bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical commentary on “Paroxysmal kinesigenic dyskinesia-like phenotype in multiple sclerosis” and “Secondary paroxysmal dyskinesia in multiple sclerosis: Clinical-radiological features and treatment. Case report of seven patients”
Authors: Pareés Isabel
Published: April 2017

This clinical commentary discusses the phenomenology and treatment of paroxysmal dyskinesia in patients with multiple sclerosis. It calls for a consensus on the definition as well as for larger studies to better understand this unusual clinical association.
Primary Physical Education
Authors: Ward Gavin , Griggs Gerald
Published: April 2017

Physical Education is widespread across the world, yet despite its cultural variation it remains remarkably similar. The ability of the subject to replicate its practices makes it a potential site for exploration from a memetic perspective. The purpose of this paper is to examine documentary evidence such as research papers, policy documents and inspection reports, and offer for consideration potential memes that are at work within the memeplex of UK, primary school Physical Education. Four proposals are offered as potential memes: ‘sport as techniques’; ‘anyone can teach it’; ‘busy, happy and good’; and ‘nowhere important’. It is concluded that the current environment in primary schooling within the UK, serves to strengthen the proposed four primary Physical Education memes by reaffirming current practices. Moving beyond these memes requires significant rethinking about what constitutes primary Physical Education.
Disgust, shame and the psychosocial impact of skin picking: Evidence from an online support forum
Authors: Anderson Suzy , Clarke Victoria
Published: April 2017

This article examines the accounts of individuals who problematically pick their skin and explores their subjective experiences. In total, 100 problem disclosure statements were taken from posts made to a publicly accessible online skin picking support forum. These posts were systematically analysed using thematic analysis. Themes of disgust, shame and psychosocial avoidance dominated the analysis and appeared central to the experience of skin picking. Skin picking was shown to be a heterogeneous experience with a complex emotional profile. We argue that disgust, shame and related avoidance behaviour should be considered when conceptualising skin picking and considering treatment interventions.
Redefining the bottom of the pyramid from a marketing perspective
Authors: Yurdakul Dicle , Atik Deniz , Dholakia Nikhilesh
Published: April 2017

Marketing literature has remained mostly silent on the issue of conceptualization of poverty, relying instead on the available definitions of the bottom-of-the-pyramid (BOP) “poor” from economics and sociology. Consequently, in marketing theory, the analytic bases and the practical implications of poverty-centered discourses sometimes remain ambiguous. This study provides a broader, culture-linked conceptualization of poverty and BOP from a consumer research perspective, initiating a dialogue on bottom-up approaches to understanding what poverty means through the lenses of the poor. Via qualitative methods such as semistructured individual in-depth interviews, observations, and fieldnotes, deeper insights were sought on how poverty can be defined from the perspectives of the poor. Transcending the economic-only approach, this study contributes to the literature by extending the contours of “felt poverty” and of the “poverty line” beyond the biogenic and stark utilitarian needs and incorporates the sociocultural dimensions of consumption. Our contribution comes from including the effects of the global consumer culture as a major source of social deprivation. Furthermore—while supporting the positions that the definitions of BOP are relative to contexts, cultures, and times—we also situate the discussion of BOP within the broader discourse on globalization of markets and consumption practices.
The Use of Stroke Volume Variation to Guide Donor Management Is Associated With Increased Organs Transplanted per Donor
Authors: Bergstrom Benjamin , de la Cruz J. Salvador , Sally Mitch , Louis Scott , Friedman Melissa , Petersen Floyd , Malinoski Darren
Published: April 2017

Background:

There is a national shortage of organs available for transplantation, and utilization rates for thoracic organs are less than 40%. In addition, the optimal method of assessing cardiovascular status during donor management is uncertain. FloTrac is a noninvasive hemodynamic technique that measures cardiac output and fluid responsiveness. Our objective was to measure the impact of using this technique to guide management on fluid balance, vasopressor usage, thyroid hormone usage, and pulmonary function. We hypothesized that FloTrac guidance will increase thoracic organs transplanted per donor (OTPD).

Methods:

Data were prospectively collected on a convenience sample of 38 donors after neurologic determination of death. Organs transplanted, net fluid balance, dosage of vasopressors, dosage of thyroid hormone, and Pao2:Fio2 were compared between treatment and control groups.

Results:

The treatment group had greater thoracic OTPD (1.3 [1.0] vs 0.4 [0.6], P = .004) and overall OTPD (4.3 [1.5] vs 2.7 [1.5], P = .002). Donors in the treatment group maintained a neutral fluid balance, had more thyroid hormone used, and had an improvement in oxygenation.

