bluuebunny/crossref_metadata_2025 huggingface dataset:
Pediatric OCD
Authors: Ginsberg Rachel E. , Morrison Samantha , Puliafico Anthony
Published: October 2017

This chapter outlines the clinical presentation and course of pediatric OCD, discusses its etiology and phenomenology, and describes principal assessment methods for evaluation of symptoms. Obsessive-compulsive disorder (OCD) often manifests during childhood and adolescence. Symptom presentation in children is similar to that in adults and is typically characterized by the presence of both obsessions and compulsions. Pediatric OCD is highly comorbid with other psychiatric disorders, and evidence suggests abnormal brain functioning in youth with OCD. The onset and progression of OCD in childhood have developmental implications, given the associated distress and interference with academic, social, and home functioning. Multiinformant and multidiagnostic evaluation, including administration of evidence-based semistructured clinical interviews and rating scales, is optimal.
Epidemiology, Comorbidity, and Burden of OCD
Authors: Torres Albina R. , Fontenelle Leonardo F. , Shavitt Roseli G. , Hoexter Marcelo Q. , Pittenger Christopher , Miguel Euripedes C.
Published: October 2017

This chapter addresses the interrelated topics of OCD epidemiology, comorbidity, and disease burden. Obsessive-compulsive disorder (OCD) is a frequent condition, especially if subthreshold manifestations are considered. Epidemiological surveys describe current and lifetime prevalence rates of full-blown OCD around 1% and 2.5%, respectively. Subthreshold symptoms occur in up to a third of the general population. Comorbidity is the rule in OCD, which increases the complexity, severity, distress, chronicity, and negative impact of the disorder. Comorbidity may influence the search for, adherence with, and response to treatment. OCD entails significant costs to society, both illness related and care/treatment related. Epidemiological surveys show that only a minority of individuals with OCD are receiving treatment. Recognition and treatment of OCD is often delayed for many years, increasing the morbidity and the burden of sufferers, family members, and society. Increasing public awareness, professional recognition, and access to treatment is an urgent clinical and public health need.
Incompleteness and Harm Avoidance in OCD
Authors: Pallanti Stefano , Barnes Jennifer , Pittenger Christopher , Eisen Jane
Published: October 2017

Obsessive-compulsive disorder (OCD) has been traditionally linked with the motivational dimension of harm avoidance (HA). However, there is increasing evidence for the involvement of a second core dimension, referred to as Incompleteness (INC) or “not just right experiences” (NJREs), in a substantial fraction of patients. INC-driven compulsions are typically driven by feelings of discomfort or tension, rather than by anxiety. Appreciation of the importance of INC in OCD is one of the factors that motivated the movement of OCD out of the Anxiety Disorders chapter and into its own grouping in the latest edition of the Diagnostic and Statistical Manual (DSM-5). Both dimensions seem to contribute to OCD symptomatology, thus representing core features underlying the disorder. In this chapter, the differential roles and neural substrates of HA and INC are discussed, together with the consequent theoretical and clinical implications.
Brain Functional Connectivity in OCD
Authors: Soriano-Mas Carles , Harrison Ben J.
Published: October 2017

This chapter provides an overview of studies assessing alterations in brain functional connectivity in obsessive-compulsive disorder (OCD) as assessed by functional magnetic resonance imaging (fMRI). Although most of the reviewed studies relate to the analysis of resting-state fMRI data, the chapter also reviews studies that have combined resting-state with structural or task-based approaches, as well as task-based studies in which the analysis of functional connectivity was reported. The main conclusions to be drawn from this review are that patients with OCD consistently demonstrate altered patterns of brain functional connectivity in large-scale “frontostriatal” and “default mode” networks, and that the heterogeneity of OCD symptoms is likely to partly arise via distinct modulatory influences on these networks by broader disturbances of affective, motivational, and regulatory systems. The variable nature of some findings across studies as well as the influence of medications on functional connectivity measures is also discussed.
Spontaneously Occurring Animal Models of OCD
Authors: Dodman Nicholas H. , Shuster Louis
Published: October 2017

This chapter summarizes what we know about compulsive behavioral disorders in several animal species. Animals can develop repetitive behaviors in a range of circumstances, generally associated with anxiety or stress. It is increasingly apparent that these behaviors recapitulate core features of obsessive-compulsive disorder. They are clearly partially genetic; for example, specific breeds of dog are susceptible to specific compulsive behavioral disorders. Understanding such OCD-like behaviors provides a potentially fruitful avenue towards understanding OCD in humans. This chapter reviews this literature, emphasizing the points of parallelism between repetitive behavior syndromes in animals and human disease. Recent advances in our understanding of the biology of these spontaneously occurring animal models, especially in dogs, have great potential to elucidate the pathophysiology of OCD.
Deep Brain Stimulation for Intractable OCD
Authors: Goodman Wayne K. , Kennedy Nigel , Lapidus Kyle , Kopell Brian H.
Published: October 2017

This chapter discusses the use of deep brain stimulation (DBS) for intractable OCD. In contrast to ablative procedures, DBS has the advantages of being reversible (explantable) and adjustable. In 2010, the FDA approved a Humanitarian Device Exemption (HDE) for ventral capsule/ventral striatum DBS in intractable OCD, based upon the device’s safety and its probable benefit, for up to 4,000 people a year in the US. DBS is only suitable for adult patients who remain severely ill despite multiple medication trials and adequate treatment with cognitive behavioral therapy. Further research is needed to further test the efficacy of DBS in OCD, compare targets, identify predictors of response, and optimize programming. Future DBS systems may take advantage of closed loop technology in which feedback from the brain is used to adjust stimulation automatically according to the patient’s changing needs.
Obsessive-Compulsive and Related Disorders
Authors: Phillips Katharine A.
Published: October 2017

