bluuebunny/crossref_metadata_2025 huggingface dataset:
The Spectrum and Sequelae of Acne in Black South Africans Seen in Tertiary Institutions
Authors: Dlova Ncoza C. , Mosam Anisa , Tsoka-Gwegweni Joyce
Published: May 2018

Introduction: Acne is a chronic disorder of the pilosebaceous unit affecting all ethnic groups. It remains in the top 5 skin conditions seen worldwide. The paucity of data characterizing acne in South African Blacks led us to the documentation of types and sequelae of acne. Methods: This is a cross- sectional study describing the spectrum and variants of acne in 5 tertiary hospitals in the second most populous province in South Africa over 3 months (January 1 – March 31, 2015). Results: Out of 3,814 patients seen in tertiary dermatology clinics, 382 (10%) had a primary diagnosis of acne or rosacea, forming the fourth most common condition seen. Acne accounted for 361 (94.5%); acne vulgaris was the commonest subtype at 273 (75.6%), followed by steroid-induced acne 46 (12.7%), middle-age acne 6 (1.7%), acne excoriée 2 (0.6%), and “undefined” 34 (9.4%). Conclusion: The observation of steroid-induced acne as the second most common variant in Black patients underlines the need to enquire about steroid use and education about the complications of using steroid-containing skin-lightening creams. Treatment of postinflammatory hyperpigmentation should be part of the armamentarium for holistic acne treatment in Blacks, as it remains a major concern even after active acne has resolved.
A New Model for Adrenarche: Inhibition of 3β-Hydroxysteroid Dehydrogenase Type 2 by Intra-Adrenal Cortisol
Authors: Majzoub Joseph A. , Topor Lisa Swartz
Published: May 2018

We propose that the normal adrenarche-related rise in dehydroepiandrosterone (DHEA) secretion is ultimately caused by the rise in cortisol production occurring during childhood and adolescent growth, by the following mechanisms. (1) The onset of childhood growth leads to a slight fall in serum cortisol concentration due to growth-induced dilution and a decrease in the negative feedback of cortisol upon ACTH secretion. (2) In response, ACTH rises and stimulates increased cortisol synthesis and secretion in the growing body to restore the serum cortisol concentration to normal. (3) The cortisol concentration produced within and taken up by adrenocortical steroidogenic cells may rise during this time. (4) Cortisol competitively inhibits 3β-hydroxysteroid dehydrogenase type 2 (3βHSD2)-mediated conversion of 17αOH-pregnenolone to cortisol, causing a further fall in serum cortisol, a further decrease in the negative feedback of cortisol upon ACTH, a further rise in ACTH, and further stimulation of adrenal steroidogenesis. (5) The cortisol-mediated inhibition of 3βHSD2 also blocks the conversion of DHEA to androstenedione, causing a rise in adrenal DHEA and DHEA sulfate relative to androstenedione secretion. Thus, the combination of normal body growth plus inhibition of 3βHSD2 by intra-adrenal cortisol may cause normal adrenarche. Childhood obesity may hasten this process by causing a pathologic increase in body size that triggers these same processes at an earlier age, resulting in the premature onset of adrenarche.
A Proposal for a New Severity Index for the Evaluation of Chronic Paronychia
Authors: Atış Güldehan , Göktay Fatih , Altan Ferhatoğlu Zeynep , Kaynak Emre , Sevim Keçici Ayşegül , Yaşar Şirin , Aytekin Sema
Published: May 2018

Introduction: Chronic paronychia (CP) is an inflammatory disease of the nail folds. Staging of CP is important for clinicians. We developed an objective scale that evaluates each finding of CP separately in addition to evaluating the treatment process and follow-up. Methods: A new “chronic paronychia severity index scale” was developed to enable dermatologists to examine all features of CP. A previous categorical severity scale and this new scale were used for the evaluation of CP by 6 different dermatologists. The dermatologists evaluated the nails with both scales again 20 days later using randomly ordered photographs. Results: Using the previous scale, the intra-observer intraclass correlation coefficient (ICC) values between the first and second evaluations were 0.767, 0.860, 0.734, 0.609, 0.900, and 0.840 for the 6 dermatologists. Using the new proposed scale, the intra-observer ICC values between the first and second evaluations were 0.930, 0.931, 0.942, 0.934, 0.938, and 0.920 for the 6 dermatologists. All intra-observer ICC values were higher for the results of the proposed scale than for those of the previous scale. The inter-observer ICC values were also higher for the proposed scale than for the previous scale for the 6 dermatologists. Conclusion: The new scale is a standardized, more suitable, objective, and valuable method to use in clinical practice and studies on CP.
The Best Digital Biomarkers Papers of 2017
Authors: Snyder Christopher W. , Dorsey E. Ray , Atreja Ashish
Published: May 2018

The use and evaluation of digital biomarkers, objective and quantifiable measures of biology, and health collected through digital devices is growing rapidly. To highlight some of the most promising work in the field, we have compiled a list of the top digital biomarkers papers from the past year. Eligible papers reported on original research that evaluated a digital sensor (e.g., smartphone, wearable sensor, implantable device) in humans and was published in a peer-reviewed journal in 2017. Nominations were solicited from the editorial board of Digital Biomarkers and supplemented by papers the editorial team identified from Web of Science, Google Scholar, and PubMed. The editorial board then selected up to ten papers to be recognized among 28 nominations. Here, we present all of the nominated papers and profile the eight that received the most votes. The top eight papers evaluated 1,290 individuals with digital pills, smartwatches, wearable devices, and electronic inhalers in disease states ranging from dementia to diabetes and from Parkinson disease to pain.
A Change of Heart: Yield of Cardiac Imaging in Acute Stroke Workup
Authors: Kauw Frans , Dankbaar Jan W. , Habets Jesse , Cramer Maarten J.M. , de Jong Hugo W.A.M. , Velthuis Birgitta K. , Kappelle L. Jaap
Published: May 2018