Conclusion:

The implementation of this technology to aid providers may help ameliorate the shortage of thoracic and overall organs available for transplantation.
A link prediction approach based on deep learning for opportunistic sensor network
Authors: Shu Jian , Chen Qifan , Liu Linlan , Xu Lei
Published: April 2017

Link prediction for opportunistic sensor network has been attracting more and more attention. However, the inherent dynamic nature of opportunistic sensor network makes it a challenging issue to ensure quality of service in opportunistic sensor network. In this article, a novel deep learning framework is proposed to predict links for opportunistic sensor network. The framework stacks the conditional restricted Boltzmann machine which models time series by appending connections from the past time steps. A similarity index based on time parameters is proposed to describe similarities between nodes. Through tuning learning rate layer-adaptively, reconstruction error of restricted Boltzmann machine goes stable rapidly so that the convergence time is shortened. The framework is verified by real data from INFOCOM set and MIT set. The results show that the framework can predict links of opportunistic sensor network effectively.
Improved method of step length estimation based on inverted pendulum model
Authors: Zhao Qi , Zhang Boxue , Wang Jingjing , Feng Wenquan , Jia Wenyan , Sun Mingui
Published: April 2017

Step length estimation is an important issue in areas such as gait analysis, sport training, or pedestrian localization. In this article, we estimate the step length of walking using a waist-worn wearable computer named eButton. Motion sensors within this device are used to record body movement from the trunk instead of extremities. Two signal-processing techniques are applied to our algorithm design. The direction cosine matrix transforms vertical acceleration from the device coordinates to the topocentric coordinates. The empirical mode decomposition is used to remove the zero- and first-order skew effects resulting from an integration process. Our experimental results show that our algorithm performs well in step length estimation. The effectiveness of the direction cosine matrix algorithm is improved from 1.69% to 3.56% while the walking speed increased.
ASMT: An augmented state-based multi-target tracking algorithm in wireless sensor networks
Authors: Xiao Kejiang , Wang Rui , Zhang Lei , Li Jian , Fun Tun
Published: April 2017

Due to the resource limitation and low performance of sensor node, research works of multi-target tracking became a hot spot in the applications of wireless sensor networks. Here, we propose an algorithm named augmented state-based multi-target tracking algorithm. To augment the state of the target tracking, augmented state-based multi-target tracking algorithm can effectively reduce the computational complexity of data association. Then, multi-target tracking in wireless sensor networks can be implemented by augmented state-based multi-target tracking algorithm as a simplified Bayesian estimation method is adopted. The simulation of multi-target tracking in wireless sensor networks demonstrates that augmented state-based multi-target tracking algorithm has less computation and higher accuracy than traditional method, especially in the implementation of maneuvering targets with intersection.
Fall prediction based on biomechanics equilibrium using Kinect
Authors: Tao Xu , Yun Zhou
Published: April 2017

The fall is one of the most important research fields of solitary elder healthcare at home based on Internet of Things technology. Current studies mainly focus on the fall detection, which helps medical staffs bring a fallen elder out of danger in time. However, it neither predicts a fall nor provides an effective protection against a fall. This article studies the fall prediction based on human biomechanics equilibrium and body posture characteristics through analyzing three-dimensional skeleton joints data from the depth camera sensor Kinect. The research includes building a human bionic mass model using skeleton joints data from Kinect, determining human balance state, and proposing a fall prediction algorithm based on recurrent neural networks by unbalanced posture features. We evaluate the model and algorithm on an open database. The performance indicates that the fall prediction algorithm by studying human biomechanics can predict a fall (91.7%) and provide a certain amount of time (333 ms) before the elder injuring (hitting the floor). This work provides a technical basis and a data analytics approach for the fall protection.
The Clinical Application of Mastectomy With Single Incision Followed by Immediate Laparoscopic-Assisted Breast Reconstruction With Latissimus Dorsi Muscle Flap
Authors: Yuan Huozhong , Xie Donghua , Xiao Xigang , Huang Xingwei
Published: April 2017

Objective: To explore the clinical application of mastectomy with single incision followed by immediate laparoscopic-assisted breast reconstruction with latissimus dorsi muscle flap. Methods: Fifteen women with primary early breast cancer, 3 women with breast ductal carcinoma in situ, and 7 women with severe plasma cell mastitis were treated with partial mastectomy or total mastectomy, sentinel lymph node biopsy, or axillary lymph node dissection through a breast lateral transverse incision. Subsequent breast reconstruction with latissimus dorsi muscle flap was assisted by laparoscopy. The patient’s position, time used in dissecting latissimus dorsi muscle flap, size of latissimus dorsi muscle flap, postoperative complications, and the cosmetic results after reconstruction were assessed. Results: All the operations were well done through the breast lateral transverse incision and assistance of laparoscopy. The patient’s position was changed only once during the operation. It took 1.5 to 2 hours to dissect latissimus dorsi muscle flap. The sizes of the latissimus dorsi muscle flap were 5 to 8 × 12 to 16 cm. There were no serious postoperative complications noted. The patients were satisfied with the appearance of the breasts and the small surgical scar. Conclusion: The surgical approach introduced is minimally invasive with concealed scar and outstanding cosmetic results. It is worth promoting in clinical application.
Noncyclic scheduling of dual-armed cluster tools for minimization of wafer residency time and makespan
Authors: Sakai Masaru , Nishi Tatsushi
Published: April 2017

