bluuebunny/crossref_metadata_2025 huggingface dataset:
Electronic identity services as sociotechnical and political-economic constructs
Authors: van Dijck José , Jacobs Bart
Published: September 2019

Electronic identification services (eIDs) have become strategic services in the global governance of online societies. In this article, we argue that eIDs are sociotechnical constructs that also have political-economic dimensions. In the European context, governmental and corporate efforts to develop eIDs are shaped by legal EU frameworks, which are almost exclusively focussed on technical and legal interoperability, such as the European Interoperability Framework (EIF) and the European Interoperability Reference Architecture (EIRA). Public concerns such as privacy, security, user empowerment and control over one’s personal information prompts developers to propose a decentralized, attribute-based system governed on a nonprofit, nonstate basis (DAN-eID). To illustrate our argument, we explore a single emerging eID system (IRMA; acronym for I Reveal My Attributes) that is developing in a national context (The Netherlands). We argue that developing eIDs requires more than engineering ingenuity and legal compliance; as sociotechnical and political-economic constructs, they involve negotiation of conflicting social and political values.
Intersectional identifications: Ethnicity and sexuality among diasporic queer women in Belgium
Authors: Dhoest Alexander
Published: September 2019

While research on migration and diasporas tends to be heteronormative, research on sexual minorities tends to ignore migrants and ethnic minorities. The current paper aims to problematize both tendencies by taking a queer perspective on migration and a diasporic perspective on sexuality. As part of a larger project on diasporic LGBTQs living in Belgium, this paper discusses the social positions and identifications of six non-heterosexual women with a migration background, as narrated in individual in-depth interviews. Drawing on intersectionality theory, the relative importance and mutual interplay between their sexual and ethno-cultural identifications are analysed. This analysis discloses the irreducible individuality of each narrative, where the balance and interaction between ethno-cultural and sexual identifications is part of an intricate interplay of social positions and contexts. The participants’ migration background is a key structuring element, leading to a combination of geographic and/or social distance from their family and ethno-cultural community in which religious, family and gender norms lead to a range of expectations and pressures. Sexual identifications tend to be more salient when they are strongly rejected, in which case they lead to more social and often also geographic distancing. This is further modulated by race, as non-white participants tend to identify more strongly along racial lines because they are continuously reminded of their otherness.
Modal-based vibrothermography using feature extraction with application to composite materials
Authors: Chi Xintian , Di Maio Dario , Lieven Nicholas AJ
Published: September 2019

This research focuses on the development of a damage detection algorithm based on modal testing, vibrothermography, and feature extraction. The theoretical development of mathematical models is presented to illustrate the principles supporting the associated algorithms, through which the importance of the three components contributing to this approach is demonstrated. Experimental tests and analytical simulations have been performed in laboratory conditions to show that the proposed damage detection algorithm is able to detect, locate, and extract the features generated due to the presence of sub-surface damage in aerospace grade composite materials captured by an infrared camera. Through tests and analyses, the reliability and repeatability of this damage detection algorithm are verified. In the concluding observations of this article, suggestions are proposed for this algorithm’s practical applications in an operational environment.
Endovascular Treatment of Iliac Artery Stenosis Caused by Takayasu Arteritis: A 10-Year Experience
Authors: Dong Hui , Chen Yang , Xiong Hong-liang , Che Wu-qiang , Zou Yu-bao , Jiang Xiong-jing
Published: September 2019

Purpose: To evaluate the safety and efficacy of endovascular treatment for iliac artery stenosis caused by Takayasu arteritis (TA). Methods: Twenty-three consecutive TA patients (mean age 28.6±9.5 years; 17 women) with 30 iliac artery stenoses underwent percutaneous transluminal angioplasty (PTA) and selective stent implantation between January 2007 and December 2016. All had claudication (Rutherford category 2 or 3). The changes in the Rutherford category, ankle-brachial index (ABI), 6-minute walking capacity, and adverse events were assessed. Results: The success rate of endovascular therapy for iliac artery lesions was 93.3% (28/30). Guidewires could not cross either lesion in a patient with bilateral stenoses. Twenty-four lesions were treated by PTA alone and the other 4 lesions with provisional stents. One patient had a puncture site hematoma. Over an average of 4.8±3.3 years, 18 patients remained asymptomatic or had mild intermittent claudication. The other 4 patients developed moderate to severe intermittent claudication due to progression of a previously existing iliac lesion (n=1) or restenosis (n=3); all 4 underwent PTA. At the last follow-up, improvements were seen in the ABI (0.95±0.12 vs 0.51±0.22, p<0.001), 6-minute walking capacity (409.5±46.1 vs 272.6±32.3 m, p<0.001), and the Rutherford category of 22 patients. One patient died of a hemorrhagic stroke at 27 months due to uncontrolled hypertension. Conclusion: Endovascular therapy was safe and effective in treating TA patients with iliac artery stenosis, with good clinical outcomes in the long term.
High LET Radiation Overcomes In Vitro Resistance to X-Rays of Chondrosarcoma Cell Lines
Authors: Chevalier Francois , Hamdi Dounia Houria , Lepleux Charlotte , Temelie Mihaela , Nicol Anaïs , Austry Jean Baptiste , Lesueur Paul , Vares Guillaume , Savu Diana , Nakajima Tetsuo , Saintigny Yannick
Published: September 2019

