bluuebunny/crossref_metadata_2025 huggingface dataset:
Bifrontal Biparietal Cruciate Decompressive Craniectomy in Pediatric Traumatic Brain Injury
Authors: McHugh Daryl C. , Fiore Susan M. , Strong Nancy , Egnor Michael R.
Published: January 2019

Background: We investigated a novel surgical approach to decompressive craniectomy (DC), the bifrontal biparietal, or “cruciate,” craniectomy, in severe pediatric traumatic brain injury (TBI). Cruciate DC was designed with a fundamentally different approach to intracranial pressure (ICP) control compared to traditional DC. Cruciate DC involves craniectomies in all 4 skull quadrants. The sagittal and coronal bone struts are disarticulated at the skull to allow the decompression of the sagittal sinus and bridging veins in addition to permitting cerebral expansion, thereby maintaining cranial compliance. Objective: To characterize ICP control with cruciate DC in pediatric TBI. Methods: We performed a retrospective review of TBI patients who underwent cruciate DC. We investigated mortality and preoperative and postoperative ICP. Group 1 underwent medical therapy prior to DC and Group 2 required immediate DC. Results: Fifteen of 18 patients survived. In Group 1, mean preoperative ICP was 18.5 mm Hg and mean postoperative ICP was 11.5 mm Hg. In Group 2, mean preoperative ICP was 27.3 mm Hg and mean postoperative ICP was 15.0 mm Hg. Conclusion: Cruciate DC was associated with lowering ICP. We observed acute drops in ICP and long-term ICP control. The floating bone struts of the cruciate DC permits the decompression of the sagittal sinus and bridging veins, with maximal relief of cerebral edema.
Early Diagnosis and Prompt Treatment Improves Quality of Life in Patients with Frontal Fibrosing Alopecia
Authors: Dhurat Rachita , Shukla Deepti , Dandale Ameet , Ghate Smita , Agrawal Sandip , Shanshanwal Sujit
Published: January 2019

Frontal fibrosing alopecia (FFA) is a slowly progressive cicatricial alopecia. FFA patients typically present with hair loss in the frontal, temporal, or frontotemporal scalp and eyebrows. It can also involve facial and body hair. It has an early inflammatory stage, which slowly progresses to the stage of fibrosis. In this article, we report a case of FFA in the early inflammatory stage who responded well to intralesional steroid.
Role of Hypothalamic-Pituitary-Adrenal Axis, Hypothalamic-Pituitary-Gonadal Axis and Insulin Signaling in the Pathophysiology of Alzheimer’s Disease
Authors: Ahmad Mir Hilal , Fatima Mahino , Mondal Amal Chandra
Published: January 2019

Alzheimer’s disease (AD), the commonest progressive neurodegenerative disorder of the brain, is clinically characterized by the formation of extracellular amyloid plaques and intracellular neurofibrillary tangles. Recent studies suggest a relationship between the endocrinal dysregulation and the neuronal loss during the AD pathology. Dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis and hypothalamic-pituitary-gonadal (HPG) axis regulating circulating levels of glucocorticoid hormones has been implicated in the pathophysiology of AD. Likewise, dysregulated insulin signaling, impaired glucose uptake and insulin resistance are some of the prime factors in the onset/progression of AD. In this review, we have discussed the changes in HPA and HPG axes, implicated insulin resistance/signaling and glucose regulation during the onset/progression of AD. Therefore, simultaneous detection of these endocrinal markers in the early or presymptomatic stages may help in the early diagnosis of AD. This evidence for implicated endocrinal functions supports the fact that modulation of endocrinal pathways can be used as therapeutic targets for AD. Future studies need to determine how the induction or inhibition of endocrinal targets could be used for predictable neuroprotection in AD therapies.
Oral Litholysis in Patients with Chronic Calcific Pancreatitis Unresponsive to or Ineligible for Extracorporeal Shock Wave Lithotripsy and Endoscopic Therapy
Authors: Hamano Koichi , Noda Aiji , Ibuki Eri , Ashizawa Nobuo , Inamoto Shunsuke , Izumi Junko , Usami Jun , Nakagawa Hiroaki , Wakita Yoshinori , Maekawa Masato
Published: January 2019

Background/Aims: Our study aimed to evaluate the effect of oral litholysis in patients with chronic calcific pancreatitis (CCP) unresponsive to or ineligible for extracorporeal shock wave lithotripsy (ESWL) and endoscopic therapy. Methods: Trimethadione, an antiepileptic agent, was administered orally at a dose of 0.6–0.9 g/day to 15 patients with this condition. Treatment outcome was evaluated by assessment of dissolution of the pancreatic stones on plain X-ray films and computed tomography scans of the upper abdomen. Plasma glucose, hemoglobin A1c, and body mass index (BMI) were also monitored throughout the therapy. Results: Litholysis was observed in 13 out of 15 patients (86.7%) and was definite in 10 and partial in 3. Six patients had pancreatitis attacks during the therapy; 5 of whom showed definite litholysis and had only 1 mild attack. Of the 11 patients with normal or impaired glucose tolerance at baseline, none developed diabetes mellitus and all showed litholysis. BMI significantly increased in patients whose pancreatic stones dissolved. There was no vital organ impairment by trimethadione. Conclusion: Oral litholysis using trimethadione may represent a noninvasive and effective complementary treatment in patients with CCP unresponsive to or ineligible for ESWL and endoscopic therapy.
Adrenomedullin Induces Cardiac Lymphangiogenesis After Myocardial Infarction and Regulates Cardiac Edema Via Connexin 43
Authors: Trincot Claire E. , Xu Wenjing , Zhang Hua , Kulikauskas Molly R. , Caranasos Thomas G. , Jensen Brian C. , Sabine Amélie , Petrova Tatiana V. , Caron Kathleen M.
Published: January 2019

Rationale:

Cardiac lymphangiogenesis contributes to the reparative process post-myocardial infarction, but the factors and mechanisms regulating it are not well understood.

