bluuebunny/crossref_metadata_2025_split huggingface dataset:
Preventing Retained Central Venous Catheter Guidewires
Authors: Mariyaselvam Maryanne Z. A. , Catchpole Ken R. , Menon David K. , Gupta Arun K. , Young Peter J. 
Published: August 2017

Abstract

Background
Retained central venous catheter guidewires are never events. Currently, preventative techniques rely on clinicians remembering to remove the guidewire. However, solutions solely relying upon humans to prevent error inevitably fail. A novel locked procedure pack was designed to contain the equipment required for completing the procedure after the guidewire should have been removed: suture, suture holder, and antimicrobial dressings. The guidewire is used as a key to unlock the pack and to access the contents; thereby, the clinician must remove the guidewire from the patient to complete the procedure.

Methods
A randomized controlled forced-error simulation study replicated catheter insertion. We created a retained guidewire event and then determined whether clinicians would discover it, comparing standard practice against the locked pack.

Results
Guidewires were retrieved from 2/10 (20%) standard versus 10/10 (100%) locked pack, n = 20, P < 0.001. In the locked pack group, participants attempted to complete the procedure; however, when unable to access the contents, this prompted a search for the key (guidewire). Participants discovered the guidewire within the catheter lumen, recovered it, utilized it to unlock the pack, and finish the procedure. A structured questionnaire reported that the locked pack also improved subjective safety of central venous catheter insertion and allowed easy disposal of the sharps and guidewire (10/10).

Conclusions
The locked pack is an engineered solution designed to prevent retained guidewires. Utilizing forced-error simulation testing, we have determined that the locked pack is an effective preventative device and is acceptable to clinicians for improving patient safety.
Bromodomain-containing Protein 4 Activates Voltage-gated Sodium Channel 1.7 Transcription in Dorsal Root Ganglia Neurons to Mediate Thermal Hyperalgesia in Rats
Authors: Hsieh Ming-Chun , Ho Yu-Cheng , Lai Cheng-Yuan , Wang Hsueh-Hsiao , Lee An-Sheng , Cheng Jen-Kun , Chau Yat-Pang , Peng Hsien-Yu 
Published: August 2017

Abstract

Background
Bromodomain-containing protein 4 binds acetylated promoter histones and promotes transcription; however, the role of bromodomain-containing protein 4 in inflammatory hyperalgesia remains unclear.

Methods
Male Sprague–Dawley rats received hind paw injections of complete Freund’s adjuvant to induce hyperalgesia. The dorsal root ganglia were examined to detect changes in bromodomain-containing protein 4 expression and the activation of genes involved in the expression of voltage-gated sodium channel 1.7, which is a key pain-related ion channel.

Results
The intraplantar complete Freund’s adjuvant injections resulted in thermal hyperalgesia (4.0 ± 1.5 s; n = 7). The immunohistochemistry and immunoblotting results demonstrated an increase in the bromodomain-containing protein 4–expressing dorsal root ganglia neurons (3.78 ± 0.38 fold; n = 7) and bromodomain-containing protein 4 protein levels (2.62 ± 0.39 fold; n = 6). After the complete Freund’s adjuvant injection, histone H3 protein acetylation was enhanced in the voltage-gated sodium channel 1.7 promoter, and cyclin-dependent kinase 9 and phosphorylation of RNA polymerase II were recruited to this area. Furthermore, the voltage-gated sodium channel 1.7–mediated currents were enhanced in neurons of the complete Freund’s adjuvant rats (55 ± 11 vs. 19 ± 9 pA/pF; n = 4 to 6 neurons). Using bromodomain-containing protein 4–targeted antisense small interfering RNA to the complete Freund’s adjuvant–treated rats, the authors demonstrated a reduction in the expression of bromodomain-containing protein 4 (0.68 ± 0.16 fold; n = 7), a reduction in thermal hyperalgesia (7.5 ± 1.5 s; n = 7), and a reduction in the increased voltage-gated sodium channel 1.7 currents (21 ± 4 pA/pF; n = 4 to 6 neurons).

