bluuebunny/crossref_metadata_2025 huggingface dataset:
Educational Biopolitics
Authors: Bourassa Gregory
Published: October 2018

Educational biopolitics is a growing field of study that explores the intersections of education, life, and power. A central question this literature has formed is a powerful, albeit familiar one: what types of life do schools validate, and what types of life do schools attempt to negate? Given this focus, the concept of educational life has emerged as one of the key units of analysis that informs inquiries in this field. There are two predominant modes of engagement that characterize studies in educational biopolitics: (a) analytical endeavors that seek to understand the operation of contemporary logics of biopower (a power over life) in schools and (b) affirmative educational endeavors that seek to highlight the potential of life to create power. Each approach begins with an understanding that schools do more than transmit knowledge; they are sites of struggle over the production, reproduction, and management of subjectivity. These approaches have led to unique inquiries that explore a number of tangentially related themes and make use of various concepts, including disposability, extractive schooling, and the common.
Time Preferences for Health
Authors: Pol Marjon van der , Irvine Alastair
Published: October 2018

The interest in eliciting time preferences for health has increased rapidly since the early 1990s. It has two main sources: a concern over the appropriate methods for taking timing into account in economics evaluations, and a desire to obtain a better understanding of individual health and healthcare behaviors. The literature on empirical time preferences for health has developed innovative elicitation methods in response to specific challenges that are due to the special nature of health. The health domain has also shown a willingness to explore a wider range of underlying models compared to the monetary domain. Consideration of time preferences for health raises a number of questions. Are time preferences for health similar to those for money? What are the additional challenges when measuring time preferences for health? How do individuals in time preference for health experiments make decisions? Is it possible or necessary to incentivize time preference for health experiments?
Analysis in case–control sequencing association studies with different sequencing depths
Authors: Chen Sixing , Lin Xihong
Published: October 2018

With the advent of next-generation sequencing, investigators have access to higher quality sequencing data. However, to sequence all samples in a study using next generation sequencing can still be prohibitively expensive. One potential remedy could be to combine next generation sequencing data from cases with publicly available sequencing data for controls, but there could be a systematic difference in quality of sequenced data, such as sequencing depths, between sequenced study cases and publicly available controls. We propose a regression calibration (RC)-based method and a maximum-likelihood method for conducting an association study with such a combined sample by accounting for differential sequencing errors between cases and controls. The methods allow for adjusting for covariates, such as population stratification as confounders. Both methods control type I error and have comparable power to analysis conducted using the true genotype with sufficiently high but different sequencing depths. We show that the RC method allows for analysis using naive variance estimate (closely approximates true variance in practice) and standard software under certain circumstances. We evaluate the performance of the proposed methods using simulation studies and apply our methods to a combined data set of exome sequenced acute lung injury cases and healthy controls from the 1000 Genomes project.
Sensitive Period for Cognitive Repurposing of Human Visual Cortex
Authors: Kanjlia Shipra , Pant Rashi , Bedny Marina
Published: October 2018

Studies of sensory loss are a model for understanding the functional flexibility of human cortex. In congenital blindness, subsets of visual cortex are recruited during higher-cognitive tasks, such as language and math tasks. Is such dramatic functional repurposing possible throughout the lifespan or restricted to sensitive periods in development? We compared visual cortex function in individuals who lost their vision as adults (after age 17) to congenitally blind and sighted blindfolded adults. Participants took part in resting-state and task-based fMRI scans during which they solved math equations of varying difficulty and judged the meanings of sentences. Blindness at any age caused “visual” cortices to synchronize with specific frontoparietal networks at rest. However, in task-based data, visual cortices showed regional specialization for math and language and load-dependent activity only in congenital blindness. Thus, despite the presence of long-range functional connectivity, cognitive repurposing of human cortex is limited by sensitive periods.
Silent Synapse Unsilencing in Hippocampal CA1 Neurons for Associative Fear Memory Storage
Authors: Wang Yao , Liu Yu-zhang , Wang Lidan , Tang Wei , Wang Zhiru
Published: October 2018

Clarifying learning-induced synaptic plasticity in hippocampal circuits is critical for understanding hippocampal mechanisms of memory acquisition and storage. Many in vitro studies have demonstrated learning-associated plasticity at hippocampal synapses. However, as a neural basis of memory encoding, the nature of synaptic plasticity underlying hippocampal neuronal responses to memorized stimulation remains elusive. Using in vivo whole-cell recording in anaesthetized adult rats and mice, we investigated synaptic activity of hippocampal CA1 pyramidal cells (PCs) in response to a flash of visual stimulation as the conditioned stimulus (CS) in associative fear conditioning. We found that shortly (<3 days) after conditioning, excitatory synaptic responses and spiking responses to the flash CS emerged in a large number (~70%) of CA1 PCs, a neuronal population previously unresponsive to the flash before conditioning. The learning-induced CA1 excitatory responsiveness was further indicated to result from postsynaptic unsilencing at flash-associated silent synapses, with NMDA receptor-gated responses we recently reported in naive animals. Our findings suggest that associative fear learning can induce excitatory responsiveness to the memorized CS in a large population of CA1 neurons, via a process of postsynaptic unsilencing at CA1 silent synapses, which may be critical for hippocampal acquisition and storage of associative memory.
Age validation of juvenile cod in the Western Baltic Sea
Authors: McQueen Kate , Hrabowski Josef , Krumme Uwe
Published: October 2018

