bluuebunny/crossref_metadata_2025 huggingface dataset:
Dimensional Error in Rapid Prototyping with Open Source Software and Low-cost 3D-printer
Authors: Rendón-Medina Marco A. , Andrade-Delgado Laura , Telich-Tarriba Jose E. , Fuente-del-Campo Antonio , Altamirano-Arcos Carlos A.
Published: January 2018

Rapid prototyping models (RPMs) had been extensively used in craniofacial and maxillofacial surgery, especially in areas such as orthognathic surgery, posttraumatic or oncological reconstructions, and implantology. Economic limitations are higher in developing countries such as Mexico, where resources dedicated to health care are limited, therefore limiting the use of RPM to few selected centers. This article aims to determine the dimensional error of a low-cost fused deposition modeling 3D printer (Tronxy P802MA, Shenzhen, Tronxy Technology Co), with Open source software. An ordinary dry human mandible was scanned with a computed tomography device. The data were processed with open software to build a rapid prototype with a fused deposition machine. Linear measurements were performed to find the mean absolute and relative difference. The mean absolute and relative difference was 0.65 mm and 1.96%, respectively (P = 0.96). Low-cost FDM machines and Open Source Software are excellent options to manufacture RPM, with the benefit of low cost and a similar relative error than other more expensive technologies.
CHORIOCAPILLARIS FLOW VOIDS IN CRYPTOCOCCAL CHOROIDITIS USING OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY
Authors: Vu Daniel M. , Thomas Akshay S. , Finn Avni P. , Grewal Dilraj S.
Published: January 2018

Purpose:

To report an unusual case of cryptococcal choroiditis and highlight the multimodal imaging findings, particularly the choriocapillaris flow voids using optical coherence tomography angiography.

Methods:

Retrospective review of the clinical course of a single patient with cryptococcal choroiditis.

Results:

A 69-year-old man undergoing chemotherapy for T-cell prolymphocytic leukemia developed disseminated crytococcal neoformans infection. He developed bilateral cryptococcal choroiditis with multiple yellow-white choroidal lesion on fundoscopy in both eyes. Multimodal imaging of the choroidal lesions revealed flow voids at the level of the choriocapillaris on optical coherence tomography angiography that corresponded to hypocyanescent areas on indocyanine green angiography when registered and overlaid on the indocyanine green angiography images. The superficial and deep capillary plexuses were spared.

Conclusion:

This case illustrates that optical coherence tomography angiography was useful in demonstrating that the cryptococcal choroidal lesions impaired choriocapillaris perfusion but spared the superficial and deep retinal plexuses.
Early Corneal Innervation and Trigeminal Alterations in Parkinson Disease: A Pilot Study
Authors: Arrigo Alessandro , Rania Laura , Calamuneri Alessandro , Postorino Elisa Imelde , Mormina Enricomaria , Gaeta Michele , Marino Silvia , Di Lorenzo Giuseppe , Quartarone Angelo , Anastasi Giuseppe , Puzzolo Domenico , Aragona Pasquale
Published: January 2018

Purpose:

To describe corneal innervation and trigeminal alterations in drug-naive patients with Parkinson disease (PD).

Methods:

A case series study was conducted by recruiting 3 early drug-naive patients with PD, 2 men and 1 woman (age: 72, 68, and 66, respectively). Ophthalmologic assessment included Ocular Surface Disease Index questionnaire, visual acuity by the logarithm of the minimum angle of resolution score, pupillary light reflexes, extrinsic ocular movements, corneal sensitivity, and slit-lamp examination. Corneal innervation parameter changes were evaluated in vivo using the Confoscan 4 confocal microscope, and they were compared with a control data set. The Heidelberg Retina Tomograph 3 (HRT3) has been used to assess retinal alterations in our patients, if compared with normal range values provided by the HRT3. Moreover, 3T magnetic resonance imaging (MRI) analysis of water diffusion property changes of trigeminal nerves was performed. All data were analyzed and compared with 2 control data sets made by 14 age-matched controls.

Results:

Patients with PD showed profound alterations of corneal innervation and of trigeminal diffusion MRI parameters, compared with controls. Strong differences (PD vs. controls) were found for deep nerve tortuosity (Kallinikos mean 19.94 vs. 2.13) and the number of beadings (mean 34.2 vs. 15.5). HRT3 retinal evaluation revealed less structural changes compared with the normal range. Diffusion MRI showed profound changes of white matter diffusion properties (PD vs. controls), with fractional anisotropy decrement (mean 0.3029 vs. 0.3329) and mean diffusivity increment (mean 0.00127 vs. 0.00106).

Conclusions:

Corneal innervation changes might occur earlier in patients with PD than in retinal ones. Confocal corneal innervation analysis might provide possible early biomarkers for a better PD evaluation and for its earlier diagnosis.
Refined Lab-score, a Risk Score Predicting Serious Bacterial Infection in Febrile Children Less Than 3 Years of Age
Authors: Leroy Sandrine , Bressan Silvia , Lacroix Laurence , Andreola Barbara , Zamora Samuel , Bailey Benoit , Da Dalt Liviana , Manzano Sergio , Gervaix Alain , Galetto-Lacour Annick
Published: January 2018

Background:

The identification of serious bacterial infection (SBI) in children with fever without source remains a challenge. A risk score called Lab-score, based on C-reactive protein, procalcitonin and urinary dipstick results was derived to predict SBI. However, all biomarkers were initially dichotomized, leading to weak statistical reliability and lack of transportability across diverse settings. We aimed to refine and validate this risk-score algorithm.

