bluuebunny/crossref_metadata_2025 huggingface dataset:
Numerical analysis of a time domain elastoacoustic problem
Authors: Araya Rodolfo , Rodríguez Rodolfo , Venegas Pablo
Published: December 2018

This paper deals with the numerical analysis of a system of second order in time partial differential equations modeling the vibrations of a coupled system that consists of an elastic solid in contact with an inviscid compressible fluid. We analyze a weak formulation with the unknowns in both media being the respective displacement fields. For its numerical approximation, we propose first a semidiscrete in space discretization based on standard Lagrangian elements in the solid and Raviart–Thomas elements in the fluid. We establish its well-posedness and derive error estimates in appropriate norms for the proposed scheme. In particular, we obtain an $\mathrm L^{\infty }(\mathrm L^2)$ optimal rate of convergence under minimal regularity assumptions of the solution, which are proved to hold for appropriate data of the problem. Then we consider a fully discrete approximation based on a family of implicit finite difference schemes in time, from which we obtain optimal error estimates for sufficiently smooth solutions. Finally, we report some numerical results, which allow us to assess the performance of the method. These results also show that the numerical solution is not polluted by spurious modes as is the case with other alternative approaches.
From Timbuktu to The Hague and Beyond
Authors: Drumbl Mark A
Published: December 2018

This essay refracts the criminal conviction and reparations order of the International Criminal Court (ICC) in the Al Mahdi case into the much broader frame of increasingly heated public debates over the protection, removal, defacement, relocation, display and destruction of cultural heritage in all forms: monuments, artefacts, language instruction, art and literature. What might the work product of the ICC in the Al Mahdi proceedings — and international criminal law more generally — add, contribute or excise from these debates? This essay speculatively explores connections between the turn to penal law to protect cultural property and the transformative impulses that undergird transitional justice which, in turn, often insist upon cultural change, including to cultures of oppression and impunity. Along the way, this essay also unpacks thorny questions as to how to value cultural property; how to determine what, exactly, constitutes the kind of property whose destruction should be criminalized; and which ‘cultures’ should be protected by ‘whom’ and in ‘whose’ interests.

‘Culture is who we are.’1
Controversies in relation to neck management in N0 early oral tongue cancer
Authors: Hanai Nobuhiro , Asakage Takahiro , Kiyota Naomi , Homma Akihiro , Hayashi Ryuichi
Published: December 2018

The standard local treatment for early-stage tongue cancer with no clinical lymph node metastases is partial glossectomy. The frequency of occult lymph node metastasis is ~20–30%. Thus, whether prophylactic neck dissection with glossectomy or glossectomy alone should be performed has been a controversial issue since the 1980s. Both treatments have advantages and disadvantages; however, especially in cases involving prophylactic neck dissection, surgical invasion and complications including the cosmetic disadvantage caused by neck skin incision, accessory nerve paralysis or facial nerve (mandibular marginal branch) paralysis, stiffness of the shoulder or neck and a feeling of neck tightness have been considered issues that could be solved by providing less-invasive treatment to the 70–80% of patients without occult lymph node metastasis.

A more accurate preoperative diagnosis and strict follow-up are required to provide minimally invasive treatment while ensuring the therapeutic effect. It is also necessary to narrow down the target based on the risk–benefit balance. The depth of invasion should be considered in cases involving oral cavity malignancies. This was also taken into account in recent revisions of eighth edition of the TNM Classification of Malignant Tumors and it is an important factor for N0 neck management. This review article summarizes previous and recent reports on neck management, focusing on the risk–benefit and future perspectives of the diagnosis and treatment of early-stage oral tongue cancer. This effort is an attempt to establish treatment from the patient’s point of view, with the patient’s quality of life taken into account.
Headache at High Altitude
Authors: Salas Renee N.
Published: December 2018

Headache is a condition that medical practitioners commonly encounter with a broad differential that ranges from the benign to the life threatening. High altitude environments have unique diseases that present with headache, which this case will outline. Providers practicing at high altitude must be facile with diagnosing these conditions such as high altitude headache and acute mountain sickness. Astute providers must also assess for high altitude cerebral edema and high altitude pulmonary edema as they can co-exist with acute mountain sickness. Given that radiographic and laboratory testing are often not available, determining a diagnosis based on history and physical is essential with the knowledge that “normal” vital signs differ from that of sea level.
Wrist Pain
Authors: Lee Eric
Published: December 2018

This chapter discusses the diagnosis and management of distal radial fractures, the most common type of wrist fracture in adults. It reviews the differential diagnosis of traumatic wrist pain. It also discusses the use of various imaging modalities in both the diagnosis and management of a distal radial fracture. It also reviews appropriate management steps, including proper examination components and splinting techniques. Specifically, the chapter examines a case study of a patient who presented to the emergency department following a fall while hiking. He reported landing on his right wrist and experiences pain and swelling. On X-ray and ultrasound, he is diagnosed with a displaced distal radius fracture.
Interfacility Ventilator Management
Authors: Galton Christopher
Published: December 2018