The methods routinely used to estimate fish age are often un-validated and susceptible to errors and uncertainties. Despite numerous attempts, age determination of western Baltic cod (WBC, Gadus morhua) using otoliths is still unreliable, predominantly due to inconsistent interpretation of the first translucent zone (TZ). Length-frequencies of undersized (<38 cm) cod collected during 2013–2016 from pound nets near Fehmarn Island were analysed to understand TZ formation patterns. A clear minimum separated two cohorts within the length-frequency samples every year. The length-frequency information was combined with otolith edge analysis to observe the development of TZs in age-0 and age-1 cod otoliths, and to validate the timing of TZ formation, which was consistently completed between September and December. Mean TZ diameters of 4 917 juvenile cod otoliths varied between cohorts (mean diameters of the first TZ: 2.0 ± 0.5 mm; second TZ: 3.9 mm ± 0.5) and TZ diameter variation was found to be related to individual growth rate. The timing of formation of the first TZ was positively related to water temperature, and was confirmed as a “summer ring” rather than a “winter ring”. TZ formation and shallow-water occupancy suggest an influence of peak summer water temperatures on WBC ecology. An age reading guide for juvenile WBC otoliths is provided.
Noma—knowledge and practice competence among primary healthcare workers: a cross-sectional study in Burkina Faso
Authors: Brattström-Stolt Louise , Funk Tjede , Sié Ali , Ndiaye Charlotte , Alfvén Tobias
Published: October 2018

Background

Noma is a quickly progressing, neglected opportunistic infection. It starts in the mouth as an oral lesion but can relatively quickly develop into extensive facial destruction and lead to death if not treated in time. This study aims to shed light on primary healthcare workers’ practice competences in working with and knowledge of noma.

Methods

A structured questionnaire using questions and case scenarios was filled out by 76 healthcare workers in Burkina Faso. Half of the nurses included in this study participated in a 2-day noma training. Data were analysed descriptively and Fisher’s exact test was used to study differences between occupational groups using Stata.

Results

Most healthcare workers reported having examined the mouth of children with diseases predisposing to noma. The total practice competence was poor, with almost 70% having suboptimal or very low competences. However, competences varied between different stages of noma disease. Knowledge scores varied between occupational groups. The majority of nurses and odontostomatology specialist nurses had optimal or good knowledge of noma. Significant differences in knowledge and practice competence were found between nurses who attended a 2-day training course on noma and those who did not.

Conclusions

Health care workers in this study had quite poor practice competences in managing noma. The knowledge scores of these health workers were moderate. It is important for healthcare workers to be able to identify noma patients at an early stage, as at this point the disease can still be completely reversed.
Neonatal Conjunctivitis Caused by Neisseria cinerea: A Case of Mistaken Identity
Authors: Fiorito Theresa M , Noor Asif , Silletti Rodger , Krilov Leonard R
Published: October 2018

We report a case of a 3-day-old boy with Neisseria cinerea conjunctivitis, originally misidentified as Neisseria gonorrhoeae conjunctivitis. Neonates are at increased risk for disseminated gonococcal infection, and physicians should be cognizant of N cinerea and its potential to be mistaken for N gonorrhoeae.
An ontology and a memory island to give access to digital literature works
Authors: Rucar Yan , Ganascia Jean-Gabriel
Published: October 2018

We have designed an ontology to index a corpus of digital literature works. We have given this ontology the shape of a memory island, a navigable virtual territory where categories are regions and descriptor places, and where archives of these ephemeral works are made accessible.
Machine learning, template matching, and the International Tracing Service digital archive: Automating the retrieval of death certificate reference cards from 40 million document scans
Authors: Lee Benjamin Charles Germain
Published: October 2018

Scattered throughout the International Tracing Service (ITS) digital archive, one of the largest and most heterogeneous collections of Holocaust-related material, are hundreds of thousands of reference cards to official death certificates recording a fraction of individuals who perished within concentration camps. These cards represent the most comprehensive collection of digital material pertaining to these death certificates issued by Sonderstandesamt Arolsen, a German civil registry office. However, the reference cards can only be found dispersed throughout the Central Name Index (CNI), ITS’s 46+ million-card finding aid that is indexed only by name. Consequently, aggregating the death certificate reference cards for research requires an intractable manual search. I adopt template matching and machine learning to automate the retrieval of these cards from the ITS digital archive. I demonstrate the efficacy of my method on a test set of 22,117 hand-classified cards, reporting 100% precision and 100% recall. Running this algorithm on 39,967,358 scans of cards from the CNI, I identify 312,183 death certificate reference cards in 13.75 days of elapsed real runtime on a personal computer with only a single, $600 Intel processor. Finally, I demonstrate that this approach can be generalized to many different card types within the CNI, showing great promise for application to other archives.
An introduction to the functioning process of embedded paratext of digital literature: Technoeikon of digital poetry
Authors: Shanmugapriya T , Menon Nirmala , Campbell Andy
Published: October 2018