Chondrosarcomas are malignant tumors of the cartilage that are chemoresistant and radioresistant to X-rays. This restricts the treatment options essential to surgery. In this study, we investigated the sensitivity of chondrosarcoma to X-rays and C-ions in vitro. The sensitivity of 4 chondrosarcoma cell lines (SW1353, CH2879, OUMS27, and L835) was determined by clonogenic survival assays and cell cycle progression. In addition, biomarkers of DNA damage responses were analyzed in the SW1353 cell line. Chondrosarcoma cells showed a heterogeneous sensitivity toward irradiation. Chondrosarcoma cell lines were more sensitive to C-ions exposure compared to X-rays. Using D10 values, the relative biological effectiveness of C-ions was higher (relative biological effectiveness = 5.5) with cells resistant to X-rays (CH2879) and lower (relative biological effectiveness = 3.7) with sensitive cells (L835). C-ions induced more G2 phase blockage and micronuclei in SW1353 cells as compared to X-rays with the same doses. Persistent unrepaired DNA damage was also higher following C-ions irradiation. These results indicate that chondrosarcoma cell lines displayed a heterogeneous response to conventional radiation treatment; however, treatment with C-ions irradiation was more efficient in killing chondrosarcoma cells, compared to X-rays.
Artificial Intelligence in Radiotherapy Treatment Planning: Present and Future
Authors: Wang Chunhao , Zhu Xiaofeng , Hong Julian C. , Zheng Dandan
Published: September 2019

Treatment planning is an essential step of the radiotherapy workflow. It has become more sophisticated over the past couple of decades with the help of computer science, enabling planners to design highly complex radiotherapy plans to minimize the normal tissue damage while persevering sufficient tumor control. As a result, treatment planning has become more labor intensive, requiring hours or even days of planner effort to optimize an individual patient case in a trial-and-error fashion. More recently, artificial intelligence has been utilized to automate and improve various aspects of medical science. For radiotherapy treatment planning, many algorithms have been developed to better support planners. These algorithms focus on automating the planning process and/or optimizing dosimetric trade-offs, and they have already made great impact on improving treatment planning efficiency and plan quality consistency. In this review, the smart planning tools in current clinical use are summarized in 3 main categories: automated rule implementation and reasoning, modeling of prior knowledge in clinical practice, and multicriteria optimization. Novel artificial intelligence–based treatment planning applications, such as deep learning–based algorithms and emerging research directions, are also reviewed. Finally, the challenges of artificial intelligence–based treatment planning are discussed for future works.
Periulcer Foam Sclerotherapy Injection in Chronic Venous Leg Ulcers Using Near-Infrared Laser for Vein Visualization
Authors: Kamhawy Adel Hussieny , Elbarbary Ahmed Husseiny , Elhenidy Mohamed Ahmed , Elwagih Ahmed Mohamed Morsy
Published: September 2019

High recurrence and high costs of treatment are the main problems with venous ulcer management. Therefore, it is of utmost importance to target the exact pathological cause. The role of cutaneous microvalves reflux in the pathogenesis of these ulcers has been confirmed. In this study, 20 chronic venous leg ulcers were prospectively subjected to foam sclerotherapy injection into periulcer veins using direct visualization by AccuVein AV400. Patients having infected ulcers, acute deep vein thrombosis, hypercoagulability, Ankle-Brachial Index <0.9, pregnancy, and/or allergy to the sclerosant were excluded. Endpoints included rates of ulcer size reduction, complete healing, ulcer recurrence, and procedure-related complications. Aethoxysklerol 1% was used in all cases to produce foam employing the double-syringe system. The mean reduction in ulcer surface area, postinjection, was 75% after 8 weeks and 91% after 12 weeks. Nineteen ulcers (95%) healed in a median time of 8 weeks, range 3 to 17 weeks. At 1 year of follow-up, 18 patients (90%) were still ulcer-free, while 1 patient’s ulcer (5%) recurred 19 weeks postinjection. No major complications were encountered. Periulcer foam sclerotherapy injection, guided by vein visualization technology, should be one of the main lines of treatment of venous leg ulcers. It offers good results with regard to rapid ulcer healing and low recurrence rate without major risk. Randomized controlled trials are needed to establish these conclusions.
Blocking TrkB’s Effectors Reveal Benefits of the Road Not Taken
Authors: Danzer Steve C.
Published: September 2019

[Box: see text]
Incidence, Natural History, and Factors Associated With Paravalvular Leak Following Surgical Aortic Valve Replacement
Authors: Shah Vishal N. , Orlov Oleg I. , Orlov Cinthia P. , Buckley Meghan , Sicouri Serge , Takebe Manabu , Thomas Matthew P. , Goldman Scott M. , Plestis Konstadinos A.
Published: September 2019

