bluuebunny/crossref_metadata_2025_split huggingface dataset:
Short-Term Morbidity after the Endoscopic Modified Lothrop (Draf-III) Procedure Compared with Draf-IIa
Authors: Jafari Aria , Tringale Kathryn R. , Panuganti Bharat A. , Acevedo Joseph R. , Pang John , DeConde Adam S. 
Published: July 2017

Background The endoscopic modified Lothrop (Draf-III) surgery has improved treatment of recalcitrant frontal sinus disease, with favorable safety and long-term results. However, the short-term clinical and quality-of-life morbidity after Draf-III relative to less-extensive procedures has yet to be investigated. Objective To evaluate the surgical and quality-of-life outcomes, including the burden of follow-up care, in patients who underwent endoscopic modified Lothrop (Draf-III), and compared these results with a less-extensive intervention, the endoscopic frontal sinusotomy (Draf-IIa). Methods A retrospective review of early (<8 weeks) postoperative recovery of patients who underwent Draf-III (2014 to 2016) for chronic rhinosinusitis was conducted and compared with age and radiographically matched Draf-IIa controls. Primary outcomes included perioperative complications, the number of postoperative clinic visits, debridements, and steroid and antibiotic therapy days. Secondary outcomes included the change in the 22-item Sino-Nasal Outcome Test (SNOT-22) scores and/or subscores (domains). Results Thirty-eight patients (19 Draf-III, 19 Draf-IIa) were included. Patients who underwent Draf-III versus Draf-IIa required more postoperative clinic visits (4.9 ±1.7 versus 3.3 ± 0.8; p < 0.05), debridements (4.2 ± 2.0 versus 2.3 ± 0.8; p < 0.05), and antibiotic therapy days (24.4 ± 11.8 versus 15.6 ± 6.3; p < 0.05). The mean (SD) SNOT-22 scores improved for both groups (−12.7 ± 34.5 versus -9.5 ± 20.4; p = 0.74) over the follow-up period, and subscore (domain) analysis demonstrated worsening extranasal symptoms (2.5 ± 3.0 versus -1.5 ± 4.7; p < 0.05) at the first postoperative visit, and less improvement in ear/facial symptoms at the second (−0.5 ± 2.6 versus -3.9 ± 4.7; p = 0.03) and third postoperative visits (−1.1 ± 1.6 versus 3.5 ± 3.3; p = 0.01). Conclusion Draf-III is associated with more postoperative clinic visits, debridements, and antibiotic therapy days. The patients who underwent Draf-III demonstrated worsening of extranasal symptoms at the first postoperative visit and less improvement in the ear/facial score at the second and third visits. Informed consent and counseling patients who may require Draf-III should include a detailed discussion of the burden of postoperative care and recovery.
Sinonasal T2R-Mediated Nitric Oxide Production in Response to Bacillus Cereus
Authors: Carey Ryan M. , Workman Alan D. , Yan Carol H. , Chen Bei , Adappa Nithin D. , Palmer James N. , Kennedy David W. , Lee Robert J. , Cohen Noam A. 
Published: July 2017