Cluster tools are used for semiconductor wafer fabrication. A cluster tool consists of several loadlock modules, processing modules, and material handling armed robots to transfer wafers between loadlocks and processing modules. Most conventional scheduling methods consider a cyclic schedule to minimize makespan. We consider noncyclic scheduling of dual-armed cluster tools. In practice, it is important to minimize wafer residency time in processing modules to maintain the surface quality of wafers. In the noncyclic operations, the cluster tool causes deadlock which may lead to excessive loss in the wafer fabrication process. We propose an efficient deadlock-free scheduling method for the noncyclic scheduling problem of a dual-armed cluster tool to minimize the residency time and makespan. The proposed method is applied to a dual-armed cluster tool with a non-revisiting process and a revisiting process. Computational results demonstrate the effectiveness of the proposed method.
Aluminum nitride–filled elastic silicone rubber composites for drag reduction
Authors: Tian Limei , Wang Yangjun , Jin E , Li Yinwu , Wang Runmao , Shang Yangeng
Published: April 2017

This study presents aluminum nitride/silicone rubber composite as a drag reduction material, inspired by the boundary heating drag reduction mechanism of dolphin skin. Aluminum nitride was added as a thermal conductive filler at weight fractions of 16.67, 21.05, and 28.57 wt% to pristine silicone rubber. Tests of the thermal conductivity and tensile properties showed that the thermal conductivity of all three aluminum nitride/silicone rubber composites were increased 27.9%, 41.4%, and 43.7% than that of the pristine silicone rubber, and the elastic modulus of the composites was increased with the aluminum nitride content. Droplet velocity testing, which can reflect the drag reduction mechanism of the heating boundary controlled by the aluminum nitride/silicone rubber composites, was performed between all three aluminum nitride/silicone rubber composites and pristine silicone rubber. The results showed that the droplet velocity of all three aluminum nitride/silicone rubber composites were higher than pristine silicone rubber, implying that the composites had a drag-reducing function. In terms of the drag-reducing mechanism, the heat conductivity performance of the aluminum nitride/silicone rubber accelerates the heat transfer between the aluminum nitride/silicone rubber composite surface and droplet. The forces between the molecules and droplet dynamic viscosity are reduced, which result in drag reduction. The application of aluminum nitride/silicone rubber composite to control fluid medium will have important value for fluid machinery.
Recovery of mechanical detection thresholds after direct digital nerve repair versus conduit implantation
Authors: Huber J. L. , Maier C. , Mainka T. , Mannil L. , Vollert J. , Homann H.-H.
Published: April 2017

The purpose of this study was to assess sensory and functional nerve recovery after digital nerve injury in patients with an end-to-end suture (S) or with implantation of a collagen conduit (C) to bridge a nerve gap. Fifteen S and 11 C with a follow-up of 6–36 months and 28 healthy control participants were enrolled. Methods of assessments were quantitative sensory testing, the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH), range of motion and the painDetect questionnaire. After both procedures, sensory profiles showed largely recovered function of C and Aδ fibres but severe loss of Aβ-fibre function leading to increased mechanical detection thresholds. There was only minimal allodynia. Severe pain was absent. Patients with conduits reported more functional impairment, especially in work performance, which correlated with the assessed loss of Aß-fibre function.

Level of evidence: III
Assessing the Validity of Emotional Intelligence Measures
Authors: Miners Christopher T. H. , Côté Stéphane , Lievens Filip
Published: April 2017

We describe an approach that enables a more complete evaluation of the validity of emotional intelligence measures. We argue that a source of evidence for validity is often overlooked by researchers and test developers, namely, evidence based on response processes. This evidence can be obtained through (a) a definition of the ability, (b) a description of the mental processes that operate when a person uses the ability, (c) the development of a theory of response behaviour that links variation in the construct with variation on the responses to the items of a measure, and (d) a test of the theory of response behaviour through one or more strategies that we describe.
An update on best practice in the diagnosis and management of post-prostatectomy anastomotic strictures
Authors: Rocco Nicholas R , Zuckerman Jack M
Published: April 2017

Postprostatectomy vesicourethral anastomotic stenosis (VUAS) remains a challenging problem for both patient and urologist. Improved surgical techniques and perioperative identification and treatment of risk factors has led to a decline over the last several decades. High-level evidence to guide management is lacking, primarily relying on small retrospective studies and expert opinion. Endourologic therapies, including dilation and transurethral incision or resection with or without adjunct injection of scar modulators is considered first-line management. Recalcitrant VUAS requires surgical reconstruction of the vesicourethral anastomosis, and in poor surgical candidates, a chronic indwelling catheter or urinary diversion may be the only option. This review provides an update in the diagnosis and management of postprostatectomy VUAS.
The effects of tolterodine on anterior segment and choroidal thickness in patients with overactive bladder syndrome
Authors: Telek Hande Hüsniye , Doluoglu Omer Gokhan , Burcu Ayse , Demirok Gulizar , Ornek Firdevs , Ayyildiz Ali
Published: April 2017

Background:

To evaluate the effects of tolterodine on anterior segment and choroidal thickness by using the Pentacam system and optical coherence tomography (OCT) (Pentacam).

