bluuebunny/crossref_metadata_2025 huggingface dataset:
The relationship between physical activity, fitness, physical complaints and BMI in German adults – results of a longitudinal study
Authors: Tittlbach Susanne A. , Jekauc Darko , Schmidt Steffen C. E. , Woll Alexander , Bös Klaus
Published: July 2017

Objectives: This study's aims were to describe the development of physical activity, physical fitness (PF), subjective (physical complaints (PC)) and objective (Body mass index (BMI)) health measures and to examine the relationship between the development trajectories. In addition, the study also aimed to assess the influence of sociodemographic determinants (age, sex, socioeconomic status (SES)) in German adults over a period of 18 years. Methods: The longitudinal study population comprises of 721 men and women, aged 33–76 years over the study period. There was self‐report of physical activity and PC and testing of physical fitness and BMI in each study year (1992, 1997, 2002 and 2010). Latent growth curve models were used to analyse the development. Results: Physical activity slightly increased while fitness, PC and BMI worsened over the course of 18 years. Sex, age and SES play important roles concerning physical activity, fitness and health. Several integrative associations could be detected between physical activity, fitness, PC and BMI as well as their trajectories. In particular, high initial levels of physical activity and fitness protect from high PC and BMI.The slope of physical activity was not significantly associated with slopes of fitness, PC and BMI. However, increase of fitness resulted in decrease of PC. Conclusions: A general positive development regarding the amount of physical activity could be detected. However, if it is only an unsystematic increase of physical activity, this is not in itself enough to achieve health benefits. The strengthening of fitness should be focused when increasing physical activity, since only then a health benefit is possible.
Static versus dynamic kinematics in cyclists: A comparison of goniometer, inclinometer and 3D motion capture
Authors: Holliday W. , Fisher J. , Theo R. , Swart J.
Published: July 2017

Kinematic measurements conducted during bike set‐ups utilise either static or dynamic measures. There is currently limited data on reliability of static and dynamic measures nor consensus on which is the optimal method. The aim of the study was to assess the difference between static and dynamic measures of the ankle, knee, hip, shoulder and elbow. Nineteen subjects performed three separate trials for a 10‐min duration at a fixed workload (70% of peak power output). Static measures were taken with a standard goniometer (GM), an inclinometer (IM) and dynamic three‐dimensional motion capture (3DMC) using an eight camera motion capture system. Static and dynamic joint angles were compared over the three trials to assess repeatability of the measurements and differences between static and dynamic values. There was a positive correlation between GM and IM measures for all joints. Only the knee, shoulder and elbow were positively correlated between GM and 3DMC, and IM and 3DMC. Although all three instruments were reliable, 3D motion analysis utilised different landmarks for most joints and produced different means. Changes in knee flexion angle from static to dynamic are attributable to changes in the positioning of the foot. Controlling for this factor, the differences are negated. It was demonstrated that 3DMC is not interchangeable with GM and IM, and it is recommended that 3DMC develop independent reference values for bicycle configuration.
Diverse mitotic functions of the cytoskeletal cross-linking protein Shortstop suggest a role in Dynein/Dynactin activity
Authors: Dewey Evan B. , Johnston Christopher A.
Published: July 2017

Proper assembly and orientation of the bipolar mitotic spindle is critical to the fidelity of cell division. Mitotic precision fundamentally contributes to cell fate specification, tissue development and homeostasis, and chromosome distribution within daughter cells. Defects in these events are thought to contribute to several human diseases. The underlying mechanisms that function in spindle morphogenesis and positioning remain incompletely defined, however. Here we describe diverse roles for the actin-microtubule cross-linker Shortstop (Shot) in mitotic spindle function in Drosophila. Shot localizes to mitotic spindle poles, and its knockdown results in an unfocused spindle pole morphology and a disruption of proper spindle orientation. Loss of Shot also leads to chromosome congression defects, cell cycle progression delay, and defective chromosome segregation during anaphase. These mitotic errors trigger apoptosis in Drosophila epithelial tissue, and blocking this apoptotic response results in a marked induction of the epithelial–mesenchymal transition marker MMP-1. The actin-binding domain of Shot directly interacts with Actin-related protein-1 (Arp-1), a key component of the Dynein/Dynactin complex. Knockdown of Arp-1 phenocopies Shot loss universally, whereas chemical disruption of F-actin does so selectively. Our work highlights novel roles for Shot in mitosis and suggests a mechanism involving Dynein/Dynactin activation.
law, Roman, institutional scheme of
Authors: Stagl Jakob Fortunat
Published: July 2017

The institutional scheme of Roman law was developed primarily by Gaius on the basis of a preceding tradition of law manuals. The scheme consists of dividing the law into a General Part, Family Law, Property Law, Law of Succession, Law of Obligations, and Civil Procedure. This scheme is apparent not only in Gaius’s Institutes but also in the whole of his didactic scheme, which can be discerned from descriptions of the curriculum in his time. Gaius’s larger didactic scheme is indebted to contemporary philosophical, rhetorical, and didactic currents, which made it possible for him to organise the law of Rome in such a solid and plausible way that the emperor Justinian adopted this scheme for his compilation, comprising the Institutes, the Digest, and the Codex.
Rayleigh phase velocities in Southern California from beamforming short-duration ambient noise
Authors: Roux Philippe , Ben-Zion Yehuda
Published: July 2017