This case report describes a patient who experienced a recurrent ischemic stroke within 24 h. Dual-energy computed tomography (DECT) angiography on admission showed 2 intracardiac thrombi, 1 in the left ventricle and 1 in the left atrial appendage. Following the second ischemic event, repeated DECT angiography showed that the ventricular thrombus had considerably diminished, suggesting that the recurrent brain infarction was caused by cardioembolism. This case emphasizes (1) the potential benefit of cardiac evaluation through CT angiography in the acute stroke setting, and (2) the use of DECT angiography for the detection of thrombus and the differentiation between thrombus, the myocardial wall, and a slow flow of contrast.
In Vivo Molecular Characterization of Abdominal Aortic Aneurysms Using Fibrin‐Specific Magnetic Resonance Imaging
Authors: Botnar René M. , Brangsch Julia , Reimann Carolin , Janssen Christian H. P. , Razavi Reza , Hamm Bernd , Makowski Marcus R.
Published: May 2018

Background

The incidence of abdominal aortic aneurysms (
AAA
s) will significantly increase during the next decade. Novel biomarkers, besides diameter, are needed for a better characterization of aneurysms and the estimation of the risk of rupture. Fibrin is a key protein in the formation of focal hematoma associated with the dissection of the aortic wall and the development of larger thrombi during the progression of
AAA
s. This study evaluated the potential of a fibrin‐specific magnetic resonance (MR) probe for the in vivo characterization of the different stages of
AAA
s.

Methods and Results

AAA
s spontaneously developed in ApoE
−/−
mice following the infusion of angiotensin‐
II
(Ang‐
II
, 1 μg/kg
−1
·per minute). An established fibrin‐specific molecular
MR
probe (
EP
2104R, 10 μmol/kg
−1
) was administered after 1 to 4 weeks following Ang‐
II
infusion (n=8 per group). All imaging experiments were performed on a clinical 3T Achieva
MR
system with a microscopy coil (Philips Healthcare, Netherlands). The development of
AAA
‐associated fibrin‐rich hematoma and thrombi was assessed. The high signal generated by the fibrin probe enabled high‐resolution
MR
imaging for an accurate assessment and quantification of the relative fibrin composition of focal hematoma and thrombi. Contrast‐to‐noise‐ratios (
CNRs
) and R1‐relaxation rates following the administration of the fibrin probe were in good agreement with ex vivo immunohistomorphometry (
R
2
=0.83 and 0.85) and gadolinium concentrations determined by inductively coupled plasma mass spectroscopy (
R
2
=0.78 and 0.72).

Conclusions

The fibrin‐specific molecular
MR
probe allowed the delineation and quantification of changes in fibrin content in early and advanced
AAA
s. Fibrin
MRI
could provide a novel in vivo biomarker to improve the risk stratification of patients with aortic aneurysms.
Sex Differences in Omega‐3 and ‐6 Fatty Acids and Health Status Among Young Adults With Acute Myocardial Infarction: Results From the VIRGO Study
Authors: Lu Yuan , Ding Qinglan , Xu Xiao , Spatz Erica S. , Dreyer Rachel P. , D'Onofrio Gail , Caulfield Michael , Nasir Khurram , Spertus John A. , Krumholz Harlan M.
Published: May 2018

Background

Young women (aged ≤55 years) with acute myocardial infarction (
AMI
) have poorer health status outcomes than similarly aged men. Low omega‐3 fatty acids (
FA
s) have been implicated as risk factors for cardiovascular outcomes in
AMI
patients, but it is not clear whether young women have similar or different post‐
AMI
omega‐3
FA
profiles compared with young men.

Methods and Results

We assessed the sex differences in post‐
AMI
omega‐3
FA
s and the associations of these biomarkers with patient‐reported outcomes (symptom, functioning status, and quality of life) at 12‐month follow‐up, using data from 2985 US adults with
AMI
aged 18 to 55 years enrolled in the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young Acute Myocardial Infarction Patients) study. Biomarkers including eicosapentaenoic acid, docosahexaenoic acid, arachidonic acid (
AA
), eicosapentaenoic acid/
AA
ratio, omega‐3/omega‐6 ratio, and omega‐3 index were measured 1 month after
AMI
. Overall, the omega‐3
FA
s and
AA
were similar in young men and women with
AMI
. In both unadjusted and adjusted analysis (controlling for age, sex, race, smoking, hypertension, diabetes mellitus, body mass index, and health status score at 1 month), omega‐3
FA
s and
AA
were not significantly associated with 12‐month health status scores using the Bonferroni corrected statistical threshold.

