bluuebunny/crossref_metadata_2025 huggingface dataset:
An Analysis on the Unemployment Rate in the Philippines: A Time Series Data Approach
Authors: Urrutia J D , Tampis R L , Atienza JB E
Published: April 2017

This study aims to formulate a mathematical model for forecasting and estimating unemployment rate in the Philippines. Also, factors which can predict the unemployment is to be determined among the considered variables namely Labor Force Rate, Population, Inflation Rate, Gross Domestic Product, and Gross National Income. Granger-causal relationship and integration among the dependent and independent variables are also examined using Pairwise Granger-causality test and Johansen Cointegration Test. The data used were acquired from the Philippine Statistics Authority, National Statistics Office, and Bangko Sentral ng Pilipinas. Following the Box-Jenkins method, the formulated model for forecasting the unemployment rate is SARIMA (6, 1, 5) × (0, 1, 1)4 with a coefficient of determination of 0.79. The actual values are 99 percent identical to the predicted values obtained through the model, and are 72 percent closely relative to the forecasted ones. According to the results of the regression analysis, Labor Force Rate and Population are the significant factors of unemployment rate. Among the independent variables, Population, GDP, and GNI showed to have a granger-causal relationship with unemployment. It is also found that there are at least four cointegrating relations between the dependent and independent variables.
Using Ag/Ag2O/SnO2 Nanocomposites to Remove Malachite Green by a Photocatalytic Process
Authors: Taufik A. , Paramarta V. , Prakoso S.P. , Saleh R.
Published: April 2017

Silver/silver oxide/tin oxide nanocomposites of various weight ratios were synthesized using a microwave-assisted method. The Ag/Ag2O:SnO2 nanoparticle weight ratios used were 25:75, 50:50, and 75:25. All samples were characterized using X-ray diffraction, UV-Vis spectroscopy, Differential Scanning Calorimetry and Thermogravimetric Analysis (TGA). The Ag/Ag2O/SnO2 nanocomposites contained cubic structures provided by the Ag and Ag2O and tetragonal structures provided by the SnO2. The silver resulted in surface plasmon resonance (SPR) at a wavelength of about 435 nm. The silver oxide material was transformed into pure Ag at a temperature of about 370 °C The photocatalytic activity was tested on the degradation of malachite green (MG) from an aqueous solution. The results showed that Ag/Ag2O/SnO2 at a ratio of 50:50 exhibited the best photocatalytic performance for degrading MG under visible-light irradiation. The degradation of MG using Ag/Ag2O/SnO2 nanocomposites followed pseudo first-order kinetic reactions, and electron holes were found to be the main species acting on the degradation process.
Photodegradation of Methylene Blue by LaFeO3/ZnO Nanocomposites under Visible and UV Light Irradiation
Authors: Afifah Nur , Saleh Rosari
Published: April 2017

In this study, LaFeO3/ZnO nanocomposites with different molar ratios of ZnO (0.1, 0.3, 0.5, and 1) have been prepared using the sol-gel method. The structural and elemental analyses of the samples were measured by X-ray diffraction (XRD) and X-ray fluorescence (XRF) spectroscopy. XRD results showed that the synthesized samples exhibited an orthorhombic structure of LaFeO3 and a hexagonal wurtzite structure of ZnO. However, the ZnO hexagonal wurtzite structure could not be detected below the ZnO molar ratio of 0.5. The presence of ZnO on the nanocomposites was confirmed using XRF measurements. The results revealed that the XRF spectra of the samples consisted of La, Fe, and Zn atoms. The photodegradation of methylene blue (MB) using LaFeO3/ZnO nanocomposites was then monitored under visible and UV light irradiation. The photodegradation results showed that the presence of LaFeO3/ZnO nanocomposites could degrade the MB solution. The highest MB degradation was found in the presence of ZnO at a molar ratio of 0.5. All of the LaFeO3/ZnO nanocomposites showed better photocatalytic performance than did LaFeO3 nanoparticles alone. Furthermore, several parameters, such as the effect of catalyst dose, initial concentration of MB, and various radical scavengers, were also measured to obtain the maximum condition and the main active species involved in the photocatalytic process.
Development of Fe3O4/ZrO2 Composite Powered by Nanographene Platelets (NGP) for Degradation of Water Pollutants via Photo- and Sonocatalysis
Authors: Kristianto Yogi , Taufik Ardiansyah , Saleh Rosari
Published: April 2017

In this study, a series of Fe3O4/ZrO2/nanographene platelets (NGP) composite, with various weight percent (wt%) of NGP (5%, 10% and 15%), were prepared successfully using ultrasonic-assisted followed by simple hydrothermal method. Their physicochemical properties were fairly characterized by X-ray diffraction, fourier transform infrared and thermal gravimetric analysis. Furthermore, their catalytic activities were investigated toward anionic congo red (CR) and cationic methylene blue (MB) as models of organic pollutant under ultraviolet (UV) and ultrasonic (US) irradiation, respectively. The experimental results showed that the incorporation of NGP in Fe3O4/ZrO2 composite improved its efficiency in degrading CR and MB and became maximum at 10wt% of NGP. In addition, the role of active radicals involved in catalytic activities were discussed.
RTK: efficient rarefaction analysis of large datasets
Authors: Saary Paul , Forslund Kristoffer , Bork Peer , Hildebrand Falk
Published: April 2017

Motivation

The rapidly expanding microbiomics field is generating increasingly larger datasets, characterizing the microbiota in diverse environments. Although classical numerical ecology methods provide a robust statistical framework for their analysis, software currently available is inadequate for large datasets and some computationally intensive tasks, like rarefaction and associated analysis.

