bluuebunny/crossref_metadata_2025 huggingface dataset:
Introduction to Part 2: The greatest challenges
Authors: Omaswa Francis , Crisp Nigel
Published: November 2017

Chapter 3 describes the greatest challenges facing countries in sub-Saharan Africa. It highlights the Millennium Development Goals against the background of the whole range of issues that need to be confronted by health leaders. It sets the scene for two compelling chapters written by leaders in Uganda and Malawi about their country’s achievements. These are complemented by an authoritative account by Dr Luis Sambo, the WHO Regional Director, of the state of health and healthcare in Africa.
Design and analysis of health state valuation data for model-based economic evaluations and for economic evaluations alongside clinical trials
Authors: Brazier John , Ratcliffe Julie , Salomon Joshua A. , Tsuchiya Aki
Published: November 2017

This chapter focuses upon the needs of two approaches, economic evaluations based on decision analytic models, and those alongside clinical trials in terms of the collection and analysis of health state values. The first section of the chapter presents requirements that are likely to be common to any study in which health state values are collected from patients and/or members of the general population, including: who to ask, mode of administration, timing of assessments, sample size, and handling uncertainty. The second section of the chapter considers issues specific to trial-based economic evaluations, and the final section considers issues specific to the design and analysis of health state valuation data for economic models.
Who is involved in health protection?
Authors: Ghebrehewet Sam , Stewart Alex G.
Published: November 2017

Health protection encompasses a wide range of professionals, with a complex skill mix, in a wide variety of fields, across all domains of public health, and in every corner of the globe. Contributions to health protection functions and activities are not limited to those who practice health protection professionally. Protecting the nation’s health relies on involvement and meaningful engagement of the general public, professionals, media, politicians, and many other parties. This chapter describes how the health protection functions delivered by specialized professionals are complemented by the roles of other individuals and organizations, from the lowest operator to the highest strategist. It also sets out the different roles of the organizations and staff providing health protection functions for communicable disease control, emergency preparedness, resilience and response (EPRR), and environmental public health in the UK.
Key principles and practice of health protection
Authors: Ghebrehewet Sam , Stewart Alex G. , Rufus Ian
Published: November 2017

As a result of the unpredictability in time, space, and scope of health protection issues, the provision of a 24/7 local service across the three domains of health protection—communicable disease control, environmental public health, and emergency preparedness, resilience and response (EPRR)—is essential. This chapter outlines the essential principles that are applied in the organization, development, and delivery of all three domains of health protection, whether dealing with individual issues and cases or large incidents and outbreaks: (1) planning and preparedness; (2) prevention and early detection; (3) investigation and control; and (4) wider public health management and leadership (including communication to professionals and the public). It also describes how these principles translate into key elements of health protection practice across the three domains. An integrated public health risk assessment that embraces an all hazards approach to risk assessment is also discussed.
The treatment of bipolar disorder in children and adolescents
Authors: Hazell Philip
Published: November 2017

The presentation of bipolar disorder in young people can be different from that of adults; therefore, the approach to treatment differs slightly. Treatment is described for early intervention, acute mania, bipolar depression, relapse prevention, and refractory bipolar disorder. A strong therapeutic alliance with the patient and engagement and involvement of the patient’s family is critical to successful intervention. The evidence informing treatment is limited, but there is emerging research focused on the management of acute mania favouring monotherapy with a second-generation antipsychotic (SGA) over a mood stabilizer. Preliminary data favour a combination of an SGA and antidepressant over monotherapy with an SGA for the treatment of bipolar depression. Guidelines endorse electroconvulsive therapy for refractory mania and bipolar depression but there is no clinical trial evidence to support this practice. The development of algorithms to guide the management of all phases of bipolar disorder is a work in progress.
What are axial spondyloarthritis and ankylosing spondylitis?
Authors: Siebert Stefan , Raj Sengupta , Tsoukas Alexander
Published: November 2017

Ankylosing spondylitis (AS) is a chronic inflammatory arthritis affecting mainly the sacroiliac joints and spine, resulting in pain, stiffness, and reduced movement. AS has a major negative impact on patients’ quality of life. AS is part of a larger group of related spondyloarthritis (SpA) conditions and patients with AS often have extra-articular manifestations of these conditions. Over the past decade, there have been major advances in the understanding of the genetics and pathophysiology of the disease. Advances in imaging have allowed patients to be diagnosed without having to develop the radiographic structural damage that characterize AS, resulting in the concept of axial spondyloarthritis (axSpA). Together with the development of highly effective TNF inhibitors, these advances have transformed the management and outlook of patients with this condition. It is hoped that further advances in diagnosis, assessment and treatment of axSpA will lead to further progress in future.
Complications of axial spondyloarthritis
Authors: Siebert Stefan , Raj Sengupta , Tsoukas Alexander
Published: November 2017

