bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Role of Neoadjuvant Versus Adjuvant Therapy for Duodenal Adenocarcinoma: A National Cancer Database Propensity Score Matched Analysis
Authors: Linden Kimberly , Melillo Atlee , Gaughan John , Obinero Chioma , Kellish Alec , Wozniak Marisa R. , Patel Raj M. , Pandya Vidish , Atabek Umur , Spitz Francis , Hong Young K. 
Published: December 2020

Introduction Adjuvant therapy is recommended in duodenal adenocarcinoma (DA), but the role of neoadjuvant therapy remains undefined. We compared the effect of neoadjuvant therapy to adjuvant therapy on overall survival, 30-day, and 90-day mortality following the resection of DA. Methods A retrospective review of the National Cancer Database was performed on patients with DA who received either adjuvant or neoadjuvant therapy in addition to surgical resection. Propensity score matching was done for patient, socioeconomic, and tumor characteristics. Overall survival, 30-day, and 90-day mortality were compared. Results A total of 112 patients were identified; 55 received adjuvant therapy; 57 received neoadjuvant therapy. There was no difference in 30-day (0% vs. 1.75%; P = 1.00), 90-day mortality (1.82% vs. 7.02%; P = .36), nor overall survival (1 yr: 86% vs. 76; 3 yr: 49% vs. 46%; 5 yr: 42% vs. 39%; P = .28). Conclusions There was no difference in overall survival after propensity score matched analysis.
Double-Volume Intraoperative Lavage Reduce Bacterial Contamination After Pancreaticoduodenectomy
Authors: Matsuki Ryota , Sugiyama Masanori , Momose Hirokazu , Kogure Masaharu , Suzuki Yutaka , Mori Toshiyuki , Sakamoto Yoshihiro 
Published: December 2020

Background To clarify whether double-volume peritoneal lavage can decrease the risk of clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy. Materials and Methods Forty-nine patients who underwent pancreaticoduodenectomy and intraoperative peritoneal lavage using 6000 mL of saline before abdominal closure were studied retrospectively. Bacterial cultures of the lavage fluid were taken twice, after irrigation using 3000 mL of saline and then after an additional 3000 mL of saline. Bacterial culture of the drainage fluid was taken on day 1, and the relationship between the results of bacterial cultures and clinically relevant postoperative pancreatic fistula was examined. Results Double amount of peritoneal lavage significantly decreased the incidence of positive bacterial cultures than single amount of peritoneal lavage (45% vs. 29%, P < .05). Multivariate analysis showed that positive bacterial culture of drainage fluid on day 1 and main pancreatic duct size (<3 mm) were independent risk factors for clinically relevant postoperative pancreatic fistula. A positive bacterial culture of the final lavage fluid and preoperative biliary drainage were independent factors related to a positive bacterial culture on day 1. Discussion A positive bacterial culture on day 1 is an independent risk factor for clinically relevant postoperative pancreatic fistula during pancreaticoduodenectomy. Double-volume intraperitoneal lavage may be effective for reducing the incidence of clinically relevant postoperative pancreatic fistula.
Teaching and Mentoring Early in Surgical Practice
Authors: Kapadia Muneera R. , Hrabe Jennifer E. , Shelton Julia , Erdahl Lillian M. 
Published: December 2020