Results

Here we present a software package for rarefaction analysis of large count matrices, as well as estimation and visualization of diversity, richness and evenness. Our software is designed for ease of use, operating at least 7x faster than existing solutions, despite requiring 10x less memory.

Availability and Implementation

C ++ and R source code (GPL v.2) as well as binaries are available from https://github.com/hildebra/Rarefaction and from CRAN (https://cran.r-project.org/).

Supplementary information

Supplementary data are available at Bioinformatics online.
Advancing family communication skills in oncology nursing
Authors: Zaider Talia , Hichenberg Shira , Latella Lauren
Published: April 2017

This chapter presents a new communication skills training initiative designed to advance family-centred care in the inpatient oncology setting. Because of their consistent contact with families, oncology nurses are well-positioned to initiate and model supportive care to the family. Two formats of training are presented: (i) a single-session module for acute care nurses focuses on responding to challenging family interactions at the bedside; (ii) a comprehensive, six-month curriculum for advanced practice nurses focuses on conceptualization and intervention skills, as applied to a range of complex family situations that arise during a patient’s admission. The training presented here teaches nurses to effectively partner with families, assess support needs, facilitate collaborative problem-solving, and transition families to psychosocial resources. Both training efforts were piloted at a large, comprehensive cancer centre. Preliminary data supports the feasibility and perceived relevance of training content, as well as gains in nurses’ confidence working effectively with families.
Inventing the Feeble Mind
Authors: Trent James
Published: April 2017

Pity, disgust, fear, cure, and prevention—all are words that Americans have used to make sense of what today we call intellectual disability. Inventing the Feeble Mind explores the history of this disability in the United States from its several identifications over the past 200 years—idiocy, imbecility, feeblemindedness, mental defect, mental deficiency, mental retardation, and most recently intellectual disability. Using institutional records, private correspondence, personal memories, and rare photographs, James Trent argues that the economic vulnerability of intellectually disabled people (and often their families), more than the claims made for their intellectual and social limitations, has shaped meaning, services, and policies in United States history.
Management of the Camp Experience
Authors: Blane Carole , Sullivan M. Tyler , Wolfson Daniel M. , Judge Abigail M.
Published: April 2017

This chapter focuses on the therapeutic milieu environment at Overcoming Barriers camp and its integration with the program’s traditional mental health interventions. First, a brief history of milieu therapy and a review of the research literature on therapeutic camp programs are presented. Key elements of the milieu at Overcoming Barriers programs are then described, including roles of key personnel and program components. The roles of nature, a novel physical surrounding, and carefully planned recreational activities are emphasized as critical aspects of how reintegration and other change in the family system may occur. Finally, this chapter explicates the relationship between milieu-based activities and other clinical programming at Overcoming Barriers camp.
“East Group”
Authors: Ward Peggie
Published: April 2017

This chapter focuses on the group psychoeducation done with the favored parents in families with parent–child contact problems attending Overcoming Barriers programs. A systems-based understanding of parent–child contact problems highlights the importance of intervention with each member of the family. The author describes the personality traits, beliefs, feelings, and attitudes of favored parents as well as challenges that such characteristics pose to clinical intervention. Strategies to promote a shift in favored parents’ beliefs about the health of their children are discussed, including calling attention to cognitive distortions, teaching about concepts such as memory and suggestibility, and building skills for coping with emotional triggers. The role of group process and relationships among group members are discussed as possible mechanisms of change. Case material is used to illustrate key points.
Translating the Overcoming Barriers Approach to Outpatient Settings
Authors: Fidler Barbara J. , Ward Peggie , Deutsch Robin M.
Published: April 2017

This chapter discusses ways the essential components of the Overcoming Barriers approach (including the whole-family approach, experiential and recreational activities, and coordinated case management) can be translated to outpatient work with families experiencing parent–child contact problems. The nature and severity of the parent–contact problem inform the differentiated clinical and legal intervention response. Mild and moderate cases of affinity, alignment, alienation, or realistic estrangement and mixed or hybrid cases may be suitable for a whole-family, systems-based psychoeducational intervention. These interventions may begin in outpatient settings or start with a multiday family intensive intervention, with outpatient multifaceted family therapy as aftercare. Protocols for preliminary screening, clinical intake, contracting (including legal structural components), and treatment goals and planning are summarized. An overview is provided of tools and resources to assist the clinician in implementing a treatment plan tailored to meet the needs of a particular family. Case examples illustrate key points.
Program Evaluation, Training, and Dissemination
Authors: Saini Michael , Deutsch Robin M.
Published: April 2017

