bluuebunny/crossref_metadata_2025 huggingface dataset:
Vegetation Mapping
Authors: Tierney D.A. , Powell Timothy , Eriksson C.E.
Published: May 2017

Vegetation maps are critical for understanding biodiversity patterns through space and time and underpin biodiversity management and planning from local to global scales. Maps are based on two essential elements; a classification of vegetation and a spatial attribution of that classification. Miguel de Cáceres covers “Vegetation Classification” in his Oxford Bibliographies in Ecology article; therefore, this article focuses on the spatial attribution of vegetation patterns. Mapping of vegetation has progressed from the earliest geographical approaches to the development of systematic methods based on a “naturalists’” understanding of observable patterns to highly technical modeling approaches. The trade-off of increased efficiency in data processing and rapidity of mapping over large scales for a potential lower point accuracy and loss of an intimate understanding of vegetation patterns is an unresolved issue. How vegetation is mapped today is therefore a critical issue, and mapping is undertaken using a huge diversity of approaches and for a diversity of purposes. Standardized mapping approaches are thus often advocated, but standardization also brings with it a potential bias in accuracy among differing vegetation types. However, in general, the wise use of emerging technologies and thoughtful standardization of mapping approaches holds significant promise for the management of vegetation and ecosystems into the future.
Place
Authors: Anderson Jon
Published: May 2017

Place is a central concept for an increasing number of academic disciplines. Having been central to human geography for many decades, the spatial turn across the humanities and social sciences in the twenty-first century has accelerated and intensified interest in the term. The popularity of place can be understood due to the trialectic nature of the concept: “place” is at once locational, sociocultural, and temporal. Place as a locational concept refers to a straightforward point or position in space, but it is also at once a social concept, drawing attention to the cultural positioning and social relations of the people, processes, and practices involved in co-producing that location. These two components conjoin with the temporal context of place, enabling scholars to analyze how a site changes over time and how particular moments in its history should be interpreted. Drawing attention to these trialectic components implies that all beings and practices are platial in nature; in other words, they are tied through different processes and to different degrees into reciprocal relations with places. As a consequence of this recognition, the concept is now employed in arenas ranging from empiricist understandings of locations, conceptual developments in onto-epistemology, critical analysis of social relations, and reflexive praxis in methodology.
The Dose-Dependent Efficacy of Cefepime in the Empiric Management of Febrile Neutropenia: A Systematic Review and Meta-Analysis
Authors: Andreatos Nikolaos , Flokas Myrto Eleni , Apostolopoulou Anna , Alevizakos Michail , Mylonakis Eleftherios
Published: May 2017

Background

Despite reports questioning its efficacy, cefepime remains a first-line option in febrile neutropenia. We aimed to re-evaluate the role of cefepime in this setting.

Methods

We searched the PubMed and EMBASE databases to identify randomized comparisons of (1) cefepime vs alternative monotherapy or (2) cefepime plus aminoglycoside vs alternative monotherapy plus aminoglycoside, published until November 28, 2016.

Results

Thirty-two trials, reporting on 5724 patients, were included. Clinical efficacy was similar between study arms (P = .698), but overall mortality was greater among cefepime-treated patients (risk ratio [RR] = 1.321; 95% confidence interval [CI], 1.035–1.686; P = .025). Also of note, this effect seemed to stem from trials using low-dose (2 grams/12 hours, 100 mg/kg per day) cefepime monotherapy (RR = 1.682; 95% CI, 1.038–2.727; P = .035). Cefepime was also associated with increased mortality compared with carbapenems (RR = 1.668; 95% CI, 1.089–2.555; P = .019), a finding possibly influenced by cefepime dose, because carbapenems were compared with low-dose cefepime monotherapy in 5 of 9 trials. Treatment failure in clinically documented infections was also more frequent with cefepime (RR = 1.143; 95% CI, 1.004–1.300; P = .043). Toxicity-related treatment discontinuation was more common among patients that received high-dose cefepime (P = .026), whereas low-dose cefepime monotherapy resulted in fewer adverse events, compared with alternative monotherapy (P = .009).

Conclusions

Cefepime demonstrated increased mortality compared with carbapenems, reduced efficacy in clinically documented infections, and higher rates of toxicity-related treatment discontinuation. The impact of cefepime dosing on these outcomes is important, because low-dose regimens were associated with lower toxicity at the expense of higher mortality.
Tailored Extended Bifrontal Craniotomy for Anterior Skull Base Tumors: Anatomic Description of a Modified Surgical Technique and Case Series
Authors: Safaee Michael M , McDermott Michael W , Benet Arnau , Theodosopoulos Philip V
Published: May 2017

BACKGROUND

Open transcranial approaches to the anterior skull base remain an integral component of current skull base practice. Evolution of these and other techniques has resulted in revisions of standard, tried-and-true methods in attempts to improve patient outcomes and cosmesis, while still providing the best combination of surgical exposure and ergonomics.

OBJECTIVE

To describe a modified approach for midline tumors of the anterior skull base.

METHODS

We describe the anatomy and techniques of a modified extended bifrontal craniotomy for anterior skull base tumors. Case examples and a postoperative 3-dimensional computed tomographic reconstruction of the craniotomy are provided.

