bluuebunny/crossref_metadata_2025 huggingface dataset:
Dancing Difference/Gaming Gender
Authors: Miller Kiri
Published: March 2017

This chapter shows how dance games invite players to engage with embodied difference. The games are built around popular music and dance styles that function as signs of gender, sexuality, race, ethnicity, and class; their screen dancers also bear marks of intersectional identities, which may or may not match those of the musical and choreographic repertoires that they perform. Dance games follow in the footsteps of minstrelsy and drag traditions by staging song-and-dance variety shows that center on racialized and gendered performances. The games afford performative possibilities for both reinforcing and destabilizing essentialist identity categories. The chapter explains how constructivist gender theory informed the development process for the Dance Central series, and explores what happens when designers enlist players in putting theory into practice.
Measuring the Spread of Modern Manufacturing to the Poor Periphery
Authors: Bénétrix Agustín S. , O’Rourke Kevin Hjortshøj , Williamson Jeffrey Gale
Published: March 2017

This chapter documents industrial output growth around the poor periphery (Latin America, the European periphery, the Middle East and North Africa, Asia, and Sub-Saharan Africa) between 1870 and 2007. We find that although the roots of rapid peripheral industrialization stretch into the late nineteenth century, the high point of peripheral industrialization was the 1950–73 period, which saw widespread import-substituting industrialization (ISI). This ISI period was also the high point of unconditional industrial catching-up, defined as the tendency of less industrialized countries to post higher per capita manufacturing growth rates than more industrialized countries. However, this post-Second World War ISI episode was preceded by significant industrial catching-up, thus defined, in the 1920s and 1930s, as well as the 1940s in Latin America. And the catching-up in those inter-war decades was not simply because of a manufacturing collapse of the leaders during the Great Depression.
State and Market in Russian Industrialization, 1870–2010
Authors: Markevich Andrei , Nafziger Steven
Published: March 2017

This chapter surveys the history of Russian industrialization. It begins by exploring its roots in the nineteenth century; continues with an examination of the Soviet period; and concludes with a survey of developments over the post-Soviet decades. Our focus is on the dual role that markets and state policies have played in fostering, accelerating, and hindering Russian industrial development during all three periods. We provide a unified empirical picture of the industrial sector for the entire period, highlight the interactions of Russian and Soviet industry with the global economy, and emphasize the importance of the Russian case for understanding the possibilities of late industrialization.
How Peripheral was the Periphery?
Authors: Klein Alexander , Schulze Max-Stephan , Vonyó Tamás
Published: March 2017

This chapter explores the timing, pace, and spatial diffusion of modern industry in the former Habsburg Empire and its successor states. The regions adjacent to Western Europe, Alpine Austria, and the Czech lands shifted from proto-industrial to modern manufacturing first, followed by the western parts of Hungary. Though well advanced in the western and northwestern regions, industry diffused only slowly to the east and southeast, with profound implications for East Central European economies throughout the twentieth century. It is argued that this part of Europe stepped into the industrial age before most of the global periphery; that economic growth was mainly driven by industry from the late nineteenth century to the collapse of state socialism; and that the contribution of industry to aggregate value added was associated with a growing share of ‘modern’ manufacturing in industrial production. However, post-war interventionist policies failed to erase relative backwardness in East Central Europe.
Industrialization in Egypt and Turkey, 1870–2010
Authors: Karakoç Ulaş , Pamuk Şevket , Panza Laura
Published: March 2017

This chapter examines the industrial performance of Egypt and Turkey during four periods: 1870 to the First World War under open economy conditions; the inter-war era when industrialization began with the help of protection; the decades after the Second World War when the import-substituting industrialization model was adopted and rates of industrialization peaked; and trade liberalization since 1980. Per capita incomes were similar in Egypt and Turkey around 1870 but were 150 per cent higher in Turkey than in Egypt in 2010. The chapter identifies several factors which explain this divergence: land abundance in Turkey and its scarcity in Egypt; initial social structure and related political economy forces; government intervention; and the quality of related institutions. In terms of human capital investment, Turkey and Egypt lagged behind countries in Latin America and East Asia, which made it difficult for manufacturing to move towards sectors with higher technology and value added.
Industrialization in China
Authors: Brandt Loren , Ma Debin , Rawski Thomas G.
Published: March 2017

This chapter views industrial growth in China over the last 150 years as an ongoing process through which firms acquired and deepened manufacturing capabilities. Two factors have been consistently important: openness to the international economy and domestic market liberalization. For a latecomer like China, modern industry initially has greatest success in more labour-intensive products requiring only modest capabilities. Gradual upgrading entails the shift into more skilled-labour and capital-intensive products and processes. Our construction and review of long-term data shows that (i) China’s industrial growth rate consistently exceeded that of Japan, India, and Russia/USSR throughout most of the twentieth century; (ii) China’s shift from textiles and other light industry toward defence-related industries began before rather than after 1949, as did the geographic spread of industry; and (iii) the state sector has consistently been a brake on industrial upgrading, highlighting the significance of current reform initiatives in determining China’s future industrial path.
From Commodity Booms to Economic Miracles
Authors: Bassino Jean-Pascal , Williamson Jeffrey Gale
Published: March 2017

