bluuebunny/crossref_metadata_2025 huggingface dataset:
Concussion Assessment and Return to Sport for a High School, Legally Blind, Female Swimmer
Authors: Custer A , Tatman J , Lee J
Published: July 2019

Purpose

Limited research exists on treatment of sport concussion in visually impaired individuals. Adaptation to athlete’s needs is vital for individualized sport specific return to play (RTP).

Methods

Fifteen year-old, visually impaired, female, swimmer presented to an interdisciplinary Sport Concussion Program for protracted recovery with complaints of disequilibrium, headaches, cognitive fatigue, and exacerbation of premorbid resting nystagmus after being kicked in the head during practice. Patient is legally blind due to Peter’s Anomaly and right retinal detachment, with history of migraine, carsickness, and glaucoma. Patient completed two visits with clinical sports neuropsychologist and three vestibular therapy (VT) appointments, assessed via Post-Concussion Symptom Scale (PCSS), Montreal Cognitive Assessment (MoCA-BLIND), Modified Balance Error Scoring System (mBESS), Dizziness Handicap Inventory (DHI), Activities-Specific Balance Confidence scale (ABC), Buffalo Concussion Treadmill Test (BCTT), and Children's Memory Scales (CMS). Differential Diagnosis: Concussion, Post-Concussion Syndrome, Post-Traumatic Headache, Vestibular Dysfunction.

Results

Initial consult revealed PCSS of 35 and normal MoCA-BLIND (18/22). Patient’s mBESS improved from 7 to 3 errors with VT, DHI mildly elevated (36%), ABC moderately elevated (43%). VT consisted of: neuromuscular re-education, balance training, positional changes, cognitive activity, sport specific RTP progressions (dry land modifications, transitions into water, communication to team athletic trainer). BCTT passed on third VT visit. Patient cleared for RTP with PCSS at 7 and (CMS) Stories, Word Lists, Numbers, and Sequences subtests within expectations (average to high average ranges).

Conclusion

This case study illustrates an interdisciplinary approach to concussion treatment with modification of established tools and proposal of sport specific RTP guidelines for visually impaired athletes.
Self-Reported History of Seizure, Baseline Neurocognitive Performance, and Symptoms Reported in High School Athletes
Authors: Datoc A , Lashley L
Published: July 2019

Purpose

To examine whether a self-reported history of seizure is associated with differences in baseline neurocognitive performance and total reported symptoms.

Methods

Data was derived from a de-identified Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) database of high school athletes in Florida. After inclusion and exclusion criteria were applied, athletes were separated into groups dependent on self-reported history of seizure. 260 athletes (Mage=15.49, SD=1.26; 57.1% male) reported a history of seizure, and 260 athletes were randomly selected from those with no such history (Mage=15.64, SD=1.22; 61.1% male).

Results

ANOVA (alpha=.05) revealed significant differences between groups on the visual memory composite (F[1,559]=4.915, p=.027) and total symptom score (F[1,559]=28.596, p<.001) at baseline. Athletes with a self-reported history of seizure performed significantly worse than athletes without on visual memory and reported significantly higher total symptom scores. No significant between-group differences were found on the other composites of ImPACT.

Conclusion

The association between seizure history and decreased neurocognitive performance has been documented in the neuropsychological literature, and may be explained by differences at a microstructural level such as differences in white matter integrity (Yassine et al., 2018). While these microstructural differences have implications on cognitive functioning and symptomatology, the present study surprisingly found comparable scores between athletes with a history of seizure and those without. Previous researchers published similar findings; however, differences were observed on the visual-motor speed composite of ImPACT (Zalneraitis et al., 2017). The inconsistencies and small effect sizes in the present literature highlight the need for investigators to determine the clinical significance of these results in concussion evaluations.
Effects of Headache on CNS Vital Signs Performance in a Concussed Community Sample
Authors: Moreno C C , Houck Z , Svingos A , Greif S , Hromas G , Jaffee M , Heaton S , Deming C , Bauer R M
Published: July 2019

Purpose

Headache (HA) is the most common symptom following concussion. We examined the effect of HA on CNS Vital Signs (CNSVS) performance.

Methods

Data were analyzed from 63 patients (25 males, Mdn age [IQR]=23.0 [21.0], Mdn days since injury [IQR]=66.0 [112.0]) presenting to an interdisciplinary concussion clinic. HA disorders were diagnosed post-injury by a board-certified neurologist and obtained from medical records. Nearly half (51%) of the sample had a HA diagnosis. We analyzed the performance on CNSVS multiple test domains: Composite Memory, Psychomotor Speed, Complex Attention, and Cognitive Flexibility. Chi-square test of independence assessed differences in demographic and medical history factors among those with and without HA diagnosis. Multivariate analyses of covariance assessed the influence of HA on CNSVS multiple test domains. Factors significantly different between groups were added as covariates.

Results

There were significant interactions of loss of consciousness (LOC; Χ2(1, 63)= 6.22, p=.013), history of attention-deficit/hyperactivity disorder (ADHD; Χ2(1, 63)= 5.13, p=.023), and daytime sleepiness (Χ2(1, 63)= 6.14, p=.013) among those with and without HA diagnosis. The presence of these medical conditions composed 19%, 28%, and 40%, respectively, of HA diagnoses. There was no statistically significant omnibus effect of HA diagnosis on the four CNSVS domain scores without covariates (F[4, 58]= 0.46, p=.76, ηp2=.03) or when controlling for LOC, history of ADHD, and daytime sleepiness (F[4, 55]=0.44, p=.78, ηp2=.03).