Treating persistent hypoxia while attempting to transport a patient from one health care setting to a destination facility can be one of the most stressful situations emergency medical services providers face. In some cases, the primarily pathology may not be well defined. This case reviews the approach to managing a critically ill patient who is mechanically ventilated and is being transferred to a quaternary center for continued management. The case works through a differential diagnosis of hypoxemia in a mechanically ventilated patient. It also includes dynamic adjustments of the ventilator to maximize success and reduce any potential iatrogenic complications. Finally, adequate sedation is pivotal to promote ventilator synchrony and patient comfort. This case illustrates the nuances of sedation and when neuromuscular blockade should be considered.
Severe Headache
Authors: Shah Aman
Published: December 2018

This case highlights the clinical presentation and diagnostic workup of a subarachnoid hemorrhage (SAH) in an emergency department setting. Given the high morbidity and mortality associated with this diagnosis, clinicians must have a high index of suspicion when patients present with an acute onset, severe headache. While computed tomography of the head is the best initial diagnostic test, lumbar puncture should be performed if the imaging is equivocal or negative and the clinical concern for SAH persists. After SAH is diagnosed, prompt consultation and co-management with neurosurgery should occur, in addition to strict blood pressure control and efforts to reduce intracranial pressure. Trauma is the most common cause of SAH while aneurysmal rupture is the leading cause of atraumatic SAH.
Shortness of Breath
Authors: Gill Harman S.
Published: December 2018

Chest pain and dyspnea are complaints frequently associated with a diagnosis of pulmonary embolism but may also be associated with other numerous cardiac and pulmonary disease processes encountered daily in the emergency department. This case presents the classic historical risk factors of malignancy and recent surgery in combination with typical clinical findings of acute onset of chest pain and dyspnea that is worse with deep inspiration. A sequential and methodological assessment through a thorough physical exam, electrocardiogram, chest X-ray, and lab testing such as troponin, pro-brain natriuretic peptide, and D-dimer testing allow the emergency medicine practitioner to be accurate, thorough, and efficient. Once a diagnosis is made, the stratification of massive versus submassive is dictated by hemodynamic stability and the presence or absence of acute right ventricular strain to further guide treatment and disposition.
Abdominal Pain
Authors: Kamran Ali
Published: December 2018

Small bowel obstruction is an important diagnosis to consider in an adult presenting with abdominal pain with previous risk factors. Abdominal pain of unclear etiology in the Emergency Department has an exhaustive differential, but key historical and physical exam findings can help narrow the differential considerably. Key management steps for a bowel obstruction include obtaining an appropriate history and physical examination, ordering necessary laboratory studies to exclude other diagnoses, making the patient nil per os, addressing any serious electrolyte derangements, obtaining necessary imaging and a surgical consult. Multidetector computed tomography of the abdomen provides the highest sensitivity for the diagnosis of a small bowel obstruction, but an abdominal X-ray or an abdominal ultrasound can be utilized to help make the diagnosis.
Seizure
Authors: Kovalerchik Olga
Published: December 2018

Status epilepticus is defined as more than two seizures without recovery between the episodes or when seizure activity persists for 5 minutes or more. This chapter reviews management of a seizing patient in the emergency department, which begins with consideration of the airway, then breathing and circulation. The rapid treatment algorithm starts with benzodiazepines, the first-line medical therapy for seizure activity and status epilepticus, and may include second- and third-line agents. Diagnostic testing and the need for imaging will depend on details specific for the patient presenting with seizure-like activity. The chapter examines the topic based on the case of a patient brought to the emergency department having suffered a seizure.
Vertigo—Posterior Stroke
Authors: Qadri Usama
Published: December 2018

This case illustrates an evidence-oriented approach to the patient with dizziness. Symptoms of dizziness, lightheadedness, nausea, and vomiting are often described under the umbrella term vestibular syndrome. Since vestibular syndrome can be caused by both less concerning peripheral causes (labyrinthitis, vestibular neuritis) as well as emergent, central causes (posterior stroke), clinicians must try to distinguish between the two. Interestingly, clinical exam findings including a thorough neurological exam with head impulse–nystagmus–tilt of skew (HINTS) testing are superior to imaging for this purpose. For the patient with high suspicion of a central process, the next step is to obtain a head computed tomography to rule out hemorrhage. If no hemorrhage is noted, then the patient should be managed with neurology for a posterior stroke and evaluated for the use of tissue plasminogen activator.
Altered Mental Status
Authors: Marin Michelle N.
Published: December 2018

Altered mental status in a child is a common presenting complaint. One of the more common causes of altered mental status is diabetic ketoacidosis. The change in mental status from this metabolic disorder is thought to be secondary to the cerebral fluid shifts from the underlying hyperglycemia and metabolic acidosis. The only way to correct diabetic ketoacidosis and its associated symptoms like altered mental status is with intravenous fluids, insulin, and electrolyte management. This case describes the care of a child presenting with diabetic ketoacidosis and explains the testing, diagnosis, and key management points focused on subsequent fluid and electrolyte management.
Extremity Swelling and Altered Mental Status
Authors: Whitfield Denise
Published: December 2018