Background Upper airway epithelial cells produce bactericidal nitric oxide (NO) in response to both gram-positive and gram-negative bacteria. Our previous work demonstrated that T2R38, a bitter taste receptor (T2R) expressed in airway epithelium, produces NO in response to quorum-sensing molecules secreted by Pseudomonas aeruginosa. We also demonstrated that Staphylococci products elicit an NO response when using a T2R-independent pathway. When screening additional human pathogens for epithelial T2R activation, we found that the gram-positive aerobe Bacillus cereus secretes a T2R agonist that yields NO production. Objective The objective of this study was to characterize the activating B. cereus product(s) and to describe the epithelial cell signaling pathway involved. Methods Sinonasal air-liquid interface cultures were treated with B. cereus conditioned medium (CM), and NO production was measured by using 4-amino-5-methylamino-2′,7′ -difluorofluorescein fluorescence imaging. Ciliary beat frequency (CBF) was assessed in response to B. cereus CM. Pharmacologic studies that use inhibitors of the T2R-signaling pathway were used to determine if the production of NO was mediated by a T2R. Purification studies were performed to analyze the physical properties of the activating product(s) contained in the CM. Results A product(s) secreted by B. cereus induced NO production and increased CBF. The response varied markedly between individual patients and involved two important components of bitter taste signaling, phospholipase C isoform β-2 and the transient receptor potential melastatin isoform 5 ion channel. Conclusions This study demonstrated that a B. cereus product(s) elicited an NO-mediated innate defense response in upper airway epithelium that seemed to be partially mediated by a T2R signaling pathway. The active product that elicited the NO response was likely a small nonpeptide compound, but further purification is required for identification. Patient variation in the NO response to B. cereus products could potentially be due to genetic differences in T2Rs.
3D in-Situ Stress Model of Upper Tamakoshi Hydroelectric Project Area
Authors: Basnet Chhatra Bahadur , Panthi Krishna Kanta 
Published: July 2017

Reliable estimation of in-situ stress state is very important in implementing the shotcrete lined/ unlined tunnels and shafts. The in-situ stress state of the area of concern is mainly governed by the gravity-induced stress, tectonic activity of the earth’s crust and topographic condition of that area. The local tectonic and geological environment such as faulting and shearing activities in general influences the magnitude of tectonic stress level. The Himalayan region is renowned with its active tectonic movement (earthquake activities), which causes accumulation and sudden release of strain energy instigating changes in the stress environment. This paper aims to evaluate in-situ stress state at the Upper Tamakoshi Hydroelectric Project, where shotcrete lined/ unlined headrace tunnel with considerable hydrostatic head is being implemented. A detailed assessment of the in-situ stress state is carried out by using both measured data and three-dimensional numerical analysis using FLAC3D. HYDRO Nepal JournalJournal of Water Energy and EnvironmentIssue: 21, July, 2017Page: 34-41Upload Date: July 18, 2017
Optimizing Location of Cutoffs to Improve Safety and Economy of Hydropower Projects
Authors: Khanal Anup 
Published: July 2017

Large numbers of perennial rivers flowing through steep gradient has made Nepal an ideal place for hydropower development. Development of hydropower project in most economical way possible is the first prerequisite to get maximum benefit from harnessing water resources. The maximum benefit can be achieved only through optimal design of the project. Each project component must be designed considering the required level of factor of safety, performance standards of each component and economy. On this backdrop, this paper intends to optimize the location of cutoffs in headworks to get maximum benefits from use of it in terms of safety and economy.Improper placement of cutoff not only reduces the factor of safety against piping but also curtails the project benefits due to excessive seepage flow. Piping (internal erosion of soil particles under structure) is associated with high exit gradient. It threatens the structural stability and ultimately leads to failure of structure while as excessive seepage flow limits the availability of flow for power generation and reduces the project benefits. So, the optimal design of headworks is an attempt to identify the best location of cutoff to control seepage flow and reduce exit gradient. Five different cases representing different location of cutoff were analyzed and their roles in controlling seepage flow and reducing exit gradient was evaluated to optimize the cutoff location. 2D Finite Element Method (FEM) was used for the seepage analysis. The analysis showed that cutoffs are essential to control seepage flow when dam/weir is founded in pervious soil. However, the best location to place cutoff must be adroitly identified to reap maximum benefit from use of cutoff. The analysis reveals that the role of central cutoff in controlling seepage flow and reducing exit gradient is very limited. Likewise, the u/s cutoff has minimum effect in reducing exit gradient but the d/s cutoff seemed very effective in reducing exit gradient resulting increased factor of safety against piping. Hence, this paper concludes that the d/s end is the optimal location to place cutoff to improve safety and economy of the project. In addition, the use of both u/s and d/s cutoffs extend positive roles both in controlling seepage flow and reducing exit gradient. However, in author’s opinion the construction cost of two cutoffs must be compared with benefit added by use of two cutoffs over use of single d/s cutoff. HYDRO Nepal JournalJournal of Water Energy and EnvironmentIssue: 21, July, 2017Page: 42-44Upload Date: July 18, 2017
Challenges in Estimating Quantitative Precipitation Estimation (QPE) Using Weather Radar Observation Over the Mountainous Country of Nepal
Authors: P.C. Shakti , Maki Masayuki 
Published: July 2017