Indonesia, Malaysia, and Thailand emerged unexpectedly in the 1960s and 1970s as fast-growing, labour-intensive manufacturing countries. Their industrial growth rates closely matched those of Japan, South Korea, and Taiwan for more than two decades. This sudden export-led ‘miracle’ took place in the context of political instability and ethnic tensions, after more than two decades of modest success with post-independence, import-substituting industrialization strategies there and in other Southeast Asian nations. Cambodia and Vietnam joined the export-led manufacturing club in the 1990s, followed by Myanmar in the 2000s. The Philippines was the only Southeast Asian nation to miss the late twentieth-century ‘miracle’. Southeast Asia experienced some impressive GDP per capita growth between 1870 and 1940, but, outside of the Philippines, manufacturing stagnated and modern enterprises were confined to commodity export processing. The chapter analyses the region’s dismal industrial performance before the 1960s, and why manufacturing grew so fast in the following decades.
Industrialization and Growth in Peru and Mexico, 1870–2010
Authors: Gómez-Galvarriato Aurora , Colín Graciela Márquez
Published: March 2017

The industrialization experiences of Mexico and Peru differed because of their different market sizes and location. Mexico’s larger market and border with the US gave it greater opportunities for industrialization. Peru’s development is closer to that of the classic late-nineteenth-century commodity exporter and followed the primary-goods-exports model for longer. Until the 1980s both countries had relatively high wages, inhibiting the development of labour-intensive manufactured exports, but they lacked the education and skill levels to produce more technologically sophisticated manufacturing goods. Contrary to common belief, commodity export-led growth supported industrial growth as long as exports were diversified and the government pursued sound fiscal and monetary policies. Import substitution policies fostered manufacturing growth when coupled with macroeconomic stability and policies promoting domestic and foreign investment. After economic liberalization in recent decades, Peru returned to relying on commodity exports, while Mexico developed assembly export manufacturing, with very low levels of domestic value added.
Patterns of Manufacturing Growth in Sub-Saharan Africa
Authors: Austin Gareth , Frankema Ewout , Jerven Morten
Published: March 2017

This chapter reviews the ‘long twentieth-century’ development of ‘modern’ manufacturing in Sub-Saharan Africa from colonization to the present. It argues that classifying Africa generically as a ‘late industrializer’ is inaccurate. To understand the distinctively African pattern of manufacturing growth, the discussion focuses on the dynamic interplay between the region’s specific endowment structures, global economic relationships, and government policies. It concludes that Sub-Saharan Africa is best characterized as a case of interrupted industrial growth instead of sustained convergence on world industrial leaders. This is partly because, until very recently, factor endowments made it very costly for states to pursue industrialization; and partly because successive rulers, colonial and post-colonial, have rarely had both the capacity to adopt and the dedication to sustain policies that modified the region’s existing comparative advantage in primary production, by using their fiscal and regulatory powers effectively to promote industrialization.
Symmetry-protected topological phases in one-dimensional systems
Authors: Pollmann Frank
Published: March 2017

Classifying and understanding phases of matter is an important task in condensed matter physics. The class of ‘conventional’ symmetry-broken phases is well understood in terms of Landau’s theory. A paradigmatic example is the Z2-symmetric Ising model with symmetric (paramagnetic) and symmetry-broken (ferromagnet) phases, which can be distinguished by measuring the magnetization as a local order parameter. Topological phases of matter, however, are less understood and no complete classification is known. These lecture notes discuss schemes that provide an understanding and characterization of certain topological phases of matter in models with local Hamiltonians. The main focus is on symmetry-protected topological (SPT) phases in one-dimensional bosonic systems. On the basis of the entanglement properties of such systems, a motivation is given for the matrix product state (MPS) representation of ground states. Using the MPS framework, it is demonstrated how SPT phases can be classified using projective representations of the symmetries.
Ethnic Disadvantage
Authors: Singhal Saurabh , Beck Ulrik
Published: March 2017

This chapter investigates the ethnic disadvantage in rural Viet Nam, focusing on the magnitude of the majority–minority gap and constraints on ethnic minority households that contribute to the gap. The chapter documents large improvements in living standards both for the Kinh majority as well as for the ethnic minorities. However, a significant difference between the Kinh households and the rest persists. Examining the sources of income shows that non-Kinh households are less likely to diversify into high-yielding non-farm activities. Non-Kinh households have lower quality agricultural land, lower rates of ownership certificates, face more problems in producing and selling their agricultural products, and have worse access to credit. However, the locational disadvantage of the non-Kinh households has substantially declined over time. The data allows examination of intra-minority dynamics—differences are found among the various non-Kinh minorities along spatial, ethnic, and linguistic lines.
A Dictionary of Occupational Science and Occupational Therapy
Authors: Molineux Matthew
Published: March 2017

600 entries

This dictionary provides up-to-date definitions of the terms used in the related fields of occupational science and occupational therapy. Entries cover a broad range of topics from activities of daily living and autonomy to task-oriented approach and work–life balance and have a clear occupational focus. They provide an overview of the complex nature of human occupation and the impact of illness, injury, social exclusion, marginalization, or transition, for example, on occupation and well-being. Descriptions and analysis are backed up by key theories from related areas such as anthropology, sociology, and medicine.

