bluuebunny/crossref_metadata_2025 huggingface dataset:
Participação da família no tratamento terapêutico ocupacional da criança com paralisia cerebral
Authors: Araújo Palloma Moura de , Gonçalo Thainara Pires , Cazeiro Ana Paula Martins
Published: April 2019

O objetivo deste estudo foi identificar a importância da participação da família no tratamento terapêutico ocupacional da criança com paralisia cerebral, bem como as estratégias usadas pelo terapeuta para favorecer tal participação. Foi realizada uma pesquisa qualitativa e descritiva, na qual um questionário com dez questões abertas foi respondido por 33 terapeutas ocupacionais; os dados foram tratados por meio da análise de conteúdo. Os resultados indicam que a participação da família ocorre principalmente por orientações, participação nos atendimentos e continuidade em casa do que é feito em terapia. As orientações incluem temas como posicionamento, atividades da vida diária e estimulação. Com o apoio familiar, as crianças são beneficiadas em sua evolução, participação e independência. O envolvimento da família pode ser limitado por fatores como falta de tempo, sobrecarga, desinteresse ou regras da instituição. As estratégias para favorecer este envolvimento incluem escuta e orientação, atendimento à família e criação de vínculo. Os profissionais afirmam que a participação da família é de suma importância para o tratamento, mas pode não ocorrer principalmente por dificuldades do cuidador, o que evidencia que este também necessita de cuidados.
Atuação da Terapia Ocupacional no Consultório na Rua
Authors: Prodocimo Camila Regina , Milek Glenda , Ferigato Sabrina Helena
Published: April 2019

Este artigo é resultado do trabalho de conclusão de curso intitulado “Corpos de criação: A atuação da Terapia Ocupacional no Consultório na Rua” e apresenta as contribuições da Terapia Ocupacional nas ações no Consultório na Rua. Objetivos: o estudo teve como objetivo geral conhecer e analisar a atuação da Terapia Ocupacional no Consultório na Rua junto às equipes e usuários deste dispositivo e como objetivos específicos buscou identificar, descrever e diferenciar as ações no campo da Atenção Primária em geral e no núcleo profissional junto à população atendida. Métodos: O estudo tem como enfoque uma pesquisa de abordagem qualitativa com caráter exploratório através da análise de cinco entrevistas semiestruturadas realizadas em 2017 com terapeutas ocupacionais em três municípios do estado de São Paulo. Resultados: As intervenções da Terapia Ocupacional no Consultório na Rua foram apresentadas em dois grupos I) ações do campo da Atenção básica e II) ações do núcleo da Terapia Ocupacional. Conclusão: A incorporação das terapeutas ocupacionais na equipe e no trabalho in loco, permitiu a ampliação de estratégias de cuidado, para além das ações curativas ou preventivas.  Às ações de núcleo se apresentaram como uma das potências do serviço, ampliando a apropriação do usuário em relação à seu cuidado. Os terapeutas ocupacionais atuam principalmente proporcionando encontros, experimentações de si e do mundo por meio de atividades, frente as inúmeras possibilidades que a vida cotidiana na rua oferece.
Complement Membrane Attack Complexes Assemble NLRP3 Inflammasomes Triggering IL-1 Activation of IFN-γ–Primed Human Endothelium
Authors: Xie Catherine B. , Qin Lingfeng , Li Guangxin , Fang Caodi , Kirkiles-Smith Nancy C. , Tellides George , Pober Jordan S. , Jane-wit Dan
Published: April 2019

Rationale:

Complement activation contributes to multiple immune-mediated pathologies. In late allograft failure, donor-specific antibody deposits complement membrane attack complexes (MAC) on graft endothelial cells (ECs), substantially increasing their immunogenicity without causing lysis. Internalized MAC stabilize NIK (NF-κB [nuclear factor kappa-light-chain-enhancer of activated B cells]–inducing kinase) protein on Rab5+MAC+ endosomes, activating noncanonical NF-κB signaling. However, the link to increased immunogenicity is unclear.

Objective:

To identify mechanisms by which alloantibody and internalized MAC activate ECs to enhance their ability to increase T-cell responses.

Methods and Results:

In human EC cultures, internalized MAC also causes NLRP3 (NOD-like receptor family pyrin domain containing 3) translocation from endoplasmic reticulum to Rab5+MAC+NIK+ endosomes followed by endosomal NIK-dependent inflammasome assembly. Cytosolic NIK, stabilized by LIGHT (lymphotoxin-like inducible protein that competes with glycoprotein D for herpesvirus entry on T cells), does not trigger inflammasome assembly, and ATP-triggered inflammasome assembly does not require NIK. IFN-γ (interferon-γ) primes EC responsiveness to MAC by increasing NLRP3, pro-caspase 1, and gasdermin D expression. NIK-activated noncanonical NF-κB signaling induces pro-IL (interleukin)-1β expression. Inflammasome processed pro-IL-1β, and gasdermin D results in IL-1β secretion that increases EC immunogenicity through IL-1 receptor signaling. Activation of human ECs lining human coronary artery grafts in immunodeficient mouse hosts by alloantibody and complement similarly depends on assembly of an NLRP3 inflammasome. Finally, in renal allograft biopsies showing chronic rejection, caspase-1 is activated in C4d
+
ECs of interstitial microvessels, supporting the relevance of the cell culture findings.