Conclusions

We found no evidence of sex differences in omega‐3
FA
s and
AA
in young men and women 1 month after
AMI
. Omega‐3 FAs and AA at 1‐month after AMI were generally not associated with 12‐month patient‐reported health status after adjusting for patient demographic, clinical characteristics, and the corresponding 1‐month health status score.
The “Sons of Seth”
Authors: Christian Meike
Published: May 2018

This article is focussed on the question how to interpret the phrase בני שית in 4Q417 1 i 15. The analysis is based on a novel reconstruction of the preceding word, which is only poorly preserved. The common reconstructions (namely ‪עולות‬, עו(ו)נות or עלילות) have a negative meaning. Hence, the בני שית are understood as a group that will be punished by God due to their sins. However, it is also possible to reconstruct עבודת in 4Q417 1 i 15. In contrast to the other suggestions this word not only fits the gap properly, but is also attested several times throughout 4QInstruction. Following this reconstruction, 4Q417 1 i 15f. indicates that the reward for the “ser[vic]e of the sons of Seth” has already been determined. Consequently, 4QInstruction uses the term בני שית in a positive way to denote the elect and builds on a tradition that praises Seth as well as his offspring.
Burman Domination and Ethnic Discrimination: Toward A Postcolonial Theology of Resistance and Reconciliation in Myanmar
Authors: Moe David Thang
Published: May 2018

Myanmar is a country of both the majority Burmans who represent the majority of Buddhism and the minority ethnic groups who represent the majority of Christianity. However, the minority ethnic groups experience discrimination and alienation in their native land. In response to the problem of Burman domination and ethnic discrimination, I would argue that the minority ethnic groups have a twofold task. One is the minority ethnic group’s responsibility of postcolonial resistance to Burmanization, and the other alternative is their vision of struggle for a reconciling co-existence with Burmans as their fellow citizens in the same nation.
Contextualization as a Critical Transformative Agent in Christianity
Authors: Nweke K. Chinedu , Onyenali Rowland
Published: May 2018

There is an increasing acceptance that every theology is contextual. There is an equally commensurate rising concerns whether contextualization in theology is not undermining Christianity and devaluing the concept of ‘the Truth’. Among the reasons for this problem are the consequence of a blemished Christian history, the eternal truth of God in an ephemeral world, and the upsurge of pluralistic theologies with the ‘de-westernization’ of Christian theology. These have thematized contextualization in contemporary theology as important and at the same time, problematic.

This work rather argues that contextualization has been part of Christianity in the interpretation and propagation of Christ’s message, and that as far as it is an indispensable aspect of Christian theologies, it must neither devalue Christian religiosity nor suggest that the eternal God who happened in history can be subjected to historicity.

Through the exposé of the social-territorial, political, religious and economic contexts, and the analysis of the doctrinal, exegetical and missiological historicity of Christianity, this work reflects contextualization in different phases of Christian developments, and its relevance in the present time. It tries to establish that Christianity happened in context, and that it continues to happen in context to every person, group or culture it meets. Contextualization is a strength of Christianity.
Redescription and biogeography of Mabuya cochabambae Dunn with comments on Bolivian congeners (Lacertilia: Scincidae)
Authors: HARVEY MICHAEL B. , AGUAYO RODRIGO , MIRALLES AURÉLIEN
Published: May 2018

On the basis of new material, observations in the field, and data from living specimens, we redescribe Mabuya cochabambae Dunn and discuss its distribution and biogeography. Morphological and molecular evidence strongly suggests that M. cochabambae and M. dorsivittata are sister taxa. In addition to M. cochabambae, we tabulate morphological data for three other Mabuya occurring in Bolivia: M. dorsivittata Cope, M. frenata (Cope), and M. guaporicola Dunn. Mabuya altamazonica Miralles et al. and M. nigropunctata (Spix) both occur in Bolivia, specimens of the former coming from the western lowlands and of the latter from the eastern lowlands of central Santa Cruz. Finally, we propose a new key to the eight species of Mabuya occurring in Bolivia.
New taxa of oribatid mites from Korup National Park (Cameroon). The genus Pergalumna (Acari, Oribatida, Galumnidae), with description of three new species and a key to known species from the Ethiopian region
Authors: ERMILOV SERGEY G. , STARÝ JOSEF
Published: May 2018

Three new species of oribatid mites of the genus Pergalumna (Oribatida, Galumnidae) are described from litter and soil in the Korup National Park (Cameroon). Pergalumna jenoi sp. nov. differs from P. margaritata Mahunka, 1989 and P. pseudomargaritata Mahunka, 1994 by the presence of simple dorsosejugal suture, dentate anterior margin of the ventral plate, distinct reticulate pattern on the pteromorphs and dense stria on the genital plates, the localization of setal alveoli la posterior to porose areas Aa, and the absence of a median pore. Pergalumna tuberclesejugalis sp. nov. differs from P. margaritata and P. pseudomargaritata by the larger body size, the localization of porose areas Aa closer to lm than la, and setal alveoli h3 close and lateral to A2, the presence of sejugal porose areas, and the absence of a median pore and stria on the genital plates. Pergalumna grebennikovi sp. nov. differs from P. bifissurata Hammer, 1972 by the larger body size, the presence of smooth bothridial setae, well-developed interlamellar setae, reticulate anterior margin of pteromorphs, comparatively long prodorsal median ridge and a median pore, and the localization of setal alveoli la and porose areas Aa. An identification key to the known species of the genus Pergalumna from the Ethiopian region is presented.
Five new species of the Ghost Spider genus Anyphaenoides Berland from Colombia (Araneae: Anyphaenidae: Anyphaeninae)
Authors: MARTINEZ LEONEL , BRESCOVIT ANTONIO D. , MARTINEZ NEIS
Published: May 2018