Conclusion

Findings suggest that HA diagnosis is unrelated to performance on CNSVS in individuals after concussion.
Coping Style in Recovery of Injured College Athletes Differs for Concussion Versus Orthopedic Injury
Authors: Croes-Orf E , Roccaforte A , Webbe F
Published: July 2019

Purpose

To examine the coping style and depressive symptomology among student-athlete injury type (concussive vs. orthopedic) to better understand recovery factors.

Methods

Eighty-two (54.9% male) student-athletes, aged 18–25, completed the Coping with Health Injuries and Problems (CHIP) and PHQ-9 questionnaires during preparticipation medical evaluation. Baseline data scores were gathered in both student-athlete groups.

Results

A significant interaction was found between coping style and group, χ2(6)=14.06, p<.05), Cramer’s V=.29. Adjusted residuals indicated that within the concussion group, the percentage of participants who used instrumental coping (4.2%) was significantly lower than the percentage of participants who used palliative coping (41.7%), distraction coping (33.3%), and emotional preoccupation (20.8%). Conversely, participants in the orthopedic injury group were significantly more likely to utilize instrumental coping (43.3%) than the other types of coping. There was no significant relationship found between coping styles and the total PHQ-9 score. However, a significant negative relationship was found between instrumental coping and the item that measures a depressive symptom of suicidal ideation (r(82)=-.27, p=.01). Thus, reported suicidal ideation was correlated with decreased instrumental coping and vice-versa.

Conclusion

Type of injury had a significant relationship with the athlete’s coping style. Concussed athletes preferred palliative coping and the orthopedic injury group preferred instrumental coping. Importantly, these results can help psychologists formulate a better treatment plan tailored to the preferred coping strategy of the athlete and analyze how it affects recovery.
Development and Clinical Relevance of a Summary Score for the SCAT-5
Authors: DaCosta A , Roccaforte A , Webbe F
Published: July 2019

Purpose

Early versions of the Sports Concussion Assessment Tool utilized a summary score, but it was removed in the third edition due to lack of empirical support (Guskiewicz et al., 2013). Echemendia et al. (2017) note that the SCAT-5’s changes, such as an expansion from a 5-word to 10-word list, improved utility over previous additions. Therefore, empirical support for a summary score on the SCAT-5 should be reassessed.

Methods

Collegiate athletes (N=532, 64% male) completed the SCAT-5 and ImPACT during their baseline evaluation. Various SCAT-5 summary score formulas were created to determine a concurrently valid summary score that remained comprehensive of all three SCAT-5 domains (cognitive, symptom, vestibular). The summary score was calculated by: [Immediate Memory Total + Delayed Recall + Orientation + Concentration + (30 – BESS Total Errors) - Total Symptom Score].

Results

Pearson correlations determined that the summary score was significantly correlated with ImPACT Verbal Memory (r=.27, p<.001), Visual Memory (r=.24, p<.001), Visual-Motor Speed (r=.30, p<.001), Reaction Time (r=-.25, p<.001) and Total Symptoms (r=-.18, p<.001).

Conclusion

Our results support the validity of a SCAT-5 summary score. Clinically, the summary score is intended to measure changes in global functioning across baseline, post-trauma and follow-up concussion evaluation. Additionally, it should serve as a measure of global progression during the acute post-trauma window of sideline to post-trauma evaluation. Future research should examine the SCAT-5 summary score with outcome measures such as recovery time.
Defensive posture in a terrestrial salamander deflects predatory strikes irrespective of body size
Authors: Myette Alexander L , Hossie Thomas J , Murray Dennis L
Published: July 2019

A wide variety of prey use defensive postures as a means of protection from predators. Many salamanders engage in broadly similar defensive postures, which may function as a warning signal and reduce the probability of attack, or may deflect predator attacks away from vital body parts. The extent to which these strategies (i.e., aposematism and deflection) act exclusively or synergistically, however, remains unknown. We deployed clay salamanders in the field, manipulating size (small, large) and posture (resting, defensive), and documented attack rates across three predator types. Competing risks analysis revealed that attack rates were affected by model size, deployment period, and leaf litter depth at the site of deployment, whereas model posture had no significant effect. Model size and posture did not interact, indicating that defensive posture was ineffective in deterring attack irrespective of prey size. Model prey in the defensive posture received significantly more attacks on the tail irrespective of size, and the defensive posture was more effective at deflecting avian attacks compared to mammal predation. We conclude that defensive posture increases tail conspicuousness without increasing predation risk, and primarily functions to deflect attacks away from vital body parts. The efficacy of defection may be further increased by tail undulation, however our use of static models means that we cannot exclude aposematic or deimatic functions for such movements. Our results provide important support for the deflection hypothesis in explaining antipredator behavior, and thereby set the stage for additional research targeting the functionality of attack deflection in natural predator–prey encounters.
Growth arrest-specific protein-6/AXL signaling induces preeclampsia in rats†
Authors: Hirschi Kelsey M , Tsai Kary Y F , Davis Taylor , Clark J Christian , Knowlton M Nekel , Bikman Benjamin T , Reynolds Paul R , Arroyo Juan A
Published: July 2019