Snake envenomation is a significant global health problem, particularly in tropical and subtropical locations. In this case, a 38-year-old performing military field operations in South America develops systemic symptoms consistent with snake envenomation after falling into brush. His symptoms were recognized by his unit medic who initiated appropriate field care and immediate resuscitation with intravenous fluids. He was rapidly transported to a local hospital. The hospital administered polyvalent snake antivenom given his systemic symptoms while providing continued supportive care. Field care for snake bites includes removal of the patient from the snake’s striking range, immobilization of the affected extremity, and supportive care. Immediate transport to a facility with snake envenomation management capability is crucial for definitive management.
Ossification of the Posterior Longitudinal Ligament
Authors: Vogel Todd D. , Deng Hansen , Mummaneni Praveen V.
Published: December 2018

Ossification of the posterior longitudinal ligament (OPLL) may occur in patients presenting with cervical myelopathy or cervical radiculopathy. Mild trauma may aggravate symptoms, resulting in a rapid progression of cervical myelopathy. Recognition is key and utilization of computed tomography is the preferred imaging modality for diagnosing OPLL. Timing of surgery is dependent on severity and progression of symptoms. Anterior and posterior approaches are acceptable, but generally the posterior approach is preferred. The use of intraoperative neuromonitoring may assist the surgeon in taking corrective actions to reduce or prevent permanent neurological deficits. Prophylactic surgery may be considered in mildly symptomatic patients less than 65 years old with a high degree of canal compromise.
Spinal Cord Tumor
Authors: Iyer Rajiv R. , Jallo George I.
Published: December 2018

Intramedullary spinal cord tumors (IMSCTs) are rare central nervous system lesions with heterogeneous patient presentations that often include pain and neurological dysfunction. In adults, ependymomas are the most common IMSCT, and in children, pilocytic astrocytomas are most frequent. The mainstay of treatment for IMSCTs is maximal safe surgical resection. Careful surgical planning and technique are critical for successful outcomes. This includes the choice of appropriate spinal levels for surgery, interpretation of real-time intraoperative neurophysiological monitoring, maintenance of meticulous hemostasis, careful microsurgical dissection, and watertight dural closure. Close attention to intraoperative neuromonitoring can allow for maximal tumor resection without permanent postoperative deficits in experienced hands. Transient postoperative deficits often improve with time. Aggressive resection often leads to excellent outcomes and should be attempted regardless of patient age.
Lumbar Stenosis
Authors: Ross Miner N. , Than Khoi D.
Published: December 2018

Low back pain is an extremely frequent outpatient complaint across all fields of medicine. Among its surgical causes, lumbar stenosis is one of the most commonly seen in the neurosurgeon’s clinic. In this chapter, the authors present a case of a patient with classic symptoms of neurogenic claudication who is found to have multilevel degenerative lumbar stenosis on imaging. The authors discuss the evaluation of such patients by examination and imaging, with attention given to important alternatives in the differential diagnosis. They describe the surgical management of lumbar stenosis by conventional open decompression as well as newer minimally invasive techniques. Finally, the authors discuss key aspects of postoperative and complication management.
Isthmic Spondylolisthesis
Authors: Lewis Evan , Sansur Charles A.
Published: December 2018

Isthmic spondylolisthesis (IS) is the slippage of one spinal vertebra on another, which is the result of a defect in the pars interarticularis. IS can be clinically asymptomatic or can present with axial back pain, leg pain, or neurological dysfunction. There are multiple treatment approaches to a patient with IS that include conservative and operative techniques. Patients with IS in the absence of neurological deficits should initially be managed conservatively. Individuals who fail conservative therapies or individuals with neurological deficits are candidates for operative intervention. There are many different operative approaches to treating IS. Operative techniques fall into two major categories: decompression versus decompression and instrumented fusion.
Electrical Stimulation for Mapping of the Epileptogenic Zone
Authors: Landazuri Patrick , Minotti Lorella
Published: December 2018

Electrical cortical stimulation mapping (ECM) is a neurophysiological technique used to help identify the epileptogenic zone (area of brain responsible for a person’s epilepsy). ECM accomplishes this in two ways: (1) direct stimulation of a specified cortical area resulting in the patient’s habitual seizures and (2) the understanding of specific cortical function based on ECM studies. This chapter begins by reviewing neurophysiological concepts underlying ECM. It then continues with an anatomical survey of cortical function as defined by ECM and an explanation of how the identified cortical functions relate to understanding seizure semiology. It proceeds to examine the techniques for electrically provoking seizures and interpretation of such provoked seizures. It concludes by exploring advanced electrophysiological concepts and how they may improve characterization of the epileptogenic zone. In short, this chapter seeks to conceptualize the use of ECM in accurately identifying the epileptogenic zone and informing safe surgical treatment when necessary.
SEEG in Temporal Lobe Epilepsy
Authors: Job-Chapron Anne-Sophie , Minotti Lorella , Hoffmann Dominique , Kahane Philippe
Published: December 2018