The recent digital-born electronic literature has heterogeneous components such as kinetic texts, kinetic images, graphical designs, sounds, and videos. These digital components are embedded with the main text as the paratext of print and digital works such as preface, author’s name, illustrations, and title. However, the comparative study between paratext and embedded paratext of electronic literature shows the different strategic patterns and functions of these entities. We discuss the conceptual framework of illuminant devices of paratexts and propose a new term technoeikon to recognize the functions of embedded literary artifact in digital literary works. We examine the critical construction of new term technoeikon which has a unique characteristic that makes electronic literary works different from print literature. This essay reviews the cyclical process of technoeikon from the historical perspective of pre-print culture and print culture and acknowledges technoeikon as inherited from our tradition. Due to digital contrivances, technoeikon takes a new expression as performing in digital ecology which is different from our traditional analog. This article presents a case study on Andy Campbell's (2007b) Dim O'Gauble. Also, Campbell responds to the interpretation of new term technoeikon in the fourth section of the essay.
Automatic profiling of L2-simplified texts: Identifying discriminate features of linguistic proficiency
Authors: Zarco-Tejada Maria Angeles
Published: October 2018

We describe the first wide results of the linguistic profiling of the Common European Framework of Reference (CEFR)-levelled English Corpus (CLEC), a corpus built up for Natural Language Processing purposes. The CLEC is a proficiency-levelled English corpus that covers A1, A2, B1, B2, and C1 CEFR levels and that has been built up to train statistic models for automatic proficiency assessment. We describe not only the main aspects of the corpus development but also display the linguistic features and the statistic results for levels A2, B1, and B2 written examples, carried out automatically. We show how raw text, lexical, morphosyntactic, or syntactic statistic outcomes can help to identify levels of proficiency, to test teaching materials accurate proficiency classification, to provide computable support to new text proficiency validation, and to specify level boundaries. In fact, upper levels strengthen proficiency by showing higher outcomes of lexical and syntactic complexity. This analysis validates the use of automatic tools for proficiency level identification based on lexical and syntactic data, whereas morphosyntactic features strengthen competence-level distinctions. Finally, we suggest that these results are a first step onto the CEFR-levelled automatic assessment of new texts.
Abominable KK Failures
Authors: Dorst Kevin
Published: October 2018

KK is the thesis that if you can know p, you can know that you can know p. Though it’s unpopular, a flurry of considerations has recently emerged in its favour. Here we add fuel to the fire: standard resources allow us to show that any failure of KK will lead to the knowability and assertability of abominable indicative conditionals of the form ‘If I don’t know it, p’. Such conditionals are manifestly not assertable—a fact that KK defenders can easily explain. I survey a variety of KK-denying responses and find them wanting. Those who object to the knowability of such conditionals must either (i) deny the possibility of harmony between knowledge and belief, or (ii) deny well-supported connections between conditional and unconditional attitudes. Meanwhile, those who grant knowability owe us an explanation of such conditionals’ unassertability—yet no successful explanations are on offer. Upshot: we have new evidence for KK.
The temporal relationship between cancer and adult onset anti-transcriptional intermediary factor 1 antibody–positive dermatomyositis
Authors: Oldroyd Alexander , Sergeant Jamie C , New Paul , McHugh Neil J , Betteridge Zoe , Lamb Janine A , Ollier William E , Cooper Robert G , Chinoy Hector ,   UKMyoNet, Ahmed Yasmeen , Armstrong Raymond , Bernstein Robert , Black Carol , Bowman Simon , Bruce Ian , Butler Robin , Carty John , Chattopadhyay Chandra , Chelliah Easwaradhas , Clarke Fiona , Dawes Peter , Devlin Joseph , Edwards Christopher , Emery Paul , Fordham John , Fraser Alexander , Gaston Hill , Gordon Patrick , Griffiths Bridget , Gunawardena Harsha , Hall Frances , Harrison Beverley , Hay Elaine , Horden Lesley , Isaacs John , Jones Adrian , Kamath Sanjeet , Kennedy Thomas , Kitas George , Klimiuk Peter , Knights Sally , Lambert John , Lanyon Peter , Laxminarayan Ramasharan , Lecky Bryan , Luqmani Raashid , Marks Jeffrey , Martin Michael , McGonagle Dennis , McHugh Neil , McKenna Francis , McLaren John , McMahon Michael , McRorie Euan , Merry Peter , Miles Sarah , Miller James , Nicholls Anne , Nixon Jennifer , Ong Voon , Packham John , Pipitone Nicolo , Plant Michael , Pountain Gillian , Pullar Thomas , Roberts Mark , Sanders Paul , Scott David , Scott David , Shadforth Michael , Sheeran Thomas , Srinivasan Arul , Swinson David , Teh Lee-Suan , Webley Michael , Williams Brian , Winer Jonathan
Published: October 2018

Objectives

To characterize the 10 year relationship between anti-transcriptional intermediary factor 1 antibody (anti-TIF1-Ab) positivity and cancer onset in a large UK-based adult DM cohort.

Methods

Data from anti-TIF1-Ab-positive/-negative adults with verified diagnoses of DM from the UK Myositis Network register were analysed. Each patient was followed up until they developed cancer. Kaplan–Meier methods and Cox proportional hazard modelling were employed to estimate the cumulative cancer incidence.

