bluuebunny/crossref_metadata_2025 huggingface dataset:
Form-function Relations in Narrative Development
Authors: Svensson Birgitta
Published: March 2018

This book provides insights into the development toward narrative competence, and illustrates multifaceted patterns in the developing capacity to create globally coherent narrative texts. The methodology draws from both a psycholinguistic approach to narrative development, systemic functional linguistics, and writing pedagogy theory. This book extends previous studies on narrative writing development since it provides a multifaceted window into the progression of narrative development, from elementary school through secondary school and university to life as a professional journalist and writer. It also shows how narrative writing development is related to the cognitive, emotional/psychological and social development of the individual.
Training Addiction Counselors to Deliver a Brief Psychoeducational Intervention for Chronic Pain among Patients in Opioid Agonist Treatment: A Pilot Investigation
Authors: Butner Jenna L. , Bone Curtis , Ponce Martinez Caridad C. , Kwon Grace , Beitel Mark , Madden Lynn M. , Bono Madeline H. , Eller Anthony , Barry Declan T.
Published: March 2018

Background

Despite high rates of chronic pain among their patients, opioid agonist treatment (OAT) counselors report an absence of training to manage chronic pain.

Methods

A multidisciplinary team developed a tailored training for counselors to screen and address chronic pain via a brief psychosocial intervention, and implemented it with 52 addiction counselors. Data on knowledge (9 true-false items) as well as attitudes, interest, and perceived ability (scored on 5-point Likert-type scales) were collected from counselors before (pre-test), after (post-test) training, and after 6 months (follow-up).

Results

Pre-test knowledge scores varied considerably. Compared to pre-test, mean counselor knowledge scores increased significantly post-training and at follow-up (p's.<05). The training was associated with increases in positive attitudes toward the role of counselors in managing chronic pain, interest in assessing chronic pain, and counselor ability to assess as well as suggest appropriate interventions for pain (all p's <.05). Perceived ability to assess chronic pain and suggest appropriate treatment interventions were higher at follow-up than at pre-test (p's <.05).

Conclusions

Findings related to the initial evaluation of this training were promising, and future research is warranted to further examine the efficacy of training drug counselors on psychosocial interventions to manage chronic pain among OAT patients.
Dualities for root systems with automorphisms and applications to non-split groups
Authors: Haines Thomas
Published: March 2018

This article establishes some elementary dualities for root systems with automorphisms. We give several applications to reductive groups over non-archimedean local fields: (1) the proof of a conjecture of Pappas-Rapoport-Smithling characterizing the extremal elements of the

{
μ
}

\{ \mu \}

-admissible sets attached to general non-split groups; (2) for quasi-split groups, a simple uniform description of the Bruhat-Tits échelonnage root system

Σ
0

\Sigma _0

, the Knop root system

Σ
~

0

\widetilde {\Sigma }_0

and the Macdonald root system

Σ
1

\Sigma _1

, in terms of Galois actions on the absolute roots

Φ
\Phi

; and (3) for quasi-split groups, the construction of the geometric basis of the center of a parahoric Hecke algebra, and the expression of certain important elements of the stable Bernstein center in terms of this basis. The latter gives an explicit form of the test function conjecture for general Shimura varieties with parahoric level structure.
SMMB: a stochastic Markov blanket framework strategy for epistasis detection in GWAS
Authors: Niel Clément , Sinoquet Christine , Dina Christian , Rocheleau Ghislain
Published: March 2018

Motivation

Large scale genome-wide association studies (GWAS) are tools of choice for discovering associations between genotypes and phenotypes. To date, many studies rely on univariate statistical tests for association between the phenotype and each assayed single nucleotide polymorphism (SNP). However, interaction between SNPs, namely epistasis, must be considered when tackling the complexity of underlying biological mechanisms. Epistasis analysis at large scale entails a prohibitive computational burden when addressing the detection of more than two interacting SNPs. In this paper, we introduce a stochastic causal graph-based method, SMMB, to analyze epistatic patterns in GWAS data.

Results

We present Stochastic Multiple Markov Blanket algorithm (SMMB), which combines both ensemble stochastic strategy inspired from random forests and Bayesian Markov blanket-based methods. We compared SMMB with three other recent algorithms using both simulated and real datasets. Our method outperforms the other compared methods for a majority of simulated cases of 2-way and 3-way epistasis patterns (especially in scenarii where minor allele frequencies of causal SNPs are low). Our approach performs similarly as two other compared methods for large real datasets, in terms of power, and runs faster.

Availability and implementation

Parallel version available on https://ls2n.fr/listelogicielsequipe/DUKe/128/.

Supplementary information

Supplementary data are available at Bioinformatics online.
From siphonophores to deep scattering layers: uncertainty ranges for the estimation of global mesopelagic fish biomass
Authors: Proud Roland , Handegard Nils Olav , Kloser Rudy J , Cox Martin J , Brierley Andrew S
Published: March 2018