Conclusions:

In response to antibody-mediated complement activation, IFN-γ-primed human ECs internalize MAC, triggering both endosomal-associated NIK-dependent NLRP3 inflammasome assembly and IL-1 synthesis, resulting in autocrine/paracrine IL-1β-mediated increases in EC immunogenicity. Similar responses may underlie other complement-mediated pathologies.
Anna Maria Ortese’s palette: Colors and achromaticity in Neapolitan Chronicles
Authors: Morra Eloisa
Published: April 2019

The article outlines the forms and functions of Anna Maria Ortese’s palette in Neapolitan Chronicles. Moving through short stories, essays, and reportages, we can identify topical colors in Ortese’s work: gray, and the achromatic shades black and white. In addition to differentiating the roles of the color series, the article traces Chronicles’ literary genealogies, linking it to Melville and Poe’s works. Far from being a traditional colorist, Ortese gives life to a pictorial writing, which makes of the deformation of reality a key to a more vivid and acute perception of the world.
Demographic Causes of Conflict and Their Implications for Public Health
Authors: Hessel Philipp
Published: April 2019

Although levels of violence have declined, exposure to conflict, unfortunately, remains a common feature of many people’s lives. While “demography is not destiny,” demographic factors have been widely discussed as potential causes for conflict. This essay discusses the implications of two demographic megatrends – population growth and aging – on the future risk for conflict and their wider implications for public health and health care systems.
Pectus excavatum repair using bridge fixation system
Authors: Vinh Vu Huu , Khanh Huynh Quang , Binh Nguyen Hoang , Khoi Nguyen Van
Published: April 2019

Background

The stability of the pectus bar is an important determinant of the success of pectus excavatum repair surgery. In practice, several different types of fixation method are in use for stabilizing pectus bars. The aim of this study was to compare the performance of the bridge fixation system with previous fixation systems for stabilizing pectus bars.

Methods

We performed a retrospective review of 1760 pectus excavatum repair cases conducted in the Thoracic Department of Choray Hospital and its satellite hospitals, between 2007 and 2017. We compared the results of 560 patients who had the bridge fixation system with the previous 1200 patients who had other fixation techniques.

Results

The bridge fixation system with 2 bars in 560 patients gave better results in terms of bar stabilization, operative time, and postoperative complications, compared to the previous 1200 patients who had other stabilization techniques. The average skin-to-skin surgery time using the bridge fixation system was 55 min. Of the 560 cases, only one patient showed trivial one bar dislocation, and one had a postoperative complication (pneumothorax).

Conclusions

We found the bridge fixation system to be superior not only in terms of stabilizing the bars but also for minimizing the time of surgery and postoperative complications, compared to other fixation systems. The bridge fixation system with 2 bars showed excellent results. Use of 3 bars is not necessary. One bar was used in the other fixation techniques and the results were found to be inferior compared to those using 2 bars.
Grading lumbar disc degeneration: a comparison between low- and high-field MRI
Authors: Hansen Bjarke B , Ciochon Urszula M , Trampedach Charlotte R , Christensen Anders F , Rasti Zoreh , Boesen Mikael
Published: April 2019

Background

More advanced disc degeneration on magnetic resonance imaging (MRI) is found in individuals with low back pain. However, it is unclear whether this grading is independent of the scanner’s field strength.

Purpose

To compare disc degeneration on high- versus low-field MRI.

Material and Methods

Low back pain patients were enrolled to undergo high-field (3 T) MRI, followed by low-field (0.25 T) MRI of the lumbar spine within 3 h. Three radiologists graded the disc degeneration on Pfirrmann’s grading scale with a hiatus of 3 months. A subsample was regraded 6 months later. Reproducibility was measured by weighted kappa statistics (using PROC FREQ statement with AGREE in the TABLES statement for SAS), absolute agreement (i.e. 1:1 agreement/the total number) and the difference in the prevalence (McNemar test).

Results

Moderate to substantial agreement (κ = 0.52–0.62) and absolute agreement of 43.8–66.1% were found between field strengths. Low-field MRI tended to have numerically higher and lower grades than high-field MRI resulting in a significant difference in the prevalence of grades ( p < 0.001). Both field strengths resulted in a moderate to substantial inter-reader agreement (low-field: κ = 0.63, 0.63, 0.54 and high-field: κ = 0.55, 0.43, 0.53) and intra-reader agreement (high-field: κ = 0.57, 0.77, 0.67 and low-field: κ = 0.51, 0.50, 0.70). Only, the reader with the shortest experience had better agreement with high-field compared to low-field.

