is independent of initial tumor characteristics. Small tumors still have a risk for metastases after 10 years. Thus, lifelong follow-up is necessary for uveal melanoma patients. Larger series of metastatic patients are needed to evaluate aggressive multimodal treatments of metastases. Death after metastasis is independent of the initial tumor characteristics. Small tumors contraintuitively have a long-life risk of metastases. MFI is associated independently with pre-equatorial location, tumor stage, and retinal detachment.
The Effect of Lavender Oil Application via Inhalation Pathway on Hemodialysis Patients' Anxiety Level and Sleep Quality
Authors: Şentürk Arzu , Tekinsoy Kartın Pınar
Published: October 2018

Sleep and anxiety problems occur in hemodialysis (HD) patients due to physical symptoms, lifestyle changes, and psychosocial changes. To remove these sleep and anxiety problems, lavender oil inhalation is one of the nonpharmacological treatment options with less adverse effects than pharmacological methods. The purpose of this study was to determine the effect of lavender oil application via inhalation pathway on HD patients' anxiety level and sleep quality. The study was conducted with 34 HD patients who have been on HD treatment at 2 dialysis centers. The patients of the intervention group (n = 17) were told to drip 2 drops into the box and to place it 15 to 20 cm away from the pillow, 30 minutes before going to bed for 1 week. Control group (n = 17) received no intervention. Data were collected with questionnaire form, Visual Analog Scale, and Hamilton Anxiety Assessment Scale with a face-to-face interview. Subjective sleep quality of the intervention group was higher than that of control group, mean Visual Analog Scale daytime sleepiness score declined (P < .05), and mean score of sleep duration increased (P < .001) in the intervention group. However, the differences of mean score of time for falling asleep between the 2 groups were not different. The mean score of total and subdimensions of Hamilton Anxiety Assessment Scale of intervention group and control group was significantly different (P < .001). These study results provide new promising information about the effect of lavender inhalation on sleep problems and anxiety and these have made significant contributions to nursing, especially for dialysis nurses.
Head Impact Burden and Change in Neurocognitive Function During a Season of Youth Football
Authors: Rose Sean C. , Yeates Keith O. , Fuerst Darren R. , Ercole Patrick M. , Nguyen Joseph T. , Pizzimenti Natalie M.
Published: October 2018

Objective:

To determine the association of repetitive subconcussive head impacts with functional outcomes in primary and high school tackle football players.

Setting:

Youth football fields and an outpatient sports neurology clinic.

Participants:

A total of 112 primary school (n = 55, age 9-12 years) and high school (n = 57, age 15-18 years) football players.

Design:

A prospective cohort study.

Main Measures:

Helmet-based sensors were used to record head impacts during practices and games during the 2016 football season. Impact g-forces were summed to yield a measure of cumulative impact. History of self-reported premorbid medical diagnoses was obtained preseason. Players completed assessments of a variety of outcomes both pre- and postseason: neuropsychological test performance, symptoms, vestibular and ocular-motor screening, balance, parent-completed attention-deficit hyperactivity disorder (ADHD) symptoms, and self-reported behavioral adjustment.

Results:

Average cumulative impact was 3700 (standard deviation = 2700) g-forces for the season and did not differ between age groups (P = .594). Cumulative impact did not predict pre- to postseason change scores on any outcome measures (all P > .05). Instead, younger age group and reported history of premorbid ADHD predicted change scores on several cognitive testing measures and parent-reported ADHD symptoms, while reported history of premorbid anxiety and depression predicted change scores on symptom reporting.

Conclusions:

In youth tackle football, subconcussive head impacts sustained over the course of a single season may not be associated with neurocognitive functional outcomes. The absence of a significant association may reflect the relatively short follow-up interval, and signals the need for studies across multiple seasons.
A Case of Diprosopus Tetraophthalmos: Ocular Findings and Surgical Treatment of Exposure Keratopathy
Authors: Yazici Bulent , Yuksel Nilay O. , Kologlu Nuri
Published: October 2018

Diprosopus is a rare variation of conjoined twinning. In this report, ophthalmic findings in an infant with diprosopus tetraophthalmos are presented. A male infant who was born at 33 weeks of gestation to a nonconsanguineous 42-year-old mother and 47-year-old father was examined for orbital abnormalities. The infant had a large head, 2 faces, and 4 eyes, of which 2 were placed laterally and 2 were fused in the midline. In the laterally placed eyes, the pupils were unresponsive to light, and the optic discs were hypoplastic. In the fused eyes, the lower and upper eyelids were also fused, horizontally wide, vertically short, and immobile, resulting in a progressive exposure keratopathy. On the 33rd day of life, a modified total tarsorrhaphy was performed with the use of inhalational mask anesthesia. The patient died due to pneumonia and septicemia on the 45th day of life.
Emergency nurse practitioner practice analysis: Report and implications of the findings
Authors: Tyler Diane O. , Hoyt Karen Sue , Evans Dian Dowling , Schumann Lorna , Ramirez Elda , Wilbeck Jennifer , Agan Donna
Published: October 2018

Background and purpose:

A practice analysis of nurse practitioners (NPs) working in emergency care was undertaken to define their job tasks and develop a specialty certification by examination.