This is an authoritative resource for students of occupational science and occupational therapy, as well as an accessible point of reference for practitioners from both areas.
Teaching Inpatient Medicine
Authors: Harrod Molly , Saint Sanjay , Stock Robert W.
Published: March 2017

Each year, roughly 18,000 medical students graduate from 170 plus medical schools in the United States. Nearly all of these graduates will continue their medical education at one of the more than 1,000 teaching hospitals across the country. Because of the reduction in the resident work week and the more recent intern shift cap, medical education on the wards must be high yield. This educational responsibility falls on the shoulders of attending physicians, few of whom have had formal education in teaching. This book utilized an in-depth exploratory, qualitative approach to uncover how a group of attendings, identified as experts in the field of medical teaching, construct learning environments that promote team-based learning while delivering high-quality patient-centered care. We observed attendings with their teams on rounds and conducted interviews and focus groups with the attendings and current and former learners in order to obtain multiple perspectives on what makes an attending a great teacher and clinician. Using real examples derived from the inpatient teaching environment, this book will provide readers with strategies they can modify and incorporate into their own teaching repertoire, including how to utilize the expertise of other allied health professionals and involve the patient in the teaching process.
Insulin basics
Authors: Perkins Amanda
Published: March 2017

Keep your patients safe with this must-know information.
Patient Response to an Integrated Orthotic and Rehabilitation Initiative for Traumatic Injuries: The PRIORITI-MTF Study
Authors: Hsu Joseph R. , Owens Johnny G. , DeSanto Jennifer , Fergason John R. , Kuhn Kevin M. , Potter Benjamin K. , Stinner Daniel J. , Sheu Robert G. , Waggoner Sandra L. , Wilken Jason M. , Huang Yanjie , Scharfstein Daniel O. , MacKenzie Ellen J. ,   METRC
Published: March 2017

Although limb salvage is now possible for many high-energy open fractures and crush injuries to the distal tibia, ankle, hindfoot, and midfoot, orthotic options are limited. The Intrepid Dynamic Exoskeletal Orthosis (IDEO) is a custom, energy-storing carbon fiber orthosis developed for trauma patients undergoing limb salvage. The IDEO differs from other orthoses in that it allows patients with ankle weakness to have more normal ankle biomechanics and increased ankle power. This article describes the design of a study to evaluate the effectiveness of the IDEO when delivered together with a high-intensity, sports medicine–based approach to rehabilitation. It builds on earlier studies by testing the program at military treatment facilities beyond the Brooke Army Medical Center and the Center for the Intrepid where the device was developed. The PRIORITI-MTF study is a multicenter before-after program evaluation where participants at least 1 year out from a traumatic lower extremity injury serve as their own controls. Participants are evaluated before receiving the IDEO, immediately after 4 weeks of physical therapy with the IDEO and at 6 and 12 months after the completion of physical therapy. Primary outcomes include functional performance, measured using well-validated assessments of speed, agility, power, and postural stability and self-reported functioning using the Short Musculoskeletal Function Assessment (SMFA) and the Veterans Health Survey (VR-12). Secondary outcomes include pain, depression, posttraumatic stress, and satisfaction with the IDEO.
Outcomes After Severe Distal Tibia, Ankle, and/or Foot Trauma: Comparison of Limb Salvage Versus Transtibial Amputation (OUTLET)
Authors: Bosse Michael J. , Teague David , Reider Lisa , Gary Joshua L. , Morshed Saam , Seymour Rachel B. , Toledano James , Cannada Lisa K. , Steverson Barbara , Scharfstein Daniel O. , Luly Jason , MacKenzie Ellen J. ,   METRC
Published: March 2017

Severe foot and ankle injuries are complex and challenging to treat, often requiring multiple operations to salvage the limb contributing to a prolonged healing period. There is some evidence to suggest that early amputation for some patients may result in better long-term outcomes than limb salvage. The challenge is to identify the regional injury burden for an individual that would suggest a better outcome with an amputation. The OUTLET study is a prospective, multicenter observational study comparing 18-month outcomes after limb salvage versus early amputation among patients aged 18–60 years with severe distal tibia, ankle, and foot injuries. This study aims to build upon the previous work of the Lower Extremity Assessment Project by identifying the injury and patient characteristics that help define a subgroup of salvage patients who will have better outcomes had they undergone a transtibial amputation.
A Prospective Randomized Trial to Assess Oral Versus Intravenous Antibiotics for the Treatment of Postoperative Wound Infection After Extremity Fractures (POvIV Study)
Authors: Obremskey William T. , Schmidt Andrew H. , O'Toole Robert V. , DeSanto Jennifer , Morshed Saam , Tornetta Paul , Murray Clinton K. , Jones Clifford B. , Scharfstein Daniel O. , Taylor Tara J. , Carlini Anthony R. , Castillo Renan C. ,   METRC
Published: March 2017