Preeclampsia (PE) is a complicated obstetric complication characterized by increased blood pressure, decreased trophoblast invasion, and inflammation. The growth arrest-specific 6 (Gas6) protein is known to induce dynamic cellular responses and is elevated in PE. Gas6 binds to the AXL tyrosine kinase receptor and AXL-mediated signaling is implicated in proliferation and migration observed in several tissues. Our laboratory utilized Gas6 to induce preeclamptic-like conditions in pregnant rats. Our objective was to determine the role of Gas6/AXL signaling as a possible model of PE. Briefly, pregnant rats were divided into three groups that received daily intraperitoneal injections (from gestational day 7.5 to 17.5) of phosphate buffered saline (PBS), Gas6, or Gas6 + R428 (an AXL inhibitor administered from gestational day 13.5 to 17.5). Animals dispensed Gas6 experienced elevated blood pressure, increased proteinuria, augmented caspase-3-mediated placental apoptosis, and diminished trophoblast invasion. Gas6 also enhanced expression of several PE-related genes and a number of inflammatory mediators. Gas6 further enhanced placental oxidative stress and impaired mitochondrial respiration. Each of these PE-related characteristics was ameliorated in dams and/or their placentae when AXL inhibition by R428 occurred in tandem with Gas6 treatment. We conclude that Gas6 signaling is capable of inducing PE and that inhibition of AXL prevents disease progression in pregnant rats. These results provide insight into pathways associated with PE that could be useful in the clarification of potential therapeutic approaches.
Column-orthogonal strong orthogonal arrays of strength two plus and three minus
Authors: Zhou Yongdao , Tang Boxin
Published: July 2019

Strong orthogonal arrays have better space-filling properties than ordinary orthogonal arrays for computer experiments. We consider column-orthogonal strong orthogonal arrays of strength two plus and three minus, and present methods of constructing such designs. Several situations are examined, including those of four or higher levels and mixed levels. The methods are based on both regular and nonregular designs. The resulting designs inherit the good property of strong orthogonal arrays of strength two plus or three and have the additional property of column orthogonality. This type of design is a better choice for computer experiments.
Strategic Differentiation by Business Models: Free-To-Air and Pay-TV
Authors: Calvano Emilio , Polo Michele
Published: July 2019

Broadcasting markets are marked by the coexistence of outlets with radically different business models, some offering content free of charge and relying on advertising, others charging for access and airing few ads. We develop a model with competing broadcasters that leads to endogenous differentiation in business models. Differentiation is not driven by the heterogeneity of agents as in classic works. Rather it relates to the ‘two-sided’ nature of these markets. A key driver is a strong form of strategic substitutability induced by natural properties of technology that allows advertisers to reach viewers.
Meningococcal Meningitis Outbreaks in the African Meningitis Belt After Meningococcal Serogroup A Conjugate Vaccine Introduction, 2011–2017
Authors: Fernandez Katya , Lingani Clément , Aderinola Olaolu Moses , Goumbi Kadadé , Bicaba Brice , Edea Zewdu Assefa , Glèlè Clément , Sarkodie Badu , Tamekloe Agbeko , Ngomba Armelle , Djingarey Mamoudou , Bwaka Ado , Perea William , Ronveaux Olivier
Published: July 2019

Background

In 2010–2017, meningococcal serogroup A conjugate vaccine (MACV) was introduced in 21 African meningitis belt countries. Neisseria meningitidis A epidemics have been eliminated here; however, non-A serogroup epidemics continue.

Methods

We reviewed epidemiological and laboratory World Health Organization data after MACV introduction in 20 countries. Information from the International Coordinating Group documented reactive vaccination.

Results

In 2011–2017, 17 outbreaks were reported (31 786 suspected cases from 8 countries, 1–6 outbreaks/year). Outbreaks were of 18–14 542 cases in 113 districts (median 3 districts/outbreak). The most affected countries were Nigeria (17 375 cases) and Niger (9343 cases). Cumulative average attack rates per outbreak were 37–203 cases/100 000 population (median 112). Serogroup C accounted for 11 outbreaks and W for 6. The median proportion of laboratory confirmed cases was 20%. Reactive vaccination was conducted during 14 outbreaks (5.7 million people vaccinated, median response time 36 days).

Conclusion

Outbreaks due to non-A serogroup meningococci continue to be a significant burden in this region. Until an affordable multivalent conjugate vaccine becomes available, the need for timely reactive vaccination and an emergency vaccine stockpile remains high. Countries must continue to strengthen detection, confirmation, and timeliness of outbreak control measures.
Blue Screen Biosphere: The Absent Presence of Biodiversity in International Law
Authors: Burke Anthony
Published: July 2019

From the social contract theory of Hobbes and Locke to the United Nations Charter, the sovereign state has formed the fulcrum of political order and law. Yet in the Anthropocene, this humanist political containment fails to grapple with humanity's dangerous enmeshment with the ecological systems of planet Earth. This article addresses one aspect of this dilemma by focusing on the international law and governance of biodiversity, which presents a “blue screen” biosphere: a material simulation that enables a double disappearance of biodiversity from the text of international law and from the actuality of the world. Through a critique of the figure of the “natural resource,” the article finds that the founding texts of international environmental law entrench a twofold humanism-as-statism that simultaneously supports the geopower of the state to facilitate the capitalist appropriation of the nonhuman and imports the modern metaphysics of the human domination of nature into international customary law. Such legal-political ontologies block a path to a more hopeful system of global ecological law and governance based on the “rights of nature” that might be able to honor the intrinsic value of the biosphere as a rich, agentic, and communicative whole, fundamental to the Earth's survival.
Seismic absolute acoustic impedance inversion with L1 norm reflectivity constraint and combined first- and second-order total variation regularizations
Authors: Guo Song , Wang Huazhong
Published: July 2019

