bluuebunny/crossref_metadata_2025 huggingface dataset:
“Can you tell me why you made that choice?”: A qualitative study of the influences on treatment decisions in advance care planning among adolescents and young adults undergoing bone marrow transplant
Authors: Needle Jennifer S , Peden-McAlpine Cynthia , Liaschenko Joan , Koschmann Kara , Sanders Noah , Smith Angela , Schellinger Sandra E , Lyon Maureen E
Published: October 2019

Background:

Adolescent and young adult advance care planning is beneficial in improving communication between patients, surrogates, and clinicians. The influences on treatment decisions among adolescents and young adults are underexplored in the literature.

Aim:

The aim of this study was to explore and better understand the influences on decision-making for adolescent and young adult bone marrow transplant patients about future medical care.

Design:

Clinical case studies and qualitative inductive content analysis of treatment decisions made during the Respecting Choices® Next Steps Pediatric Advance Care Planning conversation as a component of the Family-Centered Advance Care Planning Intervention.

Settings/participants:

A total of 10 adolescent and young adult patients (aged 14–27 years) undergoing bone marrow transplant at an academic Midwest children’s hospital were involved in the study.

Results:

Influences on participants’ decisions were consideration for family, quality of life, and awareness of self. Desire to avoid suffering and maintain an acceptable quality of life was often in competition with participant’s concern over the perceived negative impact of discontinuing treatment on their families.

Conclusion:

This study highlights that adolescent and young adult bone marrow transplant patients are capable of meaningful deliberation about future treatment decisions. Influences on decision-making should be incorporated into advance care planning conversations to facilitate communication between patients and their surrogates. Longitudinal research is needed to explore these influences throughout the trajectory of illness.
Refining model estimates of potential species’ distributions to relevant accessible areas
Authors: Gherghel Iulian , Brischoux François , Papeş Monica
Published: October 2019

Dispersal is an important, yet overlooked phenomenon when studying species’ distributions using ecological niche models (ENMs). Here, we use species’ dispersal limits to evaluate and refine ENM estimates only to the areas accessible to the species within the study region and, thereby, enhance the model interpretations. First, we ran multiple ENMs to estimate the distribution of sea krait species in both marine and terrestrial environments. Second, we estimated dispersal of the sea kraits using a cost analysis approach. Finally, we outline a new approach that combines dispersal models and ENMs with the purpose of estimating the accessible range when projecting species’ distribution estimates outside the known species range. We found that only a small proportion of the area the ENMs were projected over was accessible to sea kraits. The majority of the suitable areas for sea kraits are within the accessible area. Outside the accessible area, there is only a very limited suitable area for sea kraits. Our results suggest that when dispersal is taken into account, sea kraits seem to occupy most of their suitable available niche and that they may be unable to colonize much of the area outside of their dispersal ranges. Using dispersal estimates to refine species’ distribution predictions is a useful tool for refining the area of focus when ENM results are interpreted. Estimating species’ dispersal also helps evaluate the ability of the models to predict the species’ distributions in areas that are not accessible to the species and, hence, the potential commission error represented by overprediction.
Using social reproduction theory to understand unfree labour
Authors: Gore Ellie , LeBaron Genevieve
Published: October 2019

Most scholarship within social reproduction theory focuses on women’s paid and unpaid care and domestic work, typically within the global North. Rarely has social reproduction theory grappled with unfree labour in commodity supply chains, particularly in the global South. However, these labour relations also involve gendered power relations that cut across the productive and reproductive realms of the economy, which can be illuminated by social reproduction theory analysis. In this article, we reflect on how social reproduction theory can be used to make sense of unfree labour’s role in global supply chains, expanding its geographical scope and the forms of labour exploitation encompassed within it. Conceptually, we harness the insights of social reproduction theory, and Jeffrey Harrod and Robert W Cox’s work on ‘unprotected work’ in the global economy to examine how gendered power relations shape patterns of unfree labour. Empirically, we analyse interview and survey data collected among cocoa workers in Ghana through LeBaron’s Global Business of Forced Labour project. We argue that social reproduction theory can move global supply chain scholarship beyond its presently economistic emphasis on the productive sphere and can shed light into the overlaps between social oppression, economic exploitation, and social reproduction.
Gender and violence: Rape as a spectacle on prime-time television
Authors: Kaya Şehriban
Published: October 2019

This article focuses on the representation of rape on prime-time Turkish television and its context, where the industry, marketing and politics intersect, to investigate how the representation of rape on television serials functions. Since 2010, the prime-time episodic television of Turkey has used images of beautiful young girls and women who have been raped as a motif. A large number of TV serials have featured male violence against women as a central narrative concern, while there has been a rising trend featuring female characters as victims of rape. Often an episode in a television serial that features the act of rape is the most-viewed one in the series. The eroticization of violence against women through rape and gang rape scenes demonstrates that media, especially television, plays a key role in the construction of a violent masculinity that works according to the motto ‘I hurt therefore I am’. However, the television serial that give rape a central place in their narrative open a new space for public discussion about rape and other issues related to violence against women, and could encourage public outcry and defeat the government’s proposals based on traditional norms unfavorable to victims of sexual violence. While this article accepts the potential of television serials in bringing about social change, it does not forget the function of television series as entertainment and their active role in strengthening hegemonic masculinity. This article aims to shed light on the complex relations between gender, violence and television, as well as how gender relations are reproduced at a time when politics, media and economy interact and interlace.
Rhabdomyolysis and Hepatotoxicity From Valproic Acid: Case Reports
Authors: Walker Cucnhat P. , Deb Subrata
Published: October 2019

