bluuebunny/crossref_metadata_2025 huggingface dataset:
CHEER National Study of Chronic Rhinosinusitis Practice Patterns: Disease Comorbidities and Factors Associated with Surgery
Authors: Chapurin Nikita , Pynnonen Melissa A. , Roberts Rhonda , Schulz Kristine , Shin Jennifer J. , Witsell David L. , Parham Kourosh , Langman Alan , Carpenter David , Vambutas Andrea , Nguyen‐Huynh Anh , Wolfley Anne , Lee Walter T.
Published: February 2017

Objectives

(1) Describe national patterns of chronic rhinosinusitis (CRS) care across academic and community practices. (2) Determine the prevalence of comorbid disorders in CRS patients, including nasal polyposis, allergic rhinitis, asthma, and cystic fibrosis. (3) Identify demographic, clinical, and practice type factors associated with endoscopic sinus surgery (ESS).

Study Design

Multisite cross‐sectional study.

Setting

Otolaryngology’s national research network CHEER (Creating Healthcare Excellence through Education and Research).

Subjects and Methods

A total of 17,828 adult patients with CRS were identified, of which 10,434 were seen at community practices (59%, n = 8 sites) and 7394 at academic practices (41%, n = 10 sites). Multivariate logistic regression was used to evaluate the association between demographic, practice type, and clinical factors and the odds of a patient undergoing ESS.

Results

The average age was 50.4 years; 59.5% of patients were female; and 88.3% were Caucasian. The prevalence of comorbid diseases was as follows: allergic rhinitis (35.1%), nasal polyposis (13.3%), asthma (4.4%), and cystic fibrosis (0.2%). In addition, 24.8% of patients at academic centers underwent ESS, as compared with 12.3% at community sites. In multivariate analyses, nasal polyposis (odds ratio [OR], 4.28), cystic fibrosis (OR, 2.42), and academic site type (OR, 1.86) were associated with ESS (P <. 001), while adjusting for other factors.

Conclusions

We describe practice patterns of CRS care, as well as demographic and clinical factors associated with ESS. This is the first study of practice patterns in CRS utilizing the CHEER network and may be used to guide future research.
Idiopathic Subglottic Stenosis: Long‐Term Outcomes of Open Surgical Techniques
Authors: Menapace Deanna C. , Modest Mara C. , Ekbom Dale C. , Moore Eric J. , Edell Eric S. , Kasperbauer Jan L.
Published: February 2017

Objectives

Idiopathic subglottic stenosis (iSGS) is rare, and its cause remains elusive. Treatment options include empiric medical therapy and endoscopic or open surgery. We present our results for open surgical technique.

Study Design

Case series with chart review (1978‐2015).

Setting

Tertiary academic center.

Subjects/Methods

Thirty‐three patients (32 female; median age, 51 years) met inclusion criteria and underwent cricotracheal resection with thyrotracheal anastomosis, tracheal resection with primary anastomosis, or laryngotracheoplasty with rib grafting. Continuous variables were summarized using medians and ranges while categorical features are presented using frequency counts and percentages.

Results

Sixteen patients (48%) underwent a single‐stage approach with immediate extubation or temporary intubation following surgery (median, 1 day; range, 1‐3 days). Seventeen patients (52%) underwent a double‐staged approach with a median time to decannulation of 35 days (range, 13‐100 days). Twenty‐four (73%) patients underwent a previous intervention. Median stay in the intensive care unit was 1 day (range, 0‐3 days), with a median hospital stay of 4 days (range, 2‐7 days). Recurrence requiring further surgical intervention was observed in 12 patients (36%). The median time to recurrence was 8 years over an average follow‐up of 9.7 years. The most common complaint following surgery was change in voice quality (fair to poor; n = 10; 30%).

Conclusions

Open surgery should be reserved for refractory cases of iSGS; cricotracheal resection with thyrotracheal anastomosis is the preferred open technique. Recurrence may occur after open treatment, highlighting the importance of long‐term follow‐up. Patients should be counseled about the potential for worsening voice quality with the open approach.
Relational knowledge leadership and local economic development
Authors: Horlings Lummina , Collinge Chris , Gibney John
Published: February 2017

This paper concerns the role of spatial leadership in the development of the knowledge-based economy. It is argued within academic and practitioner circles that leadership of knowledge networks requires a particular non-hierarchical style that is required to establish an ambience conducive to networking and knowledge sharing across boundaries. In this paper, we explore this hypothesis at both theoretical and empirical levels. Theoretically, we propose a conceptualization of relational knowledge leadership, which is ‘nomadic’ in its capacity to travel across multiple scales and cross sectoral, thematic and geographical boundaries. We have operationalized this type of relational knowledge leadership along four key features, derived from literatures on regional learning, organizational leadership and place leadership. Two empirical case studies are then presented, one from Birmingham in the UK and one from Eindhoven in the Netherlands, exploring how these features are expressed on the sub-national level. Also conclusions are drawn regarding the status of relational knowledge leadership. It is argued that the concept of relational knowledge leadership as viewed through our analytical lens does accord with the experience of leadership in the two cases presented. The cases also show that this style of leadership is confronted with three types of tensions that play through knowledge networking. Furthermore, it is argued that the cases exhibit this style of leadership to different degrees, reflecting their different cultural and political contexts.
Failures to Imagine
Authors: Maxwell Reed , Lynn Steven Jay , Lilienfeld Scott
Published: February 2017