Beamforming of ambient noise recorded by regional arrays of seismometers is presented as an alternative imaging approach to cross-correlations between pairs of sensors. The method is used to obtain phase velocities and propagation directions of Rayleigh surface waves around the first and second microseism peaks in southern California. The derived velocity maps and propagation directions correlate with major geological structures and changes of the coastal shape in the region. The results are consistent with and complementary to those obtained using cross-correlations of long-duration data between pairs of sensors. Significant advantages of the presented high-resolution adaptive beamforming method over point-to-point noise cross-correlations are the short time interval of required data (hours to days compared to a year) and robust performance with directive (rather than omnidirectional) noise propagation. Given the recent trend toward dense and large seismic arrays at various scales, the combination of beamforming and noise-correlation processing may provide an optimal strategy for performing noise-based tomography.
The MIMIC Code Repository: enabling reproducibility in critical care research
Authors: Johnson Alistair E W , Stone David J , Celi Leo A , Pollard Tom J
Published: July 2017

Objective

Lack of reproducibility in medical studies is a barrier to the generation of a robust knowledge base to support clinical decision-making. In this paper we outline the Medical Information Mart for Intensive Care (MIMIC) Code Repository, a centralized code base for generating reproducible studies on an openly available critical care dataset.

Materials and Methods

Code is provided to load the data into a relational structure, create extractions of the data, and reproduce entire analysis plans including research studies.

Results

Concepts extracted include severity of illness scores, comorbid status, administrative definitions of sepsis, physiologic criteria for sepsis, organ failure scores, treatment administration, and more. Executable documents are used for tutorials and reproduce published studies end-to-end, providing a template for future researchers to replicate. The repository’s issue tracker enables community discussion about the data and concepts, allowing users to collaboratively improve the resource.

Discussion

The centralized repository provides a platform for users of the data to interact directly with the data generators, facilitating greater understanding of the data. It also provides a location for the community to collaborate on necessary concepts for research progress and share them with a larger audience. Consistent application of the same code for underlying concepts is a key step in ensuring that research studies on the MIMIC database are comparable and reproducible.

Conclusion

By providing open source code alongside the freely accessible MIMIC-III database, we enable end-to-end reproducible analysis of electronic health records.
Social Intervention Research
Authors: Sundell Knut , Olsson Tina
Published: July 2017

This article is about social intervention research. A general definition of intervention is any interference that would modify a process or situation. In social work, interventions are intentionally implemented change strategies which aim to impede or eradicate risk factors, activate and/or mobilize protective factors, reduce or eradicate harm, or introduce betterment beyond harm eradication; thus social work intervention encompasses a range of psychotherapies, treatments, and programs. Interventions may be simple or complex. Yet simple interventions may have multiple elements that contribute to their effectiveness. Although social intervention research is an essential aspect of social work as a profession and research discipline, it is clearly multidisciplinary in its nature. The current knowledge base of social intervention research draws on knowledge gained from a wide variety of behavioral, psychological, and health interventions as well as from disciplines as diverse as psychology, education, medicine, public health, social work and other caring sciences. Social intervention research is vital to social work practice as professional decisions should be informed by evidence of both the potential benefits and harms of alternative interventions. Social intervention research focuses on the effects of an intervention under study. Of primary importance is understanding changes in the health and well-being of a target population. Subsequent results are then, ideally, used for decisions on future service provision. The goal of social intervention research is to bring about change in individuals, groups, or entire communities, and requires research methods that are most appropriate for achieving this goal.
Dizang (Jizō, Ksitigarbha)
Authors: Glassman Hank
Published: July 2017

The name Kṣitigarbha is attested as one member of a group of “eight great bodhisattvas” in the iconography of Indian Buddhism by the 8th century ce, and it appears in Śāntideva’s Bodhisattvacharyāvatāra around the same time. Indeed, this grouping of eight continues down to the present within Tibetan traditions. However, the Buddhist deity under discussion in this article is most accurately understood as a novel creation of Buddhists in China, and thus will be referred to primarily as Dizang (Ti-tsang) 地蔵 in this article. Dizang in China and Central Asia predates these Indian references by at least two centuries. (On this point see Appendix 2, pp. 229–239, in Zhiru 2007, under China; for a different view on the origins of the Dizang Cult in China, see Wang 1998, also under China). While the Indian and Tibetan Kṣitigarbha is invariably found together with the remaining seven, and in appearance resembles other celestial bodhisattvas, Dizang’s iconography in China and subsequent East Asian contexts, where he appears in the guise of a monk, diverges greatly from this model (see Iconography). In East Asia, Dizang is very much tied to the dead and to passage through the underworld. Closely associated with the Ten Kings who preside over the judgment of the deceased, he is portrayed as psychopomp (soul-guide) and as savior from the infernal regions. While Dizang has been very popular in the East Asian countries of China, Korea, Vietnam, and Japan, the character of his cult has varied widely in each region. Since Dizang has been such a prominent deity, images of him and stories about him appear in a great many texts and source collections. Here, in the interests of concision and usability, citations are limited to those that take Dizang as their main topic. Also, while there is a separate heading here for iconography, many of the studies listed in other sections (e.g., Wang 1998 and Zhiru 2007, under China; Glassman 2012, under Japan) rely heavily on visual evidence and iconographical analysis. This bibliography includes only secondary sources.
Communitarianism
Authors: Frazer Elizabeth
Published: July 2017