The mesopelagic community is important for downward oceanic carbon transportation and is a potential food source for humans. Estimates of global mesopelagic fish biomass vary substantially (between 1 and 20 Gt). Here, we develop a global mesopelagic fish biomass model using daytime 38 kHz acoustic backscatter from deep scattering layers. Model backscatter arises predominantly from fish and siphonophores but the relative proportions of siphonophores and fish, and several of the parameters in the model, are uncertain. We use simulations to estimate biomass and the variance of biomass determined across three different scenarios; S1, where all fish have gas-filled swimbladders, and S2 and S3, where a proportion of fish do not. Our estimates of biomass ranged from 1.8 to 16 Gt (25–75% quartile ranges), and median values of S1 to S3 were 3.8, 4.6, and 8.3 Gt, respectively. A sensitivity analysis shows that for any given quantity of fish backscatter, the fish swimbladder volume, its size distribution and its aspect ratio are the parameters that cause most variation (i.e. lead to greatest uncertainty) in the biomass estimate. Determination of these parameters should be prioritized in future studies, as should determining the proportion of backscatter due to siphonophores.
Operation Pacific Haven: Humanitarian Medical Support for Kurdish Evacuees
Authors: Rumbaugh Jack R.
Published: March 2018

This article reviews the medical aspects of the humanitarian assistance mission Joint Task Force Operation Pacific Haven from September 1996 to April 1997. It reviews the effectiveness of the deployable medical units used to support the medical screening, treatment, and processing of more than 6,600 Kurdish evacuees applying for political asylum in the United States. The distinct cultural mores and language barriers of the Kurdish population made the provision of even basic medical care a challenge. Designed for combat service support, these deployable medical units were successful in the performance of the comprehensive public health and humanitarian assistance medical support mission because of the support of two on-island military treatment facilities. In short, for military medicine to successfully conduct humanitarian assistance and/or disaster relief missions, deployable medical units need to be designed, equipped, staffed, and trained to perform these operations.
The Health and Physical Readiness of Army Reservists: A Current Review of the Literature and Significant Research Questions
Authors: Wynd Christine A. , Ryan-Wenger Nancy A.
Published: March 2018

Individual soldier combat readiness through enhanced physical fitness is a major emphasis in the United States military today. Unfortunately, the prevalence of cigarette smoking, alcohol abuse, and other poor health practices continues to be reported at higher rates for active duty military personnel than for civilian populations. There is a dearth of research about health and fitness in the Army Reserve. Changing trends point toward more rapid mobilization of reservists for peacekeeping and combat missions throughout the world; however, it is important to remember that the Army Reserve is unique in its blending of both military and civilian occupational environments. The purpose of this paper is to review the current literature regarding Army Reserve health behaviors and physical readiness. Examples of significant future research questions are provided. More studies are needed to assess both individual motivational activities and organizational values that enhance health-promoting efforts. Interventions can then be designed to eliminate impediments to health and endorse specific organizational values and interpersonal skills that increase healthy behaviors.
Physiological Effects of Thermal Stress on Aviators Flying a UH-60 Helicopter Simulator
Authors: Reardon Matthew , Fraser Beth , Omer Julia
Published: March 2018

An evaluation of the physiological effects on aviators of heat stress (90°F wet bulb globe temperature [WBGT]) versus a cooler condition (70°F WBGT) when wearing either a MOPPO (Mission-Oriented Protective Posture 0) uniform or a MOPP4 ensemble encumbered with a ballistic chest plate and overwater survival gear was performed at the United States Army Aeromedical Research Laboratory. The study used a repeated-measures design with 14 aviators flying 4-hour missions in a UH-60 helicopter simulator. Average crew endurance in the MOPP4-hot condition was reduced to one-third of the fully completed mission time of 309 minutes. For the hot condition, core temperature in the simulator rose 1.4°F/hour when aviators wore the encumbered MOPP4 ensemble versus 0.27°F/hour when they wore the MOPPO uniform. Sweating rate in the MOPP4-hot condition was 1,523 ml/hour, resulting in 2.5% dehydration, in contrast to 183 ml/hour and 0.9% dehydration in the MOPP4-cool condition. In this study, pilots flying realistic UH-60 simulator sorties rapidly incurred significant physiological heat strain when wearing an encumbered MOPP4 flight ensemble in hot cockpit conditions.
A New Wellness Center Concept: Integration of the Physical Therapy and the Morale, Welfare, and Recreation Departments
Authors: Woodhead Alfred B.
Published: March 2018

This case study describes the implementation of a wellness center based on the integration of a Navy outpatient physical therapy department and a morale, welfare, and recreation cardiovascular center. The logistics and services provided are discussed. The productivity of the physical therapy department based on the monthly number of patient treatments is assessed. A statistically significant increase in patient visits of 38% above the previous year was noted. The newly established cardiovascular center averaged 1,500 client visits monthly. This unique collaboration appears to hold promise as an effective wellness center concept.
High-Velocity Gunshot Wounds to the Head and Neck: A Review of Wound Ballistics
Authors: Yetiser Sertac , Kahramanyol Mustafa
Published: March 2018

Patients who sustain gunshot injuries to the head and neck face heavy tissue damage and eventually life-threatening conditions. A very significant factor that determines the degree of injury is the course and extent of the missile track. The missile track is well correlated with bullet structure, size, and velocity, which have distinct features in civilian and military firearm injuries. The missile entrance or exit wound may be out of sight in some injuries, and often it is difficult to predict the severity of the injury in the chaotic circumstances of the battlefield. We studied the wound ballistics in five soldiers who suffered penetrating cranial and cervical firearm injuries.
Dark matter dynamics in Abell 3827: new data consistent with standard cold dark matter
Authors: Massey Richard , Harvey David , Liesenborgs Jori , Richard Johan , Stach Stuart , Swinbank Mark , Taylor Peter , Williams Liliya , Clowe Douglas , Courbin Frédéric , Edge Alastair , Israel Holger , Jauzac Mathilde , Joseph Rémy , Jullo Eric , Kitching Thomas D , Leonard Adrienne , Merten Julian , Nagai Daisuke , Nightingale James , Robertson Andrew , Romualdez Luis Javier , Saha Prasenjit , Smit Renske , Tam Sut-Ieng , Tittley Eric
Published: March 2018