The category of Obsessive-Compulsive and Related Disorders (OCRDs) is new to DSM-5 and was one of the more interesting, potentially impactful changes in the revised manual. The new DSM-5 chapter contains OCD, body dysmorphic disorder (BDD), hoarding disorder, trichotillomania (hair-pulling disorder), and excoriation (skin-picking) disorder. The addition of the new OCRD chapter to DSM-5, and grouping these disorders together, has diagnostic, clinical, and research implications. This chapter reviews why and how this new category was added to DSM-5, considers whether this grouping of disorders is correct, and examines the pros and cons of the change. The introduction OCRDs in DSM-5 had wide support. However, the current classification is not perfect, and much more research is needed to establish veridical relationships among disorders. In the meantime, it is hoped that these changes to DSM-5 yield advances in research and improvements in patient care.
Psychological Trauma Exposure and Obsessive-Compulsive Symptoms
Authors: McKay Dean , Ojserkis Rachel , Elhai Jon D.
Published: October 2017

This chapter has three broad aims: it outlines research on the shared and unique features of OCD and PTSD; it reviews the extant literature on how trauma exposure impacts treatment outcome for OCD; and it offers recommendations for treatment and future research on the intersection of trauma and OCD. Obsessive-compulsive disorder is a complex and heterogeneous condition. Considerable research has been conducted related to subtypes and symptom dimensions, but comparably little attention has been paid to commonly cooccurring psychiatric disorders. One diagnosis that has distinct etiological and prognostic implications is cooccurring posttraumatic stress disorder, and other trauma disorders. The chapter focuses on trauma generally and its impact on OCD. However, the literature also refers specifically to PTSD. Accordingly, the research related to PTSD is highlighted, to distinguish it from literature discussing trauma exposure more generally.
The Dynamics of Obsessive-Compulsive disorder: A Heuristic Framework
Authors: Pittenger Christopher , Gruner Patricia , Adams Thomas A. , Kelmendi Benjamin
Published: October 2017

Obsessive-compulsive disorder (OCD) is defined by the presence of obsessions and/or compulsions. In general, obsessions trigger anxiety or discomfort, whereas compulsions relieve it. Unfortunately, this transient relief can reinforce obsessions, compulsions, and the association between them. This feedback reinforcement has been described as the “OCD cycle.” Many of the specific issues explored throughout this text can be conceptualized in relation to this cycle. The heterogeneity of OCD symptomatology means there are many variations on this scheme. Despite these variations, the idea of a feedback cycle between obsessions and compulsions is broadly applicable and heuristically useful. Most treatments can be thought of as efforts to interrupt this cycle of reinforcement. This chapter explores the complexities of this feedback, and how it may be initiated and maintained. It is probable that different individuals with OCD can enter the cycle of maladaptive reinforcement via different routes.
OCD in the Educational Setting
Authors: Weg Allen H.
Published: October 2017

This chapter looks at how OCD is typically manifested in the school environment. Various symptom presentations are reviewed, each with multiple illustrations of how they might be manifested in students with OCD. Examination of how treatment protocols can be developed to reverse and minimize the effects of the disorder on school-related functioning is followed by an exploration of how school personnel, together with mental health professionals and parents, can become active participants in OCD therapy. A strong emphasis throughout is placed on educating the educators, and virtually all school personnel, on what OCD is, how it might appear in the academic setting, and how to respond to it. The goal is to promote early identification of the disorder and appropriate referral for treatment, as well as an understanding of how school personnel can be a part of the treatment process.
First Encounters
Authors: Hawkes Christopher H. , Sethi Kapil D. , Swift Thomas R.
Published: October 2017

This chapter describes disorders that can be diagnosed as the patient enters the consulting room, and how the patient turns to close the door, walks toward the clinician and shakes the clinician’s hand. Much information is gleaned by inspecting the face, clothes, fingernails, and jewelry or listening to the voice and smelling the breath. The clinician works as a bedside Sherlock Holmes. Some of the symptoms addressed in this chapter include hypersalivation, Horner's syndrome, and macroglossia. Individual disorders described include idiopathic intracranial hypertension, neurofibromatosis type 1, Sturge-Weber syndrome, Waardenburg syndrome, Vogt Harada Koyanagi syndrome, Fabry’s disease, fragile X syndrome, relapsing polychondritis, myasthenia gravis, Ehlers Danlos Syndrome type IV, Carney complex, cocaine and meth addiction, and ankylosing spondylitis, among others.
Myopathy and Motor Neuron Disorders
Authors: Hawkes Christopher H. , Sethi Kapil D. , Swift Thomas R.
Published: October 2017

This chapter deals with the main varieties of muscular dystrophy and their differential diagnosis, including dystrophia myotonica, Duchenne muscular dystrophy, Becker muscular dystrophy, facioscapulohumeral muscular dystrophy, limb girdle muscular dystrophy, Emery-Dreifuss muscular dystrophy and oculopharyngeal muscular dystrophy. Diagnostic clues are given for the main neuromuscular junction disorders, including myasthenia gravis and Lambert-Eaton myasthenic syndrome. Inflammatory and dysthyroid myopathies are evaluated. Also appraised are periodic paralysis, McArdle’s syndrome, mitochondrial, distal, and medication-induced myopathy. The characteristic features of amyotrophic lateral sclerosis and its mimics are debated as well as various forms of bulbar palsy. Hereditary spastic paraplegia and its variants are also included in the chapter.
Spinal Lesions and Cerebrospinal Fluid
Authors: Hawkes Christopher H. , Sethi Kapil D. , Swift Thomas R.
Published: October 2017