Five new species of the ghost spider genus Anyphaenoides Berland from Colombia are described and illustrated: A. sierraensis sp. nov. (based on male and female) from Magdalena department, A. caribensis sp. nov. (male and female) from Atlántico department, A. foreroi sp. nov. (male) from Vaupes department, A. hilli sp. nov. (male) from Putumayo department and A. enigmaticus sp. nov. (male and female) from Santander department.
A remarkable new species of cavernicolous Collartidini from Madagascar (Hemiptera: Heteroptera: Reduviidae)
Authors: CHŁOND DOMINIK , GUILBERT ERIC , FAILLE ARNAUD , BAŇAŘ PETR , DAVRANOGLOU LEONIDAS-ROMANOS
Published: May 2018

Mangabea troglodytes sp. nov. (Hemiptera: Heteroptera: Reduviidae: Emesinae) is described based on four specimens collected in a cave of the Namoroka Karstic System, Madagascar, and deposited in the Collection of the Muséum National d’Histoire Naturelle, Paris. The dorsal habitus as well as diagnostic characters of male and female genitalia are extensively illustrated and imaged. A key to species of the genus Mangabea Villiers, 1970 is provided and the degree of cave specialization of the new species is discussed.
First report of aphaenopsoid trechines (Coleoptera: Carabidae: Trechini) from Serbia, with descriptions of new taxa
Authors: ĆURČIĆ SREĆKO , PAVIĆEVIĆ DRAGAN , VESOVIĆ NIKOLA , MARKOVIĆ ĐORĐE , PETKOVIĆ MATIJA , BOSCO FABRIZIO , KURAICA MILOŠ , NEŠIĆ DRAGAN
Published: May 2018

The trechine ground beetle taxa, Velesaphaenops gen. n., Velesaphaenops tarensis sp. n., and Acheroniotes lethensis sp. n., are described and diagnosed. The new taxa differ clearly from their closest relatives in a number of external characters and the shape of the genitalia. They probably belong to phyletic lineages of Pliocene age (the age of the palaeokarst of Kamena Gora and Mt. Tara). The new taxa are endemic to western and southwestern Serbia. Keys to the aphaenopsoid trechine genera in Serbia and to species of the genus Acheroniotes Lohaj & Lakota, 2010 are appended.
Sensitivity of Surface Temperature to Oceanic Forcing via q-Flux Green’s Function Experiments. Part II: Feedback Decomposition and Polar Amplification
Authors: Liu Fukai , Lu Jian , Garuba Oluwayemi A. , Huang Yi , Leung L. Ruby , Harrop Bryce E. , Luo Yiyong
Published: May 2018

A large set of Green’s function-type experiments is performed with q-flux forcings mimicking the effects of the ocean heat uptake (OHU) to examine the global surface air temperature (SAT) sensitivities to the location of the forcing. The result of the experiments confirms the earlier notion derived from experiments with different model complexities that the global mean SAT is far more sensitive to the oceanic forcing from high latitudes than the tropics. Remarkably, no matter in which latitude the q-flux forcings are placed, the SAT response is always characterized by a feature of polar amplification, implicating that it is intrinsic to our climate system. Considerable zonal asymmetry is also present in the efficacy of the tropical OHU, with the tropical eastern Pacific being much more efficient than the Indian Ocean and tropical Atlantic in driving global SAT warming by exciting the leading neutral mode of the SAT that projects strongly onto global mean warming. Using a radiative kernel, feedback analysis is also conducted to unravel the underlying processes responsible for the spatial heterogeneity in the global OHU efficacy, the polar amplification structures, and the tropical altruism of sharing the warmth with remote latitudes. Warming “altruism” for a q flux at a given latitude is also investigated in terms of the ratio of the induced remote latitudes versus the directly forced local warming. It is found that the tropics are much more altruistic than higher latitudes because of the high-energy transport efficiency of the Hadley circulation.
Clinical Pharmacist Impact on Intensive Care Unit Delirium: Intervention and Monitoring
Authors: Lightfoot Myaa , Sanders Adam , Burke Christopher , Patton Jessica
Published: May 2018

Purpose: The purpose of this study was to determine the impact of pharmacist monitoring with a clinical decision support system (CDSS) on clinical outcomes related to intensive care unit (ICU) delirium. Methods: This was a single-center, before-and-after study. This study compares patient outcomes of the preintervention group, which is the standard of care of pharmacist rounding, and the intervention group of pharmacy rounding with the CDSS rules. Using a CDSS, specific delirium risk factor rules were created to alert pharmacists to patients who have an increased risk of developing ICU delirium. Patients were included in the study if they were ⩾18 years of age, admitted to the trauma intensive care unit (TICU), and had one of the CDSS rule alerts. The CDSS notified pharmacists in real time to patients in the intervention group that met these criteria to provide timely recommendations in an effort to prevent ICU delirium. Results: Compared with the preintervention group receiving the standard of care (n = 28), the intervention CDSS group (n = 33) had a nonsignificant trend in decreased incidence of delirium (33.3% vs 24.1%, P = .45), ICU length of stay (LOS) (10.11 vs 7.55 days, P = .26), and ventilator duration (7.11 vs 5.03 days, P = .26). The intervention group had a significantly shorter hospital LOS (14.74 vs 9.98 days, P = .04). There was a nonsignificant increase in mortality with the intervention group from nondelirium causes (24.2% vs 7%, P = .07). Conclusion: The utilization of a CDSS by clinical pharmacists to monitor for delirium-specific risk factors led to a significantly shorter hospital LOS. Further studies using this model are warranted to see the impact on the ICU population.
A Survey of Opioid Medication Stewardship Practices at Academic Medical Centers
Authors: Phelps Pamela , Achey Thomas S. , Mieure Katherine D. , Cuellar Lourdes , MacMaster Heidemarie , Pecho Robert , Ghafoor Virginia
Published: May 2018

