bluuebunny/crossref_metadata_2025 huggingface dataset:
Molecular Mechanisms Directing Spine Outgrowth and Synaptic Partner Selection in Caenorhabditis elegans
Authors: Oliver Devyn , Alexander Kellianne , Francis Michael M
Published: December 2018

The development of the nervous system requires precise outgrowth, extension, and wiring of both axons and dendrites to generate properly functioning neural circuits. The molecular mechanisms that shape neurite development, in particular dendritic development, remain incompletely understood. Dendrites are often highly branched and coated with actin-filled, thorny protrusions, called dendritic spines, that allow for increased numbers of synaptic contacts with neighboring neurons. Disruptions in dendritic spine development have been implicated in many neurological disorders such as autism, schizophrenia, and Alzheimer’s disease. Although the development of dendritic spines is vital for cognitive function, understanding the mechanisms driving their outgrowth and stabilization in vivo remains a challenge. Our recent work identifies the presence of dendritic spine-like structures in the nematode Caenorhabditis elegans and provides initial insights into mechanisms promoting spine outgrowth in this system. Specifically, we show that neurexin /nrx-1 is a critical molecular component in directing the development of synaptic connections and promoting spine outgrowth. Our investigation provides important insights into the molecular machinery that sculpt synaptic connectivity, and continuing efforts in this system offer the potential for identifying new mechanisms governing both synaptic partner selection and dendritic spine outgrowth.
Pregnancy and multiple sclerosis in the DMT era: A cohort study in Western Austria
Authors: Bsteh Gabriel , Algrang Laura , Hegen Harald , Auer Michael , Wurth Sebastian , Di Pauli Franziska , Deisenhammer Florian , Berger Thomas
Published: December 2018

Background:

Multiple sclerosis (MS) predominantly affects women of child-bearing potential. Pregnancy in MS is still a controversial issue lacking standardized treatment recommendations.

Objective:

To examine the reciprocal effects of pregnancy, MS, and disease-modifying treatment (DMT).

Methods:

We analyzed 387 pregnancies in 239 women with relapsing remitting multiple sclerosis (RRMS) and ⩾1 pregnancy, establishment of diagnosis >1 year before conception, and ⩾2 years of follow-up after delivery. Relapse rates and Expanded Disability Status Scale (EDSS) scores were compared in the year before conception, during pregnancy, and 2 years postpartum. Binary logistic regression was used to investigate predictors of risk for relapses and disability progression during pregnancy and postpartum.

Results:

Risk of relapse and disability progression during pregnancy was predicted by pre-conception relapse activity, higher EDSS score at conception, use of highly effective disease-modifying treatment (H-DMT) pre-conception, and prolonged washout period. Postpartum relapse and disability progression was associated with relapse activity pre-conception and during pregnancy and use of H-DMT pre-conception. Early restart of DMT reduced the risk of postpartum relapse.

Conclusion:

A personalized approach in planning pregnancy in women with MS while on H-DMT needs to be adopted. It seems reasonable maintaining natalizumab closer to conception and restarting the drug early postpartum to reduce the considerable risk of disease reactivation during early pregnancy and after delivery.
Fatigue at enrollment predicts EDSS worsening in the New York State Multiple Sclerosis Consortium
Authors: Vaughn Caila B , Kavak Katelyn S , Dwyer Michael G , Bushra Aisha , Nadeem Muhammad , Cookfair Diane L , Ramanathan Murali , Benedict Ralph HB , Zivadinov Robert , Goodman Andrew , Krupp Lauren , Motl Robert W , Weinstock-Guttman Bianca , Kolb Channa , Robb Jessica F. , Jubelt Burk , Gerber Allen , Kister Ilya , Ryerson Lana Zhovtis , Coyle Patricia , Perel Allan , Gottesman Malcolm , Lenihan Michael , Edwards Keith , Garten Lore , Picone Mary Ann
Published: December 2018

Background:

Fatigue is one of the most common and distressing symptoms among persons with multiple sclerosis (pwMS).

Objective:

The aim of this study is to evaluate fatigue as a predictor for disease worsening among pwMS.

Methods:

In this retrospective cohort study of New York State MS Consortium (NYSMSC) registry, MS patients reporting moderate-to-severe fatigue at study enrollment ( n = 2714) were frequency matched to less-fatigued subjects ( n = 2714) on age, baseline Kurtzke Expanded Disability Status Scale (EDSS), disease duration, and MS phenotype. Change from baseline patient-reported outcomes (PROs), as measured by LIFEware™, categorized participants into two groups: those with stable/improved outcomes and those who worsened. In a subgroup of patients with longitudinal data ( n = 1951), sustained EDSS worsening was analyzed using Cox proportional hazards modeling to explore the effect of fatigue.

Results:

The median survival time from study enrollment to sustained EDSS worsening was 8.7 years (CI: 7.2–10.1). Participants who reported fatigue at baseline were more likely to experience sustained EDSS worsening during follow-up (HR: 1.4, 95% CI: 1.2–1.7). Patients who were fatigued at baseline were also more likely to report worsening psychosocial limitations (all ps ⩽ 0.01).