In the context of temporal lobe epilepsy (TLE), there are different scenarios where a stereo-electroencephalographic (SEEG) study must be strongly considered. This chapter reviews these situations, which include bitemporal epilepsy, unilateral lesional and non-lesional TLE, temporal ‘plus’ epilepsy (TPE), and pseudo-TLE. It also emphasizes why SEEG is especially appropriate to adequately sample all possible ictal generators, either temporal (amygdala, hippocampus, entorhinal cortex, or temporal neocortex) or extratemporal (insula, orbitofrontal cortex, or posterior cingulate gyrus). It includes illustrative cases explaining why and how SEEG studies are designed, and provides examples of SEEG schemes and traces.
SEEG in Frontal Lobe Epilepsy
Authors: McGonigal Aileen , Chauvel Patrick
Published: December 2018

Frontal lobe epilepsy (FLE) constitutes a challenge for presurgical evaluation because of specific anatomical and physiological factors. Semiological expression of frontal lobe seizures is notably varied and complex but nevertheless certain distinct patterns can be characterized, associated with different sublobar epilepsy localizations. These electro-clinical patterns have been largely demonstrated by stereo-electroencephalographic (SEEG) studies. An electro-clinical spectrum of semiological expression has been shown, with the most anterior prefrontal regions being associated with complex motor behaviour, distal stereotypies, and an integrated or naturalistic appearance; posterior prefrontal regions associated with proximal stereotypies sometimes associated with tonic posture; and motor/premotor regions associated with elementary motor signs. This rostrocaudal gradient is in keeping with current theories of frontal lobe functional organization. This chapter discusses issues specific to SEEG exploration of FLE, reviews historical investigations of frontal semiology, and highlights different patterns of semiological expression in both focal and widespread frontal seizures, as elucidated by SEEG.
SEEG in Posterior Cortex Epilepsies
Authors: Francione Stefano , Liava Alexandra , Cardinale Francesco
Published: December 2018

Defining the extent of the epileptogenic zone is particularly problematic in posterior cortex epilepsies (PCEs). Non-invasive information is frequently insufficient for surgical planning, and individually tailored surgery is likely to be curative only when guided by invasive investigation. Stereotactic placement of intracerebral multicontact electrodes is performed according to an individually tailored pre-implantation hypothesis of the presumed epileptogenic zone and, in the posterior cortex, usually follows three main exploration patterns, in relation to the origin and preferential spreading pattern of ictal discharges. This chapter presents the methodology for stereo-EEG (SEEG) exploration of PCEs by means of illustrative cases. It also presents the characteristics and the surgical outcome and its determinants of a cohort of patients operated on for drug-resistant PCE, about half of whom underwent invasive investigation by SEEG. Duration of epilepsy represented the most consistent predictor of surgical outcome, with early surgery being correlated with higher chances of surgical success.
Simultaneous Macro- and Microrecordings
Authors: Kucewicz Michal T. , Berry B. Michael , Worrell Gregory A.
Published: December 2018

Invasive recordings from patients with epilepsy are increasingly employing new hybrid electrode technologies, which combine macro- and microelectrode electrophysiology, to explore the large scope of brain processes. These range from action potentials of single neurons to coordinated activity of neuronal ensembles to oscillations of widespread brain networks, all buried in oscillations of the extracellular local field potential sampled at various spatiotemporal scales. This chapter reviews various approaches to simultaneous micro- and macroscale electrophysiology, with current electrode designs and applications being discussed together with particular examples of epilepsy pathophysiology. The chapter highlights the advantages, limitations, and challenges for new technologies in the emerging era of human brain mapping projects. It is this technological advance that drives the progress of human intracranial electrophysiology and shifts attention to a vast scale of neuronal networks.
Mapping of Seizure Networks
Authors: David Olivier
Published: December 2018

Intracranial electroencephalography (iEEG) is used to localize the seizure onset zone (SOZ) and connected neuronal networks in surgical candidates suffering from intractable focal epilepsy. Identification of the SOZ is usually based on visual inspection of iEEG signals, but new computer-based quantitative iEEG analyses are being developed to improve and expedite SOZ detection. Two main questions arise. First, which signal features are the best proxys to identify the SOZ and the propagation pathways constituting epileptic networks? Second, how can the results of data analysis be represented in a clinically useful and meaningful manner? This chapter adopts an epileptogenicity mapping approach based on maps of ictal high-frequency oscillations superimposed on neuroanatomy and illustrates the main concepts underlying mapping of seizure networks. Future quantitative iEEG approaches should complete and operationalize understanding of seizure networks. Quantitative neuroimaging of iEEG features of seizures should help provide better presurgical assessment of patients undergoing resective surgery.
Semiconductor quantum computation
Authors: Zhang Xin , Li Hai-Ou , Cao Gang , Xiao Ming , Guo Guang-Can , Guo Guo-Ping
Published: December 2018