Although interest in the relationship between mental imagery and psychopathology has increased greatly over the last decade, few publications to date have examined relationships between personality-related psychopathology and mental imagery use, abilities, or both. However, we have reason to expect that substantive relationships may exist. For example, studies have consistently linked psychopathy and borderline personality disorder to problems in emotion experience and emotion regulation, and a growing number of studies indicate that deficits in visual mental imagery use and ability in particular may contribute to such problems. Using correlational data from multiple self-report measures of normal and pathological personality functioning and visual mental imagery, our study presents preliminary evidence for lower levels of self-reported visual mental imagery use, abilities, or both among noncriminal individuals with higher levels of self-reported psychopathy and individuals with greater emotional regulation difficulties, a core feature of borderline personality disorder. We also found significant relationships among self-reported visual mental imagery use, ability, or both, and personality variables shown to strongly predict psychopathy and emotional regulation difficulties. Limitations of the study, especially its reliance on a correlational, cross-sectional design, are discussed, and implications for future research are explored.
Mindfulness and Lucid Dream Frequency Predicts the Ability to Control Lucid Dreams
Authors: Stumbrys Tadas , Erlacher Daniel
Published: February 2017

In lucid dreams, the dreamer is aware that one is dreaming; however, this does not necessary imply that the dreamer has complete control over the ongoing dream narrative. The present study explored the extent to which the lucid dreamers are able to control their dreams, as well as underlying factors. An online survey was completed by 528 respondents, of whom 386 had lucid dream experience. According to their reports, full control over the dream body is possible in about two thirds of cases, while control of the dream environment and the ability to maintain dream awareness are possible in less than half of cases. The main predictors of lucid dream control were higher lucid dream frequency and dispositional mindfulness in wakefulness, as well as younger age. The findings suggest that by cultivating mindfulness lucid dreamers might be able to develop greater dream control; however, further longitudinal research is needed.
Preoperative prediction of papillary thyroid microcarcinoma via multiparameter ultrasound
Authors: Ma Hui Juan , Yang Jing Chun , Leng Zhen Peng , Chang Ying , Kang Hua , Teng Liang Hong
Published: February 2017

Background

Accurate diagnosis of papillary thyroid microcarcinoma (PTMC) is important for further management. Ultrasound (US) is the most frequently used imaging modality for PTMC.

Purpose

To evaluate the diagnostic value of conventional US, contrast-enhanced ultrasound (CEUS) and real-time elastography (RTE) for patients with PTMC.

Material and Methods

In total, 135 patients with subcentimeter thyroid nodules who underwent conventional US, CEUS, and RTE before surgery were enrolled. A multivariate logistic regression analysis was performed to assess the independent predictors of PTMC. The diagnostic performances of conventional US, CEUS, and RTE were evaluated with a receiver operating characteristic (ROC) curve analysis.

Results

A taller-than-wide shape was identified as the strongest predictor of PTMC (odds ratio [OR], 25.21), followed by heterogeneous enhancement (OR, 24.03), marked hypoechogenicity (OR, 21.71), poorly defined margin (OR, 5.51), strain ratio (OR, 2.59), and age (OR, 0.92; all P values < 0.05). Heterogeneous enhancement on CEUS showed the highest positive predictive value (PPV; 88.0%) and an accuracy of 83.7%. A logistic regression model was created to predict PTMC using conventional US, CEUS, and RTE. The area under the ROC curve was 0.97, with a sensitivity of 88.6% and a specificity of 94.6%.

Conclusion

Conventional US combined with CEUS and RTE can improve the diagnostic accuracy of PTMC.
Anatomic and Biomechanical Comparison of the Classic and Congruent-Arc Techniques of the Latarjet Procedure
Authors: Montgomery Scott R. , Katthagen J. Christoph , Mikula Jacob D. , Marchetti Daniel Cole , Tahal Dimitri S. , Dornan Grant J. , Dahl Kimi D. , Brady Alex W. , Turnbull Travis Lee , Millett Peter J.
Published: February 2017

Background:

The Latarjet procedure is commonly performed using either the classic or the congruent-arc technique. Each technique has potential clinical advantages and disadvantages. However, data on the anatomic and biomechanical effects, benefits, and limitations of each technique are limited.

Hypothesis/Purpose:

To compare the anatomy and biomechanical fixation strength (failure load) between the 2 techniques. It was hypothesized that the classic technique would have superior initial fixation when compared with the congruent-arc technique and that this would be affected by sex and coracoid size.

Study Design:

Controlled laboratory study.

Methods:

A biomechanical cadaver study was performed with 20 pairs of male and female shoulders. One of each pair of shoulders was randomly assigned to receive the classic or congruent-arc technique. Coracoid and glenoid anatomic measurements were collected before biomechanical testing. A tensile force was applied through the conjoined tendon to replicate forces experienced by the coracoid graft in the early postoperative period, and the failure load was determined for each specimen.