This chapter focuses on the application of research methods to understanding and evaluating interventions that have been developed to address strained parent–child relationships after separation and divorce. Emphasis is placed on evaluation approaches that are commonly applied to complex interventions. These include exploring program logic, operationalizing key indicators of short- and long-term success, creating a fidelity checklist to measure the process and implementation of the intervention, and using evaluation designs to answer specific questions about the intervention. The focus of this chapter is on creating a roadmap for developing a program evaluation design that is both transparent and methodologically sound to capture program change and to enable program adjustments to be made as needed. The program evaluation of the Overcoming Barriers camp is used as a case illustration.
Sexual Behaviors in Sleep
Authors: del Busto Elena , Stoddard Frederick R. , Cruz Jourdan S.
Published: April 2017

Sexual behavior in sleep (also termed sexsomnia, sleep sex, or abnormal sexual behavior in sleep) includes a range of sexual or sexualized behaviors ranging from erotic vocalizations to genital penetration, which occur with complete amnesia for the sufferer. Subjects are often shocked and surprised when informed of their activities. Although this parasomnia has gained increasing levels of public and professional attention over the past decade, relatively little is known about the disorder. The need for a better understanding is made more pressing by the fact that sexual behavior in sleep has been the focus of several high-profile court cases involving allegations of sexual assault.
Alice in Wonderland Syndrome
Authors: Dirk Blom Jan
Published: April 2017

The symptoms that are considered characteristic of Alice in Wonderland Syndrome (AIWS) are quite diverse and constitute distortions of regular sense perception (i.e., distortions of visual, somaesthetic, temporal, and self-perception). Although these symptoms are often of short duration, especially in children, extended episodes can occur. Many cases are benign and self-limiting, but symptoms of Alice in Wonderland Syndrome can occur in the context of Epstein-Barr virus encephalitis, cerebral lesion, epilepsy, and schizophrenia. Most of the symptoms characteristic of AIWS traditionally are attributed to central (as opposed to peripheral) nervous mechanisms. Epidemiological surveys and clinical prevalence studies of AIWS are lacking, but the syndrome is generally considered rare. Studies among clinical populations, however, indicate that its prevalence may well be underestimated.
Diogenes Syndrome
Authors: O’Shea Brian
Published: April 2017

Diogenes syndrome, also termed senile squalor syndrome, was named after the Greek Cynic philosopher Diogenes. Although symptoms of Diogenes syndrome are not currently a strong focus of scientific interest, the syndrome has received considerable coverage in the media. Symptoms include extreme self-neglect, a dirty appearance, domestic squalor, lying in excrement, social withdrawal, and compulsive hoarding of garbage. Diogenes syndrome appears to be associated with a high physical morbidity and mortality rate. As discussed in this chapter, the particular nature of Diogenes syndrome represents a particular dilemma for the mental health professions and society. The chapter also discusses hoarding disorder, a separate but overlapping concept.
Pseudologia Fantastica —Pathological Lying
Authors: Garlipp Petra
Published: April 2017

Lying is a part of normal psychological behavior; it can be triggered by feelings of shame or guilt, and is often used to avoid conflict. However, pseudologia fantastica is characterized by the creation of eloquent and interesting stories, sometimes bordering on the fantastic, that are told to impress others. These stories may seem to be just on the verge of believability and often involve the patient assuming important and heroic roles. Patients react to questions or doubts with ad hoc elaborations in order to satisfy the listener. Thus, new lies are needed to supplement the old, and patients sometimes start to believe their own deceptions. Detection of pathological lying and differential diagnosis are, not surprisingly, quite difficult, and require modifications to standard assessment procedures. The chapter also discusses the known associations of pseudologia phantastica with other psychiatric conditions.
Hidden ADHD
Authors: Willer Jan
Published: April 2017

Hidden ADHD is common. Most adults with ADHD—between 70% and 90%—have psychiatric comorbidity. When ADHD is comorbid with another disorder, it is often unrecognized and untreated. Certain functional problems and behaviors are suggestive of ADHD. Substance abuse, anxiety disorders, depression, and bipolar disorder are often comorbid and may be the presenting problem. Ways psychotherapists can distinguish these comorbidities are discussed. Other possible comorbid conditions are also presented.
Assessing Family History, Childhood, and Adult Development
Authors: Willer Jan
Published: April 2017

Symptoms of ADHD emerge when the environmental demands exceed the resources that the person can bring to bear. Internal and external resources change with personal circumstances, developmental level, age, and maturity. ADHD is among the most heritable mental illnesses. Prenatal and childhood risk factors impact the likelihood of ADHD developing. Challenges for children, adolescents, college-age adults, and older adults with ADHD are presented, with a special focus on emerging adults. Whether childhood ADHD remits in adulthood is discussed, as well as whether ADHD can emerge in adulthood. Clinical interview questions to diagnose whether childhood ADHD went undiagnosed are presented, including those that explore ADHD symptoms; development, emotional, and behavioral problems; and educational and learning problems.
Psychotherapy Goals, Structure, and Challenges
Authors: Willer Jan
Published: April 2017