RESULTS

The technique has been employed with success in 3 tuberculum sellae meningiomas where the anterior limit of the tumor is several centimeters back from the inner table of the frontal bone. The mean distance from the tumor to inner table was 2.8 cm (range 1.3-3.8 cm). Mean tumor dimensions were 3.0 cm (transverse), 3.5 cm (anterior-posterior), and 2.2 cm (craniocaudal). Average operative time was 557 min. No cases had new T2/fluid-attenuated inversion recovery magnetic resonance imaging signal of the inferior frontal lobe to indicate retraction injury.

CONCLUSION

The tailored extended bifrontal craniotomy for anterior skull base tumors provides adequate access to the anterior cranial fossa and has replaced our standard extended bifrontal approach. Keeping the osteotomy cut lines outside of the orbit reduces orbital swelling and mechanical disruption of conjugate eye movements in the early postoperative period, while allowing for minimal frontal lobe retraction and providing sufficient surgical exposure along the anterior skull base.
How electronic health records can unmask the hidden value of PAs
Authors: Ogunfiditimi Folusho , Sherry Scott P. , Foote Monica , Christie Sarah L. , Shock Lisa P. , Cawley James , Browne Aaron ,   American Academy of PAs Fee for Value Task Force
Published: May 2017

The Fee for Value (FFV) Task Force, a subgroup of the American Academy of PAs' Research and Strategic Initiatives Commission, has examined tools and mechanisms aimed at better clarifying the volume and value of PA work and how that work contributes to improving access to high-quality care. Establishing the value of PAs has been a challenging task for many healthcare providers. Often, PA value has been defined by their clinical productivity, without any clear direction as to what constitutes value versus productivity. The objective of this article is to unmask the value of PAs through the role of electronic health records and highlight PAs' ability to produce services that are value-oriented and quantifiably productive.
Factors Associated With Success of Clinician–Researchers Receiving Career Development Awards From the National Institutes of Health: A Longitudinal Cohort Study
Authors: Jagsi Reshma , Griffith Kent A. , Jones Rochelle D. , Stewart Abigail , Ubel Peter A.
Published: May 2017

Purpose

Understanding the careers of recent career development awardees is essential to guide interventions to ensure gender equity and success in academic medicine.

Method

In 2010–2011 (T1) and 2014 (T2), 1,719 clinician–researchers who received new K08 and K23 awards in 2006–2009 were longitudinally surveyed. Multivariable analyses evaluated the influence of factors on success, including demographics, job characteristics, work environment, priorities, and domestic responsibilities.

Results

Of 1,275 respondents at T1, 1,066 (493 women; 573 men) responded at T2. Men and women differed in job characteristics, work environment, priorities, and domestic responsibilities. By T2, women had less funding (mean $780,000 vs. $1,120,000, P = .002) and published fewer papers (mean 33 vs. 45). Using a composite measure that considered funding, publications, or leadership to define success, 53.5% (264/493) of women and 67.0% (384/573) of men were successful. Gender differences in success persisted after accounting for other significant predictors—K award type, specialty, award year, work hours, funding institute tier, feeling responsible for participating in department/division administration, importance of publishing prolifically, feeling responsible for contributing to clinical care, importance of publishing high-quality research, collegiality of the mentoring relationship, adequacy of research equipment, and departmental climate. A significant interaction existed between K award type and gender; the gender difference in success was most pronounced among K23 researchers (among whom the odds ratio for females = 0.32).

Conclusions

Men and women continue to have different experiences and career outcomes, with important implications for the design of interventions to promote equity and success.
Adherence to Mediterranean diet and risk of gastric cancer: results of a case–control study in Italy
Authors: Stojanovic Jovana , Giraldi Luca , Arzani Dario , Pastorino Roberta , Biondi Alberto , Persiani Roberto , Boccia Stefania , Leoncini Emanuele
Published: May 2017

The aim of this study is to evaluate the association between adherence to Mediterranean diet (MD) and gastric cancer (GC). A case–control study was carried out at the Fondazione Policlinico ‘A. Gemelli’ (Rome, Italy) from 2003 to 2015. A total of 223 incident cases and 223 controls were interviewed. Dietary intake was assessed through a validated food frequency questionnaire that collected information on more than 25 food items. The association between adherence to MD and risk of GC was quantified by calculating Odds Ratios (OR) and 95% confidence intervals (CI). The analysis reports that a higher adherence to MD is associated with a reduced risk of GC (OR: 0.70; 95% CI: 0.61–0.81). A high consumption of vegetables (OR: 0.34; 95% CI: 0.14–0.85), legumes (OR: 0.13; 95% CI: 0.06–0.29), and fish (OR: 0.33; 95% CI: 0.15–0.68), as well as low consumption of meat (OR: 0.29; 95% CI: 0.10–0.85) and alcohol (OR: 0.46; 95% CI: 0.24–0.90) are consistently related to a lower risk of GC. Our study indicates a protective role of the MD eating pattern and MD individual components against GC. Our results showed a beneficial role of high vegetable, legume, and fish consumption, along with low intake of alcohol and meat in the development of GC.
A population-level investigation of cancer clinical trials participation in a UK region
Authors: Donnelly Conan B. , Wotherspoon Amy C. , Morris Melanie , Wilson Richard H. , Chen Jingwen J. , Cairnduff Victoria , Morgan Eileen , Devlin Amy , Gavin Anna T.
Published: May 2017

