bluuebunny/crossref_metadata_2025 huggingface dataset:
‘La Vida Normal’: Young people adapting to Type 1 diabetes in Bolivia
Authors: Souris Katherine J , Caballero Gonzales Maria del Carmen , Barrington Clare , Klatman Emma L , Anderson Barbara J , Duarte Elizabeth , Middlehurst Angela C , Nostas Miriam C , Ogle Graham D
Published: May 2019

Objectives

To identify challenges and coping strategies of young people with Type 1 diabetes (T1D) and their families in Bolivia through qualitative analysis of interviews with beneficiaries of Centro Vivir con Diabetes (CVCD), a diabetes health center supported by the International Diabetes Federation Life for a Child (LFAC) program.

Methods

Eighteen young people aged 14–33 and at least one caregiver participated in semi-structured interviews in five cities in Bolivia from May to June 2016. Interviews were recorded, transcribed, and analyzed using inductive thematic analysis.

Results

Participants described needing guidance at diagnosis and facing stigma in communities. Young people expressed that life with T1D was ‘la vida normal’ (a normal life), although interpretations of normalcy varied. For some, ‘la vida normal’ meant resistance to T1D; for others it indicated acceptance.

Discussion

Access to interdependent spheres of support allowed young people to form a new normal around T1D. Receiving supplies through the CVCD/LFAC partnership maintained family connection to clinical care, CVCD education helped families share in T1D management, and peer support mitigated stigma for young people. Programs like CVCD that combine supply-based aid with clinical education for whole families, create effective support for young people with T1D in low- and middle-income countries.
Effects of a peer-mediated performance improvement intervention on recording of child well-body checks by educational care-providers
Authors: Hartz Renee M , Butler Brittany L , Natale Kerianne R , Williams Stacey , Luiselli James K
Published: May 2019

We report the effects of peer-mediated training as a performance improvement intervention on recording of well-body checks by classroom instructors at a specialized school for children and youth. The instructors were trained as peer mediators and then assumed performance monitoring responsibilities in the classroom. Compared to baseline phases in a withdrawal design, peer-mediation increased recording of well-body checks to near-100% among the instructors. Results of the study document positive training effects on a critical health and wellness objective, support and expand the limited research base concerning the effects of peer-mediated training, suggest further application of such training in human services settings.
Sidestepping spatial confounds in object-based correspondence effects: The Bimanual Affordance Task (BMAT)
Authors: Azaad Shaheed , Laham Simon M
Published: May 2019

Tucker and Ellis found that when participants made left/right button-presses to indicate whether objects were upright or inverted, responses were faster when the response hand aligned with the task-irrelevant handle orientation of the object. The effect of handle orientation on response times has been interpreted as evidence that individuals perceive grasp affordances when viewing briefly presented objects, which in turn activate grasp-related motor systems. Although the effect of handle alignment has since been replicated, there remains doubt regarding the extent to which the effect is indeed driven by affordance perception. Objects that feature in affordance-compatibility paradigms are asymmetrical and have laterally protruding handles (e.g., mugs) and thus confound spatial and affordance properties. Research has attempted to disentangle spatial compatibility and affordance effects with varying results. In this study, we present a novel paradigm with which to study affordance perception while sidestepping spatial confounds. We use the Bimanual Affordance Task (BMAT) to test whether object affordances in symmetrical objects facilitate response times. Participants ( N = 36) used one of three (left unimanual/right unimanual/bimanual) responses to indicate the colour of presented objects. Objects afforded either a unimanual (e.g., handbag) or a bimanual (e.g., laundry hamper) grasp. Responses were faster when the afforded grasp corresponded with the response type (unimanual vs. bimanual), suggesting that affordance effects exist independent of spatial compatibility.
A comparative analysis of right-wing radical and Islamist communities’ strategies for survival in social networks (evidence from the Russian social network VKontakte)
Authors: Myagkov Mikhail , Shchekotin Evgeniy V , Chudinov Sergey I , Goiko Vyacheslav L
Published: May 2019

This article presents a comparative analysis of online communities of right-wing radicals and Islamists, who are considered to be numerous and dangerous extremist groups in Russian society. The online communities were selected based on the content posted on the largest Russian social networking site VKontakte. The goal of this article is to determine the strategy and tactics employed by extremist online communities for survival on social networking sites. The authors discovered that both right-wing radical and Islamist groups employ similar behavioural techniques, with the mimicry of ideologically neutral content as the most common. In addition, every extremist community also applies some unique methods. For example, if there is a risk of being blocked, right-wing radicals tend to shift their activity and communication to the other internet-based platforms that are not under state control; however, Islamists prefer to suddenly change the content of their communities (i.e. by using secondary mimicry).
Re-enacting the past in TV news on war crime trials: A method for analysis of visual narratives in archival footage
Authors: Ristić Katarina
Published: May 2019