Objective:

To determine if epicardial-secreted factor AM (adrenomedullin;
Adm
=gene) improves cardiac lymphangiogenesis post-myocardial infarction via lateralization of Cx43 (connexin 43) in cardiac lymphatic vasculature.

Methods and Results:

Firstly, we identified sex-dependent differences in cardiac lymphatic numbers in uninjured mice using light-sheet microscopy. Using a mouse model of
Adm

hi/hi

(
Adm
overexpression) and permanent left anterior descending ligation to induce myocardial infarction, we investigated cardiac lymphatic structure, growth, and function in injured murine hearts. Overexpression of
Adm
increased lymphangiogenesis and cardiac function post-myocardial infarction while suppressing cardiac edema and correlated with changes in Cx43 localization. Lymphatic function in response to AM treatment was attenuated in mice with a lymphatic-specific Cx43 deletion. In vitro experiments in cultured human lymphatic endothelial cells identified a novel mechanism to improve gap junction coupling by pharmaceutically targeting Cx43 with verapamil. Finally, we show that connexin protein expression in cardiac lymphatics is conserved between mouse and human.

Conclusions:

AM is an endogenous, epicardial-derived factor that drives reparative cardiac lymphangiogenesis and function via Cx43, and this represents a new therapeutic pathway for improving myocardial edema after injury.
Application of PCSK9 Inhibitors in Practice
Authors: Kaufman Tina M. , Warden Bruce A. , Minnier Jessica , Miles Joshua R. , Duell P. Barton , Purnell Jonathan Q. , Wojcik Cezary , Fazio Sergio , Shapiro Michael D.
Published: January 2019

PCSK9i (protein convertase subtilisin/kexin type 9 inhibitors) are set to revolutionize the treatment of hypercholesterolemia in the management of atherosclerotic risk, but numerous reports have detailed unprecedented barriers to access for these drugs. To overcome these challenges, our group created a model to facilitate provision of this new therapy for patients who qualify according to Food and Drug Administration criteria. This report details the real-world follow-up experience of PCSK9i use in a large patient cohort structured to ensure rigor in data collection, analysis, and interpretation. The 271 patients approved and actively followed in our PCSK9i clinic between July 2015 and August 2018 represent a 97% approval rate from insurance, with 28% of prescriptions requiring at least one appeal. Over 50% of patients were statin intolerant. On average, there was a median lapse of 15 days between initial visit and insurance approval. PCSK9i therapy was affordable for most patients, with an average monthly out-of-pocket expense of $58.05 (median $0). Only 2.3% of patients were unable to initiate or continue therapy because of cost. Reductions from baseline in LDL (low-density lipoprotein) cholesterol and Lp(a) (lipoprotein [a])were comparable to published reports with median reductions of 60% and 23% at 1 year, respectively. PCSK9i therapy was well-tolerated overall, though 9% of patients reported adverse events, and 5% of patients discontinued due mostly to musculoskeletal and flu-like symptoms. Our practice model demonstrates that PCSK9i therapy can be accessed easily and affordably for the majority of eligible patients, resulting in dramatic improvement in lipid profile results. Moreover, our registry data suggest that results from the prospective clinical trials of PCSK9i on LDL and Lp(a) reduction and on tolerability are applicable to a real-world cohort.
Tenecteplase Versus Alteplase Between 3 and 4.5 Hours in Low National Institutes of Health Stroke Scale
Authors: Rønning Ole Morten , Logallo Nicola , Thommessen Bente , Tobro Håkon , Novotny Vojtech , Kvistad Christopher E. , Aamodt Anne Hege , Næss Halvor , Waje-Andreassen Ulrike , Thomassen Lars
Published: January 2019

Background and Purpose—

Thrombolysis with alteplase has beneficial effect on outcome and is safe within 4.5 hours. The present study compares the efficacy and safety of tenecteplase and alteplase in patients treated 3 to 4.5 hours after ischemic stroke.

Methods—

The data are from a prespecified substudy of patients included in The NOR-TEST (Norwegian Tenecteplase Stroke Trial), a randomized control trial comparing tenecteplase with alteplase.

Results—

The median admission National Institutes of Health Stroke Scale for this study population was 3 (interquartile range, 2–6). In the intention-to-treat analysis, 57% of patients that received tenecteplase and 53% of patients that received alteplase reached good functional outcome (modified Rankin Scale score of 0–1) at 3 months (odds ratio, 1.19; 95% CI, 0.68–2.10). The rates of intracranial hemorrhage in the first 48 hours were 5.7% in the tenecteplase group and 6.7% in the alteplase group (odds ratio, 0.84; 95% CI, 0.26–2.70). At 3 months, mortality was 5.7% and 4.5%, respectively. After excluding stroke mimics and patients with modified Rankin Scale score of >1 before stroke, the proportion of patients with good functional outcome was 61% in the tenecteplase group and 57% in the alteplase group (odds ratio, 1.24; 95% CI, 0.65–2.37).