We present integral field spectroscopy of galaxy cluster Abell 3827, using Atacama Large Millimetre Array (ALMA) and Very Large Telescope/Multi-Unit Spectroscopic Explorer. It reveals an unusual configuration of strong gravitational lensing in the cluster core, with at least seven lensed images of a single background spiral galaxy. Lens modelling based on Hubble Space Telescope imaging had suggested that the dark matter associated with one of the cluster's central galaxies may be offset. The new spectroscopic data enable better subtraction of foreground light, and better identification of multiple background images. The inferred distribution of dark matter is consistent with being centred on the galaxies, as expected by Λ cold dark matter. Each galaxy's dark matter also appears to be symmetric. Whilst, we do not find an offset between mass and light (suggestive of self-interacting dark matter) as previously reported, the numerical simulations that have been performed to calibrate Abell 3827 indicate that offsets and asymmetry are still worth looking for in collisions with particular geometries. Meanwhile, ALMA proves exceptionally useful for strong lens image identifications.
Perspectives on symptom experiences and symptom reporting among individuals on hemodialysis
Authors: Flythe Jennifer E , Dorough Adeline , Narendra Julia H , Forfang Derek , Hartwell Lori , Abdel-Rahman Emaad
Published: March 2018

Background

Individuals on hemodialysis bear substantial symptom burdens, but providers often underappreciate patient symptoms. In general, standardized, patient-reported symptom data are not captured during routine dialysis care. We undertook this study to better understand patient experiences with symptoms and symptom reporting. In exploratory interviews, we sought to describe hemodialysis nurse and patient care technician perspectives on symptoms and symptom reporting.

Methods

We conducted semi-structured interviews with 42 US hemodialysis patients and 13 hemodialysis clinic personnel. Interviews were conducted between February and October 2017 and were analyzed using thematic analysis.

Results

Seven themes were identified in patient interviews: (i) symptoms engendering symptoms, (ii) resignation that life is dependent on a machine, (iii) experiencing the life intrusiveness of dialysis, (iv) developing adaptive coping strategies, (v) creating a personal symptom narrative, (vi) negotiating loss of control and (vii) encountering the limits of the dialysis delivery system. Overall, patient symptom experiences and perceptions appeared to influence symptom-reporting tendencies, leading some patients to communicate proactively about symptoms, but others to endure silently all but the most severe symptoms. Three themes were identified in exploratory clinic personnel interviews: (i) searching for symptom explanations, (ii) facing the limits of their roles and (iii) encountering the limits of the dialysis delivery system. In contrast to patients, clinic personnel generally believed that most patients were inclined to spontaneously report their symptoms to providers.

Conclusions

Interviews with patients and dialysis clinic personnel suggest that symptom reporting is highly variable and likely influenced by many personal, treatment and environmental factors.
Delays in diagnosis for children with newly diagnosed central nervous system tumors
Authors: Coven Scott L , Stanek Joseph R , Hollingsworth Ethan , Finlay Jonathan L
Published: March 2018

Background

United States studies documenting time interval from symptom onset to definitive diagnosis for childhood central nervous system (CNS) tumors are more than a quarter-century old. The purpose of this study is to establish an accurate and contemporary Ohio baseline of the diagnostic interval for children with newly diagnosed CNS tumors.

Methods

Medical records were retrospectively reviewed for 301 children with newly diagnosed CNS tumors from January 2004 to August 2015 at Nationwide Children’s Hospital. We obtained comprehensive data on 171 patients (56.8%). Records were reviewed for age, gender, tumor type, presenting symptoms, number of health care visits prior to diagnosis, time interval (in months) from onset of symptoms to definitive diagnosis, and any associated genetic syndromes.

Results

Of the 171 patients with newly diagnosed CNS tumors, 25 children (14.6%) had a known cancer predisposition syndrome (all with neurofibromatosis type 1). Among the remaining 146 children, the median and mean time intervals from symptom onset to definitive diagnosis were 42 days and 138 days (range < 1 to 2190 days), respectively.

Conclusions

We have documented and quantified the contemporary delays in diagnosis of childhood brain tumors in central Ohio to serve as a benchmark for our future planned interventions to reduce the time interval from symptom onset to diagnosis through adaptation of the United Kingdom HeadSmart program throughout the state of Ohio and ultimately throughout the United States.
Symptomatic Acute Toxoplasmosis in Returning Travelers
Authors: Henao-Martínez Andrés F , Franco-Paredes Carlos , Palestine Alan G , Montoya Jose G
Published: March 2018

We report a family who acquired acute toxoplasmosis after a trip to Central America. One member developed severe clinical manifestations including bilateral chorioretinitis, hepatitis, and myocarditis requiring therapy. Symptomatic acute toxoplasmosis is unusual and possesses a diagnostic challenge. We discuss the clinical and epidemiological implications, laboratory diagnosis, and treatment plan.
The YebN Leader RNA Acts as a Mn2+ Sensor Required for the Interaction of Xanthomonas oryzae and Rice
Authors: Li Chunxia , Liu Shiyao , Liu Peiyi , Wang Yaxin , Xu Chunli , Tao Jun , He Chaozu
Published: March 2018