This article provides a method for the analysis of the visual narratives present in the archival footage in programs of TV news, based on an analysis of TV news on war crime trials transmitted by Serbian TV stations. The archival footage in TV news presents specific claims as to an understanding of the trials, as it is assumed to present the ‘reality’ of war, re-enacting the past and eliciting viewers’ emotions. The author argues that the visual narratives emerging from the selection and editing of archival footage create specific meanings of the past, and provide a method for their analysis, applying social semiotic multimodal analysis and drawing on structural narrative analysis. The patterning of the visual narratives in the archival footage contributes to the creation of an artificial memory of war, signaling a particular version of the past within the preferred meaning of a TV news channel. The main advantage of this method is that it enables a systematic analysis of visual narratives in the archival footage, revealing the ideological work of sign-makers embedded in the visual structure.
Family overrule of registered refusal to donate organs
Authors: Shaw David , Lewis Penney , Jansen Nichon , Samuel Undine , Wind Tineke , Georgieva Denie , Haase Bernadette , Ploeg Rutger , Gardiner Dale
Published: May 2019

It is well known that families frequently overrule the wishes of dying patients who had previously expressed a wish to donate their organs. Various strategies have been suggested to reduce the frequency of these ‘family overrules’. However, the possibility of families overruling a patient’s registered decision not to donate has not been discussed in the medical literature, although it is legally possible in some countries. In this article, we provide an ethical analysis of family overrule of a relative’s refusal to donate, using the different jurisdictions of the UK, Switzerland, Germany and the Netherlands to provide some context. Despite some asymmetries between overruling consent and overruling refusal, there are some cases in which donation should proceed despite a recorded refusal to do so.
Feasibility of mirabegron in the treatment of overactive bladder in patients affected by Parkinson’s disease: A pilot study
Authors: Gubbiotti Marilena , Conte Antonella , Di Stasi Savino M. , Tambasco Nicola , Giannantoni Antonella
Published: May 2019

Background:

We investigated the effectiveness and safety of mirabegron oral treatment in a group of patients with Parkinson’s disease (PD) and overactive bladder (OAB), refractory to antimuscarinics.

Materials and methods:

Thirty patients with PD and refractory OAB were prospectively included in the study. At baseline, motor symptoms, severity of disease and cognitive status were assessed with the Hoehn–Yahr Scale, the Unified Parkinson’s disease Rating Scale, the Mini Mental State examination and the Montreal Cognitive Assessment. At baseline, urinary symptoms, satisfaction with treatment and the impact of urinary incontinence on quality of life (QoL) were assessed with the 3-day voiding diary, the Visual Analogue Scale (VAS), the Incontinence–QoL questionnaire and urodynamics. Patients started assuming mirabegron 50 mg tablets once daily. Evaluation of urinary symptoms and related questionnaires, motor symptoms, severity of PD and uroflowmetry with postvoid residual volume measurement were then repeated at the 3- and 6-month follow up. Side effects were also noted.

Results:

At baseline, the most frequently reported urinary symptoms were: urinary urgency (present in all the patients), urge urinary incontinence in 28/30 (93.3%) and increased daytime urinary frequency in 25 (83.3%) patients. At the 3-month follow up, 7 out of the 30 patients achieved a complete urinary continence. Significant improvements in VAS and Incontinence–QoL scores were observed in 24 patients. These benefits were maintained for the whole observation period. Four patients discontinued treatment due to poor efficacy, and two due to the cost of the drug.

Conclusions:

Mirabegron is a safe and effective treatment in patients with PD and OAB refractory to anticholinergics in the short-term follow up.
Getting More Information From Glucose Meter Evaluations
Authors: Krouwer Jan S. , Garrett Patricia E.
Published: May 2019

Glucose meter evaluations are common in publications and inform whether the meter meets the ISO 15197 specification. The ISO 15197 specifications, which are universally cited, leave 1% of results unspecified, which can be thought of as typical performance of results (99%) versus rare performance (1%). Suggestions are provided to extract more information from these evaluations, including rare performance, since highly discrepant results or failure to obtain a result can be observed in a glucose meter that has met the ISO 15197 specification. It is also recommended that when manufacturers perform evaluations, they analyze adverse events contained in the FDA MAUDE database. Finally, we point out an important problem with the ISO 15197 specifications.
Antifungal Metabolites From Alternaria atrans: An Endophytic Fungus in Psidium guajava
Authors: Yang Zhi , Dan Wen-Jia , Li Yi-Xiao , Peng Guang-Rui , Zhang An-Ling , Gao Jin-Ming
Published: May 2019

Six metabolites (1–6), including 1 new fusaric acid derivative, designated atransfusarin (1), and 5 known compounds, (3 R,6 R)-3-benzyl-6-isopropyl-4-methylmorpholine-2,5-dione (2), daucoterol (3), adenosine (4), cerebroside B (5), and 2,3-dihydroxypropyl ( Z,Z)-9,12-octadecadienate (6), were isolated from the solid culture of an endophytic Alternaria atrans MP-7, associated with the medicinal plant Psidium guajava. The structure of the new compound was elucidated by spectral data. The antifungal test indicated that (3 R,6 R)-3-benzyl-6-isopropyl-4-methylmorpholine-2,5-dione (2) showed obvious inhibitory activity against Alternaria solani, Colletotrichum gloeosporioides, and Phyricularia grisea. Compared to fusaric acid (1a), even though the antifungal activity of atransfusarin (1) against A. solani, C. gloeosporioides, and P. grisea was greatly decreased, its inhibitory effect against Botrytis cinerea was still retained.
A Multilevel Analysis of Surgical Category and Individual Patient-Level Risk Factors for Postoperative Stroke
Authors: Kummer Benjamin R. , Hazan Rebecca , Merkler Alexander E. , Kamel Hooman , Willey Joshua Z. , Middlesworth William , Yaghi Shadi , Marshall Randolph S. , Elkind Mitchell S. V. , Boehme Amelia K.
Published: May 2019

Background and Purpose:

Many studies supporting the association between specific surgical procedure categories and postoperative stroke (POS) do not account for differences in patient-level characteristics between and within surgical categories. The risk of POS after high-risk procedure categories remains unknown after adjusting for such differences in patient-level characteristics.