This chapter expounds on the major lesions of the spinal cord, whether from within the cord or from outside it, with particular emphasis on syringomyelia. Points from the history and examination that aid lesion localization are detailed, together with tips that might lead to a speedy diagnosis. Diagnostic clues for specific disorders are listed, such as spinal dural arteriovenous fistula and claudication. Detail is supplied on infectious myelopathies, in particular recurrent myelopathy and recurrent meningitis. Clues are given that would allow rapid interpretation of cerebrospinal fluid analysis, including high or low cell–protein ratio, cell and protein levels, chronic polymorphonuclear reaction, eosinophilia, and low glucose. The causes of a dry spinal tap are also outlined.
Peripheral Neuropathy
Authors: Hawkes Christopher H. , Sethi Kapil D. , Swift Thomas R.
Published: October 2017

This chapter divides discussion of peripheral neuropathy into sections on mononeuropathy, radiculopathy, and polyneuropathy. Disorders of major peripheral nerves are highlighted— median, ulnar, radial sciatic, and femoral nerves—and how their associated dysfunction may be identified speedily. Carpal tunnel syndrome and unilateral hip flexor weakness are discussed in this section, together with mononeuritis multiplex. Radiculopathy affecting the upper and lower limbs is detailed. Polyneuropathy is subdivided according to pattern of onset; accompanying pain; axonal or demyelinating; length- or non-length dependent; inherited or acquired; presence of nerve thickening; occurrence of tremor; skin, hair, or nail changes; deafness; ophthalmoplegia; anosmia; ageusia; and cataract.
Cancer
Authors: Firth Helen V. , Hurst Jane A.
Published: October 2017

This chapter discusses a range of familial cancer predisposition disorders and their genetic implications. The chapter mentions the key points for the examination, the investigations which may be indicated, strategies and resources for risk assessment, and the appropriate genetic advice, as well as a list of support groups.
Impact of Timing of Adjuvant Chemoradiation for Glioblastoma in a Large Hospital Database
Authors: Osborn Virginia W , Lee Anna , Garay Elizabeth , Safdieh Joseph , Schreiber David
Published: October 2017

BACKGROUND

Although the standard of care for glioblastoma remains maximal safe resection followed by chemoradiation, conflicting reports have emerged regarding the importance of the time interval between these 2 treatments.

OBJECTIVE

To assess whether differences in the duration between surgery and initiation of chemoradiation for glioblastoma had an impact on overall survival (OS) in a large hospital-based database.

METHODS

The National Cancer Database was queried to identify patients diagnosed with glioblastoma between 2010 and 2012 treated with surgery followed by chemoradiation. Patients who received biopsy only were excluded. The time from surgery to initiation of radiation therapy was divided into 4 equal quartiles of ≤24, 25 to 30, 31 to 37, and >37 d. Patient characteristics were compared between groups using Pearson Chi Square and Fisher's Exact test. OS was analyzed via the Kaplan–Meier method and compared via the log-rank test. Univariable and multivariable Cox regression were performed to assess for impact of covariables on OS.

RESULTS

A total of 11 652 patients were included in the analysis. Median duration from surgery to radiation was 30 d. On multivariable regression, black race, larger tumor, gross-total resection, methyguanine-methyl transferase (MGMT+), and treatment at an academic facility were associated with a duration >30 d. On multivariable analysis, there were no significant differences when comparing start within 24 d to 25 to 30 d (hazard ratio [HR] 0.96, 95% confidence interval [CI] 0.90-1.01, P = .13) or > 37 d (HR 0.97, 95% CI 0.91-1.03, P = .26), although a small OS improvement was seen if initiated within 31 to 37 d (HR 0.93, 95% CI 0.88-0.99, P = .02).

CONCLUSION

There was no clear association between duration from surgery to initiation of chemoradiation on OS.
Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on Otologic and Audiologic Screening for Patients With Vestibular Schwannomas
Authors: Sweeney Alex D , Carlson Matthew L , Shepard Neil T , McCracken D Jay , Vivas Esther X , Neff Brian A , Olson Jeffrey J
Published: October 2017

QUESTION 1

What is the expected diagnostic yield for vestibular schwannomas when using a magnetic resonance imaging (MRI) to evaluate patients with previously published definitions of asymmetric sensorineural hearing loss?

TARGET POPULATION

These recommendations apply to adults with an asymmetric sensorineural hearing loss on audiometric testing.

RECOMMENDATION

Level 3: On the basis of an audiogram, it is recommended that MRI screening on patients with ≥10 decibels (dB) of interaural difference at 2 or more contiguous frequencies or ≥15 dB at 1 frequency be pursued to minimize the incidence of undiagnosed vestibular schwannomas. However, selectively screening patients with ≥15 dB of interaural difference at 3000 Hz alone may minimize the incidence of MRIs performed that do not diagnose a vestibular schwannoma.

QUESTION 2

What is the expected diagnostic yield for vestibular schwannomas when using an MRI to evaluate patients with asymmetric tinnitus, as defined as either purely unilateral tinnitus or bilateral tinnitus with subjective asymmetry?