Conclusions
Complete Freund’s adjuvant triggers enhanced bromodomain-containing protein 4 expression, ultimately leading to the enhanced excitability of nociceptive neurons and thermal hyperalgesia. This effect is likely mediated by the enhanced expression of voltage-gated sodium channel 1.7.
Association of Gender With Outcome and Host Response in Critically Ill Sepsis Patients*
Authors: van Vught Lonneke A. , Scicluna Brendon P. , Wiewel Maryse A. , Hoogendijk Arie J. , Klein Klouwenberg Peter M. C. , Ong David S. Y. , Cremer Olaf L. , Horn Janneke , Franitza Marek , Toliat Mohammad R. , Nürnberg Peter , Bonten Marc M. J. , Schultz Marcus J. , van der Poll Tom 
Published: August 2017

Objective:
To determine the association of gender with the presentation, outcome, and host response in critically ill patients with sepsis.

Design and Setting:
A prospective observational cohort study in the ICU of two tertiary hospitals between January 2011 and January 2014.

Patients:
All consecutive critically ill patients admitted with sepsis, involving 1,815 admissions (1,533 patients).

Interventions:
The host response was evaluated on ICU admission by measuring 19 plasma biomarkers reflecting organ systems implicated in sepsis pathogenesis (1,205 admissions) and by applying genome-wide blood gene expression profiling (582 admissions).

Measurements and Main Results:
Sepsis patients admitted to the ICU were more frequently males (61.0%; p < 0.0001 vs females). Baseline characteristics were not different between genders. Urosepsis was more common in females; endocarditis and mediastinitis in men. Disease severity was similar throughout ICU stay. Mortality was similar up to 1 year after ICU admission, and gender was not associated with 90-day mortality in multivariate analyses in a variety of subgroups. Although plasma proteome analyses (including systemic inflammatory and cytokine responses, and activation of coagulation) were largely similar between genders, females showed enhanced endothelial cell activation; this difference was virtually absent in patients more than 55 years old. More than 80% of the leukocyte blood gene expression response was similar in male and female patients.

Conclusions:
The host response and outcome in male and female sepsis patients requiring ICU admission are largely similar.
Aesthetic Female-to-Male Chest Transformation: Power of Combining Modified Mastectomy with a Pectoral Implant
Authors: Abbed Turkia , Shifrin David A. 
Published: August 2017

Summary:
Gender reassignment surgery has gained in popularity with increased media exposure and society’s recognition of gender dysphoria. Female-to-male gender reassignment often begins with the “top” or chest surgery. Mastectomy with free nipple grafting is the most frequently described technique in the literature. This technique is reliable yet lacks the ability to provide a true male chest shape. We discuss our technique for female-to-male “top” surgery combining traditional mastectomy techniques with a lower pole pedicle vascularized areola and a pectoral implant. A 32-year-old African American female with bilateral C cup breast with grade 2/3 ptosis presented for “top” surgery. Intraoperatively, the nipple areola complex was maintained on a lower pole pedicle at a thickness of 1.5 cm to maintain neurovascularity. A superior mastectomy flap was raised at the level of the breast capsule and remaining breast tissue excised. A lateral subpectoral pocket was created for insertion of a silicone pectoral implant. The new nipple position matured in the infero-lateral quadrant of greatest projecting portion of the chest. Lower pole pedicle provided vascularity to the areola, which avoids the need for a free nipple graft and potential hypopigmentation. Pectoral silicone implant provided upper pole fullness to mimic the male chest muscular distribution. Modification of mastectomy-based female-to-male gender reassignment surgery with a lower pole pedicle–based areola and pectoral implant provides an aesthetic improvement over the classic mastectomy with free nipple graft technique.
CHOROIDAL NEVI WITH FOCAL CHOROIDAL EXCAVATION AND POLYPOIDAL CHOROIDAL NEOVASCULARIZATION
Authors: Simhaee Daniel , Dolz-Marco Rosa , Freund K. Bailey 
Published: August 2017

Purpose:
To report two cases of choroidal nevi associated with focal choroidal excavation (FCE) and polypoidal choroidal neovascularization (PCN).