Methods:

Using inpatients in the American College of Surgeons National Surgical Quality Initiative Program database, we conducted a retrospective cohort study between January 1, 2000, and December 31, 2010. Our primary outcome was POS within 30 days of surgery. We characterized the relationship between surgical- and individual patient-level factors and POS by using multivariable, multilevel logistic regression that accounted for clustering of patient-level factors with surgical categories.

Results:

We identified 729 886 patients, 2703 (0.3%) of whom developed POS. Dependent functional status (odds ratio [OR]: 4.11, 95% confidence interval [95% CI]: 3.60-4.69), history of stroke (OR: 2.35, 95%CI: 2.06-2.69) or transient ischemic attack (OR: 2.49 95%CI: 2.19-2.83), active smoking (OR: 1.20, 95%CI: 1.08-1.32), hypertension (OR: 2.11, 95%CI: 2.19-2.82), chronic obstructive pulmonary disease (OR: 1.39 95%CI: 1.21-1.59), and acute renal failure (OR: 2.35, 95%CI: 1.85-2.99) were significantly associated with POS. After adjusting for clustering, patients who underwent cardiac (OR: 11.25, 95%CI: 8.52-14.87), vascular (OR: 4.75, 95%CI: 3.88-5.82), neurological (OR: 4.60, 95%CI: 3.48-6.08), and general surgery (OR: 1.40, 95%CI: 1.15-1.70) had significantly greater odds of POS compared to patients undergoing other types of surgical procedures.

Conclusions:

Vascular, cardiac, and neurological surgery remained strongly associated with POS in an analysis accounting for the association between patient-level factors and surgical categories.
Function, information, and contributions: An evaluation of national multidisciplinary team meetings for rare cancers
Authors: Rosell Linn , Wihl Jessica , Hagberg Oskar , Ohlsson Björn , Nilbert Mef
Published: May 2019

National virtual multidisciplinary team meetings have been established in Swedish cancer care in response to centralized treatment of rare cancers. Though national meetings grant access to a large multidisciplinary network, we hypothesized that video-based meetings may challenge participants’ contributions to the case discussions. We investigated participants’ views and used observational tools to assess contributions from various health professionals during the multidisciplinary team meetings. Data on participants’ views were collected using an electronic survey distributed to participants in six national multidisciplinary team meetings for rare cancers. Data from observations were obtained from the multidisciplinary team meetings for penile cancer, anal cancer, and vulvar cancer using the standardized observational tools Meeting Observational Tool and Metric of Decision-Making that assess multidisciplinary team meeting functionality and participants’ contributions to the case discussions. Participants overall rated the multidisciplinary team meetings favorably with high scores for development of individual competence and team competence. Lower scores applied to multidisciplinary team meeting technology, principles for communicating treatment recommendations, and guidelines for evaluating the meetings. Observational assessment resulted in high scores for case histories, leadership, and teamwork, whereas patient-centered care and involvement of care professionals received low scores. National virtual multidisciplinary team meetings are feasible and receive positive ratings by the participants. Case discussions cover medical perspectives well, whereas patient-centered aspects achieve less attention. Based on these findings, we discuss factors to consider to further improve treatment recommendations from national multidisciplinary team meetings.
Lymphatic flow restoration after stripping surgery for varicose veins: A case report
Authors: Yoshida Shuhei , Koshima Isao , Imai Hirofumi , Sasaki Ayano , Fujioka Yumio , Nagamatsu Shogo , Yokota Kazunori
Published: May 2019

It has been suggested that the dynamics of the venous and lymphatic systems interact as a mutually dependent dual outflow system and that derangement of lymph flow could be reversed by surgical treatment of venous incompetence. In this report, we describe a patient in whom lymphatic function was restored after stripping of the great saphenous vein for varicosity. The patient was a 79-year-old woman who had varicose veins along the medial side of an edematous left leg. Lymphatic function was investigated using indocyanine green imaging to evaluate for the presence of lymphedema. Based on the findings, we made a diagnosis of bilateral varicosity of the great saphenous vein with left-sided lymphedema. The great saphenous vein was stripped between the groin and ankle on both sides. At 3 months after the stripping procedure, lymphatic flow was observed immediately after injection of indocyanine green in both legs along the medial side from the foot to the groin. We therefore determined that lymphatic flow had been restored after the stripping surgery. The functions of the venous and lymphatic systems are thought to be closely related, and that, if the function of one declines, the other will also be affected. Treatment of venous system, including stripping, may help to break the vicious cycle of lymphatic stasis and venous insufficiency.
Corporate actors, the UN Sustainable Development Goals and Earth System Governance: A research agenda
Authors: Dahlmann Frederik , Stubbs Wendy , Griggs Dave , Morrell Kevin
Published: May 2019