TARGET POPULATION

These recommendations apply to adults with subjective complaints of asymmetric tinnitus.

RECOMMENDATION

Level 3: It is recommended that MRI be used to evaluate patients with asymmetric tinnitus. However, this practice is low yielding in terms of vestibular schwannoma diagnosis (<1%).

QUESTION 3

What is the expected diagnostic yield for vestibular schwannomas when using an MRI to evaluate patients with a sudden sensorineural hearing loss?

TARGET POPULATION

These recommendations apply to adults with a verified sudden sensorineural hearing loss on an audiogram.

RECOMMENDATION

Level 3: It is recommended that MRI be used to evaluate patients with a sudden sensorineural hearing loss. However, this practice is low yielding in terms of vestibular schwannoma diagnosis (<3%).

 The full guideline can be found at: https://www.cns.org/guidelines/guidelines-management-patients-vestibular-schwannoma/chapter_2.
Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on Intraoperative Cranial Nerve Monitoring in Vestibular Schwannoma Surgery
Authors: Vivas Esther X , Carlson Matthew L , Neff Brian A , Shepard Neil T , McCracken D Jay , Sweeney Alex D , Olson Jeffrey J
Published: October 2017

FACIAL NERVE MONITORING

Question 1

Does intraoperative facial nerve monitoring during vestibular schwannoma surgery lead to better long-term facial nerve function?

Target Population

This recommendation applies to adult patients undergoing vestibular schwannoma surgery regardless of tumor characteristics.

Recommendation

Level 3: It is recommended that intraoperative facial nerve monitoring be routinely utilized during vestibular schwannoma surgery to improve long-term facial nerve function.

Question 2

Can intraoperative facial nerve monitoring be used to accurately predict favorable long-term facial nerve function after vestibular schwannoma surgery?

Target Population

This recommendation applies to adult patients undergoing vestibular schwannoma surgery.

Recommendation

Level 3: Intraoperative facial nerve can be used to accurately predict favorable long-term facial nerve function after vestibular schwannoma surgery. Specifically, the presence of favorable testing reliably portends a good long-term facial nerve outcome. However, the absence of favorable testing in the setting of an anatomically intact facial nerve does not reliably predict poor long-term function and therefore cannot be used to direct decision-making regarding the need for early reinnervation procedures.

Question 3

Does an anatomically intact facial nerve with poor electromyogram (EMG) electrical responses during intraoperative testing reliably predict poor long-term facial nerve function?

Target Population

This recommendation applies to adult patients undergoing vestibular schwannoma surgery.

Recommendation

Level 3: Poor intraoperative EMG electrical response of the facial nerve should not be used as a reliable predictor of poor long-term facial nerve function.

COCHLEAR NERVE MONITORING

Question 4

Should intraoperative eighth cranial nerve monitoring be used during vestibular schwannoma surgery?

Target Population

This recommendation applies to adult patients undergoing vestibular schwannoma surgery with measurable preoperative hearing levels and tumors smaller than 1.5 cm.

Recommendation

Level 3: Intraoperative eighth cranial nerve monitoring should be used during vestibular schwannoma surgery when hearing preservation is attempted.

Question 5

Is direct monitoring of the eighth cranial nerve superior to the use of far-field auditory brain stem responses?

Target Population

This recommendation applies to adult patients undergoing vestibular schwannoma surgery with measurable preoperative hearing levels and tumors smaller than 1.5 cm.

Recommendation

Level 3: There is insufficient evidence to make a definitive recommendation.

 The full guideline can be found at: https://www.cns.org/guidelines/guidelines-manage-ment-patients-vestibular-schwannoma/chapter_4.
Variability and Lack of Prognostic Value Associated With Atypical Pituitary Adenoma Diagnosis: A Systematic Review and Critical Assessment of the Diagnostic Criteria
Authors: Chesney Kelsi , Memel Zoe , Pangal Dhiraj J , Donoho Daniel , Hurth Kyle , Mathew Anna , Carmichael John D , Zada Gabriel
Published: October 2017

BACKGROUND

Atypical pituitary adenomas (APAs) are a subset of pituitary adenomas (PAs) characterized by the 2004 World Health Organization (WHO) guidelines to have higher risk histopathological features than typical PAs. In July 2017, the WHO published an update to their classification of pituitary tumors and abandoned the APA terminology.

OBJECTIVE

To assess the prevalence and outcomes of patients diagnosed with APA through a literature review. Focus was placed on variation in the application of the previous WHO criteria and on rates of recurrence.

METHODS

A systematic review of PubMed (2004-July 2017) was performed to identify studies reporting prevalence and clinical characteristics/outcomes of APA. Eight studies were analyzed for prevalence. Six studies reporting histopathological details were analyzed in depth.

RESULTS

Of the 7105 included patients, 373 (5.2%) met criteria for APA (prevalence range: 3%-15%). Only 2 of 8 studies utilized identical grading criteria, demonstrating a lack of standardized application. Most APAs (84%) were macroadenomas, with 52% invasive on magnetic resonance imaging. Nonfunctional PAs were most common (37%), followed by prolactinomas (23%) and Growth Hormone adenomas (21%). Recurrence/progression occurred in 21% of APA patients (follow-up range 37-75 mo). Only 2 of 8 studies reported an association between APA diagnosis and recurrence/progression.