Background Transitioning from trainee to independent surgeon is challenging, with teaching and mentoring learners adding complexity. This study aimed to identify benefits and challenges of teaching and mentoring residents early in surgical practice. Materials and Methods A mixed-methods survey with multiple choice and open-ended questions was developed for early career (first 3 years) and experienced (more than 3 years) surgeons working with residents. The survey was initially piloted by 6 surgeons, revised according to feedback and distributed on Twitter. Quantitative and qualitative analyses were performed. Results Seventy-three valid responses were analyzed, 21 (25%) from early career surgeons and 53 (75%) from experienced surgeons. The majority were women (62%), practiced in academics (78%) and lived in the United States (76%). Most of the early career and experienced surgeons selected the operating room as the most teaching challenging location (62% early career; and 60% experienced). Top teaching challenges of early career surgeons were the need to focus on own skills (24%) and concern for patient safety/outcomes (24%), while experienced surgeons reported need to focus on own skills (23%) and difficulty giving up control (23%). Open-ended responses identified themes related to teaching and mentoring. Comments highlighted benefits of organizational support to facilitate teaching and mentoring and negative experiences due to resident learners not respecting early career surgeons. Discussion This pilot study explores an area not previously studied. Early career surgeons and experienced surgeons find many similar challenges and benefits of teaching and mentoring residents. Challenges and themes identified can guide early career surgeons and organizations with regard to teaching and mentoring.
Optimal Management of the Hyperkinetic Gallbladder: A Comparison of Outcomes Between Operative and Nonoperative Approaches
Authors: Williford Michael L. , Fay Katherine T. , Simpson Francis J. , Defnet Ann M. , Schuster David M. , Sethi Ila , Lin Edward , Davis Steven Scott 
Published: December 2020

Background A hyperkinetic gallbladder is defined as a hepatobiliary iminodiacetic acid (HIDA) scan ejection fraction (EF) of >80%. This condition is poorly described, and there is no current consensus on optimal management. The intent of this study was to determine if cholecystectomy improves symptoms in patients with a hyperkinetic gallbladder when compared to those managed nonoperatively and if there were variables predictive of symptom improvement with or without cholecystectomy. Materials and Methods This retrospective study included patients from 3 academic hospitals in the Atlanta metro area between the years 2006 and 2018. All patients with an EF >80% were included. Following voluntary exclusion patients were contacted by phone. Each patient was administered a questionnaire regarding their surgical history, medical management, and current symptom profile via Otago score. Institutional Institutional Review Board approval was obtained. Results 4785 HIDA scans were performed, and 194 reported an EF >80% (incidence 15.7%). 96% of these scans were reported as normal by the radiologist. 68 patients were able to be contacted by phone and completed the questionnaire. 18 patients underwent cholecystectomy, and 89% reported that their symptoms attributed to gallbladder disease were no longer present. 50 patients did not undergo cholecystectomy, and alternate diagnoses, medication prescriptions, diet modification, emergency department visits, and Otago score were higher in this cohort. Discussion Patients who undergo cholecystectomy for a diagnosis of hyperkinetic gallbladder, on average, report improvement in symptoms when compared to patients managed nonoperatively. This study supports the practice of reporting and managing hyperkinetic gallbladders as a pathologic entity.
Protocol-Based Intravenous Fluid Hydration for Newly Created Ileostomies Decreases Readmissions Secondary to Dehydration
Authors: Borsuk Daniel J. , Studniarek Adam , Marecik Slawomir J. , Park John J. , Kochar Kunal 
Published: December 2020

Background Newly created ileostomies often result in patient readmission due to dehydration secondary to high ostomy output. Implementation of a mandatory home intravenous hydration protocol can avoid this. We aim to evaluate the impact of mandatory home intravenous hydration for patients with newly created ileostomies. Materials and Methods All patients at a single, tertiary care center who underwent ileostomy creation during a period of sporadic home intravenous hydration (February 2011-December 2013) and mandatory protocol hydration (March 2016-December 2018) were reviewed for incidence of dehydration, readmissions, and emergency department visits. Results 241 patients were evaluated. 119 were in the “sporadic” group and 122 were in the “protocol” group. Operative approach differed among both groups, with hydration protocol patients undergoing 15% less open procedures and 4.9% more hand-assisted laparoscopic procedures ( P = .0017). Prior to protocol implementation, 23.5% of patients were sent home with intravenous hydration. Length of hospital stay after index ileostomy creation was shorter for “protocol” patients by 3.3 days ( P < .0001). 15.1% of “sporadic” patients experienced dehydration as compared to 7.4% of “protocol” patients ( P = .0283). Following protocol implementation, the number of patients readmitted due to dehydration increased from 13 to 14 ( P = .01). Discussion Standardized, mandatory at-home intravenous hydration following ileostomy creation leads to a significant reduction in postoperative incidence of dehydration and dehydration-associated readmissions. This protocol should be followed for all patients with newly created ileostomies, so long as adequate home health nursing support and active surveillance are available.
Heart rate variability in patients with dementia or neurocognitive disorders: A systematic review and meta-analysis
Authors: Cheng Ying-Chih , Huang Yu-Chen , Huang Wei-Lieh 
Published: December 2020