Valproic acid (VPA) has been widely used more frequently as its approved indications have been expanded. More and more case reports on rare toxicities have been published in the literature (ie, hepatotoxicities, hyperammonemic encephalopathy, coagulation disorders, pancreatitis, thrombocytopenia). In spite of the long history of VPA, there is a lack of awareness of VPA toxicities among clinicians. We present two cases of a 44-year-old African American female and a 60-year-old Hispanic male taking chronic VPA therapy for psychiatric disorders admitted to the hospital with a combination of hepatotoxicities and acute kidney injury–associated rhabdomyolysis. In both cases, home VPA therapy was continued during hospitalization. Consequently, the female patient deceased and the male patient survived and discharged with continuation of his chronic VPA therapy. In cases of surviving patients, resumption of maintenance VPA upon discharge should be held and alternative therapy should be considered.
An innovating business model for the higher education sector: A platform-based approach to university career services
Authors: Lee June Y. , Patel Sheetal J.
Published: October 2019

With a changing landscape of higher education institutions (HEIs), the authors explore the concepts of a platform business model in the context of university career services. Through an inductive, multiyear case study of an HEI, this study analyzes how university career services can innovate and transform by operating as a platform. This exploratory research bridges the gap between HEIs and business by applying a well-developed theoretical framework for platform business models to HEIs.
Does SLE widen or narrow race/ethnic disparities in the risk of five co-morbid conditions? Evidence from a community-based outpatient care system
Authors: Falasinnu T , Chaichian Y , Li J , Chung S , Waitzfelder B E , Fortmann S P , Palaniappan L , Simard J F
Published: October 2019

Objective

The heterogeneous spectrum of systemic lupus erythematosus (SLE) often presents with secondary complications such as cardiovascular disease (CVD), infections and neoplasms. Our study assessed whether the presence of SLE independently increases or reduces the disparities, accounting for the already higher risk of these outcomes among racial/ethnic minority groups without SLE.

Methods

We defined a cohort using electronic health records data (2005–2016) from a mixed-payer community-based outpatient setting in California serving patients of diverse racial/ethnic backgrounds. The eligible population included adult patients with SLE and matched non-SLE patients (≥18 years old). SLE was the primary exposure. The following outcomes were identified: pneumonia, other infections, CVD and neoplasms. For each racial/ethnic group, we calculated the proportion of incident co-morbidities by SLE exposure, followed by logistic regression for each outcome with SLE as the exposure. We evaluated interaction on the additive and multiplicative scales by calculating the relative excess risk due to interaction and estimating the cross-product term in each model.

Results

We identified 1036 SLE cases and 8875 controls. The incidence for all outcomes was higher among the SLE exposed. We found little difference in the odds of the outcomes associated with SLE across racial/ethnic groups, even after multivariable adjustment. This finding was consistent on the multiplicative and additive scales.

Conclusion

We demonstrated that SLE status does not independently confer substantial interaction or heterogeneity by race/ethnicity toward the risk of pneumonia, other infections, CVD or neoplasms. Further studies in larger datasets are necessary to validate this novel finding.
Nationalization and the Incumbency Advantage
Authors: Carson Jamie L. , Sievert Joel , Williamson Ryan D.
Published: October 2019

Legislative scholars have investigated both the growth in the incumbency advantage since the early 1970s and its decline in recent decades, but there are several unanswered questions about this phenomenon. In this paper, we examine the incumbency advantage across a much wider swath of history to better understand its connection with changing levels of electoral nationalization. Based on an analysis of U.S. House elections extending back to the antebellum era, we find that the incumbency advantage fluctuates in predictable ways over time with changes in nationalization, which can be a product of both institutional and political conditions. We also demonstrate that the increased influence of local forces in congressional elections may not be strictly necessary nor sufficient for the existence of an incumbency advantage.
Overturning risk of furniture in earthquake-affected areas
Authors: Cimellaro Gian P , Domaneschi Marco , Qu Bing
Published: October 2019

The main aim of this study is to develop a new straightforward approach to assess the overturning risk of furniture. The proposed formula is based on the geometrical parameters of the furniture and seismic intensity measures. In particular, the equation is identified by fitting the data obtained by Housner’s mechanical model from the literature. The new equation is compared with the model of Kaneko and Hayashi, which, to the authors’ knowledge, is the only existing formulation in the literature to assess the overturning risk of furniture so far. Furthermore, to evaluate the consistency of the proposed formula, a comparison with the literature experimental data has also been performed.
Experimental study of stability prediction for high-speed robotic milling of aluminum
Authors: Hao Daxian , Wang Wei , Liu Zhaoheng , Yun Chao
Published: October 2019