Conclusion:

In addition to being a common symptom of MS, severe fatigue was a significant predictor for EDSS worsening in the NYSMSC.
Compatible effect or competitive effect: An investigation of attraction spatial interdependency
Authors: Zhou Bo , Yang Bi , Liu Yi
Published: December 2018

This study empirically examines the spatial interdependency of attractions, using a unique database of 75 important attractions in Guangdong (GD) province, China and spatial econometric models. According to the estimation results, compatible effects apply to the samples in GD overall and in eastern GD, while competitive effects apply to the samples in northern GD. To analyze further, this study finds attraction theme matters to the nature of spatial interdependency. There are competitive effects among natural attraction (NA) and man-made attraction (MA) and insignificant compatible effects among cultural attractions. The competitive effects among NAs have a root in the competition for tourists’ time budget, and competitive effects among MAs are related to product homogeneity, resulting from the ubiquitous product imitation in MAs in China. This study concludes that to distinctly diversify attraction theme is a critical way to generate a positive spatial interdependency among attractions within a certain geographic area.
Me, my self, and the multitude: Microbiopolitics of the human microbiome
Authors: Ironstone Penelope
Published: December 2018

The human microbiome has become one of the dominant biomedical frameworks of the contemporary moment that may be understood to be post-Pasteurian. The recognitions the human microbiome opens up for thinking about the biological self and the individual have ontological and epistemological ramifications for considering what and who the human being is. As this article illustrates, the microbiopolitics of the human microbiome challenges the immunitarian Pasteurian model in which the organismic self shores itself up and defends itself against a microbial non-self or other. Instead, this theory presents the human organism as comprised of multiple ecosystems and as a multitude, suggesting that the thanatopolitical attempts to wipe out microbial others (evident in the overuse and misuse of antibiotics, for example) are giving way to an affirmative microbiopolitics grounded in generative multispecies relationality. This article sets out to make the case for this affirmative microbiopolitics.
Externally bonded carbon fiber–reinforced polymer composites for seismic retrofit of reinforced concrete coupling beams designed according to old codes
Authors: Honarparast Sara , El-Saikaly Georges , Chaallal Omar
Published: December 2018

A large number of existing buildings have seismic-resistant systems designed according to old code provisions. These structural systems exhibit non-ductile behavior and can present a significant risk in the case of a moderate or significant seismic event. Reinforced concrete–coupled shear walls designed to old codes and standards are among those deficient structures that need to be seismically upgraded. This article aims to investigate a new retrofitting and upgrading method using externally bonded carbon fiber–reinforced polymer composites for existing or/and damaged reinforced concrete coupling beams that can improve the seismic performance of them during earthquakes. To this end, an experimental test was conducted to evaluate the seismic behavior of two identical reinforced concrete–coupled shear wall specimens under reverse cyclic loading. To simulate the old existing building, the specimens were designed and constructed according to the old 1941 National Building Code of Canada with a conventionally reinforced coupling beam. One of the specimens was tested as a control, and the other was strengthened using externally bonded carbon fiber–reinforced polymer composites to evaluate the improvement in its seismic performance. Results show that the retrofit using externally bonded carbon fiber–reinforced polymer resulted in significant enhancement in strength and energy dissipation capacity compared to the conventionally reinforced coupling beam from the control specimen. In addition, externally bonded carbon fiber–reinforced polymer sheets resulted in much improved hysteretic and ductile behavior and in lesser strength and stiffness degradation.
Radio buttons in web surveys: Searching for alternatives
Authors: Cernat Alexandru , Liu Mingnan
Published: December 2018

Web surveys are struggling to attract and retain respondents due to high burden and competition for the users’ attention. One possible solution to this issue is the improvement of the visual design of surveys. In this article, we evaluate the impact of visual aids such as smiley faces, stars, hearts, and thumbs as alternatives to traditional radio buttons. We use an experimental design in a nonprobability online survey to investigate how the new designs compare with radio buttons and how the results might interact with device used for completion (PC vs mobile), the use of labels, the type of response scale (bipolar vs unipolar), and the number of response categories (5 vs 7 point). While we do not find big differences in response, quality and experience, there seem to be some indication that the use of smiley faces leads to worse data quality.
Imagining societies through discourses on educational equality: A cross-cultural analysis of Finnish and Swedish upper secondary curricula from 1970 to the 2010s
Authors: Lappalainen Sirpa , Nylund Mattias , Rosvall Per-Åke
Published: December 2018

Educational equality has been a central tenet framing educational policy in Nordic welfare states and stimulating school reforms in the 1960s and 1970s. However, the conceptualisation of equality has fluctuated, reflecting the changing economic and political climate within which policy statements have been made. In this article, we analyse policy and curriculum documents relating to upper secondary education from the 1970s to the 2010s in two Nordic countries. Drawing on Nancy Fraser’s theorisation of different forms of injustice, we focus on the aims and goals that are attached to the concept of educational equality, analysing how ideas about society and educational equality have changed over these decades. Our analysis suggests that over this period there have been quite dramatic shifts in how equality is conceptualised, inter alia shifting from a focus on economic inequalities to questions of sexuality and ethnicity. Furthermore, ambitions about tackling economic inequality have largely been replaced with ambitions about promoting employability, which is particularly visible in the curriculum of vocational upper secondary education. The Finnish general upper secondary education (GUS) curriculum has gone against the tide. In the 1970s the GUS curriculum had the most conservative tone in terms of equality, whereas the current curriculum requires an agentic stance against discrimination and a critical stance towards marketisation.
Open Education platforms: Theoretical ideas, digital operations and the figure of the open learner
Authors: Decuypere Mathias
Published: December 2018