Conclusions—

Tenecteplase is at least as effective as alteplase to achieve a good clinical outcome in patients with mild stroke treated between 3 and 4.5 hours after ischemic stroke.

Clinical Trial Registration—

URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT01949948.
Penstemon reidmoranii (Plantaginaceae), a new species from Baja California, Mexico
Authors: ZACARÍAS-CORREA ANA GABRIELA , WOLFE ANDREA D. , MARTÍNEZ SALAS ESTEBAN , SAMAIN MARIE-STÉPHANIE
Published: January 2019

Penstemon reidmoranii is described from the southern region of the state of Baja California, Mexico. This new species belongs to the subgenus Penstemon, section Peltanthera, subsection Peltanthera, and is distinguished primarily by its length, shape, margin and texture of the leaves. In addition, the staminode is covered in almost its full length by glandular hairs, while towards the apex it bears long white hairs of 6 mm long. Here, we describe and illustrate this new species. We also provide a distribution map and a comparison with Penstemon eximius, a morphologically similar taxon.
Nomenclatural notes on triporous taxa of Chrysococcus G.A. Klebs (Chrysophyceae)
Authors: KAPUSTIN DMITRY A.
Published: January 2019

The genus Chrysococcus G.A. Klebs (1892: 413) comprises unicellular planktonic chrysophytes with cells surrounded by a lorica. Lorica shape and size, ornamentation, number of pores and presence or absence of stigma are the main features for distinguishing taxa (Starmach 1985; Nicholls & Wujek 2015). In his treatment Starmach (1985) listed 25 species of Chrysococcus and several intraspecies taxa.
Uncertainty Estimates for SeaSonde HF Radar Ocean Current Observations
Authors: Emery Brian , Washburn Libe
Published: January 2019

HF radars typically produce maps of surface current velocities without estimates of the measurement uncertainties. Many users of HF radar data, including spill response and search and rescue operations, incorporate these observations into models and would thus benefit from quantified uncertainties. Using both simulations and coincident observations from the baseline between two operational SeaSonde HF radars, we demonstrate the utility of expressions for estimating the uncertainty in the direction obtained with the Multiple Signal Classification (MUSIC) algorithm. Simulations of radar backscatter using surface currents from the Regional Ocean Modeling System show a close correspondence between direction of arrival (DOA) errors and estimated uncertainties, with mean values of 15° at 10 dB, falling to less than 3° at 30 dB. Observations from two operational SeaSondes have average DOA uncertainties of 2.7° and 3.8°, with a fraction of the observations (10.5% and 7.1%, respectively) having uncertainties of >10°. Using DOA uncertainties for data quality control improves time series comparison statistics between the two radars, with r2=0.6 increasing to r2=0.75 and RMS difference decreasing from 15 to 12 cm s−1. The analysis illustrates the major sources of error in oceanographic HF radars and suggests that the DOA uncertainties are suitable for assimilation into numerical models.
Systematic Review of Hormonal Contraception and Risk of Venous Thrombosis
Authors: Keenan Lynn , Kerr Tyson , Duane Marguerite , Van Gundy Karl
Published: January 2019

Background:

Hormonal contraception (HC) is widely used throughout the world and has been associated with venous thrombosis (VT) such as deep vein thrombosis, pulmonary emboli, and cerebral VT.

Objectives:

To provide a current comprehensive overview of the risk of objectively confirmed VT with HC in healthy women compared to nonusers.

Search methods:

PubMed was searched from inception to April 2018 for eligible studies in the English language, with hand searching from past systematic reviews.

Selection criteria:

We selected original research evaluating risk of objectively confirmed VT in healthy women taking oral or nonoral HC compared with nonusers.

Data collection:

The primary outcome of interest was a fatal or nonfatal VT in users of HC compared to nonusers or past users. Studies with at least twenty events were eligible. Adjusted relative risks with 95 percent confidence intervals were reported. Three independent reviewers extracted data from selected studies.

Results:

1,962 publications were retrieved through the search strategy, with 15 publications included. Users of oral contraception with levonorgesterol had increased risk of VT by a range of 2.79–4.07, while other oral hormonal preparations increased risk by 4.0–48.6. Levonorgestrel intrauterine devices did not increase risk. Etonogestrel/ethinyl estradiol vaginal rings increased the risk of VT by 6.5. Norelgestromin/ethinyl estradiol patches increased risk of VT by 7.9. Etonogestrel subcutaneous implants by 1.4 and depot-medroxyprogesterone by 3.6. The risk of fatal VT was increased in women aged fifteen to twenty-four by 18.8-fold.

Conclusion:

Users of HC have a significant increased risk of VT compared to nonusers. Current risks would project at least 300–400 healthy young women dying yearly in the United States due to HC. Women should be informed of these risks and offered education in fertility-awareness-based methods with comparable efficacy for family planning.