Objective: Our study investigates the incidence, cumulative incidence, natural history, and factors associated with intraoperative paravalvular leak (PVL) and the development of a postoperative PVL in a contemporary consecutive cohort of patients following surgical aortic valve replacement. Methods: A total of 636 patients underwent surgical aortic valve replacement from 2006 to 2016; 410 (64.5%) underwent minimally invasive aortic valve replacement and 226 (35.5%) underwent conventional aortic valve replacement. Primary outcomes were the incidence of intraoperative PVL and cumulative incidence of postoperative PVL. Secondary outcomes were the incidence of in-hospital and long-term death and need for reoperation. Results: The overall incidence of intraoperative PVL was 1.4% (95% confidence interval [CI]: 1% to 3%). All intraoperative PVLs developed in the hand-tied group. The overall incidence of postoperative PVL was 5.3% (95% CI: 4% to 7%). In the univariable and multivariable analyses, postoperative renal failure was the only factor significantly associated with the development of a postoperative PVL. Conclusions: The incidence of intraoperative PVL is low. Cumulative incidence of postoperative PVL was 3.1% (95% CI: 1.0% to 13.6%), 4.3% (95% CI: 1.3% to 16.5%), and 5.0% (95% CI: 1.4% to 17.9%) at 1, 3, and 5 years, respectively. All intraoperative PVLs occurred with hand-tied knots. A larger cohort may identify additional risk factors.
Leaders in action: The experiences of seven Texas superintendents before, during, and after Hurricane Harvey
Authors: Hemmer Lynn , Elliff D Scott
Published: September 2019

The devastating impact of Hurricane Harvey on school districts along the Texas coast in 2017 required public school superintendents to provide strong, decisive leadership for their students, staff, and communities. Limited research exists on the experiences of superintendents who lead during times of crisis. The purpose of this study was to explore how superintendents understood the conditions of their leadership and decisions made before, during, and after Hurricane Harvey. Interpretative Phenomenological Analysis (IPA) was used to explore two questions: (1) how do superintendents make sense of their world and experiences during a crisis? (2) how do superintendents describe actions made in context of a crisis? Technical-adaptive leadership combined with sensemaking served as theoretical frames. Interviews and a focus group were conducted over the course of a year. Superintendents recalled their experiences chronologically, revealing leadership experiences and action that happened sequentially. Findings are separated by four distinct episodes in which superintendents enabled sensemaking and action, and featured by representative quotes and vignettes to foreground the critical issues as reported by the superintendents. The findings suggest that their experiences and action taken were situated in terms of school district vulnerability, leadership development, and networks of collaboration and advocacy.
Conceptualising Social Types and Figures: From Social Forms to Classificatory Struggles
Authors: le Grand Elias
Published: September 2019

The analysis of social types, such as the stranger, the marginal man and the folk devil, has a long, significant history in sociology and related fields. Although the social type concept currently enjoys a rather marginal status, in recent years the related concept of figure has been increasingly deployed in research. This article contends that Bourdieu’s work on classification and social differentiation can offer fruitful tools for a renewed focus on types and figures. To this end, it advocates a critical approach to the study of social types and figures in which they are conceived as social identities tied to classificatory struggles over meaning, value, recognition and resources between differentially positioned actors. The article also attempts to clarify the distinction between types and figures and discuss how they can be applied in research. The main arguments of the article are developed through a critical reading of key contributions to research on social types and figures as well as through the discussion of two empirical studies.
A body force model to assess the impact of a swimmer’s arm on propelled swimming resistance
Authors: Banks Joseph , Phillips Alexander B , Hudson Dominic A , Turnock Stephen R
Published: September 2019

The dynamic forces acting on a swimmer’s body are notoriously difficult to measure experimentally, thus motivating many researchers to use computational fluid dynamics to assess the propulsion and resistance forces. To assess both the thrust generated and the self-propelled resistance, fully dynamic simulations are required, including the large range of body motions involved in swimming. This comes with a heavy computational cost and often limits the ability of the method to resolve detailed flow features associated with resistance force. This article applies a body force approach to propelled swimming simulations by combining an unsteady Reynolds Averaged Navier–Stokes simulation of the passive resistance with momentum source terms which accelerate the fluid in the location of the arm to represent the impact the arm has on the flow. Both passive and active towed swimming experiments were conducted and compared with the simulations. Despite observing a 24% variation in the pressure resistance associated with the arm entry, the arms had no significant effect on the mean propelled resistance of a swimmer. The passive resistance methodology agreed well with experimental data.
Renal cell cancer treatment: an expert panel recommendation from the Latin American cooperative group-genitourinary and the Latin American renal cancer group: focus on surgery
Authors: de Cássio Zequi Stênio , da Costa Walter Henriques , Korkes Fernando , dos Reis Rodolfo Borges , Busato Wilson Francisco Schreiner , Matheus Wagner Eduardo , da Silva Neto Deusdedit Cortez Vieira , de Almeida e Paula Felipe , Carvalhal Gustavo Franco , Nogueira Lucas , de Carvalho Fernandes Roni , Silva Adriano Gonçalves e , Sasse André Deeke , Fay André P. , Jardim Denis Leonardo , Bastos Diogo Assed , da Rosa Diogo Augusto Rodrigues , Wierman Evanius , Kater Fabio , Schutz Fabio A. , Maluf Fernando Cotait , de Oliveira Fernando Nunes Galvão , Morbeck Igor Alexandre Protzner , Rinck José Augusto , da Trindade Karine Martins , Maia Manuel Caitano , Souza Vinicius Carrera , Monteiro Fernando Sabino Marques , Soares Andrey
Published: September 2019

Background:

Renal cell cancer (RCC) is one of the 10 most common cancers in the world, and its incidence is increasing, whereas mortality is declining only in developed countries. Therefore, two collaborative groups, The Latin American Oncology Cooperative Group-Genitourinary Section (LACOG-GU) and the Latin American Renal Cancer Group (LARCG), held a consensus meeting to develop this guideline.