Objective: Heart rate variability, a quantitative measure of mainly parasympathetic activity, has been applied in evaluating many types of psychiatric and neurological disorders, including dementia (or neurocognitive disorders). However, although dementia patients often showed significantly lower heart rate variability (various indices) than healthy controls, and different types of dementia had distinct heart rate variability features, the results were not identical across studies. We designed a systematic review and meta-analysis for incorporating data from different studies. Methods: We gathered studies comparing heart rate variability in patients with dementia and in healthy controls. Heart rate variability was analysed in several ways: parasympathetic function in hierarchical order (main analysis), total variability, comparison of heart rate variability between different subtypes of dementia, specific indices of heart rate variability and heart rate variability reactivity. Results: In the initial search, we found 3425 relevant articles, from which 24 studies with a total of 1107 dementia patients and 1017 control participants finally entered the main meta-analysis. The dementia patients had a significantly lower resting heart rate variability for parasympathetic function (Hedges’ g = −0.3596, p = 0.0002) and total variability (Hedges’ g = −0.3059, p = 0.0002) than the controls. For diagnostic subgroup analysis relative to the controls, heart rate variability was significantly lower in patients with mild cognitive impairment (Hedges’ g = −0.3060) and in patients with dementia with Lewy bodies (Hedges’ g = −1.4154, p < 0.0001). Relative to patients with Alzheimer’s disease, heart rate variability in patients with dementia with Lewy bodies was significantly lower (Hedges’ g = −1.5465, p = 0.0381). Meta-regression revealed that gender proportion was significantly associated with effect size. Conclusion: Our results show that dementia patients (especially those with dementia with Lewy bodies and mild cognitive impairment) have lower parasympathetic activity than healthy people. The influence of gender on the results should be carefully interpreted.
Functional near-infrared spectroscopy during a decision-making task in patients with major depressive disorder
Authors: Husain Syeda F , Ong Samantha K , Cuizhen Liu , Tran Bach , Ho Roger C , Ho Cyrus S 
Published: December 2020

Objective: Patients with major depressive disorder tend to exhibit poorer decision-making capacity than the general population, but neurobiological evidence is lacking. Functional near-infrared spectroscopy monitors changes in oxy-haemoglobin concentration in the cerebral cortex. It may provide an objective assessment of neurophysiological responses during decision-making processes. Thus, this study investigated the effect of major depressive disorder diagnosis and severity on prefrontal cortex activity during the Iowa gambling task. Methods: Right-handed healthy controls ( n = 25) and patients with major depressive disorder ( n = 25) were matched for age, gender, ethnicity and years of education in this cross-sectional study. Functional near-infrared spectroscopy signals and the responses made during a computerised Iowa gambling task were recorded. In addition, demographics, clinical history and symptom severity were noted. Results: Compared to healthy controls, patients with major depressive disorder had reduced haemodynamic response in several cortical regions of the frontal lobe (Hedge’s g range from 0.71 to 1.52; p values range from ⩽0.001 to 0.041). Among patients, mean oxy-haemoglobin declined with major depressive disorder severity in the right orbitofrontal cortex (Pearson’s r = −0.423; p = 0.024). Conclusion: Haemodynamic dysfunction of the prefrontal cortex during decision-making processes is associated with major depressive disorder diagnosis and severity. These neurophysiological alterations may have a role in the decision-making capacity of patients with major depressive disorder.
Be Wise: A complementary and alternative medicine health literacy skill-building programme
Authors: Weinert Clarann , Nichols Elizabeth , Shreffler-Grant Jean 
Published: December 2020