Methods:

The Lab-score was refined using a secondary analysis of a multicenter cohort study of children with fever without source via multilevel regression modeling. The external validation was conducted on data from a Canadian cohort study.

Results:

Eight hundred seventy-seven children (24% SBI) were included for the derivation study, and 347 (16% SBI) for validation. Only C-reactive protein, procalcitonin, age and urinary dipstick remained independently associated with SBI. The model achieved an area under the receiver operating characteristic (ROC) curve of 0.94 (95% confidence interval [CI]: 0.93–0.96), which was significantly higher than any other isolated biomarker (P < 0.0001), and the original Lab-score (P < 0.0001). According to a decision curve analysis, the model yielded a better strategy than those based on independently considered biomarkers, or on the original Lab-score. The threshold analysis led to a cutoff that yielded 96% (95% CI: 92–98) sensitivity and 73% (95% CI: 70–77) specificity. The external validation found similar predictive abilities: 0.96 area under the ROC curve (95% CI: 0.93–0.99), 95% sensitivity (95% CI: 85–99) and 87% specificity (95% CI: 83–91).

Conclusion:

The refined Lab-score demonstrated higher prediction ability for SBI than the original Lab-score, with promising wider applicability across settings. These results require validation in additional populations.
Litigation in Perinatal Care
Authors: Miller Lisa A.
Published: January 2018

Litigation in perinatal nursing represents a disproportionate share of indemnity payouts and results in excessive psychological stress. Testimony at deposition or trial can be challenging for clinicians; little is taught in training or postgraduate education regarding litigation. Nurses, midwives, and physicians can effectively navigate the deposition process and prepare for trial testimony by understanding the plaintiff's goals, recognizing the role of documentation, and becoming familiar with various plaintiff's strategies including reptile theory. Knowledge of psychological concepts such as confirmation bias and cognitive dissonance may assist clinicians in responding to plaintiff's lines of questioning. Deposition preparation is crucial to the defense and requires active participation on the part of clinicians; it may include mock deposition or use of simulation laboratories. Common mistakes in deposition may be avoided with foresight and anticipatory planning by clinicians working closely with risk managers and defense attorneys. This article provides an overview of the deposition process, including the plaintiff's goals and common approaches, as well as the role of documentation and common errors of deponents.
Infants in Drug Withdrawal
Authors: Smith Jessica G. , Rogowski Jeannette A. , Schoenauer Kathryn M. , Lake Eileen T.
Published: January 2018

Infants in drug withdrawal have complex physiological and behavioral states, requiring intensive nursing care. The study objectives were to describe acuity, parental needs, and nurse workload of infants in drug withdrawal compared with other infants. The design was cross-sectional and involved secondary nurse survey data from 6045 staff nurses from a national sample of 104 neonatal intensive care units. Nurses reported the care of 15 233 infants, 361 (2.4%) of whom were in drug withdrawal. Three-fourths of hospitals had at least 1 infant in drug withdrawal. In these hospitals, the mean number of infants in drug withdrawal was 4.7. Infant acuity was significantly higher among infants in drug withdrawal. Parents of infants in drug withdrawal required significantly more care to address complex social situations (51% vs 12%). The number of infants assigned to nurses with at least 1 infant in withdrawal (mean = 2.69) was significantly higher than typical (mean = 2.51). Given infant acuity and parental needs, policies legislating patient-to-nurse ratios should permit professional discretion on the number of patients to assign nurses caring for infants in drug withdrawal. Managers and charge nurses should consider the demands of caring for infants in drug withdrawal in assignment decisions and provide support and education.
Match Situations Leading to Head Injuries in Professional Male Football (Soccer)—A Video-Based Analysis Over 12 Years
Authors: Beaudouin Florian , aus der Fünten Karen , Tröß Tobias , Reinsberger Claus , Meyer Tim
Published: January 2018

Objective:

To identify risk situations promoting head injuries in professional male football (soccer) and to investigate the impact of a rule change in 2006 punishing elbow-head contacts.

Design:

Analysis of video sequences of head events leading to head injury.

Participants:

Professional football players of the first male German Bundesliga.

Main Outcome Measures:

Observational criteria of head impacts on video recordings (players' actions preceding head injuries, foul play—referee's decision and assessment of rater, ball possession, on-pitch medical treatment, and consequences of head impact).

Results:

Three hundred thirty-four head injuries were reported in kicker Sportmagazin corresponding to an incidence rate of 2.25 (95% confidence interval 2.01-2.51) per 1000 player match hours. The injured player predominantly jumped (60%), headed the ball (36%), or ran forwards (20%); the noninjured players mainly jumped (64%), headed the ball (27%), or raised the elbow to the head (23%). Free ball situations (2 players challenge for the ball) caused most of the head injuries (81%). The players' action “raising the elbow” during a head injury seemed to be lower after the rule change.