HC is widely used throughout the world and has been associated with blood clots in the legs and lungs. We searched the literature and found the risks of currently used forms of birth control increased between three- and ninefold for blood clots for healthy women. The risks found would project 300–400 women dying from using HC each year in the United States.
Servant leadership, span of control, and outcomes in a municipality context
Authors: Thompson Geir , Buch Robert , Glasø Lars
Published: January 2019

The purpose of the current study was to investigate the moderating role of span of supervision in the association between servant leadership and multiple outcomes such as job satisfaction and follower performance in a municipality context in Norway. Cross-sectional research design was applied, where data were collected from 237 respondents where leaders and their followers participated. Results showed how the positive relationship between servant leadership and job satisfaction is attenuated by a larger span of supervision, resulting in poorer follower performance. The present study contributes to the servant leadership literature by showing that servant leaders do not operate in the same manner across different degrees of span of supervision. Evidence suggests that span of supervision creates distance between leaders and followers and moderates the types of leader behaviors that may emerge or are viable, such that serving every follower’s highest priority needs becomes difficult to execute.
Effect of secondary crystal orientations on the deformation anisotropy for nickel-based single-crystal plate with notch feature
Authors: Zhai Yu , Khan Muhammad Kashif , Correia José , de Jesus Abílio MP , Huang Zhiyong , Zhang Xu , Wang Qingyuan
Published: January 2019

The effects of the secondary crystal orientations on the nickel-based single-crystal superalloy turbine blades were investigated. The stress concentration features were used for investigation of the optimal secondary crystal orientation leading to the higher strength of the single-crystal turbine blades. The crystal plastic finite element method coupled with micromechanics constitutive model is applied to study the effect of secondary crystal orientation on plastic deformation and mechanical behavior around the cooling holes and notches with the primary (load) orientation fixed at [001] direction. For nickel-based superalloy plates with holes or notches, the secondary crystal orientation effect on the strength needs to be clarified at various load levels. The maximum von Mises stress in the single-crystal alloy varies significantly with variation in the secondary crystal orientations. It was found that only two slip systems dominate the deformation process of the material owing to their favorable orientation with loading. The secondary orientation of 45° was identified with lowest resolved shear stress in the dominating slip systems and potential of producing higher strength for single-crystal turbine blades.
Measuring residual stress in finite thickness plates using the hole-drilling method
Authors: Beghini Marco , Bertini Leonardo , Giri Anoj , Santus Ciro , Valentini Emilio
Published: January 2019

Hole-drilling is one of the most popular methods for measuring residual stress in mechanical components. The ASTM E837 standard defines the hole-drilling method for plates that are either thicker or thinner than the size of the hole diameter and provides the related calibration coefficients for these two conditions. Measurements for components with a thickness in the range of a few millimetres, such as typical metal sheets, are not considered. In this article, the effects of thickness on the hole-drilling measurements are examined by a finite element parametric analysis. A method is proposed to analyse the measurements in plates with an intermediate thickness. The procedure is suitable for determining a general in-depth non-uniform residual stress distribution. Mathematical relationships are proposed which enable calibration coefficients to be obtained for any thickness. An experimental application confirms the validity of the procedure.
Irradiation effects of Cu ions on the electrical and morphological properties of polypropylene
Authors: Irfan M , Ali S , Tahir MB , Rafique MS
Published: January 2019

The irradiation of metallic ions on polymeric surfaces may change the chemical, electrical and physical properties of polymers. In this article, we have investigated the effects on the electrical and morphological properties of polypropylene caused by irradiating with copper (Cu) ions generated from laser-produced plasmas. For this purpose Nd: YAG laser (1064 nm) was employed to produce Cu ions. The flux of ions was controlled by varying the number of laser shots in the range 100–400, with a step size of 100. The changes in the electrical conductivity of the irradiated sample were studied using a four-point probe technique, while the surface features were examined by using optical microscopy. The electrical conductivity changed from 4.758 × 10−8 Ω−1 cm−1 to 5.003 × 10−8 Ω−1 cm−1 for unexposed and exposed (with 400 shots) samples, respectively.
Reliability of Americleft Yardstick Nasolabial Appearance Assessment With/Without Basal View for Japanese Children With Unilateral Complete Cleft Lip and Palate
Authors: Amir Muhammad Subhan , Fuchigami Takao , Kibe Toshiro , Tezuka Masahiro , Ishihata Kiyohide , Nakamura Norifumi
Published: January 2019

Objective:

There is debate on the reliability of the Americleft Yardstick (AY) global nasolabial appearance assessment method. The objective was to analyze the effect of the additional basal view (BV) feature on the reliability of the AY method for Japanese children with complete cleft lip and palate (CUCLP).

Design:

Blind retrospective analysis of clinical records on 43 patients (5- to 7-year-old) with nonsyndromic CUCLP who underwent primary lip repair from 2005 to 2011.

Main Outcome Measure:

Color pictures published in AY and Rubin’s studies were used as reference pictures. Patients’ photographs were cropped and rated on a 5-point scale for the vermilion border (VB), nasolabial frontal (NLF), and nasolabial profile (NLP) according to AY with/without BV assessment by Rubin’s methods. Rating was performed twice by 3 oral surgeons. Intra- and inter-rater reliabilities were analyzed using weighted κ, and correlations between BV and other features were analyzed.

Results:

Overall average assessment scores were 2.742 (0.573) with AY and 2.702 (0.489) with AY+BV methods ( P = .728). Average intra-rater reliabilities were 0.605 and 0.611 and average inter-rater reliabilities were 0.525 and 0.48 with AY and AY+BV, respectively. Inter-rater reliability was the lowest for NLP. ρ scores between BV versus VB, NLF, and NLP were 0.025, 0.659, and 0.092, respectively.