Methods:
Report of two patients with choroidal nevi showing FCE and PCN who underwent multimodal imaging including color fundus photography, fluorescein angiography, indocyanine green angiography, fundus autofluorescence, spectral domain optical coherence tomography, swept-source optical coherence tomography, and optical coherence tomography angiography.

Results:
Two patients presented with choroidal nevi associated with FCE and PCN. In the first case, a 74-year-old woman, the nevus had sharp margins, a deep FCE, surrounding drusen, and subretinal exudation at its inferior edge due to PCN that responded well to intravitreal anti–vascular endothelial growth factor therapy. In the second case, a 64-year-old woman, the nevus had ill-defined margins, a shallow FCE, and angiographic evidence of PCN without associated exudation.

Conclusion:
There have been several reports showing an association of either choroidal nevi or FCE with PCN. To our knowledge, there have been no previous reports of FCE identified within choroidal nevi, with or without associated PCN. Since, in one of our cases, the FCE was not apparent on clinical examination, the prevalence of FCE within nevi may be underdiagnosed.
MAINTENANCE OF GOOD VISUAL ACUITY IN BEST DISEASE ASSOCIATED WITH CHRONIC BILATERAL SEROUS MACULAR DETACHMENT
Authors: Gattoussi Sarra , Boon Camiel J. F. , Freund K. Bailey 
Published: August 2017

Purpose:
We describe the long-term follow-up of a patient with multifocal Best disease with chronic bilateral serous macular detachment and unusual peripheral findings associated with a novel mutation in the BEST1 gene.

Methods:
Case report.

Results:
A 59-year-old white woman was referred for an evaluation of her macular findings in 1992. There was a family history of Best disease in the patient's mother and a male sibling. Her medical history was unremarkable. Best-corrected visual acuity was 20/20 in her right eye and 20/25 in her left eye. The anterior segment examination was normal in both eyes. Funduscopic examination showed multifocal hyperautofluorescent vitelliform deposits with areas of subretinal fibrosis in both eyes. An electrooculogram showed Arden ratios of 1.32 in the right eye and 1.97 in the left eye. Ultra-widefield color and fundus autofluorescence imaging showed degenerative retinal changes in areas throughout the entire fundus in both eyes. Optical coherence tomography, including annual eye-tracked scans from 2005 to 2016, showed persistent bilateral serous macular detachments. Despite chronic foveal detachment, visual acuity was 20/25 in her right eye and 20/40 in her left eye, 24 years after initial presentation. Genetic testing showed a novel c.238T>A (p.Phe80Ile) missense mutation in the BEST1 gene.

Conclusion:
Some patients with Best disease associated with chronic serous macular detachment can maintain good visual acuity over an extended follow-up. To our knowledge, this is the first report of Best disease associated with this mutation in the BEST1 gene.
Comparison of the Quality of Informal Care of Community-Dwelling Taiwanese Older People
Authors: Chiao Chia-Yi , Lin Yen-Ju , Hsiao Chiu-Yueh 
Published: August 2017

ABSTRACT

Background:
With social structures changing and the average life-span of individuals increasing, Taiwan is experiencing a steady rise in its elderly population. Thus, caring for older parentsis an urgent problem. Many foreign caregivers have been hired tocare for older parents.However, measuring the quality ofinformal care has not yet been fully explored in Taiwan, particularly among older people who are cared for by foreign caregivers in home settings.

Purpose:
The purposes of this study were to understand the differences in quality of care for older Taiwanese and to explore the predictors of quality of care in two types of caregiving.

Methods:
A comparative descriptive study design was conducted. The study was held in several community healthcare centers in the middle and southern regions of Taiwan. Study data were collected over an 18-month period between 2012 and 2014. t Tests were used to compare continuous variables according to the types of caregiving. Multiple linear regressions with group analyses were performed to evaluate the underlying statistical assumptions.