Conclusions:

Jumping for the ball with the intention of heading is the predominant action associated with head injury risk. Head injuries occur most often when players challenge for the ball in a header duel. As head injuries bear the potential risk of long-term health sequelae, the identification of situational circumstances is essential to develop preventative means in the future.
Combined Anterolateral, Anterior, and Anteromedial Ankle Impingement in an Adolescent Soccer Player: A Case Report and Review of the Literature
Authors: Cosma Dan I. , Vasilescu Dana E. , Corbu Andrei , Todor Adrian , Valeanu Madalina , Ulici Alexandru
Published: January 2018

A unique case of combined anterolateral, anterior, and anteromedial ankle impingement in an adolescent soccer player is presented in this article. To the best of our knowledge, this is the only report of circumferential, massive, anterior ankle impingement in children described in the literature. The importance of proper diagnosis and treatment of such a lesion is illustrated in this case report. We also emphasize that clinical examination combined with 3D computed tomography scan reconstruction is an excellent and cost-effective imaging modality that can help with the diagnosis of anterior ankle impingement. Finally, open surgical treatment showed excellent results in an elite athlete.
Rare monogenic causes of primary adrenal insufficiency
Authors: Narumi Satoshi
Published: January 2018

Purpose of review

Monogenic disorders play significant roles in the pathogenesis of childhood-onset primary adrenal insufficiency (PAI). The most common form of PAI is congenital adrenal hyperplasia (CAH), which includes the enzymatic defects of the steroidogenic pathway. This review focuses on less common forms of monogenic PAI (i.e. non-CAH monogenic PAI) with particular attention on their cause, clinical phenotypes and genetic epidemiology.

Recent findings

Non-CAH monogenic PAI can be classified into three major categories: first, adrenocorticotropic hormone resistance, second, impaired adrenal redox homeostasis and third, defective organogenesis of the adrenal glands. The clinical phenotypes of the mutation-carrying patients vary depending on the responsible gene, and they are partially explained by the tissue RNA expression patterns. Genetic epidemiology studies conducted in Turkey and Japan showed that about 80% of PAI of unknown cause was monogenic.

Genetic basis of non-CAH monogenic PAI had been less clearly understood than CAH; however, significant advances have been made with use of new research techniques such as next-generation sequencing. Understanding of these rare forms of PAI may contribute to clarifying the physiology and pathology of the adrenal glands.
The lysophosphatidic acid acyltransferases (acylglycerophosphate acyltransferases) family: one reaction, five enzymes, many roles
Authors: Bradley Ryan M. , Duncan Robin E.
Published: January 2018

Purpose of review

Lysophosphatidic acid acyltransferases (LPAATs)/acylglycerophosphate acyltransferases (AGPATs) are a homologous group of enzymes that all catalyze the de novo formation of phosphatidic acid from lysophosphatidic acid (LPA) and a fatty acyl-CoA. This review seeks to resolve the apparent redundancy of LPAATs through examination of recent literature.

Recent findings

Recent molecular studies suggest that individual LPAAT homologues produce functionally distinct pools of phosphatidic acid, whereas gene ablation studies demonstrate unique roles despite a similar biochemical function. Loss of the individual enzymes not only causes diverse effects on down-stream lipid metabolism, which can vary even for a single enzyme from one tissue to the next, but also results in a wide array of physiological consequences, ranging from cognitive impairment, to lipodystrophy, to embryonic lethality.

LPAATs are critical mediators of cell membrane phospholipid synthesis, regulating the production of specific down-stream glycerophospholipid species through generation of distinct pools of phosphatidic acid that feed into dedicated biosynthetic pathways. Loss of any specific LPAAT can lead to alterations in cellular and organellar membrane phospholipid composition that can vary for a single enzyme in different tissues, with unique pathophysiological implications.
Salivary duct carcinoma
Authors: D’heygere Emmanuel , Meulemans Jeroen , Vander Poorten Vincent
Published: January 2018

Purpose of review

The review puts new information on geno- and phenotype of salivary duct carcinoma (SDC) in the perspective of the updated 2017 WHO classification.

Recent findings

The proportion of SDC is increasing. This may be because of a true rise in incidence, but certainly to better diagnostic tests and changed WHO definitions. In this light, a substantial proportion of carcinoma expleomorphic adenoma is now attributed to the category of SDC. ‘Low-grade SDC’ and ‘SDC in-situ’ of the former WHO classification, are now named low-grade and high-grade intraductal carcinoma (IDC), respectively. Recent series quantify biologic aggressiveness: perineural growth, vascular invasion, and extracapsular extension in lymph node metastasis are each observed in two out of three patients with SDC. Most patients die within 3 years, but once 5-year disease-free survival is reached, further disease activity is exceptional. The typical molecular biological profile with high human epidermal growth factor receptor 2 and androgen receptor expression is increasingly successfully exploited in clinical trials for advanced SDC.

The aggressive SDC is increasingly diagnosed. Despite intensive combined surgery and radiation therapy, many patients recur, for whom new bullets, targeting the molecular biological mechanisms, are the subject of ongoing clinical trials.
The physiology of neonatal resuscitation
Authors: Hooper Stuart B. , Kitchen Marcus J. , Polglase Graeme R. , Roehr Charles C. , te Pas Arjan B.
Published: January 2018

Purpose of review

As the infant's physiology changes dramatically after birth, modern neonatal resuscitation approaches should detect and be modified in response to these changes. This review describes the changes in respiratory physiology at birth and highlights approaches that can assist these changes.