Semiconductors, a significant type of material in the information era, are becoming more and more powerful in the field of quantum information. In recent decades, semiconductor quantum computation was investigated thoroughly across the world and developed with a dramatically fast speed. The research varied from initialization, control and readout of qubits, to the architecture of fault-tolerant quantum computing. Here, we first introduce the basic ideas for quantum computing, and then discuss the developments of single- and two-qubit gate control in semiconductors. Up to now, the qubit initialization, control and readout can be realized with relatively high fidelity and a programmable two-qubit quantum processor has even been demonstrated. However, to further improve the qubit quality and scale it up, there are still some challenges to resolve such as the improvement of the readout method, material development and scalable designs. We discuss these issues and introduce the forefronts of progress. Finally, considering the positive trend of the research on semiconductor quantum devices and recent theoretical work on the applications of quantum computation, we anticipate that semiconductor quantum computation may develop fast and will have a huge impact on our lives in the near future.
Conclusion
Authors: Fredman Sandra
Published: December 2018

The first part of this book sets out the themes which form the analytic framework for subsequent chapters: the role of comparative materials; the meaning of human rights; the relationship between civil and political rights and socio-economic rights; the role of adjudication; and approaches to judicial interpretation. Subsequent chapters apply these themes to some of the most challenging issues in comparative human rights law. The coverage is not intended to be complete, but aims to bring comparative human rights to life, asking similar questions across several jurisdictions and a range of human rights topics. Judges faced with acutely difficult questions must refer to their textual mandate, the fundamental values informing the text, their own interpretive philosophy, and their perception of their role relative to the legislature. But increasingly, their decision-making can be enriched by considering, in a deliberative sense, how judges in other jurisdictions have faced these questions.
Intensity of Withdrawal Symptoms During Opioid Taper in Patients with Chronic Pain—Individualized or Fixed Starting Dosage?
Authors: Bienek Natalia , Maier Christoph , Kaisler Miriam , Michel-Lauter Beate , Schwarzer Andreas , Meyer-Frießem Christine H
Published: December 2018

Objective

Controlled opioid withdrawal is recommended for patients with chronic noncancer pain (CNCP) with insufficient pain reduction or intolerable side effects while on opioid treatment. Few studies have investigated the management of opioid withdrawal (OW). Most common are protocols with an individualized starting dosage (ISD), calculated from the last opioid intake. After two cases of overdose, we introduced a novel withdrawal protocol using a low fixed starting dosage (FSD) for safety reasons. The present study compares the intensity of withdrawal symptoms using the Subjective Opioid Withdrawal Scale (SOWS) and incidences of serious adverse events (SAE) and dropouts in each taper schedule in 195 CNCP patients with OW in an inpatient facility.

Methods

Two protocols were compared: FSD (2014–2016): N = 68, starting dose: 90 mg morphine/d; and ISD (2010–2014): N = 127, starting dose: 70% of the patient’s daily morphine equivalent dose (MED). Outcome criteria: primary: mean daily SOWS score during the first 10 days (16 questions, daily score 0–64); secondary: change in pain intensity on a numeric rating scale (0–10), rate of dropouts and SAEs. Statistics: Student test, Mann-Whitney U test, chi-square test, analysis of variance, P < 0.05.

Results

The mean daily SOWS score was lower in the FSD group (14.9 ± 9.4 vs 16.1 ± 10, P < 0.05) due to a lower rate of high-intensity withdrawal symptoms (12.4% vs 17.6%, P < 0.01), particularly in patients on >180 mg MED (9.7% vs 18.4%, P < 0.01). Pain intensity decreased after withdrawal, and the incidence of SAEs and dropouts was low in both groups.

Conclusions

The FSD protocol provides a lesser burden of withdrawal symptoms and equal patient safety. It can be recommended for OW in CNCP patients.
Stock Volatility and the Great Depression
Authors: Cortes Gustavo S , Weidenmier Marc D
Published: December 2018

Stock return volatility during the Great Depression has been labeled a “volatility puzzle” because the standard deviation of stock returns was 2 to 3 times higher than any other period in American history. We investigate this puzzle using a new series of building permits and leverage. Our results suggest that volatility in building permit growth and financial leverage largely explain the high level of stock volatility during the Great Depression. Markets factored in the possibility of a forthcoming economic disaster.

Received September 30, 2017; editorial decision August 27, 2018 by Editor Philip E. Strahan. Authors have furnished an Internet Appendix, which is available on the Oxford University Press Web site next to the link to the final published paper online
Masking Release for Speech in Modulated Maskers: Electrophysiological and Behavioral Measures
Authors: Tanner A. Michelle , Spitzer Emily R. , Hyzy JP , Grose John H.
Published: December 2018

Objectives:

The purpose of this study was to obtain an electrophysiological analog of masking release using speech-evoked cortical potentials in steady and modulated maskers and to relate this masking release to behavioral measures for the same stimuli. The hypothesis was that the evoked potentials can be tracked to a lower stimulus level in a modulated masker than in a steady masker and that the magnitude of this electrophysiological masking release is of the same order as that of the behavioral masking release for the same stimuli.