Purpose: The results of a survey of academic medical centers assessing the presence and description of opioid stewardship activities. Methods: Academic medical centers within the Vizient University Health System Consortium Pharmacy Network were asked to complete a survey related to opioid stewardship activities. The survey consisted of 30 questions aimed at identifying current opioid stewardship practices among hospitals and health systems. Results: There were 27 respondents to the survey. Only 42.3% of respondents have opioid stewardship activities in place. Opioid stewardship practices are primarily linked to either formal consult services or the role of a clinical pharmacy specialist. Very few institutions have opioid stewardship embedded into the daily practice of clinical pharmacists. Just over half of respondents have pharmacists as part of a pain consult team. Principle roles of pharmacists on consult teams include provider education, patient education, and optimization of therapy outside of a collaborative practice or prescribing role. Over half of the respondents participating in stewardship maintain a pharmacist’s role in monitoring surgery and postoperative opioid prescribing. The majority of respondents have opioid medication policies in place to address range orders, smart pump programming of opioids, limits on meperidine use, and cumulative limits on acetaminophen dosing. Conclusion: There are limited examples of pharmacy services related to opioid stewardship. The authors believe this is a pharmacy practice model that will evolve with the national attention to the opioid epidemic and new Joint Commission Standards.
Significant Published Articles for Pharmacy Nutrition Support Practice in 2017
Authors: Dickerson Roland N. , Kumpf Vanessa J. , Bingham Angela L. , Blackmer Allison B. , Canada Todd W. , Chan Lingtak - Neander , Cogle Sarah V. , Tucker Anne M.
Published: May 2018

Purpose: The purpose of the article is to assist the pharmacist engaged in nutrition support therapy in staying current with pertinent literature. Methods: Several clinical pharmacists engaged in nutrition support therapy compiled a list of articles published in 2017 considered important to their clinical practice. The citation list was compiled into a spreadsheet where the author participants were asked to assess whether the article was considered important to nutrition support pharmacy practice. A culled list of publications was then identified whereby the majority (at least 5 out of 8 authors) considered the article to be of significance. Guideline and consensus articles from professional organizations, important to practice but not scored, were also included. Results: A total of 95 articles were identified; six from the primary literature were voted by the group to be of high importance. An additional 13 organizational guidelines, position, recommendation, or consensus papers were also identified. The top-ranked articles from the primary literature were reviewed. Conclusion: It is recommended that pharmacists engaged in nutrition support therapy be familiar with these articles as it pertains to their practice.
Stability of Meropenem After Reconstitution for Administration by Prolonged Infusion
Authors: Fawaz Sarah , Barton Stephen , Whitney Laura , Swinden Julian , Nabhani-Gebara Shereen
Published: May 2018

Objective: Meropenem is a parenteral carbapenem antibiotic which has a broad spectrum of activity against aerobes and anaerobes. Meropenem’s bactericidal activity is determined by the time during which meropenem concentration remains above the minimal inhibition concentration (MIC) during the dosing interval. Thus, prolonged infusion is the optimal way to maximize the time-dependant activity. However, studies to date have shown that carbapenems and in particular, meropenem, are relatively unstable in solution. The aims of this study were therefore (1) to establish the effects of temperature on the concentration of a generic brand reconstituted meropenem solution and (2) to determine whether 24-hour continuous infusion is possible without concentrations dropping below the recommended 90%. Method: Preliminary examination was carried out by the means of nuclear magnetic resonance (NMR) spectroscopy. Meropenem was subsequently assayed using high-performance liquid chromatography (HPLC). The method was developed and validated in compliance with International Council for Harmonisation (ICH) guidelines. Meropenem’s stability was examined at two temperatures 22°C and 33°C to mimic average and high temperature in hospital wards. Solutions were prepared aseptically at the clinically relevant concentration. Results: NMR results obtained showed an increase in open ring methyl groups peak intensity, indicating that meropenem begins to degrade upon dissolution (d=1.05 and 1.25). Results obtained from quantitative HPLC confirm that meropenem concentrations dropped to 90% of initial concentration at 7.4 hours and 5.7 hours at 22°C and 33°C, respectively. Conclusion: Although results obtained indicate that meropenem should not be continuously infused over 24 hours, it is possible that meropenem could be continuously infused for at least 7 hours if temperature does not exceed 22°C and for 5 hours if temperature does not exceed 33°C.
Social support and clinical and functional outcome in people with schizophrenia
Authors: Vázquez Morejón Antonio J , León Rubio Jose Mª , Vázquez-Morejón Raquel
Published: May 2018

Purpose:

The impact of Social Support (SS) on the clinical and functional evolution of patients diagnosed with schizophrenia was studied from a multidimensional concept of SS in the framework of the vulnerability-stress model.

Methods:

In total, 152 patients diagnosed with schizophrenia according to the International Classification of Diseases, Tenth Edition (ICD-10) treated in a Community Mental Health Unit were assessed using the Mannheim Interview on Social Support (MISS) and the Brief Psychiatric Rating Scale (BPRS). Then they were followed up for 3 years with a final assessment for the period using the Social Functioning Scale. The impact of SS was explored in clinical and functional measurements with a multiple regression analysis in a 3-year longitudinal prospective design.