The aim of this study was to document cancer trial participation since establishment of the Northern Ireland Cancer Trials Network and investigate population and disease factors associated with trial participation. An independent cohort of over 51 000 cancer patients from the Northern Ireland Cancer Registry covering the same population (2007–2012) was linked to a database of 1316 interventional cancer trial participants in a UK region. The primary outcome measure was participation in an intervention clinical trial. Patients were followed up until 31 March 2013. Kaplan–Meier tests and Cox proportional hazard models using person days at risk to allow for death were used to investigate factors associated with trial participation. Multivariate analysis assessed the impact of age, cancer type and stage, distance from the cancer centre (radiotherapy), marital status, deprivation quintile and rurality. Participation was analysed separately for children (<15 years) and young individuals (15–24 years). Trial recruitment increased three-fold with establishment of a network. Participation was the highest for children at 21%, but relatively low at 2.05% for adults, although higher for haematological malignancies (4.5%). Lower likelihood of trial participation in adults was associated with female sex, older age, distance from regional Cancer Centre and stage 1 disease. The introduction of a regional Cancer Trials Network was associated with increased participation; however, trial participation remains relatively low at the population level especially among elderly patients. Linkage of clinical trials and cancer registry database provide an easy mechanism to monitor trial representativeness at the population level.
Obesity is Independently Associated With Increased Risk of Hepatocellular Cancer–related Mortality
Authors: Gupta Arjun , Das Avash , Majumder Kaustav , Arora Nivedita , Mayo Helen G. , Singh Preet P. , Beg Muhammad S. , Singh Siddharth
Published: May 2017

Objective:

Excess body weight is associated with increased risk of developing hepatocellular cancer (HCC), but its effect on HCC-related mortality remains unclear. We performed a systematic review and meta-analysis to assess the association between premorbid obesity and HCC-related mortality.

Materials and Methods:

Through a systematic literature search-up to March 2016, we identified 9 observational studies (1,599,453 individuals, 5705 HCC-related deaths) reporting the association between premorbid body mass index (BMI), and HCC-related mortality. We estimated summary adjusted hazard ratio (aHR) with 95% confidence intervals (CIs), comparing obese (BMI>30 kg/m2) and overweight (BMI, 25 to 29.9 kg/m2) individuals with normal BMI individuals using random-effects model.

Results:

On meta-analysis, compared with individuals with normal BMI, obese (aHR, 1.95; 95% CI, 1.46-2.46), but not overweight individuals (aHR, 1.08; 95% CI, 0.97-1.21), had higher HCC-related mortality, with moderate heterogeneity. On subgroup analysis, magnitude of increased mortality was higher in obese men (aHR, 2.50; 95% CI, 2.02-3.09; 3 studies) as compared with obese women (aHR, 1.45; 95% CI, 1.08-1.97; 2 studies). The impact of premorbid obesity on HCC-related mortality was observed only in western populations (aHR, 2.10; 95% CI, 1.77-2.48; 4 studies), but not Asian populations (aHR, 1.10; 95% CI, 0.63-1.92; 1 study). There was limited assessment of competing risk because of advanced liver disease.

Conclusions:

On the basis of this meta-analysis, premorbid obesity may be independently associated with a 2-fold risk of HCC-related mortality. This association was more pronounced in men and western populations. Strategies targeting obesity-associated metabolic abnormalities may provide novel pathways for HCC therapy.
Contralateral Augmentation with a Transmidline Scarless Technique During Unilateral Breast Reconstruction Using Implants
Authors: Ho Olivia A. , Lin Yi-Ling , Huang Jung-Ju , Cheng Ming-Huei
Published: May 2017

Background:

Unilateral breast reconstruction can be a challenge when attempting to achieve an aesthetically pleasing and symmetrical breast mound on the contralateral side. This study investigates the outcomes of using a contralateral augmentation transmidline scarless (CATS) technique to simultaneously augment the contralateral breast using implants.

Methods:

Between January 2004 and July 2016, patients undergoing unilateral implant-based breast reconstruction and simultaneous contralateral implant augmentation using a transmidline access were studied. Characteristics and complications using this technique were assessed.

Results:

Sixty-five (91.5%) of 71 patients used the CATS technique for unilateral breast reconstruction using implants with contralateral breast implant augmentation. The remaining 6 cases used a preexisting chest scar. In the assessment of complication rates between the reconstructed and augmented sides, the reconstructed side had a statistically significant higher rate of implant exposure (P = 0.04) and total complications (P = 0.02). In comparing the revision rates between these 2 groups, the need for implant change (P = 0.04) and the total revision rates (P = 0.01) were higher in the reconstructive side. Use of saline implants had a higher rate of chest wall and breast skin necrosis (P = 0.03) in comparison with silicone implants. There was not a statistically significant difference in complications when comparing timing of reconstructions (immediate versus delayed).

Conclusions:

The CATS technique can be performed safely, with a desirable aesthetic outcome, and also symmetry with minimal risk of symmastia during unilateral breast reconstruction using implant-based reconstruction.
Multiuse of Disposable Microsurgical Instruments as a Cost-Efficient Alternative for Training and Research
Authors: Aman Martin , Sporer Matthias E. , Riedl Otto , Wang Wei-Te , Kramer Anne , Aszmann Oskar C. , Bergmeister Konstantin D.
Published: May 2017

Microsurgery demands significant preclinical training, often hampered by the high costs of the required microsurgery instruments. We hypothesized that recently available disposable microsurgery instruments provide sufficient quality and significantly reduced costs. In a comparative analysis with standard reusable instruments, participants performed equally with both instrument sets and recommended the disposable instruments for microsurgery training and research applications.
Comparative Analysis of Perioperative and Mid-Term Results of TECAB and MIDCAB for Revascularization of Anterior Wall
Authors: Kofler Markus , Schachner Thomas , Sebastian J. Reinstadler , Stastny Lukas , Dumfarth Julia , Wiedemann Dominik , Feuchtner Gudrun , Friedrich Guy , Bonatti Johannes , Bonaros Nikolaos
Published: May 2017

Objective

Totally endoscopic coronary artery bypass (TECAB) and minimally invasive direct coronary artery bypass (MIDCAB) grafting through minithoracotomy are currently the two minimally invasive surgical techniques of left ventricular anterior wall revascularization. We aimed to compare both techniques in terms of perioperative and mid-term results.