It has been fully demonstrated that the regenerative chatter theory is applicable for predicting chatter-free milling parameters for computer numerical control machine tools, but researchers are still arguing whether it is effective for robotic milling processes. The main reason is that the robot’s modes greatly shift, depending on its varying dynamic parameters and joint configurations. More experimental investigations are required to study and better understand the mechanism of vibration in robotic machining. The present paper is focusing on finding experimental support for chatter-free prediction in robot high-speed milling by the regenerative chatter theory. Modal tests are first conducted on a milling robot and used to predict stability lobes by zeroth order approximation. A number of high-speed slotting tests are then carried out to verify the prediction results. Thus, the regenerative chatter theory is proved to be also applicable to robotic high-speed milling. Furthermore, low-frequency modes of the robot structure are investigated by more modal experiments involving a laser tracker and a displacement sensor. The low-frequency modes are identified as the main part of the prediction error of the zeroth order approximation method, which could also be dominant in low-speed robotic milling processes. In addition, robots are different from computer numerical control machines in terms of stiffness, trajectory following error, forced vibration, and motion coupling. These long-period trend terms have to be carefully taken into account in the regenerative chatter theory for robotic high-speed milling.
Three Faces of the ‘Post-Socialist’ Juvenile Justice Systems
Authors: Párkányi Eszter
Published: October 2019

In comparative juvenile justice, it is often suggested that Eastern European juvenile jurisdictions have a similar, ‘post-socialist’, character. This presumption indicates a certain level of uniformity in legislative features and justice policies across these countries that is related to their development before and after the political transition. The comparative approach taken in this article is focusing on the historical and contemporary differences in the development of these systems and thereby provide a more sophisticated understanding of this region. The evidence is presented in a comparative analysis of three Central European juvenile justice systems: the Czech Republic, Hungary and Slovenia.
Understanding Changes in Youth Offenders’ Risk Profiles: A Latent Transition Analysis
Authors: Xu Xuexin , Li Dongdong , Chu Chi Meng , Chng Grace S. , Ruby Kala
Published: October 2019

This study examined youth probationers’ risk profiles at the start and the end of probation and the types of transition in risk profiles over time. It further identified the association between the transition types, their adverse family background as well as their probation completion status. Using a sample of 935 youth probationers in Singapore, a latent transition analysis was conducted based on seven dynamic domains captured in the Youth Level of Service/Case Management Inventory 2.0. Based on the risk profiles, three subgroups of youths were identified: (1) the “De-escalators” had reduced risk in one or multiple domains; (2) the “Persistors” continued to have moderate risk in most domains; and (3) the “Escalators” showed an increase in risk levels in one or multiple domains. Compared to the De-escalators, the Persistors and Escalators were less likely to complete their probation orders. Further analysis revealed that youths from nonintact families or families with conviction history showed higher relative risk in being Persistors. These findings contribute to our understanding on the changes in probationers’ risk profiles over time and provide information for early and more targeted intervention efforts.
Energy efficiency in buildings: Middle-class status as a trigger for the European fight against climate change
Authors: Svobodová Iva
Published: October 2019

After signing the COP 21 Paris Agreement, the EU pledged to become the leading force in the transition to a low-carbon economy. To this end, a new legislative package called ‘Clean Energy for All Europeans’ was passed at the end of 2018. By setting targets for the energy transition, the legislation represents both a great challenge and a great opportunity for European society. The package puts energy efficiency and the active participation of consumers at its core, and so does this article. Focusing on the specific role of buildings, the article argues that the package has significantly increased the potential for the middle class to become one of the driving forces behind the energy transition. Because of specific historical and social developments, the middle class has become capable of being and willing to be involved in environmental protection, and the package has given them more tools to be so.
The responsiveness of the Manchester Chronic Obstructive Pulmonary Disease Fatigue Scale to pulmonary rehabilitation
Authors: Yohannes Abebaw Mengistu , Dryden Sheila , Hanania Nicola Alexander
Published: October 2019

Background:

We examined the responsiveness of the Manchester Chronic Obstructive Pulmonary Disease (COPD) Fatigue Scale (MCFS) in patients with COPD following 8 weeks of pulmonary rehabilitation (PR).

Methods:

Patients ( n = 273) with clinically stable COPD completed 8 weeks of outpatient multidisciplinary PR, comprising 2 h (1 h exercise and 1 h education) weekly. Anxiety, exercise capacity, quality of life, dyspnea, fatigue were measured pre- and post-PR, utilizing the Anxiety Inventory for Respiratory Disease (AIR), Incremental Shuttle Walk Test (ISWT), St. George’s Respiratory Questionnaire (SGRQ), and modified Medical Research Council (mMRC) scale and MCFS, respectively.