The Anthropocene requires significant shifts and innovation in policy as well as human action and behavior. While much research attention has focused on society and policy makers, we know significantly less about how businesses exercise agency as part of Earth System Governance such as their contribution to the UN Sustainable Development Goals. Concerns are mounting over how large corporations are being governed and how businesses generally should operate in the Anthropocene. In this Perspective, we outline three potential high-impact areas for interdisciplinary research: (1) integrating global goals into corporate target-setting; (2) integrating global goals into codes of corporate governance; and (3) integrating global goals into new business models. We argue that understanding the role that corporate actors play in Earth System Governance is of vital importance to ensure efforts and outcomes are effective and equitable.
Timing of Fistula Creation and the Probability of Catheter-Free Use: A Cohort Study
Authors: Clarke Alix , Ravani Pietro , Oliver Matthew J. , Hiremath Swapnil , Blake Peter G. , Moist Louise M. , Garg Amit X. , Lam Ngan N. , Quinn Robert R.
Published: May 2019

Background:

Fistula creation is recommended to avoid the use of central venous catheters for hemodialysis. The extent to which timing of fistula creation minimizes catheter use is unclear.

Objective:

To compare patient outcomes of 2 fistula creation strategies: fistula attempt prior to the initiation of dialysis (“predialysis”) or fistula attempt after starting dialysis (“postinitiation”).

Design:

Cohort study.

Setting:

Five Canadian dialysis programs.

Patients:

Patients who started hemodialysis between 2004 and 2012, who underwent fistula creation, and were tracked in the Dialysis Measurement Analysis and Reporting (DMAR) system.

Measurements:

Catheter-free fistula use within 1 year of hemodialysis start, probability of catheter-free fistula use during follow-up, and rates of access-related procedures.

Methods:

Retrospective data analysis: logistic regression; negative binomial regression.

Results:

Five hundred and eight patients had fistula attempts predialysis and 583 postinitiation. At 1 year, 80% of those with predialysis attempts achieved catheter-free use compared to 45% with post-initiation attempts (adjusted odds ratio [OR]preVSpost = 4.67; 95% confidence interval [CI] = 3.28-6.66). The average of all patient follow-up time spent catheter-free was 63% and 28%, respectively (probability of use per unit time, ORpreVSpost = 2.90; 95% CI = 2.18-3.85). This finding was attenuated when accounting for maturation time and when restricting the analysis to those who achieved catheter-free use. Predialysis fistula attempts were associated with lower procedure rates after dialysis initiation—1.61 procedures per person-year compared with 2.55—but had 0.65 more procedures per person prior to starting dialysis.

Limitations:

Observational design, unknown indication for predialysis and postinitiation fistula creation, and unknown reasons for prolonged catheter use.

Conclusions:

Predialysis fistula attempts were associated with a higher probability of catheter-free use and remaining catheter-free over time, and also resulted in fewer procedures compared with postinitiation attempts, which could be due to timing of attempt or patient factors. Catheter use and procedures were still common for all patients, regardless of the timing of fistula creation.
Changes in Body Weight Before and After Kidney Donation
Authors: Bugeja Ann , Harris Sophie , Ernst Jaclyn , Burns Kevin D. , Knoll Greg , Clark Edward G.
Published: May 2019

Background:

Living kidney donors remain at low risk of end-stage kidney disease (ESKD), but the risk for obese and overweight donors is increased. The Kidney Disease Improving Global Outcomes (KDIGO) clinical guideline recommends that overweight and obese patients pursue weight loss before donation and maintain a healthy post-donation weight.

Objective:

To determine the trajectory of weight changes before and after living kidney donation.

Design:

Retrospective cohort study.

Setting:

The Living Kidney Donor program in the Champlain Local Health Integration Network at The Ottawa Hospital in Ottawa, Canada.

Patients:

The study included 151 living kidney donors who donated between January 2009 and December 2017.

Measurements:

Date of kidney donation, relationship to the transplant recipient, and cause of ESKD in the transplant recipient were documented. Demographic data, markers of glycemic control, and weights at the time of clinic visits were recorded.

Methods:

The analysis included use of paired Student’s t tests to compare mean differences in weight at kidney donation relative to the time of initial assessment and at last follow-up.

Results:

The median (interquartile range [IQR]) follow-up was 392 (362, 1096) days post-donation. Among donors with normal body mass index (BMI; 18.5-24.9 kg/m2), weight loss occurred before donation (62.8 ± 3.1 kg to 61.5 kg ± 2.9 kg; mean difference 1.1 ± 2.7 kg, P < .01) and did not change significantly post-donation. Among overweight/obese donors (BMI ≥25 kg/m2), weight did not change significantly pre-donation, but increased significantly post-donation (86.0 ± 2.1 kg to 88.8 ± 2.7 kg; mean difference 2.3 ± 0.9 kg, P < .0001).

Limitations:

The single-center design of the study limits generalizability.