Riboswitches are RNA elements that sense metabolites and control gene expression. Recently, the yybP-ykoY riboswitches were found to sense manganese (Mn2+) and regulate the expression of diverse genes. Here, we show that the leader RNA (a yybP-ykoY RNA) of yebN in Xanthomonas oryzae pv. oryzae also functions as a sensor of Mn2+. This leader RNA detects Mn2+ levels in plants and is essential to X. oryzae pv. oryzae virulence. Our data also indicate that Mn2+ is not only required as a microelement for plant growth but also acts as a defense molecule to inhibit pathogen growth. This finding highlights that Mn2+ plays important roles in pathogen-plant interactions and that the yebN leader RNA can be a target candidate for anti–X. oryzae pv. oryzae drug development.
Is there an association between psychological factors and developing complex regional pain syndrome after an ankle fracture?
Authors: Alluri Ram K. , Bouz Gabriel , Foster Brock , Wang Christopher , Marecek Geoffrey , Tan Eric W.
Published: March 2018

Background:

The purpose of this study was to evaluate the association between psychological dysfunction and developing complex regional pain syndrome (CRPS) after an ankle fracture.

Methods:

The PearlDiver database was used to identify patients who sustained an ankle fracture and developed CRPS based on the presence or absence of psychological disorders.

Results:

Results of the database identified 163,529 patients who sustained an ankle fracture, and CRPS was identified in 10,127 (6.2%) of these patients. The risk of developing CRPS after an ankle fracture was significantly elevated, with an odds ratio (OR) of 5.44 (P<0.0001) in patients with a psychological disorder. There was no additional risk (OR 0.98, P=0.31) for developing CRPS in patients with a psychological disorder who underwent operative management.

Conclusions:

In patients with known psychological comorbidities who sustain an ankle fracture and have atypical posttraumatic pain, there should be elevated suspicion for CRPS.
One Brace: One Visit: Treatment of Pediatric Distal Radius Buckle Fractures With a Removable Wrist Brace and No Follow-up Visit
Authors: Kuba Megan H.M. , Izuka Byron H.
Published: March 2018

Background:

Previous studies have showed the efficacy of removable brace treatment for distal radius buckle fractures in children, whereas others have independently suggested that these injuries do not require additional radiographic imaging. However, no study has sought to collectively determine whether treating pediatric distal radius buckle fractures with a removable brace and no follow-up visit or imaging after the initial visit is a safe and satisfactory protocol.

Methods:

In total, 42 consecutive patients with a distal forearm buckle fracture seen by a single fellowship trained pediatric orthopaedic surgeon were eligible to participate. Two patients refused participation, yielding 40 patients treated with a standard protocol of immobilization with a removable wrist brace for a prescribed period of time with no additional imaging or clinical follow-up. Two staggered telephone surveys were then conducted. The first survey was conducted within 1 week of the designated brace-removal date to determine the exact date the brace was discontinued. The second survey was conducted 5 to10 months postinjury to determine patient outcomes and parent satisfaction.

Results:

In total, 100% of patients were reached for the initial survey and 90% (36/40) of patients were reached for the secondary survey. There were no complications, including refracture or residual pain, following treatment. In total, 100% of parents felt their child had returned to full and normal function and all said they would choose to have the same treatment again. In total, 67% of parents would have had to take time off from work and 77% of children would have missed school if they had hypothetically been required to attend a follow-up appointment.

Conclusion:

Treatment of pediatric distal forearm buckle fractures with a removable wrist brace and no follow-up visit or radiographs results in both excellent patient outcomes and parental satisfaction.

Level of Evidence:

Level IV—case series.
NKG2D Immunoligand rG7S-MICA Enhances NK Cell-mediated Immunosurveillance in Colorectal Carcinoma
Authors: Wang Tong , Sun Fumou , Wang Yang , Jiang Jiahao , Pan Mingzhu , Yuan Minne , Zhang Hang , Du Xiaodian , Hezam Kamal , Song Kai , Wang Min , Zhang Juan
Published: March 2018

Colorectal carcinoma (CRC) is one of the most common malignant cancers worldwide. The poor response of CRC to chemotherapy has whipped up the interest in targeted therapy with monoclonal antibodies for its potential efficiency. However, cetuximab, as one of the first-line targeted drugs in the treatment of CRC, has drug resistance and poor prognosis in clinic. To address this, a novel bispecific protein with CRC targeting and natural killer (NK) cell triggering was used for treatment. NK cell-mediated immunosurveillance is normally activated by the activating receptor natural killer cell receptor NK group 2, member D (NKG2D), which binds its key ligand major histocompatibility complex (MHC) class I-related chain A (MICA) expressed on the tumor cells. To trigger NK cell-mediated cytotoxicity, we fused MICA portion to a single-chain antibody fragment rG7S targeting the tumor-associated antigen CD24. In vitro, flow cytometry, cytotoxicity assay, degranulation, and cytokines release assay revealed that the fusion protein rG7S-MICA could both binds to CD24 and NKG2D which enhances NK cell sensitivity and NKG2D-mediated immunosurveillance against CD24+ CRC cells. Furthermore, in a CD24+ CRC-bearing nude mice model, rG7S-MICA effectively recruits NK cell to the tumor site and increase the release of cytokines such as interferon-γ (IFN-γ) and tumor necrosis factor-α (TNF-α), and shows potential antitumor effects. In conclusion, rG7S-MICA provides a novel immunotherapeutic strategy for CRC, which could be further developed against other CD24+ malignancies.
Integrative Music Therapy
Authors: Barnes Thomas Bryan
Published: March 2018