Methods:

A total of 122 eyes of 61 patients (34 female; 27 male) were included in the study. All patients underwent a regular ocular examination and intraocular pressure measurements before and after 3 months of antimuscarinic drug tolterodine treatment, in addition, pupil diameter, anterior chamber depth, anterior chamber volume, anterior chamber angle, and lens thickness were measured through Pentacam (Oculus Inc., Wetzlar, Germany) system. Measurements of choroidal thickness were performed by OCT (Spectralis®, Heidelberg Engineering, Heidelberg, Germany).

Results:

The mean age was 58.4 ± 7.3 years and 56.5 ± 11.1 years for female and male patients. The mean intraocular pressure was 15.10 ± 2.75 mmHg before treatment and 15.18 ± 2.65 mmHg after treatment. Pupil diameters were 3.09 ± 0.48 mm before treatment and 3.12 ± 0.43 mm after treatment. Anterior chamber depth, before and after treatment were 2.68 ± 0.65 mm and 2.70 ± 0.61 mm. The mean value for subfoveal choroidal thickness was 267.92 ± 81.35 μm before the administration of tolterodine, whereas the mean choroidal thickness was 271.83 ± 75.42 μm after the administration of tolterodine. The alterations in the subfoveal choroidal thickness were not statistically significant ( p = 0.862).

Conclusions:

After 3 months of therapy with tolterodine, there were no significant changes in anterior segment parameters and choroidal thickness.
Better, Sooner, More Convenient? The reality of pursuing greater integration between primary and secondary healthcare providers in New Zealand
Authors: Lovelock Kirsten , Martin Greg , Gauld Robin , MacRae Jayden
Published: April 2017

Objectives:

This article focuses on the results of evaluations of two business plans developed in response to a policy initiative which aimed to achieve greater integration between primary and secondary health providers in New Zealand. We employ the Consolidated Framework for Implementation Research to inform our analysis. The Better, Sooner, More Convenient policy programme involved the development of business plans and, within each business plan, a range of areas of focus and associated work-streams.

Methods:

The evaluations employed a mixed method multi-level case study design, involving qualitative face-to-face interviews with front-line staff, clinicians and management in two districts, one in the North Island and the other in the South Island, and an analysis of routine data tracked ambulatory sensitive hospitalisations and emergency department presentations. Two postal surveys were conducted, one focussing on the patient care experiences of integration and care co-ordination and the second focussing on the perspectives of health professionals in primary and secondary settings in both districts.

Results:

Both evaluations revealed non-significant changes in ambulatory sensitive hospitalisations and emergency department presentation rates and slow uneven progress with areas of focus and their associated work-streams. Our evaluations revealed a range of implementation issues, the barriers and facilitators to greater integration of healthcare services and the implications for those who were responsible for putting policy into practice.

Conclusion:

The business plans were shown to be overly ambitious and compromised by the size and scope of the business plans; dysfunctional governance arrangements and associated accountability issues; organisational inability to implement change quickly with appropriate and timely funding support; an absence of organisational structural change allowing parity with the policy objectives; barriers that were encountered because of inadequate attention to organisational culture; competing additional areas of focus within the same timeframe; and consequent overloading of front-line staff which led to workload stress, fatigue and disillusionment. Where success was achieved, this largely hinged on the enthusiasm of a small pool of front-line workers and their initial buy-into the idea of integrated care.
Density, race, and vote choice in the 2008 and 2012 presidential elections
Authors: Teigen Jeremy M. , Shaw Daron R. , McKee Seth C.
Published: April 2017

Voting is a complex dynamic driven by the sociopolitical attributes of individuals and how they are spatially located in proximity to similar or different populations. In this research note we examine how presidential vote choice is influenced by the interaction between the population density and racial composition of the ZIP code of respondents in the 2008 and 2012 Cooperative Congressional Election Studies. Our findings reveal interesting patterns with respect to a respondent’s racial background. For whites in racially diverse settings, as density increases, so does support for Obama. By contrast, for blacks the spatial and racial context has almost no effect, providing evidence in support of the claim that this is a group strongly attached to the Democratic Party and its co-racial standard-bearer.
“For Me, the Biggest Benefit Is Being Ahead of the Game”:The Use of Social Media in Health Work
Authors: Lupton Deborah , Michael Mike
Published: April 2017

Using social media in the workplace raises a number of issues for any occupation. In this article, we report the findings of a study that investigated how social media are used in a field of health work. The study uses semi-structured interviews conducted by telephone with 15 participants working in communicable disease in Australia. We identified several key features shaping the use of social media. These included the sociomaterial aspects of the workplace (to what extent employees were provided with access to and allowed to use the Internet), the affordances of social media technologies (fast and real-time communication and sharing, opportunities to easily connect with peers as well as the public, and the casual tone of interactions), tacit norms and assumptions about professional behavior and social media (whether social media are considered to be appropriate tools to use for work and how they should best be used), the specific nature of people’s work (how sensitive, stigmatized, contentious, or political were the diseases they focused on), and the nature of people’s own experiences (how other social media users responded to them, what value they perceived they gained from using social media for work, and the types of networks they were able to establish). The findings of this study highlight the importance of context when considering how people use social media in the workplace.
“I Know I’m an Adult When…I Can Care for Myself and Others”
Authors: Katsiaficas Dalal
Published: April 2017