Conclusions:

Donors with normal BMI experienced significant weight loss before donation and maintained healthy body weight post-donation. Conversely, donors with BMI ≥25 kg/m2 at donation experienced significant weight gain over 1-year post-donation. Our findings suggest the need for enhanced weight control efforts among obese and overweight kidney donors to reduce the risk of ESKD.
Description of Patients Medications Needs and the Community Pharmacist’s Role in Puerto Rico Following a Natural Disaster
Authors: Jiménez-Mangual Beatriz C. , Cuevas-Acevedo Darilys M. , Quiles-Alves Nicole , Rodríguez-Nazario Ileana , Melin Kyle R.
Published: May 2019

Background: In September 2017, Puerto Rico was hit by Hurricane Maria, a natural disaster that caused devastation. Initial reports of disruption to the health care system were later followed by increases in the death toll in Puerto Rico. Objective: This project assessed patient medications needs, level of satisfaction with community pharmacy services, and perceptions about the role of the pharmacist during the emergency following Hurricane Maria in Puerto Rico. Methodology: The investigation utilized a descriptive, cross-sectional design. Data were collected at 3 community pharmacies located in San Juan, Puerto Rico: Walgreens (Specialty Pharmacy and Store 891) and Farmacia Caridad #9. Patients receiving care at these locations were invited to complete a 10-item questionnaire. These were provided with an information sheet describing details of the study prior to participation. Results: Sixty-five patients participated in the study, with an average age of 59 years. The majority (77%) of the respondents reported problems related to their medications and nearly half (47.7%) reported having trouble either contacting or getting to their pharmacy following the hurricane. Regarding the role of pharmacists following a natural disaster, 94% of respondents reported the pharmacist was available to help them and 95% reported the information provided by the pharmacist was “trustworthy/very trustworthy.” Conclusion: Although the challenges reported in Puerto Rico with regard to medications following Hurricane Maria were significant, patients reported a high level of confidence in the ability of community pharmacists to help them.
Prosocial Behavior Across Professional Boundaries: Experimental Evidence From Hospitals
Authors: Liebe Ulf , Naumann Elias , Tutic Andreas
Published: May 2019

Differences in social status might impede teamwork and cooperation among health professionals. Against this background, we study the social interaction between health professionals using a simple experimental tool from behavioral economics (the dictator game). In our setup, physicians, nurses, and student nurses had to allocate monetary endowments between themselves and recipients, whereby the professional status of the recipient (physician, nurse, and student nurse) was varied. This way, we obtain insights into the prosocial motives of health professionals. Our results indicate a considerable amount of pure altruistic concern for the welfare of others among health practitioners, which also reaches across professional boundaries. These findings put concerns expressed in the literature on the doctor–nurse relationship such as a potential lack of team identity, in-group favoritism, and overly strict hierarchies along professional boundaries into perspective. Our study also paves the way for further experimental research on the relationship between social status and cooperation in the medical sector.
“Motherhood Is Hard”: Exploring the Complexities of Unplanned Motherhood Among HIV-Positive Adolescents in South Africa
Authors: Josephine Adeagbo Morolake
Published: May 2019

For any woman, pregnancy and giving birth are major life-changing experiences. This period is argued to indicate a shift from girlhood into womanhood. However, this experience takes on new meaning when the woman is very young—an adolescent, who is still in school—and learns that she is HIV-positive. For such adolescent, becoming a mother, just like living with HIV/AIDS, involves moving from a known, current reality to an unknown, new reality. To understand how HIV-positive adolescent mothers grapple with the demands and responsibilities of unplanned motherhood while living with HIV, this study explores the complexities of their experiences in South Africa. Drawing on qualitative methods, this study examines their meaning to motherhood while meeting their personal health needs. Through in-depth interviews conducted among 10 HIV-positive adolescent mothers living in Johannesburg, this article presents an empirical study of their narratives and how they negotiate these complexities in their unplanned new realities. Emerging themes from the interview transcripts were identified, coded, and analyzed thematically following an interpretivist approach. From the interviews conducted, it is evident that HIV-positive adolescent mothers perceive unplanned motherhood as difficult and this negatively affects their future childbearing decisions. Given the importance of motherhood and adolescents globally, this article advocates for feminist policies that would facilitate larger transformative narratives. It also recommends the implementation of relevant policy that would alleviate the difficulties of HIV-positive adolescent mothers generally.
Essential Concepts for the Management of Metastatic Spine Disease: What the Surgeon Should Know and Practice
Authors: Barzilai Ori , Boriani Stefano , Fisher Charles G. , Sahgal Arjun , Verlaan Jorrit Jan , Gokaslan Ziya L. , Lazary Aron , Bettegowda Chetan , Rhines Laurence D. , Laufer Ilya
Published: May 2019

Study Design:

Literature review.

Objective:

To provide an overview of the recent advances in spinal oncology, emphasizing the key role of the surgeon in the treatment of patients with spinal metastatic tumors.

Methods:

Literature review.

Results:

Therapeutic advances led to longer survival times among cancer patients, placing significant emphasis on durable local control, optimization of quality of life, and daily function for patients with spinal metastatic tumors. Recent integration of modern diagnostic tools, precision oncologic treatment, and widespread use of new technologies has transformed the treatment of spinal metastases. Currently, multidisciplinary spinal oncology teams include spinal surgeons, radiation and medical oncologists, pain and rehabilitation specialists, and interventional radiologists. Consistent use of common language facilitates communication, definition of treatment indications and outcomes, alongside comparative clinical research. The main parameters used to characterize patients with spinal metastases include functional status and health-related quality of life, the spinal instability neoplastic score, the epidural spinal cord compression scale, tumor histology, and genomic profile.