Method:

In phase I, clinical experts created a qualitative description of domains of practice, tasks performed, knowledge required, and procedures performed by NPs in emergency care. Phase II involved validating the qualitative description through a national survey (N = 474) of emergency nurse practitioners (ENPs). Evidence from the validation survey was used to create a test content outline for the ENP examination.

Findings and Conclusions:

The delineation of ENP practice validated by the survey (Cronbach alpha = 0.86–0.94 across rating scales) included 5 ENP practice domains: medical screening, medical decision-making/differential diagnoses, patient management, patient disposition and professional, legal and ethical practices. There were 22 job tasks across domains, 10 types of patient conditions/emergency types, 42 knowledge areas, and 68 procedures performed by ENPs. These resulted in a test blueprint providing the foundation for the ENP certification examination content validity.

Implications for practice:

Beyond certification, the practice analysis has the potential to further inform the scientific basis of emergency specialty practice. Additional uses include refining professional scope and standards of practice, job descriptions, performance appraisals, research, and policy development.
Proposed standardized educational preparation for the emergency nurse practitioner
Authors: Wilbeck Jennifer , Evans Dian Dowling , Hoyt Karen Sue , Schumann Lorna , Ramirez Elda , Tyler Diane , Agan Donna
Published: October 2018

The dynamic climate within health care policy-making and academia, in conjunction with updated Emergency Nurse Practitioner (ENP) competencies and a recent role delineation study, supports development of standardized curricula to ensure appropriate preparation for practice. Emergency NP curricular content should align with the updated ENP Practice Standards and National Organization of Nurse Practitioner Faculties' competencies for the Core and Family NP. This article provides rationale for establishing standardized educational curricula for ENP programs, delineates core specialty curricular content for inclusion, and discusses applicability of ENP specialty competencies within graduate academic education and postgraduate fellowship programs. As national ENP program curricula are standardized, clarity of the ENP specialty role will be enhanced and educational outcomes can be uniformly evaluated.
Colchicine: an affordable anti-inflammatory agent for atherosclerosis
Authors: Thompson Peter L. , Nidorf S. Mark
Published: October 2018

Purpose of review

Inflammation has been shown to be central to the development and progression of atherosclerosis. Despite detailed understanding of its central role and the cellular dynamics, which contribute to atherosclerotic inflammation, there has been slow progress in finding suitable agents to treat it. The recent CANTOS trial showed that the interleukin-1β inhibitor canakinumab can improve outcomes after acute coronary syndromes. Being a monoclonal antibody, it is expensive and inconvenient to administer for long-term treatment. This review summarizes recent work in finding effective, affordable alternatives to canakinumab.

Recent findings

Statin drugs have anti-inflammatory properties but separating their LDL lowering effect from their anti-inflammatory effect has been difficult. Drugs acting on targets outside of the interleukin-1β (IL-1β) pathway have been tested without finding a suitable candidate. Following the proof of principle provided by the success of canakinumab, other candidates targeting the IL-1β pathway are undergoing detailed evaluation. The most likely candidates are low-dose methotrexate and low-dose colchicine. The potential mechanisms and ongoing clinical trials are described.

Targeting the IL-1β pathway has already been successful with canakinumab but its expense and inconvenience of administration may limit its widespread uptake for controlling inflammation in atherosclerosis. Low-dose methotrexate and low-dose colchicine are affordable and more accessible alternatives, currently undergoing detailed evaluation for safety and efficacy in large randomized controlled trials.
Food Protein‐induced Enterocolitis Syndrome
Authors: Díaz Juan J. , Espín Beatriz , Segarra Oscar , Domínguez‐Ortega Gloria , Blasco‐Alonso Javier , Cano Beatriz , Rayo Ana , Moreno Ana ,   Gastrointestinal Allergy Working Group of the Spanish Society of Pediatric Gastroenterology, Hepatology and Nutrition (SEGHNP)
Published: October 2018

Objective:

The aim of the study was to describe clinical, epidemiological, and management characteristics of food protein‐induced enterocolitis syndrome (FPIES) cases in Spain.