Results:

The mean (SD) age of participants was 72 (8) years, and 50% were women. Total MCFS score fell after PR mean (95% confidence interval) −4.89 (–7.90 to −3.79) as did domain scores: physical −1.89 (–2.33 to −1.46), cognition −1.37 (–1.65 to −1.09), and psychosocial −1.62 (–2.00 to −1.62). Total MCFS effect size (ES) was 0.55; and for domains, physical was 0.52, cognition was 0.59, and psychosocial was 0.51. The ES for AIR was 0.30, mMRC was 0.38, SGRQ was 0.66, and ISWT was 1.19. MCFS changes correlated with changes in both SGRQ ( p < 0.002) and AIR ( p < 0.004), but not ISWT ( p = 0.30) or mMRC ( p = 0.18). The AIR, SGRQ, mMRC, and ISWT all improved after PR (all, p < 0.001).

Conclusion:

The MCFS scale is a valid and responsive scale to measure fatigue in patients with COPD after pulmonary rehabilitation.
The role of negative physical contagion in the online purchase of second-hand products
Authors: Bezançon Marjolaine , Guiot Denis , Le Nagard Emmanuelle
Published: October 2019

The perception of negative physical contagion has been identified in the literature as a deterrent to the purchase of second-hand goods in an offline context. In view of the growth of second-hand shopping on the Internet, this article studies the effect of the salience of physical contact between the previous owner and the product in the purchase of second-hand products online. An initial experiment reveals a negative physical contagion effect on purchase intention, an effect mediated by perceived physical risk. However, many sellers of second-hand products on the Internet adopt presentation strategies aimed at emphasizing their similarity to new products. A second experiment shows that similarity with a new product reduces perceived physical risk for non-experts in the product category, while it decreases perceived quality for experts. In both experiments, the effect of disgust, which plays an important role in physical sales channels, is found to be not significant.
Fear of a Black (and Poor) School: Race, Class, and School Safety Policy Preferences
Authors: Dunbar Adam , Kupchik Aaron , Hughes Cresean , Lewis Raven
Published: October 2019

School security and punishment practices have changed throughout the United States since the 1990s. Yet we know little about public support for these practices nor how this support varies when considering different students. The current study uses an experimental approach to assess public preferences for school punishment and security practices and how public opinion relates to student body race and class, as well as attitudes about crime. Results indicate that participants prefer security measures for schools with more low-income students and mental health services for schools with more high-income students. We also find that participants with racialized views of crime, along with those who view crime as a growing problem and fear victimization, are more supportive of carceral disciplinary policies and less supportive of therapeutic policies. We conclude by considering how ostensibly race-neutral mechanisms, such as attitudes about poverty and crime, may contribute to racially disparate surveillance and punishment practices.
Effects of Volitional Spine Stabilization on Trunk Control During Asymmetric Lifting Task in Patients With Recurrent Low Back Pain
Authors: Haddas Ram , Samocha Yigal , Yang James
Published: October 2019

Study Design:

Prospective, concurrent-cohort study.

Objectives:

To determine the effects of volitional preemptive abdominal contraction (VPAC) on trunk control during an asymmetric lift in patients with recurrent low back pain (rLBP) and compare with matched controls.

Methods:

Thirty-two rLBP patients and 37 healthy controls performed asymmetric lifting with and without VPAC. Trunk, pelvis, and hip biomechanical along with neuromuscular activity parameters were obtained using 3-dimensional motion capture and electromyography system. Hypotheses were tested using analysis of variance.

Results:

The VPAC resulted in significantly reduced muscle activity across all trunk extensor muscles in both groups (M ± SD, 6.4% ± 8.2% of maximum contraction; P ≤ .005), and reduced trunk side flexion (1.4° ± 5.1° smaller; P ≤ .005) and hip abduction (8.1° ± 21.1° smaller; P ≤ .003). rLBP patients exhibited reduced muscle activity in external oblique (12.3% ± 5.5% of maximum contraction; P ≤ .012), as well as decreased hip flexion (4.7°, P ≤ .008) and hip abduction (5.2°, P ≤ .001) at the final position of lifting in comparison with healthy controls.

Conclusions:

The results of this study defend the recommendation that the use of a VPAC increase spine stability during an asymmetrical loading task. Our results provide an indication that a VPAC strategy that is achieved during an asymmetric lifting decreases exposure for lumbar spine injury and instability. Spine care providers and ergonomists can use this information when designing neuromuscular control training programs, both for healthy individuals aimed at prevention of injury, as well as those with a history of rLBP, aimed at full functional recovery and protection from future injury.
Reliability of measuring lateral bowing angle of the femur in patients with atypical femur fractures
Authors: Lee Young-Kyun , Yeom Jiung , Jang Byung-Woong , Nho Jae-Hwi , Suh You-Sung , Koo Kyung-Hoi
Published: October 2019

Background:

Lateral femoral bowing causes a higher tensile mechanical load on the lateral side of the femur, which plays a critical role in the pathogenesis of atypical femoral fractures (AFFs). There are many ways to measure lateral femoral bowing on plain radiographs, and there are difficulties in finding a correspondence point between measurements among multiple measurers. The purpose of this study is to prove the best method of correspondence between the investigators by analyzing the reliability of various methods for measuring lateral femoral bowing.