Growing populations of emerging adults are demographically diverse in terms of race/ethnicity, socioeconomic status, and immigration history in the United States and many attend community colleges. Yet, we still do not fully understand the developmental experiences of emerging adults in community colleges which mostly serve low-income, ethnically diverse immigrant-origin commuter populations. This descriptive mixed-method study examined the ways in which ( N = 645) 18- to 25-year-old students at three community college campuses in the Northeast United States perceive adulthood and identify criteria for adulthood. Participants responded to measures of subjective sense of adulthood and responsibilities for family, community, and work, as well as provided an open-ended response to criteria for adulthood. Subjective sense of adulthood significantly increased with age. Participants listed responsibilities for themselves and others, independence, and role transitions as the three most important criteria characteristic of adulthood. Findings revealed that as community college students emerge into adulthood, they engage in multiple social responsibilities as they navigate community college. Furthermore, engaging with community responsibilities was associated with higher levels of subjective sense of adulthood. These data point to the possible existence of a sixth pillar of emerging adulthood, caring for others. Community colleges need to take into account the various social responsibilities present in students’ lives, not only as a competing responsibility on the road to degree attainment but as a resource to be drawn upon. We must find ways for these youth to contribute to both the institutional and economic structures that they find themselves embedded within.
Efficacy of Early Fusion With Local Bone Graft and Platelet-Rich Plasma in Lumbar Spinal Fusion Surgery Followed Over 10 Years
Authors: Imagama Shiro , Ando Kei , Kobayashi Kazuyoshi , Ishikawa Yoshimoto , Nakamura Hiroshi , Hida Tetsuro , Ito Kenyu , Tsushima Mikito , Matsumoto Akiyuki , Morozumi Masayoshi , Tanaka Satoshi , Machino Masaaki , Ota Kyotaro , Nakashima Hiroaki , Takamatsu Junki , Matsushita Tadashi , Nishida Yoshihiro , Ishiguro Naoki , Matsuyama Yukihiro
Published: April 2017

Study Design:

Prospective clinical study.

Objective:

Many oral surgeons use platelet-rich plasma (PRP) for bone defects, but the efficacy of PRP for spinal arthrodesis remains uncertain. The objective was to compare the efficacy of autologous local bone graft and PRP with local bone graft alone for promotion of bony union in posterolateral lumbar fusion (PLF) surgery, with investigation of the safety of PRP over 10 years.

Methods:

A prospective study was conducted in 29 consecutive patients who underwent one-level PLF at L4/5 for degenerative lumbar disease. Local bone on the left (control) side and local bone with PRP on the right side were grafted. The fusion area and absorption of grafted bone at 58 regions were determined using computed tomography at 2 weeks and 3, 6, and 12 months after surgery.

Results:

Average bone fusion areas on the PRP side were significantly wider at 3 and 6 months after surgery ( P < .05). Average absorption values were significantly lower on the PRP side than on the control side at 3 and 6 months after surgery ( P < .05). The PRP/control ratio was significantly different at 3 and 6 months compared to that at 2 weeks ( P < .005). No adverse events related to PRP occurred with good clinical outcome over 10 years follow-up.

Conclusions:

Local application of PRP combined with autologous local bone graft has a positive impact on early fusion for lumbar arthrodesis with no adverse events over 10 years, and thus is a safe and low cost autologous option in spinal fusion.
Usefulness of Tokuhashi Score in Survival Prediction of Patients Operated for Vertebral Metastatic Disease
Authors: Gruenberg Marcelo , Mereles Maximiliano E. , Willhuber Gastón O. Camino , Valacco Marcelo , Petracchi Matias G. , Solá Carlos A.
Published: April 2017

Study Design:

Retrospective study.

Objective:

Spinal metastasis can produce pain, deformity, neurological compromise and can decrease life expectancy. Surgical management is usually indicated for pain control, neurological decompression, and to avoid deformity progression. Tokuhashi et al created a scoring system to estimate survival and stratify surgical treatment based on established parameters. Our objective was to evaluate the usefulness of Tokuhashi scoring (TS) system by comparing the predicted and real survival times and analyze the survival time according to the type of tumor.

Methods:

From 2004 to 2014, 105 patients with vertebral metastasis who underwent surgical treatment were enrolled and retrospectively analyzed. Preoperative TS was performed in all cases. Patients were classified into 3 groups according to TS; group 1 (TS 0-8), group 2 (TS 9-11), and group 3 (TS 12-15). Patients’ average age was 61.5 years, main primary tumor site were as follows: kidney (23%), lung (19%), and breast (18%).

Results:

The Tokuhashi general concordance was 67.6%. Per group concordance was as follows: group 1 80%, in group 2, only 33% of concordance was observed. In group 3, 100% of concordance was observed. In group 2, the most common primary sites were breast and kidney and the mean survival was 20 and 22.3 months, respectively, both longer than that expected for this group.