Results

Data from 263 DM cases were analysed, with a total of 3252 person-years and a median 11 years of follow-up; 55 (21%) DM cases were anti-TIF1-Ab positive. After 10 years of follow-up, a higher proportion of anti-TIF1-Ab-positive cases developed cancer compared with anti-TIF1-Ab-negative cases: 38% vs 15% [hazard ratio 3.4 (95% CI 2.2, 5.4)]. All the detected malignancy cases in the anti-TIF1-Ab-positive cohort occurred between 3 years prior to and 2.5 years after DM onset. No cancer cases were detected within the following 7.5 years in this group, whereas cancers were detected during this period in the anti-TIF1-Ab-negative cases. Ovarian cancer was more common in the anti-TIF1-Ab-positive vs -negative cohort: 19% vs 2%, respectively (P < 0.05). No anti-TIF1-Ab-positive case <39 years of age developed cancer, compared with 21 (53%) of those ≥39 years of age.

Conclusion

Anti-TIF1-Ab-positive-associated malignancy occurs exclusively within the 3 year period on either side of DM onset, the risk being highest in those ≥39 years of age. Cancer types differ according to anti-TIF1-Ab status, and this may warrant specific cancer screening approaches.
Acute Kidney Injury Secondary to Severe Hand, Foot and Mouth Disease Caused by Enterovirus-A71: Hypertension Is a Common
Authors: Xu Yao , Wu Yang Fang , Luo Huang Huang , Zhang Dong Dong , Wu Yue , Hu Peng
Published: October 2018

Hand, foot and mouth disease (HFMD) is a common infectious disease among children, caused primarily by human enterovirus-A71 (EV-A71) and coxsackievirus-A16 (CV-A16). To date, only two case reports mention that renal involvement can be secondary to or coexisting with CV-A16-associated HFMD. In the present report, we describe a 10-year-old girl who was infected with EV-A71 and subsequently developed a definite acute kidney injury (AKI), mainly based on the characteristic rash, virus isolation, eyelid edema, hypertension, decreased urine output, mild proteinuria and impaired renal function. She was treated with intravenous ribavirin, immunoglobulin, oral administration of nifedipine and ramipril. After 7 days of intensive observations, she recovered fully. Hypertension is a common feature in both HFMD and AKI. On one hand, hypertension serves as a risk factor for severe HFMD; on the other hand, hypertension induces AKI onset and is also deteriorated by AKI.
Evidence-Based Improvisation: Facing the Challenges of Cervical Cancer Care in Uganda
Authors: Swanson Megan , Ueda Stefanie , Chen Lee-May , Huchko Megan J. , Nakisige Carol , Namugga Jane
Published: October 2018

(Abstracted from Gynecol Oncol Rep 2018;24:30–35)

In 2012, cervical cancer accounted for more than a half million new cases and 250,000 deaths worldwide. This cancer is the most common malignancy in Uganda and is responsible for the greatest cancer-related mortality among women in that country.
Developing the Agile Implementation Playbook for Integrating Evidence-Based Health Care Services Into Clinical Practice
Authors: Boustani Malaz A. , van der Marck Marjolein A. , Adams Nadia , Azar Jose M. , Holden Richard J. , Vollmar Horst C. , Wang Sophia , Williams Christopher , Alder Catherine , Suarez Shelley , Khan Babar , Zarzaur Ben , Fowler Nicole R. , Overley Ashley , Solid Craig A. , Gatmaitan Alfonso
Published: October 2018

Problem

Despite the more than $32 billion the National Institutes of Health has invested annually, evidence-based health care services are not reliably implemented, sustained, or distributed in health care delivery organizations, resulting in suboptimal care and patient harm. New organizational approaches and frameworks that reflect the complex nature of health care systems are needed to achieve this goal.

Approach

To guide the implementation of evidence-based health care services at their institution, the authors used a number of behavioral theories and frameworks to develop the Agile Implementation (AI) Playbook, which was finalized in 2015. The AI Playbook leverages these theories in an integrated approach to selecting an evidence-based health care service to meet a specific opportunity, rapidly implementing the service, evaluating its fidelity and impact, and sustaining and scaling up the service across health care delivery organizations. The AI Playbook includes an interconnected eight-step cycle: (1) identify opportunities; (2) identify evidence-based health care services; (3) develop evaluation and termination plans; (4) assemble a team to develop a minimally viable service; (5) perform implementation sprints; (6) monitor implementation performance; (7) monitor whole system performance; and (8) develop a minimally standardized operating procedure.

Outcomes

The AI Playbook has helped to improve care and clinical outcomes for intensive care unit survivors and is being used to train clinicians and scientists in AI to be quality improvement advisors.

Next Steps

The authors plan to continue disseminating the details of the AI Playbook and illustrating how health care delivery organizations can successfully leverage it.
Developing a Culture of Mentorship to Strengthen Academic Medical Centers
Authors: Choi Augustine M.K. , Moon Jennifer E. , Steinecke Ann , Prescott John E.
Published: October 2018

Mentorship is central to academic medicine and its missions, and it has long played a critical role in the training and career development of physicians and scientists. A growing body of literature has documented the positive impact of mentorship on various outcomes, including research productivity, academic promotion, faculty retention, and career satisfaction. These benefits span academic medical centers’ missions and have the potential to enhance biomedical research, patient care, education, and faculty diversity and leadership.