Conclusions:

Present study demonstrates moderate intra- and inter-rater reliabilities obtained with the AY assessment method for Japanese children with CUCLP. Nasolabial profile standard ambiguity may lead to the poor reliability of AY assessment. Addition of the BV feature does not improve overall reliability.
Sandwich-structured bamboo powder/glass fibre-reinforced epoxy hybrid composites – Mechanical performance in static and dynamic evaluations
Authors: Md Shah Ain U , Sultan Mohamed TH , Jawaid Mohammad
Published: January 2019

A layer of woven E-glass fibre was embedded each at top and bottom layer of bamboo-filled epoxy, producing sandwich-structured hybrid composites. The incorporation of woven glass fibre was intended to slow down the crack propagation in composites. Different bamboo powder loading was applied to analyse its effect on the static and dynamic mechanical properties of composites. The composite with the lowest bamboo powder loading of 10% marked the highest tensile strength, where the strength decreased as the loading increased. Poor bamboo-epoxy adhesion, observed from the SEM, leads to more chances of pull out fibres when tensile load was applied. Opposite trend was observed in flexural strength, where the highest loading of 30% marked the highest value of flexural strength. The dynamic evaluation was carried out with respect to temperature, which ranged from 25°C to 150°C, and at a fixed frequency of 1 Hz. Effective stress transfer between the fibre and the matrix takes place in composites with 30% bamboo powder loading, shown by the lowest peak height of the Tanδ curves. The significant increase in the storage modulus values for the composites at low temperature compared to the rubbery plateau region at high temperature suggested the high utility of the composites at low temperature regardless of the effect of the percentage increment in bamboo powder loading. These results showed that the bamboo powder inclusion helps in bestowing stiffness to the composites with 30% as the optimum percentage in this dynamic mechanical evaluation. It can be suggested that the introduction of woven-typed fibre into short fibre composites in sandwich structure, as discussed in this study, can slow down the failure of composites, and thus notify users before the total failure.
National survey of telemedicine education and training in medical schools in France
Authors: Yaghobian Sarina , Ohannessian Robin , Mathieu-Fritz Alexandre , Moulin Thierry
Published: January 2019

Introduction

Telemedicine is a remote medical practice using information communication technology (ICT), and has been increasing in France since 2009. With all new forms of medical practice, education and training (ET) is required for quality and safety. To date, implementation of telemedicine ET has not been assessed in France. The objective of this study was to describe the implementation of telemedicine ET and evaluate the knowledge, attitudes and practices (KAP) of deans and associate deans from all medical schools in France.

Methods

A cross-sectional non-mandatory, descriptive online survey with a self-administered questionnaire was performed from 15 November to 6 December, 2017. Respondents were accessed through the ‘ Conférence des doyens des Facultés de médecine’.

Results

There were 48 respondents with a 47.4% response rate among deans. Telemedicine ET was limited in France; 10.4% in 1st year medicine (PACES); 4% in the final 3 years of medical school (D.F.A.S.M.) and 18.8% in medical residency. Emergency medicine, dermatology, radiology, neurology and geriatrics were specialties with implemented telemedicine training during residency. Of all respondents, 90% expressed a need to increase telemedicine ET, among which 75% accepted external support. A highly positive attitude towards telemedicine practice was reflected by 60.4% of respondents, and 56.2% practiced telemedicine at least once.

Discussion

This study was the first to assess national telemedicine ET implementation in France. Telemedicine was integrated into initial medical education; however, telemedicine ET remains limited despite the positive attitudes of deans and associate deans. Further research would need to be conducted on telemedicine ET implementation and KAP of medical students and residents.
Book Review: Freeman, Carla, editor. 2016: Handbook on China and Developing Countries (Handbooks of Research on Contemporary China series)
Authors: Leite Alexandre Cesar Cunha
Published: January 2019

Freeman, Carla, editor. 2016: Handbook on China and Developing Countries (Handbooks of Research on Contemporary China series). Basingstoke, Cheltenham: Edward Elgar Publishing Limited. 579 pp., US$ 61.37 (Paperback), ISBN: 9781786434968.
Sites of learning: Exploring political ecologies and visceral pedagogies of surplus food redistribution in the UK
Authors: Spring Charlotte , Adams Mags , Hardman Michael
Published: January 2019

Drawing on ethnographic research with organisations redistributing wasted food, this paper explores potentials for political and ethical learning by comparing different approaches to food handling and teaching. Food acts as instigator and tool for learning about ecological impacts, wellbeing, provenance, health and pleasure. Re-learning wasted food challenges accusations of its stigmatising potential while attempting to address serious material issues of food insecurity and food access. Taking seriously the charge that ‘community-level’ approaches might depoliticise and individualise food distribution at the expense of structural critique and action, these pragmatic and polysemic enrolments of food waste can nevertheless embody a teleology of change, through changing practices of food handling and fostering critical understandings of food system issues. While acknowledging the spatial, temporal and technological mediators of food’s journey from bin towards mouth, attention is paid to the sensorial, embodied and affective means by which the food/waste distinction is known and taught/learned. A political ecology of the body framework is used to explore the ‘visceral realm’ of food access as always part-situated in learners’ diverse foodscapes. These visceral pedagogies of knowing food sit alongside the power dynamics of regulatory food governance in the form of, for example, expiry date labels. In short, these practices, albeit rooted in environmentally damaging and unequally distributed foodscapes requiring systemic transformation, can nevertheless foster more vibrant sympathies between people and food, more careful connections between learners and their food futures.
Treatment of Mechanical Aortic Valve Thrombosis Fibrinolytic Treatment versus Surgical Intervention: Result of Eight Cases
Authors: Yay Kerem , Boysan Emre , Irdem Ahmet , Cetin Erdem , Altinay Levent , Tutun Ufuk , Cicekcioglu Ferit , Katircioglu Salih Fehmi
Published: January 2019