South Asian country Nepal characterizes a complex mountain range in this world. The country’s population density is increasing along with rapid growth of population especially over mountainous cities, southern hills and the Terai. On the other hand, a number of fatal natural calamities, such as flash flooding and landslides raised by clutter intensive rainfall, have been increasing since the last decade. To deal with such water hydro meteorological disasters, accurate information on spatial and temporal variation of rainfall distribution is very important. In Nepal, the amount of rainfall has been obtained from limited rain gauge networks, which may leads to many errors in making a Quantitative Precipitation Estimation (QPE). Weather radar observations have recently been highlighted as an alternative option for estimating the spatial and temporal distribution of precipitation across specified time intervals. However, estimating rainfall from radar observation has its own challenges, especially over a mountainous country like Nepal.Another mountainous country Japan is well known for using weather radar observation to make QPE product. Different types of weather radar have been used to record, monitor and forecast precipitation in Japan for both operational and research purposes. A high level research work has also been done on this field. The high spatial and temporal (250-m and 1-min) QPE product obtained from the radar observation is available for the public. It shows good harmony with ground data in the flat and mountain areas of Japan. Though Nepal and Japan are located in different regions, both countries represent complex mountain regions and have been facing natural disaster caused by extreme rainfall. In Nepal, weather radar observation for estimating precipitation amounts has not started on an operational basis till date. Hence, sharing knowledge and skills from Japan’s research on weather radar observation would play a key role to achieve the radar based QPE product in Nepal. Therefore, we discuss about the challenge in obtaining QPE product, considering an example of the progress of weather radar system in Japan. It is believed that any discussion on it will be a reference for weather radar deployment and its QPE product in Nepal in coming days. HYDRO Nepal JournalJournal of Water Energy and EnvironmentIssue: 21, July, 2017Page: 50-59Upload Date: July 18, 2017
Engaging Anthropology in an Ebola Outbreak
Authors: Venables Emilie , Pellecchia Umberto 
Published: July 2017

AbstractThe articles in this special issue demonstrate, through ethnographic fieldwork and observations, how anthropologists and the methodological tools of their discipline became a means of understanding the Ebola outbreak in West Africa during 2014 and 2015. The examples, from Liberia, Guinea and Sierra Leone, show how anthropologists were involved in the Ebola outbreak at different points during the crisis and the contributions their work made. Discussing issues including health promotion, gender, quarantine and Ebola survivors, the authors show the diverse roles played by anthropologists and the different ways in which they made use of the tools of their discipline. The case studies draw upon the ethical, methodological and logistical challenges of conducting fieldwork during a crisis such as this one and offer reflections upon the role of anthropology in this context.
Extended training to prepare GPs for future workforce needs: a qualitative investigation of a 1-year fellowship in urgent care
Authors: Dale Jeremy , Russell Rachel , Harkness Frances , Wilkie Veronica , Aiello Matthew 
Published: July 2017