Conclusions

There were a significant difference in the prevalence of disc degeneration grading between 0.25 T and 3 T MRI. Therefore, field strength should be taken into consideration when comparing studies using disc degeneration grading as an outcome.
Visualizing the largest annual human migration during the Spring Festival travel season in China
Authors: Hu Maogui
Published: April 2019

The large human migration between different areas in China indicates unequal urban and economic development under the background of rapid urbanization and rush for economic growth. Based on social networking big data, we analyzed the difference of population distribution during the Spring Festival holiday and the non-holiday periods. We find that the two patterns differ significantly and there are mainly two levels of population migration center.
A Beijing that you might not know: Geovisualizing selected crimes in Beijing
Authors: Zhou Jiangping , Yang Yuling , Zhang Yanji , Zhang Chun
Published: April 2019

China is generally considered a safe place: among the safest for foreigners to visit. For local (long-term) residents and for Chinese criminology scholars, China as a country and its individual cities might be safer compared to many of their foreign peers; however, they might not be as safe as some travel agents claim. To show why this is the case, we crawled and geovisualized the 2015–2016 crime records ( n = 24,803) available to the public online. The geovisualization shows that the seven crimes ( n = 12,516) that were most likely to be influenced by space in Beijing were aggravated assault, blackmail, cheating and bluffing, dangerous driving, picking quarrels and provoking trouble, robbery and theft. It also shows a Beijing that many might not have known before.
Peripheral and central nervous system distribution of the CGRP neutralizing antibody [125I] galcanezumab in male rats
Authors: Johnson Kirk W , Morin S Michelle , Wroblewski Victor J , Johnson Michael P
Published: April 2019

Objective

The objective of this investigation was to examine the distribution of galcanezumab and a control immunoglobulin 4 antibody containing the same constant regions as galcanezumab, into peripheral and central tissues.

Methods

Galcanezumab and a control immunoglobulin 4 antibody were radioiodinated with Iodine-125 to specific activities of 0.11 mCi/mg and 0.16 mCi/mg, respectively. At 24, 72, and 168 hours following subcutaneous injection of either antibody (4 mg/kg), cerebrospinal fluid and plasma were obtained followed by saline perfusion to remove residual blood and collection of selected tissues for determination of Iodine-125 content by gamma counting.

Results

The peak plasma levels of Iodine-125 galcanezumab and Iodine-125 control immunoglobulin 4 were observed at 72 hours and remained high at 168 hours post-dose. The rank order of tissue levels was dura mater = spleen > trigeminal ganglia ≫hypothalamus = spinal cord = prefrontal cortex = cerebellum. Iodine-125 galcanezumab levels in peripheral tissue (dura mater, spleen, and trigeminal ganglia) averaged 5% to 11% of plasma, whereas all of the central nervous system (CNS) tissue levels and the cerebrospinal fluid levels were < 0.4% of plasma. Distribution of the antibodies into the dura mater and the trigeminal ganglia was similar to that observed in the spleen and significantly greater than exposure in the brain or spinal cord.

Conclusions

The central levels of galcanezumab were relatively low, which would favor the dura mater and trigeminal ganglia as sites of action for its observed clinical efficacy. However, a central site of action cannot be excluded.
Dynamic effect of environmental tax on export trade: Based on DSGE mode
Authors: Gao Yantao , Yao Xilong , Wang Wenxi , Liu Xin
Published: April 2019

We develop a Dynamic Stochastic General Equilibrium (DSGE) model with four sectors, including households, production, government, and export. The model is used to assess the response of China’s export trade to environmental tax shocks. The model parameters are obtained through a combination of calibration and Bayesian estimation. Using the impulse response analysis and variance decomposition, we find that environmental tax shocks can drive the reduction of export volume in China. However, the effect of the environmental tax shocks is smaller than export price mark-up rate shocks. These findings yield important implications for reasonably designing and choosing environmental tax rate and export trade policies.
Alternate energy sources for lighting among rural households in the Himalayan region of Pakistan: Access and impact
Authors: Ali Akhter , Rahut Dil Bahadur , Mottaleb Khondoker Abdul , Aryal Jeetendra Prakash
Published: April 2019

This paper analyzes the alternate energy option for lighting among rural households in the Himalayan region of Pakistan using a primary dataset collected from 500 households from the seven districts of Gilgit-Baltistan regions. A multivariate probit model was employed for examining the determinants of use of different sources of energy and a Poisson regression to estimate the number of alternate sources of energy used for lighting by the rural households. The propensity score matching (PSM) approach was employed to assess the impact of electricity as a source of light for the use of household appliances as well as providing light for evening work. Empirical results show the rural households in the study area use five different sources of energy for lighting, namely electricity, kerosene, candles, solar energy and batteries. Education and wealth play an important role in the use of clean sources of energy for light. The PSM results indicated a positive impact of electricity on the use of appliances, as well as on more extended working hours in the households in this Himalayan region.
Reconciling rights-based discourse with Pacific culture and way-of-life: Re-defining our understanding of ‘rights’
Authors: Zheng Gina
Published: April 2019

There is no denying that human rights play an integral role in our social and legal existence. However, contemporary developments of rights-based discourse have become preclusive to cultural accommodation. Drawing on a case-study of the application of Western conceptions of human rights in Papua New Guinea, this work will illustrate Mutua’s argument that the dissemination of rights-based discourse through hegemonic voices can undermine the universality and effective application of rights-based doctrines in non-Western contexts. This article will thus argue that informing rights-based discourse with local-cultural circumstances and social values is necessary for the genuine achievement of ‘universal’ human rights.
Evaluation and Comparison of Short Form Methadone Maintenance Treatment Training Courses Among Iranian General Physician and Psychologist Participants
Authors: Saberi Zafarghandi Mohammad Bagher , Dadfar Mahboubeh , Arezoomandan Reza , Veisy Fateme , Behnood Rod Azin
Published: April 2019

