Contextual Facilitators and Barriers of Community Reintegration among Injured Female Military Veterans: A Qualitative Study

Publication date: Available online 1 September 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Brent L. Hawkins, Brandi M. Crowe
ObjectiveTo understand the facilitators and barriers to community reintegration (CR) among injured female veterans.DesignPhenomenological qualitative designSettingCommunityParticipantsCommunity-dwelling female veterans with physical and/or psychological injury (N=13).InterventionsNoneMain Outcome MeasuresNoneResultsConventional content analysis revealed three types of facilitators, including: (a) strong social supports; (b) impactful programs; and (c) protective personal beliefs. Six types of barriers included: (a) inadequate services; (b) lack of access to services; (c) poor social support; (d) difficulty trusting others; (e) non-supportive personal beliefs; and (f) injury factors.DiscussionMultiple environmental and personal factors acted as facilitators and barriers to CR. Findings are relatively consistent with previous veteran and civilian community reintegration research that indicates the importance of health-related services, attitudes of others, and social support. However, females in this study reported being impacted by many of these facilitators and barriers because of their gender.ConclusionsThis study supports the need to foster social support among injured female veterans throughout the rehabilitation process to promote CR. Long-term social support can be gained by incorporating services such as adjunctive therapies, recreation, and other social programming into the rehabilitation repertoire to help with CR for all veterans, particularly females.



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What is the longitudinal profile of impairments and can we predict difficulty caring for the profoundly-affected arm in the first year post-stroke?

Publication date: Available online 1 September 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Rhoda Allison, Cherry Kilbride, Jade Chynoweth, Siobhan Creanor, Ian Frampton, Jonathon Marsden
ObjectiveTo establish the longitudinal profile of impairments of body functions and activity limitations of the arm, and evaluate potential predictors of difficulty caring for the profoundly-affected arm post-stroke.DesignProspective cohort study.SettingThree UK stroke services.ParticipantsPeople unlikely to regain functional use of the arm (N=155) were recruited at 2-4 weeks post-stroke, and followed up at 3, 6 and 12 months. Potential predictors at baseline were hypertonicity, pain, motor control, mood, sensation/perception, age and stroke severity.InterventionsNAMain Outcome MeasuresDifficulty caring for the arm (LASIS), pain, hypertonicity, range of movement, arm function and skin integrity. Multi-variable linear regression identified the best fitting model for predicting LASIS at 12 months.ResultsOne hundred and ten participants (71%) were reviewed at one year. There was a large variation in the profile of arm functions and activity limitations. Inability or severe difficulty caring for the arm affected 29% of participants. Hypertonicity developed in 77%, with severe hypertonicity present in 25%. Pain was reported by 65%, 94% developed shoulder contracture and 6% had macerated skin. Difficulty caring for the arm increased with age, greater level of hypertonicity and stroke classification; collectively these factors accounted for 33% of the variance in LASIS.ConclusionsAt one year post-stroke, there was a high incidence of impairments of body functions and activity limitations in people with a profoundly-affected arm. Individual profiles were very variable and although some pre-disposing factors have been identified, it remains difficult to predict who is at greatest risk.



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Development of a Computerized Adaptive Test of Children’s Gross Motor Skills

Publication date: Available online 1 September 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Chien-Yu Huang, Li-Chen Tung, Yeh-Tai Chou, Hing-Man Wu, Kuan-Lin Chen, Ching-Lin Hsieh
ObjectiveThis study aimed to develop a computerized adaptive test (CAT) for gross motor skills (GM-CAT) as a diagnostic test and an outcome measure, using the gross motor subtest of the Comprehensive Developmental Inventory for Infants and Toddlers (CDIIT-GM) as the candidate item bank. Moreover, we examined the psychometric properties and the efficiency of the GM-CAT.SettingA developmental center of a medical centerDesignRetrospective study.ParticipantsChildren with and without developmental delay (N=1,738)InterventionsNot Applicable.Main Outcome MeasuresThe CDIIT-GM contains 56 universal items on gross motor skills assessing children's antigravity control, locomotion, and body movement coordination.ResultsThe item bank of the GM-CAT had 44 items that met the dichotomous Rasch model's assumptions. High Rasch person reliabilities were found for each estimated gross motor skill for the GM-CAT (Rasch person reliabilities = 0.940 ∼ 0.995, standard error = 0.68∼2.43). For children of 6 ∼ 71 months, the GM-CAT had good concurrent validity (rs = 0.97 ∼ 0.98), adequate to excellent diagnostic accuracy (area under receiver operating characteristics curve = 0.80 ∼ 0.98), and moderate to large responsiveness (effect size =0.65 ∼ 5.82). The averages of items administered for the GM-CAT were 7 to 11, depending on the age group.ConclusionsThe results of this study support the use of the GM-CAT as a diagnostic and outcome measure to estimate children's gross motor skills in both research and clinical settings.