Materials and Methods:

We retrospectively collected data from 85 patients (87 femurs) diagnosed with AFF who had plain radiographs of entire femur from October 2013 to March 2018. The femoral bowing was measured in coronal view of femur plain radiographs using five methods (Sasaki, Morin, Jang, Kim, and Yau) by three examiners, respectively. The intra- and interobserver reliability of each method was assessed using intraclass correlation coefficient (ICC) for continuous variables.

Results:

All methods showed excellent intra- and interobserver reliability with ICC of >0.8. Among five methods, the Yau’s method was the highest reliable method (ICC = 0.980, 95% confidence interval = 0.971–0.986).

Conclusions:

All methods of measuring lateral femoral bowing in the coronal plane of plain radiographs are reliable. And, we recommend Yau’s method, which has a clear reference point for measuring femoral bowing and is highest reproducible.
Economic burden of stroke across Europe: A population-based cost analysis
Authors: Luengo-Fernandez Ramon , Violato Mara , Candio Paolo , Leal Jose
Published: October 2019

Introduction

In 2017, 1.5 million people were diagnosed with stroke, 9 million were living with stroke and 0.4 million died because of stroke in 32 European countries. We estimate the economic burden of stroke across these countries in 2017.

Patients and methods

In a population-based cost analysis, we evaluated the cost of stroke. We estimated overall health and social care costs from expenditure on care in the primary, outpatient, emergency, inpatient and nursing/residential care settings, and pharmaceuticals. Additionally, we estimated the costs of unpaid care provided by relatives or friends of patients, lost earnings due to premature death and costs associated with individuals who temporarily or permanently left employment because of illness.

Results

In 2017 stroke cost the 32 European countries under analysis €60 billion, with health care accounting for €27 billion (45%), representing 1.7% of health expenditure. Adding the costs of social care (€5 billion), annual stroke-related care costs were equivalent to €59 per citizen, varying from €11 in Bulgaria to €140 in Finland. Productivity losses cost €12 billion, equally split between early death and lost working days. A total of €1.3 billion hours of informal care were provided to stroke survivors, costing Europe €16 billion.

Conclusion

Our study provides a snapshot of the economic consequences posed by stroke to 32 European countries in 2017. It also strengthens and updates the evidence we have gathered over the last 15 years, indicating that the costs of stroke are rising, partly due to an ageing population.
Small samples and increased variability – discussing the need for restricted types of randomization in exercise interventions in old age
Authors: Netz Yael , Lidor Ronnie , Ziv Gal
Published: October 2019

Background

Randomization provides an equal chance for participants to be allocated to intervention groups, in order to create an equal distribution of all variables at baseline in all groups. However, this is not guaranteed, particularly if the groups are too small, or if the researched groups consist of older adults. The aims of this commentary are to discuss the increased variability in old age which intensifies the risk of baseline inequalities, to elaborate on the need to estimate potential baseline group differences in small samples of older participants in exercise intervention, to discuss alternative procedures for creating equal groups at baseline and to provide specific guidelines for selecting the design of small studies.

Main body

Small groups with increased inter-individual differences may lead to reduced power, thus differences that truly exist may not be detected, or false group differences may appear in the outcome following the treatment. Studies that focused exclusively on older adults have found increased variability in advanced age. Therefore, baseline group differences are more common in older adults as compared to younger persons, and may lead to misinterpretation of the intervention′s results. Imbalances can be reduced by covariate-adaptive randomization procedures, such as stratified permuted-block randomization or minimization. Specific guidelines are provided for selecting a randomization procedure by assessing the probability of unequal groups at baseline in typical, widely used functional tests in old age. A calculation of the required number of participants for creating equal groups for these functional tests is provided, and can be used when increasing the number of participants is possible. R-scripts specifically created for assessing the probability of unequal groups, or for determining the sample size assuring equal groups, are recommended.

Conclusions

In exercise interventions assessing older adults, it is recommended to have a sample large enough for creating equal groups. If this is not possible, as is the case quite often in intervention studies in old age, it is recommended to assess the probability of inequality in the study groups and to apply an alternative randomization.
Lazy Sundays: role of day of the week and reactivity on objectively measured physical activity in older people
Authors:   the ActiFE Study Group, Klenk Jochen , Peter Raphael Simon , Rapp Kilian , Dallmeier Dhayana , Rothenbacher Dietrich , Denkinger Michael , Büchele Gisela
Published: October 2019

Background

The aim of this study was to assess the effect of day of the week and wearing a device (reactivity) on objectively measured physical activity (PA) in older people.

Methods

Walking duration as a measure for PA was recorded from 1333 German community-dwelling older people (≥65 years, 43.8% women) over 5 days using accelerometers (activPAL). Least-square means of PA with 95%-confidence intervals (95%-CI) from multi-level analysis were calculated for each day of the week and each measurement day (days after sensor attachment).