Results:

The mean ± SD surface area available for fixation was 263 ± 63 mm2 in the classic technique compared with 177 ± 63 mm2 in the congruent-arc group ( P < .001). 36% of the glenoid width was recreated in the classic group and 50% in the congruent-arc group ( P < .001). The congruent-arc technique resulted in a significantly lower ( P = .005) mean failure load (239 ± 91 N) compared with the classic technique (303 ± 114 N). Failure load was significantly higher in males ( P = .037); male specimens had a mean failure load of 344 ± 122 N for the classic technique and 289 ± 73 N for the congruent-arc technique, and females had a mean failure load of 266 ± 98 N and 194 ± 84 N, respectively.

Conclusion:

In this biomechanical model, the classic technique of the Latarjet procedure provided a greater surface area for healing to the glenoid and superior initial fixation when compared with the congruent-arc technique. The congruent-arc technique allowed restoration of a larger glenoid defect.

Clinical Relevance:

The classic and congruent-arc techniques of coracoid transfer have anatomic and biomechanical advantages and disadvantages that should be considered when choosing between the 2 techniques.
Medicalization, Normalization, and Performance Edge: Teachers’ Attitudes about ADHD Medication Use and the Influence of Race and Social Class
Authors: Simoni Zachary R.
Published: February 2017

Little qualitative sociological research has investigated teachers’ attitudes supporting or opposing medication use for Attention-deficit/Hyperactivity Disorder (ADHD) and how these attitudes vary by social class and race. This study aims to fill that gap by conducting a thematic analysis using qualitative data gathered from 34 semistructured interviews with elementary school teachers in a medium-sized metropolitan area. Emergent themes in support of ADHD medication use include severity of ADHD symptoms and academic normalcy. Emergent themes in opposition to ADHD medication use included personality change and medicalization. In addition, African American teachers and teachers from lower-class areas were less approving of medication use for ADHD. In contrast, white teachers and teachers from upper-class areas were more in favor of medication use. I conclude with a discussion concerning attitudes for medication use in relation to teachers’ race and neighborhood-level social class, medicalization, and medical mistrust.
Collective Security, Fear of Crime, and Support for Concealed Firearms on a University Campus in the Western United States
Authors: De Angelis Joseph , Benz Terressa A. , Gillham Patrick
Published: February 2017

Recently, a number of state legislatures in the United States have sought to loosen restrictions on the carrying of concealed firearms on university campuses. Often these legislative initiatives are driven by the argument that concealed firearms on campuses will deter crime. Unfortunately, little attention has been paid to variation in employee support for the carrying of concealed firearms. Moreover, little is known about the intersection between fear of crime, trust in the police, and support for concealed firearms on campus. Given that, this study draws on a survey administered to a random sample of faculty and staff at one large rural university in the Western United States ( n = 1,170). More specifically, this study examines whether fear of workplace violence and/or trust in police and local government predict/predicts support for concealed firearms on campus, even after controlling for other potential factors such as prior victimization, political orientation, and demographic background. Results indicate that fear of violence and distrust in the police/government are strongly related to support for concealed carry, though a number of other factors matter, including political orientation, social capital, and respondent demographic characteristics.
The Institutionalization of CCO Scholarship: Trends from 2000 to 2015
Authors: Boivin Geneviève , Brummans Boris H. J. M. , Barker James R.
Published: February 2017

This article presents an empirical analysis of the communicative constitution of organization (CCO) literature to demonstrate how, and to what extent, CCO scholarship is becoming established within organizational communication studies and related fields. We assess the trajectory of CCO research from 2000 to 2015 and, via the application of a neo-institutional perspective, show that CCO scholarship is gaining legitimacy within organizational communication and is becoming increasingly recognized in fields such as management and organization studies, although it has not focused extensively on formalizing its approaches to investigating how organizations are produced in communication. Our analysis reveals key questions and challenges that future CCO scholarship should address to strengthen its institutional legitimacy and influence.
‘Capitalism 2.0’: Web 2.0 Manifestoes and the New Spirit of Capitalism
Authors: Yeritsian Gary
Published: February 2017

This article locates social media management literature in relation to broader shifts in management ideology. While studies of recent management ideology have highlighted its emphasis on the participation and autonomy of labor, they have largely failed to address how similar discourses have developed with respect to the informal ‘digital labor’ of social media users. I argue that the ‘new spirit of capitalism’ has spread from the formal workplace to the internet, and from the employee to the user. More specifically, I carry out a thematic analysis of ‘Web 2.0 manifestoes’ that finds them to be animated by three central ‘frames’: (a) user participation; (b) the pooling together of the contributions arising from that participation via the network; and (c) the resulting transformation of business and society. I conclude by pointing to the persistence of these sorts of ‘normative’ managerial discourses around social media, even with the recent prevalence of more ‘rational’ data-centered discourses.
‘Justice for Janitors’ goes Dutch: the limits and possibilities of unions’ adoption of organizing in a context of regulated social partnership
Authors: Connolly Heather , Marino Stefania , Martinez Lucio Miguel
Published: February 2017