In this Invited Commentary, the authors argue that a dynamic culture of mentorship is essential to the success of academic medical centers and should be elevated to the level of a major strategic priority. This culture of mentorship would capitalize on an institution’s intellectual resources and seek to develop leaders in biomedical discovery, patient care, and education. The bidirectional transmission of knowledge between mentors and mentees, through both formal programs and informal relationships, can foster the growth of faculty members needed to meet the complex challenges currently confronting medical schools and teaching hospitals.

Developing a culture of mentorship requires a strong commitment by leaders at all levels to nurture the next generation of physicians and scientists as well as grassroots efforts by trainees and faculty to seek out and create mentorship opportunities. The authors conclude by outlining possible mechanisms and incentives for elevating mentorship to the level of a strategic priority to strengthen academic medical centers across their missions.
Major Adverse Cardiac Events and Mortality Associated with Electroconvulsive Therapy
Authors: Duma Andreas , Maleczek Mathias , Panjikaran Basil , Herkner Harald , Karrison Theodore , Nagele Peter
Published: October 2018

EDITOR’S PERSPECTIVE

What We Already Know about This Topic

The incidence of major adverse cardiac events after electroconvulsive therapy is not known

What This Article Tells Us That Is New

Major adverse cardiac events and death after electroconvulsive therapy are infrequent and occur in about 1 of 50 patients and after about 1 of 200 to 500 electroconvulsive therapy treatments

Background

Cardiac events after electroconvulsive therapy have been reported sporadically, but a systematic assessment of the risk is missing. The goal of this study was to obtain a robust estimate of the incidence of major adverse cardiac events in adult patients undergoing electroconvulsive therapy.

Methods

Systematic review and meta-analysis of studies that investigated electroconvulsive therapy and reported major adverse cardiac events and/or mortality. Endpoints were incidence rates of major adverse cardiac events, including myocardial infarction, arrhythmia, pulmonary edema, pulmonary embolism, acute heart failure, and cardiac arrest. Additional endpoints were all-cause and cardiac mortality. The pooled estimated incidence rates and 95% CIs of individual major adverse cardiac events and mortality per 1,000 patients and per 1,000 electroconvulsive therapy treatments were calculated.

Results

After screening of 2,641 publications and full-text assessment of 284 studies, the data of 82 studies were extracted (total n = 106,569 patients; n = 786,995 electroconvulsive therapy treatments). The most commonly reported major adverse cardiac events were acute heart failure, arrhythmia, and acute pulmonary edema with an incidence (95% CI) of 24 (12.48 to 46.13), 25.83 (14.83 to 45.00), and 4.92 (0.85 to 28.60) per 1,000 patients or 2.44 (1.27 to 4.69), 4.66 (2.15 to 10.09), and 1.50 (0.71 to 3.14) per 1,000 electroconvulsive therapy treatments. All-cause mortality was 0.42 (0.11 to 1.52) deaths per 1,000 patients and 0.06 (0.02 to 0.23) deaths per 1,000 electroconvulsive therapy treatments. Cardiac death accounted for 29% (23 of 79) of deaths.

Conclusions

Major adverse cardiac events and death after electroconvulsive therapy are infrequent and occur in about 1 of 50 patients and after about 1 of 200 to 500 electroconvulsive therapy treatments.
Cervical Spine Movement in a Cadaveric Model of Severe Spinal Instability: A Study Comparing Tracheal Intubation with 4 Different Laryngoscopes
Authors: Romito Jia W. , Riccio Christina A. , Bagley Carlos A. , Minhajuddin Abu , Barden Catherine B. , Michael Meghan M. , Bhoja Ravi , Mootz Brady L. , Skrivanek Gary D. , Klein Kevin W. , McDonagh David L.
Published: October 2018

Background:

This study compared the Macintosh blade direct laryngoscope, Glidescope, C-Mac d-Blade, and McGrath MAC X-blade video laryngoscopes in 2 cadaveric models with severe cervical spinal instability. We hypothesized that the Glidescope video laryngoscope would allow for intubation with the least amount of cervical spine movement. Our secondary endpoints were glottic visualization and intubation success.

Methods:

In total, 2 fresh cadavers underwent maximal surgical destabilization from the craniocervical junction to the cervicothoracic junction by a neurosurgical spine specialist, with subsequent neutral positioning of the heads with surgical head fixation devices. On each cadaver, 8 experienced anesthesiologists performed four intubations with the 4 laryngoscopes in random order. Lateral radiographic measurements determined vertebral displacement during intubation.

Results:

Cervical spine displacements were not significantly different amongst video laryngoscopes. Cormack-Lehane Grade 1 views were achieved with all attempts with each of the 3 video laryngoscopes; intubation attempts with the Macintosh blade achieved only grade 3 or grade 4 views. Intubation was successful every time with a video laryngoscope but only during 1 of 16 intubation attempts with the Macintosh blade.