Patients surgically treated for infection after extremity fractures are typically discharged with a 6- to 12-week antibiotic regimen. Intravenous (IV) antibiotics are associated with significant cost and potential complications of deep vein thrombosis, line clotting, and sepsis. Many of the pathogens that cause musculoskeletal infection have both oral (PO) and IV antibiotic options with adequate bioavailability and antibacterial effect, yet IV antibiotics remain the standard of care absent evidence that PO options are clinically as efficacious. The POvIV study is a prospective, multicenter, randomized trial to compare PO with IV antibiotic therapy in patients with postoperative wound infections after extremity fractures. Patients between the ages of 18 and 84 who have a culture-positive surgical site infection after internal fixation for fracture repair or arthrodesis are approached for this study, and if they provide consent, are randomly assigned to receive either PO or IV antibiotics. Antibiotic selection is based on culture and sensitivity results. Randomization determines the route of administration. Patients are followed for 1 year after study enrollment. This study will be the largest prospective randomized trial to evaluate the safety and effectiveness of PO antibiotic use for treatment of postoperative wound infections. Results will inform clinician decisions on antibiotic delivery in patients with postoperative wound infections.
Supplemental Perioperative Oxygen to Reduce Surgical Site Infection After High-Energy Fracture Surgery (OXYGEN Study)
Authors: O'Toole Robert V. , Joshi Manjari , Carlini Anthony R. , Sikorski Robert A. , Dagal Armagan , Murray Clinton K. , Weaver Michael J. , Paryavi Ebrahim , Stall Alec C. , Scharfstein Daniel O. , Agel Julie , Zadnik Mary , Bosse Michael J. , Castillo Renan C. ,   METRC
Published: March 2017

Supplemental perioperative oxygen (SPO) therapy has been proposed as one approach for reducing the risk of surgical site infection (SSI). Current data are mixed regarding efficacy in decreasing SSI rates and hospital inpatient stays in general and few data exist for orthopaedic trauma patients. This study is a phase III, double-blind, prospective randomized clinical trial with a primary goal of assessing the efficacy of 2 different concentrations of perioperative oxygen in the prevention of SSIs in adults with tibial plateau, pilon (tibial plafond), or calcaneus fractures at higher risk of infection and definitively treated with plate and screw fixation. Patients are block randomized (within center) in a 1:1 ratio to either treatment group (FiO2 80%) or control group (FiO2 30%) and stratified by each study injury location. Secondary objectives of the study are to compare species and antibacterial sensitivities of the bacteria in patients who develop SSIs, to validate a previously developed risk prediction model for the development of SSI after fracture surgery, and to measure and compare resource utilization and cost associated with SSI in the 2 study groups. SPO is a low cost and readily available resource that could be easily disseminated to trauma centers across the country and the world if proved to be effective.
Surgical Treatment of Congenital and Obligatory Dislocation of the Patella in Children
Authors: Sever Ronen , Fishkin Michael , Hemo Yoram , Wientroub Shlomo , Yaniv Moshe
Published: March 2017

Background:

Congenital (fixed) dislocations and obligatory (habitual) patellar dislocations represent a complex clinical and surgical challenge. Numerous treatment options, offering different perspectives, and surgical solutions are reported in the literature.

We implemented the surgical technique principles, originally described by Stanisavljevic, for congenital (fixed) and obligatory (habitual) patellar dislocations, with slight modifications.

Methods:

We retrospectively evaluated the results of group of 12 patients (15 knees), operated between the years 2002 and 2013. The procedure includes extensive subperiosteal quadriceps realignment and soft tissue medial plication, followed by distal realignment through patellar tendon splitting. The outcome measures were patellar stability, knee range of motion, Pedi-IKDC knee function score, and the PODCI global function score.

Results:

The study group included 12 patients, 9 females and 3 males (15 knees) whose mean age was 5 years 2 months at diagnosis and 7 years 5 months at surgery. Nine patients had an underlying diagnosed genetic background [Down syndrome (n=6), Larsen syndrome (n=2), nail-patella syndrome (n=1)]. The mean follow-up was 46.2 months. Eleven patients, gained stable patella with no recurrence of dislocation. Postoperative knee active extension was improved significantly (P<0.0001) for all patients. The average postoperative Pedi-IKDC and PODCI scores were significantly higher (P<0.001) among the idiopathic group.

Conclusions:

These results suggest that the Stanisavljevic procedure principles with modifications, provides an efficient method for treatment of fixed and obligatory patellar dislocation. In our opinion, young age at surgery played an important role in the surgical outcome.

Level of Evidence:

Level IV—therapeutic.
Control of Walking Speed in Children With Cerebral Palsy
Authors: Davids Jon R. , Cung Nina Q. , Chen Suzy , Sison-Williamson Mitell , Bagley Anita M.
Published: March 2017

Background:

Children’s ability to control the speed of gait is important for a wide range of activities. It is thought that the ability to increase the speed of gait for children with cerebral palsy (CP) is common. This study considered 3 hypotheses: (1) most ambulatory children with CP can increase gait speed, (2) the characteristics of free (self-selected) and fast walking are related to motor impairment level, and (3) the strategies used to increase gait speed are distinct among these levels.

Methods:

A retrospective review of time-distance parameters (TDPs) for 212 subjects with CP and 34 typically developing subjects walking at free and fast speeds was performed. Only children who could increase their gait speed above the minimal clinically important difference were defined as having a fast walk. Analysis of variance was used to compare TDPs of children with CP, among Gross Motor Function Classification System (GMFCS) levels, and children in typically developing group.

Results:

Eight-five percent of the CP group (GMFCS I, II, III; 96%, 99%, and 34%, respectively) could increase gait speed on demand. At free speed, children at GMFCS I and II were significantly faster than children at GMFCS level III. At free speed, children at GMFCS I and II had significantly greater stride length than those at GMFCS levels III. At free speed, children at GMFCS level III had significantly lower cadence than those at GMFCS I and II. There were no significant differences in cadence among GMFCS levels at fast speeds. There were no significant differences among GMFCS levels for percent change in any TDP between free and fast walking.