Despite significant cognitive improvement from stimulant medication, often the coping skills of adults with ADHD remain suboptimal. Psychotherapy focuses on improving coping skills to effectively address cognitive and emotional challenges. Psychotherapists also help the client process the emotional fallout from years of untreated ADHD and perceived failures. Cognitive-behavioral therapy (CBT) for ADHD focuses on psychoeducation, acquiring healthy habits and coping skills, and examining maladaptive cognitions that naturally develop from living with ADHD. ADHD behaviors that may interfere with effective treatment are addressed, including lateness, poor time awareness, missed appointments, tangentiality, motivation problems, homework problems, medication nonadherence, and social problems at work and home.
Psychoeducation about Cognitive Differences
Authors: Willer Jan
Published: April 2017

Psychoeducation is probably the most powerful and effective intervention for ADHD, and experts universally agree that psychoeducation is essential for effective treatment. Clients learn to understand the differences in how their brains function and how this has contributed to their difficulties. Psychoeducation helps clients stop telling themselves that they “should” be able to use their brains the same way everyone else does. These insights empower the client to learn, develop, and deploy effective individualized coping strategies. Some of the challenges of ADHD are also examined in this chapter, including attention problems, working memory deficits, distractibility, hyperactivity, time estimation problems, emotional dysregulation, and others.
Overview
Authors: Marchese Dana D. , Becker Kimberly D. , Keperling Jennifer P. , Domitrovich Celene E. , Reinke Wendy M. , Embry Dennis D. , Ialongo Nicholas S.
Published: April 2017

Chapter 1 provides a rationale for the use of prevention programs in schools, the benefits of a school-based prevention program, and a description of two of the most widely disseminated, evidence-based universal school-based preventive interventions: the PATHS Curriculum and the PAX Good Behavior Game. The importance of coaching in obtaining quality implementation of prevention programs is discussed. In addition, an overview of the PATHS to PAX Coaching Model is provided based on research and theory in the literature. Also described are coaching strategies, including building positive relationships, modeling, observing, providing personalized feedback, discussing barriers, and planning action items.
Universal Coaching Model
Authors: Marchese Dana D. , Becker Kimberly D. , Keperling Jennifer P. , Domitrovich Celene E. , Reinke Wendy M. , Embry Dennis D. , Ialongo Nicholas S.
Published: April 2017

Chapter 3 discusses the Universal Coaching Model, a collaborative approach that includes specific activities and strategies used with every teacher implementing the program. Coaching activities are grouped into three phases: (a) connect, (b) cultivate, and (c) consolidate. Strategies for establishing the coach–teacher team, visiting the classroom, engaging students as active participants, and starting the PATHS Curriculum and the PAX Good Behavior Game are discussed. The importance of timelines, pacing guides, and data collection are reviewed, as is the process of being a collaborative coach. Also described are tips for how to provide support and structure to coaching sessions while providing performance feedback, setting goals, and using positive reinforcement with teachers. Common early implementation challenges, coaching pitfalls, and strategies to enhance student engagement are also discussed.
Selection, Training, Supervision, and Observation of Coaches
Authors: Marchese Dana D. , Becker Kimberly D. , Keperling Jennifer P. , Domitrovich Celene E. , Reinke Wendy M. , Embry Dennis D. , Ialongo Nicholas S.
Published: April 2017

In this chapter, the importance of selecting effective coaches, providing quality coach training, conducting collaborative supervision, and scheduling ongoing observation of coach activities are reviewed. Also, skills to become a supportive and positive supervisor are described. Suggestions for effective group and individual supervision meetings are discussed, including using coaching logs in supervision to review teacher implementation of program components, supporting coach implementation of strategies, increasing coach engagement in the supervision process, improving time management and organizational skills, promoting problem solving as a way to reduce coach stress, and helping coaches optimize their use of behavior change principles and scientific methods. Methods for supervisors to observe coaching sessions and to provide feedback to coaches are also discussed.
Disseminating, Teaching, and Implementing Evidence-Based Practices
Authors: Norcross John C. , Hogan Thomas P. , Koocher Gerald P. , Maggio Lauren A.
Published: April 2017

Moving research evidence from science to service, from the lab bench to the bedside, poses a challenge for evidence-based practices (EBPs). Translation(al) research inclusively refers to the process of successfully moving research-supported discoveries into established practice and policy. This chapter begins with synopses of the empirical research on predicting adoption of EBP and the barriers to its implementation. The chapter then reviews effective methods for disseminating, teaching, and implementing EBPs. Like EBP itself, the new field of implementation science sensitively integrates the best research evidence, clinical expertise, and staff characteristics and preferences into deciding what works in each unique healthcare system.
“Cool Kids/Chilled Adolescents”
Authors: Thastum Mikael , Lundkvist-Houndoumadi Irene , Arendt Kristian Bech , Stjerneklar Silke , Fishman Daniel B.
Published: April 2017