Methods

Arrested heart TECAB was carried out in 204 patients with a median (range) age of 60 (53–76) years and a median (range) EuroSCORE I of 2 (0–3). Minimally invasive direct coronary artery bypass was performed in 60 patients with a median (range) age of 66 (54–75) years and a median (range) EuroSCORE I of 2 (1–5). Both techniques were used for single or sequential internal mammary artery grafts to the anterior wall. Operative times, conversion rates, and surgical complications as well as mid-term results were compared between the groups after a median follow-up of 36 months.

Results

No perioperative deaths were noted. Rates of myocardial infarction (TECAB: 1.5% vs MIDCAB: 0%, P = 0.463) and stroke (TECAB: 1.5% vs MIDCAB: 0%, P = 0.454) were not significantly different between the groups. Total operative times were longer in the TECAB compared with the MIDCAB group [292 (250–345) minutes in TECAB versus 201 (173–289) minutes in MIDCAB ( P < 0.001)]. Intensive care unit stay and total length of stay were similar between the groups. There was no difference in mid-term survival (TECAB: 1.5% vs MIDCAB: 1.7%, P = 0.298) and freedom from major adverse cardiac and cerebrovascular events (TECAB: 12.4% vs MIDCAB: 5.1%, P = 0.358).

Conclusions

Robotically assisted arrested heart TECAB and robotic MIDCAB perform equally in terms of perioperative results and mid-term follow-up in this single-center patient cohort.
Effects of Music Listening During Loop Electrosurgical Excision Procedure on Pain and Anxiety: A Randomized Trial
Authors: Chantawong Nopwaree , Charoenkwan Kittipat
Published: May 2017

Objective

The aim of the study was to compare pain, anxiety, and satisfaction between women, who listened to music, and those who did not during loop electrosurgical excision procedure (LEEP).

Material and Methods

Participants were randomly assigned into two groups. In group 1 (music), the participants listened to relaxing instrumental music through the stereo headset from the time of arrival at the preoperative waiting room until the procedure completed. For group 2 (control), the participants underwent LEEP without music listening. The women rated pain, anxiety, and satisfaction according to 10-cm visual analog scales. Pain was assessed at the time of speculum insertion (baseline pain) and immediately after the LEEP completed (procedural pain). Anxiety and satisfaction were examined just before starting the LEEP and 10 minutes after the procedure completed.

Results

One hundred fifty patients (74 in music group and 76 in control group) participated. Mean baseline pain scores after speculum insertion were comparable between the groups (3.7 in the music group vs. 3.5 in the control group, p = .55). Mean procedural pain scores were not different between the groups (4.7 in the music group vs. 5.2 in the control group, p = .32). The differences of the procedural pain scores from baseline were statistically comparable between the study groups (0.9 in the music group vs. 1.7 in the control group, p = .15). There were no significant differences in anxiety and satisfaction scores at any time points assessed between the groups.

Conclusions

The effects of music listening on reducing pain and anxiety during LEEP could not be demonstrated in this study.
Increased arterial stiffness in nonalcoholic fatty liver disease: a systematic review and meta-analysis
Authors: Jaruvongvanich Veeravich , Chenbhanich Jirat , Sanguankeo Anawin , Rattanawong Pattara , Wijarnpreecha Karn , Upala Sikarin
Published: May 2017

Background

Arterial function is a marker of early atherosclerotic changes and cardiovascular disease. Several studies have suggested the possible association between nonalcoholic fatty liver disease (NAFLD) and increased arterial stiffness. Thus, we conducted a systematic review and meta-analysis to better characterize this association.

Patients and methods

A comprehensive search of the databases of the MEDLINE and EMBASE was carried out from inception through September 2016. All observational studies that compared arterial stiffness between NAFLD patients and healthy controls were included. Arterial stiffness was measured by pulse wave velocity (PWV) and augmentation index. We calculated pooled mean difference (MD) with 95% confidence intervals (CIs) using the random-effects model.

Results

Data were extracted from 12 studies involving 9351 NAFLD patients and 17 684 controls. NAFLD is significantly associated with increased arterial stiffness as determined by carotid–femoral PWV (MD=0.75 m/s, 95% CI: 0.43–1.07, I
2=88%), brachial–ankle PWV (MD=0.82 m/s, 95% CI: 0.57–1.07, I
2=92%), and augmentation index (pooled MD=2.54%, 95% CI: 0.07–5.01, I
2=73%) compared with healthy controls.