Conclusions:

Tokuhashi concordance was acceptable in our study, particularly in lower and higher scores. The lesser concordance observed in group 2 (33.3%) was observed in almost all tumors. For our practice, TS constitutes an acceptable tool to define survival, particularly in lower and higher scores.
Assessing Foraminal Stenosis in the Cervical Spine: A Comparison of Three-Dimensional Computed Tomographic Surface Reconstruction to Two-Dimensional Modalities
Authors: Schell Adam , Rhee John M. , Holbrook John , Lenehan Eric , Park Kun Young
Published: April 2017

Study Design:

Retrospective radiographic study.

Objective:

The optimal radiographic modality for assessing cervical foraminal stenosis is unclear. Determination on conventional axial cuts is made difficult due in part to the complex, oblique orientation of the cervical neuroforamen. The utility of 3-dimensonal (3D) computed tomography (CT) reconstruction in improving neuroforaminal assessment is not well understood. The objective of this study is to determine inter-rater variability in grading cervical foraminal stenosis using 3 different CT imaging modalities: 3D CT surface reconstructions (3DSR), 2D sagittal oblique multiplanar reformations (2D-SOMPR), and conventional 2D axial CT imaging.

Methods:

Pretreatment CT scans of 25 patients undergoing surgery for cervical spondylotic radiculopathy were analyzed at 2 levels: C5-C6 and C6-C7. Simple interrater agreement and kappa-Fleiss coefficients were calculated for each imaging modality and stenosis grade. Image reviewers (attending spine surgeon, attending neuroradiologist, spine fellow) interpreted each CT scan in 3 different formats: axial, 2D-SOMPR, and 3DSR. Four cervical foramina at 2 spinal levels were graded as normal (no stenosis), mild (≤25% stenosis), moderate (25%-50% stenosis), or severe (>50% stenosis).

Results:

Across all imaging modalities, interrater reliability was fair when grading foraminal stenosis (κ < 0.4). Agreement was lowest for the axial images (κ = 0.119) and highest for the 3D CT reconstructions (κ = 0.334). 2D-SOMPR images also led to improved interrater reliability when compared with axial images (κ = 0.255).

Conclusion:

Grading cervical foraminal stenosis using conventional axial CT imaging is difficult with low interrater reliability. CT modalities that provide a circumferential view of the cervical foramen, such as 2D-SOMPR and 3D CT reconstruction, had higher rates of interobserver reliability in grading foraminal stenosis than conventional axial cuts, with 3D having the highest. As these 3D reconstructions can be obtained at no additional cost or radiation exposure over a conventional CT scan, and because they can provide useful information in determining levels being considered for surgical decompression, we recommend they be utilized when evaluating cervical foramina.
Postoperative Kinetics of C-Reactive Protein and Erythrocyte Sediment Rate in One-, Two-, and Multilevel Posterior Spinal Decompressions and Instrumentations
Authors: Kunakornsawat Sombat , Tungsiripat Rachata , Putthiwara Dechporn , Piyakulkaew Chaiwat , Pluemvitayaporn Tinnakorn , Pruttikul Pritsanai , Kittithamvongs Piyabuth
Published: April 2017

Study design:

Prospective study.

Objective:

To characterize the normal pattern of kinetics of postoperative C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) after decompression, spinal instrumentation, and posterolateral fusion in 1, 2, and more than 2 levels.

Methods:

Blood specimens were obtained from patients who underwent posterior decompression, instrumentation with pedicular screws, and posterolateral fusion from June 2009 to January 2011. CRP and ESR levels were measured on the day before surgery and on postoperative days 1, 3, 7, 11, 14, 28, and 42.

Results:

Mean CRP levels peaked on the third day postoperatively in all groups. By day 7 postoperatively, it had dropped rapidly. At the 14th and 28th postoperative days, decreases to normal CRP levels were found in 16% and 80% of all patients, respectively. The pattern of decline in CRP was similar among groups. Values of ESR increased and peaked between the third and seventh postoperative days. ESR values gradually decreased. At the 42 day postoperatively, ESR level still remain above normal values in all groups.

Conclusions:

We compared conventional operation groups of 1-, 2-, and more than 2-level posterior instrumentation and found no statistically significant differences in the peak of CRP level, the ESR value, and the pattern of decline. CRP levels of 80% of the patients returned to normal within 4 weeks.
Multi-Rod Constructs Can Prevent Rod Breakage and Pseudarthrosis at the Lumbosacral Junction in Adult Spinal Deformity
Authors: Merrill Robert K. , Kim Jun S. , Leven Dante M. , Kim Joung Heon , Cho Samuel K.
Published: April 2017

Study Design:

Retrospective cohort study.

Objective:

To determine if patients fused with multi-rod constructs to the pelvis have a lower incidence of lumbosacral rod failure and pseudarthrosis than those fused with dual-rod constructs.

Methods:

We performed a retrospective review of consecutive adult spinal deformity patients who underwent long fusion to the pelvis. Inclusion criteria were >5 levels, primary fusion or revision for L5-S1 pseudarthrosis, and minimum 1-year follow-up. Revision patients with indications other than L5-S1 pseudarthrosis were excluded. One-year follow-up plain radiographs were reviewed for rod integrity, and computed tomography scan (CT) was obtained whenever rod breakage was observed. Dual-rod and multi-rod (3 or 4 rods) cohorts were statistically compared.