Conclusions:

Stereotactic body radiotherapy revolutionized spinal oncology through delivery of durable local tumor control regardless of tumor histology. Currently, the major surgical indications include mechanical instability and high-grade spinal cord compression, when applicable, with surgery providing notable improvement in the quality of life and functional status for appropriately selected patients. Surgical trends include less invasive surgery with emphasis on durable local control and spinal stabilization.
Management of Acute Traumatic Central Cord Syndrome: A Narrative Review
Authors: Divi Srikanth N. , Schroeder Gregory D. , Mangan John J. , Tadley Madeline , Ramey Wyatt L. , Badhiwala Jetan H. , Fehlings Michael G. , Oner F. Cumhur , Kandziora Frank , Benneker Lorin M. , Vialle Emiliano N. , Rajasekaran Shanmuganathan , Chapman Jens R. , Vaccaro Alexander R.
Published: May 2019

Study Design:

Narrative review.

Objectives:

To provide an updated overview of the management of acute traumatic central cord syndrome (ATCCS).

Methods:

A comprehensive narrative review of the literature was done to identify evidence-based treatment strategies for patients diagnosed with ATCCS.

Results:

ATCCS is the most commonly encountered subtype of incomplete spinal cord injury and is characterized by worse sensory and motor function in the upper extremities compared with the lower extremities. It is most commonly seen in the setting of trauma such as motor vehicles or falls in elderly patients. The operative management of this injury has been historically variable as it can be seen in the setting of mechanical instability or preexisting cervical stenosis alone. While each patient should be evaluated on an individual basis, based on the current literature, the authors’ preferred treatment is to perform early decompression and stabilization in patients that have any instability or significant neurologic deficit. Surgical intervention, in the appropriate patient, is associated with an earlier improvement in neurologic status, shorter hospital stay, and shorter intensive care unit stay.

Conclusions:

While there is limited evidence regarding management of ATCCS, in the presence of mechanical instability or ongoing cord compression, surgical management is the treatment of choice. Further research needs to be conducted regarding treatment strategies and patient outcomes.
RE-CODE DCM (REsearch Objectives and Common Data Elements for Degenerative Cervical Myelopathy): A Consensus Process to Improve Research Efficiency in DCM, Through Establishment of a Standardized Dataset for Clinical Research and the Definition of the Research Priorities
Authors: Davies Benjamin M. , Khan Danyal Z. , Mowforth Oliver D. , McNair Angus G. K. , Gronlund Toto , Kolias Angelos G. , Tetreault Lindsay , Starkey Michelle L. , Sadler Iwan , Sarewitz Ellen , Houlton Delphine , Carter Julia , Kalsi-Ryan Sukhvinder , Aarabi Bizhan , Kwon Brian K. , Kurpad Shekar N. , Harrop James , Wilson Jefferson R. , Grossman Robert , Curt Armin , Fehlings Michael G. , Kotter Mark R. N.
Published: May 2019

Study Design:

Mixed-method consensus process.

Objectives:

Degenerative cervical myelopathy (DCM) is a common and disabling condition that arises when mechanical stress damages the spinal cord as a result of degenerative changes in the surrounding spinal structures. RECODE-DCM ( REsearch Objectives and Common Data Elements for Degenerative Cervical Myelopathy) aims to improve efficient use of health care resources within the field of DCM by using a multi-stakeholder partnership to define the DCM research priorities, to develop a minimum dataset for DCM clinical studies, and confirm a definition of DCM.

Methods:

This requires a multi-stakeholder partnership and multiple parallel consensus development processes. It will be conducted via 4 phases, adhering to the guidance set out by the COMET (Core Outcomes in Effectiveness Trials) and JLA (James Lind Alliance) initiatives. Phase 1 will consist of preliminary work to inform online Delphi processes (Phase 2) and a consensus meeting (Phase 3). Following the findings of the consensus meeting, a synthesis of relevant measurement instruments will be compiled and assessed as per the COSMIN (Consensus-based Standards for the Selection of Health Measurement Instruments) criteria, to allow recommendations to be made on how to measure agreed data points. Phase 4 will monitor and promote the use of eventual recommendations.

Conclusions:

RECODE-DCM sets out to establish for the first time an index term, minimum dataset, and research priorities together. Our aim is to reduce waste of health care resources in the future by using patient priorities to inform the scope of future DCM research activities. The consistent use of a standard dataset in DCM clinical studies, audit, and clinical surveillance will facilitate pooled analysis of future data and, ultimately, a deeper understanding of DCM.
What Is Brewing with Kangra Tea!!
Authors: Manisha  , Rao R. V. S. , Reddy B. Shashank , Verma Parmod
Published: May 2019