In addition to the well-recognized extra-articular manifestations (EAMs) of ankylosing spondylitis (AS), this condition can also be associated with a number of clinically important complications. While EAMs are considered part of the spondyloarthritis (SpA), the complications are generally a consequence of having the disease. Patients with AS are at increased risk of osteoporosis and spinal fractures. The latter may occur after seemingly minor trauma and may lead to significant neurological compromise. Other potential neurological complications include atlantoaxial subluxation and compressive radiculopathy or myelopathy. Cardiac complications include cardiovascular events, valvular disease, and conduction disturbances. Pulmonary disease in AS relates to parenchymal involvement or mechanical constraint from chest wall inflammation. Renal disease is generally rare in AS.
Imaging in axial spondyloarthritis
Authors: Siebert Stefan , Raj Sengupta , Tsoukas Alexander
Published: November 2017

Imaging has always been a key component in the diagnosis of ankylosing spondylitis as part of the modified New York criteria. With the increased availability of MRI and the development of the ASAS axial spondyloarthritis (axSpA) criteria, there has been a shift from x-ray imaging of structural damage to MRI imaging of inflammation. This information can help in both the diagnosis of axSpA and in guiding treatment decisions in patients with this diagnosis. However, imaging results must be evaluated in the context of the clinical picture and should not be acted on in isolation. Here we review the key imaging modalities used in axSpA, with the main focus on x-rays and MRI of the sacroiliac joints, spine, and peripheral structures. Advances in technology are also likely to lead to the development of even better imaging modalities for axSpA in future.
The Politics of the Pedagogy: Cripping, Queering and Un-homing Health Humanities
Authors: DasGupta Sayantani
Published: November 2017

Drawing upon progressive pedagogical theorists and her own experiences, the author examines the potential effects and ethical responsibility of the health humanities workshop/classroom. Is it possible to search for oppositional knowledge—as described by Talpade Mohanty—within the health humanities disciplines; what does it mean to crip, queer, or un-home these many fields? In what ways might narrative work pose risks to students when it is practiced without attention to the operation of power and privilege? The author describes the evolution of her own pedagogical approach and proposes three pedagogical pillars to guide socially just narrative practices: narrative humility, structural competency, and engaged pedagogy. By embracing the state of being “un-homed”, the health humanities may strive to become a multiply layered space and time that both affirms difference and provides an alternative to authoritarian power and oppression.
A Framework for Teaching Close Reading
Authors: Charon Rita
Published: November 2017

This chapter describes one framework for teaching close reading to groups of learners. It proposes that learners focus on one narrative feature at a time—for example, time, space, voice, and metaphor—over the course of a seminar. For each feature, students read and discuss seminal conceptual writings to situate them in the classical and contemporary critical discourse. The chapter provides capsule summaries of these four narrative features that guide students in their own close reading of texts. The discussion of temporality, for example, includes theological, philosophical, scientific, and literary/narratological writings and the close reading of literary, visual arts, and musical texts that display temporal complexity. In the chapter are described particular teaching sessions in a variety of settings where learners read and respond in writing to short texts that highlight a particular narrative feature. The teaching texts and those written by students are reproduced in the chapter.
Improving quality of life
Authors: Bush Shirley , Bruera Eduardo
Published: November 2017

Chapter 12 discusses oncological treatments that may be administered with either a curative or palliative intent. If cancer in a patient cannot be cured, then the focus of treatment changes to achieving an improvement in survival time, reducing symptom burden, optimizing performance, and hence improving quality of life (QOL). Palliative care is the last of the four components of a cancer control programme, after prevention, early detection, and diagnosis and treatment. Patients with advanced cancer may experience physical, psychosocial, and spiritual difficulties throughout their illness which impact on their overall QOL. The main objective of palliative care is to improve the QOL for both patients with life-threatening illness and their families. Therefore, it is necessary to assess QOL to ascertain if this goal is being met.
Legal framework for care in obstetrics and gynaecology
Authors: Arulkumaran Sabaratnam , Farquharson David I. M. , Monga Ash , Papageorghiou Aris T. , Regan Lesley
Published: November 2017

Abstracts and keywords to be supplied.
The ethics of incomprehensibility
Authors: Stanghellini Giovanni
Published: November 2017

What can psychiatrists learn today from Karl Jaspers, who at the dawn of XX Century, held that the future of medicine was in binding philosophy to science ? How can young psychiatrists, who are so hungry for handbook knowledge, structured interviews, decision-making criteria, and therapeutic protocols be so patient as to listen to such a hybrid clinician-philosopher arguing for a kind of knowledge which is stubbornly aware of its limits, and breathlessly revolting against all sorts of objectification and dogmatism? How can those who are looking for ‘expert knowledge’ be satisfied with a kind of knowledge which conceives of itself as an ‘unlimited task’ which takes place in the face-to-face, here-and-now encounter between two persons? How can they be happy with a mentor whose main teaching can be condensed into one sentence: ‘[Q]uestions are more essential than answers, and every answer becomes a new question’? To respond to these interrogations, we need to tackle another more fundamental one: On what kind of knowledge can we rely to establish the foundations of psychiatry? Jaspers’ answer can be condensed in one single word: Psychopathology.
On psychosis: Karl Jaspers and beyond
Authors: Parnas Josef
Published: November 2017