Results:

The quality of Global Social Support (GSS) and satisfaction with GSS appeared to be protective factors from frequency and duration of hospital admissions, with explanatory intensity varying from 9% in survival time to relapse to 13% in number of relapses. Concerning functional measurements, GSS quantity, quality and satisfaction showed an explanatory power for several different dimensions of social functioning, varying from 12% in isolation to 20% in communication.

Conclusion:

The results confirm SS as a protective factor in the evolution of schizophrenia patients and enable the SS variables with the most explanatory power in their clinical and functional evolution to be identified.
Liberal Peacebuilding in Sierra Leone: A Critical Exploration
Authors: Bindi Idrissa Tamba , Tufekci Ozgur
Published: May 2018

There is increasing awareness and international support for rebuilding states that have gone through conflict. Third-party interventions in bringing peace to countries that have emerged from civil wars have been channeled through a fundamental concept known as liberal peacebuilding. Liberal peacebuilding, even though it faces much criticism, has been a prominent strategy for third-party intervention in post-war countries since the end of the Cold War. This paper deals with the liberal peacebuilding process in Sierra Leone, after its decade-long brutal civil war. The focus lies on Dr Roland Paris’ institutionalization before liberalization (IBL) peacebuilding strategy, its strengths and shortcomings, and its contributions to sustaining peace in Sierra Leone since the end of the war in 2002. Arguing that the IBL strategy has helped to maintain peace in Sierra Leone after ten years of civil war, the paper analyzes how peacebuilding has been implemented in post-war Sierra Leone under the six different pillars of the IBL strategy.
Recommendations on How to Manage Anticipated Communication Dilemmas Involving Medical Countermeasures in an Emergency
Authors: Schoch-Spana Monica , Brunson Emily , Chandler Hannah , Gronvall Gigi Kwik , Ravi Sanjana , Sell Tara Kirk , Shearer Matthew P.
Published: May 2018

National investments to facilitate prompt access to safe and effective medical countermeasures (MCMs) (ie, products used to diagnose, prevent, protect from, or treat conditions associated with chemical, biological, radiological, or nuclear threats, or emerging infectious diseases) have little merit if people are not willing to take a recommended MCM during an emergency or inadvertently misuse or miss out on a recommended MCM during an emergency. Informed by the Expert Working Group on MCM Emergency Communication, the Johns Hopkins Center for Health Security developed recommendations for achieving desired public health outcomes through improved MCM communication based on a review of model practices in risk communication, crisis communication, and public warnings; detailed analysis of recent health crises involving MCMs; and development of a scenario depicting future MCM communication dilemmas. The public’s topics of concern, emotional requirements, capacity for processing information, and health needs will evolve as an emergency unfolds, from a pre-event period of routine conditions, to a crisis state, to a post-event period of reflection. Thus, MCM communication by public health authorities requires a phased approach that spans from building up a reputation as a trusted steward of MCMs between crises to developing recovery-focused messages about applying newly acquired data about MCM safety, efficacy, and accessibility to improve future situations.
Commutativity of systems with their feedback conjugates
Authors: Koksal Mehmet Emir
Published: May 2018

After introducing commutativity concept and summarizing the relevant literature, this work is focused on the commutativity of feedback conjugates. It is already known that a linear time-varying differential system describing a single input-single output dynamical system is always commutative with its constant gain feedback pairs. In this article, it is proven that among the time-varying feedback conjugates of a linear time-varying system, constant feedback conjugates are the only commutative feedback pairs and any of the time-varying feedback conjugates cannot constitute a commutative pair of a linear time-varying system.
Mind the gap
Authors: Henley Andrew
Published: May 2018

This article discusses the relationships and tensions between the sentencing, statutory supervision and legal rehabilitation of lawbreakers under UK legislation. It does so with reference to both the Rehabilitation of Offenders Act 1974, which allows some criminal records to become ‘spent’ after a set period of time, and the Offender Rehabilitation Act 2014, which was designed to significantly expand statutory supervision arrangements. The article also demonstrates how, post-supervision, many former lawbreakers are cast into a state of ‘civic purgatory’, before suggesting that a more fully integrated approach to rehabilitation is required.
The effects of inspiratory muscle training on exercise capacity, dyspnea and respiratory functions in lung transplantation candidates: a randomized controlled trial
Authors: Pehlivan Esra , Mutluay Fatma , Balcı Arif , Kılıç Lütfiye
Published: May 2018

Objective:

To investigate whether inspiratory muscle training would contribute to the improvement of exercise capacity, dyspnea perception and respiratory functions in lung transplantation candidates.

Design:

Prospective randomized controlled trial.

Setting:

Pulmonary Rehabilitation center.

Subjects:

A total of 34 patients with severe lung disease requiring lung transplantation were randomly allocated to either pulmonary rehabilitation plus inspiratory muscle training group (PR + IMT group, n = 17) or pulmonary rehabilitation group (PR group, n = 17) before any lung transplantation operation.

Methods:

All patients underwent supervised pulmonary rehabilitation program on two days per week for three months. The PR + IMT group received inspiratory muscle training in addition to the standard pulmonary rehabilitation program. The 6-minute walk test, maximal inspiratory pressure, modified Medical Research Concile dyspnea scores and spirometric parameters were measured for each patient.