Open Education (OE), a generic term for a collection of practices that seek to broaden the access to education through digital means, has gained increasing traction and popularity over the last years and from various corners, both globally and in European circles. Rather than taking the technologies OE makes use of at face value, this article analyzes the concrete operations that Massive Open Online Courses (MOOC) platforms perform, and more specifically the sorts of open learning and the type of open learner that are being shaped by these platforms. Understanding such platforms as active, socio-technical devices, the article first provides an overview of the conceptual milieu out of which these MOOC platforms originated. In a second part, contemporary MOOC platforms that have concretized out of this milieu are analyzed. Different types of operations that enact a very specific figure of the open learner (and types of open learning) are advanced: The open learner is increasingly being lured and made flexible, controlled and molded, communalized and responsibilized, and finally trained and empowered. The article ends with some outlines for possible future concretizations of OE and its MOOC platforms.
Time-lapse acoustic monitoring of deteriorating pipes
Authors: Vogelaar Bouko , Priems Giel , Bourgonje Kees , Golombok Michael
Published: December 2018

In-service degradation of a pipe section is monitored in real time with torsional guided waves which can resolve 5% damage to the internal wall. We use a single permanently installed source–receiver pair as opposed to the current state-of-the-art sensor rings. There is no baseline subtraction requirement as a single reflection coefficient is derived by internal referencing of the time trace. Even with continuously operating pump vibration, there is enough acoustic signal for confident damage localization. Since pipelines wear out gradually in industrial installations, the acoustic footprint is similar to that previously determined in periodically damaged pipes. The reflective method can thus be applied successfully to monitor structural health in industrial pipelines during operation as opposed to the current state-of-the-art guided wave inspection approaches using near-weld reflection techniques along with disassembled and re-assembled sensor rings.
A crowdsourcing-based methodology using smartphones for bridge health monitoring
Authors: Mei Qipei , Gül Mustafa
Published: December 2018

This article presents a novel framework for monitoring and evaluation of a population of bridges using smartphones in a large number of moving vehicles as mobile sensors. Within this framework, a damage detection methodology based on Mel-frequency cepstral coefficients and Kullback–Leibler divergence is developed. For this method, Mel-frequency cepstral coefficients of the vibration data collected from smartphones in vehicles crossing bridges are first extracted as features. Then, Kullback–Leibler divergence is used to compare the distributions of features. The damage in a bridge can be identified by quantifying the difference of the distributions obtained for the same bridge. Both numerical and lab experiments are conducted to verify the proposed framework and methodology. In lab experiments, a smartphone and two wireless accelerometers are used for data collection. From our results, it is concluded that the damage existence can be successfully identified using smartphones in a large number of vehicles. Also, it is observed that there is a significant correlation between the magnitude of the damage features and the severity of damage. The results show that the method has the potential to monitor a population of bridges simultaneously and in almost real time.
The Focus and Target: Angiogenesis in Refractory Wound Healing
Authors: Cheng Biao , Fu Xiaobing
Published: December 2018

In recent years, wound repair, especially chronic and refractory wounds, is still a growing worldwide health problem that concerns the physical and mental health of patients and the productivity of society as a whole. In many developed countries and developing countries, such as China, rapid economic growth, negative lifestyle changes (such as increased dietary fat intake and reduced physical activity), and increasingly serious aging problems have led to more and more refractory wounds caused by chronic diseases, such as diabetes and microvascular diseases. There is a clear and orderly stage in the process of wound healing, and the malfunction of any step will lead to poor healing effect. There are many causes of refractory wounds, among which the poor vascular network is closely related. This review focuses on the role and improvement of the microvasculature in wound repair. In addition, the future developmental trend of wound regenerative therapy (active factors, [stem] cells, tissue-induced biomaterials, gene therapy, etc) is also considered.
Scatter Artifact with Ga-68-PSMA-11 PET: Severity Reduced With Furosemide Diuresis and Improved Scatter Correction
Authors: Lawhn-Heath Courtney , Flavell Robert R. , Korenchan David E. , Deller Timothy , Lake Spencer , Carroll Peter R. , Hope Thomas A.
Published: December 2018

Purpose:

To assess the utility of furosemide diuresis and the role of an improved scatter correction algorithm in reducing scatter artifact severity on Ga-68- Prostate-specific membrane antigen (PSMA)-11 positron emission tomography (PET).