Communitarianism, like other “isms,” is relational—worked out and articulated in distinction from rival philosophical positions and political ideologies. We could present a bibliography of avowedly communitarian references without explicitly including communitarianism’s rivals and antagonists. But communitarianism would then look more free-standing than it really is. This article presents works that contribute to communitarianism as a position and also some that are critical of and dissent from it. Communitarianism is a position with a history. Communitarian critiques of individualism and liberalism developed in response to a particular articulation, from the 1970s to the mid-1980s, of “liberal individualism.” As well as engaging with, diagnosing, and criticizing particular aspects of liberal individualism, communitarian critics made reference to a wide range of historical and philosophical precursors and antecedents. These included a diverse range of philosophical sources, which were interpreted as congenial to contemporary communitarian concerns, and a range of sources from humanities and social sciences that focused on forms of community in human societies. The communitarian critiques of liberalism and individualism generated a sizeable critical literature, beginning with publications from the mid-1980s that individuated communitarianism as a specific, though ambiguous and contested, position in political philosophy and theory and weighed up the respective merits of “liberalism,” “individualism,” and “communitarianism.” This critical literature is notable, first, for the contributions of a number of thinkers who had originally been grouped under the heading “communitarian” or “liberal,” who published rejoinder papers that considered the debate and the issues, distancing the author from the position ascribed to them by early commentators. Second, the critical literature complicated communitarianism, separating out questions of metaphysics or ontology, philosophical anthropology, epistemology, meta-ethics, ethics, and methodology in social science, ethics, and philosophy. Criticism of liberalism as a tradition in political philosophy was separated out from the political projects of liberal parties and broadly liberal societies. Most analyses attempt to show that positions on these various dimensions of the debate are independent: for instance, one can be communitarian metaphysically and individualist ethically, or vice versa; one’s commitments as an individualist in the one branch of philosophy—methodology of social science, for instance—do not commit one to an individualist stand in another—epistemology or philosophical anthropology. Further, such philosophical analysis is indeterminate regarding one’s attitude to communitarian, socialist, conservative, liberal, or other political and social programs, including policy aims, objectives, means, strategies, and tactics.
Nation-Building
Authors: Mylonas Harris
Published: July 2017

Nation-building may be defined as the process through which the boundaries of the modern state and those of the national community become congruent. The desired outcome is to achieve national integration (Reference Works: Concepts and Definitions). The major divide in the literature centers on the causal path that leads to national integration. Thus, nation-building has been theorized as a structural process intertwined with industrialization, urbanization, social mobilization, etc. (Structural Explanations); as the result of deliberate state policies that aim at the homogenization of a state along the lines of a specific constitutive story—that can and often does change over time and under certain conditions (State-Planned Policies); as the product of top-bottom processes that could originate from forces outside of the boundaries of the relevant state; and as the product of bottom-up processes that do not require any state intervention to come about (Contingency, Events, and Demonstration Effects). Since the emergence of nationalism as the dominant ideology to legitimate authority and the template of the nation-state as an organizational principle of the international system, state elites have pursued different policies toward the various unassimilated groups within their territorial boundaries (Seminal Case Studies) with variable consequences (Nation-Building and Its Consequences). Thus, scholars have suggested that the nation-building experience of each state—or lack thereof—has had an impact on patterns of State Formation and Social Order, Self-Determination Movements, War Onset, and Public Goods Provision.
Campaign Finance in the Era of Super-PACS
Authors: Boatright Robert G.
Published: July 2017

The regulations concerning how American political campaigns are financed have changed dramatically over the past decade. The US Supreme Court’s Citizens United v. Federal Election Commission decision (2010) removed restrictions on corporate and labor spending on elections. A subsequent decision in American Tradition Partnership v. Bullock held that the ruling also applied to state elections. The Supreme Court’s decision ultimately led to the establishment of “super PACs” as a result of the District of Columbia Court of Appeals opinion in SpeechNow.org v. Federal Election Commission, which held that political committees that only spend money independently in support of candidates are not subject to federal contribution limits but must comply with disclosure rules. Super PACs were thus permitted to use unlimited contributions to finance independent advocacy spending. While super PACs cannot give money directly to candidates or directly coordinate their efforts with candidates or parties, within a short amount of time they developed the ability to come quite close to serving as parallel campaign organizations. Not coincidentally, total spending on presidential and congressional elections increased substantially in the election cycles following the decision. The Citizens United decision did not merely increase spending in these elections, however; it shifted the balance in spending away from candidates and parties and toward groups. This prompted a variety of changes, as well, in the content of political advertisements; in public attitudes toward campaign finance; and in the ability of citizens to know the sources of campaign money. However, not all changes in campaign finance were a consequence of the Citizens United decision; candidate fundraising practices, advertising strategies, communication techniques, and many other activities related to the campaign finance system are constantly evolving. This literature review focuses on the origins of the Citizens United decision, ways in which we might measure its consequences for campaign spending, and the broader consequences for American democracy of campaign finance laws and practices.
Online Education
Authors: Daniel-Gittens Kathy-ann
Published: July 2017