Methods:

Issues (134) related to the treatment of RCC were previously formulated by a panel of experts. The voting panel comprised 26 specialists (urologists and medical oncologists) from the LACOG-GU/LARCG. A consensus was reached if 75% agreement was achieved. If there was less concordance, a new discussion was undertaken, and a consensus was determined by the most votes after a second voting session.

Results:

The expert meeting provided recommendations that were in line with the global literature; 75.0% of the recommendations made by the panel of experts were evidence-based level A, 22.5% of the recommendations were level B, and 2.5% of the recommendations were level D.

Conclusions:

This review suggests recommendations for the surgical treatment of RCC according to the LACOG-GU/LARCG experts.
Leveraging School Nurse Expertise to Meet Children’s Health and Nutrition Needs in Afterschool Programs
Authors: Venrick Heather Wensil , McClure Natasha , Hande Karen
Published: September 2019

The National Association of School Nurses’ position statement clarifies the role of school nurses in afterschool activities is to assess, plan, and evaluate the health needs of students in programs that extend beyond the regular school day. School nurses leverage their expertise as trusted and caring providers to deliver health promotion education in the school setting. They can partner with afterschool programs to assess students’ healthy eating and physical activity. The purpose of this article is to describe an exemplar assessment of Healthy Eating and Physical Activity in one afterschool program and discuss approaches to address preventable factors associated with childhood obesity.
Using Youth Risk Behavior Survey Data to Create Change: A Guide for 21st-Century School Nurses
Authors: Reising Virginia A. , Cygan Heide
Published: September 2019

To meet the diverse and complex needs of school-age children, school nurses must practice student-centered, evidence-based, and quality care. As school nurses look to increase the use of data within their practice, the Youth Risk Behavior Survey (YRBS) is an essential source of information about adolescent behaviors that contribute to leading causes of morbidity and mortality. Results from the YRBS are available at the national, state and, in some cases, school district and county level. In addition to providing an overview of the YRBS survey, this article will guide readers on how to implement the survey, access results, and apply the findings within their student population. The use of these data aids nurses who act as leaders within the school community.
Religiosity Predicts Evidentiary Standards
Authors: Lobato Emilio J. C. , Tabatabaeian Shadab , Fleming Morgan , Sulzmann Sven , Holbrook Colin
Published: September 2019

Research shows that religious and nonreligious individuals have different standards of evidence for religious and scientific claims. Here, in a preregistered replication and extension of McPhetres and Zuckerman, participants read about an effect attributed to either a scientific or religious cause, then assessed how much evidence, in the form of successful replications, would be needed to confirm or to reject the causal claim. As previously observed, religious individuals exhibited a bias for believing religious claims relative to scientific claims, while nonreligious individuals were consistent in their standards of evidence across domains. In a novel extension examining standards of evidence with respect to failures of replication, we found that religious individuals were consistent across domains, whereas nonreligious individuals indicated a lower threshold for rejecting religious claims relative to scientific claims. These findings indicate asymmetries in the evaluation of claims based on the presence versus absence of supportive evidence.
How to decontextualize in economic geography?
Authors: Hassink Robert
Published: September 2019

Moving beyond regional description by focusing on decontextualization and strengthening the explanatory power of theories in economic geography is a key undertaking. Therefore, the analysis of underlying processes and causal mechanisms is useful, but too often process and mechanism are conflated, as has been convincingly argued by Yeung ((2019) Rethinking mechanism and process in the geographical analysis of uneven development. Dialogues in Human Geography 9(3): 226–255 in his theory of mechanism in which he clearly distinguishes process from mechanism. However, while achieving clarity concerning process and mechanism, other key notions, namely conditions, context, and decontextualization, remain relatively unclear and show the need to intensify and continue the dialogue.
Factors influencing physical activity in patients with early rheumatoid arthritis: A mixed-methods study
Authors: Qvarfordt Maria , Andersson Maria LE , Larsson Ingrid
Published: September 2019

Objective:

The goal of this study was to provide a greater understanding of physical activity in patients with early rheumatoid arthritis. The aim was twofold: first to explore if physical activity was associated with factors in the clinical picture of rheumatoid arthritis in this patient group, and second, to explore factors influencing physical activity in patients with early rheumatoid arthritis.

Methods:

A total of 66 patients with early rheumatoid arthritis were included in the study. A sequential explanatory mixed-methods design was used, where quantitative data from a questionnaire were analysed with Mann–Whitney, post hoc Kruskal–Wallis and χ2 test in order to detect differences between groups, and find possible associations between physical activity and independent variables, such as disease activity, health-related quality of life and physical function. Qualitative data were collected in a follow-up questionnaire with open-ended questions that focused on factors influencing physical activity.