Psychosis is one of the cardinal concepts of psychopathology (Jaspers), with an important descriptive use and frequent but unclear nosological connotations. Despite its central role in clinical psychiatry, it is only inadequately and vaguely addressed and articulated in the contemporary psychodiagnostic manuals. Typically, the descriptive use of this concept—as a ”break with reality”—is always infused with, and framed by pathogenetic hypotheses (e.g. ”weak ego-function” or ”brain disorder”). Because we are not in possession of any extraclinical index of psychosis, all definitions of”psychosis” and ”psychotic” remain on a vague, descriptive level and are often tautological. In particular, the attempts to define psychosis through the presence of delusions (or other ”psychotic symptoms”) only recapitulate the puzzle. This essay tries to identify a phenomenological commonality to such descriptions, examining the philosophical and clinical aspects of the concepts of”reality”, ”rationality” (theoretical and practical), ”reality testing”, ”intersubjectivity”, delusion, hallucination etc. It is concluded that ”psychosis” is a normative, context-sensitive, non-operationalizable concept, indicating a condition of ”radical irrationality”. This concept, although invaluable in clinical and legal work, is probably of only limited nosological (etiological) value.
Statistical basis of clinical trials
Authors: Prout Jeremy , Jones Tanya , Martin Daniel
Published: November 2017

This chapter summarizes some aspects of study design and statistical analysis to allow the anaesthetist to appraise research. Types of observational study are described and aspects of interventional studies such as sample size calculation and power are explained. Research governance, phases of drug trials and levels of evidence are described. A section on statistical analysis includes expression of proportion for binary data (odds ratio, number needed to treat) and use of probability and confidence intervals to measure statistical significance.
Vascular anaesthesia
Authors: Prout Jeremy , Jones Tanya , Martin Daniel
Published: November 2017

This chapter on vascular anaesthesia covers the challenges for anaesthetic management during elective and emergency aorta repair, carotid surgery and sympathectomy. The diagnosis and initial management of ruptured aortic aneurysm and evidence for open versus endovascular techniques are discussed. The physiology of cross-clamping and reperfusion are described. The advantages and disadvantages of awake carotid surgery are explained. Anaesthetic techniques and considerations for major surgery are described including the use of cell salvage to increase autolagous transfusion.
The development of radiation protection
Authors: Martin Colin J
Published: November 2017

The opening chapter introduces the use of radiation in medicine. It lists the main events in the application of radiation following the discovery of X-rays in 1895, the beginning of the use of radioactive sources in therapy in the early 1900s, the development of nuclear medicine in the 1960s, and the first computed tomography scanner in 1972. Radiation protection began to develop as a specialty at an early stage, but it was following analysis of effects on the survivors of the atomic bombs dropped on Japan that the need for stricter control became apparent. The chapter also reviews the development of standards for non-ionizing radiations. Summaries of medical applications for all parts of the electromagnetic spectrum are included, and the main biological effects of different types of radiation are included.
Interaction of ionizing radiations with matter
Authors: Martin Colin J
Published: November 2017

Interactions of ionizing radiations with matter are fundamental to the practice of radiation protection. They determine the magnitude and distribution of doses in tissues, the performance of detectors and imaging devices, and the attenuating properties of shielding materials. This chapter describes briefly the processes of radioactive decay and the properties of the various particles emitted, and then goes on to consider the interactions of radiation with matter. Electron interactions with metals result in bremsstrahlung and characteristic X-rays that form the basis of X-ray production. The interaction mechanisms of X-rays with tissue, particularly the photoelectric effect and Compton scattering, are inherent in the process of radiology image formation. Understanding the physics behind X-ray interactions so that scattered radiation can be taken into account is crucial in designing methods for accurately measuring radiation dose parameters. The final section deals with the dose related variables involved in measurement of radiation fields.
Diagnostic radiology—patient dosimetry
Authors: Martin Colin J , Sutton Dr David G
Published: November 2017

A knowledge of the doses that patients receive is important to optimize radiation protection in diagnostic radiology. This chapter covers the methodology involved in assessment and management of patient dose for radiography and fluoroscopy. The dose quantities are described and ones to use for different applications are discussed. The instruments and measurement techniques used are described, including passive techniques such as TLD and radiochromic film. The need to consider scattering of X-rays from surfaces is explained. Factors to be taken into account include whether the assessment is for practical evaluation of technique or to provide an indication of risk. The appropriate dose to assess could be that to the whole body, the skin surface, or a particular organ such as the breast in mammography. These factors all feed into the patient dose audit process, which is explained together with the setting of diagnostic references levels to aid optimization.
CT dosimetry
Authors: McLean Donald , Chapple Claire-Louise
Published: November 2017