Results:

There were 31 patients with 15 in the dual-rod group and 16 in the multi-rod group, with average ages of 68 ± 9 and 63 ± 12 years, respectively. No patients in the multi-rod group experienced rod fracture, whereas 6 in the dual-rod group fractured a rod ( P = .007), with 4 occurring at the lumbosacral junction ( P = .04). CT scan in the 4 lumbosacral rod fracture cases, and surgical exploration in 3, confirmed pseudarthrosis and hypertrophic nonunion at the L5-S1 junction.

Conclusion:

Patients with dual-rod constructs had a statistically greater incidence of lumbosacral pseudarthrosis with implant failure than those with multi-rod constructs. CT and surgical exploration showed hypertrophic nonunion as opposed to oligo- or atrophic nonunion. This suggests that mechanical instability, not biology, is the main reason for failure, and could be addressed with the use of multi-rods.
Risk Factors for Delirium After Spine Surgery in Extremely Elderly Patients Aged 80 Years or Older and Review of the Literature: Japan Association of Spine Surgeons with Ambition Multicenter Study
Authors: Kobayashi Kazuyoshi , Imagama Shiro , Ando Kei , Ishiguro Naoki , Yamashita Masaomi , Eguchi Yawara , Matsumoto Morio , Ishii Ken , Hikata Tomohiro , Seki Shoji , Terai Hidetomi , Suzuki Akinobu , Tamai Koji , Aramomi Masaaki , Ishikawa Tetsuhiro , Kimura Atsushi , Inoue Hirokazu , Inoue Gen , Miyagi Masayuki , Saito Wataru , Yamada Kei , Hongo Michio , Matsuoka Yuji , Suzuki Hidekazu , Nakano Atsushi , Watanabe Kazuyuki , Chikuda Hirotaka , Ohya Junichi , Aoki Yasuchika , Shimizu Masayuki , Futatsugi Toshimasa , Mukaiyama Keijiro , Hasegawa Masaichi , Kiyasu Katsuhito , Iizuka Haku , Iizuka Yoichi , Kobayashi Ryoichi , Nishida Kotaro , Kakutani Kenichiro , Nakajima Hideaki , Murakami Hideki , Demura Satoru , Kato Satoshi , Yoshioka Katsuhito , Namikawa Takashi , Watanabe Kei , Nakanishi Kazuyoshi , Nakagawa Yukihiro , Yoshimoto Mitsunori , Fujiwara Hiroyasu , Nishida Norihiro , Imajo Yasuaki , Yamazaki Masashi , Sakane Masataka , Abe Tetsuya , Fujii Kengo , Kaito Takashi , Furuya Takeo , Orita Sumihisa , Ohtori Seiji
Published: April 2017

Study Design:

Retrospective database analysis.

Objective:

Spine surgeries in elderly patients have increased in recent years due to aging of society and recent advances in surgical techniques, and postoperative complications have become more of a concern. Postoperative delirium is a common complication in elderly patients that impairs recovery and increases morbidity and mortality. The objective of the study was to analyze postoperative delirium associated with spine surgery in patients aged 80 years or older with cervical, thoracic, and lumbar lesions.

Methods:

A retrospective multicenter study was performed in 262 patients 80 years of age or older who underwent spine surgeries at 35 facilities. Postoperative complications, incidence of postoperative delirium, and hazard ratios of patient-specific and surgical risk factors were examined.

Results:

Postoperative complications occurred in 59 of the 262 spine surgeries (23%). Postoperative delirium was the most frequent complication, occurring in 15 of 262 patients (5.7%), and was significantly associated with hypertension, cerebrovascular disease, cervical lesion surgery, and greater estimated blood loss ( P < .05). In multivariate logistic regression using perioperative factors, cervical lesion surgery (odds ratio = 4.27, P < .05) and estimated blood loss ≥300 mL (odds ratio = 4.52, P < .05) were significantly associated with postoperative delirium.

Conclusions:

Cervical lesion surgery and greater blood loss were perioperative risk factors for delirium in extremely elderly patients after spine surgery. Hypertension and cerebrovascular disease were significant risk factors for postoperative delirium, and careful management is required for patients with such risk factors.
Demystifying the Survival of North Korea
Authors: Yea Sanghan
Published: April 2017

North Korea still exists. The majority of researchers today tend to attribute the nation’s surprising resilience to the total social control the regime exerts. There are telltale signs, however, that the information cordon that once surrounded the country is deteriorating and that the outside world is filtering in through such means as cell phones. It is therefore reasonable to assume that North Koreans already have accumulated enough information to judge how miserable and hopeless their lot is. A true mystery of North Korea thus becomes the question of why the regime has survived, when so many North Koreans hate it. There is some parallelism between the present-day North Korea and the final days of Germany under the Third Reich. At that time, although Germans knew how despicable the Hitler regime was and how that regime was bound to end, they nonetheless supported Hitler and fought to the end. This has been ascribed to their fear of the Soviet Red Army. In this vein, we could assume that North Koreans see no alternative to the current regime and instead opt to be inert because they believe they face an overwhelming threat to their existence, as the Germans did 70 years ago.
Nuclear Strategy and Regional Stability in Southern Asia
Authors: Mehdi Jalil
Published: April 2017