Results

Walking duration on Sundays was significantly lower compared to working days (Sunday vs. Monday-Friday: − 12.8 min (95%-CI: − 14.7; − 10.9)). No statistically significant difference compared to working days was present for Saturdays. The linear slope for measurement day and walking duration was marginal and not statistically significant.

Conclusions

Studies using PA sensors in older people should assess Sundays and working days to adequately determine the activity level of the participants.
Shaping anesthetic techniques to reduce post-operative delirium (SHARP) study: a protocol for a prospective pragmatic randomized controlled trial to evaluate spinal anesthesia with targeted sedation compared with general anesthesia in older adults undergoing lumbar spine fusion surgery
Authors: Brown Charles H. , Jones Emily L. , Lin Charles , Esmaili Melody , Gorashi Yara , Skelton Richard A. , Kaganov Daniel , Colantuoni Elizabeth A. , Yanek Lisa R. , Neufeld Karin J. , Kamath Vidyulata , Sieber Frederick E. , Dean Clayton L. , Edwards Charles C. , Hogue Charles W.
Published: October 2019

Background

Postoperative delirium is common in older adults, especially in those patients undergoing spine surgery, in whom it is estimated to occur in > 30% of patients. Although previously thought to be transient, it is now recognized that delirium is associated with both short- and long-term complications. Optimizing the depth of anesthesia may represent a modifiable strategy for delirium prevention. However, previous studies have generally not focused on reducing the depth of anesthesia beyond levels consistent with general anesthesia. Additionally, the results of prior studies have been conflicting. The primary aim of this study is to determine whether reduced depth of anesthesia using spinal anesthesia reduces the incidence of delirium after lumbar fusion surgery compared with general anesthesia.

Methods

This single-center randomized controlled trial is enrolling 218 older adults undergoing lumbar fusion surgery. Patients are randomized to reduced depth of anesthesia in the context of spinal anesthesia with targeted sedation using processed electroencephalogram monitoring versus general anesthesia without processed electroencephalogram monitoring. All patients are evaluated for delirium using the Confusion Assessment Method for 3 days after surgery or until discharge and undergo assessments of cognition, function, health-related quality of life, and pain at 3- and 12-months after surgery. The primary outcome is any occurrence of delirium. The main secondary outcome is change in the Mini-Mental Status Examination (or telephone equivalent) at 3-months after surgery.

Discussion

Delirium is an important complication after surgery in older adults. The results of this study will examine whether reduced depth of anesthesia using spinal anesthesia with targeted depth of sedation represents a modifiable intervention to reduce the incidence of delirium and other long-term outcomes. The results of this study will be presented at national meetings and published in peer-reviewed journals with the goal of improving perioperative outcomes for older adults.

Trial registration

Clinicaltrials.gov, NCT03133845. This study was submitted toClinicaltrials.govon October 23, 2015; however, it was not formally registered until April 28, 2017 due to formatting requirements from the registry, so the formal registration is retrospective.
Retroclavicular vs Infraclavicular block for brachial plexus anesthesia: a multi-centric randomized trial
Authors: Blanco Andrés Felipe Gil , Laferrière-Langlois Pascal , Jessop David , D’Aragon Frédérick , Sansoucy Yanick , Albert Natalie , Tétreault Pascal , Echave Pablo
Published: October 2019

Background

The coracoid approach is a simple method to perform ultrasound-guided brachial plexus regional anesthesia (RA) but its simplicity is counterbalanced by a difficult needle visualization. We hypothesized that the retroclavicular (RCB) approach is not longer to perform when compared to the coracoid (ICB) approach, and improves needle visualization.

Methods

This randomized, controlled, non-inferiority trial conducted in two hospitals, included patients undergoing distal upper limb surgery. Patients were randomly assigned to a brachial plexus block (ICB or RCB). The primary outcome was performance time (sum of visualization and needling time), and was analyzed with a non-inferiority test of averages. Depth of sensory and motor blockade, surgical success, total anesthesia time, needle visualization, number of needle passes and complications were also evaluated. Subgroup analysis restricted to patients with higher body mass index was completed.

Results

We included 109 patients between September 2016 and May 2017. Mean RCB performance time was 4.8 ± 2.0 min while ICB was 5.2 ± 2.3 min (p = 0.06) with a 95% CI reaching up to 5.8% longer. RCB conferred an ultrasound-needle angle closer to 0° and significantly improved needle visibility after the clavicle was cleared and before local anesthetic administration. No differences were found in the secondary outcomes. Similar results were found in the subgroup analysis.

Conclusion

RCB approach for brachial plexus anesthesia was similar to ICB approach in terms of time performance. Needle visibility, which represent an important clinical variable, was superior and angle between needle and ultrasound probe was close to 0° in the RCB group.