Recent findings

To better target assistance given to infants at birth, the changes in lung physiology have been classified into three phases. The first phase involves lung aeration. As little or no gas exchange can occur, assistance should focus on airway liquid clearance. During the second phase, as airway liquid resides in lung tissue, assistance should focus on minimizing the complications associated with lung edema. The third phase occurs whenever the liquid is cleared from the tissue and respiratory mechanics stabilize. Although more traditional approaches are most effective during this phase, this is not the case for the first two phases. Furthermore, the glottis actively adducts during apnea in newborns and so noninvasive respiratory support requires the infant to be breathing so that the glottis will open.

The respiratory support provided to infants at birth should match the infant's changing physiology during transition, which requires a more sophisticated approach and equipment than current recommendations.
The importance of cohort research starting early in life to understanding child health
Authors: Paneth Nigel , Monk Catherine
Published: January 2018

Purpose of review

The current review addresses the importance of the prospective cohort design in large, unselected populations starting early in life for understanding the origins of childhood health disorders.

Recent findings

Cohort studies originating in healthy populations have contributed to great advances in health, especially in cardiovascular diseases, but have only recently been applied systematically to study the origins of childhood disorders. Several large population-based pregnancy and/or birth cohorts have been developed in different parts of the world, and these are beginning to contribute to better understanding of the underlying causes of rare but important childhood disorders, such as autism. The environmental influences on child health outcomes (ECHO) Program is distinct in leveraging and building upon 84 existing cohorts to prospectively investigate the role of early-life exposures and underlying biological mechanisms in childhood health and disease, specifically perinatal conditions, obesity, neurodevelopmental disorders, asthma and related pulmonary disorders as well as optimum child health. ECHO is expected to comprise approximately 50 000 children. It is the first US study of this size and scope since the US Collaborative Perinatal Project of 1959–1966.

The ECHO project represents a new approach to cohort studies in childhood, efficiently making use of extant cohorts while adding new data collection elements that should permit novel insights into the underlying causes of several important pediatric conditions.
Pediatric Gastroesophageal Reflux Clinical Practice Guidelines
Authors: Rosen Rachel , Vandenplas Yvan , Singendonk Maartje , Cabana Michael , DiLorenzo Carlo , Gottrand Frederic , Gupta Sandeep , Langendam Miranda , Staiano Annamaria , Thapar Nikhil , Tipnis Neelesh , Tabbers Merit
Published: January 2018

This document serves as an update of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) 2009 clinical guidelines for the diagnosis and management of gastroesophageal reflux disease (GERD) in infants and children and is intended to be applied in daily practice and as a basis for clinical trials. Eight clinical questions addressing diagnostic, therapeutic and prognostic topics were formulated. A systematic literature search was performed from October 1, 2008 (if the question was addressed by 2009 guidelines) or from inception to June 1, 2015 using Embase, MEDLINE, the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Clinical Trials. The approach of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) was applied to define and prioritize outcomes. For therapeutic questions, the quality of evidence was also assessed using GRADE. Grading the quality of evidence for other questions was performed according to the Quality Assessment of Studies of Diagnostic Accuracy (QUADAS) and Quality in Prognostic Studies (QUIPS) tools. During a 3‐day consensus meeting, all recommendations were discussed and finalized. In cases where no randomized controlled trials (RCT; therapeutic questions) or diagnostic accuracy studies were available to support the recommendations, expert opinion was used. The group members voted on each recommendation, using the nominal voting technique. With this approach, recommendations regarding evaluation and management of infants and children with GERD to standardize and improve quality of care were formulated. Additionally, 2 algorithms were developed, 1 for infants <12 months of age and the other for older infants and children.
Relationship Between the DSM-5 Anxious Distress Specifier and the Hamilton Depression Rating Scale Anxiety/Somatization Factor
Authors: Zimmerman Mark , Clark Heather , McGonigal Patrick , Harris Lauren , Guzman Holst Carolina , Martin Jacob
Published: January 2018

We examined the association between the Hamilton Depression Scale (HAMD) approach to classifying depressed patients into anxious and nonanxious subgroups and the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) anxious distress specifier subtyping. Two hundred two depressed patients were interviewed with semistructured diagnostic interviews. Patients were rated on the 17-item HAMD and the Hamilton Anxiety Rating Scale and completed the Clinically Useful Anxiety Outcome Scale. Both approaches toward identifying anxiety in depressed patients resulted in most of the patients meeting the anxiety subtype. Both subtyping methods were significantly correlated with clinician-rated and self-report measures of anxiety, and scores on the anxiety scales were higher in the patients who met the anxious subtype. However, DSM-5 anxious distress subtyping was only marginally associated with the HAMD anxiety/somatization factor subtyping approach (k = 0.21), and dimensional scores were only moderately correlated (r = 0.50). These findings indicate that the DSM-5 and HAMD approaches toward identifying an anxious subtype of depression are not interchangeable.
An Innovative End-of-Life Nursing Education Consortium Curriculum That Prepares Nursing Students to Provide Primary Palliative Care
Authors: Ferrell Betty , Mazanec Polly , Malloy Pam , Virani Rose
Published: January 2018