Design:

Cortical potentials evoked by an 80-ms /ba/ stimulus were measured in two steady maskers (30 and 65 dB SPL), and in a masker that modulated between these two levels at a rate of 25 Hz. In each masker, a level series was undertaken to determine electrophysiological threshold. Behavioral detection thresholds were determined in the same maskers using an adaptive tracking procedure. Masking release was defined as the difference between signal thresholds measured in the steady 65-dB SPL masker and the modulated masker. A total of 23 normal-hearing adults participated.

Results:

Electrophysiological thresholds were uniformly elevated relative to behavioral thresholds by about 6.5 dB. However, the magnitude of masking release was about 13.5 dB for both measurement domains.

Conclusions:

Electrophysiological measures of masking release using speech-evoked cortical auditory evoked potentials correspond closely to behavioral estimates for the same stimuli. This suggests that objective measures based on electrophysiological techniques can be used to reliably gauge aspects of temporal processing ability.
Prognostic significance of CD163 expression and its correlation with cyclooxygenase-2 and vascular endothelial growth factor expression in cutaneous melanoma
Authors: Lee Woo J. , Lee Mi H. , Kim Hak T. , Won Chong H. , Lee Mi W. , Choi Jee H. , Chang Sung E.
Published: December 2018

In several cancers, tumor progression is associated with the infiltration of tumor-associated macrophages (TAMs). The aim was to evaluate the prognostic significance of expression of CD163 and CD68 (TAMs’ markers) and their correlation with vascular endothelial growth factor (VEGF) and cyclooxygenase-2 (COX-2) expression in cutaneous melanoma. Diagnostic tissues from 102 patients of cutaneous melanoma were evaluated by immunohistochemistry for their CD68, CD163, VEGF, and COX-2 expression. Correlations between the proteins were then investigated. Clinicopathological features, overall survival (OS), and progression-free survival were analyzed in terms of the expression of these proteins. CD163, but not CD68, expression correlated with VEGF and COX-2 expression. High expression for CD163 was associated with a deeper Breslow thickness and an advanced stage of the disease. High expression of CD163 was associated with lower OS. No significant differences were noted in CD68 expression between the clinicopathological variables and the OS. COX-2 expression was associated with a deeper Breslow thickness and a higher frequency of lymph node involvement. Multivariate analysis revealed that CD163 expression and COX-2 expression were independent prognostic markers of lower survival outcomes. Our data confirmed that CD163 expression provides independent prognostic information in cutaneous melanoma. The correlation of CD163 with VEGF and COX-2 expression suggests various tumor-promoting actions of CD163-positive TAMs.
Alcohol Use in Pregnancy
Authors: DEJONG KATHERINE , OLYAEI AMY , LO JAMIE O.
Published: December 2018

Alcohol exposure during pregnancy results in impaired growth, stillbirth, and fetal alcohol spectrum disorder. Fetal alcohol deficits are lifelong issues with no current treatment or established diagnostic or therapeutic tools to prevent and/or ameliorate some of these adverse outcomes. Despite the recommendation to abstain, almost half of the women consume alcohol in pregnancy in the United States. This review focuses on the trends in prenatal alcohol exposure, implications for maternal and fetal health, and evidence suggesting that preconception and the prenatal period provide a window of opportunity to intervene, mitigate, and ideally curtail the lifetime effects of fetal alcohol spectrum disorder.
An Update of Eye Shape and Myopia
Authors: Matsumura Saiko , Kuo Anthony N. , Saw Seang-Mei
Published: December 2018

Myopia is one of the most prevalent eye diseases, and its advanced form, high myopia, is a leading cause of subsequent pathologic myopia, which in turn results in an increased risk of retinal diseases. The prevalence of myopia and high myopia is 28.3% and 4.0% of the global population, respectively, and these numbers are estimated to increase to 49.8% for myopia 9.8% for high myopia by 2050, thus making myopia a severe global socioeconomic problem. The eye shape has been receiving increasing attention as a possible biomarker for myopia. Among several modalities, magnetic resonance imaging (MRI) is currently considered to be the best to measure the 3-dimensional eye shape, and one study using MRI revealed that myopic eyes became much larger in all 3 dimensions, but more so in length (0.35 mm/D) than in height (0.19 mm/D) or in width (0.10 mm/D), which fitted in global and axial elongation models. Another recent study reported that emmetropic retinas were oblate but oblateness decreased with myopia progression. According to a study to evaluate eye shapes in high myopia, although all emmetropic eyes had a blunt shape, almost half of the high myopic eyes had a pointed shape. Multiple lines of evidence suggest that abnormal eye shape changes can cause not only simple myopia but also various ocular complications through biomechanical stretching. In this review, we highlight recent findings on eye shape changes in myopic eyes and abnormal eye shapes in pathologic myopia.
The Impact of Left Ventricular Assist Device Infections on Postcardiac Transplant Outcomes: A Systematic Review and Meta-Analysis
Authors: Chahal Daljeet , Sepehry Amir A. , Nazzari Hamed , Wright Alissa Jade , Toma Mustafa
Published: December 2018