Clinical trial registration

ClinicalTrials.gov (NCT02913625), registered 26 September 2016.
Thoracotomy for emergency repair of iatrogenic tracheal rupture: single center analysis of perioperative management and outcomes
Authors: Struck Manuel F. , Hempel Gunther , Pietsch Uta C. , Broschewitz Johannes , Eichfeld Uwe , Werdehausen Robert , Krämer Sebastian
Published: October 2019

Background

Iatrogenic tracheal ruptures are rare but life-threatening airway complications that often require surgical repair. Data on perioperative vital functions and anesthetic regimes are scarce. The goal of this study was to explore comorbidity, perioperative management, complications and outcomes of patients undergoing thoracotomy for surgical repair.

Methods

We retrospectively evaluated adult patients who required right thoracotomy for emergency surgical repair of iatrogenic posterior tracheal ruptures and were admitted to a university hospital over a 15-year period (2004–2018). The analyses included demographic, diagnostic, management and outcome data on preinjury morbidity and perioperative complications.

Results

Thirty-five patients who met the inclusion criteria were analyzed. All but two patients (96%) presented with critical underlying diseases and/or emergency tracheal intubations. The median time (interquartile range) from diagnosis to surgery was 0.3 (0.2–1.0) days. The durations of anesthesia, surgery and one-lung ventilation (OLV) were 172 (128–261) min, 100 (68–162) min, and 52 (40–99) min, respectively. The primary airway management approach to OLV was successful in only 12 patients (34%). Major complications during surgery were observed in 10 patients (29%). Four patients (11%) required cardiopulmonary resuscitation, one of whom received extracorporeal membrane oxygenation, and another one of these patients died during surgery. Major complications were associated with significantly higher all-cause 30-day mortality (p = 0.002) and adjusted mortality (p = 0.001) compared to patients with minor or no complications.

Conclusions

Surgical repair of iatrogenic tracheal ruptures requires advanced perioperative care in a specialized center due to high morbidity and potential complications. Airway management should include early anticipation of alternative OLV approaches to provide acceptable conditions for surgery.
Persistent trigeminal artery in a patient with posterior circulation stroke treated with rt-PA: case report
Authors: Ferreira Axel , Coelho Paulo S. , Cruz Vítor Tedim
Published: October 2019

Background

A persistent trigeminal artery (PTA) is a non-involuted embryonic vessel that connects the cavernous part of the internal carotid artery with the posterior circulation. In the adult it is associated with multiple pathological conditions including trigeminal neuralgia, ophthalmoplegia, hypopituitarism, intracavernous fistula, brain aneurysms and posterior circulation strokes. The latter may occur through steal phenomena or thrombosis in the anterior circulation. PTA associated vertebrobasilar hypoplasia has yet to be associated to TIA like events, however, in the reported case, that seems to be the case with reported vertigo being probably linked to vertebrobasilar insufficiency.

Case report

We present a case of an 82-year-old man with sudden onset neurological deficits, including left hemiparesis with crural predominance, vertical nystagmus, right internuclear ophthalmoplegia, dysarthria and dysmetria on the left arm. CT angiography disclosed basilar artery hypoplasia in the proximal two thirds and a persistent trigeminal artery. He was diagnosed with acute ischemic stroke. He was submitted to rt-PA with partial reversion of deficits.

Conclusion

The ischemic events related to PTA remain a rare cause of stroke with specific pathophysiological mechanisms and implications. They may occur through steal phenomena or thrombosis in the anterior circulation. Upon literature review, in the described case both mechanisms seem possible, however the transient episodes of vertigo could have been the first sign of vertebrobasilar insufficiency.
Complete horizontal gaze palsy due to bilateral paramedian pontine reticular formation involvement as a presentation of multiple sclerosis: a case report
Authors: Akhavan Sigari Amirhossein , Etemadifar Masoud , Salari Mehri
Published: October 2019

Background

Demyelinating central nervous system diseases include several disorders that multiple sclerosis (MS) is identified as the most common among them. Ocular movement disturbances are a typical presentation in MS patients where lesions affect the complex and interconnected pathways involved in eye motion. Centers for gaze control are located in the pons primarily; therefore, lesions involving these centers can be presented with abnormalities in gaze. However, bilateral lesions in pontine gaze centers are exceptionally rare.

Case presentation

A 16-year-old girl with bilateral horizontal gaze palsy was referred to the neurology clinic. Magnetic resonance imaging of the patient indicated bilateral hyperintensities in the pons at the level of the paramedian pontine reticular formation. The patient was diagnosed with multiple sclerosis with respect to clinical and imaging findings and managed.

Conclusion

Ocular movement abnormalities are a commonly encountered manifestation in patients with multiple sclerosis, however, bilateral gaze palsy is an exceptionally rare sign and should guide the physician to contemplate for anticipated lesions in the pons, and suspect MS, especially in childbearing-aged women. Although an extensive workup should also be done to rule out possible mimickers.
Prevalence and factors associated with intestinal parasitic infection among under-five children in and around Haro Dumal Town, Bale Zone, Ethiopia
Authors: Gadisa Eshetu , Jote Kefiyalew
Published: October 2019

Background

Intestinal parasitic infection is diversified illness and diseases caused millions morbidity among under-five children lives in developing countries particularly vulnerable rural communities. Deworming coverage in such community is low. The aim of this study was to determine the prevalence and associated risk factors of intestinal parasitic infections (IPIs) among under-five children live in and around Haro Dumal Town.