Absolute acoustic impedance (AI) is generally divided into background AI and relative AI for linear inversion. In practice, the intermediate frequency components of the AI model are generally poorly reconstructed, so the estimated AI will suffer from an error caused by the frequency gap. To remedy this error, a priori information should be incorporated to narrow down the gap. With the knowledge that underground reflectivity was sparse, we solved an L1 norm constrained problem to extend the bandwidth of the reflectivity section, and an absolute AI model was then estimated with broadband reflectivity section and given background AI. Conventionally, the AI model is regularized with the total variation (TV) norm because of its blocky feature. However, the first-order TV norm that leads to piecewise-constant solutions will cause staircase errors in slanted and smooth regions in the inverted AI model. To better restore the smooth variation while preserving the sharp geological structure of the AI model, we introduced a second-order extension of the first-order TV norm and inverted the absolute AI model with combined first- and second-order TV regularizations. The algorithm used to solve the optimization problem with the combined TV constraints was derived based on split-Bregman iterations. Numerical experiments that were tested on the Marmousi AI model and 2D stacked field data illustrated the effectiveness of the sparse constraint with respect to shrinking the frequency gaps and proved that the proposed combined TV norms had better performances than those with conventional first-order TV norms.
Species Composition and Abundance of Stomoxys spp. (Diptera: Muscidae) in Peninsular Thailand
Authors: Lorn Sokchan , Ratisupakorn Sakda , Duvallet Gerard , Chareonviriyaphap Theeraphap , Tainchum Krajana
Published: July 2019

Stable fly collections were conducted to study the species composition and daytime activity of Stomoxys spp. (Diptera: Muscidae) in Peninsular Thailand (Songkhla, Trang, Pattalung, Nakon Si Thammarat, and Satun provinces). Vavoua traps were used for fly collections in wet and dry seasons each year. Four Stomoxys species were found, S. calcitrans (L.) (Diptera: Muscidae) being the most common with 2,512 specimens (87.43% of captures), followed by S. indicus (Picard) (Diptera: Muscidae) with 306 specimens (10.65%), S. sitiens (Rondani) (Diptera: Muscidae) with 44 specimens (1.53%), and S. uruma (Shinonaga and Kano) (Diptera: Muscidae) with 11 specimens (0.39%). Subsequently, Songkhla Province was further selected to be a potential collection site to conduct a 1-yr abundance study, due to mixed crop-livestock farming in one place. Stomoxys calcitrans was predominant from 0800 to 1000 h with 4,921 specimens (93.6%) while S. indicus with 317 specimens (6%) and S. sitiens with 19 specimens (0.4%) were numerically dominant from 0600 to 0800 and 1600 to 1800 h. A proportion of male and female of each species was also established. This overall finding could be used as an ideal for nationwide species distribution status for the guidance of appropriate fly control. This information can lighten the way for the future control measures program activity of stable flies in Thailand.
Feasibility of Home-Based Neurologic Music Therapy for Behavioral and Psychological Symptoms of Dementia: A Pilot Study
Authors: Holden Samantha K , Sheffler Julia , Stewart Rebekah , Thompson Sarah , Persson Justin , Finseth Taylor , Sillau Stefan , Kluger Benzi M
Published: July 2019

Family caregivers often feel ill-equipped to handle bothersome behavioral and psychological symptoms of dementia, such as agitation, apathy, and sleep disturbances, leading to increased caregiver distress and nursing home placement for people with dementia. Therapies for such symptoms are currently limited and non-pharmacological options are preferred, given potential side effects of medications. Neurologic music therapy (NMT) could provide an additional treatment option for managing behavioral and psychological symptoms for community-dwelling people with dementia and their caregivers. This pilot study sought to evaluate the feasibility, acceptability, and effectiveness of home-based NMT for behavioral and psychological symptoms of dementia. Eighteen persons with dementia-caregiver dyads were enrolled to receive one-hour weekly sessions of home-based NMT for 6 weeks. Demographic, quality of life, neuropsychiatric symptom, and caregiver burden and self-efficacy information was collected at baseline, 6 weeks, and 12 weeks. Seven dyads (38.9%) withdrew from therapy before completing all sessions; these participants had higher Neuropsychiatric Inventory scores and were of older age at baseline. For those who completed therapy, neuropsychiatric symptom scores improved at 6 weeks, an effect that was sustained at 12 weeks. No other outcome measures changed significantly after therapy. Initiating NMT too late in the course of dementia, when behavioral symptoms are already present, may be impractical for people with dementia and increase caregiver stress, even when provided within the home. Introducing and incorporating the principles of NMT earlier in the course of dementia could allow for increased comfort and benefit for people with dementia and their caregivers.
Thinking Through Exposure
Authors: Smits Jasper A. J. , Powers Mark B. , Otto Michael W.
Published: July 2019