Left ventricular assist devices (LVADs) are associated with numerous short- and long-term complications, including infection. The impact LVAD infections have on clinical outcomes after transplantation is not well established. We sought to determine whether the presence of infection while on LVAD support negatively influences outcomes after cardiac transplantation. We searched electronic databases and bibliographies for full text studies that identified LVAD infections during support and also reported on posttransplant outcomes. A meta-analysis of posttransplant survival was conducted using a random effects model. Of 2,373 records, 13 bridge to transplant (BTT) cohort studies were selected (n = 6,631, 82% male, mean age 50.7 ± 2.7 years). A total of 6,067 records (91.5%) received transplant. There were 3,718 (56.1%) continuous-flow LVADs (CF-LVADs), 1,752 (26.4%) pulsatile LVADs, and 1,161 (17.5%) unknown type records. A total of 2,586 records (39.0%) developed LVAD infections. Patients with LVAD infections were younger (50.5 ± 1.5 vs. 51.3 ± 1.5, p = 0.02), had higher body mass indeices (BMIs) (28.4 ± 0.7 vs. 26.8 ± 0.4, p < 0.01), and longer LVAD support times (347.0 ± 157.6 days vs. 180.2 ± 106.0 days, p < 0.01). Meta-analysis demonstrated increased posttransplant mortality in those patients who had an LVAD infection (hazard ratio [HR] 1.30, 95% CI: 1.16–1.46, p < 0.001). Subgroup meta-analyses by continuous-flow and pulsatile device type demonstrated significant increased risk of death for both types of devices (HR 1.47, 95% CI: 1.22–1.76, p < 0.001 and 1.71, 95% CI: 1.19–2.45, p = 0.004, respectively). Patients who develop LVAD infections are younger, have higher BMIs and longer LVAD support times. Our data suggests that LVAD-related infections result in a 30% increase in postcardiac transplantation mortality. Strategies to prevent LVAD infections should be implemented to improve posttransplant outcomes in this high-risk population.
Factors Affecting the Levels of Satisfaction With Nurse-Patient Communication Among Oncology Patients
Authors: Lam Winsome , Wong Fiona Y. , Chan Angela E.
Published: December 2018

Background

Nurse-patient communication is of the utmost importance to oncology patients.

Objective

The aim of this study was to investigate the factors influencing the level of satisfaction with nurse-patient communication among oncology patients during their daily routine procedures.

Methods

In this observational study, 25 registered nurses and 94 patients were recruited from an oncology unit. The patients were asked to complete a concern checklist before and after each admission, administration of medication, and wound-dressing procedure. Nonverbal cues expressed by the nurses and patients were noted on the checklist during these nursing procedures.

Results

The results showed that patients at stage 3 cancer and patients receiving admission procedures were significantly more satisfied with their communication with nurses compared with those who were more concerned about the impact of the disease on self-care.

Conclusions

Cancer stage, time of admission, and psychological concern related to self-care ability are the potential factors affecting the satisfaction level of nurse-patient communication.

Implications for Nursing

Emphasis could be placed on utilizing the time of admission to interact with patients in a busy environment to strive for better communication with oncology patients. The results underscore the importance of applying the self-care enhancement approach for hospitalized cancer patients.
Relationships Among Fatigue, Anxiety, Depression, and Pain and Health-Promoting Lifestyle Behaviors in Women With Early-Stage Breast Cancer
Authors: Kelly Debra Lynch , Yang Gee Su , Starkweather Angela R. , Siangphoe Uma , Alexander-Delpech Paula , Lyon Debra E.
Published: December 2018

Background

With a nearly 89% 5-year survival rate for women with early-stage breast cancer, symptoms are a priority. Healthy lifestyle behaviors may be temporally associated with symptoms; however, evidence is lacking.

Objective

This research examined temporal relationships among healthy lifestyle behaviors and symptoms in women diagnosed with breast cancer receiving chemotherapy.

Methods

This research was part of a study (R01NR012667) approved by the institutional review board. Women (n = 76) providing written informed consent participated in this longitudinal study examining health-promoting lifestyle behaviors and symptoms (fatigue, anxiety, depression, and pain). Participants completed well-validated self-report questionnaires primarily at a clinic visit. Statistical methods included descriptive statistics, linear mixed-effects models, and pairwise comparisons using SAS 9.4; α was set at .05.

Results

Lowest healthy lifestyle behavior scores for physical activity and highest scores for spiritual growth were reported. Significant changes in physical activity and stress management were noted. Fatigued patients had lower physical activity and nutrition scores than did patients without fatigue. Patients with anxiety had lower spiritual growth and interpersonal relation scores than did patients without anxiety. Relationships demonstrated temporal differences.

Conclusions

Breast cancer survivors did not routinely engage in healthy lifestyle behaviors. Significant temporal changes in healthy lifestyle behaviors and symptoms and significant associations among healthy lifestyle behaviors, symptoms, and demographic and clinical factors were noted in this study.