Conclusions:

In a cadaveric model with maximally destabilized cervical spines, cervical spine movement was observed during attempted laryngoscopy using each of 3 video laryngoscopes, although there was no significant difference between the laryngoscopes. Given cervical spine displacement occurred, these video laryngoscopes do not prevent cervical spine motion during laryngoscopy. However, with improved glottic visualization and intubation success, video laryngoscopes are superior to the Macintosh blade in both cervical spine safety and intubation efficacy in the model studied.
Radiation Safety Aspects of Iodine-131 metaiodobenzylguanidine (131I mIBG) Therapy Program Startup
Authors: Barnes J.A. , de la Guardia M. , Easley T. , Downs H. , Mims S. , Nielson K. , Granger M.
Published: October 2018

As a medical center without a pre-existing radiopharmaceutical therapy program, it was a daunting endeavor to implement a 131I metaiodobenzylguanidine (mIBG) high-dose treatment regimen. It took several years of planning with hospital administration, vendors, and Texas Department of Health Radiological Control regulators to establish a viable program. Effective communication between physicians, nursing, nuclear medicine, environmental services, maintenance, and other support staff is essential and paramount for the successful execution and continued sustainability of the mIBG therapy program. Besides providing an effective treatment for patients, an additional goal for the program is to keep radiation exposure As Low As Reasonably Achievable (ALARA) for staff and patient caregivers. As such, start-up presented many training, logistical, and radiation safety challenges. The location of the isolation room and shielding specifications were designed to keep radiation exposure to public access areas to less than 2 microsieverts per hour. Before the first patient was treated the policies and procedures for training, radiation safety, product quality control, and infusion process needed to be developed, tested, and approved by various committees. Furthermore, a similar process was required for developing room set-up, post therapy cleanup, and waste storage procedures. Throughout the maturation process of the program, the departments involved have found that our safety culture has continually improved by the re-enforcement of knowledge and lessons learned, as both the ancillary and treatment staff grew more confident in each other’s ability during more patient treatments are performed. This article describes the process and lessons learned during the time leading up to the startup and early years of the mIBG therapy program.
Visualizing High-Order Decay after Disequilibria
Authors: Wilson Charles A. , Hendrickson Katherine R. , Hamideh Amin M. , Matthews Kenneth L. , Wang Wei-Hsung
Published: October 2018

High-order decay equations are often difficult to study without significant care taken with variables and assumptions. As parent and progeny activities evolve over time, the effects of uncertainties and approximations confound the quality and interpretation of results. Of particular concern is the situation when decay equilibrium has been disturbed and progenies have arbitrary initial activities. To address this, code was created using Wolfram Mathematica to visualize the time-activity plots of the high order progenies of naturally occurring radioactive material after secular equilibrium is disturbed. The Bateman equation for an un-replenished parent was expanded to calculate activity vs. time for up to 13 progenies at different initial activities. The code uses the formula of Skrable et al., without parent production, expanded to the 13th progeny with arbitrary initial concentration. The code calculates and plots activity vs. time; it also reports the cumulative disintegrations of each progeny over a user-specified time period for comparison to counting measurements. The code could also be modified to incorporate additional production or branched decay schemes. We believe this code may be useful to health physicists and is intended to be accessible for anyone’s use. This paper presents the code with explanations and examples on how to use it.
SPECKLED HYPOAUTOFLUORESCENCE AS A SIGN OF RESOLVED SUBRETINAL HEMORRHAGE IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION
Authors: Hussnain S. Amal , Dolz-Marco Rosa , Dunaief Joshua L. , Curcio Christine A. , Freund K. Bailey
Published: October 2018

Purpose:

To describe patterns of hypoautofluorescence in eyes with neovascular age-related macular degeneration occurring after subretinal hemorrhage.

Methods:

This was a retrospective descriptive analysis of neovascular age-related macular degeneration eyes presenting with subretinal hemorrhage over the last 5 years that underwent serial multimodal imaging. A review of color fundus photographs, fundus autofluorescence, near-infrared reflectance, and optical coherence tomography was performed at baseline and all available follow-up visits to document the course and evolution of subretinal hemorrhage in these eyes.

Results:

Eleven eyes of 10 patients (9 female, 1 male; mean age: 84.1 years, range: 72–99 years) with a mean follow-up of 19.8 months (range: 3–68 months) were included. Color fundus photographs showed subretinal hemorrhage that resolved over a mean of 5.5 months. During and after hemorrhage resolution, all eyes showed hypoautofluorescence, which appeared distinct from that due to retinal pigment epithelium loss. Discrete multifocal punctate hyperpigmented lesions were observed in 90% of eyes and were markedly hypoautofluorescent, producing a speckled pattern on fundus autofluorescence.

Conclusion:

Areas of hypoautofluorescence in the absence of retinal pigment epithelium atrophy, often with a speckled pattern, delineate areas of prior subretinal hemorrhage long after its resolution in patients with neovascular age-related macular degeneration. Potential mechanisms for the development of this pattern are proposed.
Geographic and Provider Variations in Ocular Hypotensive Medication Claims Among Medicare Part D Enrollees
Authors: Janetos Timothy M. , French Dustin D. , Beaumont Jennifer L. , Tanna Angelo P.
Published: October 2018

Purpose:

The purpose of this study was to describe the prescribing patterns of ocular hypotensive medications by ophthalmologists and optometrists in the United States for Medicare beneficiaries.