Results:
One hundred fifty-nine participants were included. The study results showed that age, activities of daily living level, and quality of care were significantly different between the two types of caregiving. Relationships with caregivers, social support, and depressive symptoms contributed to the quality of care in family caregiving, explaining 50.2% of the variance. Social support and depressive symptoms contributed to the quality of care in foreign caregiving, explaining 36.6% of the variance.

Conclusions/Implications for Practice:
The study results support that the types of primary caregiving affect the quality of care that is received by elderly Taiwanese. This study may be used as a reference for families whose family members need long-term care when considering hiring foreign caregivers as an alternative option to Taiwanese caregivers.
Parents’ Reactions to the Diagnosis of Duchenne Muscular Dystrophy: Associations Between Resolution, Family Functioning, and Child Behavior Problems
Authors: Baiocco Roberto , Castelli Gattinara Paola , Cioccetti Giorgia , Ioverno Salvatore 
Published: August 2017

ABSTRACT

Background:
Duchenne muscular dystrophy (DMD) is the most frequent inherited form of muscular dystrophy during childhood. DMD is a severe and progressive disease. Children initially have no symptoms, but the diagnosis is often delayed until the child is about 5 years old.

Purpose:
Although few studies have addressed parent reactions to DMD, parental reactions to other serious childhood conditions have been documented. This study aims to understand the resolution styles that parents use in the context of their children with DMD.

Methods:
Data were collected on 39 parents residing in central Italy, comprising 23 mothers and 16 fathers of children with DMD of a mean age of 12 years. The participants attended a single assessment session lasting 60–80 minutes in which they were interviewed and completed the questionnaire. The participants completed the Reaction to Diagnosis Interview, which is composed of five open-ended questions about parents’ memories, thoughts, and feelings about their child’s diagnosis. The interviews were videotaped, transcribed, and coded. The Reaction to Diagnosis Interview classifies parents into two main classifications: “resolved” and “unresolved.” In addition, the participants responded to questions about their perceptions of family functioning and about the behavioral problems of their children. A hierarchical multiple regression analysis was used to examine the role of child characteristics, disease severity, resolution classification (yes/no), and family variables as predictors of child behavior problems.

Results:
The proportion of the resolved cases found in this study (41%) was lower than the mean proportion of resolved cases (60%) found in previous studies. Within the resolved category, “thinking oriented” was the most prevalent subcategory. Resolved participants reported significantly higher scores for family functioning and family satisfaction than unresolved participants. No differences were found between the groups in terms of perceptions of family communication. The hierarchical multiple regression analysis showed that a lower level of family functioning was the strongest predictor of child behavior problems. Having a higher level of disease severity and being unresolved were also identified as predictors of child behavior problems.

Conclusions/Implications for Practice:
Results highlight the relevance of parent resolution in the adjustment process of children. The findings of this study may assist professionals in the medical field to focus on family variables and the parent process of diagnosis resolution as the primary goals in the prevention of child behavior problems.
Cochlear Implantation in Postlingual Adult Patients With Long-Term Auditory Deprivation
Authors: Medina Maria del Mar , Polo Ruben , Gutierrez Auxiliadora , Muriel Alfonso , Vaca Miguel , Perez Cecilia , Cordero Adela , Cobeta Ignacio 
Published: August 2017

Objective:
The role of long-term hearing deprivation in cochlear implant performance is not well established, and the limits for implanting an auditory deprived ear are still unknown. The objective of this study was to evaluate the effect of long-term auditory deprivation time on cochlear implant results.

Study Design:
Retrospective case review study.

Setting:
Cochlear implantation tertiary referral center.

Patients:
Adult patients with postlingual deafness.

Intervention:
Unilateral cochlear implantation between 2001 and January 2015.