Online education is considered the latest generation in the practice of distance education. As described by professionals in the field, distance education is a form of teaching and learning characterized by the physical separation of student from teacher and from other students. In distance education, teaching and learning is always mediated by technology. The goal of technology has always been to decrease the distance between learners and teachers and to make education accessible. In online education, distance education teaching and learning is mediated by Internet technology. In its earliest days, distance education was accomplished using the postal system. This paper-based distance education model gave rise to the term “correspondence school.” This was used to describe vocational and technical schools using distance education as their primary means of instruction. Higher education institutions using this mode of instruction were designated “open universities.” As technology changed over the years, so did the means of instruction in distance education. Newer technologies were employed to bridge the physical distance. Increased use of television, radio, audio and video cassettes and video conferencing for instruction were some of the major technological shifts that changed the way education at a distance was mediated. Instead of completely paper-based instructional materials and communication modes, students could physically see and hear their teachers. In video conferencing, there was also the opportunity for synchronous communication with instructors. More recently, in the late 20th and early 21st centuries, Internet technology has also radically shifted the way distance education is carried out. Like previous electronic technologies, Internet technology affords opportunities to produce instructional materials in a variety of multimedia formats. Unlike previous electronic technologies, Internet technology allows this development to occur at significantly reduced costs, making the production of multimedia instructional materials more prevalent in distance education. It also promotes the sharing of these materials at much faster speeds. In addition, Internet technology has had a wide-ranging impact on the communication patterns that defined distance education. One of the well-documented limitations of distance education was the difficulty in supporting synchronous communication between teachers and students and among students themselves. Internet technology has removed this limitation by affording easy and affordable access to synchronous communication tools. Internet technology has not only changed the content delivery and communication models in distance education, it has also changed the way instruction is viewed and designed. Although online education is recognized as the latest generation of distance education, it remain true that distance education represents the larger field of theoretical study, With a deep foundation of research literature, distance education encompasses not only online education, but also every other form of mediated instruction.
Organizational Image and Reputation
Authors: Slaughter Jerel E. , Evans Jonathan B.
Published: July 2017

Organizational image and reputation are important components of the views external constituents hold of organizations. Because of the effects these variables have on profits, stock prices, and the company’s ability to attract the best applicants and employees, executives often monitor closely, and seek out ways to improve, company reputations and the images that nonmembers hold about the company. In turn, reputation and image have become frequent topics of inquiry for organizational researchers.
The Pelvic Girdle Questionnaire: Responsiveness and Minimal Important Change in Women With Pregnancy-Related Pelvic Girdle Pain, Low Back Pain, or Both
Authors: Stuge Britt , Jenssen Hanne Krogstad , Grotle Margreth
Published: July 2017

Background

The Pelvic Girdle Questionnaire (PGQ) is a condition-specific measure for women with pelvic girdle pain (PGP). The PGQ includes items relating to activity/participation and bodily symptoms and has reliability, validity, and feasibility for use in research and clinical practice.

Objective

The purposes of this study were to examine the responsiveness of the PGQ, to determine the minimal important change (MIC) for the PGQ, and to compare the PGQ with other outcome measures.

Design

This study used a prospective cohort design.

Methods

A total of 801 women responded to a booklet of questionnaires in the last trimester of their pregnancy and within 3 months post partum. Responsiveness analyses followed recommendations from the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist. The responsiveness of the PGQ was tested by examining correlations between the change scores of the total PGQ and the other patient-reported outcome measures.

Results

A total of 606 women (76%) reported PGP, low back pain, or both. Of these women, 441 (73%) responded to the follow-up questionnaire post partum. The PGQ (both subscale and total scores) discriminated most accurately between participants who improved and those who did not improve, with an area under the receiver operator characteristic curve of 72%. The MIC values indicated that a change score smaller than 25 for the total score and activity subscale score and a change score of 20 for the symptom subscale score should be regarded as insignificant. Baseline PGQ scores had a large impact on the MIC estimates for the absolute change scores but not on the relative percentage change scores. Five of 6 hypotheses were supported (83%).

Limitations

The type of anchor and definition of important change used might be weaknesses in women whose status is changing from pregnant to post partum.