Organizing has been adopted as a strategy for union renewal in the Netherlands, where the dominant repertoire has been consensus-based social dialogue. Certain Dutch unions have developed strategies inspired by the US ‘organizing model’ and have been relatively successful in recruiting and mobilizing under-represented workers. Despite some tensions emerging, the introduction of organizing resulted in the greater representation of workers in sectors such as cleaning, which has to an extent complemented social dialogue-based strategies. At the same time, the narrative and tactics of organizing have stimulated internal debate on union purpose and identity and indirectly contributed to a process of reform and democratization within parts of the union movement. The research demonstrates the pragmatic features of organizing as a strategy for union renewal in a context of regulated social partnership, but also points towards the potential for organizing to encourage shifts in the dominant sources of union legitimacy and power.
Publicness in times of market accountability: Lessons from a changing hospital industry in Germany
Authors: Bode Ingo
Published: February 2017

Drawing on findings from a multiple case study on the changing hospital industry in Germany, this article sheds fresh light on the implications new public management-driven regulatory frameworks may have regarding the ‘publicness’ of public service settings. It is shown that, in the area under study, key ingredients of the settings’ traditional mission persist, as do expectations towards soci(et)al effectiveness of actual service delivery. However, this is paralleled by the rise of market accountability within and around these settings which undergirds the ‘privateness’ of public-service providing undertakings. Hydrid accountability relations coincide with a new organisational settlement which leads to a fuzzy configuration regarding the role of publicness. This is why a consistent reinvention of the latter is unlikely to occur under a regulatory framework featuring non-statutory and competitive public service provision.
A comprehensive analysis of three-phase electrolyte conductivity during electrochemical macromachining/micromachining
Authors: Jain VK , Chouksey Ankit Kumar
Published: February 2017

Electrolyte electrical conductivity plays a vital role as a process parameter during electrochemical macromachining as well as micromachining, especially during anode shape prediction and tool design. Electrolyte electrical conductivity during electrochemical machining varies due to generation of gas bubbles at the tool and workpiece surfaces, sludge due to the dissolution of workpiece material, and heat due to the flow of electric current in the circuit. The electrolyte becomes a multiphase system. A mathematical model to predict the electrolyte electrical conductivity in the multiphase system is presented in this article. An experimental study has also been carried out to validate the proposed model. This model has been applied to study the variation in electrolyte electrical conductivity along the electrolyte flow direction during electrochemical micromachining by measuring change in workpiece thickness. Optimum input machining parameters are also presented at which the change in electrolyte conductivity is negligible in the machining zone.
The Marrakesh Copyright Treaty for those with visual disabilities and its implications in the European Union and in the United Kingdom
Authors: Oppenheim Charles
Published: February 2017

A review is provided of the current state of play for the Marrakesh Treaty providing exceptions to copyright, allowing those with visual disabilities or organisations acting on their behalf to make accessible copies of works, in order to assist those with such visual disabilities. A key feature of this Treaty is the fact that it is the first international copyright treaty that gives users, as opposed to copyright holders, explicit rights that cannot be overridden by contract or by technical protection measures. Another key feature is that it provides users with the possibility of receiving ‘accessible copies’ of works from abroad. The current situation regarding implementation of the Treaty with 88 countries signing up to it, but only 25 so far having ratified it, is provided, together with an analysis of the position in the European Union (EU) and an analysis of the United Kingdom’s curiously inconsistent attitude towards the Treaty, when compared to its own even more generous provisions for those with all disabilities, not just visual ones. An explanation of this inconsistent approach – the intense euroscepticism of the UK Government leading to its unwillingness to let the EU pass directives, together with the manner in which the problem has been bypassed by the European Court of Justice – is given.
‘Deus Vult!’ The Idea of Crusading in Finnish Clerical War Rhetoric, 1941–1944
Authors: Tilli Jouni
Published: February 2017

Finland’s Winter War (1939–40) against the Soviet Union had been defensive, but the so-called Continuation War that broke out in June 1941 was not. This offensive operation in alliance with Nazi Germany demanded a thorough justification. The Lutheran clergy were important in legitimizing the war because the priests were de jure officials of the state, as well as of the church. Also, nearly 96 per cent of Finns belonged to the Lutheran Church. This article analyses how the Lutheran clergy used crusading imagery in the Continuation War, 1941–4, strategically shifting the emphasis as the war progressed.
Subnational transnational networking and the continuing process of local-level Europeanization
Authors: Huggins Christopher
Published: February 2017

One of the features of local-level Europeanization has been the emergence of transnational networking (TN) undertaken by subnational authorities (SNAs). This activity, which received much attention during the 1990s, enables SNAs to take advantage of the opportunities created by European integration. However, empirical analyses of TN are lacking, despite European integration and the wider context SNAs find themselves within evolving. Consequently, little remains understood about how SNAs engage in TN and how they are affected by Europeanization pressures. Using the case of TN undertaken by SNAs in South East England and Northern France, this article finds that Europeanization has created more opportunities for SNAs to engage at the European level. SNAs have, in turn, taken advantage of these opportunities, leading to increased participation in TN. However, SNAs’ approaches to TN are not uniform. Engagement remains marked by differentiation as local-level factors, such as local strategy and political objectives, affect how SNAs participate in TN. This differentiation is likely to become increasingly marked as SNAs respond to contemporary challenges, such as budgetary pressures and, in the case of South East England, Brexit.
Beyond the youth culture: Understanding middle-aged skateboarders through temporal capital
Authors: O’Connor Paul
Published: February 2017