Materials and Methods:

A total of 139 patients underwent Ga-68-PSMA-11 PET imaging for prostate cancer: 47 non-time-of-flight (non-TOF) PET/computed tomography, 51 PET/magnetic resonance imaging (MRI) using the standard TOF scatter correction algorithm, and 41 PET/MRI using an improved TOF scatter correction algorithm. Whole-body PET acquisitions were subdivided into 3 regions: around kidneys; between kidneys and bladder; and around bladder. The images were reviewed, and scatter artifact severity was rated using a Likert-type scale.

Results:

The worst scatter occurred when using non-TOF scatter correction without furosemide, where 42.1% of patients demonstrated severe scatter artifacts in 1 or more regions. Improved TOF scatter correction resulted in the smallest percentage of studies with severe scatter (6.5%). Scatter ratings by region were lowest using improved TOF scatter correction. Furosemide reduced mean scatter severity when using non-TOF and standard TOF.

Conclusions:

Both furosemide and scatter correction algorithm play a role in reducing scatter in PSMA PET. Improved TOF scatter correction resulted in the lowest scatter severity.
Colorectal Cancer Surgery Using the Da Vinci Xi and Si Systems: Comparison of Perioperative Outcomes
Authors: Huang Yu-Min , Huang Yan Jiun , Wei Po-Li
Published: December 2018

Purpose. Robotic surgery for colorectal cancer is an emerging technique. Potential benefits as compared with the conventional laparoscopic surgery have been demonstrated. However, experience with the previous da Vinci Si robotic system revealed several unsolved problems. The novel features of the new da Vinci Xi increase operational flexibility and maneuverability and are expected to facilitate the performance of multiquadrant surgery. Methods. Between December 2011 and May 2015, 120 patients with colon or rectal cancer were operated on using the Si robotic system (the Si group). Between May 2015 and October 2017, 60 more patients with colon or rectal cancer were operated on using the Xi robotic system (the Xi group). The clinicopathological characteristics and perioperative outcomes of these 2 groups of patients were compared. Results. The 2 groups of patients were comparable with regard to baseline clinical characteristics, types of resection performed, and the proportion of patients undergoing neoadjuvant chemoradiation therapy. The statuses of resection margin, the numbers of lymph nodes harvested, and the rates of postoperative complications were also similar between the 2 groups. Nevertheless, a lower rate of diverting ileostomy, a shorter operation time, less estimated blood loss, and a faster postoperative recovery was observed in the Xi group. Conclusions. Colorectal cancer surgery using the Xi robotic system was associated with improved perioperative outcomes. These benefits may be attributed to its improved, more user-friendly design.
The Effect of Age on Fracture Healing Time in Metacarpal Fractures
Authors: Wollstein Ronit , Trouw Arie , Carlson Lois , Staff Ilene , Mastella Daniel J. , Ashmead Duffield
Published: December 2018

Background: Older patients are treated for fracture with increasing frequency. Although studies on animals suggest that older mice and rats heal fractures more slowly, the clinical implications remain unclear. A better understanding of differences in healing with age can help customize fracture treatment. Our purpose was to retrospectively evaluate metacarpal fractures for healing time looking specifically at age-related differences. Methods: A retrospective review of patients treated for metacarpal fractures was conducted. Patients with incomplete charts or inadequate follow-up were excluded. One hundred ninety-eight charts were analyzed. Demographic and other patient factors were documented. Fracture characteristics and treatment type were documented. Fracture healing was determined clinically. Plain radiographs and examination were used in decision making. Results: Age was not associated with fracture healing time as a continuous variable ( P = .09). Patients above 75 years were not associated with increased healing time ( P = .58). Fracture characteristics were related to healing time: minimally displaced and comminuted fractures healed faster than oblique fractures, spiral fractures, or transverse fractures ( P = .048). Patients undergoing surgery healed faster than those without surgery ( P = .046). Renal failure negatively affected fracture healing time ( P = .03). Diabetes, hypothyroidism, and gender were not associated with healing time. Complications were not associated with age or other patient or fracture-related factors. Conclusions: Age does not affect clinical fracture healing time in adult. Therefore, older patients do not require disparate treatment. Other fracture-related factors and considerations such as functional demand and support systems might influence treatment decisions in fracture care.
Cuing both positive and negative episodic foresight reduces delay discounting but does not affect risk-taking
Authors: Bulley Adam , Miloyan Beyon , Pepper Gillian V , Gullo Matthew J , Henry Julie D , Suddendorf Thomas
Published: December 2018

Humans frequently create mental models of the future, allowing outcomes to be inferred in advance of their occurrence. Recent evidence suggests that imagining positive future events reduces delay discounting (the devaluation of reward with time until its receipt), while imagining negative future events may increase it. Here, using a sample of 297 participants, we experimentally assess the effects of cued episodic simulation of positive and negative future scenarios on decision-making in the context of both delay discounting (monetary choice questionnaire) and risk-taking (balloon-analogue risk task). Participants discounted the future less when cued to imagine positive and negative future scenarios than they did when cued to engage in control neutral imagery. There were no effects of experimental condition on risk-taking. Thus, although these results replicate previous findings suggesting episodic future simulation can reduce delay discounting, they indicate that this effect is not dependent on the valence of the thoughts, and does not generalise to all other forms of “impulsive” decision-making. We discuss various interpretations of these results, and suggest avenues for further research on the role of prospection in decision-making.
Stable preview difficulty effects in reading with an improved variant of the boundary paradigm
Authors: Risse Sarah , Seelig Stefan
Published: December 2018