Results:

Associations between physical activity, disease activity and health-related quality of life were seen in patients with early rheumatoid arthritis together with strong negative correlations between physical activity and physical function. Patients on sick leave showed the strongest associations between disease-related variables and lower levels of physical activity. The findings from the qualitative analysis showed that physical limitations, awareness as a motivational factor and external environment factors influenced physical activity in patients with early rheumatoid arthritis.

Conclusion:

The results showed a complex underlying motive where physical, psychological and environmental factors influenced the physical activity in patients with early rheumatoid arthritis. In order to provide more effective health interventions, it is important to consider the complex nature of practicing physical activity, where a person-centred approach should be considered. Factors such as physical limitations, economic aspects and time for practicing physical activity should be included in the person-centred approach.
A rare presentation of multiple scrotal basal cell carcinomas secondary to Gorlin’s syndrome
Authors: Rohan Pat , Shilling Christine , Shah Nigam , Daly Padraig , Cullen Ivor
Published: September 2019

Basal cell carcinoma is the most commonly occurring cancer worldwide but it is rarely seen in non-sun-exposed areas of the body such as the scrotum.1 Basal cell carcinomas account for 5–10% of all scrotal tumours.2,3 Scrotal basal cell carcinoma is considered more aggressive with higher rates of metastasis versus non-scrotal basal cell carcinoma.1 Gorlin syndrome or nevoid basal cell carcinoma syndrome is an autosomal dominant condition characterised by the development of multiple basal cell carcinomas at a young age.4,5 Prevalence of nevoid basal cell carcinoma syndrome is reported to range from 1 in 57,000 to 1 in 164,000.5 We present the case of a 58-year-old gentleman with a 3-month history of bleeding scrotal and penile lesions. These lesions were excised with 2 cm margins and without complication. Histology showed surface ulceration with basaloid infiltrating tumour extending into the dermis. Given the potential for a very high rate of tumour occurrence within individuals, surgical management of basal cell carcinomas can result in significant, lifestyle-limiting disfigurement.5 As understanding of the pathogenesis of nevoid basal cell carcinoma syndrome has advanced, a number of targeted therapies have been developed.5 Vismodegib targets the Hedgehog signalling pathway and is used in the treatment of locally advanced and metastatic basal cell carcinomas. This represents a rare case of basal cell carcinoma of the scrotum associated with nevoid basal cell carcinoma syndrome caused by a de novo mutation. It is not clear from the literature whether incidence of scrotal tumours is increased in Gorlin syndrome but given the increased risk of basal cell carcinoma elsewhere, it may be prudent for those with known Gorlin syndrome to regularly examine the scrotal skin along with recommended frequent dermatologic surveillance.

Level of evidence: 5.
Identifying Opportunities for Advancing Weight Management in Primary Care
Authors: Croghan Ivana T. , Ebbert Jon O. , Njeru Jane W. , Rajjo Tamim I. , Lynch Brian A. , DeJesus Ramona S. , Jensen Michael D. , Fischer Karen M. , Phelan Sean , Kaufman Tara K. , Schroeder Darrell R. , Rutten Lila J. Finney , Crane Sarah J. , Tulledge-Scheitel Sidna M.
Published: September 2019

Objective: Much has been written about the patients’ perspective concerning weight management in health care. The purpose of this survey study was to assess perspectives of primary care providers (PCPs) and nurses toward patient weight management and identify possible areas of growth. Patients and Methods: We emailed a weight management–focused survey to 674 eligible participants (437 [64.8%] nurses and 237 [35.2%] PCPs) located in 5 outpatient primary care clinics. The survey focused on opportunities, practices, knowledge, confidence, attitudes, and beliefs. A total of 219 surveys were returned (137 [62.6%] from nurses and 82 [34.4%] from PCPs). Results: Among 219 responders, 85.8% were female and 93.6% were white non-Hispanic. In this study, PCPs and nurses believed obesity to be a major health problem. While PCPs felt more equipped than nurses to address weight management ( P < .001) and reported receiving more training than nurses (50.0% vs 17.6%, respectively), both felt the need for more training on obesity (73.8% and 79.4%, respectively). Although, PCPs also spent more patient contact time providing weight management services versus nurses ( P < .001), the opportunity/practices score was lower for PCPs than nurses (−0.35 ± 0.44 vs −0.17 ± 0.41, P < .001) with PCPs more likely to say they lacked the time to discuss weight and they worried it would cause a poor patient-PCP relationship. The knowledge/confidence score also differed significantly between the groups, with nurses feeling less equipped to deal with weight management issues than PCPs (−0.42 ± 0.43 vs −0.03 ± 0.55, P < .001). Neither group seemed very confident, with those in the PCP group only answering with an average score of neutral. Conclusion: By asking nurses and PCP general questions about experiences, attitudes, knowledge, and opinions concerning weight management in clinical care, this survey has identified areas for growth in obesity management. Both PCPs and nurses would benefit from additional educational training on weight management.
Pulmonary Embolism in a Neonate Following Modified Norwood Procedure With Sano Shunt
Authors: Schlueter Sarah M. , Wilhelm Michael , Anagnostopoulos Petros V. , Al-Subu Awni M.
Published: September 2019