Tea cultivation has been playing a pivotal role in the sustainable development of the Kangra Valley (in Himachal Pradesh, India). Due to unique local geographical conditions, the aroma and flavour of Kangra tea is different from the tea produced in other parts of India, which resulted in worldwide fame in the past. Kangra cooperative tea factory which was having high productivity is facing the problem of reduced productivity due to reduction in area for tea cultivation and number of farmers supplying raw material. Presently, it is passing through a difficult phase due to certain constraints which need immediate attention for the development of tea cultivation and industry in Kangra valley. The problem does not lie with the tea, but the manner in which it is being managed, processed and marketed within India. The case focuses on analysing the major constraints faced by different stakeholders of Kangra tea value chain and evolve strategy to regenerate and rejuvenate the lost glory of Kangra tea, especially with the increased usage of geographical indication (GI). Cooperative failures, unmarketed GI Label, high labour cost and labour availability problem, seasonal demand, lack of market availability and so on were some key issues identified during the study.
Quality Assessment of Prospective Cohort Studies Evaluating Arthroscopic Treatment for Femoroacetabular Impingement Syndrome: A Systematic Review
Authors: Öhlin Axel , Karlsson Louise , Senorski Eric Hamrin , Jónasson Páll , Ahldén Mattias , Baranto Adad , Ayeni Olufemi R. , Sansone Mikael
Published: May 2019

Background:

Femoroacetabular impingement (FAI) syndrome is a cause of pain and reduced range of motion in the hip joint. Given the limited number of randomized controlled trials, prospective cohort studies constitute the dominant part of the available prospective evidence evaluating relevant clinical outcomes after arthroscopic hip surgery for FAI.

Purpose:

To assess the methodological quality of prospective cohort studies evaluating arthroscopic surgery for FAI and to determine whether there has been an improvement in methodological quality over time.

Study Design:

Systematic review; Level of evidence, 4.

Methods:

A systematic literature search was performed in PubMed, Embase (OvidSP), and the Cochrane Library. Included studies were clinical prospective cohort studies of primary arthroscopic surgery for cam and/or pincer morphology FAI. Methodological quality was assessed with the Methodological Index for Non-randomized Studies (MINORS). The mean MINORS score for studies published during the first 5 years of the period was compared with those published during the last 5 years to evaluate methodological improvement over time. The methodological quality of randomized controlled trials was also assessed with the Coleman Methodology Score.

Results:

The search yielded 53 studies. There were 34 noncomparative studies, 15 nonrandomized comparative studies, and 4 randomized controlled trials. The included studies were published between 2008 and 2017. The mean ± SD MINORS score for noncomparative and comparative studies was 10.4 ± 1.4 of 16 possible and 18.7 ± 2.0 of 24 possible, respectively. The mean Coleman Methodology Score for randomized controlled trials was 79.0 ± 7.0 of 100 possible.

Conclusion:

The methodological quality of prospective cohort studies evaluating arthroscopic surgery for FAI is moderate for comparative and noncomparative studies. Common areas for improvement include unbiased assessment of study endpoints and prospective sample-size calculations. Despite an increase in the number of published studies, an improvement in methodological quality over time was not observed.
De Novo Interstitial Deletion of 9q in a Pediatric Patient With Global Developmental Delay
Authors: Keselman Dennis , Singh Ram , Cohen Ninette , Fefer Zipora
Published: May 2019

Cytogenomic microarray (CMA) methodologies, including array comparative genomic hybridization (aCGH) and single-nucleotide polymorphism-detecting arrays (SNP-array), are recommended as the first-tier test for the evaluation of imbalances associated with intellectual disability, autism, and multiple congenital anomalies. The authors report on a child with global developmental delay (GDD) and a de novo interstitial 7.0 Mb deletion of 9q21.33q22.31 detected by aCGH. The patient that the authors report here is noteworthy in that she presented with GDD and her interstitial deletion is not inclusive of the 9q22.32 locus that includes the PTCH1 gene, which is implicated in Gorlin syndrome, or basal cell nevus syndrome (BCNS), has not been previously reported among patients with a similar or smaller size of the deletion in this locus suggesting that the genomic contents in the identified deletion on 9q21.33q22.31 is critical for the phenotype.
Multiple Mitochondrial Dysfunctions Syndrome 4 Due to ISCA2 Gene Defects: A Review
Authors: Alfadhel Majid
Published: May 2019

Multiple mitochondrial dysfunctions syndrome 4, caused by ISCA2 gene defects (OMIM #616370), was first described by Al-Hassnan et al in 2015. To date, 20 cases have been reported: 13 females and 7 males from 18 different families. All cases are from Saudi Arabia except those from one Italian family. Typically, the patients have normal antenatal and birth history and attain normal development initially. Rapid deterioration occurs between 2 and 7 months of age, with the triad of neurodevelopmental regression, optic atrophy with nystagmus, and diffuse white matter disease. Magnetic resonance imaging findings include 75% of patients have cerebellar white matter abnormalities, and the spinal cord was affected in 55%. Magnetic resonance spectroscopy showed elevated glycine peaks in 2 (10%) cases and elevated lactate peaks in 5 (25%) cases. Biochemical abnormalities include high cerebrospinal fluid glycine and lactate and high plasma glycine and lactate, but these findings were not consistent. Diagnosis is based on the detection of biallelic mutations in the ISCA2 gene. To date, no curative treatment has been discovered, and disease management is exclusively supportive. In this report, the authors review the published cases of ISCA2 gene defects and retrospectively characterize disease phenotypes, the affected biochemical pathways, neuroradiological abnormalities, diagnosis, genetics, and treatment.
Apathy and Color-Blindness in Privatized Immigration Control
Authors: Ebert Kim , Liao Wenjie , Estrada Emily P.
Published: May 2019