Chapter 2 introduces a model of fears in terms of a network of learned associations among interconnected nodes. When these memories are cued, they can elicit expectancies for potential threat outcomes. Exposure therapy is used to alter these danger expectancies through new learning through confronting feared cues. This is an active learning process in which patients learn unconditional safety in response to their fear cues across diverse contexts. Over time, patients learn the difference between danger and fear (true vs. false alarms). To achieve this, it is important to (a) identify negative outcome expectancies to safe but feared cues (false alarms), (b) actively test these expectancies with exposure, (c) conduct postexposure processing of what was (was not) learned, and (d) rehearse this learning between sessions.
Fear of People
Authors: Smits Jasper A. J. , Powers Mark B. , Otto Michael W.
Published: July 2019

Chapter 6 describes exposure therapy for the fear of people (fear of negative evaluation). Successful treatment shifts the perception of seeing other’s evaluations as harmful to viewing these evaluations as lacking true danger. The chapter includes the steps to plan, deliver, and process exposures to alleviate fears of people. Patients with these fears tend to overestimate the likelihood and cost of bad outcomes when they are the center of attention. Thus, different exposures are needed to address these two concerns. Example exposures are presented such as presentations, interactions, being observed, and inconveniencing others. Case examples are provided to demonstrate how to use exposure for fears of people along with modifications to address traps, contexts, and safety behaviors.
Assessment Strategies
Authors: Smits Jasper A. J. , Powers Mark B. , Otto Michael W.
Published: July 2019

Chapter 9 serves as a supplement to Chapter 4 and includes a list and brief description of available self-report measures that can help determine if the clinician and the patient are meeting the goals of exposure therapy. Consistent with the personalized approach to exposure therapy, the authors organize the list by feared cues, domains, and outcomes. Specifically, the chapter covers measures for fear of emotions and related physical sensations, fear of people, and fear of thoughts, images and trauma memories, designated by intervention targets and outcomes. Copies or links to URLs for the measures are provided on the companion website.
Psychoeducation about Anxiety, Fear, and the Role of Exposure
Authors: Smits Jasper A. J. , Powers Mark B. , Otto Michael W.
Published: July 2019

Chapter 10 is an accessible primer on the human alarm system and an introduction to exposure therapy. This general resource should be read by clinicians as an overall summary and may also be used as a patient handout as part of the psychoeducation phase of treatment. The handout discusses the alarm system as it related to worry, anxiety, and panic. Definitions are provided to differentiate between stress, worry, anxiety, and fear/panic. The handout also clarifies true versus false alarms and anxiety versus an anxiety disorder. Finally, a clear overview of exposure therapy is provided. The authors frequently suggest patients read this handout several times to overlearn the material such that it will be readily accessible even during times of high anxiety.
Bibliography
Authors: Smits Jasper A. J. , Powers Mark B. , Otto Michael W.
Published: July 2019

Chapter 11 is a list of key references to research papers, chapters, and books that have informed the approach to exposure therapy that we described in the previous chapters. By listing these here, we (a) underscore that our approach is rooted in theory and guided by data from studies and clinical trials that have tested the principles, efficacy, and mechanisms of action of exposure therapy and (b) acknowledge that much of our thinking about exposure therapy and its delivery has been informed by the work of our mentors, peers, and students.
Addressing Parental Accommodation When Treating Anxiety In Children
Authors: Lebowitz Eli R.
Published: July 2019

This book is a practical guide to addressing family accommodation in the treatment of childhood anxiety. Accommodation refers to changes that parents make to their own behavior to help a child avoid or alleviate anxiety (e.g., sleeping next to their child at night, providing repeated reassurance). The book deals with addressing accommodation within the context of a broader treatment strategy that includes additional interventions such as cognitive-behavioral therapy, as well as addressing accommodation as a stand-alone parent-based treatment. There is consensus among experts and acknowledgement among practitioners that family accommodation is a key aspect of child anxiety, with major impact on clinical course, severity of symptoms and impairment, family distress, and treatment outcomes. Yet, most treatment programs do not focus on this important element of childhood anxiety, and most clinicians feel ill-equipped to effectively address accommodation in their clinical work. After briefly reviewing the relevant research on accommodation in child anxiety, this concise and easily accessible primer focuses on the practical and pragmatic aspects of addressing parental accommodation in the treatment of child anxiety. The book includes rich clinical illustrations and many suggestions for how to broach the topic of accommodation with both parents and children including a wealth of easily understood metaphors to approach the topic in an empathic and nonjudgmental manner. Therapists working with anxious children and their families will find useful tips and numerous suggestions for addressing accommodation in every part of the treatment process.
Why Accommodation Matters
Authors: Lebowitz Eli R.
Published: July 2019

This chapter reviews the negative outcomes of parental accommodation of childhood anxiety. Family accommodation is associated with more severe child anxiety symptoms over time, greater functional impairment, and high levels of distress for the parents and family. The chapter lays out a theoretical model for the negative cycle of family accommodation and anxiety. The “accommodation trap” ensnares parents and children in an ongoing cycle in which parents accommodate to reduce child anxiety but the accommodation actually leads to more child anxiety, and to even more accommodation. The chapter also discusses some of the ways that accommodation maintains childhood anxiety including through promoting avoidant behavior in the child, reducing insight, and lowering the child’s motivation for treatment.
Assessing Family Accommodation
Authors: Lebowitz Eli R.
Published: July 2019