Pulmonary embolism is a rare but potentially fatal complication in neonates with congenital heart disease. The authors report a case of pulmonary embolism in the immediate postoperative period following modified Norwood procedure with Sano shunt. In addition, this report discusses the initial evaluation and available anticoagulation options to treat pulmonary embolism in children with congenital heart disease.
Congenital Heart Disease and Thyroid Dysfunction: Combination, Association, and Implication
Authors: Lerner Reut Kassif , Gruber Noah , Pollak Uri
Published: September 2019

Background:

Patients with congenital heart disease have higher prevalence of thyroid dysfunction due to embryonic and genetic coexistence. Marked changes in cardiac function occur secondary to alternations in thyroid hormone levels. Cardiac catheterizations or cardiac surgeries with cardiopulmonary bypass can cause abnormalities in the circulating hormones, in the absence of primary thyroid disease. Therefore, monitoring of thyroid function should be routinely performed in children with congenital heart disease. Thyroid hormone supplementation has been postulated as a possible therapeutic option; however, the therapeutic decisions should be made based on individual circumstances, symptoms, and the severity of the thyroid dysfunction.

Objectives:

To describe the correlation between congenital heart disease in children and thyroid dysfunction and the debate on monitoring, intervention, and treatment.

Methods:

PubMed, Clinical Key, and the Cochrane Library were searched using keywords relevant to congenital heart disease/surgery, cardiopulmonary bypass, thyroid hormones, sick euthyroid syndrome, and cardiac catheterization. Studies were limited to the English language and to children 0 to 18 years old. Studies in adults with important findings were reviewed as well. All clinical studies believed to have relevance were considered. All relevant studies were reviewed, and the most pertinent data were incorporated in this review.

Conclusion:

There is lack of significant evidence concerning treatment for thyroid dysfunction in children with a congenital cardiac diagnosis. Adequately powered studies are needed before a uniform recommendation about treatment can be made.
Noninvasive Neurally Adjusted Ventilatory Assist Versus High Flow Cannula Support After Congenital Heart Surgery
Authors: Parashar Nirbhay , Amidon Matthew , Milad Abdulhamid , Devine Adam , Yi Li , Penk Jamie
Published: September 2019

Background:

Extubation failure rates for critical patients in pediatric intensive care units (ICUs) range from 5% to 29%. Noninvasive (NIV) ventilation has been shown to decrease extubation failure. We compared reintubation rates and outcomes of patients supported with NIV neurally adjusted ventilation assist (NAVA) versus historical controls supported with high-flow nasal cannula (HFNC).

Methods:

Case–control study of infants less than three months of age who underwent cardiac surgery and received NIV support after extubation from January 2011 to May 2017. All patients supported with NIV NAVA after it became available in September 2013 were compared to matched patients extubated to HFNC from prior to September 2013.

Results:

Forty-two patients identified for the NIV NAVA group were matched with 42 historical controls supported with HFNC. Groups had similar baseline characteristics based on rate of acute kidney injury, number of single ventricle patients, Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery (STAT) category, age, weight, bypass time, and duration of intubation. There was no significant difference in reintubation rates within 72 hours (14.3% in the HFNC group and 16.7% in the NIV NAVA group, P = 1.0). Median duration from extubation to coming off NIV support was longer in the NIV NAVA group (3.6 days vs 0.6 days, P < .001). Median time from extubation to ICU discharge was longer in the NIV NAVA group (10.5 vs 6.8 days, P = .02), as was total postoperative ICU length of stay (LOS; 17.6 vs 12.2, P = .01).

Conclusions:

Introduction of NIV NAVA for postextubation support did not reduce reintubation rates compared to HFNC. Further study is needed as adoption of NIV NAVA may prolong LOS.
Prevalence of Culture-Negative Fever in Infants With Down Syndrome Undergoing Cardiac Surgery
Authors: Vergales Jeffrey , Seckeler Michael D. , Chew Joshua , Gangemi James
Published: September 2019

Background:

Children with Down syndrome (DS) often have congenital heart disease that requires surgical repair in the first year. Anecdotally, we have noted that patients with DS seem to have a higher rate of culture-negative postoperative fever. The objective was to evaluate the prevalence of postoperative fever and recovery among patients with DS undergoing cardiac surgery.

Methods:

We conducted a retrospective, case–control study of all patients at our institution less than one year of age with DS undergoing surgical repair of an atrioventricular septal defect or ventricular septal defect between 2010 and 2016. The control group was patients with no chromosomal anomalies who were age and surgery matched to the DS group. Temperatures were recorded for the first 72 hours postoperatively, with duration and degree of fever being assessed using the area under the curve.

Results:

Patients with DS (n = 34) had a significantly higher prevalence of fever than the control group (59% vs 24%, P = .003), longer ventilator time, and longer length of stay. Among the DS group, those who developed fever tended to be older at the time of surgery (146 ± 63 vs 103 ± 45 days, P = .04). The DS group with fever had similar cardiopulmonary bypass times, intensive care unit and total lengths of stay, ventilator days, and hospital costs compared to patients with DS without fever.