Patients and Methods:

Multicenter observational retrospective study. FPIES cases diagnosed in specialized units in Spain over 12 months in 2017 (January–December) according to the recently published international diagnostic criteria were included.

Results:

One hundred twenty patients (53.3% boys) were included. The majority were acute cases (111) with mild‐to‐moderate severity (76.7%). Triggering foods were cow's milk (48/120), fish (38), egg (13), rice (12), and soy (1). The majority (84.2%) of the patients had FPIES to 1 food only. In addition to vomiting (100%), pallor (89.2%), and altered behavior (88.3%) were most frequently observed in acute forms. On the contrary, diarrhea (70%), abdominal distension (33.3%), and blood in stools (44.4%) were more frequently observed in chronic cases. Oral challenge was performed in 18.9% of the acute forms compared to 44.4% of the chronic forms. The most common treatment was intravenous fluids followed by ondansetron. Corticosteroids were used in 6 patients (5 with acute symptoms and 1 chronic). Seven patients were treated with antibiotics for suspicion of infection. Most cases of cow's milk FPIES were treated with extensively hydrolyzed formulas (69.8%).

Conclusions:

FPIES is not uncommon in our units. Unlike other published series, fish and egg are important triggers in our country. A greater knowledge and diffusion of the international consensus criteria will allow a better characterization of the cases and a standardization of their management.
Treatment of influenza with neuraminidase inhibitors
Authors: Beard Kate R. , Brendish Nathan J. , Clark Tristan W.
Published: October 2018

Purpose of review

Seasonal and pandemic influenza are major causes of morbidity and mortality globally. Neuraminidase inhibitors (NAIs) are the only class of antiviral agent recommended for the treatment of currently circulating strains of influenza. There has previously been controversy over the level of evidence for patient benefit with NAIs. We review here the current evidence base for the clinical impact of treatment of influenza with NAIs.

Recent findings

Meta-analysis of pharma-sponsored studies (including previously unpublished data) shows that NAIs reduce the duration of illness in influenza-infected patients, and suggest a possible reduction in the rate of complications and hospitalization. Meta-analysis of observational studies examining oseltamivir use during the H1N1 2009 pandemic, suggest a reduction in hospitalization rate in community-dwelling patients and a reduction in mortality in hospitalized adults treated with NAIs. Current NAI use in the community and hospitals varies widely but in general they are underutilized.

Although there has been controversy over the level of evidence for patient benefit, a growing body of evidence suggests that treatment of influenza with NAIs is associated with improved outcomes for both patients in the community and more severely unwell patients in hospital. Clinical outcomes are optimal with earlier use and strategies to improve early widespread NAI utilization are needed.
The Use of a Double Suture and Conjunctival Cuts in the Lateral Tarsal Strip: A New Approach to Involutional Ectropion
Authors: Meduri Alessandro , Inferrera Leandro , Oliverio Giovanni William , Tumminello Giuseppe , Rechichi Miguel , Mazzotta Cosimo , Frisina Rino , Kaufman Stephen , Aragona Pasquale
Published: October 2018

Purpose:

To describe the use of a double suture and conjunctival cuts in the lateral tarsal strip (LTS) and to evaluate postsurgical outcome in patients with severe involutional ectropion.

Methods:

A prospective randomized study was conducted on 16 eyelids of 8 patients with symptomatic severe involutional ectropion. The 8 patients were between 62 and 79 years. They were distributed into 2 groups consisting of 4 patients each. The control group was treated with a conventional lateral tarsal strip (C-LTS), the second group underwent a modified lateral tarsal strip (M-LTS). The mean follow-up was 18 months. Success was defined as relief in lid laxity. The recurrence rate was also evaluated.

Results:

Patients treated with M-LTS showed lower horizontal laxity (3.5 ± 0.2) than patients treated with C-LTS (5.7 ± 0.2). During the 18-month follow-up, a statistically significant difference was found between the 2 groups with P value <0.05.