Addressing family accommodation begins with assessing the extent and form of accommodations being provided. Assessing family accommodation should be part of the broader assessment plan when evaluating childhood anxiety and obsessive-compulsive disorder. This chapter provides guidelines and tools for the initial assessment of family accommodation. Methods of assessing family accommodation include clinical interviewing and structured rating scales. The chapter provides many examples and suggestions for ways to broach the topic of family accommodation with parents in an empathic and nonjudgmental manner. The chapter also provides detailed information on the currently available rating scales for measuring family accommodation and the relative advantages of each tool.
Teenager with Generalized Anxiety Disorder
Authors: Lebowitz Eli R.
Published: July 2019

This chapter illustrates the work of reducing family accommodation as part of a larger treatment strategy that also includes working directly with the anxious child. The chapter presents the case of Heather, a 14-year-old girl who suffered from generalized anxiety disorder. The chapter first introduces the case, including a detailed description and history. Next, the chapter describes the course of treatment with a focus on the work with parents and the ways it was integrated into Heather’s treatment. The chapter includes transcripts from treatment sessions with parents and child and exemplifies some of the problems and solutions in working with families of anxious children.
Child with Separation Anxiety Disorder
Authors: Lebowitz Eli R.
Published: July 2019

This chapter illustrates the work of reducing family accommodation as part of a larger treatment strategy that also includes working directly with the anxious child. The chapter presents the case of Yuki, a 7-year-old boy with separation anxiety disorder. The chapter first introduces Yuki’s case including a detailed description and history. Next, the chapter describes the course of treatment with a focus on the work with his mother and the ways it was integrated alongside Yuki’s treatment. The chapter includes excerpts of transcripts from treatment sessions that illustrate how the therapist dealt with challenges that arose during the clinical work.
Spontaneous bleeding of the inferior pancreatic-duodenal artery in median arcuate ligament syndrome: do not miss the diagnosis
Authors: Rebelos Eleni , Cipriano Alessandro , Ferrini Laura , Trifirò Silvia , Napoli Niccolò , Santini Massimo , Napoli Vinicio
Published: July 2019

Median arcuate ligament syndrome (MALS) is a rare condition in which the median arcuate ligament (MAL) causes compression of the coeliac trunk. The chronic compression leads to coeliac trunk luminal narrowing and reduced blood supply to the abdominal splanchnic organs with possible local complications such as pseudo-aneurysms and spontaneous bleeding. Its incidence is probably underestimated due to the poor availability of color Doppler ultrasonography (CD-US), especially in an Emergency Department (ED) setting.

A 44-year old woman presented to Pisa University Hospital ED with acute abdominal pain. An abdominal ultrasonography scan (US scan) was performed showing the presence of free liquid in the Douglas pouch. The abdominal computed tomography scan (CT scan) highlighted the presence of a large mesenteric hematoma. A CD-US revealed a significant stenosis of the coeliac artery. A selective angiography confirmed the diagnosis of MALS with a pseudo-aneurysm of the inferior pancreatic-duodenal artery, which was successfully embolized.
RESULTS OF THE JOINT IAEA/ARPANSA INTERCOMPARISON EXERCISE ON WHOLE BODY DOSEMETERS FOR PHOTONS IN ASIA AND THE PACIFIC REGION
Authors: Rizk Chadia , Long Stephen , Okyar H Burçin , Baradaran Samaneh , Al Fares Elham , Sangau John Konsoh , Shah Buddha R
Published: July 2019

An intercomparison exercise (IC) on whole body dosemeters to determine the quantity personal dose equivalent Hp (10) in photon radiation fields was jointly organised and conducted by the International Atomic Energy Agency (IAEA) and the Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) for individual monitoring services (IMS) in Asia and the Pacific region. This was arranged to help the IMS in the region to achieve a more accurate dosimetry service and to improve their performance. Twenty-four IMS participated in this IC. Four sets of dosemeters were irradiated using X-ray and gamma radiation qualities at 0° and 20° angle of incidence, respectively. All the IMS provided results that were within the acceptable limits defined by the IAEA. However, only a minority of participants reported confidence intervals that included the reference dose, for each exposure scenario. For few systems, the overall performance could be significantly improved by reviewing calibration procedures.
Are Randomized Controlled Trials on Pharmacotherapy and Psychotherapy for Positive Symptoms of Schizophrenia Comparable? A Systematic Review of Patient and Study Characteristics
Authors: Bighelli Irene , Leucht Claudia , Huhn Maximilian , Reitmeir Cornelia , Schwermann Felicitas , Wallis Sofia , Davis John M , Leucht Stefan
Published: July 2019

Background

We examined patient and study characteristics of pharmacotherapy and psychotherapy trials to establish whether the effects of these 2 treatment strategies can be compared meaningfully.

Methods

We inspected all randomized controlled trials included in 2 recent meta-analyses on antipsychotics and psychotherapy in patients with positive symptoms of schizophrenia, searching EMBASE, MEDLINE, PsycINFO, Cochrane Library, and ClinicalTrials.gov. Differences between psychotherapy and pharmacotherapy trials were analyzed with Wilcoxon–Mann–Whitney and chi-square tests.