BackgroundIt has been argued that UK general practice specialist training should be extended to better prepare GPs for the challenges facing 21st-century health care. Evidence is needed to inform how this should occur.AimTo investigate the experience of recently trained GPs undertaking a 1-year full-time fellowship programme designed to provide advanced skills training in urgent care, integrated care, leadership, and academic practice; and its impact on subsequent career development.Design and settingSemi-structured interviews conducted longitudinally over 2 years augmented by observational data in the West Midlands, England.MethodParticipants were interviewed on at least three occasions: twice while undertaking the fellowship, and at least once post-completion. Participants’ clinical and academic activities were observed. Data were analysed using a framework approach.ResultsSeven GPs participated in the pilot scheme. The fellowship was highly rated and felt to be balanced in terms of the opportunities for skill development, academic advancement, and confidence building. GPs experienced enhanced employability on completing the scheme, and at follow-up were working in a variety of primary care/urgent care interface clinical and leadership roles. Participants believed it was making general practice a more attractive career option for newly qualified doctors.ConclusionThe 1-year fellowship provides a defined framework for training GPs to work in an enhanced manner across organisational interfaces with the skills to support service improvement and integration. It appears to be well suited to preparing GPs for portfolio roles, but its wider applicability and impact on NHS service delivery needs further investigation.
Diagnosis and management of perinatal depression and anxiety in general practice: a meta-synthesis of qualitative studies
Authors: Ford Elizabeth , Lee Suzanne , Shakespeare Judy , Ayers Susan 
Published: July 2017

BackgroundUp to 20% of women experience anxiety and depression during the perinatal period. In the UK, management of perinatal mental health falls under the remit of GPs.AimThis review aimed at synthesising the available information from qualitative studies on GPs’ attitudes, recognition, and management of perinatal anxiety and depression.Design and settingMeta-synthesis of the available published qualitative evidence on GPs’ recognition and management of perinatal anxiety and depression.MethodA systematic search was conducted on Embase, Medline, PsycInfo, Pubmed, Scopus, and Web of Science, and grey literature was searched using Google, Google Scholar, and British Library EThOS. Papers and reports were eligible for inclusion if they reported qualitatively on GPs’ diagnosis or treatment of perinatal anxiety or depression. The synthesis was constructed using meta-ethnography.ResultsFive themes were established from five eligible papers: labels: diagnosing depression; clinical judgement versus guidelines; care and management; use of medication; and isolation: the role of other professionals. GPs considered perinatal depression to be a psychosocial phenomenon, and were reluctant to label disorders and medicalise distress. GPs relied on their own clinical judgement more than guidelines. They reported helping patients make informed choices about treatment, and inviting them back regularly for GP visits. GPs sometimes felt isolated when dealing with perinatal mental health issues.ConclusionGPs often do not have timely access to appropriate psychological therapies and use several strategies to mitigate this shortfall. Training must focus on these issues and must be evaluated to consider whether this makes a difference to outcomes for patients.
Du jeu au jeu vidéo. Sur l’intérêt des univers vidéo ludiques dans la clinique de la psychose infantile
Authors: Duris Olivier 
Published: July 2017

Les jeux vidéo, première industrie culturelle mondiale, occupent aujourd’hui une place importante dans la majorité des foyers. Plus de 80 % des enfants et adolescents sont joueurs, et il est désormais difficile de ne pas rencontrer en situation thérapeutique un jeune qui ne s’intéresse pas aux univers vidéoludiques. Notre but sera ici de montrer aux soignants qu’une meilleure connaissance des jeux vidéo peut s’avérer utile, que ce soit pour comprendre les effets qu’ils peuvent avoir sur les joueurs ou pour connaître leur intérêt en tant que médiation thérapeutique. Pour ce faire, nous tenterons tout d’abord de faire le lien entre la notion de virtuel psychique et les mondes numériques, avant de comprendre en quoi les jeux vidéo peuvent être considérés comme une « évolution numérique » des jouets et jeux décrits il y a de nombreuses années par Melanie Klein et Donald Winnicott. Enfin, nous présenterons l’intérêt que peut avoir l’utilisation des jeux vidéo dans une médiation thérapeutique auprès d’enfants présentant une psychose infantile.
Retirés et connectés, les hikikomori et les écrans
Authors: Vellut Natacha 
Published: July 2017