Implications for Practice

Knowing the temporal relationships among these variables provides insight that could be useful for nurses so they can encourage healthy lifestyle behaviors to mitigate symptoms throughout the cancer trajectory.
Call for “High-Dose” Olanzapine Research in Treatment-Resistant Psychosis
Authors: Westermeyer Joseph
Published: December 2018

Psychiatric care has entered a new era in which care for treatment-resistant psychiatric disorder has attained priority status. Addressing treatment resistance involves 1) alleviating symptoms and signs of the diagnostic condition, 2) returning the patient to functional capacity, and 3) preventing subsequent recurrence. This approach has achieved considerable momentum in regard to major depressive disorder, as evidenced by early recognition and timely treatment, medication augmentation strategies, mind-body training for the populace at large, effective and efficient psychotherapies, and new biomedical interventions. This report proposes a pharmacotherapy that may qualify for treatment-resistant psychosis, that is, high-dose olanzapine. Considerable thought, planning, resources, and effort would be necessary to test this intervention. This proposal includes suggestions for developing an affordable means of assessing this and future candidates for treatment-resistant psychosis.
Objective Assessment of Disparity Vergence after Treatment of Symptomatic Convergence Insufficiency in Children
Authors: Scheiman Mitchell , Talasan Henry , Alvarez Tara L.
Published: December 2018

SIGNIFICANCE

This first report of the use of objective measures of disparity vergence as outcome measures for symptomatic convergence insufficiency in children provides additional information that is not accessible with clinical tests. The study results also demonstrate that objective measures of vergence could be used in future randomized clinical trials of binocular vision disorders with children.

PURPOSE

This study was designed to evaluate changes in objective measures of disparity vergence after office-based vergence/accommodative therapy (OBVAT) for convergence insufficiency in children 12 to 17 years old.

METHODS

In this prospective trial, we recruited 10 participants with normal binocular vision and 12 with convergence insufficiency. All participants with convergence insufficiency were treated with 12 weeks of OBVAT. The primary outcome measure was average peak velocity for 4° symmetrical convergence steps. Other objective outcome measures of disparity vergence included time to peak velocity, latency, and accuracy. Changes in clinical measures (near point of convergence, positive fusional vergence at near) and symptoms were evaluated.

RESULTS

There was a statistically significant increase in peak velocity and more accurate response amplitude to 4° symmetrical convergence step stimuli after OBVAT compared with baseline measurements. Near point of convergence, positive fusional vergence, and symptoms also statistically significantly improved after OBVAT. Ten of the 12 participants met clinical success criteria.

CONCLUSIONS

In this prospective study on the treatment of symptomatic convergence insufficiency in children in which both clinical and objective eye movement measurements were used to evaluate the results of treatment, significant changes were found in symptoms and both clinical and objective measures of disparity vergence after completion of OBVAT in children with symptomatic convergence insufficiency.
Ovarian Combined Low-grade Serous and Mesonephric-like Adenocarcinoma: Further Evidence for A Mullerian Origin of Mesonephric-like Adenocarcinoma
Authors: McCluggage W. Glenn , Vosmikova Hana , Laco Jan
Published: December 2018

Mesonephric-like adenocarcinomas are rare neoplasms occurring in the uterine corpus and ovary which bear a close morphologic resemblance to cervical mesonephric adenocarcinomas. They also have a similar immunophenotype and harbor similar molecular abnormalities to mesonephric adenocarcinomas and it is debated whether they are truly of mesonephric origin or represent Mullerian neoplasms closely mimicking mesonephric adenocarcinomas. We report an unusual case with bilateral ovarian serous borderline tumors and extraovarian low-grade serous carcinoma (invasive implants). In one ovary, there was a component of mesonephric-like adenocarcinoma. The immunophenotypes of the serous and the mesonephric-like components were distinct and as expected for the individual tumor types (serous component diffusely positive with WT1 and estrogen receptor and negative with GATA3, TTF1 and CD10; mesonephric-like component WT1 and estrogen receptor negative and GATA3, TTF1, and CD10 positive; both components diffusely positive with PAX8 and exhibiting “wild-type” p53 immunoreactivity). In all components (bilateral serous borderline tumors, low-grade serous carcinoma and mesonephric-like adenocarcinoma), an identical KRAS mutation was detected (NM_004985.4): c.35G>A, p.(G12D) proving a clonal association between the serous and mesonephric-like components and excluding a collision neoplasm. This represents the second reported case of a combined ovarian low-grade serous tumor and mesonephric-like adenocarcinoma; in the previously reported case, an identical NRAS mutation was present in both components. These 2 cases provide evidence that ovarian mesonephric-like adenocarcinomas have, at least in some cases, a Mullerian origin and differentiate along mesonephric lines. We present additional evidence for this by reviewing associated findings in published and unpublished ovarian mesonephric-like adenocarcinomas; 8 of 11 of these neoplasms contained other Mullerian lesions in the same ovary, mainly endometriosis and adenomas/adenofibromas.