Background: Health literacy has been found to be the strongest predictor of health status; and without adequate health literacy, consumers may not understand/adequately evaluate the myriad of choices available. Older rural residents tend to use self-prescribed complementary and alternative medicine (CAM) therapies and glean information about these therapies primarily by word of mouth/media. Objectives: The purpose of this article is to describe the Be Wise health literacy skill building programme and the participants’ evaluation of the programme. Design: The programme involved four sessions delivered over 7 weeks at seniors’ centres in rural communities. Method: Data were collected initially ( N = 127), at the end of the sessions ( N = 67) and after 5 months ( N = 52). Setting: Participants were primarily rural Caucasian women, mean age 76 years, and most had an associate/baccalaureate degree. Results: Questions were worded to ascertain satisfaction with the programme, usefulness of the information provided, willingness to recommend the programme, and the likelihood of using the programme. All scores were most favourable ranging from 3.35 to 4.41 on a 5-point scale. A question regarding the usefulness of the Be Wise programme in managing health received at mean score of 3.55 on a 5-point scale. Written comments on the questionnaires were overwhelmingly favourable. Conclusion: Delivering programmes to older adults in small rural communities has special challenges and rewards. Participants were enthusiastic about learning more about making informed health care choices. There is a compelling need for continued programme development and long-term outcomes evaluation.
Family perception of the symptoms of Obsessive-Compulsive Disorder patient and the family accommodation
Authors: de Matos Mariana Bonati , Pires Andressa Jacondino , Trettim Jéssica Puchalski , Scholl Carolina Coelho , Tabeleão Viviane Porto , Stigger Rafaelle Stark , Rubin Bárbara Borges , Molina Mariane Lopez , Pinheiro Ricardo Tavares , Quevedo Luciana de Avila 
Published: December 2020

Background: Family members tend to modify their routine by assisting or participating in the patient’s rituals. These behaviors have been identified as family accommodation (FA). Aims: The aim of this study was to describe the relationship between family accommodation of relatives of Obsessive-Compulsive Disorder (OCD) patients and their perceptions about the obsessions and compulsions of the patient. Method: This was a cross-sectional study with family members of Obsessive-Compulsive Disorder in a Southern Brazilian city. The family perception of the OCD symptoms and their accommodation were assessed through the Family Accommodation Scale for Obsessive-Compulsive Disorder – Interviewer-Rated (FAS-IR). Results: The level of family accommodation was higher in those family members who lived with the patient when compared to those who did not live with them ( p = .011). The obsessions associated with higher levels of family accommodation were: contamination ( p < .001), hoarding/saving ( p = .001), symmetry/exactness ( p = .001), religious ( p = .019), and diverse ( p = .003). Regarding compulsions, the perception of all symptoms was associated with higher levels of family accommodation ( p < .05). Conclusion: The family accommodation is present in family members of Obsessive-Compulsive Disorder patients, regardless of the type of obsessive/compulsive symptom perceived.
Three-dimensional finite element analysis comparative model of tooth–implant nonrigid fixation
Authors: Muradyan Tigran A , Muradyan Nshan A , Verlinski Sergey V , Poghosyan Anna Yu 
Published: December 2020

Connecting implants with teeth is sometimes considered for the support of prostheses in partial edentulism, especially in periodontally compromised and surgical treated patients. The aim of this study is the presentation of a model of tooth–implant nonrigid fixation in comparison with implant–implant and implant–tooth rigid fixation by three-dimensional (3D) finite element analysis. As a model, a situation with a mandibular second premolar and two molars edentulism was selected. Two implantation options with three prosthetics designs were considered. The comparative analysis of stress and strain distribution values under vertical 100 and 200 N loading was performed. The highest peri-implant crestal bone stress distribution was observed in the model with the implant–tooth rigid fixation with 200 N vertical loading with results of 136.56 MPa. In the model with implant–tooth nonrigid fixation, the maximum strain value was observed in the tooth–connector zone and the stress distribution was higher in the connectors and the prosthesis pontic zone, with a maximal value of 27.77 MPa. The design of a tooth–implant fixed denture could be suggested as a method of choice for rehabilitation of the posterior edentulous segment in cases when only one distal implant could be installed. Further clinical research is required to obtain reliable validation data for the proposed method.
Communal Responses to Structural Violence and Dispossession in Cherán, Mexico
Authors: Gasparello Giovanna 
Published: December 2020