Conclusion

In conclusion, our study demonstrated a higher degree of arterial stiffness in NAFLD patients compared with controls. However, this association might be related to the higher prevalence of cardiometabolic risk factors in NAFLD patients. Further studies are needed to determine an independent association between NAFLD and arterial stiffness adjusting to cardiometabolic risks.
Predictors of pouchitis after ileal pouch–anal anastomosis in pediatric-onset ulcerative colitis
Authors: Rinawi Firas , Assa Amit , Eliakim Rami , Mozer Glassberg Yael , Nachmias Friedler Vered , Niv Yaron , Rosenbach Yoram , Silbermintz Ari , Zevit Noam , Shamir Raanan
Published: May 2017

Objectives

Few studies have reported on the incidence and risk factors for pouchitis following colectomy and ileal pouch–anal anastomosis (IPAA) in patients with pediatric-onset ulcerative colitis (UC). We aimed to determine clinical predictors for the development of pouchitis following IPAA in this population.

Patients and methods

We performed a retrospective chart review of all pediatric UC cases that were diagnosed at the Schneider Children’s Medical Center of Israel between 1981 and 2013 and who underwent colectomy during disease course. Potential predictors for pouchitis and chronic pouchitis including various demographic, clinical, endoscopic, and histological variables at diagnosis and at the time of surgery were assessed.

Results

Of 188 patients with pediatric-onset UC, 33 (18%) underwent colectomy and IPAA surgery. During a median postsurgical follow-up of 7.6 (range: 1–21.5) years following IPAA, 20/33 (60%) patients developed pouchitis including 11/33 (33%) patients who developed chronic pouchitis. Kaplan–Meier survival estimates of the cumulative probability for pouchitis were 9% at 1 year and 36 and 55% at 5 and 10 years, respectively. Multivariate Cox models showed that older age at colectomy (hazard ratio: 0.86, P=0.024) was a protective factor, whereas preoperative vitamin-D deficiency (≤20 ng/ml) (hazard ratio: 4.4, P=0.021) increased the risk for pouchitis. Age at diagnosis, sex, disease extent, and preoperative therapeutic regimens did not affect the risk of pouchitis.

Conclusion

Long-term risk for pouchitis is significantly high in pediatric-onset UC after IPAA. Vitamin-D deficiency and younger age at colectomy may increase the risk for pouchitis.
Anti‐transglutaminase 6 Antibody Development in Children With Celiac Disease Correlates With Duration of Gluten Exposure
Authors: De Leo Luigina , Aeschlimann Daniel , Hadjivassiliou Marios , Aeschlimann Pascale , Salce Nicola , Vatta Serena , Ziberna Fabiana , Cozzi Giorgio , Martelossi Stefano , Ventura Alessandro , Not Tarcisio
Published: May 2017

Objectives:

Antibodies against transglutaminase 6 (anti‐TG6) have been implicated in neurological manifestations in adult patients with genetic gluten intolerance, and it is unclear whether autoimmunity to TG6 develops following prolonged gluten exposure. We measured the anti‐TG6 in children with celiac disease (CD) at the diagnosis time to establish a correlation between these autoantibodies and the duration of gluten exposure. We investigated a correlation between anti‐TG6 and the presence of neurological disorders.

Methods:

Anti‐TG6 (IgA/IgG) were measured by ELISA in sera of children with biopsy‐proven CD and of children experiencing gastrointestinal disorders. CD patients positive for anti‐TG6 were retested after 2 years of gluten‐free diet (GFD).

Results:

We analyzed the sera of 274 CD children and of 121 controls. Anti‐TG6 were detected in 68/274 (25%) CD patients and in 19/121 (16%) controls, with significant difference between the 2 groups (P = 0.04). None of the CD patients and of the controls testing positive for anti‐TG6 were experiencing neurological disorders. Eleven of 18 (61%) CD patients with other autoimmune diseases were positive for anti‐TG6. In CD patients, a significant correlation between the gluten exposure before the CD diagnosis and anti‐TG6 concentration was found (P = 0.006 for IgA; P < 0.0001 for IgG). After GFD anti‐TG6 concentrations were significantly reduced (P < 0.001). No significant correlation was observed between anti‐TG6 and anti‐TG2 serum concentrations.

Conclusions:

Anti‐TG6 are more prevalent in children with untreated CD in the absence of overt neurological disorders. The synthesis of the anti‐TG6 is related to a longer exposure to gluten before the CD diagnosis, and the autoimmunity against TG6 is gluten dependent and disappeared during GFD.
Induction Therapy With Biosimilar Infliximab in Children With Crohn Disease
Authors: Sieczkowska‐Golub Joanna , Meglicka Monika , Plocek Anna , Banaszkiewicz Aleksandra , Jarzębicka Dorota , Toporowska‐Kowalska Ewa , Gawronska Agnieszka , Oracz Grzegorz , Kierkus Jaroslaw
Published: May 2017

Introduction:

In most European countries, an infliximab biosimilar (CT‐P13) is currently in common use. In vitro and in vivo studies have proved a high similarity between CT‐P13 and the reference infliximab. CT‐P13 was licensed for use in patients with Crohn disease (CD) based on the extrapolation of data from preclinical studies and clinical trials in rheumatology indications. The aim of this study was to assess the similarity between CT‐P13 and the originator infliximab in induction therapy in CD paediatric patients.

Methods:

Thirty‐six CD paediatric patients from 3 Polish academic centres who started biological therapy with CT‐P13 were enrolled in this prospective, observational study. Patients received 3 induction doses (5 mg/kg) of CT‐P13 at weeks 0, 2, 6. Assessment was performed before the first infusion and at week 14.