Materials and Methods:

This cross-sectional observational study examined all Medicare part D claims of ocular hypotensive medications prescribed by practicing ophthalmologists and optometrists in the United States in 2014. Claims rate was calculated as a function of the total number of Medicare part D beneficiaries within a given region. Claims rates were compared between ophthalmologists and optometrists and by region (state, and county level). The coefficient of variation was used to quantify treatment variation at the state level.

Results:

The rates of claims for prescriptions from ophthalmologists were higher nationally than from optometrists by a 6:1 ratio. Claims rates in urban, large and small rural cities were significantly greater for ophthalmologists. Claims rates associated with optometrists were greater in isolated small rural towns. The coefficient of variation at the state level was 52.0 for optometrists, 32.6 for ophthalmologists, and 25.2 for both groups combined.

Conclusions:

Medicare part D claims data for ocular hypotensive medications indicate ophthalmologists used a significantly wider range of medications, derived from more medication classes and treated more patients than optometrists. A larger proportion of ocular hypotensive medication claims were associated with ophthalmologists in urban and suburban regions. The opposite was observed in isolated small rural towns. At the state level, there is a large variation in medication claims rates with the highest rates in New York and Washington, DC.
Microcatheter-assisted Trabeculotomy for Primary Congenital Glaucoma After Failed Glaucoma Surgeries
Authors: Hu Man , Wang Huaizhou , Huang Alex S. , Li Li , Shi Yan , Xu Yongli , Wang Ningli
Published: October 2018

Purpose:

To evaluate the effectiveness of microcatheter-assisted trabeculotomy (MAT) to treat primary congenital glaucoma after failed previous glaucoma surgeries.

Materials and Methods:

Retrospective, noncomparative, interventional case series conducted at Beijing Tongren Eye Center, China. Outcome measures were compared between 3 groups: successful and complete (≥330 degrees) MAT; successful and partial (<330 degrees) MAT; or cases converted to traditional trabeculotomy when the Schlemm’s canal could not be catheterized >180 degrees. Success was defined as final intraocular pressure ≤21 mm Hg, with (qualified success) or without (complete success) glaucoma medications.

Results:

In total, 74 eyes of 63 consecutive patients were included. MAT was performed in 50 eyes (67.6%). Postoperative intraocular pressure and number of glaucoma drops (17.7±8.6 mm Hg, 0.6±1.2 medications) was significantly less than the preoperative values (35.3±7.2 mm Hg, 2.7±0.8 medications; P<0.001). Cumulative probabilities of qualified and complete success were 84.0% and 80.0% at 3-year follow-up with no difference between complete and partial trabeculotomies. MAT was not successfully performed in 24 eyes (32.4%), requiring conversion to traditional trabeculotomy and associated with greater incidence of previous surgeries (P<0.001), earlier age of disease onset (P=0.024) and worse corneal transparency (P=0.010). Cumulative probabilities of qualified and complete success were 37.0% and 29.2% at 3-year follow-up.

Conclusions:

Both complete and partial MAT achieved significant pressure reduction in cases of primary congenital glaucoma with previous failed glaucoma surgeries in intermediate term.
Social representations of chronic pain in newspapers, online media, and film
Authors: Kugelmann Robert , Watson Kelsey , Frisby Gregory
Published: October 2018

Social representation theory provides a framework for studying how scientific knowledge affects common sense and communication through inquiries into everyday discourse. This qualitative study examined social representations of chronic pain from 4 sources: North American newspapers; “Chronic Illness Cat” memes from the social media web site, Pinterest; video blogs on YouTube; and from a 2014 film, Cake, and interviews and comments concerning it. Using thematic analysis, we first identified social representations found in our 4 sources and others found in 1 or 2 of them. Second, we analyzed the sources for their rhetorical intentions. Vlogs directly and memes indirectly were first-person accounts, self-authorizing statements of the truth of chronic pain, whereas newspaper articles and the film were third-person accounts of pain, the differences between these perspectives affecting what was said. We conclude that the medium shapes the message.
Safety of once-weekly glucagon-like peptide-1 receptor agonists in patients with type 2 diabetes
Authors: Patel Dhiren
Published: October 2018

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have been shown to be efficacious in lowering HbA1c in patients with type 2 diabetes (T2D) and are associated with reduction in meal-related hyperglycemia and bodyweight, low rates of hypoglycemia, and most recently, with reduction of major adverse cardiovascular events for all of them. This narrative review compares the safety of the existing once-weekly (OW) GLP-1RAs with other currently available antidiabetic treatments. Key safety data from 29 sponsor-led trials of albiglutide, dulaglutide, exenatide extended-release (ER), and semaglutide were included in the analysis. Once-weekly GLP-1RAs were associated with lower rates of hypoglycemic events compared with most other antidiabetic agents. Gastrointestinal adverse events were common, tended to dissipate with time, and tended to be less frequent with albiglutide and exenatide ER compared with semaglutide. Of the currently approved OW GLP-1RAs as of Q4 2018, exenatide ER is the only one without an indication for patients with T2D with comorbid severe renal impairment or end-stage renal disease. Implications for practice: OW GLP-1RAs offer a well-tolerated therapeutic option for T2D. Further studies are needed to further differentiate the safety profiles of OW GLP-1RAs.
Overview of the burden of illness and the role of once-weekly glucagon-like peptide-1 receptor agonist therapy in type 2 diabetes
Authors: Hinnen Deborah
Published: October 2018