Discussion:

Almost all children with CP at GMFCS levels I and II can control the speed of gait, however, only one-third at GMFCS III level have this ability. This study suggests that children at GMFCS III level can be divided into 2 groups based on their ability to control gait speed; however, the prognostic significance of such categorization remains to be determined.

Level of Evidence:

Diagnostic level II.
Impact of Targeted Interventions on Trends in Central Line-Associated Bloodstream Infection: A Single-Center Experience From the Republic of Korea
Authors: Cho Sun Young , Chung Doo Ryeon , Ryu Jae Geum , Choi Jong Rim , Ahn Nayeon , Kim Seonwoo , Kim Min-Ji , Ha Young Eun , Kang Cheol-In , Peck Kyong Ran , Song Jae-Hoon
Published: March 2017

Objective:

To assess the impact of targeted interventions on trends in central line-associated bloodstream infection.

Design:

A before-and-after study between January 2013 and September 2014.

Setting:

Tertiary hospital in the Republic of Korea.

Patients:

All patients with central-line catheters in the hospital.

Interventions:

In September 2013, interventions that targeted central line insertion practices were implemented in 10 ICUs, including compliance monitoring with a central line insertion practices bundle and use of an all-inclusive catheter kit. The impact of targeted interventions on trends in central line-associated bloodstream infection was evaluated by segmented autoregression analysis of an interrupted time series.

Measurements and Main Results:

The average hospital-wide central line-associated bloodstream infection rates in the baseline and intervention periods were 1.84 and 1.56 per 1,000 catheter-days, respectively. During the baseline period, there was an increase of central line-associated bloodstream infection rate of 0.12 per 1,000 catheter-days per month. In the intervention period, there was a decrease of central line-associated bloodstream infection rate of 0.16 per 1,000 catheter-days per month (change in slope, –0.28; 95% CI, –0.37 to –0.19; p < 0.0001). In ICUs, the average central line-associated bloodstream infection rates in the baseline and intervention periods were 1.92 and 1.64 per 1,000 catheter-days, respectively. During the baseline period, there was an increase of central line-associated bloodstream infection rate of 0.18 per 1,000 catheter-days per month in ICUs. After sequential-targeted interventions, there was a decrease of central line-associated bloodstream infection rate of 0.16 per 1,000 catheter-days per month (change in slope, –0.34; 95% CI, –0.50 to –0.18; p = 0.0007).

Conclusions:

Targeted interventions were associated with significant changes in trends in the occurrence rate of central line-associated bloodstream infection in ICUs and the entire hospital.
The Absence of Fever Is Associated With Higher Mortality and Decreased Antibiotic and IV Fluid Administration in Emergency Department Patients With Suspected Septic Shock
Authors: Henning Daniel J. , Carey Jeremy R. , Oedorf Kimie , Day Danielle E. , Redfield Colby S. , Huguenel Colin J. , Roberts Jonathan C. , Sanchez Leon D. , Wolfe Richard E. , Shapiro Nathan I.
Published: March 2017

Objective:

This study evaluates whether emergency department septic shock patients without a fever (reported or measured) receive less IV fluids, have decreased antibiotic administration, and suffer increased in-hospital mortality.

Design:

This was a secondary analysis of a prospective, observational study of patients with shock.

Setting:

The study was conducted in an urban, academic emergency department.

Patients:

The original study enrolled consecutive adult (aged 18 yr or older) emergency department patients from November 11, 2012, to September 23, 2013, who met one of the following shock criteria: 1) systolic blood pressure less than 90 mm Hg after at least 1L IV fluids, 2) new vasopressor requirement, or 3) systolic blood pressure less than 90 mm Hg and IV fluids held for concern of fluid overload. The current study is limited to patients with septic shock. Patients were grouped as febrile if they had a subjective fever or a measured temperature >100.4°F documented in the emergency department; afebrile patients lacked both.

Measurements and Main Results:

Among 378 patients with septic shock, 207 of 378 (55%; 50–60%) were febrile by history or measurement. Afebrile patients had lower rates of antibiotic administration in the emergency department (81% vs 94%; p < 0.01), lower mean volumes of IV fluids (2,607 vs 3,013 mL; p < 0.01), and higher in-hospital mortality rates (33% vs 11%; p < 0.01). After adjusting for bicarbonate less than 20 mEq/L, lactate concentration, respiratory rate greater than or equal to 24 breaths/min, emergency department antibiotics, and emergency department IV fluids volume, being afebrile remained a significant predictor of in-hospital mortality (odds ratio, 4.3; 95% CI, 2.2–8.2; area under the curve = 0.83).

Conclusions:

In emergency department patients with septic shock, afebrile patients received lower rates of emergency department antibiotic administration, lower mean IV fluids volume, and suffered higher in-hospital mortality.
Novel Approach to Treating Androgenetic Alopecia in Females With Photobiomodulation (Low-Level Laser Therapy)
Authors: Friedman Shelly , Schnoor Patricia
Published: March 2017

BACKGROUND

Photobiomodulation, also referred to as low-level laser therapy (LLLT), has been studied and used for (among other diseases) the promotion of hair regrowth.