Objective

Thrombosis of mechanical heart valve prosthesis is a rare fatal complication after heart valve replacement. Although surgical intervention is the suggested treatment in many series, fibrinolytic treatment offers a good alternative. We describe eight cases with mechanical aortic valve thrombosis and compare their results after fibrinolytic treatment or redo aortic valve replacement.

Methods

Between February 2008 and March 2009, eight patients with previous mechanical prosthetic aortic valve replacement history were admitted to our center with mechanical aortic valve thrombosis. Four patients were operated, and the remaining four patients received low-dose fibrinolytic treatment. All patients’ data were collected prospectively.

Results

Two of the four operated patients died. In the fibrinolytic group, all patients totally recovered, and there was no mortality or morbidity during the follow-up period.

Conclusions

We thought that fibrinolytic treatment is a feasible and effective method for thrombosed mechanical aortic valve. However, much more populated patient groups are needed for the vigorous inference.
Video-Assisted Thoracoscopic Lobectomy in Children: Safety and Efficacy Compared with the Conventional Thoracotomy Approach
Authors: Seong Yong Won , Yoo Byung Su , Kim Jin Tae , Park In Kyu , Kang Chang Hyun , Kim Young Tae
Published: January 2019

Objective

There have been only small numbers of reports for video-assisted thoracoscopic surgery (VATS) lobectomy in children because of its technically demanding aspects. This study was performed to evaluate the safety and the efficacy of the VATS lobectomy compared with the conventional lobectomy by thoracotomy and to investigate the risk factors of thoracotomy conversion.

Methods

From May 2005 to October 2010, a total of 37 pediatric patients underwent VATS lobectomy and 28 pediatric patients underwent conventional lobectomy. The VATS lobectomy group consisted of relatively older patients compared with the thoracotomy group. Clinical outcomes from the two groups were analyzed and compared.

Results

Of the 37 patients in the VATS group, 8 patients (23%) required thoracotomy conversion and 29 patients (77%) were successfully operated on thoracoscopically. There were no in-hospital mortalities in both groups. Annual thoracotomy conversion rate has decreased from 50% in 2005 to 9% in 2010. There were no significant differences in the outcome between the VATS group and the thoracotomy group. Morbidities in the VATS group included prolonged drainage longer than 7 days (two patients), prolonged air leakage (two patients), and bleeding (one patient). There was no difference in the incidence of morbidities between the two groups. Univariate analyses revealed failure of single-lung ventilation (P = 0.007) and history of pneumonia (P = 0.001) to be risk factors of thoracotomy conversion.

Conclusions

Video-assisted thoracoscopic surgery lobectomy in children is a safe and effective treatment modality, with results comparable with those of conventional lobectomy. In the univariate analysis, failure of single-lung ventilation and history of pneumonia were the two factors related to thoracotomy conversion.
Does Dual Antiplatelet Therapy Affect Blood Loss and Transfusion Requirements in Robotic-Assisted Coronary Artery Surgery?
Authors: Hemli Jonathan M. , Darla Lincoln S. , Panetta Christopher R. , Jennings Joan , Subramanian Valavanur A. , Patel Nirav C.
Published: January 2019

Objective

Patients who present for coronary surgery often receive preoperative dual antiplatelet therapy with aspirin and a thienopyridine derivative (clopidogrel or prasugrel), especially after a recent acute coronary syndrome. Studies have shown that patients on aspirin and clopidogrel are at increased risk for perioperative bleeding and related events. We sought to examine the impact of dual antiplatelet therapy on bleeding and transfusion requirements in patients undergoing robotic-assisted minimally invasive coronary artery bypass grafting.

Methods

From January 2010 to November 2011, a total of 110 patients underwent robotic-assisted off-pump coronary surgery at our institution. All patients underwent robotic-assisted harvest of the left internal mammary artery from the chest wall. Some patients then underwent direct coronary anastomosis to the left anterior descending coronary artery via a left minithoracotomy, whereas others had a complete robotic endoscopic procedure within the closed chest. The patients were divided into two groups for outcome analysis on the basis of preoperative antiplatelet therapy: group 1 (either aspirin alone or no antiplatelet agents at all; n = 53) and group 2 (aspirin plus clopidogrel or prasugrel; n = 57).

Results

Perioperative chest tube drainage was not significantly different between the patient groups, irrespective of the preoperative antiplatelet agents used. Transfusion requirements and other morbidities were also similar in both groups of patients.