Conclusions

The PGQ showed acceptable responsiveness in women with PGP, low back pain, or both.
Evaluation of Prognostic Factors and Proposed Changes to the Modified Tokuhashi Score in Patients With Spinal Metastases From Breast Cancer
Authors: Tan Kimberly-Anne , Tan Jiong Hao , Zaw Aye Sandar , Tan Joel Yong Hao , Hey Hwee Weng Dennis , Kumar Naresh
Published: July 2017

Study Design.

A retrospective study of all patients with histologically confirmed breast cancer spinal metastases presenting to a single institution between May 2001 and April 2012.

Objectives.

The aim of this study was to investigate whether the 2014mT is more accurate than the 2005mT.

Summary of Background Data.

The commonly used 2005 modified Tokuhashi score (2005mT) has become more inaccurate as oncologists move toward treating tumors according to their molecular and genomic profile, rather than their tissue-of-origin. In attempts to improve the accuracy of the 2005mT, a revised score (2014mT) was published, suggesting that hormone receptor negative and triple-negative breast cancer patients be given a modified Tokuhashi histological score of 3 rather than 5.

Methods.

Demographic characteristics, tumor receptor status, clinical findings in relation to the primary tumor and its metastases, and actual survival time were collated. The 2005mT was compared with the 2014mT. Univariate and multivariate Cox regression analyses were used to evaluate the influence of each parameter on survival, and receiver operating characteristic curves were used to determine predictive values of each score version.

Results.

Of the 185 patients included, 32 underwent operative treatment, while 153 were managed nonoperatively for their spinal metastases. The overall cohort had a median survival time of 24 months following the diagnosis of spinal metastases, with a 6-month survival rate of 90%. Hormone, HER2 and triple-negative receptor statuses were significant predictors of poorer survival upon multivariate analysis (P = 0.004, P = 0.007, P < 0.001, and P < 0.001, respectively). Age, the original Tokuhashi score components, previous breast surgery for cancer, previous radiotherapy to the breast, previous radiotherapy to the spine, previous chemotherapy, and previous immunotherapy were not significant. At 6 months, the 2005mT AUROC was 0.62, while that of the 2014mT was 0.64 (P = 0.5394).

Conclusion.

Tumor histological subtype is crucial when prognosticating the survival of patients with breast cancer spinal metastases. Although the 2014mT was marginally more accurate than the 2005mT, its predictive ability remains poor.

Level of Evidence: 3
Effect of Donor and Recipient Diabetes Status on Descemet Membrane Endothelial Keratoplasty Adherence and Survival
Authors: Price Marianne O. , Lisek Marek , Feng Matthew T. , Price Francis W.
Published: July 2017

Purpose:

To evaluate whether donor and/or recipient diabetes status affects the outcomes of Descemet membrane endothelial keratoplasty (DMEK).

Methods:

A consecutive, single-center DMEK case series was reviewed. The outcome measures were success of surgeon tissue preparation, air reinjection rate, Kaplan–Meier 4-year graft replacement/failure rate for any reason, and endothelial cell loss.

Results:

The donor had a history of diabetes in 504 of 1791 cases (28%) and the recipient in 14%. For donors without and with diabetes, the preparation success rate was 99% versus 95% (P < 0.0001), the air reinjection rate was 16% versus 18% (P = 0.19), and the 4-year graft replacement/failure rate was 7% versus 9%, respectively (P = 0.15). Endothelial cell loss was not associated with donor diabetes (P = 0.76). For recipients without and with diabetes, the 4-year graft replacement/failure rate was 7% versus 9% (P = 0.68), and median endothelial cell loss increased from 27% versus 29% at 1 month to 42% versus 48% at 4 years, respectively (P = 0.02). Recipient use of insulin therapy was associated with poorer graft attachment and a higher air reinjection rate (P = 0.0023).

Conclusions:

Although donor diabetes was associated with a 5-fold increased risk of tissue preparation failure, it was not significantly associated with air reinjection, graft survival, or endothelial cell loss. This provides reassurance that tissue prepared successfully from donors with diabetes is safe to use for DMEK. Recipient diabetes was associated with increased endothelial cell loss; the potential effect on longer-term graft survival merits further study.
Role of Scleral Contact Lenses in Management of Coexisting Keratoconus and Stevens–Johnson Syndrome
Authors: Rathi Varsha M. , Taneja Mukesh , Dumpati Srikanth , Mandathara Preeji S. , Sangwan Virender S.
Published: July 2017

Purpose:

To report the rare coexistence of keratoconus and Stevens–Johnson syndrome (SJS) managed with scleral contact lenses (ScCLs).

Methods:

This is a retrospective case series. Five patients (9 eyes) who had coexisting SJS and corneal ectasia were identified from the database during the 2-year period. Diagnosis of SJS was based on a positive history of drug reactions, signs of ocular surface disease, and the presence of keratinization of lid margins. Keratoconus was diagnosed by slit-lamp biomicroscopy.