OBJECTIVE/MATERIALS AND METHODS/RESULTS

A clinical study was developed to define the physiologic effects that occur when the human hair follicle and surrounding tissue structures are exposed to laser light using a novel device that is fitted with an array of laser diode sources operating at 650 nm and placed inside a sports cap to promote discretion while in use. The study demonstrates that low-level laser treatment of the scalp every other day for 17 weeks using the HANDI-DOME LASER device is a safe and effective treatment for androgenetic alopecia in healthy females between the ages of 18 to 60 with Fitzpatrick skin Types I to IV and Ludwig–Savin Baldness Scale I-2 to II-2 baldness patterns. Subjects receiving LLLT at 650 nm achieved a 51% increase in hair counts as compared with sham-treated control patients in this multicenter randomized controlled trial.

CONCLUSION

These results suggest that the emerging technology of low-level laser therapy may play a potentially significant role in health care providers' armamentarium for the disease androgenic alopecia.
Acetylcholine–Atropine Interactions: Paradoxical Effects on Atrial Fibrillation Inducibility
Authors: Liu Yu , Scherlag Benjamin J. , Fan Youqi , Xia Wenfang , Huang He , Po Sunny S.
Published: March 2017

Atropine (ATr) is well known as a cholinergic antagonist, however, at low concentrations ATr could paradoxically accentuate the parasympathetic actions of acetylcholine (ACh). In 22 pentobarbital anesthetized dogs, via a left and right thoracotomy, a leak-proof barrier was attached to isolate the atrial appendages (AAs) from the rest of the atria. In group 1 (Ach+ATr+Ach), ACh, 100 mM, was placed on the AA followed by the application of ATr, 2 mg/mL. The average atrial fibrillation (AF) duration was 17 ± 7 minutes. After ATr was applied to the AA and ACh again tested, the AF duration was markedly attenuated (2 ± 2 minutes, P < 0.05). In group 2 (ATr+Ach), ATr was initially applied to the AA followed by the application of ACh, 100 mM. There was no significant difference in AF duration (16 ± 4 minutes vs. 18 ± 2 minutes, P = NS). The inhibitory effect of ATr on induced HR reduction (electrical stimulation of the anterior right ganglionated plexi and vagal nerves) was similar between groups 1 and 2. These observations suggest that when ATr is initially administered it attaches to the allosteric site of the muscarinic ACh receptor (M2) leaving the orthosteric site free to be occupied by ACh. The M3 receptor that controls HR slowing does not show the same allosteric properties.
Induration at Injection or Infusion Site May Reduce Bioavailability of Parenteral Phenobarbital Administration
Authors: Nakayama Hirokazu , Echizen Hirotoshi , Ogawa Ryuichi , Akabane Atsuya , Kato Toshiaki , Orii Takao
Published: March 2017

Background:

Phenobarbital is well tolerated and effective for controlling agitation or preventing convulsion at the end of life. No information is available concerning parenteral bioavailability of phenobarbital when induration develops at the injection or infusion site. We investigated whether induration at injection or infusion site is related to phenobarbital bioavailability via parenteral routes of continuous subcutaneous infusion and intermittent subcutaneous or intramuscular injection.

Methods:

A retrospective analysis was conducted on the medical data obtained from 18 patients who received chronic subcutaneous or intramuscular injections of phenobarbital for the prevention of convulsions and underwent plasma concentration monitoring of the drug. Patients whose concomitant medications were altered during the observation periods were excluded from the analysis. Comparisons were performed for concentration/dose (C/D) ratios obtained from patients with induration at injection or infusion sites (induration group, n = 6) and those without induration (noninduration group, n = 12).P< 0.05 was considered statistically significant.

Results:

The induration group showed significantly reduced C/D ratio compared with the noninduration group [median (range): 0.131 (0.114–0.334) versus 0.219 (0.180–0.322) d/L,P< 0.05). Assuming that systemic clearance was constant in our patients, changes in the C/D ratio would have contributed to 40% (median) reduction in bioavailability of the drug from the injection or infusion site.

Conclusions:

Our data suggest that absolute bioavailability of phenobarbital may be reduced when induration develops at the injection or infusion site in patients treated parenterally by continuous subcutaneous infusion or intramuscular injection.
ONE-YEAR RESULTS OF HALF- VERSUS STANDARD-DOSE PHOTODYNAMIC THERAPY COMBINED WITH RANIBIZUMAB FOR POLYPOIDAL CHOROIDAL VASCULOPATHY
Authors: Wong Ian Y. , Shi Xuan , Gangwani Rita , Iu Lawrence P. , Fung Nicholas , Li Qing , Ng Alex L. K. , Li Xiaoxin
Published: March 2017

Purpose:

To explore the efficacy of half-dose verteporfin photodynamic therapy (hd-PDT) and standard-dose photodynamic therapy (sd-PDT), when combined with ranibizumab in the treatment of polypoidal choroidal vasculopathy.

Methods:

Subjects were allocated to either the hd-PDT arm or the sd-PDT arm. All subjects received an injection of ranibizumab and PDT treatment (dosage according to allocation) at baseline. Subjects were followed up monthly for 12 months, and re-treatment were given at each visit if criteria were met.