Conclusions

Preoperative dual antiplatelet therapy does not result in significantly increased bleeding or perioperative transfusion requirements. If clinically indicated, it is reasonable to continue preoperative combination antiplatelet therapy in patients undergoing robotic-assisted coronary surgery.
Left Atrial Roof: An Alternative Minimal Approach for Mitral Valve Surgery
Authors: Esposito Giampiero , Cappabianca Giangiuseppe , Bichi Samuele , Patrini Davide , Pellegrino Pasquale
Published: January 2019

Objective

The most common surgical incisions to expose the mitral valve include a paraseptal left atriotomy or a transeptal biatrial approach. Both techniques are normally performed through a full sternotomy and bicaval cannulation. We report our experience with an alternative incision to expose the mitral valve using the left atrial roof (LAR) through a complete sternotomy or a J-shaped upper ministernotomy.

Methods

Between 2007 and 2011, a total of 512 patients underwent mitral procedures using the LAR approach. A J-shaped ministernotomy was performed in 189 patients, and 61 of these had concomitant aortic valve/root procedures. A standard sternotomy was performed in 323 patients, and 126 of these had concomitant aortic valve/root procedures. The repair rate in patients with mitral regurgitation was 398 of 460 (86.5%).

Results

In-hospital mortality was 2.3%. An adjunctive pericardial patch to repair the LAR was necessary in 1.9% of patients. A permanent pacemaker was necessary in 3.1% of patients. Four-year survival rate was 91% ± 4.2%. In patients who underwent mitral repair, 4-year freedom from mitral regurgitation greater than 2 was 97.4%.

Conclusions

The LAR approach is a safe and effective option to perform mitral valve surgery. The limited extension of this incision and the possibility to use a single venous cannula make this approach suitable for minimally invasive isolated mitral valve procedures, whereas the proximity of the LAR to the aortic root makes this approach particularly attractive for combined mitroaortic procedures through a ministernotomy.
Mitral Valve Annuloplasty Rings: Review of Literature and Comparison of Functional Outcome and Ventricular Dimensions
Authors: Khamooshian Arash , Buijsrogge Marc P. , De Heer Frederiek , Gründeman Paul F.
Published: January 2019

In the past decades, more than 40 mitral valve annuloplasty rings of various shapes and consistency were marketed for mitral regurgitation (MR), although the effect of ring type on clinical outcome remains unclear. Our objective was to review the literature and apply a simplification method to make rings of different shapes and rigidity more comparable. We studied relevant literature from MEDLINE and EMBASE databases related to clinical studies as well as animal and finite element models. Annuloplasty rings were clustered into 3 groups as follows: rigid (R), flexible (F), and semirigid (S). Only clinical articles regarding degenerative (DEG) or ischemic/dilated cardiomyopathy (ICM) MR were included and stratified into these groups. A total of 37 rings were clustered into R, F, and S subgroups. Clinical studies with a mean follow-up of less than 1 year and a reported mean etiology of valve incompetence of less than 60% were excluded from the analysis. Forty-one publications were included. Preimplant and postimplant end points were New York Heart Association class, left ventricular ejection fraction (LVEF), left ventricular end-systolic dimension (LVESD), and left ventricular end-diastolic dimension (LVEDD). Statistical analysis included paired-samples t test and analysis of variance with post hoc Bonferroni correction. P < 0.05 indicated statistical difference. Mean ± SD follow-up was 38.6 ± 27 and 29.7 ± 13.2 months for DEG and ICM, respectively. In DEG, LVEF remained unchanged, and LVESD decreased in all subgroups. In our analysis, LVEDD decreased only in F and R, and S did not change; however, the 4 individual studies showed a significant decline. In ICM, New York Heart Association class improved in all subgroups, and LVEF increased. Moreover, LVESD and LVEDD decreased only in F and S; R was underpowered (1 study). No statistical difference among R, F, and S in either ICM or DEG could be detected for all end points. Overall, owing to underpowered data sets derived from limited available publications, major statistical differences in clinical outcome between ring types could not be substantiated. Essential end points such as recurrent MR and survival were incomparable. In conclusion, ring morphology and consistency do not seem to play a major clinical role in mitral valve repair based on the present literature. Hence, until demonstrated otherwise, surgeons may choose their ring upon their judgment, tailored to specific patient needs.
Safety of Single-Dose Histidine-Tryptophan-Ketoglutarate Cardioplegia during Minimally Invasive Mitral Valve Surgery
Authors: Savini Carlo , Murana Giacomo , Di Eusanio Marco , Suarez Sofia Martin , Jafrancesco Giuliano , Castrovinci Sebastiano , Castelli Andrea , Di Bartolomeo Roberto
Published: January 2019

Objective

Minimally invasive mitral valve surgery may require a prolonged period of myocardial ischemia. Cardioplegic solutions that necessitate a single dose for adequate myocardial protection are evoked to simplify surgery and result to be appealing in this setting. The aim of this study was to assess early outcomes after minimally invasive mitral valve surgery using one single dose of histidine-tryptophanketoglutarate solution (HTK; Custodiol) for myocardial protection.

Methods

Between February 2003 and October 2012, a total of 49 consecutive patients underwent minimally invasive mitral valve surgery using a single dose of HTK solution for myocardial protection. The patients’ mean (SD) age was 57 (14) years; the preoperative ejection fraction was normal in all cases. The mean (SD) CPB time and aortic cross-clamp time were 148 (45) minutes and 97 (45) minutes, respectively.