The computed tomography (CT) medical examination is the highest single source of radiation to the general public in the developed world. Its use is rapidly growing, as is its technical complexity. The primary dosimetry formalism is based on the computed tomography dose index (CTDI), which can be measured in air or in standard phantoms using a calibrated pencil ionization chamber with adaptations for wide beam scanners. Displayed dose parameters can be used with caution to estimate patient organ doses, effective dose, and risk, using a variety of models and software. An understanding of automatic exposure control and the influence of patient size is essential when interpreting dosimetry results. CT examination protocols require optimisation, including the appropriate use of newly available dose reduction features. Particular consideration needs to be given to paediatric CT and to specialist applications such as radiotherapy planning, cardiac CT and volume imaging.
Nuclear medicine, pet, and radionuclide laboratories
Authors: Batchelor Stanley , Walmsley Bruce
Published: November 2017

In nuclear medicine departments and radionuclide laboratories, there is extensive handling of unsealed radionuclides. This chapter provides information to aid in assessment of the level of hazard and the design of facilities to ensure adequate radiation protection of staff. It covers nuclear medicine, PET, radionuclide laboratories, and radiopharmacies, and includes factors such as local shielding, benching, washing facilities, and requirements for disposal of radioactive waste to minimize the spread of contamination. Requirements for personnel dose monitoring and contamination monitoring are discussed, and sections are included on decontamination of facilities and personnel following spills or accidents. Aspects relating to management of radioactive waste and precautions for pregnant staff working with radionuclides are included.
Ultrasound
Authors: Pye Stephen D , Zeqiri Bajram
Published: November 2017

Ultrasound is used in many areas of medicine, including diagnostic imaging, therapy, lithotripsy, and surgery. The chapter gives a general description of ultrasound, its propagation, bioeffects, and measurement techniques. Potential biohazards of ultrasound are tissue heating, cavitation, acoustic radiation forces, and mechanical strain due to particle displacement. Any bioeffects produced by ultrasound in diagnostic applications have little consequence for the individual, as illustrated by its routine use in diagnostic foetal scanning, but surgical techniques destroy tissue on a macroscopic scale. There are separate sections which consider exposure, standards and give practical guidance measures for each of the four main areas of medical application. All applications of ultrasound in medicine have an impressive safety record, and the 3 W cm-2 limit for therapeutic ultrasound is the only safety criterion that has been formally adopted into current international standards.
Imaging: magnetic resonance imaging
Authors: Hunter David J. , Roemer Frank W. , Riordan Ed
Published: November 2017

Magnetic resonance imaging (MRI) overcomes many of the limitations associated with conventional radiography, the technique historically regarded as the gold standard in imaging of osteoarthritis (OA). MRI allows visualization of changes and pathologies in joint tissues including cartilage and the menisci, the two tissue components responsible for the indirect radiographic marker of joint space narrowing, decreasing the length of time that must elapse before disease progression can be detected. Other elements of the joint can also be analysed simultaneously: a key development in the understanding of OA. This chapter focuses on the utility of MRI in observational studies and clinical trials, detailing the available MRI techniques and quantitative/qualitative measurements, and their correlation with tissue damage. The possible future directions of MRI in OA are also discussed, with a view to its potential utility in identifying disease-modifying interventions.
Non-steroidal anti-inflammatory drugs
Authors: Simon Lee S. , Hochberg Marc C.
Published: November 2017

Non-steroidal anti-inflammatory drugs (NSAIDs) are a chemically diverse group of compounds that share three cardinal characteristics: they are anti-inflammatory, analgesic, and antipyretic. They are approved by regulatory authorities for the treatment of patients with osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, acute gout, and some forms of juvenile idiopathic arthritis. There are at least 20 chemically different NSAIDs currently available in Europe and the United States. These include not only the ‘traditional’ non-selective cyclooxygenase (COX) inhibitors that inhibit both the COX-1 and COX-2 enzymes but also the COX-2 selective inhibitors. This chapter gives a background of NSAIDs, including the mechanism of action, pharmacology and adverse effects (including hypersensitivity and gastrointestinal, cardiovascular thrombotic, and renal adverse effects), before summarizing the use of NSAIDs in patients with osteoarthritis.
Measuring change
Authors: Streiner David L. , Norman Geoffrey R. , Cairney John
Published: November 2017

Although the goal of many clinical assessments and research studies is to measure how much people change between two occasions, the measurement of change is fraught with conceptual and methodological difficulties. One of the difficulties is that there are (at least) two different reasons to measure change: to determine if intervention had any effect, and to identify the correlates of change. These two goals work against each other, because the former requires there to be little difference in the amount of change among people in the same group, while the latter depends on inter-individual differences. The chapter also discusses various biases that exist when people are asked directly how much they think they have changed. This chapter addresses the issues of the relationship of change to the reliability of the scale, difficulties of measuring change in experimental and quasi-experimental studies, and new approaches to measuring change, such as growth curve analysis.
The motor unit
Authors: Burke David , Howells James
Published: November 2017