The evaluation of the effectiveness of education plays an important role in the improvement of training processes. The aim of the present study was to evaluate and compare the short form training courses for methadone maintenance treatment (MMT) in Iranian general physicians (GPs) and psychologists. This was a descriptive cross-sectional study with 203 participants (91 GPs and 112 psychologists) in three 10-day short form MMT training courses at the School of Behavioral Sciences and Mental Health - Tehran Institute of Psychiatry. After the courses, participants were asked to complete the Kirkpatrick Training Evaluation Questionnaire. Overall, the GPs evaluated the short form MMT training course significantly more positively than did the psychologists. Evaluation scores for Levels 1, 2, and 4 were good, average, and average, respectively. The Level 2 (learning) scores of both GPs and psychologists increased after the short form MMT training course compared with before the short form MMT training course. Similarities in the views of the GPs and the psychologists were more than differences between them. Research findings raised concerns about the implementation, management, monitoring, new guidelines, support, and training for this training course while providing valuable information in helping to facilitate more involvement of GPs and psychologists in the short form MMT training course.
Kurt Benirschke, MD (1924–2018): Pioneer in Perinatal and Placental Pathology
Authors: Baergen Rebecca N
Published: April 2019

Kurt Benirschke, noted pathologist and animal conservationist, passed away on September 10, 2018 at the age of 94. Kurt Benirschke is a legendary figure in perinatal pathology and was likely the first pathologist to have a genuine interest in the placenta. With Shirley Driscoll, he wrote the first textbook on placental pathology—The Pathology of the Human Placenta published in 1967. Dr Benirschke combined interests in both human and animal biology—not only was he a noted pathologist and geneticist, but he had expertise in the reproduction of humans and many mammalian species. During his career, he advanced comparative pathology of placentation, and due to his work on the preservation of endangered species, he likely saved a number of species from extinction. He also became internationally known for his creation of the “frozen zoo” collecting embryos and tissues of numerous endangered species. I have been privileged to be among his many friends and colleagues who were awed by the breadth of his extensive knowledge, his humility, and his sense of humor. Benirschke’s life and career, which is reviewed here, should be an inspiration to the Pediatric and Developmental Pathology readership.
Implementation of provider payment system reforms in the age of universal health coverage: a realist review of evidence from Asian developing countries
Authors: Tan Si Ying , Melendez-Torres GJ , Pang Tikki
Published: April 2019

Objective

Launched to assist in achieving universal health coverage, provider payment reform (PPR) is one of the most important policy tools deployed to transform incentives within a health system that is plagued with allocative inefficiency and high out-of-pocket payments to one that is able to deliver basic services and be cost-efficient. However, the black box of such reform – that is, the contexts in which reform operates, the mechanisms by which it changes health systems and behaviour within health systems, and the outcome patterns that arise from – remains unexplored. This review aims to examine the implementation mechanisms underlying PPR in Asian developing countries.

Methods

A realist synthesis approach was employed to tease out the configurative elements of PPR in developing countries. A multimethod and retrospective search was conducted to locate the evidence. A programme theory and data extraction framework were developed. Data were analysed using thematic synthesis to inform an overarching realist synthesis, expressed as a set of synthesized context-mechanism-outcome configurations.

Results

This review found that the policy design of PPR, policy capacity, willingness of policy adoption at the local government level and provider autonomy are critical contextual factors that could trigger different policy mechanisms leading to either intended theoretical outcomes or perverse incentives.

Conclusions

Our findings, demonstrating the PPR implementation contexts and mechanisms that have worked in Asian countries, have implications in terms of policy learning for most developing countries that are contemplating rolling out similar reforms in the future.
The distribution and influential factors of PM2.5 and CO2 in urban rail carriages
Authors: Gao Yongxin , Chen Feng , Wang Zijia
Published: April 2019

The promotion of ‘Green Transport’ has increased the importance of urban rail transit in China. Increased passenger flow and longer travel time have led to increased attention to in-carriage air quality in trains. In this study, CO2 and PM2.5 monitoring were conducted in subway train carriages in a city in northern China. The study accounts for a variety of factors both inside and outside of the train carriages, such as passenger volume and exterior environment. The results reveal that good air quality outside of the train, an above ground location and the use of platform screen doors could aid in the attainment of acceptable PM2.5 concentrations. In addition, linear models of CO2 and PM2.5 concentrations were established based on passenger density. The nonlinear recursive models were constructed using time-series analysis to reflect the cumulative effects of the amounts of CO2 and PM2.5. The spatial and temporal distributions show that, given a constant passenger density, the PM2.5 concentration is higher near the door area than in the seating area. CO2 concentrations varied in three stages, consistent with the change of local passenger load. Finally, a real-time optimized control method for fresh air volume and some suggestions are proposed to improve the in-carriage air quality of subway trains.
Impact of disclosure of a dementia diagnosis on uptake of support services: A pilot study exploring a post-traumatic stress approach
Authors: Dunham Annette , Mellor David , Rand Elizabeth , McCabe Marita , Lewis Matthew
Published: April 2019

Background

At time of diagnosis, people with dementia and their carers can access support services to help them to plan for their future care needs, but often they do not engage with these services. It is not clear why this occurs but a potential explanation explored in this paper is that disclosure of a dementia diagnosis is an overwhelming and highly stressful event that may lead to behavioural avoidance in the manner of post-traumatic stress. In this study we use a post-traumatic stress screening tool to determine whether being diagnosed with dementia shares some qualitative similarities with post-traumatic stress disorder and explore whether this is associated with a reduced likelihood to engage support services following diagnosis.