Results:

Overall 34/36 (94.4%) patients completed induction therapy with CT‐P13. A clinical response or remission after 3 initial doses was achieved in 31/36 (86%) and 24/36 (67%) of patients, respectively. Clinically and statistically significant decreases in Paediatric Crohn's Disease Activity Index, C‐reactive protein, and erythrocyte sedimentation rate were observed in the responders group. An allergic reaction during infusion, which led to treatment discontinuation, was observed in one case.

Conclusions:

Induction therapy with CT‐P13 in children with CD is effective. The profile appears similar to that reported for the reference infliximab. No unexpected adverse events occurred.
Wolman Disease: A Mimic of Infant Leukemia
Authors: Gopakumar Kaduveettil G. , Thankamony Priyakumari , Nampoothiri Sheela , Bali Deeksha , Raj Jubie , A. Vasudevan Jayasudha , K. Nair Ramachandran
Published: May 2017

Background:

Infant leukemia most commonly present with pallor and hepatosplenomegaly. The possibility of other differential diagnosis also has to be kept in mind during evaluation, as identifying the precise etiology for this clinical presentation is crucial for management.

Observation:

An infant, was referred to us with suspected infant leukemia and was subsequently diagnosed to have lysosomal acid lipase deficiency/Wolman disease with a novel 5 bp deletion “c.1180_1184del” in the last exon (exon 10) of the lipase A (LIPA) gene.

Conclusions:

Hepatosplenomegaly and pallor resulting from nutritional deficiency or bone marrow involvement in Wolman disease can mimic infant leukemia.
Testing the Implementation of a Pain Self-management Support Intervention for Oncology Patients in Clinical Practice
Authors: Koller Antje , Gaertner Jan , De Geest Sabina , Hasemann Monika , Becker Gerhild
Published: May 2017

Background:

In oncology, pain control is a persistent problem. Significant barriers to cancer pain management are patient related. Pain self-management support interventions have shown to reduce pain intensity and patient-related barriers. Comparative effectiveness research is a suitable approach to test whether effects are sustained in clinical practice.

Objective:

In this pilot randomized controlled trial, the implementation of the ANtiPain intervention into clinical practice was tested to assess the effects on pain intensity, function-related outcomes, self-efficacy, and patient-related barriers to pain management to prepare a larger effectiveness trial.

Methods:

Within 14 months, 39 adult oncology patients with pain scores of 3 or higher on a 10-point numeric rating scale were recruited in an academic comprehensive cancer center in Southern Germany. Patients in the control group (n = 19) received standard care. Patients in the intervention group (n = 20) received ANtiPain, a cancer pain self-management support intervention based on 3 key strategies: provision of information, skill building, and nurse coaching. An intervention session was performed in-hospital. After discharge, follow-up was provided via telephone calls. Data were collected at baseline and 1 and 6 weeks after discharge. Effect sizes were calculated for all outcomes.

Results:

Large effects were found for activity hindrance (Cohen d = 0.90), barriers (d = 0.91), and self-efficacy (d = 0.90). Small to moderate effects were found for average and worst pain (Cohen d = 0.17-0.45).

Conclusions:

Key findings of this study involved function-related outcomes and self-efficacy.

Implications for Practice:

Because these outcomes are particularly meaningful for patients, the integration of ANtiPain to routine clinical practice may be substantial. A larger study will be based on these findings.
Providing Coordinated Cancer Care—A Qualitative Study of Norwegian Cancer Coordinators’ Experiences of Their Role
Authors: Lie Nataskja-Elena Kersting , Hauken May Aasebø , Solvang Per Koren
Published: May 2017

Background:

There is a growing need for strategies to improve coordinated, tailored services in cancer care to meet the comprehensive needs of cancer patients. In Norway, cancer coordinators (CCs) have been established to improve coordination and patient-centeredness of services. Little is known about how CCs engage to provide patients with the needed services and support throughout the treatment.

Objective:

The aim of this study was to explore how Norwegian CCs experience their role and how they enact it in order to enhance coordinated cancer care.

Methods:

The study encompasses a qualitative, hermeneutic approach, conducting semistructured in-depth interviews of 26 Norwegian CCs. The data were analyzed using thematic analysis and discussed in the light of the salutogenic theory.

Results:

Cancer coordinators take a holistic approach to patient care, including both patient- and system-level activities. “Providing coordinated cancer care” emerged as an overarching topic for their role. This topic was elaborated by 3 main themes: (1) finding their place and creating their function, (2) meeting the needs of cancer patients and helping them cope, (3) promoting well-functioning cancer care systems.

Conclusions:

Cancer coordinators evolved diversely, in adaption to the local context and patients’ needs. The functions’ diversity challenged the implementation and external role recognition. Cancer coordinators seemed to apply a salutogenic, resource-focused orientation in order to support a positive development at both the patient and the system levels.