The motor unit represent the final output of the motor system. Each consists of a motoneuron, its axon, neuromuscular junctions, and muscle fibres innervated by that axon. The discharge of a motor unit can be followed by recording its electromyographic signature, the motor unit action potential. Motoneurons are not passive responders to the excitatory and inhibitory influences on them from descending and segmental sources. Their properties can change, e.g. due to descending monoaminergic pathways, which can alter their responses to other inputs (changing ‘reflex gain’). Contraction strength depends on the number of active motor units, their discharge rate, and whether the innervated muscle fibres are slow-twitch producing low force, but resistant to fatigue, fast-twitch producing more force, but susceptible to fatigue, or intermediate fast-twitch fatigue-resistant. These properties are imposed by the parent motoneurons, and the innervated muscle fibres have different histochemical profiles (oxidative, glycolytic, or oxidative-glycolytic, respectively).
Neuroimaging in Autism Spectrum Disorders
Authors: South Mikle , Herrington John D. , Paterson Sarah J.
Published: November 2017

This chapter reviews several major themes in the neuroimaging of ASDs to date (see summary of representative themes in Table 3.1), including substantial and essential contributions from the modular framework. The chapter begins, however, with a discussion of several challenges related to the diversity of ASDs in terms of factors such as age, level of functioning, and symptom presentation. Progress in the ability to identify more homogenous subgroups, based on targeted phenotypic measures, opens the door to link neuroimaging with genetics findings and also with treatment outcome data. This should lead to better understanding of both the causes of ASDs and the best approaches to intervention. The chapter is divided according to two broad, related themes related to social information processing and cognitive factors in ASDs. Within these themes, the chapter considers evidence from both structural and functional imaging studies as well as relatively newer approaches to connectivity, including diffusion tensor imaging. The primary focus of this chapter is on research utilizing functional magnetic resonance imaging (fMRI) and electroencephalography (EEG). Although several early neuroimaging studies utilized positron emission tomography scanning, these studies are rare now and are not addressed in depth. New techniques such as near-infrared spectroscopy suggest tremendous promise for noninvasive imaging of expanded age groups and severity levels of ASDs; however, these studies are also few in number and are touched on only briefly.
Paradigm 2: There Is Little Stigmatization in Developing Countries
Authors: Stuart Heather , Arboleda-Flórez Julio , Sartorius Norman
Published: November 2017

Chapter 3 discusses Paradigm 2 - that there is little stigmatization in developing countries, including exploding the myth and stigma in other countries.
Paradigm 5: Psychiatrists Should Lead Antistigma Programmes
Authors: Stuart Heather , Arboleda-Flórez Julio , Sartorius Norman
Published: November 2017

Chapter 6 demonstrates that health and mental health professionals are worthy targets of stigma-reduction efforts and that their affiliation with a system that promotes the identification and management of dangerousness, and uses coercive treatment approaches, considerably undermines any credibility they may have as leaders of community-based anti-stigma programs. Professional training does not equip health or mental health professionals to lead anti-stigma efforts, and more likely, it entrenches stigmatizing attitudes and behaviors. Nevertheless, professionals can (and should) contribute to antistigma efforts: first by examining their own attitudes and behaviors, and second by partnering with local anti-stigma initiatives.
Case 11
Authors: Lockhart Mark E. , Sanyal Rupan
Published: November 2017

This is a case from the Kidney section of Genitourinary Imaging Cases. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Case 79
Authors: Lockhart Mark E. , Sanyal Rupan
Published: November 2017

This is a case from the Prostate section of Genitourinary Imaging Cases. The specific content of each case and its diagnosis are necessarily hidden from this abstract. Each case contains case history, followed immediately by the diagnosis, which is supported with findings, differential diagnosis, teaching points, management, and further reading suggestions.
Rule-Following, Meaning, and Primitive Normativity
Authors: Miller Alexander
Published: November 2017

This paper explores the prospects for using the notion of a primitive normative attitude in responding to the sceptical argument about meaning developed in chapter 2 of Saul Kripke’s Wittgenstein on Rules and Private Language. It takes as its stalking-horse the response to Kripke’s Wittgenstein developed in a recent series of important works by Hannah Ginsborg. The paper concludes that Ginsborg’s attempted solution fails for a number of reasons: it depends on an inadequate response to Kripke’s Wittgenstein’s ‘finitude’ objection to reductive dispositionalism; it erroneously rejects the idea that a speaker’s understanding of an expression guides her use; it threatens to collapse into either full-blown non-reductionism or reductive dispositionalism; and there is no motive for accepting it over forms of non-reductionism such as those developed by Barry Stroud and John McDowell.
A search for the presence of magnetic fields in the two supergiant fast X-ray transients, IGR J08408−4503 and IGR J11215−5952
Authors: Hubrig S , Sidoli L , Postnov K , Schöller M , Kholtygin A F , Järvinen S P , Steinbrunner P
Published: November 2017