Responding to the call of Wheaton to discuss the position of older participants in lifestyle sports, this research presents an analysis of the experiences of middle-aged skateboarders. Through qualitative interviews, ethnographic observation, and discourse analysis of skateboard media, skateboarding is revealed to be an integral part of the biographies and identities of middle-aged skateboarders. These accounts challenge the imaging of skateboarding as a youth culture and indicate that age and time have an important currency to skateboarders. The value of age is not confined to middle-aged skateboarders but is also observable in skateboard media which corresponds with the values held more broadly in skateboard culture. The concept of temporal capital is proposed as a way to make sense of the experiences of middle-aged skateboarders, highlighting how time is at once a path to subcultural authenticity, but also a resource to be managed and scheduled for their continued engagement in skateboarding.
Resisting neo-liberalism, reclaiming democracy? 21st-century organised labour beyond Polanyi and Streeck
Authors: Lloyd Christopher , Ramsay Tony
Published: February 2017

Despite its greatly weakened condition, could organised labour again be counter-hegemonic to and ultimately transformative of capitalism? Or is the current crisis, a crisis of collapse of manufacturing and wages and under-consumption due to the loss of redistributive power by key socio-political agents, possibly the final crisis of unionism, as argued by Wolfgang Streeck? Some on the political left, such as Streeck, argue that a new phase has been reached where redistributive and oppositional power of organised labour has been not just defeated but destroyed, with enormous consequences for the future of workers and capitalism itself. This article rejects such an overly pessimistic interpretation and asks what the possibility is of the labour movement’s again playing its historic role of transforming capitalism. It explores the potential role of organised labour in re-embedding the economy within democratic society, as Karl Polanyi argued, and building a socio-economic structure that is both stable and enhancing of social and environmental health. This problem is approached through a critique of the theories of Polanyi and Streeck and an examination of the unfortunate embrace of labourism and accommodation to neo-liberalism in the Australian labour movement.
The self is an illusion: a conceptual framework for psychotherapy
Authors: Stankevicius Steve
Published: February 2017

Objective:

To explain the illusory nature of the self and explore its implications for psychotherapy.

Conclusions:

Our usual experience of the self is an illusion. Rather than a discrete entity, it is a network of processes that maintains apparent irreducible unity via alterations of perceptions, beliefs, intentions and memories. By providing an efficient summary of an individual and its surroundings, the self-illusion allows one to predict, experience and interact with the world efficiently. Targeting mechanisms that preserve the self-illusion could provide a focus for psychotherapy. Viewing the self as a complex network offers a valuable conceptual framework for psychotherapy.
Integrative Therapeutic Approaches for the Management and Control of Nausea in Children Undergoing Cancer Treatment: A Systematic Review of Literature
Authors: Momani Tha’er G. , Berry Donna L.
Published: February 2017

Chemotherapy-induced nausea and vomiting (CINV) continues to be a common symptom experienced by children undergoing cancer treatment despite the use of contemporary antiemetics. Integrative therapeutic approaches in addition to standard pharmacologic antiemetic regimes offer potential to control CINV. The purpose of this review was to identify current evidence on integrative therapeutic approaches for the control of CINV in children with cancer. Online search engines (PubMed, CINAHL, PsychINFO) were queried using MESH terms. Titles, abstracts, and then full-text articles were reviewed for relevance to the review. The search resulted in 53 studies. Twenty-one studies met our review criteria. Integrative therapies identified included acupuncture/acupressure, aromatherapy, herbal supplements, hypnosis, and other cognitive behavioral interventions. Our review identified little information on the effectiveness and safety of most integrative therapeutic approaches for the control and management of CINV in children with cancer. However, evidence from adult cancer studies and some pediatric studies identify promising interventions for further testing.
Identification of Predictors for Treatment Failure in Hepatitis C Virus Patients Treated With Ledipasvir and Sofosbuvir
Authors: Jansen Jeffrey W. , Powderly Gillian M. , Linneman Travis W.
Published: February 2017

Background: New hepatitis C virus (HCV) therapies report cure rates of ~90% but are expensive. Identification of predictors for treatment failure could help decrease health care costs, limit unnecessary drug exposure and adverse events, and prevent drug-drug interactions. Failure to achieve rapid viral response (RVR), defined as detectable viral load at 4 weeks, has previously been identified as a predictor of treatment failure with some previous HCV therapies. Objective: To evaluate RVR, and other potential variables, as predictors of treatment failure in patients treated with ledipasvir and sofosbuvir (LDV/SOF). Methods: A retrospective, case-control analysis of adult veterans treated with LDV/SOF was conducted. Included patients had a viral load obtained between weeks 3 and 6 of therapy (RVR) and between weeks 12 and 16 after the end of therapy for sustained viral response (SVR12) evaluation. Identified SVR12 failures (viral load detectable) constituted the case population. The control population was randomly selected in a 1:4 case: control ratio from all identified SVR12 successes. Results: In all, 12 SVR12 failures were identified; 48 of 144 SVR12 successes were randomly selected for inclusion. Overall failure rate was 7.7% (12/156). Univariate analysis identified histamine-2 receptor antagonist, previous treatment failure, and pretreatment creatinine clearance (CrCl; Cockcroft-Gault) >90 mL/min as potential predictors of SVR12 failure; these variables were included in the regression model with RVR per protocol. In multivariate analysis, pretreatment CrCl >90 mL/min was independently associated with SVR12 failure (odds ratio = 7.27; 95% CI = 1.33 to 39.72; P = 0.022). Conclusions: Patients with pretreatment CrCl >90 mL/min were more likely to fail SVR12 than patients with CrCl <90 mL/min.
Clinical use of Antiviral Drugs
Authors: Nahata Milap C.
Published: February 2017