Main Outcome Measures:
Age at implantation, sex, etiology of hearing loss, and duration of auditory deprivation in the implanted ear were collected. Cochlear implants results were expressed in terms of vowel identification, disyllabic word recognition, and sentence recognition.
Spearman's correlation test was applied to determine the relationship between auditory deprivation time and speech recognition scores. Additionally, patients were divided according to their auditory deprivation time before implantation in group A (less than 10 yr) and group B (more than 10 yr).

Results:
One hundred three patients met inclusion criteria for this study. There were 61 patients in group A, with a mean deprivation time of 2.52 years. There were 42 patients in group B, with a mean deprivation time of 19.67 years.
There were no statistically significant differences between both groups regarding speech recognition scores.
Deprivation time in the implanted ear was not statistically correlated with cochlear implantation performance.

Conclusions:
Long-term auditory deprivation in the ear to be implanted does not negatively influence cochlear implantation results and should not be considered criterion to reject cochlear implantation.
Musical Rehabilitation in Adult Cochlear Implant Recipients With a Self-administered Software
Authors: Smith Leah , Bartel Lee , Joglekar Samidha , Chen Joseph 
Published: August 2017

Objective:
The goal of this study was to determine if a self-administered computer-based rehabilitation program could improve music appreciation and speech understanding in adults who have a cochlear implant (CI).

Study Design:
Prospective study.

Setting:
Tertiary adult CI program.

Patients:
Twenty-one postlingually deafened cochlear implant users between the ages of 27 and 79 years were recruited.

Interventions(s):
A self-administered music rehabilitative software was designed to help improve the perception of musical patterns of increasing complexity, as well as pitch and timbre perception, premised on focused and divided attention. All participants completed a diagnostic music test before and after rehabilitative training, including tests of pitch and timbre perception and pattern identification with increasing levels of difficulty. Speech data in quiet and noise was also collected both pre- and post-training. Participants trained for a minimum of 3.5 hours a week, for 4 weeks.

Main Outcome Measure(s):
Mean changes in music perception and enjoyment as well as speech perception (IEEE sentence test in quiet and noise).

Results:
Post-training diagnostic test scores, as compared with pretraining scores, indicated significant improvements in musical pattern perception. Tests of speech perception in quiet and in noise were significantly improved in a subset of this cohort. All of the training participants thought that the training helped to improve their recognition skills, and found the program to be beneficial.

Conclusion:
Despite the limitations of current CI technology, the results of this study suggest that auditory training can improve music perception skills, and possibly speech intelligibility, lending further support to rehabilitation being an integral part of the postimplantation paradigm.
What Does Music Sound Like for a Cochlear Implant User?
Authors: Jiam Nicole T. , Caldwell Meredith T. , Limb Charles J. 
Published: August 2017

Objective:
Cochlear implant research and product development over the past 40 years have been heavily focused on speech comprehension with little emphasis on music listening and enjoyment. The relatively little understanding of how music sounds in a cochlear implant user stands in stark contrast to the overall degree of importance the public places on music and quality of life. The purpose of this article is to describe what music sounds like to cochlear implant users, using a combination of existing research studies and listener descriptions. We examined the published literature on music perception in cochlear implant users, particularly postlingual cochlear implant users, with an emphasis on the primary elements of music and recorded music. Additionally, we administered an informal survey to cochlear implant users to gather first-hand descriptions of music listening experience and satisfaction from the cochlear implant population.

Conclusion:
Limitations in cochlear implant technology lead to a music listening experience that is significantly distorted compared with that of normal hearing listeners. On the basis of many studies and sources, we describe how music is frequently perceived as out-of-tune, dissonant, indistinct, emotionless, and weak in bass frequencies, especially for postlingual cochlear implant users—which may in part explain why music enjoyment and participation levels are lower after implantation. Additionally, cochlear implant users report difficulty in specific musical contexts based on factors including but not limited to genre, presence of lyrics, timbres (woodwinds, brass, instrument families), and complexity of the perceived music. Future research and cochlear implant development should target these areas as parameters for improvement in cochlear implant-mediated music perception.