Conclusions:

Patients with DS have a higher incidence of culture-negative fever within the first 72 hours. The presence of fever in these patients, however, does not affect their overall postoperative course.
A Rare Case of Cardiogenic Shock: Cor Triatriatum With Anomalous Pulmonary Venous Return
Authors: Moscoso Bosco , Congiu Stefano , Mayol Javier , Walter Carin , Caffarena José M.
Published: September 2019

Obstructive total anomalous pulmonary venous return (TAPVR) is a potentially life-threatening clinical condition and a surgical emergency. Left-sided partial anomalous pulmonary venous return (PAPVR) in association with a subdivided left atrium, also known as cor triatriatum sinister (CTS), is a very rare malformation that can mimic obstructive TAPVR. We present a case of a newborn with clinical manifestation of cardiogenic shock caused by CTS and PAPVR.
An Onsite Fitness Facility and Integrative Wellness Program Positively Impacted Health-Related Outcomes Among Teachers and Staff at an Urban Elementary/Middle School
Authors: Parker Elizabeth A , McArdle Patrick F , Gioia Debbie , Trilling Ariel , Bahr-Robertson Mary , Costa Nate , Berman Brian M , D’Adamo Christopher R
Published: September 2019

Background

Given the large number of obesity-focused studies conducted in schools, there is a surprising lack of data regarding teacher workplace health behaviors in the United States.

Objective

To determine the feasibility and effectiveness of an onsite fitness facility with a structured integrative wellness program to improve health-related outcomes among teachers and staff at an urban elementary/middle school.

Methods

A 2-year mixed-methods analysis using Patient-Reported Outcomes Measurement Information System (PROMIS) measures and qualitative interviews included 39 teachers and staff employed at an urban elementary/middle school in Baltimore, Maryland. The fitness facility was dedicated exclusively to teachers and staff and the integrative wellness program included group exercise classes, yoga, mindfulness, and nutrition competitions. T tests were used to compare quantitative outcomes at baseline, the end of year 1, and the end of year 2.

Results

Compared to baseline, at year 1, there was a significant improvement in the PROMIS Sleep Disturbance score. From baseline to end of year 2, there were significant increases in the PROMIS Global Physical Health as well as significant decreases in Sleep Disturbances, Fatigue, and Social Isolation. Qualitative interviews conducted at the end of year 1 indicated that teachers who used the facility felt that it improved their mood, increased their energy, motivated them to eat healthily, and gave them opportunities to socialize with their colleagues in new ways. This impact was further enhanced in year 2.

Conclusions

An onsite fitness facility with an integrative wellness program may improve health-related outcomes among urban elementary school teachers and staff, with the greatest benefits seen after 2 years of implementation.
Influence of Insurance Status on Curve Magnitude in Adolescent Idiopathic Scoliosis in Mainland China
Authors: Lin Tao , Meng Depeng , Yin Jia , Ji Zhe , Shao Wei , Han Meng , Lai Aining , Gao Rui , Zhou Xuhui , Meng Yichen
Published: September 2019

Study Design:

Retrospective cohort study.

Objectives:

To determine whether there is an association between insurance status and curve magnitude in idiopathic scoliosis pediatric patients in mainland China.

Methods:

Medical records of patients with adolescent idiopathic scoliosis in 4 tertiary spine centers across China from January 2013 to December 2017 were analyzed. Data was extracted on insurance status, curve magnitude, recommended treatment at presentation, source of referral, and treatment initiated. Additional information was collected for patients requiring corrective surgery, including time from recommendation for surgery to surgery and clinically relevant parameters such as, postoperative complications, and pre-/postoperative Scoliosis Research Society–22 scores were also collected for patients requiring corrective surgery.

Results:

Of the 1785 patients included, 1032 were Urban Resident Basic Medical Insurance Scheme (URBMS) insured and 753 were New Rural Cooperative Medical Scheme (NRCMS) insured. NRCMS patients presented with a larger major curve than URBMS patients (32.9° ± 15.1° vs 29.3° ± 12.6°, P = .028). For patients having surgery recommended, NRCMS patients presented with a larger mean Cobb angle at the first presentation (57.7° vs 50.9°, P < .0001) and at time of surgery (61.3° vs 52.2°, P < .0001), and experienced a significantly longer time from surgery recommendation to decision for surgery. Complication rates were comparable between the 2 groups, except for pulmonary complications (NRCMS 7.3% vs URBMS 2.8%, P = .04). Postoperatively, patients covered by NRCMS insurance experienced greater overall improvement in health-related quality of life and were less satisfied with the treatments.

Conclusions:

This study shows that health insurance may influence the severity of scoliosis on presentation, with implications on early diagnosis and surgery time.
Improved levels of physical activity in patients over 75 years following total knee arthroplasty
Authors: Matsunaga-Myoji Yuriko , Fujita Kimie , Ide Shuya , Tabuchi Yasuko , Mawatari Masaaki
Published: September 2019

Purpose:

There is insufficient evidence regarding the precise levels of physical activity (PA) in older patients following total knee arthroplasty (TKA). The aims of this study were (1) to describe the changes in the amount and intensity of PA before and after TKA with an accelerometer in older patients, compared with age- and sex-matched healthy participants and (2) to assess the effect of TKA on PA depending on age.

Methods:

Sixty-six primary TKA patients aged 60 years or over (mean age, 73.3 years) wore an accelerometer (Lifecorder EX) for 10 consecutive days and completed the Oxford Knee Score (OKS) before and at 6 months after TKA. PA was evaluated by mean step count and time spent (min) engaged in PA per day. PA intensity was classified as light (1.5–3 metabolic equivalents (METs)), moderate to vigorous (≥3 METs), and total (≥1.5 METs). Sixty-four healthy participants completed a single assessment of PA.