Results:

Five eyes of 3 patients had coexisting SJS and keratoconus and were dispensed with ScCLs (PROSE, prosthetic replacement of the ocular surface ecosystem; Boston Foundation for Sight, Needham Heights, MA). All these patients had photophobia. Visual acuity improved in all these patients with ScCL wear. Two patients (4 eyes) were excluded from this study because they had SJS with generalized corneal thinning from limbus to limbus, corneal opacification, and pannus. One patient developed deep vessels in the cornea on prolonged ScCL wear. Reduction in the ScCL wear schedule and change of material with a higher Dk resulted in regression of vascularization. Case 3 developed conjunctival congestion and was uncomfortable wearing ScCLs, although visual acuity was 20/40. He discontinued using ScCL wear.

Conclusions:

Keratoconus, a noninflammatory condition of the cornea coexisted with inflammatory SJS. Managing such patients with ScCLs may improve vision and comfort.
Atrial Esophageal Fistula Secondary to Ablation for Atrial Fibrillation
Authors: Fatula Lily K. , Bolton William D. , Hale Allyson L. , Davis Barry R. , Stephenson James E. , Ben-Or Sharon
Published: July 2017

This article describes 2 patients who presented to our institution with left atrial esophageal fistula after atrial fibrillation ablation; it also compares our experience with other atrial esophageal fistula cases reported in the literature. We performed a retrospective review of 2 patients who presented to our hospital between July 2015 and September 2015 with atrial esophageal fistula. Patient A, a 57-year-old man, presented 31 days postablation with a fever and right-sided weakness. A chest computed tomography showed gas in the left atrium and esophagus; an echocardiogram confirmed the diagnosis of atrial esophageal fistula. The patient subsequently underwent a left thoracotomy. Postoperative recovery was poor and included significant coagulopathy, sepsis, cardiogenic shock, and multisystem organ failure. The patient died on postoperative day 28. Patient B, a 77-year-old man, presented 21 days post-atrial fibrillation ablation with left-arm weakness and altered mental status. An esophagram was performed and showed no evidence of an esophageal perforation. Because of positive cultures and worsening altered mental status, the patient underwent a head computed tomography, which showed pneumocephalus, leading to our suspicion of the atrial esophageal fistula. A follow-up chest computed tomography confirmed the atrial esophageal fistula. Treatment included an esophagectomy and repair of the atrium. Unfortunately, the atrial esophageal fistula closure dehisced, and the patient developed acute respiratory failure and cardiac tamponade, which led to cardiopulmonary arrest, and the patient died on postoperative day 10. Based on our experience, and the literature, we recommend that a chest computed tomography be immediately performed on patients presenting with the described symptoms after a recent atrial fibrillation ablation.
Immunoglobulin G4 (IgG4)-Positive Ocular Adnexal Mucosa-Associated Lymphoid Tissue Lymphoma and Idiopathic Orbital Inflammation
Authors: Sohn Eun Jung , Ahn Hee Bae , Roh Mee Sook , Jung Woo Jun , Ryu Won Yeol , Kwon Yoon Hyung
Published: July 2017

Purpose:

To report clinical and pathological characteristics of idiopathic orbital inflammation and ocular adnexal mucosa-associated lymphoid tissue (MALT) lymphoma with immunoglobulin G4 (IgG4)-positive plasma cells.

Methods:

A retrospective histopathological review and clinical case series. A total of 51 biopsy samples from January 2005 to December 2015 were used in this study, including 21 cases of biopsy-confirmed idiopathic orbital inflammation and 30 cases of biopsy-confirmed ocular adnexal MALT lymphoma. Most cases of ocular adnexal lymphoma were conjunctival tissue. Retrospective immunohistochemical studies were performed to estimate the IgG4 and IgG4/IgG ratios. Histopathologic features, demographic and clinical data, radiologic findings, treatment, and follow-up information for each patient were analyzed.

Results:

Among idiopathic orbital inflammation, 6 (28.6%) of the 21 patients were diagnosed as “probable” ocular adnexal IgG4-related diseases and 13 (43.3%) of the 30 patients were diagnosed as MALT lymphoma with IgG4-positive plasma cells. Six cases of 13 IgG4-positive MALT lymphoma group had contralateral chronic inflammatory lesions infiltrated by IgG4-positive plasma cells, which was significantly (p = 0.007) higher than that in the IgG4-negative group. Conjunctival involvement was 69% of the IgG4-positive MALT lymphoma cases. Bilateral involvement of the ocular adnexa was significantly (p = 0.02) more frequent among IgG4-positive MALT lymphoma patients than that in IgG4-positive idiopathic orbital inflammation patients. Recurrence rate in the IgG4-positive group was higher (p = 0.05) than that in the IgG4-negative group but not significantly.