À partir d’une analyse d’entretiens avec des jeunes en retrait social ( hikikomori ) l’auteur cherche à saisir l’articulation entre la réclusion à domicile et les usages et les connexions numériques permises par les écrans. Elle souligne la diversité de ces usages, diversité qui est la norme pour les usagers de ces nouvelles technologies. Elle met l’accent sur quatre motivations des jeunes en retrait pour investir ces pratiques : la possibilité de l’expression d’émotions négatives sans crainte et sans jugement, le soutien par des instances imaginaires idéales qui échappent à toute sanction familiale ou sociale, l’accès à un savoir sans passer par un maître, la création d’un espace-temps très spécifique, un temps suspendu qui s’abstient des contraintes du temps et des espaces communs, qui s’abstient de la rencontre réelle, physique, corporelle, avec d’autres.
Virtuel psychique et numérique… : d’une psychanalyse des organisations limites
Authors: Tordo Frédéric 
Published: July 2017

Nous abordons les problématiques limites sous l’angle de leur incapacité à accéder à la position de sujet. C’est la réflexivité – ou en psychanalyse l’ « auto-empathie réflexive » – qui est mise en défaut : le sujet n’est pas un vrai sujet. Il ne s’agit pas seulement de la réflexivité dans l’ici et maintenant, mais également celle, « virtuelle », qui permet de se penser dans un futur proche ou éloigné. C’est en effet le virtuel psychique qui paraît largement contrarié dans les organisations limites. C’est pourquoi il semble important d’aménager le dispositif clinique pour créer un espace de réception de ce « non-advenu ». Or, justement, le numérique peut venir étayer le travail de l’analyste et de l’analysant, en créant un espace de réception de ce virtuel psychique. Nous l’illustrons par une vignette clinique.
The criteria of “inoperability”
Authors: Romagnoli Stefano , Paparella Laura , Boninsegni Paolo 
Published: July 2017

<p>In the literature, the term “inoperable” mainly refers to two specific clinical aspects: cancer staging and technical difficulty/impossibility in performing. In light of this clarification, the statement “the patient cannot be anesthetized” has no medical foundation. On the contrary, the physicians have to carefully stratify the perioperative risk and optimize the patients’ preoperative clinical status. In order to perform a precise risk stratification, the European Society of Cardiology and the European Society of Anaesthesiology have joined and published the guidelines for the perioperative cardiovascular management of patients scheduled to undergo non-cardiac surgery. The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) represents the most complete and accurate prediction tool so far. It includes 21 preoperative factors relating to demographics, comorbidities and procedures able to predict outcomes based on preoperative risk factors such as death, cardiac complications, pneumonia, and acute kidney injury. The present article will address aspects related to common aspects concerning modifiable and non-modifiable that should be addressed in every patient to whom elective surgery has been scheduled. </p>
Prognostic impact of frailty in elderly cardiac surgery patients
Authors: Vetta Francesco , Locorotondo Gabriella , Vetta Giampaolo , Mignano Maria , Bracchitta Sonia 
Published: July 2017

<p>Over the past few decades, the progressive aging of the population combined with the resulting increase in cardiovascular disease and the marked improvement of technologies applied to surgery justify the marked increase of the elderly patients requiring cardiovascular surgery. This claims a highly skilled perioperative management, which should be aimed at treating cardiac disease without increasing risk of hospitalization-related harmful events. Current preoperative assessment for cardiac surgery, such as the European System for Cardiac Operative Risk Evaluation II (EUROSCORE II) and the Society of Thoracic Surgeons (STS) risk score, are limited in their ability to predict perioperative outcomes in older patients. This is because patients’ chronological age should not be considered as the only tool to identify the surgical risk. In recent years, indeed, several studies have highlighted the role of frailty syndrome in determining the prognosis of elderly patients undergoing cardiac surgery. Particularly, some functional aspects, such as gait speed seem to have a high sensitivity and specificity in this regard. Therefore, further research is needed in order not only to identify a unique, fast and easy to use tool aimed to recognize frailty syndrome, but chiefly resulting able to give us information about the effectiveness of focused preoperative interventions. Finally, we need to have scientific data on the role that surgical, percutaneous and transcatheter procedures have on outcome in elderly patients in terms of perioperative mortality, postoperative quality of life and regarding the possible reversibility of frailty. Cardiovascular surgery is to date a “moving target”, due to changing face of patients and changing face of technical requirements and perioperative management should reflect such changes. </p>