Music plays a significant role in the lives of individuals across the lifespan. Some healthcare providers may not appreciate music therapy and the positive benefits it can have on the environment, patients, caregivers, and healthcare staff. Integrative Music Therapy (IMT) has proven to be effective in multiple settings, offering therapy for behavioral, emotional, physiological, psychological, and psychosocial needs. IMT, performed by a trained, certified professional (MT-BC), does not seek to replace medication or other procedures, but works synergistically with provided healthcare.
Student Perceptions of Spirituality and Spiritual Care
Authors: Kroning Maureen
Published: March 2018

Nurse educators must equip students with beginning skills of assessment, communication, and awareness of spiritual care. Barriers to spiritual care—lack of time or of space, inadequate training—reduce nurses' provision of spiritual care. Nursing students observe patient needs for spiritual care, but often are not skilled or comfortable offering spiritual care. This article relays observations of 28 senior nursing students about spirituality and spiritual care with implications for teaching.
Preradiotherapy Tumor Volume in Local Control of Squamous Cell Carcinoma of the Supraglottic Larynx
Authors: Nurkic Sommer , Nurkic Tarik , Morris Christopher G. , Amdur Robert J. , Mendenhall William M.
Published: March 2018

Objectives:

Examine the utility of pretreatment computed tomography in predicting local control (LC) in squamous cell carcinoma of the supraglottic larynx treated with primary radiotherapy (RT).

Methods:

In total, 167 patients treated between 1983 and 2013 were reviewed. Patients had received pretreatment diagnostic computed tomographic imaging of the larynx and neck from which primary tumor volume (PrTV) was delineated. LC, larynx function at last follow-up, and RT complications were recorded. PrTV was evaluated with respect to outcome.

Results:

In this study, median age was 61 years, and mean follow-up was 96 months. In total, 43% had T1-T2, 46% had T3, and 11% had T4 disease; 49% had N0 disease. Median tumor volume, 5.1 cm3 (0.4 to 188 cm3). Mean dose, 74 Gy; 20% received concurrent chemotherapy. Overall, 10-year LC was 78.9%. Ten-year LC stratified by tumor volume was: 0 to 4.9 cm3, 90.8%; 5 to 8.9 cm3, 67.3%; and >9 cm3, 69.4%. Ten-year LC with preserved larynx function was: 0 to 4.9 cm3, 76.7%; 5 to 8.9 cm3, 61.5%; and >9 cm3, 53.4%. LC and LC with preserved larynx function was significantly different between PrTV groups (P<0.001). On multivariate analysis, PrTV was a significant predictor of LC and LC with preserved larynx function (P<0.005). Six patients developed soft tissue necrosis; 2 suffered fatal carotid blowouts. Patients with grade 5 complications received concomitant chemotherapy. Four patients required total laryngectomy; 14 required permanent tracheostomy or gastrostomy tube.

Conclusion:

Pretreatment PrTV helps identify patients most likely to experience LC with primary RT alone or combined chemoradiation. LC for supraglottic larynx squamous cell carcinoma is optimal if the PrTV is <5.0 cm3.
Emphasis on Systemic Therapy in Women With Pelvic Bone Metastasis at Time of Diagnosis of Cervical Cancer
Authors: Manders Dustin B. , Sims Travis T. , Albuquerque Kevin V. , Carlson Matthew J. , Richardson Debra L. , Kehoe Siobhan M. , Miller David S. , Lea Jayanthi S.
Published: March 2018

Objective:

Cervical cancer presenting with metastases to the bony pelvis is rare. No available literature addresses the treatment and prognosis of these patients. Our objective was to review our experience treating women with this rare presentation.

Methods:

We performed a review of all patients treated for cervical cancer at a single institution between January 1, 2007 and November 30, 2014. All patients had pretreatment imaging with computed tomography or positron emission tomography/computed tomography. Included patients had evidence of pelvic bone metastases by imaging before initiation of treatment.

Results:

A total of 349 women were treated for cervical cancer during the study interval. Of these, 13 (3.7%) were identified as having pelvic bone metastases at initial presentation. Four of 13 patients had pelvic-confined disease and were treated with curative-intent radiation. The remainder had disseminated disease and were treated with palliative radiation. Only one complete response was seen. Seven patients received salvage chemotherapy. The median overall survival was 8.5 months. Survival was statistically similar in those who received palliative rather than curative radiotherapy (8.7 vs. 8.1 mo, P=0.76) and in those who received any postradiation chemotherapy (8.9 vs. 6.1 mo, P=0.066). Chemotherapy with bevacizumab resulted in the only 2 long-term survivors (both alive at 32.4 and 37.5 mo). All others have died of disease.

Conclusions:

Cervical cancer metastatic to the bony pelvis at initial presentation portends a dismal prognosis. Patients should be informed about this poor prognosis, and allowed to make an informed decision when considering curative-intent versus palliative treatment. Incorporation of bevacizumab appears to improve survival.
Parental Perception of Flourishing in School-Aged Children: 2011–2012 National Survey of Children's Health
Authors: Kandasamy Veni , Hirai Ashley H. , Ghandour Reem M. , Kogan Michael D.
Published: March 2018

Objective:

Flourishing reflects positive mental health and thriving and is important for children's development and well-being. Few national studies of flourishing among school-aged children exist. Exposure to socioeconomic disadvantage is negatively associated with social and health outcomes, including flourishing. This analysis describes independent associations of the child, family, school, and neighborhood factors with flourishing, which we hypothesized may contribute to sociodemographic disparities.