A significant fraction of high-mass X-ray binaries are supergiant fast X-ray transients (SFXTs). The prime model for the physics governing their X-ray behaviour suggests that the winds of donor OB supergiants are magnetized. To investigate if magnetic fields are indeed present in the optical counterparts of such systems, we acquired low-resolution spectropolarimetric observations of the two optically brightest SFXTs, IGR J08408−4503 and IGR J11215−5952, with the ESO FORS 2 instrument during two different observing runs. No field detection at a significance level of 3σ was achieved for IGR J08408−4503. For IGR J11215−5952, we obtain 3.2σ and 3.8σ detections (⟨Bz⟩hydr = −978 ± 308 G and ⟨Bz⟩hydr = 416 ± 110 G) on two different nights in 2016. These results indicate that the model involving the interaction of a magnetized stellar wind with the neutron star magnetosphere can indeed be considered to characterize the behaviour of SFXTs. We detected long-term spectral variability in IGR J11215−5952, whereas for IGR J08408−4503, we find an indication of the presence of short-term variability on a time-scale of minutes.
Asthma medication update
Authors: Montag Susan
Published: November 2017

Take these steps to minimize patient confusion and uncertainty.
Digit Triplet Test Hearing Screening With Broadband and Low-Pass Filtered Noise in a Middle-Aged Population
Authors: Vercammen Charlotte , Goossens Tine , Wouters Jan , van Wieringen Astrid
Published: November 2017

Objectives:

This study investigated whether age affects Flemish Digit Triplet Test (DTT) scores, as well as sensitivity and specificity of the test to detect high-frequency hearing impairment in middle age.

Design:

DTT performance in broadband and low-pass filtered noise was assessed for 21 young and 61 middle-aged persons with normal-hearing sensitivity. Cutoff values based on their performance were used to evaluate sensitivity and specificity of the DTT as a screening tool in 145 middle-aged persons, with varying audiometric profiles.

Results:

DTT performance for normal-hearing persons depended on age in both noise conditions. For low-pass filtered noise, the trade-off between sensitivity and specificity also increased when age-adjusted cutoff values were applied for screening in middle age.

Conclusions:

The Flemish DTT with broadband noise had high sensitivity and specificity to detect high-frequency hearing impairment in middle age. Similar results were obtained for low-pass filtered noise when cutoff values for referral were age adjusted.
Therapeutic Drug Monitoring of Busulfan for the Management of Pediatric Patients: Cross-Validation of Methods and Long-Term Performance
Authors: Eva Choong , Chakradhara Rao Satyanarayana Uppugunduri , Denis Marino , Melanie Kuntzinger , Fabienne Doffey-Lazeyras , Rodolfo Lo Piccolo , Yves Chalandon , Christina Peters , Youssef Daali , Marc Ansari
Published: November 2017

Background:

Busulfan (Bu) is an alkylating agent used as part of the conditioning regimen in pediatric patients before hematopoietic stem cell transplantation. Despite intravenous (IV) administration and dosing recommendations based on age and weight, reports have revealed interindividual variability in Bu pharmacokinetics and the outcomes of hematopoietic stem cell transplantation. In this context, adjusting doses to Bu's narrow therapeutic window is advised. We aimed to assess the utility of therapeutic drug monitoring (TDM) of Bu in children, the reliability of Bu quantification methods, and its stability in plasma when stored for up to 5 years.

Methods:

Eighteen patients from our TDM center (252 samples) were included. All of them received a 2-hour Bu IV infusion 4 times daily for a total of 16 doses. The first dose of Bu was age/weight-based, and the subsequent doses were adjusted from third or fifth dose onward based on the estimated first dose pharmacokinetic parameters to target steady-state concentrations (Css) of 600–900 ng/mL. The performance of our unit's high-performance liquid chromatography with tandem mass spectrometry method was assessed using a quality control (QC, 35 series) chart. International, multicenter, cross-validation test (n = 21) was conducted to validate different analytical methods. To assess Bu stability, regression analyses and Bland–Altman plots were performed on measurements at repeated time points on samples stored at −80°C for up to 5 years.

Results:

We observed a 4.2-fold interindividual variability in Bu Css after the first dose, with only 28% of children having a Css within the target range. During the 4 days of conditioning, 83% of children had their doses modified according to TDM recommendations. This achieved a Css within the target range in 75% of the children. Routine QC measurements were generally within the ±15% range around theoretical values, showing the optimal robustness of our center's analytical method. Two of the 21 Bu TDM centers returned inadequate results during cross-validation testing; both used a UV detection method. Storage at −80°C led to a fall in Bu content of 14.9% ± 13.4% at 2–4 years and of 20% ± 5% by 5 years (r2overall= 0.92).

Conclusions:

We conclude that TDM is an effective method of achieving targeted Bu levels in children. QC programs are crucial to monitoring and maintaining the quality of an analytical method.
LONG-TERM INTRAOCULAR PRESSURE AFTER UNCOMPLICATED PARS PLANA VITRECTOMY FOR IDIOPATHIC EPIRETINAL MEMBRANE
Authors: Tognetto Daniele , Pastore Marco R. , Cirigliano Gabriella , D'Aloisio Rossella , Borelli Massimo , De Giacinto Chiara
Published: November 2017

Purpose:

To investigate long-term intraocular pressure trends after uncomplicated pars plana vitrectomy for idiopathic epiretinal membrane.

Methods:

Three hundred and sixty-eight eyes of 368 consecutive patients were enrolled. Changes in intraocular pressure 1, 3, 6, and 12 months after surgery and during the final follow-up visit were evaluated in vitrectomized eyes and nonvitrectomized fellow eyes.