CONCLUSION

Based on diagnostic variability and lack of association with clinical outcomes, refinement of criteria for APA was necessary. The WHO update eliminates the ambiguity in APA diagnosis in favor of criteria that emphasize clinical behavior (invasion, recurrence, and resistance to treatment) and molecular markers. Our review supports abandonment of the previous APA designation due to limited prognostic utility.
Differential Reanimation of the Midface and Lower Face Using the Masseteric and Hypoglossal Nerves for Facial Paralysis
Authors: Yoshioka Nobutaka
Published: October 2017

BACKGROUND

Hypoglossal nerve transfer is frequently employed to reanimate the paralyzed facial muscles after irreversible proximal facial nerve injury. However, it can cause significant postoperative synkinesis because it involves the reinnervation of the whole mimetic musculature using a single motor source.

OBJECTIVE

To describe our experience with differential reanimation of the midface and lower face using separate motor sources in patients with short-term facial paralysis after brain surgery.

METHODS

Seven patients underwent combined nerve transfer (the masseteric nerve to the zygomatic branch and the hypoglossal nerve to the cervicofacial division of the facial nerve) and cross-facial nerve grafting with the aim of achieving a spontaneous smile. The median duration of paralysis before surgery was 7 mo and follow-up ranged from 7 to 31 mo (mean: 18 mo). For evaluation, both physical examination and video analysis were performed.

RESULTS

In all patients, reanimation of both the midface and the lower face was successful. A nearly symmetrical resting lip was achieved in all patients, and they were able to voluntarily elevate the corners of their mouths without visible synkinesis and to close their eyes while biting. No patient experienced impairment of masticatory function or tongue atrophy.

CONCLUSION

Differential reanimation of the midface and lower face with the masseteric and hypoglossal nerves is an alternative method that helps to minimize synkinetic mass movement and morbidity at the donor site.
The first-year shear catalog of the Subaru Hyper Suprime-Cam Subaru Strategic Program Survey
Authors: Mandelbaum Rachel , Miyatake Hironao , Hamana Takashi , Oguri Masamune , Simet Melanie , Armstrong Robert , Bosch James , Murata Ryoma , Lanusse François , Leauthaud Alexie , Coupon Jean , More Surhud , Takada Masahiro , Miyazaki Satoshi , Speagle Joshua S , Shirasaki Masato , Sifón Cristóbal , Huang Song , Nishizawa Atsushi J , Medezinski Elinor , Okura Yuki , Okabe Nobuhiro , Czakon Nicole , Takahashi Ryuichi , Coulton William R , Hikage Chiaki , Komiyama Yutaka , Lupton Robert H , Strauss Michael A , Tanaka Masayuki , Utsumi Yousuke
Published: October 2017

We present and characterize the catalog of galaxy shape measurements that will be used for cosmological weak lensing measurements in the Wide layer of the first year of the Hyper Suprime-Cam (HSC) survey. The catalog covers an area of 136.9 deg2 split into six fields, with a mean i-band seeing of 0${^{\prime\prime}_{.}}$58 and 5σ point-source depth of i ∼ 26. Given conservative galaxy selection criteria for first-year science, the depth and excellent image quality results in unweighted and weighted source number densities of 24.6 and 21.8 arcmin−2, respectively. We define the requirements for cosmological weak lensing science with this catalog, then focus on characterizing potential systematics in the catalog using a series of internal null tests for problems with point-spread function (PSF) modeling, shear estimation, and other aspects of the image processing. We find that the PSF models narrowly meet requirements for weak lensing science with this catalog, with fractional PSF model size residuals of approximately 0.003 (requirement: 0.004) and the PSF model shape correlation function ρ1 < 3 × 10−7 (requirement: 4 × 10−7) at 0${^{\circ}_{.}}$5 scales. A variety of galaxy shape-related null tests are statistically consistent with zero, but star–galaxy shape correlations reveal additive systematics on >1° scales that are sufficiently large as to require mitigation in cosmic shear measurements. Finally, we discuss the dominant systematics and the planned algorithmic changes to reduce them in future data reductions.
MarR-Family Transcription Factor HpaR Controls Expression of the vgrR-vgrS Operon of Xanthomonas campestris pv. campestris
Authors: Pan Yue , Liang Fang , Li Ru-Jiao , Qian Wei
Published: October 2017

MarR (multiple antibiotic resistance regulator)-family transcription factors (TFs), which regulate the expression of virulence factors and other physiological pathways in pathogenic bacteria, are regarded as ideal molecular targets for the development of novel antimicrobial strategies. In the plant bacterial pathogen Xanthomonas campestris pv. campestris, HpaR, a typical MarR-family TF, is associated with bacterial virulence, but its mechanism of virulence regulation remains unclear. Here, we dissected the HpaR regulon using high-throughput RNA sequencing and chromatin immunoprecipitation sequencing. HpaR directly or indirectly controls the expression of approximately 448 genes; it acts both as a transcriptional activator and a repressor to control the expression of downstream genes by directly binding to their promoter regions. The consensus HpaR-binding DNA motifs contain imperfect palindromic sequences similar to [G/T]CAACAATT[C/T]TTG. In-depth analysis revealed that HpaR positively modulates transcription level of the vgrR-vgrS operon that encodes an important two-component signal transduction system to sense iron depletion and regulate bacterial virulence. Epistasis analysis demonstrated that vgrR-vgrS is a core downstream component of HpaR regulation, as overexpression of vgrR restored the phenotypic deficiencies caused by a hpaR mutation. This dissection of the HpaR regulon should facilitate future studies focused on the activating mechanism of HpaR during bacterial infection.
Online Problem Solving for Adolescent Brain Injury: A Randomized Trial of 2 Approaches
Authors: Wade Shari L. , Taylor Hudson Gerry , Yeates Keith Owen , Kirkwood Michael , Zang Huaiyu , McNally Kelly , Stacin Terry , Zhang Nanhua
Published: October 2017

Objective:

Adolescent traumatic brain injury (TBI) contributes to deficits in executive functioning and behavior, but few evidence-based treatments exist. We conducted a randomized clinical trial comparing Teen Online Problem Solving with Family (TOPS-Family) with Teen Online Problem Solving with Teen Only (TOPS-TO) or the access to Internet Resources Comparison (IRC) group.