Methods:

Data from the 2011–2012 National Survey of Children's Health were used to examine parental perception of flourishing among school-aged children (6–17 years of age; n = 59,362). Flourishing was defined as curiosity about learning, resilience, and self-regulation. Unadjusted and adjusted associations between sociodemographic, child, family, school and neighborhood factors and flourishing were explored using χ2 tests and sequential logistic regression models.

Results:

Overall, 48.4% of school-aged children were perceived by parents to be flourishing. There were significant sociodemographic disparities with non-Hispanic black children (37.4%) and those below the federal poverty level (37.9%) among the least likely to flourish. After adjustment, sex, race/ethnicity, parent education, child's age, physical activity, special health care needs status, adequate sleep, adverse childhood experiences, family meals, hours of television watched, extracurricular activities, school safety, neighborhood safety, neighborhood support, and presence of amenities were significantly associated with flourishing (p < 0.05). Disparities by poverty level and household structure were no longer significant.

Conclusion:

Addressing factors associated with parent-perceived flourishing including child, family, school and neighborhood factors such as physical activity, adequate sleep, and school/neighborhood safety may promote flourishing and reduce disparities.
SPECTRAL DOMAIN OPTICAL COHERENCE TOMOGRAPHY FINDINGS IN COATS DISEASE
Authors: Gupta Mrinali P. , Dow Eliot , Jeng-Miller Karen W. , Mukai Shizuo , Orlin Anton , Xu Kunyong , Yonekawa Yoshihiro , Chan R. V. Paul
Published: March 2018

Purpose:

To evaluate microstructural retinal abnormalities on spectral domain optical coherence tomography (SD-OCT) imaging of eyes with Coats disease.

Methods:

This is a multicenter, retrospective study in which SD-OCT images of patients with treatment-naive Coats disease were correlated with clinical examination and visual acuity and, when available, followed longitudinally over time.

Results:

Macular SD-OCT of 27 eyes with Coats disease revealed intraretinal edema (59%), intraretinal exudates (67%), subretinal fluid (37%), subretinal exudate (48%), ellipsoid zone disruption (52%), external limiting membrane disruption (41%), and subfoveal nodule (26%). All these microstructural abnormalities correlated with worse baseline and final visual acuities (P < 0.05) on univariate analysis, except for intraretinal edema which exhibited a nonstatistically significant trend toward worse baseline visual acuity (P = 0.16). Within stage 2b eyes, external limiting membrane disruption and subretinal nodule on SD-OCT were associated with worse baseline visual acuity (P = 0.02 for both), and there was a trend toward worse final visual acuity with external limiting membrane disruption and subretinal nodule (P = 0.17 for both) and worse baseline (P = 0.08) and final (P = 0.13) visual acuities with ellipsoid zone disruption. No microstructural abnormalities were noted on OCT of fellow eyes.

Conclusion:

Spectral domain OCT can identify microstructural abnormalities in Coats disease that are associated on univariate analysis with worse baseline visual acuity and visual prognosis. Further larger studies are necessary.
Clinical Efficacy and Safety Profile of Micropulse Transscleral Cyclophotocoagulation in Refractory Glaucoma
Authors: Williams Alice L. , Moster Marlene R. , Rahmatnejad Kamran , Resende Arthur F. , Horan Teresa , Reynolds Michael , Yung Edward , Abramowitz Benjamin , Kuchar Sarah , Waisbourd Michael
Published: March 2018

Purpose:

To investigate the clinical efficacy and safety profile of micropulse transscleral cyclophotocoagulation (MP-CPC) in patients with refractory glaucoma.

Materials and Methods:

Retrospective case series of 79 consecutive patients who underwent MP-CPC at the Wills Eye Hospital from March 23, 2014 to June 23, 2016 and who had at least 3 months of follow-up. Treatment success was defined as an intraocular pressure (IOP) of 6 to 21 mm Hg or a reduction of IOP by 20%. Failure was defined as an inability to meet the criteria for success, need for retreatment >3 times, or need for incisional glaucoma surgery.

Results:

Patients had a mean follow-up time of 7.8±4.5 months. The mean IOP before MP-CPC was 31.9±10.2 mm Hg. The IOP was reduced by an average of 51% at the last follow-up and the mean number of IOP lowering medications was reduced from 2.3 at baseline to 1.5 at last follow-up. Treatment success rates were 75% at 3 months, 66% at 6 months, and 67% at last follow-up. Complications of MP-CPC included 7 patients with hypotony (8.8%), 21 patients with prolonged anterior chamber inflammation (1+ cell or flare for >3 mo, 26%), 13 patients with loss of ≥2 lines of best-corrected visual acuity at 3 months (17%), 4 patients with macular edema (5%), 2 patients with corneal edema and 2 patients with phthisis.