Results:

The median follow-up period was 36 months (range 12–92 months). Longitudinal data analysis evidenced a 2.5-mmHg (2.2 mmHg; 2.7 mmHg, 95% confidence interval) statistically significant difference in intraocular pressure 30 days after surgery between treated and fellow untreated eyes, gradually recovering to a not significant 0.2-mmHg (−0.1 mmHg; 0.4 mmHg, 95% confidence interval) difference within 26 months. The incidence of late-onset ocular hypertension was 5.7% (21 over 347, 2%; 12%, 95% confidence interval) without difference between the treated eyes and the group control. No significant difference in the incidence of late-onset ocular hypertension and sex, lens status, or gauge of vitrectomy instruments was detected. Only patient's age was significantly higher (mean difference 4.2 years; 0.1–8.0 years, Monte Carlo, 95% confidence interval) in those who developed late-onset ocular hypertension in the vitrectomized eye.

Conclusion:

Uncomplicated pars plana vitrectomy for idiopathic epiretinal membrane seems not to increase the risk of late-onset ocular hypertension or open-angle glaucoma development.
Acute Angle-closure Glaucoma Associated With Aripiprazole in the Setting of Plateau Iris Configuration
Authors: Shen Elizabeth , Farukhi Sarah , Schmutz Mason , Mosaed Sameh
Published: November 2017

Purpose of the Study:

The purpose of this study was to report a novel case of drug-induced angle-closure from aripiprazole (Abilify), an atypical antipsychotic, and propose a mechanism for this association.

Methods/Results:

We report a case of a 45-year-old white woman who presented in subacute angle closure 2 months after initiating aripiprazole 5 mg daily for depression. This patient reported no prior ocular history and had been on longstanding duloxetine (Cymbalta) 60 mg daily for over 10 years before starting aripiprazole. Examination at initial presentation revealed an intraocular pressure (IOP) of 16 mm Hg in the right eye and an elevated IOP of 44 mm Hg in the left eye. Gonioscopy demonstrated a plateau iris configuration in the right eye and angle closure with a plateau iris configuration in the left eye. She was started on IOP-lowering therapy and underwent a laser peripheral iridotomy. Despite recommendation to discontinue aripiprazole, duloxetine was discontinued; aripiprazole was maintained and later increased to 10 mg daily for worsening depression. Three months after the dosage increase, the patient was found to have an elevated IOP of 32 mm Hg and angle-closure with a plateau iris configuration in the left eye. Iridoplasty was performed in the left eye with subsequent opening of the angle and improvement in IOP. The second attack of angle-closure led to the discontinuation of aripiprazole and a corresponding widening of the angles in both eyes 1 week after cessation.

Conclusions:

This is the first report to describe drug-induced angle-closure glaucoma associated with aripiprazole use. The mechanism of angle closure, we hypothesize, is from mydriasis and/or supraciliary effusion mediated by the serotoninergic effect on the iris and ciliary body complex. Treatment is preferably cessation of the medication. However, in cases where the medication is necessary for management of major depression, iridoplasty should be performed to reduce the risk of angle closure.
A Prospective, Randomized, Controlled Trial Comparing Conservative Treatment With Trunk Stabilization Exercise to Standard Hip Muscle Exercise for Treating Femoroacetabular Impingement: A Pilot Study
Authors: Aoyama Michihisa , Ohnishi Yasuo , Utsunomiya Hajime , Kanezaki Shiho , Takeuchi Hiroki , Watanuki Makoto , Matsuda Dean K. , Uchida Soshi
Published: November 2017

Objective:

To assess the efficacy of conservative management of women with femoroacetabular impingement (FAI) using trunk stabilization.

Design:

Randomized controlled trial (level of evidence: I).

Subjects:

Twenty FAI female patients who met the inclusion FAI criteria.

Methods:

A prospective, randomized, controlled study was performed on 20 female patients with symptomatic FAI comprising 2 groups (10 hips in trunk stabilization exercise group vs 10 hips in control group). We evaluated hip range of motion, isometric muscle strength using a handheld dynamometer (μ-TasMF-01; Anima, Co), and patient-reported outcome measures, including modified Harris hip score, Vail hip score, and international hip outcome tool 12 (iHOT12) before and at 4 weeks and 8 weeks after the intervention.

Results:

There was a significant improvement in the range of motion of hip flexion in the trunk training group detected as early as 4 weeks after the intervention compared with the control group (P < 0.05). Hip abductor strength significantly improved in the trunk training group at 4 weeks after the intervention, whereas it did not improve in the control group (P < 0.05). Vail hip score and iHOT12 were significantly increased at 8 weeks after the intervention in the trunk training group compared with the control group (iHOT12: 78.7 ± 22.4 vs 53.0 ± 22.3; P < 0.01, Vail hip score: 81.6 ± 18.5 vs 61.1 ± 11.6; P < 0.05). There was no significant difference in the modified Harris hip score between both the groups at 4 and 8 weeks after the intervention.