Methods:

Children, aged 11 to 18 years, who sustained a complicated mild-to-severe TBI in the previous 18 months were randomly assigned to the TOPS-Family (49), TOPS-TO (51), or IRC group (52). Parent and self-report measures of externalizing behaviors and executive functioning were completed before treatment and 6 months later. Treatment effects were examined using linear regression models, adjusting for baseline symptom levels. Age, maternal education, and family stresses were examined as moderators.

Results:

The TOPS-Family group had lower levels of parent-reported executive dysfunction at follow-up than the TOPS-TO group, and differences between the TOPS-Family and IRC groups approached significance. Maternal education moderated improvements in parent-reported externalizing behaviors, with less educated parents in the TOPS-Family group reporting fewer symptoms. On the self-report Behavior Rating Inventory of Executive Functions, treatment efficacy varied with the level of parental stresses. The TOPS-Family group reported greater improvements at low stress levels, whereas the TOPS-TO group reported greater improvement at high-stress levels. The TOPS-TO group did not have significantly lower symptoms than the IRC group on any comparison.

Conclusion:

Findings support the efficacy of online family problem solving to address executive dysfunction and improve externalizing behaviors among youth with TBI from less advantaged households. Treatment with the teen alone may be indicated in high-stress families.
Filling the Spectrum Expander with Air—A New Alternative
Authors: Becker Hilton , Zhadan Olga
Published: October 2017

The Spectrum adjustable saline implant is optimal for prepectoral breast reconstruction as it can be placed virtually empty and thus flat, applying no pressure on the overlying skin flap. However, when saline is added, it tends to pool at the bottom of the implant resulting in its uneven surface and rippling. Air filling results in the uniform distribution within the implant shell and smooth even implant surface, which facilitates acellular dermal matrix adhesion. Pressure to the skin flap is averted, patients are more comfortable, and rippling is not seen.
MEASUREMENTS OF RETINAL FLUID BY OPTICAL COHERENCE TOMOGRAPHY LEAKAGE IN DIABETIC MACULAR EDEMA
Authors: Santos Ana Rita , Alves Dalila , Santos Torcato , Figueira João , Silva Rufino , Cunha-Vaz José G.
Published: October 2017

Purpose:

To evaluate the effects of anti–vascular endothelial growth factor treatment on retinal fluid in patients with diabetic macular edema by using optical coherence tomography leakage (OCT-L), a new method of quantifying sites of lower than normal optical reflectivity (LOR) in OCT, and to correlate these findings with best-corrected visual acuity (BCVA) response.

Methods:

Prospective analysis of 21 eyes with diabetic macular edema, naive to anti–vascular endothelial growth factor treatment. Macular cube 512 × 128 and OCT angiography 6 × 6-mm scans (CIRRUS AngioPlex; ZEISS, Dublin, CA) were acquired in all eyes before the first ranibizumab injection (V1) and 1 week after treatment (V2). Optical coherence tomography leakage analysis was performed with Angioplex raw scan data used to calculate LOR map ratios. Lower optical reflectivity ratios at baseline and differences from V1 to V2 and other OCT morphological features such as central retinal thickness measurements, disorganization of the inner retinal layers, and disruption of ellipsoid zone were compared with BCVA response 1 month after the first intravitreal injection.

Results:

After the first intravitreal injection of ranibizumab, eight patients (38%) were identified as good responders, 5 (24%) as moderate, and 8 (38%) as poor. There were no significant BCVA differences at baseline. Significant differences were found in LOR ratio changes between the different treatment response groups after 1 week of treatment, especially in outer segment and outer plexiform layer (outer segment—good responders: −53%, responders: −12%, and poor responders: 7% [P = 0.026]; outer plexiform layer—good responders: −49%, responders: 18%, and poor responders: 5% [P = 0.010]). Lower optical reflectivity ratios differences after 1 week of treatment predict better the BCVA treatment response at 1 month than changes of central retinal thickness, disorganization of the inner retinal layer, and ellipsoid zone disruption, especially in the outer segment and outer plexiform layer (area under the curve = 0.82 and 0.73, respectively).

Conclusion:

Optical coherence tomography leakage changes after anti–vascular endothelial growth factor treatment of diabetic macular edema, identifying the degree of decrease in retinal fluid in the outer layers of the retina is a more robust biomarker of BCVA recovery than central retinal thickness, disorganization of the inner retinal layer, or ellipsoid zone disruption changes.
Evaluation of the Clinical Utility of a Real-time PCR Assay for the Diagnosis of Streptococcus pneumoniae Bacteremia in Children
Authors: Murphy Jane , O’ Rourke Sadhbh , Corcoran Mary , O’ Sullivan Nicola , Cunney Robert , Drew Richard
Published: October 2017

Background:

The widespread uptake of pneumococcal vaccines has substantially reduced the incidence of invasive pneumococcal disease, such that pneumococcal bacteremia in children is now considered a relatively rare event. The objective of this study was to ascertain the clinical utility of a Streptococcus pneumoniae real-time polymerase chain reaction (PCR) assay compared with standard blood culture for the diagnosis of pneumococcal bacteremia in children in the post-vaccine era.