Research has demonstrated that patients facing serious, life-limiting illnesses and their families benefit from receiving palliative care. Increasingly, however, specialty palliative care has limited resources. Prelicensure nursing students who are educated to provide primary palliative care to patients with serious illness and at the end of life can fill that gap. This article describes the development and implementation of an innovative online nursing curriculum that prepares students with essential primary palliative nursing knowledge and skills.
Use of Team-Based Learning in a Nursing Leadership Course
Authors: Göktepe Nilgün , Türkmen Emine , Zeybekoğlu Zuhal , Yalçin Begüm
Published: January 2018

Team-based learning (TBL) is a learner-centered method widely used in health sciences education. The aim of this action research study was to determine the contribution of TBL to the learning experience of students participating in a nursing leadership course. The study was conducted in 2 cycles over 2 semesters, and TBL was embedded in regular class hours. Results suggest that TBL made positive contributions to student learning.
Site Variability in Regulatory Oversight for an International Study of Pediatric Sepsis
Authors: Michelson Kelly N. , Reubenson Gary , Weiss Scott L. , Fitzgerald Julie C. , Ackerman ; Kate K. , Christie ; LeeAnn , Bush ; Jenny L. , Nadkarni Vinay M. , Thomas Neal J. , Schreiner Mark S.
Published: January 2018

Objectives:

Duplicative institutional review board/research ethics committee review for multicenter studies may impose administrative burdens and inefficiencies affecting study implementation and quality. Understanding variability in site-specific institutional review board/research ethics committee assessment and barriers to using a single review committee (an increasingly proposed solution) can inform a more efficient process. We provide needed data about the regulatory oversight process for the Sepsis PRevalence, OUtcomes, and Therapies multicenter point prevalence study.

Design:

Survey.

Setting:

Sites invited to participate in Sepsis PRevalence, OUtcomes, and Therapies.

Subjects:

Investigators at sites that expressed interest and/or participated in Sepsis PRevalence, OUtcomes, and Therapies.

Interventions:

None.

Measurements and Main Results:

Using an electronic survey, we collected data about 1) logistics of protocol submission, 2) institutional review board/research ethics committee requested modifications, and 3) use of a single institutional review board (for U.S. sites). We collected surveys from 104 of 167 sites (62%). Of the 97 sites that submitted the protocol for institutional review board/research ethics committee review, 34% conducted full board review, 54% expedited review, and 4% considered the study exempt. Time to institutional review board/research ethics committee approval required a median of 34 (range 3-186) days, which took longer at sites that required protocol modifications (median [interquartile range] 50 d [35–131 d] vs 32 d [14–54 d)]; p = 0.02). Enrollment was delayed at eight sites due to prolonged (> 50 d) time to approval. Of 49 U.S. sites, 43% considered using a single institutional review board, but only 18% utilized this option. Time to final approval for U.S. sites using the single institutional review board was 62 days (interquartile range, 34–70 d) compared with 34 days (interquartile range, 15–54 d) for nonsingle institutional review board sites (p = 0.16).

Conclusions:

Variability in regulatory oversight was evident for this minimal-risk observational research study, most notably in the category of type of review conducted. Duplicative review prolonged time to protocol approval at some sites. Use of a single institutional review board for U.S. sites was rare and did not improve efficiency of protocol approval. Suggestions for minimizing these challenges are provided.
Effect of Polydeoxyribonucleotide Injection in a Patient With Carpal Tunnel Syndrome
Authors: Park Jin-Sung , Park Donghwi
Published: January 2018

Ultrasound-guided corticosteroid injection into the carpal tunnel is widely performed for the management of carpal tunnel syndrome. However, this injection may worsen the condition in patients with type 2 diabetes mellitus. Polydeoxyribonucleotide was recently recognized as a substitute for corticosteroid because of its anti-inflammatory effects. A 41-yr-old woman with type 2 diabetes mellitus was admitted to our rehabilitation clinic with a 1-mo history of numbness and tingling in her right hand and first three fingers tips. She declined corticosteroid treatment because of a previous episode of uncontrolled blood glucose levels after corticosteroid injection. Therefore, ultrasound-guided polydeoxyribonucleotide injections into the carpal tunnel were carried out. At the 6-mo follow-up, the patient demonstrated an improvement in the carpal tunnel syndrome symptoms without any complications. Thus, polydeoxyribonucleotide injections into the carpal tunnel can be an alternative to corticosteroid injections for carpal tunnel syndrome if there are limitations because of adverse effects of the latter.
Randomized Controlled Trial of the SystemCHANGE Intervention on Behaviors Related to Cardiovascular Risk in HIV+ Adults
Authors: Webel Allison R. , Moore Shirley M. , Longenecker Chris T. , Currie Jackson , Horvat Davey Christine , Perazzo Joseph , Sattar Abdus , Josephson Richard A.
Published: January 2018

Objective:

To examine the effect of a lifestyle behavior intervention (SystemCHANGE) on physical activity and diet quality among sedentary people living with HIV (PLHIV). All participants expressed a desire to improve lifestyle health behaviors.