Using gaze-contingent display changes in the boundary paradigm during sentence reading, it has recently been shown that parafoveal word-processing difficulties affect fixations on words to the right of the boundary. Current interpretations of this post-boundary preview difficulty effect range from delayed parafoveal-on-foveal effects in parallel word-processing models to forced fixations in serial word-processing models. However, these findings are based on an experimental design that, while allowing to isolate preview difficulty effects, might have established a bias with respect to asymmetries in parafoveal preview benefit for high-frequent and low-frequent target words. Here, we present a revision of this paradigm varying the preview’s lexical frequency and keeping the target word constant. We found substantial effects of the preview difficulty in fixation durations after the boundary confirming that preview processing affects the oculomotor decisions not only via trans-saccadic integration of preview and target word information. An additional time-course analysis showed that the preview difficulty effect was significant across the full fixation duration distribution on the target word without any evidence on the pretarget word before the boundary. We discuss implications of the accumulating evidence of post-boundary preview difficulty effects for models of eye movement control during reading.
Kanizsa-figure object completion gates selection in the attentional blink
Authors: Chen Siyi , Nie Qi-Yang , Müller Hermann J , Conci Markus
Published: December 2018

Previous work has demonstrated that perceptual grouping modulates the selectivity of attention across space. By contrast, how grouping influences the allocation of attention over time is much less clear. This study investigated this issue, using an attentional blink (AB) paradigm to test how grouping influences the initial selection and the subsequent short-term memory consolidation of a target. On a given trial, two red Kanizsa-type targets (T1 and T2) with varying grouping strength were embedded in a rapid serial visual presentation stream of irrelevant distractors. Our results showed the typical AB finding: impaired identification of T2 when presented close in time following T1. Moreover, the AB was modulated by the T2 grouping—independently of the T1 structure—with stronger grouping leading to a decreased AB and overall higher performance. Conversely, a reversed pattern, namely an increased AB with increasing grouping strength was observed when the Kanizsa figure was not task-relevant. Together, these findings suggest that the grouping benefit emerges at early perceptual stages, automatically drawing attentional resources, thereby leading to either sustained benefits or transient costs—depending on the task-relevance of the grouped object. This indicates that grouping modulates processing of objects in time.
Sofosbuvir, velpatasvir and voxilaprevir: a new triple combination for hepatitis C virus treatment. One pill fits all? Is it the end of the road?
Authors: Bourlière Marc , Pietri Olivia , Castellani Paul , Oules Valérie , Adhoute Xavier
Published: December 2018

The advent of oral direct-acting antiviral agents (DAAs) has dramatically improved the hepatitis C virus (HCV) treatment landscape in the last 4 years, providing cure rates over 95% with a shorter duration of treatment and a very good safety profile. This has enabled access to treatment in nearly all HCV infected patients. The launch of two pangenotypic fixed dose combinations (FDCs) in 2017 made a new step forward in HCV treatment by slightly increasing efficacy and more importantly allowing the treatment of patients without HCV genotyping, and in some cases without fibrosis assessment. However, retreatment of the few DAA failure patients was still an issue for some HCV genotypes. The launch of the triple regimen FDC, sofosbuvir/velpatasvir/voxilaprevir, solves this issue by providing a cure rate over 96% regardless of HCV genotype. In this review, we describe the current HCV treatment landscape and focus on the development of this triple FDC either in treatment-naïve or treatment-experienced patients with previous failure on a DAA regimen.
Finding Fit: School Nurses Lead the Way in the Development of Employee Wellness Program
Authors: Wood Jasmine , Huggins Althea , Clausen Lisa , Lailari Stefani
Published: December 2018

School nurses are in a unique position to monitor and influence not only the health of students but also the health of school employees. The National Association of School Nurses (NASN) provides support and evidence-based best practice guidelines for the specialty practice of school nursing. NASN’s Framework for 21st Century School Nursing Practice™ provides a road map for a healthy and safe school environment. With a focus on student health and academic success, the framework also aligns with the whole school, whole community, whole child model to provide a collaborative structure to learning and health. Both models are student centered and include family, the school community, and school employees. A group of school nurses from the Alexandria City Public Schools (ACPS) in Alexandria, Virginia, attended the Johnson and Johnson School Health Leadership Program and were challenged to create sustainable change in their community. Their goal was to develop a plan for the school division that would affect employee wellness and ultimately improve student achievement and educational outcomes. This article will describe the current ACPS Employee Wellness Program, Finding Fit, and the strategies and tools used to develop the program.
Public and Nonpublic School Nurses: Common Practice, Common Goals
Authors: Blake Cheryl , Trano Gail
Published: December 2018

Most of the members of the National Association of School Nurses have an intimate knowledge of the daily services provided by public school nurses and the challenges they face. But some may not be aware that approximately 15% of the NASN membership works in private, independent, or parochial schools. Just how different from the majority of our nurses’ daily work are the experiences of the nurses who are working in the nonpublic schools? The answer may surprise you.
Are Body Mass Index Screening Programs in Schools Enough? Body Mass Index Notification, Follow-up, and School Nurse Role
Authors: Kowalski Amy E. , Hartung Sheila Q.
Published: December 2018