Method

We conducted a small pilot study through the local memory clinic with eight people with dementia and 11 carers returning surveys. Participants completed the Impact of Events Scale-Revised, a validated post-traumatic stress disorder screening tool, and also provided information regarding their experience of the diagnosis and subsequent use of support services.

Results

One person with dementia and two carers had scores on the Impact of Events Scale-Revised indicating a probable diagnosis of post-traumatic stress disorder and two people with dementia and two carers scored within the range of clinical concern. The average Impact of Events Scale-Revised score of those who had taken-up a referral to home support was significantly lower than those who had not.

Conclusion

A dementia diagnosis can be associated with symptoms that are consistent with post-traumatic stress, which in turn may affect engagement with support services.
Controversies in applying the Abortion Act to Down syndrome
Authors: Habiba Marwan
Published: April 2019

Recently published data from the UK pointed out that the number of abortions performed under Ground E of the Abortion Act 1967, which allows abortion for foetal abnormalities, was far lower compared to the number of pregnancy terminations where foetuses had Down syndrome. This prompted calls for the matter to be rectified. This article explores the issues raised and argues that rather than being a concern; the discrepancy is consistent with moral uncertainty or a non-judgmental approach. This is, perhaps fortuitously, in tune with recognized conceptualizations of functioning ability. Debate about what constitutes substantial risk may be resolved in those conditions where a diagnosis can be confirmed. But clinical presentations of those affected can vary and there is no necessary link between functional abilities and suffering. Despite the ambiguities, some practitioners have resolved in favour of late abortion in pregnancies with Down syndrome. It is tempting to develop inferences from these cases, but advancing a convincing argument that may encompass all affected cases requires agreement on underpinning assumptions. Given the polarized debate in this area, it is perhaps best to acknowledge the reality of diverse ethical viewpoints.
The influence of gender and race on heart failure self-care
Authors: Graven Lucinda J , Abbott Laurie , Dickey Sabrina L , Schluck Glenna
Published: April 2019

Objectives

To explore gender and racial differences in heart failure (HF) self-care processes and examine whether gender and race predict HF self-care.

Methods

A secondary analysis of baseline data ( n = 107) from a longitudinal HF study (54.2% males; 56% non-Caucasians) was conducted. The self-care of heart failure index was used to measure self-care maintenance, management, and confidence. Descriptive statistics and univariate analyses examined gender and racial differences in HF self-care outcomes. Multiple linear regression examined whether gender and race predicted HF self-care maintenance, management, and confidence.

Results

Univariate analyses indicated that Caucasians reported significantly better self-care maintenance ( p = 0.042), while non-Caucasians reported significantly better self-care management ( p = 0.003). Males had significantly higher self-care confidence scores versus women ( p = 0.017). Multiple regression analysis indicated Caucasian race predicted significantly worse self-care management (β = −11.188; p = 0.006) versus non-Caucasian, while male gender predicted significantly higher self-care confidence scores (β = 7.592; p = 0.010) versus female gender. Gender nor race significantly predicted self-care maintenance.

Discussion

Although gender and race may influence HF self-care, other factors may be more important. More research is needed to identify individual factors that contribute to HF self-care to improve education and intervention.
Can masked synonym priming replicate masked translation priming?
Authors: Witzel Naoko
Published: April 2019

This study examines whether synonyms are represented similarly to translation equivalents in the bilingual mind. In particular, this study investigated whether there is masked synonym priming such that it will simulate masked translation priming in the L1-L2 direction. Given that masked translation priming studies consistently show priming in the L1-L2 direction, it was predicted that synonyms should show a masked priming effect if the prime was higher in frequency than the target. Contrary to what Bilingual Interactive Activation models would predict, there was no priming for synonyms in the high-to-low frequency (HF-LF) condition or in the low-to-high frequency (LF-HF) condition in Experiment 1. Experiment 2 only tested the HF-LF condition to ensure that previous exposure to LF words within the experiment did not affect the results. Again, no HF-LF synonym priming was observed. The effect sizes of these synonym priming effects were comparable with that of L2-L1 translation priming, all of which were weak. This is not surprising given that semantic interpretation of a given word usually occurs post-lexically and requires partial awareness. What is surprising is that there is robust evidence showing strong L1-L2 masked translation priming effect, which bilingual lexical processing models should attempt to explain, thereby uncovering the relations between L1 words and their L2 translations.
Fecal microbiota transplant for Crohn disease: A study evaluating safety, efficacy, and microbiome profile
Authors: Gutin Liat , Piceno Yvette , Fadrosh Douglas , Lynch Kole , Zydek Martin , Kassam Zain , LaMere Brandon , Terdiman Jonathan , Ma Averil , Somsouk Ma , Lynch Susan , El-Nachef Najwa
Published: April 2019

Background

Emerging trials suggest fecal microbiota transplantation (FMT) is a promising treatment for ulcerative colitis; however, there is a paucity of data in Crohn disease (CD).

Objective

The objectives of this article are to determine whether single‐dose FMT improves clinical and endoscopic outcomes in CD patients and to identify meaningful changes in the microbiome in response to FMT.