Case Studies Within Psychotherapy Trials: Integrating Qualitative and Quantitative Methods presents a specific, mixed-methods approach, called the “Cases Within Trials” (CWT) model, to psychotherapy research, combining the results from a randomized clinical trial (RCT); the results of richly and qualitatively detailed systematic case studies involving contrasting outcomes drawn from the experimental condition of the RCT; and a synthesis of the two types of knowledge. Chapter 3 of the book applies this model to an RCT study of a group-based, cognitive-behavioral treatment (CBT)—called “Cool Kids/Chilled Adolescents”—for youth anxiety in Denmark. Finding a substantial statistical advantage of the CBT treatment to a waiting-list control condition, the authors then analyze and compare the positive-outcome case of Lisa with the negative-outcome case of Marius, both drawn from the CBT condition.
Commentary
Authors: Dietz Laura J.
Published: April 2017

As a clinical researcher and practitioner with a specialty interest in preadolescent and adolescent depression and structured treatments for it, I was particularly interested in Kerner and Young’s excellent and engaging chapter (this volume) that focuses on and adds importantly to the research knowledge base on this topic. As these authors point out, depression, like other mental disorders, often begins early in life and has a recurrent course. Early-onset depression (i.e., depression occurring before the age of 18) has a more debilitating and severe course of disorder as compared to that of adult-onset depression marked by greater functional impairment, increased likelihood of depression recurrence, and higher risk of suicidality (...
Alternatives to Self-Harm Program
Authors: Clare Diane
Published: April 2017

This chapter describes the Alternatives to Self-Harm (ASH) program and its follow-up program, PHOENIX—programs that complement STEPPS and STAIRWAYS. ASH was developed for those individuals whose self-harm behaviors put them at imminent risk and those whose self-harm is likely to increase if they find therapy too emotionally challenging in the beginning. Data supportive of ASH are presented and show that the program leads to a reduction of self-harm risk for people with emotional dysregulation. ASH can stand alone or be adjunctive to STEPPS. ASH is an approach that reduces the risk of self-harm and increases participants’ confidence in their ability to acquire and maintain more effective coping strategies, as well as progressing to other therapies (e.g., STEPPS) as needed.
Ipsilateral Pupillary Dilation Following Carotid Endarterectomy: A Temporary and Benign Phenomenon
Authors: Steinberg Jeffrey A. , Carter Bob S. , Lee Marco B. , Steinberg Gary K.
Published: April 2017

BACKGROUND AND IMPORTANCE: Cases of post carotid endarterectomy (CEA) Horner's syndrome have been reported, with symptoms attributed to manipulation of the sympathetic plexus situated along the carotid artery; however, these patients presented with the typical constricted pupil. We report the first 3 cases to our knowledge of mydriasis following CEA.

CLINICAL PRESENTATION: We present 3 cases of CEA followed by immediate postoperative development of ipsilateral mydriasis. The patients were otherwise at their neurologic baseline and the mydriasis resolved over the ensuing few days.

CONCLUSION: We suggest that these cases are secondary to an ischemic phenomenon, specifically to parasympathetic structures such as the ciliary ganglion and/or oculomotor nerve, resulting in autonomic dysfunction manifested by pupillary dilation. A similar finding of mydriasis occurring subsequent to other carotid pathology has been reported, with ischemia to parasympathetic structures also proposed as the underlying etiology. Although pupillary dilation often represents a worrisome neurosurgical sign indicating herniation, it should be recognized that after CEA this finding may be a transient, benign occurrence.
Analysis of National Rates, Cost, and Sources of Cost Variation in Adult Spinal Deformity
Authors: Zygourakis Corinna C , Liu Caterina Y , Keefe Malla , Moriates Christopher , Ratliff John , Dudley R Adams , Gonzales Ralph , Mummaneni Praveen V , Ames Christopher P
Published: April 2017

BACKGROUND

Several studies suggest significant variation in cost for spine surgery, but there has been little research in this area for spinal deformity.

OBJECTIVE

To determine the utilization, cost, and factors contributing to cost for spinal deformity surgery.

METHODS

The cohort comprised 55 599 adults who underwent spinal deformity fusion in the 2001 to 2013 National Inpatient Sample database. Patient variables included age, gender, insurance, median income of zip code, county population, severity of illness, mortality risk, number of comorbidities, length of stay, elective vs nonelective case. Hospital variables included bed size, wage index, hospital type (rural, urban nonteaching, urban teaching), and geographical region. The outcome was total hospital cost for deformity surgery. Statistics included univariate and multivariate regression analyses.

RESULTS

The number of spinal deformity cases increased from 1803 in 2001 (rate: 4.16 per 100 000 adults) to 6728 in 2013 (rate: 13.9 per 100 000). Utilization of interbody fusion devices increased steadily during this time period, while bone morphogenic protein usage peaked in 2010 and declined thereafter. The mean inflation-adjusted case cost rose from $32 671 to $43 433 over the same time period. Multivariate analyses showed the following patient factors were associated with cost: age, race, insurance, severity of illness, length of stay, and elective admission (P < .01). Hospitals in the western United States and those with higher wage indices or smaller bed sizes were significantly more expensive (P < .05).