Results:

There were 26 subjects in the hd-PDT arm and 32 in the sd-PDT arm. Overall mean age was 69.3 ± 9.4 years. Baseline demographics and ocular features did not differ significantly between the two arms. Improvement in vision and reduction in central retinal thickness were similar between the two arms. When presenting, visual acuity was better than 20/50 (logarithm of the minimum angle of resolution 0.4), or when there were three or less polyps angiogram, those treated with hd-PDT tended to perform better than those treated with sd-PDT.

Conclusion:

In general, hd-PDT was able to produce similar results as sd-PDT. Subgroup analysis revealed superior results with hd-PDT when baseline vision was 20/50 or better, or when there were three or less polyps on indocyanine green angiography.
Strategies for Deep Anterior Lamellar Keratoplasty After Hydrops in Keratoconus
Authors: Fuest Matthias , Mehta Jodhbir S.
Published: March 2017

Corneal hydrops affects approximately 2.5% of keratoconus (KC) cases, predominantly young males approximately 25 years of age with steep cones. Often, patients are left with a vision-reducing corneal scar frequently necessitating surgical treatment. Penetrating keratoplasty (PK) has worse survival outcomes in hydrops than in general KC cases. Deep anterior lamellar keratoplasty (DALK) is a nonpenetrating technique believed to achieve equal or better outcomes in visual acuity, graft survival, endothelial rejection rates, and endothelial cell survival in comparison with PK, while maintaining globe integrity and the patients' Descemet membrane (DM) and endothelium. Outcomes for patients with KC are promising. After hydrops, a corneal scar involving DM complicates the ability to perform DALK using standard techniques. So far few case series described successful treatment of hydrops scars with DALK. In this review, we summarize, evaluate, and discuss the current known approaches to DALK in patients after hydrops.
Concomitant Valve-In-Valve Transcatheter Aortic Valve Replacement and Left Ventricular Assist Device Implantation
Authors: Murashita Takashi , Joyce David L. , Pochettino Alberto , Stulak John M. , Joyce Lyle D.
Published: March 2017

Redo aortic valve replacement (AVR) performed simultaneously with left ventricular assist device (LVAD) implantation carries potential for increased mortality rates. Although transcatheter AVR has been used for patients with previous LVAD placement, no literature reports concomitant valve-in-valve transcatheter AVR and LVAD implantation. Our patient had severe aortic prosthetic valve deterioration and advanced heart failure. Given the risks associated with reoperative aortic valve surgery, we chose transcatheter AVR at the time of LVAD implantation. Transthoracic echocardiography results showed severe aortic prosthetic valve deterioration with moderate aortic regurgitation as well as severe left ventricular dysfunction (ejection fraction, 11%). After redosternotomy, we performed transcatheter AVR via the ascending aorta and subsequent LVAD implantation. The postoperative course was uneventful. Generally, patients with structural deterioration of a bioprosthetic valve who report for LVAD therapy present considerable challenges to the surgeon. Concomitant transcatheter AVR offers a less-invasive alternative to surgical AVR that minimizes ischemic injury to myocardium.
Biomarker of extracellular matrix remodelling C1M and proinflammatory cytokine interleukin 6 are related to synovitis and pain in end-stage knee osteoarthritis patients
Authors: Radojčić Maja R. , Thudium Christian S. , Henriksen Kim , Tan Keith , Karlsten Rolf , Dudley Amanda , Chessell Iain , Karsdal Morten A. , Bay-Jensen Anne-Christine , Crema Michel D. , Guermazi Ali
Published: March 2017

Little is known about local and systemic biomarkers in relation to synovitis and pain in end-stage osteoarthritis (OA) patients. We investigated the associations between the novel extracellular matrix biomarker, C1M, and local and systemic interleukin 6 (IL-6) with synovitis and pain. Serum C1M, plasma, and synovial fluid IL-6 (p-IL-6, sf-IL-6) were measured in 104 end-stage knee OA patients. Contrast-enhanced magnetic resonance imaging was used to semiquantitatively assess an 11-point synovitis score; pain was assessed by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Neuropathic Pain Questionnaire (NPQ). Linear regression was used to investigate associations between biomarkers and synovitis, and biomarkers and pain while controlling for age, sex, and body mass index. We also tested whether associations between biomarkers and pain were confounded by synovitis. We found sf-IL-6 was associated with synovitis in the parapatellar subregion (B = 0.006; 95% confidence interval [CI] 0.003-0.010), and no association between p-IL-6 and synovitis. We also observed an association between C1M and synovitis in the periligamentous subregion (B = 0.013; 95% CI 0.003-0.023). Furthermore, sf-IL-6, but not p-IL-6, was significantly associated with pain, WOMAC (B = 0.022; 95% CI 0.004-0.040), and NPQ (B = 0.043; 95% CI 0.005-0.082). There was no association between C1M and WOMAC pain, but we did find an association between C1M and NPQ (B = 0.229; 95% CI 0.036-0.422). Lastly, synovitis explained both biomarker-NPQ associations, but not the biomarker-WOMAC association. These results suggest that C1M and IL-6 are associated with synovitis and pain, and synovitis is an important confounding variable when studying biomarkers and neuropathic features in OA patients.
A Hybrid Simulation-Based Pre-Professional Physical Therapist Intensive Care Unit Course
Authors: Bishop Kathy Lee , Sharp Jennifer , Ohtake Patricia J.
Published: March 2017

Background and Purpose:

There is demand for physical therapists to practice in intensive care units (ICUs); however, many physical therapists lack the specialized knowledge and skills to provide these services. Immersive simulation is an ideal instructional design strategy for learning ICU rehabilitation skills because simulation provides safe, low-risk environments to master high-risk interventions. This case report describes an elective hybrid pre-professional physical therapist course that incorporates simulation-based learning experiences (SBLEs) with clinical mentoring to prepare students for formal ICU internships.