Methods

We performed a prospective, open‐label, single‐center study. Ten CD patients underwent FMT and were evaluated for clinical response (defined as decrease in Harvey‐Bradshaw Index score ≥3 at one month post‐FMT) and microbiome profile (16S ribosomal RNA sequencing) at one month post‐FMT.

Results

Three of 10 patients responded to FMT. Two of 10 patients had significant adverse events requiring escalation of therapy. On microbiome analysis, bacterial communities of responders had increased relative abundance of bacteria commonly found in donor gut microbiota.

Conclusions

Single‐dose FMT in this cohort of CD patients showed modest effect and potential for harm. Responders tended to have lower baseline alpha diversity, suggesting baseline perturbation of microbiota may be an indicator of potential responders to FMT in this patient population. Controlled trials are needed to further assess the efficacy and safety of FMT in CD and determine whether FMT is a viable option in this patient population.

Clinicaltrials.gov number: NCT02460705.
Italian nationwide survey of pharmacologic treatments in diverticular disease: Results from the REMAD registry
Authors: Cremon Cesare , Carabotti Marilia , Cuomo Rosario , Pace Fabio , Andreozzi Paolo , Barbaro Maria Raffaella , Annibale Bruno , Barbara Giovanni ,   REMAD Group
Published: April 2019

Background

Although diverticular disease is a common condition, its effective treatment is challenging in clinical practice.

Objective

The objective of this article is to assess pharmacological management in different clinical settings of diverticular disease and factors associated with treatment using the Italian registry Registro Malattia Diverticolare (REMAD).

Methods

At study enrolment, patients were categorised into subgroups: diverticulosis, symptomatic uncomplicated diverticular disease and previous diverticulitis. We registered demographic, clinical and lifestyle factors, quality of life and the use of treatments for diverticular disease in the last year. Logistic regression analysis assessed the association between clinical factors and treatment consumption.

Results

A total of 500 of the 1206 individuals included had had at least one treatment for diverticular disease in the last year: 23.6% (166/702) of patients with diverticulosis, 55.9% (165/295) of patients with symptomatic diverticular disease, and 80.9% (169/209) of patients with previous diverticulitis (p < 0.001). In multivariate analysis, the following factors were significantly associated with treatment use: female gender, family history of colonic diverticula, organic digestive comorbidity and impaired physical quality of life components.

Conclusion

Individuals with diverticular disease take medications based on the different clinical settings of disease. We identified different features associated with treatment use in the distinct clinical entities of diverticular disease.

ClinicalTrial.gov Identifier: NCT03325829.
Antihyperglycemic therapy during colonoscopy preparation: A review and suggestions for practical recommendations
Authors: Hochberg Irit , Segol Ori , Shental Rachel , Shimoni Pnina , Eldor Roy
Published: April 2019

Patients with diabetes have distinct risks during precolonoscopy bowel preparation, caused by change of diet, change of antihyperglycemic medication regimens and diabetes‐related complications and comorbidities. These risks include hypoglycemia, water and electrolyte imbalance, acute renal failure, lactic acidosis, ketoacidosis and low quality of bowel preparation. Here we review the existing literature and present recommendations from a subcommittee of the Israeli National Diabetes Council for primary care physicians and gastroenterologists. The instructions include general suggestions on diet and glucose monitoring and specific recommendations on timing of modification or cessation of each of the antihyperglycemic medication types to ensure patient safety during bowel preparation.
Therapeutic hypothermia for acute ischaemic stroke. Results of a European multicentre, randomised, phase III clinical trial
Authors: van der Worp H Bart , Macleod Malcolm R , Bath Philip MW , Bathula Raj , Christensen Hanne , Colam Bridget , Cordonnier Charlotte , Demotes-Mainard Jacques , Durand-Zaleski Isabelle , Gluud Christian , Jakobsen Janus Christian , Kallmünzer Bernd , Kollmar Rainer , Krieger Derk W , Lees Kennedy R , Michalski Dominik , Molina Carlos , Montaner Joan , Roine Risto O , Petersson Jesper , Perry Richard , Sprigg Nikola , Staykov Dimitre , Szabo Istvan , Vanhooren Geert , Wardlaw Joanna M , Winkel Per , Schwab Stefan ,   the EuroHYP-1 investigators
Published: April 2019

Introduction

We assessed whether modest systemic cooling started within 6 hours of symptom onset improves functional outcome at three months in awake patients with acute ischaemic stroke.

Patients and methods

In this European randomised open-label clinical trial with blinded outcome assessment, adult patients with acute ischaemic stroke were randomised to cooling to a target body temperature of 34.0–35.0°C, started within 6 h after stroke onset and maintained for 12 or 24 h , versus standard treatment. The primary outcome was the score on the modified Rankin Scale at 91 days, as analysed with ordinal logistic regression.

Results

The trial was stopped after inclusion of 98 of the originally intended 1500 patients because of slow recruitment and cessation of funding. Forty-nine patients were randomised to hypothermia versus 49 to standard treatment. Four patients were lost to follow-up. Of patients randomised to hypothermia, 15 (31%) achieved the predefined cooling targets. The primary outcome did not differ between the groups (odds ratio for good outcome, 1.01; 95% confidence interval, 0.48–2.13; p = 0.97). The number of patients with one or more serious adverse events did not differ between groups (relative risk, 1.22; 95% confidence interval, 0.65–1.94; p = 0.52).