Methods:

A systematic retrospective review of laboratory and patient records from Children’s University Hospital, Temple Street, during a 6-year period was performed. Paired blood PCR and blood culture specimens from children younger than 16 years of age were investigated. Statistical analysis was performed to measure the diagnostic accuracy of PCR versus routine bacterial culture techniques.

Results:

More than 1900 PCR test requests were examined from 2010 to 2015, of which 1561 paired PCR and blood culture specimens met criteria for inclusion in the statistical analysis. The PCR assay demonstrated high specificity (99%, confidence interval 95%: 98.81%–99.69%); however, the sensitivity was low compared with that of blood culture (47%, confidence interval 95%: 21.27%–73.41%). Investigation of 10 PCR-positive/culture-negative cases revealed that these cases ranged from definite, probable, and possible significance, indicating a low false positivity rate associated with the assay.

Conclusion:

This study demonstrates the limited utility of blood PCR testing for S. pneumoniae in pediatric patients without radiographic evidence pneumonia or empyema. Moreover, we report that PCR may be a useful diagnostic tool when blood cultures are negative because of antimicrobial therapy before sampling. Given that the incidence of pneumococcal disease has decreased considerably in recent years, justification of S. pneumoniae PCR requisition is necessary. Hence, new guidelines for pediatric pneumococcal blood PCR testing have been introduced at the Irish Meningitis and Sepsis Reference Laboratory.
Clinical and symptom scores are significantly correlated with fecal microbiota features in patients with symptomatic uncomplicated diverticular disease: a pilot study
Authors: Kvasnovsky Charlotte L. , Leong Lex E.X. , Choo Jocelyn M. , Abell Guy C.J. , Papagrigoriadis Savvas , Bruce Kenneth D. , Rogers Geraint B.
Published: October 2017

Background

There is growing consensus that symptomatic uncomplicated diverticular disease is a chronic inflammatory condition, and that alterations in the fecal microbiota may contribute to its pathogenesis.

Objective

The aim of this study was to relate the fecal microbiota composition in symptomatic uncomplicated diverticular disease to measures of inflammation, symptoms, and history of previous acute diverticulitis.

Participants and methods

Fecal microbiota composition in 28 individuals with symptomatic uncomplicated diverticular disease was characterized by 16S RNA gene amplicon sequencing. Microbiota composition was related to clinical history, symptom and inflammation measures, and demographic variables.

Results

Previous acute diverticulitis was associated with higher relative abundance of Pseudobutyrivibrio, Bifidobacterium, Christensenellaceae family, and Mollicutes RF9 order (P=0.004, 0.006, 0.010, and 0.019, respectively), but not microbiota alpha or beta diversity. A higher bloating severity score was significantly correlated with a higher relative abundance of Ruminococcus (P=0.032), and significantly inversely correlated with the relative abundance of the Roseburia (P=0.002). Fecal calprotectin levels were positively correlated with alpha diversity (Shannon index, P=0.005) and the relative abundance of Lactobacillus (P=0.004). Pain score was positively correlated with the relative abundance of Cyanobacterium (adjusted P=0.032).

Conclusion

Patient symptoms in symptomatic diverticular disease are significantly correlated with features of the fecal microbiota. Our findings suggest the potential utility of therapies that target intestinal microbiology, such as dietary prebiotic supplements.
Long‐term Follow‐up After Pediatric Liver Transplantation
Authors: Loeb Nathalie , Owens Jillian S. , Strom Michele , Farassati Farsad , Van Roestel Krista , Chambers Kathryn , Kean Penni , Ng Vicky L. , Avitzur Yaron , Carricato Megan , Wales Paul W. , Courtney‐Martin Glenda
Published: October 2017

Objectives:

The aim of the study was to describe long‐term growth postpediatric liver transplantation and to conduct bivariate and multivariate analysis of factors that may predict post‐transplantation growth in children who received a liver transplant from January 1999 to December 2008 at the Hospital for Sick Children.

Methods:

A retrospective cohort study was conducted with follow‐up of up‐to 10 years post‐transplantation. Mean height and weight z scores and annual differences in mean z scores were plotted against time after transplantation. A 1‐way analysis of variance was conducted. Multivariate and univariate Cox proportional hazards analyses were conducted to determine factors associated with reaching the 50th and 25th percentiles for height.

Results:

A total of 127 children met eligibility criteria. The mean height z score at time of transplantation was −2.21 which by the second year post‐transplantation increased significantly to −0.66 (mean increase of 1.55 standard deviation units). There were no further significant increases in mean height z score from 2 years post‐transplantation until the end of follow‐up at year 10. In multivariate analysis, height at transplant was the most important predictor of linear growth post‐transplantation.