Remarkable progress has been made in antiviral chemotherapy. Six approved antiviral drugs are now available for the treatment of various viral infections. Trifluridine, idoxuridine and vidarabine are all effective in patients with herpes keratitis; trifluridine is preferred due to its low toxicity. Acyclovir is the drug of choice in patients with infections due to herpes simplex viruses, including genital herpes, herpes encephalitis, and neonatal herpes, and infections due to varicella-zoster virus. Amantadine is the only drug currently available for prophylaxis and treatment of influenza A, but an investigational drug, rimantadine, appears to be equally effective and less toxic than amantadine. Ribavirin is the most recently approved antiviral agent for the treatment of respiratory syncytial virus infections. Numerous antiviral drugs are being studied in patients with acquired immunodeficiency syndrome. Although currently available drugs have improved our ability to manage a variety of viral illnesses, much needs to be learned about specific dosage guidelines based on the studies of pharmacokinetics, pharmacodynamics, potential adverse effects and viral resistance, and the role of combination therapy to optimize therapy.
Pharmacokinetic Monitoring in the Community Health-Care Setting
Authors: Gums John G. , Robinson J. Daniel
Published: February 2017

Ambulatory care pharmacokinetic profiling has been utilized with increasing frequency over the last decade. The demonstration of need is the first step in initiating outpatient pharmacokinetic service. This article identifies methods used in demonstrating a need and discusses the normal daily activities of an ambulatory pharmacokinetic service located in a university-based family medicine clinic. The reader will also learn of trends that ambulatory care pharmacokinetic programs will become involved with in the near future.
Should Dihydroergotamine-Heparin be used for Prevention of Postoperative Thromboembolism?
Authors: Emory Catherine E. , Cuddy Paul G. , Alexander Michael R. , Conner Christopher S.
Published: February 2017

The combination of heparin 5000 U and dihydroergotamine 0.5 mg (HDHE) was marketed in the U.S. in 1985 for prophylaxis of postoperative deep venous thrombosis (DVT). This article evaluates the efficacy, safety, and cost of HDHE for abdominal, pelvic, thoracic, and total hip surgical prophylaxis. Although several controlled trials comparing HDHE to minidose heparin (MDH) indicate superior efficacy of HDHE for nonorthopedic surgical procedures, others do not. Differences in study design and insufficient sample sizes may account for the dichotomy. In the U.S. Multicenter Trial, MDH was surprisingly ineffective for preventing radiofibrinogen uptake test-proven DVT. The apparent superiority of HDHE over MDH is therefore questionable. Ergot-related side effects have been minimized in all studies due to careful patient selection. In actual use, the potential for such side effects appears to be increased. Because twice-daily HDHE is no more effective, costs 4–11 times more, and may pose a greater risk than MDH, the authors do not recommend its use for general surgical prophylaxis. HDHE may prove to be useful in patients undergoing total hip replacement.
Therapeutic Dosing of Pralidoxime Chloride
Authors: Thompson Dennis F. , Thompson G. Dail , Greenwood Robert B. , Trammel Harold L.
Published: February 2017

Pralidoxime chloride is a useful agent in the treatment of organophosphate poisoning. Poisindex, a widely used poisoning treatment resource, recommends dosing pralidoxime chloride as an intermittent iv infusion every 8–12 hours, whereas other authors have used continuous iv infusion with good results. Available animal data suggest that a serum concentration of 4 μg/ml may be a minimal level to protect against the toxic effects of organophosphates. Pharmacokinetic simulations, based on parameters obtained from healthy nonpoisoned subjects, show that pralidoxime levels fall rapidly to <4 μg/ml within 1.5–2 hours after a 1-g iv bolus. Continuous iv infusion (0.5 g/h) maintains pralidoxime levels >4 μg/ml throughout the length of infusion. We conclude that continuous iv infusion of pralidoxime chloride may be the preferred method of administration in patients with acute organophosphate poisoning. Clinical trials will be necessary to document the effectiveness of this regimen.
Constant Morphine Infusion for Severe Sickle Cell Crisis Pain
Authors: Ives Timothy J. , Guerra Marc F.
Published: February 2017

The use of a constant infusion of intravenous morphine sulfate in a patient with severe sickle cell crisis is described. After several days of poor control with intramuscular and intravenous narcotic injections, adequate analgesia was obtained with the infusion of morphine within two hours of initiation of therapy. No adverse effects were noted. With the advantages provided by an intravenous narcotic infusion, this protocol should be considered as a suitable alternative to conventional methods for providing pain control in patients in sickle cell crisis.
Comparative Evaluation of the Three Commercially Available Transdermal Nitroglycerin Delivery Systems
Authors: Cronin Carol M. , Mitrano Erasmo A. , Wilder Rowena S. , Harmon Elizabeth P. , Zusman Randall M.
Published: February 2017

We comparatively evaluated the patient preference for each of the three commercially available transdermal nitroglycerin delivery systems using a randomized crossover study design. Preference was determined by ease of application, adhesion, occurrence of local irritation at the site of application, and systemic toxicities. In addition, we recorded the number of nitroglycerin tablets taken and angina attacks reported per treatment course. Each treatment course was one month long, with each patient participating for a total of three months. This allowed all patients to be exposed to each of the three products for one treatment course, thereby serving as their own controls.