Methods:

One hundred and seven HIV+ adults were randomized to either the intervention (6, in-person, standardized group sessions focusing on improving lifestyle behaviors) or a control condition (general advice on AHA diet and exercise guidelines). All participants wore an ActiGraph accelerometer and completed 24-hour dietary recalls at baseline, 3, and 6 months. Generalized estimating equations were used to examine intervention effects. The primary activity outcome was time spent in moderate-to-vigorous physical activity, and the primary dietary outcome was Healthy Eating Index.

Results:

Mean age was 53 years, 65% were male, and 86% African American. Approximately 90% attended at least half of the sessions and 60% attended 5 or more sessions. The intervention did not significantly improve our primary lifestyle behavior endpoints (P ≥ 0.05); however, intervention participants consumed fewer carbohydrates—primarily sugar-sweetened beverages—per day and lost 0.732 kg body weight compared with a 0.153 weight gain in the control group (P = 0.03).

Conclusions:

Among sedentary PLHIV at high risk of cardiovascular disease, the SystemCHANGE intervention reduced daily carbohydrate intake and body weight, but did not increase physical activity or improve overall diet quality. Future work should identify fundamental personal, interpersonal, and contextual factors that will increase physical activity and improve overall diet quality among this population, and integrate these factors into tailored, lifestyle interventions for aging PLHIV.
Associations Between Multiple Forms of Discrimination and Tobacco Use Among People Living With HIV: The Mediating Role of Avoidance Coping
Authors: Crockett Kaylee B. , Rice Whitney S. , Turan Bulent
Published: January 2018

Background:

People living with HIV (PLWH) have higher levels of tobacco use compared with the general population, increasing their risk of morbidity and mortality. PLWH also face potential chronic stressors related to the stigma and discrimination associated with HIV and other characteristics (eg, race and sexual orientation). These experiences may be associated with harmful health behaviors, such as tobacco use. The purpose of the current study is to explore the psychosocial context of tobacco use in PLWH, examining avoidance coping as a mediator in the relationship between multiple forms of discrimination and tobacco use.

Setting:

Participants included 202 PLWH recruited from an HIV primary care clinic in Birmingham, AL, between 2013 and 2015.

Methods:

Participants responded to parallel items assessing experiences of discrimination related to HIV status, race, and sexual orientation, as well as items assessing avoidance coping. Data on current tobacco use were obtained from participants' clinic records. Mediation models for each form of discrimination (HIV, race and sexual orientation) adjusting for demographic variables and the other forms of discrimination were evaluated.

Results:

The indirect effect of HIV-related discrimination on likelihood of tobacco use through avoidance coping was significant, suggesting that avoidance coping mediates the association between HIV-related discrimination and tobacco use. However, the indirect effects of the other forms of discrimination were not significant.

Conclusions:

Given the disparity in tobacco use in PLWH, behavioral scientists and interventionists should consider including content specific to coping with experiences of discrimination in tobacco prevention and cessation programs for PLWH.
Identifying Needs in Young Adults With Inflammatory Bowel Disease
Authors: Cho Romy , Wickert Natasha M. , Klassen Anne F. , Tsangaris Elena , Marshall John K. , Brill Herbert
Published: January 2018

Successful transitional care for young adults entails that healthcare teams recognize and understand the attitudes, perspectives, and developmental maturity of young adults. The aim of this study was to identify the needs of young adults with inflammatory bowel disease. Young adults 18–30 years of age were recruited from the McMaster University Medical Centre adult inflammatory bowel disease (IBD) clinic between July 2012 and May 2013. Semistructured interviews were audio taped, transcribed verbatim, and coded using a constant comparative method. QSR NVivo10 software was used to manage the data. Twenty-one young adults, including 15 subjects diagnosed as adolescents (younger than 18 years) and 6 subjects diagnosed as young adults, were interviewed. Four broad categories of needs were identified: psychosocial, informational, self-advocacy, and daily living needs. The most commonly reported needs were psychosocial and the least common were daily living needs. Results from this study may be used to inform clinical practitioners of potential needs that may be important to the overall quality of patient health during young adulthood. In addition, these findings may be used to evaluate existing transition and self-management tools to measure success of transition interventions more effectively.
Colorectal Cancer Awareness for Women via Facebook
Authors: Brittain Kelly , Pennings Kamp Kendra J. , Salaysay Zachary
Published: January 2018

Colorectal cancer is the third leading cause of cancer death among U.S. women. Women report being screened for colorectal cancer less often than men, and if colorectal cancer screening guidelines were routinely followed, approximately 60% of colorectal cancer deaths could be prevented. Many colorectal cancer screening interventions have not used Facebook, which is the most popular social media site among women. Little is known about engaging women in colorectal cancer screening and risk reduction information using Facebook. The “Colorectal Cancer Screening Awareness for Women” Facebook page was created to promote colorectal cancer screening and risk reduction awareness among women. Facebook posts targeted women aged 45–64 years and highlighted colorectal cancer screening methods, guidelines, and colorectal cancer risk reduction strategies. Demographics and data about the women's interactions with the page were collected using Facebook analytics and analyzed. The majority of the 391 users of the Colorectal Cancer Screening Awareness for Women Facebook page were women aged 45–54 years (56.5%). The most “liked” posts were related to colorectal cancer risk reduction behaviors. In an effort to increase routine colorectal cancer screening and colorectal cancer risk reduction behaviors, gastroenterology nurses and practices should consider Facebook as a good method to regularly engage women in colorectal cancer screening and colorectal cancer risk reduction information.
Effect of Information of Patients' Coping Style on Pregastroscopy Anxiety
Authors: Liu Yuan Yuan , Liu Yan Qun , Petrini Marcia A.
Published: January 2018