Conclusions:

The use of a double suture and conjunctival cuts in the lateral tarsal strip proposed by Meduri showed a reduction of postsurgical ectropion's grade and postsurgical recurrences. This technique could be used for the treatment of patients with a severe ectropion.
Success Rate and Complications of Cerebrospinal Fluid Rhinorrhea Treated With a Transcranial Approach
Authors: Kizmazoglu Ceren , Firat Levent , Ozyoruk Safak , Kalemci Orhan , Karabay Nuri , Ozer Ercan
Published: October 2018

The aim of this study was to evaluate the clinical outcomes of cerebrospinal fluid (CSF) rhinorrhea in patients treated with transcranial surgery. Here, we retrospectively reviewed 23 patients with CSF rhinorrhea between 2008 and 2015 at our university hospital. Nine (39.1%) patients were treated conservatively, whereas 12 (52.2%) patients were treated with a transcranial approach. Our results showed that 7 (30.4%), 11 (47.8%), and 5 (21.7%) patients had spontaneous, traumatic, and iatrogenic CSF leakage, respectively. In our study, the cribriform plate was the most common site of leakage, and it was found to be involved in 5 (21.7%) patients. The mean diameter defect of the fistula was 130.40 ± 190.47 mm2 and there was no significant difference between this defect and the different etiology types. In our study, meningitis, third nerve palsy, and vasospasm were the main complications that arose during the treatment of CSF rhinorrhea. Moreover, 6 (26.1%) of 7 (30.4%) patients had spontaneous CSF leaks that were treated with surgery. Notably, spontaneous CSF leaks did not stop when treated with conservative measures. In addition, there were no significant differences between etiology types and CSF leaks. The primary surgical repair rate was 78.3% and the secondary surgery repair rate was 91.6%. Importantly, as we preferred using this type of transcranial surgery in our clinic, there has been a higher success rate with endoscopic treatments and fewer major complications from CSF rhinorrhea in the literature.
Sphenoid Sinus in Relation to Age, Gender, and Cephalometric Indices
Authors: Özer Cenk Murat , Atalar Kerem , Öz Ibrahim Ilker , Toprak Sadik , Barut Çağatay
Published: October 2018

The sphenoid sinus is located in the center of the cranial base and is surrounded by numerous neurovascular structures. The aim of this study was to determine sphenoid sinus types and subtypes, dimensions of the sinus and cranium, and the relations of these to age and gender.

Computed tomography data was obtained from 144 patients to determine right sphenoidal volume (sphVOLR), left sphenoidal volume (sphVOLL), total sphenoidal volume (sphVOLT), anteroposterior length of the sphenoid sinus (sphAP), laterolateral length of the sphenoid sinus (sphLL), head circumference (crHC), fronto-occipital length (crFO), and biparietal length (crBP), with OSIRIX software. The patients’ ages ranged between 9 and 83 years (mean age 38 ± 15.5 years). The study included 89 males (mean age 39 ± 15.5 years) and 55 females (mean age 38 ± 15.6 years).

Conchal (1.4%), presellar (8.3%), sellar (23.6%), and postsellar (66.7%) type sphenoid sinuses were determined based on the extension of pneumatization around the sella turcica. Each type of sphenoid sinus was classified into the following 5 types based on the direction of pneumatization: body, full lateral, pterygoid, lesser wing, and greater wing subtypes. Mean sphAP was determined as 29.72 mm and mean sphLL as 37.73 mm. In 5 patients only (3.4%), the sphenoid sinus was not divided into right and left by the intersphenoidal septum.

The variations in the extensions of pneumatization of the sphenoid sinus and its dimensions might be used to estimate the selection of a surgical approach to lesions bordering the sinus.
Development of Hard and Soft Palate During the Fetal Period and Hard Palate Asymmetry
Authors: Dursun Ahmet , Öztürk Kenan , Albay Soner
Published: October 2018

In the present study, it was aimed to perform the morphometric analysis of the hard and soft palate in fetal cadavers and evaluate hard palate asymmetry during the fetal development. The development of the palate was investigated in 40 (21 males, 19 females) fetal materials aged between the 17th and 40th gestational week. In this study, distances between the incisive papilla-staurion (Ip-Sr), staurion-posterior nasal spine (Sr-Pns), incisive papilla-greater palatine foramen (Ip-Gpf) on the right and left sides, Sr-Gpf, and Pns-Gpf were measured. In cases with asymmetry, the ratio of asymmetry was determined in percentage using the asymmetry index. Moreover, angular values between Ip-Sr-Gpf and Ip-Pns-Gpf on the right and left sides were measured, and the right and left side values were compared with each other. The hard and soft palate lengths were measured on the planum medianum. Upon comparing the measured parameters between males and females, the mean values of male fetuses were higher in all parameters, but a significant difference was found only in the Sr-Pns distance among these parameters. Upon comparing the angular data and asymmetry index data on the hard palate between the trimester groups, a significant difference was found only in the Ip-Sr-Gpf (left) parameter. The mean ratio of the hard palate to the soft palate was found as 1.90. It is believed that the obtained data will contribute to studies to be conducted in fields such as plastic surgery, maxillofacial surgery, intrauterine surgery, fetopathology, embryology, anatomy, and obstetrics.