Results

The heart spontaneously restarted after cross-clamp removal in 37 patients (75.5%). Five patients (10.2%) required prolonged inotropic drug support. Postoperatively, no significant increase in myocardial cytonecrosis enzymes was found [mean (SD) creatine kinase isoenzyme MB, 77.14 (53.67) μg/L at 3 hours, 71.2 (55.67) μg/L at 12 hours, and 42.53 (38.38) μg/L at 24 hours)], and no ischemic electrocardiogram modifications were observed before discharge.

Conclusions

During minimally invasive mitral valve surgery, HTK solution provided excellent myocardial protection even after prolonged periods of cardioplegic arrest. The avoidance of repetitive infusions may reduce the risk for coronary malperfusion due to dislodgement of the endoaortic clamp (if used) and increase the surgeon's comfort during the procedure.
Minimally Invasive Coronary Artery Bypass Grafting is Associated with Improved Clinical Outcomes
Authors: Rabindranauth Prem , Burns Jacob G. , Vessey Todd T. , Mathiason Michelle A. , Kallies Kara J. , Paramesh Venki
Published: January 2019

Objective

Minimally invasive coronary artery bypass grafting (MICS CABG) via left minithoracotomy is an alternative to off-pump coronary artery bypass (OPCAB) via sternotomy. Our objective was to evaluate the clinical outcomes after MICS CABG versus OPCAB.

Methods

The medical records of patients who underwent MICS CABG from December 2009 to December 2011 and OPCAB from January 2005 to April 2011 were reviewed. Patients who underwent OPCAB were matched 2:1 to patients who underwent MICS CABG by age, sex, preoperative ejection fraction, creatinine concentration, as well as history of diabetes and myocardial infarction.

Results

A total of 130 MICS CABG patients were matched with 260 OPCAB patients. Mean bypasses in the MICS CABG and OPCAB groups were 2.1 and 3.2, respectively ( P = 0.001). Extubation in the operating room (OR) occurred in 70.0% and 12.7% of patients in the MICS CABG and OPCAB groups, respectively ( P = 0.001). Mean postoperative length of stay was 4 days for the MICS CABG patients versus 5 days for the OPCAB patients ( P = 0.002) and 3.8 days versus 4.6 days for the MICS CABG patients extubated in the OR compared with those who remained intubated ( P = 0.007). There were no 30-day mortalities in the MICS CABG group and 1 in the OPCAB group (P= 0.999). Thirty-day readmissions were similar, with 5.4% and 7.4% in the MICS CABG and OPCAB groups, respectively ( P = 0.527).

Conclusions

Minimally invasive coronary artery bypass grafting is safe, and early clinical outcomes are comparable, if not superior in some respects, to OPCAB. Extubation in the OR is feasible, well tolerated, and associated with earlier discharge. Shorter hospital stays may decrease resource use and promote earlier return to activities; however, further research is needed.
A new concept of vibration-control system in continuous miner machine
Authors: Mężyk Arkadiusz , Pawlak Mariusz , Kania Jan , Klein Wojciech
Published: January 2019

The article reviews the technical solution applied to these machines which are currently in use worldwide. Special attention is paid to the new concept of a cutter drum powertrain system, where the permanent magnet technology motors are proposed. Placing them inside the cutting drum results in improved dynamic performance of the mining process, as well as the possibility of modular configuration depending on the required operating condition. The authors analysed the dynamics of mining in continuous miner machines, where the adverse impact of vibrations during this process was noticed. The reason for this problem is the occurrence of resonance frequencies in the structure of the machine, which significantly shortens its life time. In previous publications, approaches based on avoiding resonance and adjusted shape modes to reduce displacement of cutter drum were presented. One of the ways to achieve this effect is to control cutter drum’s angular velocity. It allows thinking about a new concept of vibration-control system based on smooth speed change of the cutter drum or/and the angular speed of the boom.
Reducing errors in the administration of medication with infusion pumps in the intensive care department: A lean approach
Authors: van der Sluijs Alexander F , van Slobbe-Bijlsma Eline R , Goossens Astrid , Vlaar Alexander PJ , Dongelmans Dave A
Published: January 2019

Background:

Medication errors occur frequently and may potentially harm patients. Administering medication with infusion pumps carries specific risks, which lead to incidents that affect patient safety.

Objective:

Since previous attempts to reduce medication errors with infusion pumps failed in our intensive care unit, we chose the Lean approach to accomplish a 50% reduction of administration errors in 6 months. Besides improving quality of care and patient safety, we wanted to determine the effectiveness of Lean in healthcare.

Methods:

We conducted a before-and-after observational study. After baseline measurement, a value stream map (a detailed process description, used in Lean) was made to identify important underlying causes of medication errors. These causes were discussed with intensive care unit staff during frequent stand-up sessions, resulting in small improvement cycles and bottom-up defined improvement measures. Pre-intervention and post-intervention measurements were performed to determine the impact of the improvement measures. Infusion pump syringes and related administration errors were measured during unannounced sequential audits.

Results:

Including the baseline measurement, 1748 syringes were examined. The percentage of errors concerning the administration of medication by infusion pumps decreased from 17.7% (95% confidence interval, 13.7–22.4; 55 errors in 310 syringes) to 2.3% (95% confidence interval, 1–4.6; 7 errors in 307 syringes) in 18 months (p < 0.0001).

Conclusion and Relevance:

The Lean approach proved to be helpful in reducing errors in the administration of medication with infusion pumps in a high complex intensive care environment.