Implications for Practice:

The findings reinforce the call for holistic, patient-centered services in cancer care. Cancer coordinators need appropriate support from the local management to establish the role and local collaborations.
Transforming Care for Victims of Violence
Authors: Boatright Anne C.
Published: May 2017

In this month’s Magnet® Perspectives column, Anne Boatright, MSN, RN, SANE, describes her efforts to develop a comprehensive forensic nursing program at Methodist Hospital in Omaha. Ms Boatright transformed a sexual assault nurse examiner (SANE) program into one that provides 24/7 coverage at Methodist’s 2 SANE locations and cares not only for victims of sexual assault but also for the victims domestic violence, sex trafficking, strangulation, elder abuse, and neglect. Her work extends beyond the walls of Methodist to the community, where she serves as a core member of the Nebraska Human Trafficking Task Force. She works collaboratively with the Federal Bureau of Investigation and helped Nebraska state senators draft legislation to create a sexual assault payment program. In recognition of her determination to make a difference for victims of violence, she received the 2016 National Magnet Nurse of the Year Award for Transformational Leadership.
DNP Preparation in Supporting Critical Skills for Magnet® Program Directors
Authors: Lackey Sarah
Published: May 2017

Magnet® organizations are required to identify a Magnet program director (MPD), who plays a critical role in attaining and maintaining Magnet designation. The evidence is sparse related to qualifications or recommended educational levels of those assuming an MPD role. In this article, the author discusses how one of the DNP Essentials, clinical scholarship and the use of analytical methods for evidence-based practice, is reported to prepare nurses for the MPD role.
Influencing Scope of Practice Policy and Health Literacy
Authors: Adams Jeffrey M.
Published: May 2017

This department highlights emerging nursing leaders who have demonstrated leadership in advancing innovation and patient care in practice policy, research, education, and theory. This interview profiles Joy Deupree, assistant professor, School of Nursing, The University of Alabama at Birmingham.
Approach to skin and soft tissue infections in non-HIV immunocompromised hosts
Authors: Burke Victoria E. , Lopez Fred A.
Published: May 2017

Purpose of review

Skin and soft tissue infections are frequent contributors to morbidity and mortality in the immunocompromised host. This article reviews the changing epidemiology and clinical manifestations of the most common cutaneous pathogens in non-HIV immunocompromised hosts, including patients with solid organ transplants, stem cell transplants, solid tumors, hematologic malignancies, and receiving chronic immunosuppressive therapy for inflammatory disorders.

Recent findings

Defects in the innate or adaptive immune response can predispose the immunocompromised host to certain cutaneous infections in a predictive fashion. Cutaneous lesions in patients with neutrophil defects are commonly due to bacteria, Candida, or invasive molds. Skin lesions in patients with cellular or humoral immunodeficiencies can be due to encapsulated bacteria, Nocardia, mycobacteria, endemic fungal infections, herpesviruses, or parasites. Skin lesions may reflect primary inoculation or, more commonly, disseminated infection. Tissue samples for microscopy, culture, and histopathology are critical to making an accurate diagnosis given the nonspecific and heterogeneous appearance of these skin lesions due to a blunted immune response.

As the population of non-HIV immunosuppressed hosts expands with advances in medical therapies, the frequency and variety of cutaneous diseases in these hosts will increase.
Feasibility and applicability of antimicrobial stewardship in immunocompromised patients
Authors: Robilotti Elizabeth , Holubar Marisa , Seo Susan K. , Deresinski Stan
Published: May 2017

Purpose of review

Antimicrobial stewardship is the primary intervention in the battle against antimicrobial resistance, but clinicians do not always apply many key antimicrobial stewardship principles to patients with significant immune defects due to lack of data and fear of bad outcomes. We review evidence regarding the application of stewardship principles to immunocompromised patients, with a focus on solid organ and hematopoietic stem cell transplant recipients.

Recent findings

Antimicrobial stewardship programs (ASPs), targeting immunocompromised patient populations such as oncology and transplant, are gaining traction. Emerging literature suggests that several stewardship interventions can be adapted to immunocompromised hosts and improve antimicrobial utilization, but data supporting improved outcomes is very limited.

The application of antimicrobial stewardship principles to immunocompromised patients is feasible, necessary, and urgent. As antimicrobial stewardship programs gain momentum across a diverse range of healthcare settings more immunocompromised patients will fall under their purview. It is imperative that centers applying antimicrobial stewardship principles share their experience and establish collaborative research efforts to advance our knowledge base in applying antimicrobial stewardship initiatives to immunocompromised host populations, both in terms of programmatic success and patient outcomes.
Modified Dual-Energy Algorithm for Calcified Plaque Removal
Authors: Mannil Manoj , Ramachandran Jaychandran , Vittoria de Martini Ilaria , Wegener Susanne , Schmidt Bernhard , Flohr Thomas , Krauss Bernhard , Valavanis Antonios , Alkadhi Hatem , Winklhofer Sebastian
Published: May 2017

Objectives

Computed tomography angiography (CTA) is a valuable tool for the assessment of carotid artery stenosis. However, blooming artifacts from calcified plaques might result in an overestimation of the stenosis grade. The aim of this study was to investigate a new dual-energy computed tomography (DECT) technique with a modified 3-material decomposition algorithm for calcium removal in extracranial carotid artery stenosis.

Materials and Methods

In this retrospective, institutional review board-approved study, 30 calcified carotid plaques in 22 patients (15 men; mean age, 73 ± 10 years) with clinical suspicion of stroke were included. Dual-energy computed tomography image data were obtained using second-generation dual-source CT with tube voltages at 80 and 140Sn kVp. Conventional CTA and virtual noncalcium (VNCa) images using the modified DECT algorithm were reconstructed. By assessing spectral characteristics, the modified DECT algorithm allows for a selective removal of calcium independent of blooming. Two independent and blinded readers evaluated subjective image quality, blooming artifacts, amount of (residual) calcification, and performed stenosis measurements according to the North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria. Differences were tested using a pairwise sign test. Paired sample t tests with Bonferroni correction (P < 0.017) and Bland-Altman analyses were used to test for differences in carotid stenosis measurements between VNCa and conventional CTA using digital subtraction angiography (DSA) as the standard of reference.