Conclusions:

Children who underwent liver transplantation had significant catch‐up growth in the first 2 years post‐transplantation followed by a plateau phase. Increased height z‐score at transplantation is the most important predictor of long‐term growth.
Expedited Partner Therapy: Pharmacist Refusal of Legal Prescriptions
Authors: Borchardt Lauren N. , Pickett Michelle L. , Tan Kevin T. , Visotcky Alexis M. , Drendel Amy L.
Published: October 2017

Background

Expedited partner therapy (EPT) is an effective strategy for partner management of sexually transmitted infections. Some states, including Wisconsin, allow EPT prescriptions to be filled without a patient name. This study determined the refusal rates of nameless EPT prescriptions in Milwaukee pharmacies.

Methods

In this cross-sectional study, 3 trained research assistants of different age, sex, and race posed as “patients” and visited 50 pharmacy locations from one pharmacy chain in Milwaukee County, WI, to fill nameless EPT prescriptions. A χ2 test was used to compare demographics of patients, pharmacists, and pharmacies. Multiple logistic regression was used to identify factors associated with prescription refusal.

Results

Twenty-nine (58%) of 50 nameless EPT prescriptions were refused. Univariate analysis showed that prescriptions were more likely to be refused if the pharmacy was in the suburbs (77%) compared with Milwaukee city (43%; P = 0.01), if the pharmacist was older than the patient (82%) compared with being younger (46%) or within the same age group (33%; P = 0.01 for both), and if the patient was white (78%) compared with nonwhite (47%; P = 0.03). Multivariable regression revealed significantly higher refusals for pharmacies located in the suburbs compared with the city (odds ratio, 5.3; 95% confidence interval, 1.4–20.3; P = 0.03) and in patients who were white compared with nonwhite (odds ratio: 4.8; 95% confidence interval, 1.2–19.8; P = 0.01).

Conclusions

More than half of nameless EPT prescriptions were refused in Milwaukee county pharmacies, more frequently at suburban pharmacies and for white patients. Increased pharmacist education regarding EPT is essential to help combat the sexually transmitted infection crisis.
Conceptualizing Geosexual Archetypes: Mapping the Sexual Travels and Egocentric Sexual Networks of Gay and Bisexual Men in Toronto, Canada
Authors: Gesink Dionne , Wang Susan , Guimond Tim , Kimura Lauren , Connell James , Salway Travis , Gilbert Mark , Mishra Sharmistha , Tan Darrell , Burchell Ann N. , Brennan David J. , Logie Carmen H. , Grace Daniel
Published: October 2017

Background

There are complex, synergistic, and persistent sexually transmitted infection (STI) epidemics affecting gay, bisexual and other men who have sex with men (gbMSM) in every major urban centre across North America. We explored the spatial architecture of egocentric sexual networks for gbMSM in Toronto, Canada.

Methods

Our integrative mixed methods study included in-depth interviews with 31 gbMSM between May and July 2016. During interviews, participants mapped their egocentric sexual network for the preceding 3 months geographically. At the end, a self-administered survey was used to collect sociodemographic characteristics, online technology use, and STI testing and history.

Results

We identified 6 geosexual archetypes: hosters, house-callers, privates, rovers, travellers, and geoflexibles. Hosters always, or almost always (≥80%), hosted sex at their home. House-callers always, or almost always (≥80%), had sex at their partner’s home. Rovers always or almost always (≥80%) had sex at public venues (eg, bath houses, sex clubs) and other public spaces (eg, parks, cruising sites). Privates had sex in private—their own home or their partner's (part hoster, part house-caller). Travellers had sex away from their home, either at a partner’s home or some other venue or public space (part house-caller, part rover). Geoflexibles had sex in a variety of locations—their home, their partner’s home, or public venues. All hosters and rovers, and to a lesser extent, geoflexibles, reported a history of syphilis and human immunodeficiency virus.

Conclusions

Prioritizing interventions to hosters, rovers, and geoflexibles may have an important impact on reducing STI transmission.
Tuberculosis Prevention in the Private Sector: Using Claims-Based Methods to Identify and Evaluate Latent Tuberculosis Infection Treatment With Isoniazid Among the Commercially Insured
Authors: Stockbridge Erica L. , Miller Thaddeus L. , Carlson Erin K. , Ho Christine
Published: October 2017

Context:

Targeted identification and treatment of people with latent tuberculosis infection (LTBI) are key components of the US tuberculosis elimination strategy. Because of recent policy changes, some LTBI treatment may shift from public health departments to the private sector.

Objectives:

To (1) develop methodology to estimate initiation and completion of treatment with isoniazid for LTBI using claims data, and (2) estimate treatment completion rates for isoniazid regimens from commercial insurance claims.

Methods:

Medical and pharmacy claims data representing insurance-paid services rendered and prescriptions filled between January 2011 and March 2015 were analyzed.

Participants:

Four million commercially insured individuals 0 to 64 years of age.

Main Outcome Measures:

Six-month and 9-month treatment completion rates for isoniazid LTBI regimens.

Results:

There was an annual isoniazid LTBI treatment initiation rate of 12.5/100 000 insured persons. Of 1074 unique courses of treatment with isoniazid for which treatment completion could be assessed, almost half (46.3%; confidence interval, 43.3-49.3) completed 6 or more months of therapy. Of those, approximately half (48.9%; confidence interval, 44.5-53.3) completed 9 months or more.

Conclusions:

Claims data can be used to identify and evaluate LTBI treatment with isoniazid occurring in the commercial sector. Completion rates were in the range of those found in public health settings. These findings suggest that the commercial sector may be a valuable adjunct to more traditional venues for tuberculosis prevention. In addition, these newly developed claims-based methods offer a means to gain important insights and open new avenues to monitor, evaluate, and coordinate tuberculosis prevention.