Discussion

In this trial, cooling to a target of 34.0–35.0°C and maintaining this for 12 or 24 h was not feasible in the majority of patients. The final sample was underpowered to detect clinically relevant differences in outcomes.

Conclusion

Before new trials are launched, the feasibility of cooling needs to be improved.
Does Adherence to World Health Organization Hand Hygiene Protocols in the Operating Room Have the Potential to Produce Irritant Contact Dermatitis in Anesthesia Providers?
Authors: Birnbach David J. , McKenty Nathan T. , Rosen Lisa F. , Arheart Kristopher L. , Everett-Thomas Ruth , Lindsey Scott F.
Published: April 2019

Anesthesia providers have the burden of constant hand hygiene during task dense periods. The requirement for hand hygiene often demands frequent application of alcohol-based hand rub. To assess whether frequent alcohol-based hand rub use leads to skin changes or irritant contact dermatitis, volunteers cleaned their hands with alcohol-based hand rub every 15 minutes for 8 hours for 5 sequential days. They were examined by a dermatologist before and after and asked about subjective skin changes. Results suggest an increase in irritant contact dermatitis scores and subjective complaints.
Segmented Regression and Difference-in-Difference Methods: Assessing the Impact of Systemic Changes in Health Care
Authors: Mascha Edward J. , Sessler Daniel I.
Published: April 2019

Perioperative investigators and professionals increasingly seek to evaluate whether implementing systematic practice changes improves outcomes compared to a previous routine. Cluster randomized trials are the optimal design to assess a systematic practice change but are often impractical; investigators, therefore, often select a before–after design. In this Statistical Grand Rounds, we first discuss biases inherent in a before–after design, including confounding due to periods being completely separated by time, regression to the mean, the Hawthorne effect, and others. Many of these biases can be at least partially addressed by using appropriate designs and analyses, which we discuss. Our focus is on segmented regression of an interrupted time series, which does not require a concurrent control group; we also present alternative designs including difference-in-difference, stepped wedge, and cluster randomization. Conducting segmented regression well requires a sufficient number of time points within each period, along with a robust set of potentially confounding variables. This method compares preintervention and postintervention changes over time, divergences in the outcome when an intervention begins, and trends observed with the intervention compared to trends projected without it. Difference-in-difference methods add a concurrent control, enabling yet stronger inference. When done well, the discussed methods permit robust inference on the effect of an intervention, albeit still requiring assumptions and having limitations. Methods are demonstrated using an interrupted time series study in which anesthesiologists took responsibility for an adult medical emergency team from internal medicine physicians in an attempt to improve outcomes.
High-Frequency Heart Rate Variability Index: A Prospective, Observational Trial Assessing Utility as a Marker for the Balance Between Analgesia and Nociception Under General Anesthesia
Authors: Anderson T. Anthony , Segaran Joshua R. , Toda Chihiro , Sabouri A. Sassan , De Jonckheere Julien
Published: April 2019

BACKGROUND:

Maintaining a balance between nociception and analgesia perioperatively reduces morbidity and improves outcomes. Current intraoperative analgesic strategies are based on subjective and nonspecific parameters. The high-frequency heart rate (HR) variability index is purported to assess the balance between nociception and analgesia in patients under general anesthesia. This prospective observational study investigated whether intraoperative changes in the high-frequency HR variability index correlate with clinically relevant nociceptive stimulation and the addition of analgesics.

METHODS:

Instantaneous and mean high-frequency HR variability indexes were measured continuously in 79 adult subjects undergoing general anesthesia for laparoscopic cholecystectomy. The indexes were compared just before and 2 minutes after direct laryngoscopy, orogastric tube placement, first skin incision, and abdominal insufflation and just before and 6 minutes after the administration of IV hydromorphone.

RESULTS:

Data from 65 subjects were included in the final analysis. The instantaneous index decreased after skin incision ([SEM], 58.7 [2.0] vs 47.5 [2.0]; P < .001) and abdominal insufflation (54.0 [2.0] vs 46.3 [2.0]; P = .002). There was no change in the instantaneous index after laryngoscopy (47.2 [2.2] vs 40.3 [2.3]; P = .026) and orogastric tube placement (49.8 [2.3] vs 45.4 [2.0]; P = .109). The instantaneous index increased after hydromorphone administration (58.2 [1.9] vs 64.8 [1.8]; P = .003).

CONCLUSIONS:

In adult subjects under general anesthesia for laparoscopic cholecystectomy, changes in the high-frequency HR variability index reflect alterations in the balance between nociception and analgesia. This index might be used intraoperatively to titrate analgesia for individual patients. Further testing is necessary to determine whether the intraoperative use of the index affects patient outcomes.
Ventricular Fibrillation Refractory to Cutaneous Electrical Defibrillation in a Morbidly Obese Pediatric Patient With Hypertrophic Cardiomyopathy: A Case Report
Authors: Gylys Maryte H. , Rajan Govind
Published: April 2019