Results:

Each of the PA measures and OKS increased significantly after TKA. Compared with healthy controls, light and total PA improved to 100% at 6 months after TKA in patients 75 years or older. By contrast, moderate-to-vigorous PA was 32% of that of the controls and rose to 78% after TKA. PA intensity in patients aged 60–74 years was 31–74% of the controls but did not reach the same level after TKA.

Conclusion:

TKA in older patients increases the amount of PA, with light and total PA suitable parameters for assessing PA.
From Surveys to Skill Sets: Improving Patient Experience by Supporting Clinician Well-Being
Authors: Millstein Jeffrey H
Published: September 2019

Sharing patient satisfaction survey results is not ideal as a stand-alone motivator for clinician behavior change. Rather, this is best combined with efforts to support clinician well-being by offering protected time to improve our communication skills, along with our ability to effectively process feedback.
Patient experiences of access to NCD medicines in Sri Lanka: Evidence of the success story towards universal coverage
Authors: Fernandopulle BMR , Gunawardena Nalika , de Silva SHP , Abayawardana Chinta , Hirimuthugoda LK
Published: September 2019

Introduction:

In Sri Lanka in 2013, 16 medicines were identified as priority to manage non-communicable disease (NCD), and in 2017, 48 NCD medicines were price-regulated.

Objective:

The aim of the present study was to describe the experiences on availability of drugs and out-of-pocket expenditure (OOPE) for drugs among patients with NCDs in Sri Lanka.

Methods:

This community-based, household survey was conducted in nine districts of the country. The survey included 1100 adults (aged 50 years and above) with a diagnosis of NCD for 5 years. They were interviewed by trained pharmacy students.

Results:

Approximately 66%, 49% and 21.6% suffering from hypertension, diabetes and ischaemic heart disease, respectively, with a majority having more than one NCD. The evidence showed that prescribers align to drugs that have been recognized to be made more available and more affordable. Of all, 14% had prescriptions with all NCD medicines classified in the list, while 40% had only one or two of the drugs prescribed which are not in the list. Most of the prescribed drugs were also included in the price regulation – with 29% having all medicines included, while 31.6% having only one or two drugs prescribed out of the list. Approximately, two-thirds (64.2%) had exclusively used government hospitals for NCD care during the past 5 years. A majority (58.3%) had all prescribed drugs available at the last visit to the state sector clinic, while almost all of the others (35.7%) had some of the drugs available.

Conclusion:

The study concluded that patient experiences in Sri Lanka showed good availability and access to NCD medicines in Sri Lanka.
Microenvironmental agonists generate de novo phenotypic resistance to combined ibrutinib plus venetoclax in CLL and MCL
Authors: Jayappa Kallesh D. , Portell Craig A. , Gordon Vicki L. , Capaldo Brian J. , Bekiranov Stefan , Axelrod Mark J. , Brett L. Kyle , Wulfkuhle Julia D. , Gallagher Rosa I. , Petricoin Emanuel F. , Bender Timothy P. , Williams Michael E. , Weber Michael J.
Published: September 2019

Key Points

IBR+VEN combination was designed to overcome resistance to IBR, but CLL and MCL samples ex vivo show resistance even to this combination. Microenvironmental agonists (IL-10, soluble CD40L, CpG-ODN) generate resistance via NF-κB–dependent expression of Mcl-1/Bcl-xL/survivin.
RetSynth: determining all optimal and sub-optimal synthetic pathways that facilitate synthesis of target compounds in chassis organisms
Authors: Whitmore Leanne S. , Nguyen Bernard , Pinar Ali , George Anthe , Hudson Corey M.
Published: September 2019

Background

The efficient biological production of industrially and economically important compounds is a challenging problem. Brute-force determination of the optimal pathways to efficient production of a target chemical in a chassis organism is computationally intractable. Many current methods provide a single solution to this problem, but fail to provide all optimal pathways, optional sub-optimal solutions or hybrid biological/non-biological solutions.

Results

Here we present RetSynth, software with a novel algorithm for determining all optimal biological pathways given a starting biological chassis and target chemical. By dynamically selecting constraints, the number of potential pathways scales by the number of fully independent pathways and not by the number of overall reactions or size of the metabolic network. This feature allows all optimal pathways to be determined for a large number of chemicals and for a large corpus of potential chassis organisms. Additionally, this software contains other features including the ability to collect data from metabolic repositories, perform flux balance analysis, and to view optimal pathways identified by our algorithm using a built-in visualization module. This software also identifies sub-optimal pathways and allows incorporation of non-biological chemical reactions, which may be performed after metabolic production of precursor molecules.

Conclusions

The novel algorithm designed for RetSynth streamlines an arduous and complex process in metabolic engineering. Our stand-alone software allows the identification of candidate optimal and additional sub-optimal pathways, and provides the user with necessary ranking criteria such as target yield to decide which route to select for target production. Furthermore, the ability to incorporate non-biological reactions into the final steps allows determination of pathways to production for targets that cannot be solely produced biologically. With this comprehensive suite of features RetSynth exceeds any open-source software or webservice currently available for identifying optimal pathways for target production.