Results

Eighty studies with 18 271 participants on antipsychotic drugs and 53 studies with 4068 participants on psychotherapy were included. Psychotherapy studies included less severely ill patients (P < .0001), with a shorter duration of illness (P = .021), lasted for a longer period (P < .0001), administered the intervention as add-on to antipsychotics (P < .0001), had higher risk of bias in some domains including blinding of outcome assessment (P < .0001), and were funded publicly more frequently (P < .0001). Antipsychotic trials had larger sample sizes (P < .0001) and more study centers (P < .0001), included more males (P = .0001), inpatients (P < .0001), and slightly older patients (P = .031), more often used diagnostic operationalized criteria (P = .006), and were sponsored by pharmaceutical companies. They did not differ in conflict of interest (P = .24).

Conclusions

We found key differences between the 2 groups of studies that encompass higher risk of bias in psychotherapy studies and the inclusion of more severe patients in drug trials. These differences imply that study and patient characteristics should be carefully taken into account before considering a network meta-analysis. In the interest of patients, psychopharmacologists and psychotherapists should optimize their treatments rather than seeing them in competition.
Secondary leaves of an outbreak-adapted tree species are both more resource acquisitive and more herbivore resistant than primary leaves
Authors: Fuenzalida Tomás I , Hernández-Moreno Ángela , Piper Frida I
Published: July 2019

The magnitude and frequency of insect outbreaks are predicted to increase in forests, but how trees cope with severe outbreak defoliation is not yet fully understood. Winter deciduous trees often produce a secondary leaf flush in response to defoliation (i.e., compensatory leaf regrowth or refoliation), which promotes fast replenishment of carbon (C) storage and eventually tree survival. However, secondary leaf flushes may imply a high susceptibility to insect herbivory, especially in the event of an ongoing outbreak. We hypothesized that in winter deciduous species adapted to outbreak-driven defoliations, secondary leaves are both more C acquisitive and more herbivore resistant than primary leaves. During an outbreak by Ormiscodes amphimone F. affecting Nothofagus pumilio (Poepp. & Endl.) Krasser forests, we (i) quantified the defoliation and subsequent refoliation by analyzing the seasonal dynamics of the normalized difference vegetation index (NDVI) and (ii) compared the physiological traits and herbivore resistance of primary and secondary leaves. Comparisons of the NDVI of the primary and second leaf flushes relative to the NDVI of the defoliated forest indicated 31% refoliation, which is close to the leaf regrowth reported by a previous study in juvenile N. pumilio trees subjected to experimental defoliation. Primary leaves had higher leaf mass per area, size, carbon:nitrogen ratio and soluble sugar concentration than secondary leaves, along with lower nitrogen and starch concentrations, and similar total polyphenol and phosphorus concentrations. In both a choice and a non-choice bioassay, the leaf consumption rates by O. amphimone larvae were significantly higher (>50%) for primary than for secondary leaves, indicating higher herbivore resistance in the latter. Our study shows that secondary leaf flushes in outbreak-adapted tree species can be both C acquisitive and herbivore resistant, and suggests that these two features mediate the positive effects of the compensatory leaf regrowth on the tree C balance and forest resilience.
Recognizing autism spectrum disorder
Authors: Bartolotta Theresa , Rizzolo Denise
Published: July 2019

Autism spectrum disorder (ASD), previously called autism, is a developmental condition that can cause significant social, communication, and behavioral challenges. Early symptoms of ASD can easily be overlooked. Clinicians who can recognize the symptoms of ASD can help children get prompt referral to specialists and early intervention, which is key to improving developmental outcomes for children with ASD.
The Evolution of Resident Remedial Teaching at One Institution
Authors: Guerrasio Jeannette , Brooks Elizabeth , Rumack Carol M. , Aagaard Eva M.
Published: July 2019

Residency program directors and teaching faculty invest an enormous amount of time, energy, and resources in providing underperforming at-risk learners with remedial teaching. A remediation program was created and centralized at the University of Colorado School of Medicine in 2006 and 2012, respectively, that consolidated expertise in and resources for learner assessment and individualized teaching for struggling learners, particularly those placed on probation or receiving letters of warning (called focused review letters) from their residency programs. Since the implementation of the program, the authors have observed a decrease in the number of residents being placed on probation, and, of those on probation, more are graduating and obtaining board certification. In this Article, the authors aim to describe the development and outcomes of the program and to explore possible reasons for the improved outcomes.
Valgus Intertrochanteric Osteotomy for Femoral Neck Nonunion
Authors: Medda Suman , Jinnah Alexander H. , Marquez-Lara Alejandro , Araiza Edgar T. , Hasty Eddie K. , Halvorson Jason J. , Pilson Holly T.
Published: July 2019

Valgus intertrochanteric osteotomy is an effective method of treating femoral neck nonunion by reducing shear forces at the fracture and correcting the neck-shaft angle. Good outcomes have been reported in the literature. Through careful preoperative planning and a precise operative technique, reliable healing of both the osteotomy and nonunion can be achieved.

Video available at:
http://links.lww.com/JOT/A799
Closed Reduction Percutaneous Pinning of a Pediatric Supracondylar Distal Humerus Fracture
Authors: Dineen Hannah A. , Stone Joseph , Ostrum Robert F.
Published: July 2019

Pediatric supracondylar humerus fractures are the most common type of fracture of the elbow in children. Treatment options for these fractures depend on the fracture type as well as the severity of the fracture; however, the standard of care is closed reduction and percutaneous pin fixation for Gartland type 2 and 3 fractures. Controversy exists regarding the ideal pin configuration, size, and number of pins for best stabilization. We present a technique video illustrating our method of lateral entry-pinning of a type 3 supracondylar humerus fracture using three 2.0-mm smooth pins.