Methods

Community-based cross-sectional study was conducted in 561 randomly selected under-five children from June to August, 2018. The stool samples were collected and examined by basic parasitological techniques. Data related to socio-demographic and risk factors were collected using a self administered questionnaire. Statistical data analysis was done using SPSS version 21 and the bivariate and multivariate logistic regression used to compute the association between variables. P-value of < 0.05 was statistical significance.

The results

Of the 561 total under-five children, 216 (38.5%) were found to be infected with intestinal parasites. E.histolytica/dispar (15.3%) was the most prevalent parasite, followed by hook worm (14.4%) and T.trichuria (13.9%). Regarding risk factors, geo-phage [(AOR = 4.7; 95%CI: 2.0–10.4), P < 0.001], tungiasis [(AOR = 3.1; 95%CI: 1.1–6.6), P < 0.001], eating raw vegetable [(AOR = 1.3; 95%CI: 1.4–3.3), P < 0.001] were significantly associated with intestinal parasitic infections.

Conclusion

Intestinal parasitic infections (IPIs) were found to be highly prevalent in the study area. Hence, improving sanitation, controlling ecto-parasite such as tungiasis, provision of safe water and successful mass-deworming are important.
The association between occupational loading and spine degeneration on imaging – a systematic review and meta-analysis
Authors: Macedo Luciana G. , Battié Michele C.
Published: October 2019

Background

There are inconsistencies in findings regarding the relationship of occupational loading with spinal degeneration or structural damage. Thus, a systematic review was conducted to determine the current state of knowledge on the association of occupational loading and spine degeneration on imaging.

Methods

We performed electronic searches on MEDLINE, CINAHL and EMBASE. We included cross-sectional, case control and cohort studies evaluating occupational loading as the exposure and lumbar spine structural findings on imaging as the outcomes. When possible, results were pooled.

Results

Seventeen studies were included in the review. Ten studies evaluated the association of occupational loading with disc degeneration (signal intensity), four of which were pooled into a meta-analysis. Of the 10 studies, only two did not identify a relationship between occupation loading and disc degeneration. A meta-analysis including four of the studies demonstrated an association between higher loading and degeneration for all spinal levels, with odds ratios between 1.6 and 3.3. Seven studies evaluated disc height narrowing and seven evaluate disc bulge, with six and five identifying an association of loading and with imaging findings respectively. Three studies evaluated modic changes and one identified and association with occupational load.

Conclusions

There was moderate evidence suggesting a modest association between occupational loading and disc degeneration (signal intensity), and low-quality evidence of an association between occupational loading and disc narrowing and bulging.
The correlations between the anchor density and the curve correction of adolescent idiopathic scoliosis surgery
Authors: Yeh Yu-Cheng , Niu Chi-Chien , Chen Lih-Huei , Chen Wen-Jer , Lai Po-Liang
Published: October 2019

Background

The optimal anchor density in adolescent idiopathic scoliosis (AIS) surgery to achieve good curve correction remains unclear. The purpose of the study is to analyze the correlations between three-dimensional curve correction and anchor density in the pedicle screw-based posterior fusion of AIS.

Methods

One hundred and twenty-seven AIS patients receiving primary posterior fusion with pedicle screw instrumentation were retrospectively reviewed. Anchor density (AD) was defined as the screws number per fused spinal segment. The correlations between three-dimensional curve correction radiographic parameters and anchor density were analyzed with subgroup analysis based on different curve types, curve magnitudes, and curve flexibilities. The differences of curve correction parameters between the low-density (AD ≤1.4), middle-density (1.4 < AD ≤1.7) and high-density (AD > 1.7) groups were also calculated. Independent t-test, analysis of variance (ANOVA), and Pearson’s correlation coefficient were used for statistical analysis.

Results

There were no correlations between the anchor density and the coronal curve correction or apical vertebral rotation (AVR) correction. In the sagittal plane, mild positive correlations existed between anchor density and thoracic kyphosis correction in all patients (r = 0.27, p = 0.002). Subgroup analysis revealed similar mild positive correlations in Lenke 1 (r = 0.31, p = 0.02), Lenke 1–3 (r = 0.27, p = 0.01), small curves (40°-60°, r = 0.38, p <  0.001), and flexible curves (flexibility > 40%, r = 0.34, p = 0.01).

There were no differences between low-density (mean 1.31), middle-density (mean 1.55), and high-density (mean 1.83) in terms of coronal or axial curve correction parameters. Low-density group has longer fused level (mean difference 2.14, p = 0.001) and smaller thoracic kyphosis correction (mean difference 9.25°, p = 0.004) than high-density group.

Conclusion

In our study, the anchor density was not related to coronal or axial curve corrections. Mild positive correlations with anchor density were found in thoracic kyphosis correction, especially in patients with smaller and flexible curves. Low anchor density with longer fusion level achieves similar curve corrections with middle or high anchor density in adolescent idiopathic scoliosis surgery.