CONCLUSION

The rate of adult spinal deformity surgery and the mean case cost increased from 2001 to 2013, exceeding the rate of inflation. Both patient and hospital factors are important contributors to cost variation for spinal deformity surgery.
Long-term outcomes of acromegaly treated with fractionated stereotactic radiation: case series and literature review
Authors: Rhome Ryan , Germano Isabelle M , Sheu Ren-Dih , Green Sheryl
Published: April 2017

Background

Growth hormone (GH)-secreting pituitary adenomas represent an uncommon subset of pituitary neoplasms. Stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (FSRT) have been used as primary or adjuvant treatment. The purpose of this study is to report the long-term tumor control and toxicity from our institution and to perform a systematic literature review of acromegaly patients treated with FSRT.

Methods

We retrospectively reviewed all patients treated with FSRT (median dose 50.4 Gray [Gy], range 50.4–54 Gy) between 2005 and 2012 who had: 1) GH-secreting adenoma with persistently elevated insulin growth factor-1 (IGF-1) despite medical therapy and 2) clinical follow up >3 years after FSRT. Patients were treated with modern FSRT planning techniques. Biochemical control was defined as IGF-1 normalization. Systematic review of the literature was performed for FSRT in acromegaly.

Results

With a median follow-up of 80 months, radiographic control was achieved in all 11 patients and overall survival was 100%. Long-term biochemical control was achieved in 10 patients (90.9%) with either FSRT alone (36.4%) or FSRT with continued medical management (45.5%). No patient experienced new hypopituitarism, cranial nerve dysfunctions, or visual deficits. Our systematic review found published rates of biochemical control and hypopituitarism vary, with uniformly good radiographic control and low incidence of visual changes.

Conclusions

Adjuvant FSRT offered effective long-term biochemical control and radiographic control, and there was a lower rate of complications in this current series. Review of the literature shows variations in published rates of biochemical control after FSRT for acromegaly, but low incidence of serious toxicities.
Technique for Mini-open Decompression of Chiari Type I Malformation in Adults
Authors: Pakzaban Peyman
Published: April 2017

BACKGROUND: The technique for decompression of Chiari type I malformation relies on open exposure of craniocervical junction for suboccipital craniectomy and upper cervical laminectomy with or without duraplasty. There is no detailed technical report of a minimally invasive approach for Chiari decompression in adults.

OBJECTIVE: To describe a mini-open technique for decompression of Chiari type I malformation (including duraplasty) in adults.

METHODS: Six consecutive adult patients with symptomatic Chiari type I malformation underwent decompression through a 3 to 4 cm midline incision via a speculum retractor. All patients underwent a limited suboccipital craniectomy and C1 laminectomy with an ultrasonic bone scalpel. All patients underwent duraplasty with a synthetic dural substitute. In the 2 patients with syringomyelia, the arachnoid was opened and intradural dissection was carried out. In the remaining 4 patients, the arachnoid was left intact.

RESULTS: All operations were completed successfully through the mini-open exposure. Mean surgery time, blood loss, and length of stay were 114 min, 55 mL, and 1.3 days, respectively. Mean follow-up was 13.2 months (range 9-18). All patients had excellent clinical outcomes as defined by scores of 15 (3 patients) or 16 (3 patients) on Chicago Chiari Outcome Scale. There were no neurological complications or cerebrospinal fluid leaks. Postop computed tomography revealed good boney decompression. In the 2 patients with syringomyelia, MRI at 6 months revealed resolution of the syrinx.

CONCLUSION: Decompression of Chiari type I malformation in adults can be performed safely and effectively through the mini-open exposure described in this report.
Treatment of Recurrent Intracranial Aneurysms After Neck Clipping: Novel Classification Scheme and Management Strategies
Authors: Kobayashi Shinya , Moroi Junta , Hikichi Kentaro , Yoshioka Shotaro , Saito Hiroshi , Tanabe Jun , Ishikawa Tatsuya
Published: April 2017

BACKGROUND

Recurrent aneurysms after initial clipping have been discussed as an important issue in the surgical management of aneurysm.

OBJECTIVE

To report our experience with recurrent cerebral aneurysms after neck clipping and to discuss classification and recommended management.

METHODS

Aneurysm treatments from a single institution over a 20-year period were retrospectively reviewed. Twenty-three recurrent aneurysms in 23 patients were managed during the study period. Recurrent aneurysms were classified using the concepts of closure line and closure plane, as follows. Type 1: neck situated in an almost different site from the previous clip. Type 2: existing closure plane and reconstructive closure plane are almost the same. Type 3: existing closure plane and reconstructive closure plane cross (type 3a); in rare cases, the existing closure line is sufficiently distant from the neck (type 3b). Type 4: no reconstructive closure line is identifiable.

RESULTS

Nine patients presented with subarachnoid hemorrhage at recurrence. The mean interval to recurrence was 15.0 years. Management comprised clipping with elective subsequent old-clip removal (n = 7), clipping with preceding old-clip removal (n = 2), bypass occlusion (n = 1), coating (n = 1), combined surgery (n = 1), endovascular surgery (n = 4), and observation (n = 3). Therapeutic intervention was not indicated in 4 patients. Types 3a and 4 required more complex surgical procedures or coil embolization. Procedural complications were observed in 2 patients.