Thirty-eight patients completed the three-phase crossover and expressed a preference. Results showed that Transderm-Nitro was significantly preferred over both Nitro-Dur and Nitrodisc (p < 0.005). Most of the preferences were based on cosmetic appearances or adhesive qualities. Additionally, results showed that there was no difference in efficacy among the three products when number of angina attacks reported and number of nitroglycerin tablets taken were compared.
Surgical Antibiotic Prophylaxis, Patient Morbidity, and Cost Reduction: A Three-Year Study
Authors: Scalley Robert D. , Irwin Alan D. , Poduska Paul J. , Wolff Albert J. , Cochran Robert S.
Published: February 2017

Twenty-five to 50 percent of all antibiotics prescribed for hospitalized patients are for prevention, not treatment, of infection. Procedures to institute rational, cost-effective utilization of these agents should have a significant impact on drug cost and pharmacy inventory. Several authors have described antibiotic cost reduction programs using pharmacy intervention. Unfortunately, measures that are successful in one institution may not be effective or appropriate in another.

A three-year study was undertaken to examine the impact on physician prescribing of an infection control bulletin and formalized recommendations for antibiotic utilization. Patient records also were examined to determine if any change in antibiotic utilization would influence patient morbidity. Over the three examination periods there was a significant reduction in cost of prophylaxis in 7 surgical groups, and a trend toward cost reduction in 21 additional groups. Cost of prophylaxis also increased in other surgical groups. Cost reduction was associated with limited duration of prophylaxis and a shift toward use of first generation cephalosporin products. Patient morbidity did not differ significantly.
Dedifferentiated Liposarcoma of the Retroperitoneum With Heterologous Osteosarcomatous Differentiation and a Striking Aneurysmal Bone Cyst–Like Morphology
Authors: Van Haverbeke Carole , Van Dorpe Jo , Lecoutere Evelyne , Flucke Uta , Ferdinande Liesbeth , Creytens David
Published: February 2017

A 69-year-old woman with a 10-year medical history of recurrent retroperitoneal dedifferentiated liposarcoma presented with a 3-cm large hemorrhagic and multicystic left-sided retroperitoneal mass. Histopathological examination of the resected specimen showed a heterogeneous, high-grade mesenchymal nonlipogenic tumor with areas of osteoblastic/osteosarcomatous differentiation and aneurysmal bone cyst–like features. Based on the clinical presentation, the morphology, and the supportive immunohistochemical and molecular findings (MDM2 overexpression and amplification of the MDM2 gene, respectively), a diagnosis of a dedifferentiated liposarcoma with heterologous osteosarcomatous differentiation and an aneurysmal bone cyst–like morphology was made. To the best of our knowledge, this is the first description of aneurysmal bone cyst–like morphology in dedifferentiated liposarcoma, further expanding the broad morphological spectrum of dedifferentiated liposarcoma.
Operative Repair of the Fixed Hammertoe Deformity
Authors: Coughlin Michael J. , Dorris John , Polk Eben
Published: February 2017

Sixty-three patients (118 toes) were evaluated at an average 61 month follow-up following PIP resection arthroplasty for a fixed hammertoe deformity. The deformity involved the second toe in 35%, the third toe in 21%, the fourth toe in 24%, and the fifth toe in 20%. The involved toe averaged 2 mm. greater length than the adjacent toes and was longer in 49/94 (52%). Seventy-eight percent of patients complained of pain preoperatively due to the hammertoe deformity and 49% complained of callus formation. Following a resection arthroplasty technique with intramedullary Kirschner wire fixation, fusion of the PIP joint occurred in 81% of toes. A fibrous union resulted in the remaining 19% of cases. Patients rated subjective alignment as acceptable in 86% of cases and radiographic alignment was rated as good in 79%. Malalignment and numbness were the major factors associated with an unsuccessful result. Pain was relieved in 92%of patients and subjective satisfaction was noted by 84% of patients. Minor complications occurred in 5%. The average postoperative AOFAS score was 83 points.