Conclusions:

MP-CPC is an effective treatment for patients with refractory glaucoma. Shorter treatment times with more frequent repeat treatments, if necessary, should be considered given the incidence of significant vision loss in this study.
Impact of Alcohol Screening for Traumatic Brain Injury Patients Being Admitted to Neurosurgical Intensive Care Unit
Authors: Cheever Chong (Sherry) , Barbosa-Leiker Celestina
Published: March 2018

Objective: The aims of this study were to determine the prevalence and describe the importance of alcohol screening for all patients with traumatic brain injury (TBI) and examine the relationship between gender, age, Abbreviated Injury Scale (AIS), emergent decompressive craniectomy, Glasgow Coma Scale (GCS) from the emergency department (ED), and the length of stay with alcohol screening. Method: This is a retrospective analysis of de-identified data from the 2012 TBI registry of a level 1 trauma center in the Pacific Northwest. Measurements and Main Results: Of 1591 patients with TBI, 1273 (80%) were screened for alcohol use and 318 (20%) were not screened. There was a significant association between alcohol screening and AIS (χ2(5) = 15.46, P < .001), ED GCS (χ2(12) = 22.13, P = .04), sex (χ2(1) = 7.86, P ≤ .001), and age (r = 0.23, P < .001). Women and patients with high AIS (critical), low (mild) AIS, and midrange GCS scores were less likely to be screened, as were younger patients. Urgent decompressive craniectomy (χ2(1) = 1.94, P = .16) and length of stay (r = −0.04, P = .14) did not display a significant association with alcohol screening. Conclusion: This study uncovered a systemic bias per sex and age for alcohol screening, as well as skewed AIS and GCS scores due to an unknown alcohol intoxication status. An updated ED’s triage process and screening tool is recommended to achieve a targeted 100% alcohol screening rate for all head trauma patients in the ED before admission to the neurosurgical intensive care unit.
Neurosciences Continuing Education: An Adult With New-Onset Seizures
Authors: Lukas Rimas V.
Published: March 2018

The case of a 43-year-old woman with new-onset seizures is presented within the context of a continuing education quiz. Details regarding the underlying etiology and contemporary advances in the literature are referenced.
The journey towards understanding lipoprotein(a) and cardiovascular disease risk: are we there yet?
Authors: Boffa Michael B. , Koschinsky Marlys L.
Published: March 2018

Purpose of review

Evidence continues to mount for an important role for elevated plasma concentrations of lipoprotein(a) [Lp(a)] in mediating risk of atherothrombotic and calcific aortic valve diseases. However, there continues to be great uncertainty regarding some basic aspects of Lp(a) biology including its biosynthesis and catabolism, its mechanisms of action in health and disease, and the significance of its isoform size heterogeneity. Moreover, the precise utility of Lp(a) in the clinic remains undefined.

Recent findings

The contribution of elevated Lp(a) to cardiovascular risk continues to be more precisely defined by larger studies. In particular, the emerging role of Lp(a) as a potent risk factor for calcific aortic valve disease has received much scrutiny. Mechanistic studies have identified commonalities underlying the impact of Lp(a) on atherosclerosis and aortic valve disease, most notably related to Lp(a)-associated oxidized phospholipids. The mechanisms governing Lp(a) concentrations remain a source of considerable dispute.

This article highlights some key remaining challenges in understanding Lp(a) actions and clinical significance. Most important in this regard is demonstration of a beneficial effect of lowering Lp(a), a development that is on the horizon as effective Lp(a)-lowering therapies are being tested in the clinic.
Initial presentation and management of pediatric heart failure
Authors: Romer Amy J. , Rajagopal Satish K. , Kameny Rebecca J.
Published: March 2018

Purpose of review

Heart failure is a rare but morbid diagnosis in the pediatric patient presenting to the emergency department (ED). Familiarity of the ED physician with the presentation, work-up, and management of pediatric heart failure is essential as accurate diagnosis is reliant on a high degree of suspicion.

Recent findings

Studies evaluating pediatric heart failure are limited by its rarity and the heterogeneity of underlying conditions. However, recent reports have provided new data on the epidemiology, presentation, and outcomes of children with heart failure.

The recent studies reviewed here highlight the significant diagnostic and management challenges that pediatric heart failure presents given the variety and lack of specificity of its presenting signs, symptoms, and diagnostic work-up. This review provides the ED physician with a framework for understanding of pediatric heart failure to allow for efficient diagnosis and management of these patients. The primary focus of this review is heart failure in structurally normal hearts.
Quality of Life in Patients With Pancreatic Cancer and Their Caregivers
Authors: Bauer Margaret R. , Bright Emma E. , MacDonald James J. , Cleary Elizabeth H. , Hines O. Joe , Stanton Annette L.
Published: March 2018

Little is known about quality of life (QOL) of patients with pancreatic cancer and their caregivers compared with adults with other cancers. This systematic review summarizes the available evidence base, identifies its limitations, and recommends directions for research and clinical application. A systematic review was conducted of research on QOL in adults with pancreatic cancer and their caregivers. Quality of life was examined in the following specific domains: psychological, physical, social, sexual, spiritual, and general. Of the 7130 articles reviewed, 36 studies met criteria for inclusion. Compared with healthy adults or population norms, adults with pancreatic cancer had worse QOL across all domains. Compared with patients with other cancer types, patients with pancreatic cancer evidenced worse psychological QOL. Physical and social QOL were either similar or more compromised than in patients with other cancers. Limited data preclude conclusions about sexual, spiritual, and caregiver QOL. Patients with pancreatic cancer evidence decrements in multiple QOL domains, with particular strain on psychological well-being. Methodological limitations of available studies restrict definitive conclusions. Future research with well-defined samples, appropriate statistical analyses, and longitudinal designs is needed. Findings from this review support the merits of distress screening, integration of mental health professionals into medical teams, and attention to caregiver burden.
Predictors of Progression Among Low-Risk Intraductal Papillary Mucinous Neoplasms in a Multicenter Surveillance Cohort
Authors: Gausman Valerie , Kandel Pujan , Van Riet Priscilla A. , Moris Maria , Kayal Maia , Do Catherine , Poneros John M. , Sethi Amrita , Gress Frank G. , Schrope Beth A. , Luk Lyndon , Hecht Elizabeth , Jovani Manol , Bruno Marco J. , Cahen Djuna L. , Wallace Michael B. , Gonda Tamas A.
Published: March 2018

Objectives

Our aim was to identify baseline characteristics associated with disease progression and malignant transformation in low-risk suspected intraductal papillary mucinous neoplasms (IPMNs).