Despite several widely covered scandals involving the role of for-profit corporations in administering immigration policy, the privatization of immigration control continues apace with the criminalization of immigration. How does this practice sustain its legitimacy among the public amid so much controversy? Recent studies on the criminalization of immigration suggest that supporters would explicitly vilify immigrants to defend the privatization of immigration control. Research on racialized social control, on the other hand, implies that proponents would avoid explicit racism and vilification and instead rely on subtler narratives to validate the practice. Drawing on a qualitative analysis of over 600 frames derived from nearly 200 news media articles spanning over 20 years, we find that journalists and their sources rarely vilify immigrants to justify the privatization of immigration control. Instead, they frame the privatization of immigration detention as a normal component of population management and an integral part of the U.S. economy through what we call the apathy strategy—a pattern of void in which not only the systematic oppression of immigrants is underplayed, immigrant themselves also become invisible.
Clinical Care Coordination in Medically Complex Pediatric Cases: Results From the National Survey of Children With Special Health Care Needs
Authors: Hofacer Rylon D. , Panatopoulos Andrew , Vineyard Jared , Tivis Rick , Nguyen Elaine , Jingjing Niu , Lindsay Ryan P.
Published: May 2019

This study uses a secondary analysis of the 2009-2010 National Survey of Children with Special Health Care Needs (NS-CSHCN) to describe care coordination (CC) for children with medical complexity (CMC). Chi-square test, t test, and multivariate logistic regression statistical tests are used to determine the relationships and differences between sources of CC and factors associated with receiving clinic-based CC for CMC and their family. Among CMC, 66.47% received no CC support and 25.73% received clinic-based CC. In multivariate models, families reporting dissatisfaction with communication between health care providers or reporting family-centered care were less likely to receive clinic-based CC. Families were more likely to receive clinic-based CC if they had younger children, lower household income, and greater school absenteeism. Clinic-based CC is associated with improved communication between health providers but must become more family-centered and minimize student absenteeism for the CMC population.
Medication and Medication Wastage: Short-Term and Long-Term Effects of an Educational Intervention Among School Children
Authors: West Lorna Marie , Cordina Maria
Published: May 2019

Background. Education should support the gradual development of students’ necessary abilities to empower them in participating in decision-making together with health care professionals. Aim. The aim of this study was (1) to evaluate baseline knowledge regarding medication and medication wastage among primary school children and (2) to determine the short- and long-term effects of an educational intervention. Methods. Ten primary state schools around Malta were invited to participate; 5 accepted participation (3 control and 2 intervention). Children aged 9 to 12 years attending the sixth grade completed a self-reported questionnaire containing 20 questions, with total scores ranging from 0 to 20. Students from the intervention classes filled in a questionnaire pre and post an educational seminar. All students answered the questionnaire again after 8 months. ANOVA (analysis of variance) with repeated measures was used to compare difference between preintervention and postintervention mean scores. Results. Overall, 40.8% (160/392) of children participated. Mean ± SD age was 10 ± 0.4years; 52.5% (n = 84) were boys. Average preintervention knowledge score for all 5 schools was 11.5 ± 3.6, with 43.1% (n = 69) obtaining responses ≥13 (median). A repeated-measures ANOVA with a Greenhouse-Geisser correction determined that mean knowledge scores differed significantly between preintervention and postintervention ( F[1, 81.000] = 75.190, P < .0005). Intervention students retained a significant increase in knowledge scores at 8 months ( P = .026). Discussion and Conclusion. The significantly improved knowledge score following the educational intervention both in the short- and long-term demonstrated the success of the intervention. These findings provide a basis for the introduction of education about medication and medication wastage in schools.
A Differential Approach to an Uncommon Case of Acute Anemia in a Child With Sickle Cell Disease
Authors: Srinivasan Aditya , Gourishankar Anand
Published: May 2019

Introduction: Hyperhemolytic crisis is a rare and dangerous complication of sickle cell disease where the hemoglobin level drops rapidly. This can quickly lead to organ failure and death. In the literature, most cases of hyperhemolysis in sickle cell patients followed a red cell transfusion. Case Summary: In this article, we report a case of a 6-year-old African American boy with sickle cell disease who presented with fever, increased work of breathing, and consolidation in the left lower lobe of the lung on chest X-ray. He initially improved with oxygen, fluids, and antibiotics but his hemoglobin acutely dropped from 7.6 to 6 g/dL the next day of admission. He was not previously transfused, and his reticulocyte count remained high. Subsequent transfusion recovered his hemoglobin. Conclusion: This case demonstrates that in the background of the chronic hemolysis of sickle cell disease, an acute anemia should warrant exploration of aplastic crisis (parvovirus infection), immune hemolytic anemia, hepatic sequestration crisis, splenic sequestration crisis, and hyperhemolytic crisis as possible etiologies. Ongoing reticulocytosis and a source of infection may direct suspicion especially toward hyperhemolytic crisis even without preceding red cell transfusion. We propose that the optimum management should include full supportive care (including transfusions if necessary) and treatment of the underlying cause of hemolysis (such as infections or drug exposure).