Results

Subjective image quality was similar among conventional CTA and VNCa image data sets (P = 0.82), whereas blooming artifacts were significantly reduced in VNCa images compared with conventional CTA (P < 0.001). Residual calcifications in VNCa images were absent in 11 (37%), minor in 12 (40%), medium sized in 2 (7%), and large in 5 (17%) arteries. Stenosis measurements differed significantly between VNCa (mean NASCET stenosis: 27% ± 20%) and conventional CTA images (mean NASCET stenosis: 39% ± 16%; P < 0.001) and between conventional CTA and DSA (23% ± 16%, P < 0.001). No significant differences in stenosis measurements were observed between VNCa and DSA (P = 0.189), with narrow limits of agreement (mean difference ±1.96 standard deviations: −4.7%, −35.1%, and 25.7%).

Conclusions

A modified 3-material decomposition DECT algorithm for calcium removal was introduced, which allows for an accurate removal of calcified carotid plaques in extracranial carotid artery disease. The algorithm might overcome the problem of overestimation of calcified stenosis due to blooming artifacts in conventional CTA.
Contrasting effects of aquatic subsidies on a terrestrial trophic cascade
Authors: Graf Nadin , Bucher Roman , Schäfer Ralf B. , Entling Martin H.
Published: May 2017

Subsidies from adjacent ecosystems can alter recipient food webs and ecosystem functions, such as herbivory. Emerging aquatic insects from streams can be an important prey in the riparian zone. Such aquatic subsidies can enhance predator abundances or cause predators to switch prey, depending on the herbivores. This can lead to an increase or decrease of
in situ
herbivores and herbivory. We examined the effects of aquatic subsidies on a simplified terrestrial food web consisting of two types of herbivores, plants and predators (spiders). In our six-week experiment, we focused on the prey choice of the spiders by excluding predator immigration and reproduction. In accordance with predator switching, survival of leafhoppers increased in the presence of aquatic subsidies. By contrast, the presence of aquatic subsidies indirectly reduced weevils and herbivory. Our study shows that effects of aquatic subsidies on terrestrial predators can propagate through the food web in contrasting ways. Thereby, the outcome of the trophic cascade is determined by the prey choice of predators.
Identification of vortex structures in a cohort of 204 intracranial aneurysms
Authors: Varble Nicole , Trylesinski Gabriel , Xiang Jianping , Snyder Kenneth , Meng Hui
Published: May 2017

An intracranial aneurysm (IA) is a cerebrovascular pathology that can lead to death or disability if ruptured. Abnormal wall shear stress (WSS) has been associated with IA growth and rupture, but little is known about the underlying flow physics related to rupture-prone IAs. Previous studies, based on analysis of a few aneurysms or partial views of three-dimensional vortex structures, suggest that rupture is associated with complex vortical flow inside IAs. To further elucidate the relevance of vortical flow in aneurysm pathophysiology, we studied 204 patient IAs (56 ruptured and 148 unruptured). Using objective quantities to identify three-dimensional vortex structures, we investigated the characteristics associated with aneurysm rupture and if these features correlate with previously proposed WSS and morphological characteristics indicative of IA rupture. Based on the
Q
-criterion definition of a vortex, we quantified the degree of the aneurysmal region occupied by vortex structures using the volume vortex fraction (
vVF
) and the surface vortex fraction (
sVF
). Computational fluid dynamics simulations showed that the
sVF
, but not the
vVF
, discriminated ruptured from unruptured aneurysms. Furthermore, we found that the near-wall vortex structures co-localized with regions of inflow jet breakdown, and significantly correlated to previously proposed haemodynamic and morphologic characteristics of ruptured IAs.
Ageing and agency: age-related changes in susceptibility to illusory experiences of control
Authors: Cioffi Maria Cristina , Cocchini Gianna , Banissy Michael J. , Moore James W.
Published: May 2017

Sense of agency (SoAg) is the feeling of control over one's actions and their effects. It can be augmented or attenuated by internal signals and by external cues. Research has shown a reduction in the SoAg in older adulthood, but the reasons behind this change remain unclear. We investigated agency processing differences that may underpin age-related changes in SoAg. Using a modified version of a vicarious agency paradigm, we tested the modulation of SoAg by manipulating external situational agency cues in younger and older adults. Our results show that the illusion of vicarious agency was less pronounced in older adults. These results were replicated in a second experiment which also showed that older adults performed significantly better in interoception and proprioception tasks. We suggest that increased reliance on internal cues may explain differences in agency processing in older adulthood.
Causal dissipation for the relativistic dynamics of ideal gases
Authors: Freistühler Heinrich , Temple Blake
Published: May 2017

We derive a general class of relativistic dissipation tensors by requiring that, combined with the relativistic Euler equations, they form a second-order system of partial differential equations which is symmetric hyperbolic in a second-order sense when written in the natural Godunov variables that make the Euler equations symmetric hyperbolic in the first-order sense. We show that this class contains a unique element representing a causal formulation of relativistic dissipative fluid dynamics which (i) is equivalent to the classical descriptions by Eckart and Landau to first order in the coefficients of viscosity and heat conduction and (ii) has its signal speeds bounded sharply by the speed of light. Based on these properties, we propose this system as a natural candidate for the relativistic counterpart of the classical Navier–Stokes equations.