We report a case of subcutaneous implantable cardioverter-defibrillator implantation in a morbidly obese pediatric patient with hypertrophic cardiomyopathy for the primary prevention of sudden cardiac death. During routine defibrillator threshold testing of the newly placed subcutaneous implantable cardioverter defibrillator, normal sinus rhythm could not be restored despite repeated attempts at defibrillation using the subcutaneous implantable cardioverter defibrillator and transcutaneous pads. Here, we describe the successful intraoperative resuscitation and management after failure to restore normal sinus rhythm using the newly placed subcutaneous implantable cardioverter defibrillator and repeated transcutaneous defibrillation attempts.
Ancestry patterns inferred from massive RNA-seq data
Authors: Barral-Arca Ruth , Pardo-Seco Jacobo , Bello Xabi , Martinón-Torres Federico , Salas Antonio
Published: April 2019

There is a growing body of evidence suggesting that patterns of gene expression vary within and between human populations. However, the impact of this variation in human diseases has been poorly explored, in part owing to the lack of a standardized protocol to estimate biogeographical ancestry from gene expression studies. Here we examine several studies that provide new solid evidence indicating that the ancestral background of individuals impacts gene expression patterns. Next, we test a procedure to infer genetic ancestry from RNA-seq data in 25 data sets where information on ethnicity was reported. Genome data of reference continental populations retrieved from The 1000 Genomes Project were used for comparisons. Remarkably, only eight out of 25 data sets passed FastQC default filters. We demonstrate that, for these eight population sets, the ancestral background of donors could be inferred very efficiently, even in data sets including samples with complex patterns of admixture (e.g., American-admixed populations). For most of the gene expression data sets of suboptimal quality, ancestral inference yielded odd patterns. The present study thus brings a cautionary note for gene expression studies highlighting the importance to control for the potential confounding effect of ancestral genetic background.
Comparison of the shock index, modified shock index, and age shock index in adult admissions to a tertiary hospital
Authors: Sotello David , Yang Shengping , Nugent Kenneth
Published: April 2019

Background: Multiple variables interact constantly to maintain the hemodynamic statusof patients. The shock index (SI), the modified shock index (MSI), and the age shock index(ASI) have been studied in different clinical settings to predict hemodynamic instability andassociated outcomes. These indices are calculated from simple hemodynamic parameters,are non-invasive, and represent no additional expense. We wanted to analyze the performanceof these three different indices in the patients admitted to our hospital.Methods: We performed a retrospective study in which we identified all adult patients(>18 years, <89 years) admitted to the University Medical Center in Lubbock, Texas, from10/01/2015 until 9/30/2016. We collected basic clinical information, including age, initialblood pressure measurements, discharge diagnoses, length of stay (LOS), and mortality.With these variables we calculated for each patient the admission SI (defined as heart rate/systolic blood pressure), MSI (heart rate/mean arterial pressure), and ASI (age × SI). Weseparated the patients according to their admission diagnoses and calculated the median and25th–75th percentiles for those parameters. We also compared mortality and LOS based ontheir admission SI using two different cutoff points at 0.7 and 1.0, their admission MSI (cutoff:1.3), and their ASI (cutoff: 50).Results: A total of 18,478 adult patients admitted to our institution were included in thisstudy. The median age was 53 years, the median LOS was 4 days, and the overall mortalitywas 3.8%. The median SI was 0.67; 43.3% of patients had an SI > 0.7 and 8.11% had anSI > 1.0. The median SI calculated for the patients with sepsis was 0.88; this was higher than therest of admission diagnoses (p < 0.001). The mortality of the patients with an SI > 0.7 was 5.1%and with SI > 1.0 was 11.3% (p < 0.001). When comparing the MSI, those with an MSI > 1.3 hada mortality of 10.3%, and those with an ASI > 50 had a mortality of 10.0% (p < 0.001).Conclusions: The SI, MSI, and ASI are non-invasive calculations that may provide usefulinformation when triaging patients early during admission. The diagnosis of sepsis results in ahigher median SI, which may represent better prediction in outcomes compared with the restof admission diagnoses. In our study, the three indexes performed equally. Since the SI witha cut-off of 1.0 identified patients with higher mortality risk, we would recommend using thiscut-off instead of 0.7.
Pericardial effusion and constriction as an initial presentation of acute t-cell lymphoblastic lymphoma
Authors: Rao Angela , Chariyawong Phumpattra , Nantsupawat Teerapat , Warraich Irfan , Nair Nandini
Published: April 2019

Acute T-cell lymphoblastic lymphoma is a rare subtype of non-Hodgkin’s lymphomaaccounting for 2% of adult non-Hodgkin’s lymphomas. Cardiac involvement in non-Hodgkin’slymphoma is usually a late manifestation, and pericardial effusion as an initial presentationis rare. We report a case of acute T-cell lymphoblastic lymphoma in a patient who initiallypresented with pericardial effusion. Diagnosis was difficult and challenging, as an infectiousetiology was first suspected. The patient presented with pericardial effusion without othercommon clinical manifestations of lymphoma, such as fever, night sweats, and weight loss. Hewas treated for constrictive pericarditis due to having positive Coxsackie B serology but hadno improvement with treatment. The pathology results of the pericardium after pericardiectomyreported fibrosis with a reactive lymphohistiocyte infiltrate. After CT scan revealed a largemediastinal mass, a lymph node biopsy was performed, and T-cell lymphoblastic lymphomawas confirmed. A detailed evaluation to search for occult malignancy should be considered inpatients who have persistent pericarditis that is unresponsive to anti-inflammatory therapy andin those who present with a new, large pericardial effusion or cardiac tamponade.