Resection arthroplasty of the proximal interphalangeal joint with intramedullary Kirschner wire fixation as a technique for correction of a fixed hammertoe deformity is a reliable technique that consistently gives a high level of satisfactory results.
Sinus Tarsi Approach with Trans-articular Fixation for Displaced Intra-articular Fractures of the Calcaneus
Authors: Ebraheim Nabil A. , Elgafy Hossein , Sabry Fady F. , Freih Mouhanad , Abou-Chakra Iman S.
Published: February 2017

The charts and radiographs of 99 patients with 106 intraarticular fractures of the calcaneus were retrospectively reviewed. There were 75 men and 24 women. The average age was forty-two (range, 17 to 81). Fifty-seven of the fractures were left and 49 were right. The mechanism of injury was a fall from a height in 69 patients and motor vehicle accident in 30 patients. According to Sanders classification, seventy-one cases (67%) had type II fractures, 25 cases (23.6%) had type III, and ten cases (9.4%) had type IV. All the patients had operative management through a limited sinus tarsi approach with minimal fixation of the fracture with one or several pins. One of the pins was usually applied from the talus to the calcaneus through the fracture after reduction of the posterior facet. Nine cases (8.5%) developed postoperative infection, four cases (3.8%) had superficial wound infection, four cases (3.8%) had pin tract infection and one case (0.9%) had osteomylitis. Our follow-up at an average of 29 months (range, 12 to 84 months) showed that the American Orthopedic Foot and Ankle Society, Ankle-Hindfoot Score for the all group was 77.6 (range, 31–91). Forty-one fractures (38.8%) were graded excellent, 39 fractures (36.7%) good, 14 fractures (13.2%) fair, and 12 fractures (11.3%) were failures. Although radiological degenerative changes in the subtalar joint were seen in 41 cases (38.7%), only six cases (5.6%) required subsequent subtalar fusion. The authors conclude that the operative method used in the current study which followed the principle of minimal soft tissue damage and minimal internal fixation may be a good option for management of calcaneus fractures.
Internal Architecture of the Calcaneus: Implications for Calcaneus Fractures
Authors: Sabry Fady F. , Ebraheim Nabil A. , Mehalik John N. , Rezcallah Anthony T.
Published: February 2017

Study Design

Fourteen cadaveri specimens were sectioned to analyze the internal architecture of the human calcaneus. We described the arrangement and orientation of trabecular patterns within the calcaneus and made multiple measurements of its cortical thickness.

Objective

To characterize the internal architecture of the calcaneus and correlate these findings with well-described patterns of calcaneus fracture in order to better understand the fracture mechanics of this common fracture.

Methods

Fourteen dry, frozen, human calcanei were sectioned using a saw. In each the coronal, sagittal and axial planes, we sectioned separate specimens into slices of 0.5mm thickness. High-resolution radiographic images were taken of the sectioned specimens. The internal trabecular arrays were described and measurements of cortical thickness were recorded. The correlation between these findings and the known pattern of calcaneal fractures was analyzed.

RESULTS

A dominant trabecular pattern running anteroposteriorly along the long axis of the calcaneus was observed. In the posterior tuberosity the trabeculae were arranged parallel to the posterior border. There was an area of sparse or absent mineralization in the anterior part of the calcaneus corresponding to the “neutral triangle” described by Wood and Harty 10, 23. The thickest sites of the calcaneal cortex were the lower pole of the posterior tuberosity, the upper surface at the angle of Gissane, and the lateral surface below the anterior portion of the posterior facet.

Conclusion

The trabecular architecture of the calcaneus is created by applied stress in concordance with Wolff's law. The weakest plane of resistance to stress is parallel to these organized trabeculae or through areas lacking trabeculae. This study demonstrates that the primary and secondary fracture lines commonly encountered in calcaneus fractures correlates with the internal architectural map of the calcaneal trabecular patterns.
Treatment Strategies in Osteochondral Defects of the Talar Dome: a Systematic Review
Authors: Tol J.L. , Struijs P.A.A. , Bossuyt P.M.M. , Verhagen R.A.W. , van Dijk C.N.
Published: February 2017

The aim of this study was to investigate the results of different treatment strategies for osteochondral defects (OCD) of the talus. Electronic databases from 1966 to July 1998 were systematically screened. Based on our inclusion criteria 32 studies describing the results of treatment strategies for OCD of the talus were included. No randomized clinical trials (RCT's) were identified. Fourteen studies described the results of excision alone, 11 the results of (EC), 14 the results of (ECD), 1 the results of cancellous bone grafting after EC, 1 the results of osteochondral transplantation and 3 the results of fixation. The average success rate of non-operative treatment (NT) was 45%. Comparison of different surgical procedures shows that the average highest success rate was reached by excision, curettage and drilling (ECD) (85%) followed by excision and curettage (EC) (78%) and excision alone (38%). Based on this systematic review we conclude that NT and excision alone are not to be recommended in treating talar OCD. Both EC and ECD have been shown to lead to a high percentage good/excellent results. However, due to great diversity in the articles and variability in treatment results, no definitive conclusions can be drawn. Further prospective randomized controlled trials are required to compare the outcome of these two surgical strategies for OCD of the talus.
Ankle Biomechanics During Impact Landings on Uneven Surfaces
Authors: Self Brian P. , Harris Scott , Greenwald Richard M.
Published: February 2017

Inversion sprains of the lateral ligaments of the ankle are one of the most common of all sporting injuries. While the strains in the anterior talofibular (ATFL) and calcaneofibular (CFL) ligaments have been measured in quasi-static conditions, the dynamic strains during an actual traumatic event have not been determined. The present investigation determined the strains and strain rates in the ATFL and CFL during an in vitro inversion sprain. The ATFL tended to have higher strain and strain rate values than the CFL, which may explain why it is more often injured than the CFL.