Conclusions:

This study presented an unusual framework of ocular adnexal IgG4-related inflammation, in conjunctiva. It is important to understand contralateral chronic inflammatory lesions and their relationship with IgG4-positive MALT lymphoma. Tissue biopsy and IgG4 immunostaining are required for all cases because IgG4-positive MALT lymphoma can arise from a pre-existing IgG4-positive chronic inflammatory lesions. This is the first study that performs IgG4 immunostaining for tissue from a relatively large number of conjunctival MALT lymphomas in a single center. Therefore, it will help to diagnose conjunctival lymphoproliferative disease.
Enhanced Adherence in Patients Using an Automated Home Medication Dispenser
Authors: Hoffmann Charles , Schweighardt Anne , Conn Kelly M. , Nelson Dallas , Barbano Richard , Marshall Frederick , Brown Jack
Published: July 2017

Background:

Many factors contribute to medication nonadherence including psychological and memory disorders, aging, and pill burden. The Automated Home Medication Dispenser (AHMD) is a medication management system intended to help solve unintentional medication nonadherence.

Objective:

The purpose of this study was to determine if use of the AHMD improved medication adherence.

Methods:

We conducted a 6-month prospective, feasibility study assessing use of the AHMD in 21 patient-caregiver dyads. Patients were referred by their physician because of poor medication adherence and included if they resided in Rochester, NY and on at least two medications in pill form. Pill counts were performed at baseline to assess previous adherence. Prospective medication adherence was assessed using AHMD recorded dosing information. A paired t-test was used to compare previous and prospective adherence.

Results:

The mean age of patients was 75.1 years. Fifteen patients (71.4%) and eight caregivers (38.1%) were women; half (47.6%) of caregivers lived with the patient. The most common patient comorbidities were hypertension (76.2%) and memory disorder (61.9%). Mean adherence increased from 49.0% at baseline to 96.8% after 6 months of AHMD use (p < .001).

Conclusion:

In a cohort of unintentionally nonadherent patients, use of the AHMD for 6 months significantly improved medication adherence.
Quality-of-Life Outcomes Improve with Nipple-Sparing Mastectomy and Breast Reconstruction
Authors: Bailey Christopher R. , Ogbuagu Onyebuchi , Baltodano Pablo A. , Simjee Usamah F. , Manahan Michele A. , Cooney Damon S. , Jacobs Lisa K. , Tsangaris Theodore N. , Cooney Carisa M. , Rosson Gedge D.
Published: July 2017

Background:

Loss of the nipple-areola complex can be psychologically and sexually devastating. Nipple-sparing mastectomy provides robust cosmetic results, but few studies have investigated the quality-of-life outcomes associated with it.

Methods:

The authors performed an institutional review board–approved retrospective study of 32 patients who underwent nipple-sparing mastectomy with implant-based or autologous reconstruction and 32 control patients who underwent non–nipple-sparing mastectomy with reconstruction matched by reconstruction type and operative period. They then compared premastectomy and postreconstruction responses to the BREAST-Q, a validated and breast reconstruction–specific quality-of-life questionnaire, within and between their study and control populations.

Results:

The nipple-sparing and non–nipple-sparing mastectomy groups were statistically similar in terms of mean age [49.9 ± 8.5 years (range, 36 to 69 years) and 47.7 ± 10.3 years (range, 26 to 68 years) (p = 0.29), respectively] and mean body mass index [24.3 ± 3.5 kg/m2 (range, 17.9 to 33.7 kg/m2) and 25.5 ± 5.4 kg/m2 (range, 19.2 to 39.2 kg/m2) (p = 0.29), respectively]. There were no significant between-group differences in occurrence of postreconstruction complications. The authors found significantly higher mean postreconstruction scores in the nipple-sparing mastectomy group within the Satisfaction with Breasts (p = 0.039) and the Satisfaction with Outcome (p = 0.017) domains. Finally, they noted higher median postreconstruction scores in the nipple-sparing mastectomy group within the Psychosocial Well-being (p = 0.043) and Satisfaction with Breasts (p = 0.004) domains.

Conclusions:

Psychological concerns regarding malignancy may negatively impact premastectomy patient quality of life. Reconstructive surgery improves patients’ postmastectomy quality of life. Nipple-sparing mastectomy appears to provide significantly better improvement in postreconstruction quality of life, specifically in the Satisfaction with Breasts and Satisfaction with Outcome domains of the BREAST-Q, compared with non–nipple-sparing mastectomies.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Corticosteroid Injections for Carpal Tunnel Syndrome: Long-Term Follow-Up in a Population-Based Cohort
Authors: Evers Stefanie , Bryan Andrew J. , Sanders Thomas L. , Gunderson Tina , Gelfman Russell , Amadio Peter C.
Published: July 2017

Background:

Corticosteroid injection is a recommended treatment option for carpal tunnel syndrome, before considering surgery. Nevertheless, injections remain controversial because there is strong evidence of only short-term benefits. This study aimed to determine the reintervention rate and to identify prognostic indicators for subsequent treatment after corticosteroid injection for carpal tunnel syndrome.

Methods:

This study evaluated residents of Olmsted County treated with a corticosteroid injection for carpal tunnel syndrome between 2001 and 2010. Treatment failure was the primary outcome of interest. Two definitions for failure were examined: (1) the patient receiving subsequent procedural intervention and (2) the patient undergoing carpal tunnel release. Survival was estimated using Kaplan-Meier methods, and association of covariates with increased failure was modeled using Cox proportional hazards regression.