Childhood and adolescent obesity are epidemic in the United States. Because of this crisis, schools in our nation have been challenged to develop strategies to decrease the number of overweight and obese youth, with many states passing legislation requiring body mass index (BMI) monitoring by the school. This may be done as a screening or surveillance program depending on the state, with some states requiring notification to parents. As school nurses are often the only health professional in the school, they are typically the employee tasked with leading the BMI screening programs. School nurses, both in states requiring and in states without requirements for BMI screening programs, must be knowledgeable about evidence-based programs and strategies that have promise in reversing the obesity epidemic. Indeed, school nurses are in a position to be an active participant in the fight against the obesity and overweight crisis.
Procalcitonin as a Biomarker in Rhinosinusitis: A Systematic Review
Authors: Dilger Amanda E. , Peters Anju T. , Wunderink Richard G. , Tan Bruce K. , Kern Robert C. , Conley David B. , Welch Kevin C. , Holl Jane L. , Smith Stephanie Shintani
Published: December 2018

Objectives

(1) To describe the existing literature on procalcitonin (PCT) as a biomarker in patients with acute rhinosinusitis (ARS), (2) to analyze outcomes in ARS patients who were treated with PCT-guided therapy versus traditional management, and (3) to compare PCT to other biomarkers used in diagnosis of bacterial ARS. Data Sources: PubMed and Embase. Review Methods: A systematic search in the PubMed and Embase databases was performed to identify studies related to PCT as a biomarker in ARS. After critical appraisal of validity by 2 authors, 6 studies with a total of 313 patients were selected for data extraction and analysis. We identified 2 randomized control trials (RCTs) of PCT-based guidelines for antibiotic management of ARS in outpatient settings and 4 observational studies that compared PCT to other biomarkers in patients with ARS.

Results

The 2 RCTs demonstrated a reduction (41.6% in 1 study and 71% in the other) in antibiotic prescription rate in the PCT-guided group versus the control group with no change in the number of days with impaired activity due to illness (9.0 vs 9.0 days [ P = .96]; 8.1 vs 8.2 days [95% confidence interval −0.7 to 0.7]), number of days of work missed, and percentage of patients with persistent symptoms at 28 days. In the observational cohort studies, PCT did not consistently correlate with C-reactive protein, body temperature, and/or white blood cell counts.

Conclusions

The limited existing literature on the role of PCT in diagnosis, management, and prediction of clinical outcomes in ARS suggests that PCT-based guidelines for antibiotic prescription are a safe and effective method of minimizing unnecessary antibiotic use.
Accuracy of diffusion-weighted imaging-magnetic resonance in differentiating functional from non-functional pituitary macro-adenoma and classification of tumor consistency
Authors: Sanei Taheri Morteza , Kimia Farnaz , Mehrnahad Mersad , Saligheh Rad Hamidreza , Haghighatkhah Hamidreza , Moradi Afshin , Kazerooni Anahita Fathi , Alviri Mohammadreza , Absalan Abdorrahim
Published: December 2018

Purpose

The purpose of this study was to determine the accuracy of selected first or second-order histogram features in differentiation of functional types of pituitary macro-adenomas.

Materials and methods

Diffusion-weighted imaging magnetic resonance imaging was performed on 32 patients (age mean±standard deviation = 43.09 ± 11.02 years; min = 22 and max = 65 years) with pituitary macro-adenoma (10 with functional and 22 with non-functional tumors). Histograms of apparent diffusion coefficient were generated from regions of interest and selected first or second-order histogram features were extracted. Collagen contents of the surgically resected tumors were examined histochemically using Masson trichromatic staining and graded as containing <1%, 1–3%, and >3% of collagen.

Results

Among selected first or second-order histogram features, uniformity ( p = 0.02), 75th percentile ( p = 0.03), and tumor smoothness ( p = 0.02) were significantly different between functional and non-functional tumors. Tumor smoothness > 5.7 × 10−9 (area under the curve = 0.75; 0.56–0.89) had 70% (95% confidence interval = 34.8–93.3%) sensitivity and 33.33% (95% confidence interval = 14.6–57.0%) specificity for diagnosis of functional tumors. Uniformity ≤179.271 had a sensitivity of 60% (95% confidence interval = 26.2–87.8%) and specificity of 90.48% (95% confidence interval = 69.6–98.8%) with area under the curve = 0.76; 0.57–0.89. The 75th percentile >0.7 had a sensitivity of 80% (95% confidence interval = 44.4–97.5%) and specificity of 66.67% (95% confidence interval = 43.0–85.4%) for categorizing tumors to functional and non-functional types (area under the curve = 0.74; 0.55–0.88). Using these cut-offs, smoothness and uniformity are suggested as negative predictive indices (non-functional tumors) whereas 75th percentile is more applicable for diagnosis of functional tumors.