Case Description:

Eight final-year physical therapist students participated in this course. The goal of this course was to facilitate the development of students interested in specializing in ICU practice. Course objectives included acquiring the knowledge, communication skills, and clinical skills essential for participating in mentored clinical ICU internships. Educational strategies included lectures, SBLEs, and clinical ICU experiences.

Outcomes:

All students successfully completed the course, earned the American Heart Association Advance Cardiac Life Support certification, and were identified by ICU physical therapist clinical instructors as ready for formal ICU internships. Stakeholders positively reviewed the course. One year following the course, 4 of 8 students were employed in acute care and/or ICU settings.

Discussion:

This elective course used a combination of lectures, SBLEs, and clinical experiences to successfully prepare physical therapist students for mentored ICU internships and employment in acute and critical care practice settings. More research is required to evaluate the simulation pedagogy (structure, types of cases, and time in simulation) and criteria for determining student competence level for ICU practice.
Transcanal Endoscopic Ear Surgery for Middle Ear Cholesteatoma
Authors: Glikson Eran , Yousovich Ruth , Mansour Jobran , Wolf Michael , Migirov Lela , Shapira Yisgav
Published: March 2017

Objective:

To evaluate the clinical parameters, outcomes, and complications of transcanal endoscopic ear surgeries for middle ear cholesteatoma.

Study Design:

Retrospective study.

Setting:

Tertiary university-affiliated medical center.

Patients:

Adult patients (age >18) who underwent transcanal endoscopic ear surgeries for cholesteatoma, between March 2009 and March 2015.

Intervention:

Transcanal endoscopic surgery was indicated when the cholesteatoma did not extend posterior to the anterior limb of the lateral semicircular canal. Rigid endoscopes 4 and 2.7 mm in diameter, 0, 30, 45, and 70 degrees were used with angled picks, suction, and forceps.

Preoperative assessment included high-resolution computed tomography of the temporal bones and/or non echo-planar diffusion-weighted magnetic resonance imaging and pure-tone audiometry.

Main Outcome Measures:

Residual or recurrent disease was diagnosed by clinical examination and/or magnetic resonance imaging findings consistent with cholesteatoma. Intra- and postoperative complications, pre- and postoperative audiometric results were recorded.

Results:

Sixty operations (56 patients, mean age = 43.6) were included.

Six operations (10%) were performed under local anesthesia. The most common sites of cholesteatoma involvement were: posterior epitympanum (n = 51, 91%), anterior epitympanum (n = 19, 33.9%), posterior mesotympanum (n = 13, 23.2%), and sinus tympani (n = 11, 19.6%). Intraoperative ossicular chain reconstruction was performed in 18 (30%) cases.

Our overall residual and recurrence rates were 10% (n = 6) and 8.3% (n = 5), respectively, with mean duration of follow up of 35 months. The most common sites of residual disease were the mastoid cavity/antrum (n = 3, 50%), tympanic cavity, and posterior mesotympanum. Overall minor and major complication rates were 16.6 and 6%, respectively.

Conclusions:

Transcanal endoscopic ear surgery was found to be an acceptable and safe technique for the exposure and eradication of middle ear and/or attic cholesteatoma.
Cochlear Implant in Severe Impaired Psychiatric Patients: A Case Series
Authors: Herisanu Ioana T. , Praetorius Mark , Mattern Margarete
Published: March 2017

Objective:

Psychotic disorders and intelligence deficiencies are no longer contraindications for cochlear implantation regarding the revised German guidelines from May 2012. This article aims to evaluate the outcome of patients with severe psychiatric comorbidities. Therefore the database of the Cochlear Implant Center of the University Hospital of Heidelberg was investigated.

Study Design:

Retrospective case review.

Methods:

We present three patients who received a cochlear implant (CI) despite a serious psychiatric disorder. Two were sent from psychiatrists asking if a CI was possible for their profound hearing loss. One patient had acoustic hallucinations and a recurrent depressive disorder, the other had a schizophrenic psychosis and a minor impairment of intelligence. The third patient had a recurrent depressive disorder, a posttraumatic stress disorder, a chronic pain disorder, and paranoid personality traits. We discuss the preoperative diagnosis, course of diseases, and psychosocial situation.

Results:

All three patients received a CI and rehabilitation in the Cochlear Implant Center of the University Hospital of Heidelberg. All three of them opted for a second implant and developed a good hearing outcome. Free field understanding of words in quite is for all three of them over 60% in the Freiburger monosyllable test with two implants, similar to nonpsychiatric patients’ results. No patient has acceptance problems. In the long run, no aggravation of the psychiatric diseases occurred.

Conclusion:

With interdisciplinary evaluation, a cochlear implantation is possible in severely impaired psychiatric patients. For a good result the indication is to be discussed interdisciplinary.