The essay aims to explain interconnections between international security, domestic politics and nuclear strategy of China, India and Pakistan. Most of the scholarship has been unable to probe the deep interconnections that inform the nuclear strategy of these three countries. The literature is based on a generalisation of the superpowers’ Cold War nuclear experience and an analysis of the other nuclear powers’ arsenal is made through the conceptual and theoretical categories offered by such literature. This article argues against using cold war experiences as a basis for conceptualizing regional powers’ nuclear strategies. It begins with a discussion on Posture optimization theory, applying it to understand nuclear strategies of the three Southern Asian nuclear powers and seeks to understand the nature of strategic competition between them and its effect on their respective nuclear postures.
Martha Jane Cunningham: A Women’s Missionary Society Pioneer
Authors: Dugal Alexandria
Published: April 2017

By the early twentieth century the Canadian women’s missionary movement had collectively become the largest women’s organization in North America. The Women’s Missionary Society of the Methodist Church of Canada (WMS), established in 1880, founded three girl’s schools in Japan to help meet the need for female education and to evangelize through these students. One of these schools was Shizuoka Eiwa Jo Gakkō of Shizuoka, whose first principal was Martha Jane Cunningham, a WMS missionary from Halifax, Nova Scotia. This article tells her life-story.
Shirin Ebadi and Gloria Steinem on Perspective as Key to Addressing Violence
Authors: Gupta Ruchira
Published: April 2017

This piece is based on conversations the author had with Gloria Steinem and Shirin Ebadi over the years; and explores the concept of stayagraha in the backdrop of the feminist movement, terrorism and state sponsored violence. It draws out Gloria’s understanding of stayagraha and non-violence, and is an attempt at understanding the psyche which has sustained Ebadi’s non-violent struggle for peace and human rights in Iran all through these years, despite the vitriolic attacks on her by the state.
Women in Satyagraha
Authors: Das Varsha
Published: April 2017

This photo essay illustrates how women played an active role in the Satyagraha movements during and before the independence of India. The photographs have been sourced from the National Gandhi Museum, New Delhi.
Clonal selection and asymmetric distribution of human leukemia in murine xenografts revealed by cellular barcoding
Authors: Belderbos Mirjam E. , Koster Taco , Ausema Bertien , Jacobs Sabrina , Sowdagar Sharlaine , Zwart Erik , de Bont Eveline , de Haan Gerald , Bystrykh Leonid V.
Published: April 2017

Key Points

Patient-derived leukemia xenografts are highly polyclonal and show stochastic and clone-size–driven selection. Leukemia clones are asymmetrically distributed in xenografts and preferentially localize to the bone marrow or to extramedullary sites.
Zika and chikungunya virus infections in hematopoietic stem cell transplant recipients and oncohematological patients
Authors: Machado Clarisse Martins , Pereira Bárbara Brito de Souza , Felix Alvina Clara , Oliveira Maria Carolina , Darrigo Luiz Guilherme , de Souza Mair Pedro , Paton Eduardo José de Alencar , Neves Fabia , Colturato Vergilio Rensi , Simoes Belinda Pinto
Published: April 2017

Key Points

This article describes the first reports of Zika and chikungunya infections in HSCT recipients and oncohematological patients. Fever and exanthema should prompt arbovirus diagnosis, especially in areas at risk or in patients returning from endemic or epidemic regions.
Laparoscopic uterovaginal prolapse surgery in the elderly: feasibility and outcomes
Authors: King Samuel W. , Jefferis Helen , Jackson Simon , Marfin Alexander G. , Price Natalia
Published: April 2017

Background

Uterovaginal prolapse in very elderly women is a growing problem due to increased life expectancy. Surgeons and anaesthetists may be wary of performing quality of life surgery on this higher risk group. Where surgery is undertaken, it is commonly performed vaginally; there is a perception that this is better tolerated than abdominal surgery.

Little data is published about laparoscopic prolapse surgery tolerability in this population, and laparoscopic surgery is perceived within the urogynaecological community as complex and lengthy and hence inherently unsuitable for the very elderly.

In Oxford, UK, laparoscopic abdominal surgical techniques are routinely employed for urogynaecological reconstructive surgery. The authors offer abdominal laparoscopic prolapse surgery to patients suitable for general anaesthesia with apical vaginal prolapse, irrespective of age. We here report outcomes in this elderly patient cohort and hypothesise these to be acceptable.

This is a retrospective case note review of all patients aged 79 years old and above undergoing laparoscopic prolapse surgery (hysteropexy or sacrocolpopexy) in two centres in Oxford, UK, over a 5-year period (n = 55). Data were collected on length of surgery, length of stay, intraoperative complications, early and late post-operative complications and surgical outcome.

Results

Mean age was 82.6 years (range 79–96). There were no deaths. Minor post-operative complications such as UTI and constipation were frequent, but there were no serious (Clavien-Dindo grade III or above) complications; 80% achieved objective good anatomical outcome.

Conclusions

Laparoscopic prolapse surgery appears well tolerated in the elderly with low operative morbidity and mortality.