Conclusion

First or second-order histogram features could be helpful in differentiating functional vs non-functional pituitary macro-adenoma tumors.
A different type of perforation: appendicitis after colonoscopy
Authors: Jambhekar Amani , Robinson Shawn , Lindborg Ryan , Rucinski James , Borriello Raffaele
Published: December 2018

Physicians who perform colonoscopy should consider appendicitis in the differential diagnosis of post procedure abdominal pain. Diagnostic laparoscopy is a safe adjunct for evaluation in patients with suspected perforation after colonoscopy. It is important that all physicians be aware of this complication to ensure prompt diagnosis and intervention.
Using Guttman errors to explore rater fit in rater-mediated performance assessments
Authors: Wind Stefanie A
Published: December 2018

Model-data fit indices for raters provide insight into the degree to which raters demonstrate psychometric properties defined as useful within a measurement framework. Fit statistics for raters are particularly relevant within frameworks based on invariant measurement, such as Rasch measurement theory and Mokken scale analysis. A simple approach to examining invariance is to examine assessment data for evidence of Guttman errors. I used real and simulated data to illustrate and explore a nonparametric procedure for evaluating rater errors based on Guttman errors and to examine the alignment between Guttman errors and other indices of rater fit. The results suggested that researchers and practitioners can use summaries of Guttman errors to identify raters who exhibit misfit. Furthermore, results from the comparisons between summaries of Guttman errors and parametric fit statistics suggested that both approaches detect similar problematic measurement characteristics. Specifically, raters who exhibit many Guttman errors tended to have higher-than-expected Outfit MSE statistics and lower-than-expected estimated slope statistics. I discuss implications of these results as they relate to research and practice for rater-mediated assessments.
Barriers to Accurate Blood Pressure Measurement in the Medical Office
Authors: Hwang Kevin O. , Aigbe Aitebureme , Ju Hsiao-Hui , Jackson Victoria C. , Sedlock Emily W.
Published: December 2018

Background: Despite the high prevalence of blood pressure (BP) measurement errors in the outpatient setting, little is known about why primary care clinics struggle to achieve consistently accurate BP measurements in routine practice. We investigated barriers affecting measurement of BP for adult patients in primary care. Methods: We conducted a qualitative evaluation in 6 adult primary care clinics. BP measurement was observed during 54 routine patient encounters. Six managers completed semistructured interviews and 18 clinical staff members participated in focus group discussions. We used an inductive, data-driven approach to identify and organize findings into cohesive, overarching themes describing factors affecting BP measurement. Results: Observed errors in BP measurement spanned the entire spectrum of steps required to obtain BP properly. Barriers to proper BP measurement were related to staff knowledge and behavior (inadequate knowledge, training, and feedback); workflow constraints (need to multitask, inadequate time); and equipment issues (BP monitors, seating). Patient characteristics and behavior also affected BP measurement. Conclusions: Correct measurement of BP is affected by a wide range of factors and is challenging to accomplish consistently in primary care. These findings may inform the design of performance improvement programs to maximize the quality of BP measurement in the outpatient setting.
Anterolateral Ligament Reconstruction Practice Patterns Across the United States
Authors: Tramer Joseph S. , Fidai Mohsin S. , Kadri Omar , Jildeh Toufic R. , Hooda Zamaan , Makhni Eric C. , Lock Terrence
Published: December 2018

Background:

A proposed mechanism for recurrent instability following anterior cruciate ligament (ACL) reconstruction is failure of the anterolateral ligament (ALL). Presently, there are a number of approaches to treating ALL pathology.

Purpose:

To determine practice patterns among orthopaedic surgeons regarding ALL during ACL reconstruction.

Study Design:

Cross-sectional study.

Methods:

An online 7-question survey was sent to all physicians registered with the American Orthopaedic Society for Sports Medicine between June and July 2017. Results were analyzed with the survey website.

Results:

Overall, 225 of 3467 surgeons responded to the survey, 86 of whom performed ALL reconstruction and completed each question in the survey. Eighty-six (38.2%) surgeons who responded to the questionnaire stated that they perform ALL reconstruction/lateral extra-articular tenodesis in conjunction with ACL reconstruction. The most common indications for ALL reconstruction were grade III pivot-shift test (46.0%) on physical examination and revision ACL reconstruction (46.0%). The most common technique used to perform ALL reconstruction was hamstring autograft (48.2%). The majority of participating surgeons (87.5%) stated that they do not make any alterations to their postoperative rehabilitation protocol after they perform ALL reconstruction. In addition, most surgeons responding to the survey (91.3%) anticipated either an increase in or the same number of ALL procedures performed in the coming year.