Examination of the relationship between patients' coping style, pregastroscopy information, and anxiety associated with gastroscopy in China was the aim of this study. A pretest, post-test, nonrandom assignment study with a two by two design was conducted. One hundred forty-five patients who underwent initial gastroscopy without sedation were classified into 2 groups on the basis of the coping style: information seekers or information avoiders using the Information Subscale of the Krantz Health Opinion Survey (KHOS-I). All participants were given standardized procedural information about gastroscopy as routine care. Half of each group was assigned to receive additional sensory information describing what sensation they would experience and how to cooperate to alleviate the discomfort. State anxiety assessed by the State Anxiety Scale of Spielberg's State-Trait Anxiety Inventory, blood pressure, and pulse were measured at enrollment and before gastroscopy. The information seekers and avoiders who received additional sensory information experienced significantly less state anxiety after the intervention. In contrast, the information seekers and avoiders who received standardized procedural information maintained their preintervention state anxiety level. Most patients reported their preference for sensory information. In conclusion, the provision of sensory information could significantly reduce patients' pregastroscopy anxiety regardless of patients' information coping style.
Learning Theory Foundations of Simulation-Based Mastery Learning
Authors: McGaghie William C. , Harris Ilene B.
Published: January 2018

Summary Statement

Simulation-based mastery learning (SBML), like all education interventions, has learning theory foundations. Recognition and comprehension of SBML learning theory foundations are essential for thoughtful education program development, research, and scholarship. We begin with a description of SBML followed by a section on the importance of learning theory foundations to shape and direct SBML education and research. We then discuss three principal learning theory conceptual frameworks that are associated with SBML–behavioral, constructivist, social cognitive–and their contributions to SBML thought and practice. We then discuss how the three learning theory frameworks converge in the course of planning, conducting, and evaluating SBML education programs in the health professions. Convergence of these learning theory frameworks is illustrated by a description of an SBML education and research program in advanced cardiac life support. We conclude with a brief coda.
Assessing the Safety of Overlapping Surgery at a Children's Hospital
Authors: Hyder Joseph A. , Hanson Kristine T. , Storlie Curtis B. , Madde Nageswar R. , Brown Michael J. , Kor Daryl J. , Potter D. Dean , Cima Robert R. , Habermann Elizabeth B.
Published: January 2018

Importance:

Media reports have questioned the safety of overlapping surgical procedures, and national scrutiny has underscored the necessity of single-center evaluations of its safety; however, sample sizes are likely small. We compared the safety profiles of overlapping and nonoverlapping pediatric procedures at a single children's hospital and discussed methodological considerations of the evaluation.

Data and Design:

Retrospective analysis of inpatient pediatric surgical procedures (January 2013 to September 2015) at a single pediatric referral center. Overlapping and nonoverlapping procedures were matched in an unbalanced manner (m:n) by procedure. Mixed models adjusting for Vizient-predicted risk, case-mix, and surgeon compared inpatient mortality and length of stay (LOS).

Results:

Among 315 overlapping procedures, 256 (81.3%) were matched to 645 nonoverlapping procedures. There were 6 deaths in all. The adjusted odds ratio for mortality did not differ significantly between nonoverlapping and overlapping procedures (adjusted odds ratio = 0.94 vs overlapping; 95% CI, 0.02–48.5; P = 0.98). Wide confidence intervals were minimally improved with Bayesian methods (95% CI, 0.07–12.5). Adjusted LOS estimates were not clinically different by overlapping status (0.6% longer for nonoverlapping; 95% CI, 9.7% shorter to 12.2% longer; P = 0.91). Among the 87 overlapping procedures with the greatest overlap (≥60 min or ≥50% of operative duration), there were no deaths.

Conclusions:

The safety of overlapping and nonoverlapping surgical procedures did not differ at this children's center. These findings may not extrapolate to other centers. LOS or intraoperative measures may be more appropriate than mortality for safety evaluations due to low event rates for mortality.
Early low-anticoagulant desulfated heparin after traumatic brain injury: Reduced brain edema and leukocyte mobilization is associated with improved watermaze learning ability weeks after injury
Authors: Nagata Katsuhiro , Suto Yujin , Cognetti John , Browne Kevin D. , Kumasaka Kenichiro , Johnson Victoria E. , Kaplan Lewis , Marks Joshua , Smith Douglas H. , Pascual Jose L.
Published: January 2018

BACKGROUND

Unfractionated heparin administered immediately after traumatic brain injury (TBI) reduces brain leukocyte (LEU) accumulation, and enhances early cognitive recovery, but may increase bleeding after injury. It is unknown how non-anticoagulant heparins, such as 2,3-O desulfated heparin (ODSH), impact post-TBI cerebral inflammation and long-term recovery. We hypothesized that ODSH after TBI reduces LEU-mediated brain inflammation and improves long-term neurologic recovery.