The prevalence of type 2 diabetes (T2D) is increasing globally, and as the prevalence of T2D rises, the burden of its associated comorbidities is predicted to increase. Effective treatments for T2D are required to improve diabetes control and reduce its negative impact. Glucagon-like peptide-1 receptor agonists (GLP-RAs) are effective in improving glycemic control and bodyweight, are associated with a low risk of hypoglycemia, and some have been associated with reductions in major adverse cardiovascular events (MACE). Once-weekly GLP-1RAs have been developed to overcome barriers to treatment adherence. Currently approved once-weekly GLP-1RAs include exenatide extended-release, albiglutide, and dulaglutide. Semaglutide, another once-weekly GLP-1RA, has recently been approved by the US Food and Drug Administration for the treatment of T2D. Compared with other once-weekly GLP-1RAs, semaglutide has shown greater reductions in HbA1c and weight over once-daily GLP-1RAs. This greater efficacy and improvement in MACE, combined with improvements in delivery devices and dispensing procedures, could help address the burden of T2D.
National Testing of the Emergency Department Patient Experience of Care Discharged to Community Survey and Implications for Adjustment in Scoring
Authors: Parast Layla , Mathews Megan , Tolpadi Anagha , Elliott Marc , Flow-Delwiche Elizabeth , Becker Kirsten
Published: October 2018

Background:

The emergency department (ED) setting is unique and measuring quality of care in the ED requires the development of ED-specific tools. The Emergency Department Patient Experience of Care Discharged to Community Survey was designed to measure patient experience in the ED setting.

Objectives:

Describe results from the Emergency Department Patient Experience of Care Discharged to Community Survey including respondent characteristics and reported patient experience, and examine factors, including mode of survey administration, associated with response propensity and response patterns.

Research Design:

In total, 16,006 discharges were sampled from 50 hospitals nationwide to receive the survey using a mode experiment design. Logistic regression modeled response propensity; linear regression examined associations between response patterns and patient characteristics and mode.

Subjects:

In total, 3122 survey respondents.

Measures:

Measures of patient experience.

Results:

Patients reported that hospitals consistently informed them of the purpose of any new medications (84% yes, definitely), but did not consistently explain their possible side effects (53%). Age, education, health, and arrival by ambulance were significantly associated with response patterns. There were significant differences in response rate by mode: 29% mixed mode, 22% telephone only and 14% mail only. Mode of administration was significantly associated with response patterns whereby patients surveyed using telephone-only or mixed mode tended to respond more positively than those surveyed using mail only.

Conclusions:

There is room for improvement in terms of patient experience in the ED setting. Effects of patient characteristics and survey mode on responses were large enough to necessitate appropriate adjustments if hospitals are to be compared in the future.
Risk Factors Associated With 7- Versus 30-Day Readmission Among Patients With Heart Failure Using the Nationwide Readmission Database
Authors: Pham Phuong N. , Xiao Hong , Sarayani Amir , Chen Ming , Brown Joshua D.
Published: October 2018

Background:

The 30-day all-cause readmission for heart failure (HF) is a standard measure to evaluate hospital performance. A recent study found that a shorter period after discharge may be more indicative of hospital quality.

Objective:

To compare risk factors for 7- versus 30-day readmission in patients with HF.

Design:

This is a retrospective cohort using the 2014 Nationwide Readmissions Database.

Subjects:

Patients 65 years and older with Medicare coverage discharged after HF admission.

Measures:

The 7- or 30-day all-cause readmissions were the outcomes of interest. HF-related readmissions were secondary outcomes. Covariates included patient characteristics, hospital characteristics, and admission-related information. Hierarchical logistic regression evaluated the association between covariates and readmissions.

Results:

There were N=15,039 all-cause readmissions within 7 days after discharge and N=47,896 within 30 days. Surgical service was a risk factor for 30-day but not 7-day all-cause readmission (odds ratio=1.10, 95% confidence interval=1.05–1.16). Depression, rheumatoid arthritis, liver disease, drug abuse, lymphoma, and psychosis were associated with an increased risk of 30-day all-cause readmission but not 7-day. Longer lengths of stay also had a higher likelihood of all-cause readmission within 30 days compared with 7 days. In contrast, smaller hospital bed size was associated with an increased risk of 7-day all-cause readmission (odds ratio=1.06, confidence interval=1.01–1.12) but not 30-day. Sensitivity analysis with using a 3-day readmission interval showed similar results.

Conclusions:

Risk factors for hospital readmission are slightly different dependent on the measurement interval. In general, hospital-related factors were associated with shorter readmissions intervals while patient factors were more associated with longer intervals.
Counseling in Urogynecology: A Difficult Task, or Simply Good Surgeon-Patient Communication?
Authors: Balzarro Matteo , Rubilotta Emanuele , Goss Claudia , Costantini Elisabetta , Artibani Walter , Sand Peter
Published: October 2018

(Abstracted from Int Urogynecol J 2018;29:943–948)

Surgical treatments used for pelvic organ prolapse (POP) and urinary incontinence (UI) have markedly changed in recent years. Concomitant with these changes, the patient-physician relationship has evolved over the last several years in large part due to patients asking for more information about their conditions as well as their desire to play an active role in the treatment decision-making process.