Conclusion:

The majority of surgeons who responded to the survey did not routinely reconstruct the ALL. Revision procedures and grade III pivot shift were the most cited indications for performing lateral augmentation. Anatomic reconstruction with hamstring was the most commonly used procedure, although there was no consensus among surgeons responding to the survey. Understanding the ALL and its contribution to knee stability is essential. For a community of physicians, it is useful to discover how fellow sports orthopaedic surgeons address ALL pathology to integrate effective and efficient treatment strategies into practice.
Hooking Up and the “Ritual Retelling”: Gender Beliefs in Post-hookup Conversations with Same-sex and Cross-sex Friends
Authors: Auster Carol J. , Faulkner Caroline L. , Klingenstein Hannah J.
Published: December 2018

Most scholarship on hookup culture has focused on college students’ sexual activity and has overlooked the post-hookup “ritual retelling” as a subject of systematic research. This study examines the impact of gender beliefs regarding sexual activity, particularly the recreational and relational orientations of men and women, respectively, as well as the situational context, namely, the gender of their conversational partners. Results from a survey of college students (N = 470) reveal that men and women would be more likely to share a hypothetical hookup experience with same-sex than with cross-sex best friends. Moreover, women would be more likely than men to share relational rather than recreational details, though details vary by situational context. Results suggest that women’s ritual retellings generally reflect gender beliefs, but men switch between a recreational and a relational emphasis depending on the gender of their conversational partners. This suggests that women face greater constraints than men in expectations regarding sexual activities.
Empagliflozin on top of metformin treatment improves arterial function in patients with type 1 diabetes mellitus
Authors: Lunder Mojca , Janić Miodrag , Japelj Miha , Juretič Andrej , Janež Andrej , Šabovič Mišo
Published: December 2018

Background

Deteriorated arterial function and high incidence of cardiovascular events characterise diabetes mellitus. Metformin and recent antidiabetic drugs, SGLT2 inhibitors, reduce cardiovascular events. We explored the possible effects of empagliflozin’s effect on top of metformin treatment on endothelial function and arterial stiffness parameters in type 1 diabetes mellitus (T1DM) patients.

Methods

Forty T1DM patients were randomised into three treatment groups: (1) empagliflozin (25 mg daily), (2) metformin (2000 mg daily) and (3) empagliflozin/metformin (25 mg daily and 2000 mg daily, respectively). The fourth group received placebo. Arterial function was assessed at inclusion and after 12 weeks treatment by: endothelial function [brachial artery flow-mediated dilation (FMD), reactive hyperaemia index (RHI)], arterial stiffness [pulse wave velocity (PWV) and common carotid artery stiffness (β-stiffness)]. For statistical analysis one-way analysis of variance with Bonferroni post-test was used.

Results

Empagliflozin on top of metformin treatment significantly improved endothelial function as did metformin after 12 weeks of treatment: FMD [2.6-fold (P < 0.001) vs. 1.8-fold (P < 0.05)] and RHI [1.4-fold (P < 0.01) vs. 1.3-fold (P < 0.05)]. Empagliflozin on top of metformin treatment was superior to metformin in improving arterial stiffness parameters; it significantly improved PWV and β-stiffness compared to metformin [by 15.8% (P < 0.01) and by 36.6% (P < 0.05), respectively]. Metformin alone did not influence arterial stiffness.

Conclusion

Empagliflozin on top of metformin treatment significantly improved arterial stiffness compared to metformin in T1DM patients. Endothelial function was similarly improved in all treatment groups. Empagliflozin seems to possess a specific capacity to decrease arterial stiffness, which could support its cardioprotective effects observed in large clinical studies.

Trial registration Clinical trial registration: NCT03639545
Hygro-mechanical response of oak wood cabinet door panels under relative humidity fluctuations
Authors: Luimes R. A. , Suiker A. S. J. , Jorissen A. J. M. , van Duin P. H. J. C. , Schellen H. L.
Published: December 2018

Indoor climate fluctuations are regarded as one of the major risks for the emergence of damage in historical works of art. For a safe preservation of their art objects museums try to minimize this risk, which is typically done by imposing strict limitations on the indoor temperature and humidity conditions. The high energy demand resulting from this approach, however, undermines the aim of preeminent museums to execute a sustainable preservation strategy of their collections. A rational improvement of this aspect asks for detailed information on the history of museum objects, complemented by a thorough comprehension of the failure and deformation behaviour of museum objects under indoor climate fluctuations. Accordingly, in this paper the hygro-mechanical response of mock-ups of historical Dutch cabinet door panels made of oak wood is examined under several relative humidity variations. In specific, the mock-ups were subjected to (i) an instantaneous decrease of 40% relative humidity, (ii) eight successive, instantaneous drops of 5% relative humidity, and (iii) a varying relative humidity profile ranging between 35 and 71%. The shrinkage characteristics of mock-ups are translated to their damage susceptibility using an analytical hygro-mechanical bi-layer model. This model shows that restrained hygral shrinkage may originate from: (i) a difference in moisture content across the thickness direction of the panel, or (ii) a directional difference in the coefficient of hygroscopic expansions of structural components forming a coherent connection. The first type of shrinkage occurs in the outer regions of the panel thickness, while the second type of shrinkage takes place at the cleated ends. Further, by accounting for the age-dependency of the fracture strength of oak wood, a clear distinction can be made between the damage susceptibility of new door panels and historical door panels present in museum cabinets. The six main conclusions of the experimental study—conveniently summarized at the end of this paper—provide a scientific basis for the understanding of shrinkage cracks and dimensional changes observed on decorated oak wooden panels in historical Dutch cabinets, and thus may assist in advising museums on future sustainable preservation strategies and rational guidelines for indoor climate specifications.