METHODS

CD1 male mice (n = 66) underwent either TBI (controlled cortical impact [CCI]) or sham craniotomy. 2,3-O desulfated heparin (25 mg/kg [25ODSH] or 50 mg/kg [50ODSH]) or saline was administered for 48 hours after TBI in 46 animals. At 48 hours, intravital microscopy visualized rolling LEUs and fluorescent albumin leakage in the pial circulation, and the Garcia Neurologic Test assessed neurologic function. Brain edema (wet/dry ratio) was evaluated post mortem. In a separate group of animals (n = 20), learning/memory ability (% time swimming in the Probe platform quadrant) was assessed by the Morris Water Maze 17 days after TBI. Analysis of variance with Bonferroni correction determined significance (p< 0.05).

RESULTS

Compared with CCI (LEU rolling: 32.3 ± 13.7 LEUs/100 μm per minute, cerebrovascular albumin leakage: 57.4 ± 5.6%), both ODSH doses reduced post-TBI pial LEU rolling (25ODSH: 18.5 ± 9.2 LEUs/100 μm per minute,p= 0.036; 50ODSH: 7.8 ± 3.9 LEUs/100 μm per minute,p< 0.001) and cerebrovascular albumin leakage (25ODSH: 37.9 ± 11.7%,p= 0.001, 50ODSH: 32.3 ± 8.7%,p< 0.001). 50ODSH also reduced injured cerebral hemisphere edema (77.7 ± 0.4%) vs. CCI (78.7 ± 0.4 %,p= 0.003). Compared with CCI, both ODSH doses improved Garcia Neurologic Test at 48 hours. Learning/memory ability (% time swimming in target quadrant) was lowest in CCI (5.9 ± 6.4%) and significantly improved in the 25ODSH group (27.5 ± 8.2%,p= 0.025).

CONCLUSION

2,3-O desulfated heparin after TBI reduces cerebral LEU recruitment, microvascular permeability and edema. 2,3-O desulfated heparin may also improve acute neurologic recovery leading to improved learning/memory ability weeks after injury.
Clinical Neurophysiology Training in a Developing Country: Institutional Resources and Profiles
Authors: Sámano Arturo G. , Ochoa Mena José D. , Padilla Silvana P. , Acevedo Gerardo R. , Orenday Barraza José M. , San-Juan Daniel
Published: January 2018

Purpose:

The purpose of this study was to describe the characteristics and preferences of clinical neurophysiology (CN) fellows, as well as the resources available for their training, in a developing country such as Mexico.

Methods:

An online survey (25 questions) was given to Mexican CN fellows from May to June 2017, covering their reasons for choosing the CN subspecialty, their activities, future plans, institutional resources, and administrative staff. Descriptive statistics were used.

Results:

Total respondents: 20/22 (90%), 65% female from 7 CN centers (80% public and 20% private hospitals) in Mexico City. Seventy-five percent chose CN out of personal interest, and all were not unsatisfied with their academic program. Most plan to work in private practice (75%) and are interested in learning EEG (85%) and intraoperative monitoring (75%–85%). The highest-reported training time by CN area allocated by the programs was as follows: EEG (27%), electromyography (22%), and evoked potentials (16%). The average number of fellows per center was 4; 75% of the centers perform epilepsy surgery, of which 60% offer invasive intracranial studies for the evaluation of surgical candidates.

Conclusions:

Mexican CN fellows are satisfied with their choice and with the academic program. They are increasingly interested in intraoperative monitoring, which is not addressed in current Mexican CN Programs.
Repetitive Deep TMS for Parkinson Disease: A 3-Month Double-Blind, Randomized Sham-Controlled Study
Authors: Cohen Oren S. , Rigbi Amihai , Yahalom Gilad , Warman-Alaluf Naama , Nitsan Zeev , Zangen Abraham , Hassin-Baer Sharon
Published: January 2018

Purpose:

To study the effects of a repetitive deep transcranial magnetic stimulation (rDTMS) in patients with Parkinson disease using the H5 coil for the low-frequency stimulation of the primary motor cortex, followed by the high-frequency rDTMS of the prefrontal cortex.

Methods:

The main outcome measures were the total and motor scores of the Unified Parkinson's Disease Rating Scale (UPDRS). Secondary measures included rating of depression and quantitative motor tasks.

Results:

Forty-eight patients were randomized 1:1 into real or sham rDTMS treatment arms. Analyses (n = 42) of both UPDRS scores revealed a significant main effect for time between baseline and day 90 (end of treatment), indicating that there was an improvement of both scores over time in the whole sample. Although effects of treatment and time-by-treatment were insignificant, simple effects analysis of both measures was significant in the rDTMS group and reached a P-value of 0.06 in the sham group. The response rate was higher in patients with longer disease duration and higher motor UPDRS scores. Side effects were more common in the rDTMS group but were transient and tolerable.

Conclusions:

Although rDTMS treatment exhibited some motor improvements, we could not demonstrate an advantage for real treatment over sham. Further research is required to establish stimulation parameters that may induce potentially more beneficial outcomes, probably in patients with longer and more sever disease.