Mexico is currently subject to generalized violence due to conflicts between drug cartels, the state, and resource-extraction companies jostling for territorial and economic control. In 2011 and in this context, the inhabitants of the indigenous municipality of Cherán confronted the criminal organization responsible for kidnappings, extortion, and illegal logging in their communal territory. Study of this conflict and the communal responses generated in the peace process reveals that the violence was founded on social inequality and was both cause and effect of the indigenous population’s material and cultural dispossession. The peace formation process involved the valorization of a collective and territorially rooted identity, the strengthening of security and justice practices based on the authority of assemblies, and an incipient interest in the construction of economic alternatives for the local population. Actualmente, México vive una situación de violencia generalizada debido a los conflictos entre los cárteles de droga, el Estado y las empresas de extracción de recursos que luchan por el control territorial y económico. En 2011 y en este contexto, los habitantes del municipio indígena de Cherán se enfrentaron a una organización criminal responsable de secuestros, extorsiones y tala ilegal en su territorio comunal. El estudio de este conflicto y las respuestas comunitarias generadas en el proceso de paz revela que la violencia se fundó sobre la desigualdad social y fue tanto causa como efecto del despojo material y cultural de la población indígena. El proceso de paz implicó la valorización de una identidad colectiva y territorialmente arraigada, el fortalecimiento de las prácticas de seguridad y justicia basadas en la autoridad de las asambleas, y un interés incipiente en la construcción de alternativas económicas para la población local.
Neoliberalism in the Grey Area: Community Defense, the State, and Organized Crime in Guerrero and Michoacán
Authors: Fuentes Díaz Antonio , Fini Daniele 
Published: December 2020

The various experiments in community defense of organized groups in Guerrero and Michoacán, Mexico, to confront the insecurity produced by organized crime are occurring in a social setting in which legality and illegality are blurred—a grey area— as a function of regional economic reconfigurations that have fostered violence. The state uneasily tolerates the emergence of armed defense groups in the region by attempting to subject them to the model of citizen participation in security matters. Understanding these groups calls for supplementing current views about their various forms, which focus on their legality/illegality, with an emphasis on the relationship between them and the society and its dominant actors. Los diversos experimentos en defensa comunitaria de grupos organizados en Guerrero y Michoacán, México, para enfrentar la inseguridad producida por el crimen organizado ocurren en un entorno social, un área gris en la que la legalidad y la ilegalidad se difuminan en función de las reconfiguraciones económicas regionales que han fomentado la violencia. El Estado tolera con incertidumbre el surgimiento de grupos de defensa armados en la región al tratar de someterlos a un modelo de participación ciudadana en asuntos de seguridad. Para entender a estos grupos es necesario complementar los puntos de vista actuales sobre las diversas formas que toman, centrados en su legalidad o ilegalidad, con un énfasis en la relación entre ellos y la sociedad con sus actores dominantes.
Perceptions of Assistive Technology by Teachers of Students with Visual Impairments in Jordan
Authors: Al-Zboon Eman 
Published: December 2020

Introduction: Ethical practices and technology are current trends in education for individuals with disabilities. This study investigates the perceptions of assistive technology expressed by teachers of students with visual impairments (i.e., blindness or low vision) in Jordan. Methods: The research involved 20 teachers. Data were collected via semistructured interviews and analysis carried out via the constant-comparative method. Results: The results highlight the challenges that teachers perceive in using assistive technology with their students, particularly regarding computer use, the willingness of a child to use a particular device, the lack of such technologies in schools and in the home, and a lack of training in the home. The results highlight perceived external barriers to the effective use of assistive technology, including those related to finance, training, societal attitudes, and family support. It appears that assistive technology can also have negative effects, which can be considered an ethical issue, since such technologies can expose students with visual impairments to negative community attitudes, addiction, bullying, abuse, and extremism. Discussion: Teachers highlight the issues they experience in using assistive technology with students with visual impairments in Jordan, which can be explained by the contextual conditions in the country. Implications for practitioners: Decision-makers in the field of visual impairment need to consider these issues through providing professional development, addressing financial barriers, and conducting awareness programs for students regarding the effective use of assistive technology.