CONCLUSION

A small but definite propensity toward recurrence after neck clipping exists, and most recurrent aneurysms require some form of retreatment. The novel classification scheme may provide conceptual clarity and therapeutic guidance for decision making.
Intraparenchymal Cysts Following Deep Brain Stimulation: Variable Presentations and Clinical Courses
Authors: Katlowitz Kalman , Pourfar Michael H. , Israel Zvi , Mogilner Alon Y.
Published: April 2017

BACKGROUND: The development of cysts at the electrode lead is a rare complication of deep brain stimulation (DBS), with only 3 cases reported in the literature. A better understanding of the variable clinical presentations and courses of these cysts may help increase awareness of this potentially life-threatening complication.

OBJECTIVE: To review the clinical presentation of patients with intraparenchymal cysts following DBS implantations.

METHODS: We report 3 patients who developed a cyst along the course of the DBS lead. These patients received DBS for different indications and in different brain locations.

RESULTS: Clinical courses differed considerably with 1 asymptomatic patient followed conservatively, 1 mildly symptomatic patient who had the DBS hardware removed for insidious worsening over months, and 1 who had it emergently removed for acute development of hydrocephalus. Serial imaging revealed spontaneous reduction in cyst size over time in the asymptomatic patient, and following removal in 1 of the symptomatic patients.

CONCLUSION: This report highlights the variable clinical presentation and course of patients who develop cysts along the DBS lead. It suggests that some cases can be followed clinically without removal of hardware but that ongoing vigilance is required given the potential for serious adverse events.
Patient Selection and Clinical Efficacy of Urgent Superficial Temporal Artery-Middle Cerebral Artery Bypass in Acute Ischemic Stroke Using Advanced Magnetic Resonance Imaging Techniques
Authors: Park Hyun-Seok , Kim Sang-Hyeon , Nah Hyun-Wook , Choi Jae-Hyung , Kim Dae-Hyun , Kang Myong-Jin , Cha Jae-Kwan , Huh Jae-Taeck
Published: April 2017

BACKGROUND: Selected patients with acute ischemic stroke might benefit from superficial temporal artery-middle cerebral artery (STA-MCA) bypass, but the indications for urgent STA-MCA bypass are unknown.

OBJECTIVE: To report our experiences of urgent STA-MCA bypass in patients requiring urgent reperfusion who were ineligible for other reperfusion therapies, using advanced magnetic resonance imaging (MRI) techniques.

METHODS: The inclusion criteria for urgent STA-MCA bypass were as follows: acute infarct volume <70 mL with a ratio of perfusion/diffusion lesion volume ≥1.2, and a regional cerebral blood volume ratio >0.85. From January 2013 to October 2015, 21 urgent STA-MCA bypass surgeries were performed. The control group included 19 patients who did not undergo bypass surgery mainly due to refusal of surgery or the decision of the neurologist. Clinical and radiological data were compared between the surgery and control group.

RESULTS: The median age of the control group (70 years, interquartile range [IQR] 58-76) was higher than that of the surgery group (62 years, IQR 49-66), but the median preoperative diffusion and perfusion lesion volumes of the surgery group (13.8 mL, IQR 7.5-26.0 and 120.9 mL, IQR 84.9-176.0, respectively) were higher than those of the control group (5.6 mL, IQR 2.1-9.1 and 69.7 mL, IQR 23.9-125.3, respectively). Sixteen (76.2%) patients in the surgery group and 2 (10.5%) patients in the control group had favorable outcomes (P < .001). Logistic regression analysis identified bypass surgery as the strongest predictive factor.

CONCLUSION: STA-MCA bypass can be used as a therapeutic tool for acute ischemic stroke. Advanced MRI techniques are helpful for selecting patients and for decision making.
Intraoperative FLOW 800 Analysis for Intramedullary Cystic Lesion: A Technical Case Report
Authors: Sawada Masahiro , Munemitsu Toshihiro , Hojo Masato
Published: April 2017

BACKGROUND AND IMPORTANCE: During intramedullary lesion surgery, the lesion site and the posterior median sulcus (PMS) should be accurately identified prior to myelotomy to avoid severe injury of the posterior funiculus. However, intramedullary lesions are fundamentally invisible until the myelotomy is performed. Furthermore, the PMS location is frequently unclear due to lesion-induced swelling or distortion of the spinal cord. Intraoperative indocyanine green videoangiography (ICG-VA) followed by FLOW 800 analysis, which shows vascularization of the spinal parenchyma, may provide a solution for these problems in specific cases.

CLINICAL PRESENTATION: A 61-year-old woman suffering from claudication visited our department. Magnetic resonance imaging (MRI) revealed a cystic lesion at the level of Th11. A solid portion was not detected in the T1-weighted images following gadolinium administration. We made a diagnosis of ventriculus terminalis and performed a lesion resection. Prior to opening the PMS, ICG-VA was performed, which revealed an avascular area representing the intramedullary cyst. The PMS was the most avascular area observed in the time–intensity analysis executed using FLOW 800 software (Zeiss, Oberkochen, Germany). Thus, it was helpful in determining the site for myelotomy, which should be performed at the center of the extent of the lesion. The patient was discharged 23 days after the operation, ambulating independently.