Results:

The PR + IMT group had statistically significantly increased in walking distance (100 m, P = 0.03), maximum inspiratory pressure (26 cmH2O, P = 0.001) and alveolar volume ratio of carbonmonoxide diffusion capacity (9%, P = 0.02) than PR group. Although both groups demonstrated a statistically significant decrease in the dyspnea score, no significant differences were found between the groups ( P = 0.075). There was no change in spirometric variables in both groups.

Conclusion:

A greater increase in exercise capacity was observed in the PR + IMT group. Our study showed that inspiratory muscle training improved exercise capacity even further and increased the benefits provided by pulmonary rehabilitation.
The Lifespan Personal Health Record
Authors: Williams Ben T. , Imrey Harriet , Williams Richard G.
Published: May 2018

A system for entry of health data in a computer-based patient record by lay individuals is described. The lay user is supported in data entry and data clarification, as well as by system-supported summarization of the data in context to show relationships, highlight sentinel events, and assist in evaluation of alternative decisions and actions as needed.
Development, Effects, and Educational Outcomes of Reporting from a Clinical Database
Authors: Rouan Gregory , Marks Ellen , Tuchfarber Barbara , Redington T. J. , Lorenzi Nancy
Published: May 2018

To develop clinically applicable and educationally useful reports from a clinical database, the authors explored the development of such databases at a medical center. The patient-centered database (PCD) integrates disparate data resources in the service of academic clinicians, postgraduate trainees, and students. From the PCD, daily and monthly reports are generated, which include 1) census update reports, serving as an educational format for a daily case-based morning report discussion and routine rounds; 2) reports of daily admissions and patient census stratified by appropriate housestaff providing the clinical care; and 3) quality, assurance measures such as monitoring of length of stay of each patient regardless of the initial housestaff service to which the patient is initially admitted. The results of expanding the number of report beneficiaries, outcomes from a five-month test period, and possibilities for further development and implementation are considered.
IAIMS and UMLS at Columbia-Presbyterian Medical Center
Authors: Cimino James J. , Sengupta Soumitra
Published: May 2018

The authors use an example to illustrate combining Integrated Academic Information Management System (IAIMS) components (applications) into an integral whole, to facilitate using the components simultaneously or in sequence. They examine a model for classifying IAIMS systems, proposing ways in which the Unified Medical Language System (UMLS) can be exploited in them.
Workplace aggression and organisational effectiveness: The mediating role of employee engagement
Authors: Johnson Anya , Nguyen Helena , Groth Markus , White Les
Published: May 2018

We investigate the relationship between the prevalence of workplace aggression and two key outcomes: employee engagement and organisational effectiveness. Drawing on social capital theory, we propose that the level of employee engagement within the organisation helps explain the association between workplace aggression and organisational effectiveness. We used secondary survey data and an important indicator of organisational effectiveness in the healthcare sector (i.e. rates of hospital-acquired infections (HAIs)) from 101 hospitals in NSW, Australia. We found that hospitals with higher rates of workplace aggression had higher rates of patients with HAIs and that employee engagement was an important mechanism that helped explain this effect. These findings underscore the potential benefits of management policies and practices that are aimed at preventing workplace aggression and support greater employee engagement.

JEL Classification: L120
Crisis Communication Patterns in Social Media during Hurricane Sandy
Authors: Sadri Arif Mohaimin , Hasan Samiul , Ukkusuri Satish V. , Cebrian Manuel
Published: May 2018

Hurricane Sandy was one of the deadliest and costliest of hurricanes of the past few decades. Many states experienced significant power outage; however, many people used social media to communicate while having limited or no access to traditional information sources. Using machine learning techniques, this study explored the evolution of various communication patterns and determined user concerns that emerged over the course of Hurricane Sandy. The original data included ∼52M tweets coming from ∼13M users between October 14, 2012 and November 12, 2012. A topic model was run on ∼763K tweets from the top 4,029 most frequent users who tweeted about Sandy at least 100 times. Some 250 well-defined communication patterns based on perplexity were identified. Conversations of the most frequent and relevant users indicate the evolution of numerous storm-phase (warning, response, and recovery) specific topics. People were also concerned about storm location and time, media coverage, and activities of political leaders and celebrities. Also presented is each relevant keyword that contributed to one particular pattern of user concerns. Such keywords would be particularly meaningful in targeted information-spreading and effective crisis communication in similar major disasters. Each of these words can also be helpful for efficient hash-tagging to reach the target audience as needed via social media. The pattern recognition approach of this study can be used in identifying real-time user needs in future crises.
Operative Repair of Medial Patellofemoral Ligament Injury Versus Knee Brace in Children With an Acute First-Time Traumatic Patellar Dislocation: A Randomized Controlled Trial
Authors: Askenberger Marie , Bengtsson Moström Eva , Ekström Wilhelmina , Arendt Elizabeth A. , Hellsten Anna , Mikkelsen Christina , Janarv Per-Mats
Published: May 2018

Background:

A lateral patellar dislocation (LPD) is the most common traumatic knee injury with hemarthrosis in children. The redislocation rate is high. Varying operative and nonoperative treatments have been advocated with no consensus on the best treatment.

Purpose:

(1) To evaluate if arthroscopic-assisted repair of the medial patellofemoral ligament (MPFL) in patients with an acute first-time traumatic LPD would reduce the recurrence rate and offer better objective/subjective knee function compared with a knee brace without repair. (2) To study the presence of anatomic patellar instability risk factors (APIFs) and their association with a redislocation.