Conclusions:

The addition of trunk stabilization exercise to a typical hip rehabilitation protocol improves short-term clinical outcomes and may augment nonoperative and postoperative rehabilitation.
Normative Data Set of SWAY Balance Mobile Assessment in Pediatric Athletes
Authors: Anderson Stevi L. , Gatens Dustin , Glatts Colette , Russo Stephen A.
Published: November 2017

Objective:

To examine and describe normative values for an objective, mobile measure of postural stability commonly used in concussion assessments, SWAY Balance (SWAY Medical, Tulsa, Oklahoma).

Design:

Retrospective analysis of baseline balance assessments in a healthy pediatric population.

Setting:

Baseline assessments completed by certified athletic trainers at an outpatient concussion center or sports medicine offices in Philadelphia, PA and surrounding suburban Pennsylvania and New Jersey or during an athletic trainer's baseline assessment of collegiate athletes at a National Collegiate Athletic Association (NCAA) Division-II University in Fort Lauderdale, FL.

Participants:

Test results of a sample of 466 athletes aged 5 to 18 years were included.

Interventions:

The SWAY Balance test was administered using a mobile device on all participants as part of a standard preseason, baseline evaluation, following the standard evaluation protocol.

Main Outcome Measures:

Baseline SWAY Balance mobile assessment balance and reaction time scores, age and sex effects, were examined.

Results:

Normative scores are described, with results stratified into 4 age groups (5-9, 10-12, 13-17, and 18 years old). Balance scores, overall and within each individual stance score, improved with the age of the participants. Sex effects on balance were only seen in single-leg stances, with females outperforming males. Reaction time was found to be faster in males and improved with age, peaking at 13 to 17 years old and slowing in 18-year-olds.

Conclusions:

Normative, age-specific SWAY Balance test results provided are of clinical use as references in the concussion assessments of pediatric athletes.
Preoperative Serum Thymidine Kinase Activity as Novel Monitoring, Prognostic, and Predictive Biomarker in Pancreatic Cancer
Authors: Felix Klaus , Hinz Ulf , Dobiasch Sophie , Hackert Thilo , Bergmann Frank , Neumüller Magnus , Gronowitz Simon , Bergqvist Mattias , Strobel Oliver
Published: November 2017

Objective

The aim of the study was to investigate serum thymidine kinase 1 (S-TK) activity as a diagnostic and prognostic marker for patients with pancreatic ductal adenocarcinoma (PDAC).

Methods

Using the sensitive TK activity assay DiviTum, preoperative serum samples from 404 PDAC, 28 chronic pancreatitis, and 25 autoimmune pancreatitis patients and 83 healthy volunteers were analyzed. The preoperative S-TK activities of 54 PDAC patients who received neoadjuvant therapy (nTx) were also compared with those of 258 PDAC patients who did not receive nTx.

Results

The preoperative S-TK activities of PDAC patients were significantly higher and discriminatory from autoimmune and chronic pancreatitis patients and control groups. The S-TK activity in PDAC patients was associated with overall survival. Patients with S-TK activity of less than 80 Du (DiviTum units)/L demonstrated median survival of 20.3 months with an estimated 18.0% 5-year survival rate; for S-TK activity of 80 Du/L or greater, median survival was 15.1 months with a 6.8% 5-year survival rate. For early-stage PDAC, these differences were even more pronounced. The S-TK activity in the nTx group was significantly higher than that in the group not receiving nTx.

Conclusions

Pancreatic ductal adenocarcinomas reveal a significant increase in S-TK activity, which is associated with overall survival, especially in early tumor stages. Serum thymidine kinase 1 activity may be a useful parameter for monitoring nTx efficacy.
Invasive Fungal Disease in Pediatric Acute Leukemia in the Nontransplant Setting: 8 Years’ Experience From a Tertiary Care Center in North India
Authors: Das Anirban , Oberoi Sapna , Trehan Amita , Chakrabarti Arunaloke , Bansal Deepak , Saxena Akshay K. , Sodhi Kushaljit S. , Kakkar Nandita , Srinivasan Radhika
Published: November 2017

Background/Aim:

The aim of this article is to study the spectrum, changing prevalence, and predictors for mortality of invasive fungal disease (IFD) in pediatric leukemia in a resource-limited setting.

Observations:

Prevalence was 7% (proven, 69%; probable, 16.4%; possible, 14.6%) and did not differ between acute lymphoblastic leukemia and acute myeloid leukemia. Lungs were frequently involved (46%). Aspergillus was the commonest fungus (47%). Visceral abscesses were frequent with candidiasis as compared with invasive molds (P=0.016). IFD resulted in a prolonged admission (mean, 12.6±2 d; P=0.014) and death (44%) (Aspergillus, 50%; Candida, 50%; Mucor, 34%). Diagnosis of acute myeloid leukemia predicted mortality (P=0.03).

Conclusions:

IFD was an important cause of treatment related mortality in pediatric leukemia (odds ratio, 8.39). Protocolled use of computed tomography-chest and galactomannan-assay aided diagnosis (P<0.05).