CONCLUSION: Intraoperative ICG-VA followed by FLOW 800 analysis was applied to a case of intramedullary cystic lesion. This technique may be helpful in performing safer intramedullary cystic lesion surgery because it enables visualization of the lesion location and confirmation of the PMS.
Reliability, Validity, and Minimal Detectable Change of Four-Step Stair Climb Power Test in Community-Dwelling Older Adults
Authors: Ni Meng , Brown Lorna G. , Lawler Danielle , Bean Jonathan F.
Published: April 2017

Background. Stair climb power is an important clinical measure of lower-extremity power. The stair climb power test (SCPT) was validated by requiring individuals to climb a full flight of stairs. A 4-step SCPT (4SCPT) would be more clinically feasible and easier to perform, yet its reliability and validity are unknown.

Objective. To evaluate reliability, validity, and minimal detectable change of 4SCPT among community-dwelling older adults.

Design. This study is a cross-sectional analysis of baseline data from a clinical trial.

Methods. Fifty older adults ≥65 years of age, at risk for mobility decline, consented to participate in this ancillary study. Test-retest reliability was derived from 2 measurements within each participant measured by a single assessor. Pearson correlation analyses among leg power measures (4SCPT, SCPT, single leg press power at 40% and 70% of the 1-repetition maximum [SLP40, SLP70]) were performed. Separate multivariate linear regressions were conducted evaluating the associations between each leg power measure and 2 mobility outcomes, the Short Physical Performance Battery (SPPB) and habitual gait speed (HGS). Minimal detectable change was based on a 90% confidence interval (MDC90).

Results. The 4SCPT had excellent test-retest reliability (ICC(2,1) = 0.951), and strong correlation with SCPT, SLP40, and SLP70 (r = 0.85-0.96). The 4SCPT explained a greater amount of variance in the SPPB (R2 = 0.31) than other leg power measurements (R2 = 0.23-0.25). The 4SCPT (R2 = 0.41) and SCPT (R2 = 0.42) described equivalent amounts of variance in HGS, and greater than that with SLP40 (R2 = 0.28) and SLP70 (R2 = 0.30). The MDC90 for 4SCPT was 44.0 watts.

Limitations. This was a cross-sectional analysis within a small, nonrepresentative sample. Interrater reliability was not evaluated.

Conclusions. The 4SCPT shows scientific promise as a valid and reliable leg power measurement among community-dwelling older adults.
Vermont Hub-and-Spoke Model of Care for Opioid Use Disorder: Development, Implementation, and Impact
Authors: Brooklyn John R. , Sigmon Stacey C.
Published: April 2017

Background:

Opioid use disorders (OUDs) are reaching epidemic proportions in the United States, and many geographic areas struggle with a persistent shortage in availability of opioid agonist treatment. Over the past 5 years, Vermont addiction medicine physicians and public health leaders have responded to these challenges by developing an integrated hub-and-spoke opioid treatment network.

Methods:

In the present report, we review the development, implementation, and impact of this novel hub-and-spoke model for expanding OUD treatment in Vermont.

Results:

Vermont's hub-and-spoke system has been implemented state-wide and well-received by providers and patients alike. Adoption of this model has been associated with substantial increases in the state's OUD treatment capacity, with Vermont now having the highest capacity for treating OUD in the United States with 10.56 people in treatment per 1000. There has been a 64% increase in physicians waivered to prescribe buprenorphine, a 50% increase in patients served per waivered physician, and a robust bidirectional transfer of patients between hubs and spokes based upon clinical need. Challenges to system implementation and important future directions are discussed.

Conclusions:

Development and implementation of a hub-and-spoke system of care has contributed substantially to improvements in opioid agonist treatment capacity in Vermont. This system may serve as a model for other states grappling with the current opioid use epidemic.
Silicone breast implants and autoimmune rheumatic diseases: myth or reality
Authors: Cohen Tervaert Jan Willem , Colaris Maartje J. , van der Hulst René R.
Published: April 2017

Purpose of review

In the present review, recent findings regarding silicone breast implants (SBIs) complicated by rheumatic autoimmune diseases are described.

Recent findings

Despite changes in the principal constituents of the silicone implants during the past 50 years, silicone remained an adjuvant that may ’bleed’ and subsequently may be a chronic stimulus to the immune system resulting in similar clinical manifestations as 50 years ago. Silicones are spread throughout the body and can be detected in tissues and the central nervous system. Autoimmune/inflammatory syndrome by adjuvants (ASIA), allergies, autoimmune diseases, immune deficiencies and lymphomas occur in patients with SBIs. There is a need for adequately adjusted epidemiological studies to ascertain the frequency of these diseases. Explantation of the breast implants, however, should be advised to patients with complaints, as 60–80% of patients show an amelioration of the signs and symptoms after explantation.

SBIs are associated in a proportion of patients with complaints such as fatigue, cognitive impairment, arthralgias, myalgias, pyrexia, dry eyes and dry mouth. Silicones can migrate from the implant through the body and can induce a chronic inflammatory process. Explantation of SBI results in the majority of patients in an amelioration of the symptoms.