Results:

The study included 774 affected hands in 595 patients. The median follow-up period was 7.4 years. Reintervention was performed in 68 percent of cases, of which 63 percent resulted in eventual surgery. Injectate volume was significant for the outcome of any retreatment [hazard ratio, 0.879 (95 percent CI, 0.804 to 0.96)] and surgery [hazard ratio, 0.906 (95 percent CI, 0.827 to 0.99)]. Rheumatoid arthritis was also significant in both models, with a hazard ratio of 0.627 (95 percent CI, 0.404 to 0.97) for any retreatment and 0.493 (95 percent CI, 0.292 to 0.83) for surgery.

Conclusions:

In this cohort, 32 percent of patients did not receive subsequent treatment after a single injection, which indicates that there is a therapeutic role for corticosteroid injections in treating carpal tunnel syndrome. Further research is necessary to identify those patients who will benefit from an injection, to provide more individually tailored treatment.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, III.
Using a Second Free Fibula Osteocutaneous Flap after Repeated Mandibulectomy Is Associated with a Low Complication Rate and Acceptable Functional Outcomes
Authors: Mericli Alexander F. , Schaverien Mark V. , Hanasono Matthew M. , Yu Peirong , Largo Rene D. , Villa Mark T. , Reece Greg , Butler Charles E. , Garvey Patrick B.
Published: July 2017

Background:

A significant percentage of patients who undergo segmental mandibulectomy for head and neck cancer will develop a new or recurrent cancer or osteoradionecrosis, necessitating a second mandibulectomy and reconstruction. In this scenario, many surgeons are reluctant to perform a reconstruction with an osseous flap because of the presumed increased morbidity and complexity. The purpose of this study was to evaluate the safety and efficacy of performing a second free fibula flap reconstruction after repeated segmental mandibulectomy.

Methods:

The authors retrospectively reviewed their prospectively maintained departmental database for mandible reconstructions performed between 1991 and 2016, identifying patients who had two sequential free fibula flap reconstructions. Patient, disease, and treatment characteristics were recorded and analyzed.

Results:

Twenty patients underwent a second free fibula flap reconstruction after a second mandibulectomy. The median follow-up was 72.5 months (range, 16 to 243 months). Preoperative virtual planning was used more often for the second fibula flap compared with the first (50 percent versus 10 percent; p = 0.004). The mean operative times were statistically similar for the first versus second fibula flap (673 minutes versus 586 minutes, respectively; p = 0.13). The postoperative complication rates (50 percent versus 30 percent, respectively; p = 0.19) and functional outcomes were similar between the first and second fibula flap reconstructions.

Conclusion:

Despite the increased technical complexity, the use of a second free fibula flap after repeated segmental mandibulectomy appears to be safe and to confer no higher risk than that for the first fibula flap.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
BFACE: A Framework for Evaluating Breast Aesthetics
Authors: Martinovic Maryann E. , Blanchet Nadia P.
Published: July 2017

Although much has been written about breast aesthetics, the literature lacks a simple yet systematic and comprehensive approach for preoperative breast assessment. With use of the mnemonic “BFACE,” the breast surgeon will analyze the bony skeleton and the breast footprint, areola, conus, and envelope. The authors present a thorough review of the important parameters that define the ideal breast, and several techniques for perceiving asymmetries more clearly. Strategic surgical planning is enabled by accurate perception.
Direct Anthropometry of Repaired Bilateral Complete Cleft Lip: A Long-Term Assessment
Authors: Kim David C. , Mulliken John B.
Published: July 2017

Background:

Repair of bilateral complete cleft lip requires more than following a design in a textbook. The operative strategy should incorporate knowledge of anticipated nasolabial changes with growth.

Methods:

Direct nasolabial anthropometry was recorded in 174 children with bilateral complete cleft lip before and immediately after primary repair. Serial measurements were taken in 66 Caucasian patients between the ages of 6 months and 15 years and compared to Farkas’ normal values. Data for upper philtral width were unavailable; therefore, this dimension was measured in 454 nonsyndromic Caucasian male and female subjects aged 1 year to adulthood. Rates and types of revision were also documented.

Results:

Inter–medial canthal width stayed above the mean and within normal limits throughout puberty. Interalar width was initially narrowed and hovered in the high normal range throughout adolescence. Columellar height and nasal projection were constructed slightly long and paralleled normal growth. Available cutaneous philtral length was used in the primary repair; however, this dimension remained short. The philtrum was made narrow and matched normal values throughout adolescence. Normal inferior/superior philtral width ratio was 1.60 for female subjects and 1.59 for male subjects. A full median tubercle was built at primary repair but, sometimes in late childhood, necessitated secondary augmentation with a dermal graft in 31 of 174 patients (18 percent), usually performed in late childhood or adolescence.

Conclusions:

Serial anthropometry documented postoperative changes in nasolabial dimensions compared to normal growth curves. Repair of bilateral complete cleft lip requires primary correction of nasal and labial features based on their differential growth, with special attention to nasal width, philtral height and proportions, and size of the median tubercle.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.