Study Design:

Randomized controlled trial; Level of evidence, 1.

Methods:

This was a prospective series of 74 skeletally immature patients aged 9 to 14 years (38 girls and 36 boys; mean age, 13.1 years) with a first-time traumatic LPD, with clinical examinations, radiographs, magnetic resonance imaging, and diagnostic arthroscopic surgery performed within 2 weeks of the index injury. The child was randomized to either (1) a knee brace (KB group) for 4 weeks and physical therapy or (2) arthroscopic-assisted repair (R group) of the MPFL with anchors, 4 weeks with a soft cast splint, and physical therapy. The follow-up time was 2 years.

Results:

The redislocation rate was significantly lower in the R group than in the KB group at final follow-up: 8 patients (22%) versus 16 patients (43%), respectively ( P = .047). The Knee injury and Osteoarthritis Outcome Score for children sport/play and quality of life subscales had lower scores in the R group compared with the KB group; the significant differences were among those with redislocations. The mean Kujala score was excellent in the KB group (95.9) and good in the R group (90.9). An impaired Limb Symmetry Index (median, 83%) for concentric quadriceps torque at 90 deg/s was found only in the R group. Eighty-one percent of the study patients had ≥2 APIFs. Trochlear dysplasia (trochlear depth <3 mm) had the highest odds ratio for redislocations (2.35 [95% CI, 0.69-8.03]), with no significant association between APIFs and a redislocation.

Conclusion:

Operative repair of an MPFL injury in the acute phase in skeletally immature children with a primary traumatic LPD significantly reduced the redislocation rate but did not improve subjective or objective knee function compared with a knee brace without repair. The majority of the patients in both groups were satisfied with their knee function. There was a high representation of APIFs, which needs to be considered when evaluating the risk of redislocations.

Registration:

ISRCTN 39959729 (Current Controlled Trials).
Validation of in vitro assays in three-dimensional human dermal constructs
Authors: Idrees Ayesha , Chiono Valeria , Ciardelli Gianluca , Shah Siegfried , Viebahn Richard , Zhang Xiang , Salber Jochen
Published: May 2018

Three-dimensional cell culture systems are urgently needed for cytocompatibility testing of biomaterials. This work aimed at the development of three-dimensional in vitro dermal skin models and their optimization for cytocompatibility evaluation. Initially “murine in vitro dermal construct” based on L929 cells was generated, leading to the development of “human in vitro dermal construct” consisting of normal human dermal fibroblasts in rat tail tendon collagen type I. To assess the viability of the cells, different assays CellTiter-Blue®, RealTime-Glo™ MT, and CellTiter-Glo® (Promega) were evaluated to optimize the best-suited assay to the respective cell type and three-dimensional system. Z-stack imaging (Live/Dead and Phalloidin/DAPI-Promokine) was performed to visualize normal human dermal fibroblasts inside matrix revealing filopodia-like morphology and a uniform distribution of normal human dermal fibroblasts in matrix. CellTiter-Glo was found to be the optimal cell viability assay among those analyzed. CellTiter-Blue reagent affected the cell morphology of normal human dermal fibroblasts (unlike L929), suggesting an interference with cell biological activity, resulting in less reliable viability data. On the other hand, RealTime-Glo provided a linear signal only with a very low cell density, which made this assay unsuitable for this system. CellTiter-Glo adapted to three-dimensional dermal construct by optimizing the “shaking time” to enhance the reagent penetration and maximum adenosine triphosphate release, indicating 2.4 times higher viability value by shaking for 60 min than for 5 min. In addition, viability results showed that cells were viable inside the matrix. This model would be further advanced with more layers of skin to make a full thickness model.
Electrospun poly(vinyl) alcohol/collagen nanofibrous scaffold hybridized by graphene oxide for accelerated wound healing
Authors: Senthil Rethinam , Berly Robert , Bhargavi Ram Thimmiah , Gobi Nallathambi
Published: May 2018

Purpose:

In this study, a blend of synthetic polymer (poly(vinyl) alcohol), natural polymer (collagen type I from fish bone), and graphene oxide nanoparticles is used to fabricate a composite nanofibrous scaffold, by electrospinning, for their potential application in accelerated wound healing.

Methods:

The scaffold was characterized for its physicochemical and mechanical properties. In vitro studies were carried out using human keratinocyte cell line (HaCaT) which proved the biocompatibility of the scaffold. In vivo study using mice model was carried out and the healing pattern was evaluated using histopathological studies.

Results:

Scaffold prepared from poly(vinyl) alcohol, collagen type I from fish bone, and graphene oxide possessed better physicochemical and mechanical properties. In addition, in vivo and in vitro studies showed its accelerated wound healing properties.

Conclusion:

The scaffold with required strength and biocompatibility may be tried as a wound dressing material in large animals after getting necessary approval.
On the group matrix and the morality of the nuclear deterrent: The worldview of Gregory van der Kleij
Authors: Behr Harold
Published: May 2018

This article presents the writings of Gregory van der Kleij, group analyst and Catholic priest, whose experiences of the holocaust during the Second World War shaped his thinking, not only as a therapist but also as a campaigner against the nuclear arms race. The author re-visits two significant articles on the group matrix published in this journal in the 1980s and introduces the reader to a little-known monograph addressed to the Catholic community which examines the moral dilemma faced by Christians during the Cold War. The monograph contains an exhortation to rise up in protest against what Gregory considers to be ‘the madness’ of high-level thinking on the morality of the nuclear deterrent.