Video available at:
http://links.lww.com/JOT/A787
Examination Under Anesthesia for Evaluation of Hip Stability in Posterior Wall Acetabulum Fractures
Authors: Yee Michael A. , Davis Max E. , Perdue Aaron M. , Hake Mark E.
Published: July 2019

Posterior wall fractures of the acetabulum are the most common acetabular fracture pattern. Stable, congruous hips are amenable to nonoperative management, whereas any instability in the hip is an indication for operative management of the posterior wall fracture. Stability cannot adequately be predicted by static imaging alone. Therefore, the dynamic stress examination under anesthesia remains the gold standard in determining hip stability to guide treatment. This case-based video demonstrates a systematic technique for performing an examination under anesthesia and explains how to interpret the fluoroscopic imaging to differentiate stable and unstable hips.

Video available at:
http://links.lww.com/JOT/A795
Direct Anterior Approach for Hip Hemiarthroplasty
Authors: Wroblewski Andrew , Hoffman Dustin , Miller Eric T.
Published: July 2019

Purpose:

The purpose of this video is to demonstrate a surgical technique for a hemiarthroplasty of the hip joint through a direct anterior approach. We have found this technique to be a viable option for the treatment of displaced femoral neck fractures.

Methods:

Multiple approaches to the hip are described for arthroplasty. Direct anterior approach for hemiarthroplasty is a safe, reproducible approach.

Results:

The video displays our technique for performing a direct anterior approach to the hip joint for a hemiarthroplasty in the setting of a displaced femoral neck fracture.

Conclusions:

Hemiarthroplasty after femoral neck fractures in the elderly population is becoming increasingly more common. The direct anterior approach to the hip joint provides a safe approach for this procedure. The following video demonstrates our key principles when performing this technique.

Video available at:
http://links.lww.com/JOT/A794
Capitellum Fracture Open Reduction and Internal Fixation With Headless Screws
Authors: Wolfson Theodore S. , Lowe Dylan , Egol Kenneth A.
Published: July 2019

Partial articular fractures involving the capitellum represent an injury to the lateral column of the distal humerus. Capitellum open reduction and internal fixation restores this portion of the distal humerus articular surface and biomechanical integrity to the lateral column. This video demonstrates open reduction and internal fixation of a type I capitellar fracture with headless compression screws through an extensile lateral approach.

Video available at:
http://links.lww.com/JOT/A789
Percutaneous Fixation of Calcaneal Tuberosity Avulsion Fracture
Authors: Blum Laura E. , Hundal Rajbir , Walton David , Hake Mark E.
Published: July 2019

There are little data published regarding percutaneous fixation of calcaneal tuberosity avulsion fractures, but tongue-type calcaneal fracture literature can be extrapolated to these injuries because they can be considered the extra-articular form of a tongue-type calcaneus fracture. Both injuries involve similar considerations regarding skin compromise and need for urgent management with similar percutaneous techniques to minimize further soft-tissue injury. Percutaneous fixation of tongue-type calcaneus fractures was first reported by Weshues and Gissane in their description of the Essex Lopresti maneuver as an alternative to open approaches to minimize the risk of soft-tissue complications and flap necrosis and provide a means of improving reductions in smokers and diabetics who may not otherwise be good operative candidates.

Video available at:
http://links.lww.com/JOT/A808
Bimalleolar Ankle Fracture With Syndesmotic Sprain: ORIF and Suture-Endobutton Repair
Authors: Shafiq Babar , Thamyongkit Sorawut
Published: July 2019

Syndesmosis sprain is not uncommon in unstable ankle fractures. Surgical stabilization of the syndesmosis can be achieved with either trans-syndesmotic screws or a suture-endobutton device. The suture-endobutton provides for potential advantages including more anatomical mobility of the joint, quicker return to weight-bearing, and no need for implant removal. In this article, we describe the indications and surgical technique for management of a bimalleolar ankle fracture requiring repair of the syndesmosis. This technique focuses on methods of intraoperative reduction and assessment using fluoroscopic imaging of the contralateral ankle for reference. We also demonstrate the use of a suture-endobutton for syndesmosis fixation.

Video available at:
http://links.lww.com/JOT/A805
LisFranc Fusion
Authors: Jonard Brandon , Wroblewski Andrew , Junko Jeffrey
Published: July 2019

Lisfranc injuries remain a frequently missed pathology and may present as an isolated injury or as a component of a polytrauma case. Weight-bearing films or advanced imaging such as CT may be imperative in identifying or further classifying the injury. Common indications for fusion after lisfranc injury include primarily ligamentous injuries, delayed/chronic presentations, or post-traumatic arthritis, although primary fusion in the setting of acute fracture may be considered as an alternative to open reduction internal fixation techniques. The primary goals of surgery are to provide stability to the midfoot and restoration of the anatomical arch/cascade. The purpose of this video is to demonstrate a technique for tarsometatarsal joint fusion in the setting of acute lisfranc injury. This technique may be used for both ligamentous as well as bony varieties.

Video available at:
http://links.lww.com/JOT/A804