Methods

This is a retrospective cohort study of prospectively maintained databases of pancreatic cysts at 3 international, academic institutions. Five hundred fifty-nine adult patients with clinically suspected asymptomatic IPMN evaluated by radiologic studies or endoscopic ultrasound between 2003 and 2013 without worrisome features and under surveillance for 12 months or longer were included. We evaluated the relationship of baseline demographics and cyst features to disease progression (size increase, development of worrisome features, or high-grade dysplasia/cancer).

Results

After a median of 44 months follow-up, 269 (48%) patients experienced cyst size increase, 68 (12%) developed worrisome features, and 11 (2%) developed high-grade dysplasia/cancer. In multivariable Cox-regression analysis, no baseline characteristics were associated with size increase. An initial cyst size of 2 cm or greater, multifocality, history of prostate cancer, and smoking were the strongest predictors of development of new worrisome features. Univariable analysis found male sex, diabetes, and recent weight loss associated with development of high-grade dysplasia/cancer.

Conclusions

Our study demonstrates that low-risk suspected IPMNs carry a small but clinically relevant risk of disease progression and provides data on baseline characteristics that may help in risk stratification.
Site-Specific Genomic Alterations in a Well-Differentiated Pancreatic Neuroendocrine Tumor With High-Grade Progression
Authors: Martin David R. , LaBauve Elisa , Pomo Joseph M. , Chiu Vi K. , Hanson Joshua A. , Gullapalli Rama R.
Published: March 2018

The major categories of pancreatic neuroendocrine tumor (PanNET) are well-differentiated NET and poorly differentiated neuroendocrine carcinoma. Sequencing of these tumors has identified multiple important genes in the pathogenesis of PanNETs, such as DAXX/ATRX, MEN1, TP53, RB, and mTOR pathway genes. We identified a case of well-differentiated PanNET with high-grade progression with simultaneous low- and high-grade histologic regions containing variable genomic profiles. We performed tumor microdissection and analyzed both regions using a 409-gene comprehensive cancer panel using next-generation sequencing in addition to immunohistochemical and morphologic studies. The low-grade region showed a change in the DAXX gene as a copy number variant (CNV) deletion. The high-grade region showed CNV deletion changes in the DAXX gene as well as the MEN1 gene. We observed additional mutational changes in the PTEN gene and SMAD4 gene in the high-grade region. Our data support that high-grade progression in PanNETs may be the result of the progressive accumulation of genetic changes (CNVs and point mutational changes) within the body of the tumor. Next generation sequencing may provide pathologists and clinicians with ancillary information to accurately characterize and treat these tumors.
Incorporating Advances in Molecular Pathology Into Brain Tumor Diagnostics
Authors: Velázquez Vega José E. , Brat Daniel J.
Published: March 2018

Recent advances in molecular pathology have reshaped the practice of brain tumor diagnostics. The classification of gliomas has been restructured with the discovery of isocitrate dehydrogenase (IDH) 1/2 mutations in the vast majority of lower grade infiltrating gliomas and secondary glioblastomas (GBM), with IDH-mutant astrocytomas further characterized by TP53 and ATRX mutations. Whole-arm 1p/19q codeletion in conjunction with IDH mutations now define oligodendrogliomas, which are also enriched for CIC, FUBP1, PI3K, NOTCH1, and TERT-p mutations. IDH-wild-type (wt) infiltrating astrocytomas are mostly primary GBMs and are characterized by EGFR, PTEN, TP53, NF1, RB1, PDGFRA, and CDKN2A/B alterations, TERT-p mutations, and characteristic copy number alterations including gains of chromosome 7 and losses of 10. Other clinically and genetically distinct infiltrating astrocytomas include the aggressive H3K27M-mutant midline gliomas, and smaller subsets that occur in the setting of NF1 or have BRAF V600E mutations. Low-grade pediatric gliomas are both genetically and biologically distinct from their adult counterparts and often harbor a single driver event often involving BRAF, FGFR1, or MYB/MYBL1 genes. Large scale genomic and epigenomic analyses have identified distinct subgroups of ependymomas tightly linked to tumor location and clinical behavior. The diagnosis of embryonal neoplasms also integrates molecular testing: (I) 4 molecularly defined, biologically distinct subtypes of medulloblastomas are now recognized; (II) 3 histologic entities have now been reclassified under a diagnosis of “embryonal tumor with multilayered rosettes (ETMR), C19MC-altered”; and (III) atypical teratoid/rhabdoid tumors (AT/RT) now require SMARCB1 (INI1) or SMARCA4 (BRG1) alterations for their diagnosis. We discuss the practical use of contemporary biomarkers for an integrative diagnosis of central nervous system neoplasia.