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Long-Term Functional Outcomes in Military Service Members and Veterans after Traumatic Brain Injury/Polytrauma Inpatient Rehabilitation

Publication date: Available online 1 September 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Max Gray, Joyce Chung, Fatima Aguila, T. Gavin Williams, Jeffrey K. Teraoka, Odette A. Harris
ObjectiveTo determine the impact of the established Polytrauma/TBI infrastructure on immediate post-treatment functional gains, the long-term sustainability of any gains and participation-related community reintegration outcomes in a baseline cohort of patients eight years post-admission.DesignRetrospective review and prospective repeated measures of an inception cohort.SettingVeterans Affairs Palo Alto, Polytrauma Rehabilitation Center (PRC)Participants44 patients consecutively admitted to the PRC inpatient rehabilitation unit during its first full Fiscal Year, 2006.InterventionsThe PRC infrastructure and the formalized rehabilitation for Polytrauma/TBI.Main Outcome MeasuresFunctional Independence Measure scores at admission, discharge, 3 months and 8 years post discharge; participation-related socioeconomic factors reflecting community reintegration eight years after admission.ResultsFunctional gains were statistically significantly increased from admission to discharge. Improvements were maintained at both 3 months post-discharge and 8 years post-discharge. The socio-economic data collected at 8 year follow-up showed greater than 50% either competitively employed or continuing their education and 100% living in a non-institutionalized setting.ConclusionsThis study addresses a concern regarding the long-term functional outcomes of rehabilitation patients treated by the established infrastructure of the Polytrauma System of Care inpatient rehabilitation centers. The results suggest that Polytrauma/TBI rehabilitation care utilizing a comprehensive, integrated approach is effective and durable in achieving functional gains and successful community reintegration within our initial PRC cohort. Follow-up of subsequent FY cohorts would add to the validity of these outcome findings.



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Common Versus Unique Findings on Processing-Based Task Performance in Korean Speaking Children With Cochlear Implants.

Hypothesis: To better understand individual variability by examining overall neurocognitive underlying features in children with cochlear implants (CIs), and to investigate whether previous findings hold constant in Asian-language users. Background: Studies have tried to explain the individual variability in children with CIs. However, performance on experience-dependent tasks does not seem to be sensitive enough to explain the underlying reason why children have language difficulties even after the surgical procedure. Thus, this current research has focused on underlying neurocognitive functions to better explain the reason for the wide variability in this population. Methods: Using a separate univariate analysis paradigm, performance on processing-based tasks was compared between children with CIs and children with normal hearing. A total of 34 children ranging from 10 to 12 years old participated in the study. There were two different categories of processing-based tasks tapping processing capacity and processing speed. This study used nonword repetition (NWR), competing language processing task (CLPT), and counting span (CS) for examining processing capacity, while rapid naming (RAN) in color, shape, and color shape were used to investigate processing speed. Results: Children with NH outperformed children with CIs on all processing-capacity tasks, except CS. Children with CIs performed similarly to children with NH on processing speed tasks. Conclusions: We found children with CIs still experienced difficulties with processing capacity. Due to cross-linguistic features, we also discovered some interesting findings that differed from previous studies. Lastly, we found processing speed was fairly intact in children with CIs, which is a new finding. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Development of sulfonamides incorporating phenylacrylamido functionalities as carbonic anhydrase isoforms I, II, IX and XII inhibitors

Publication date: Available online 1 September 2017
Source:Bioorganic & Medicinal Chemistry
Author(s): Srinivas Angapelly, P.V. Sri Ramya, Andrea Angeli, Sonia Del Prete, Clemente Capasso, Mohammed Arifuddin, Claudiu T. Supuran
A series of novel sulfonamides incorporating phenylacrylamido functionalities were synthesized and investigated for the inhibition of the metalloenzyme carbonic anhydrase (CA, EC 4.2.1.1). The physiologically and pharmacologically relevant human (h) isoforms hCA I and II (cytosolic isozymes), as well as the transmembrane tumor-associated hCA IX and XII were included in the study. These compounds showed low nanomolar or sub-nanomolar inhibition constants against hCA II (KIs in the range of 0.50-50.5 nM), hCA IX (KIs of 1.8-228.5nM), and hCA XII (KIs of 3.5-96.2 nM) being less effective as inhibitors of the off target isoform hCA I. A detailed structure-activity relationship study demonstrates that the nature and position of substituents present on the aromatic part of the scaffold strongly influence the inhibition of CA isoforms. As hCA II, IX and XII are involved in pathologies such as glaucoma and hypoxic, and metastatic tumors, compounds of the type reported in this work may be useful preclinical candidates.

Graphical abstract

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Highly potent antiobesity effect of a short-length peptide YY analog in mice

Publication date: Available online 1 September 2017
Source:Bioorganic & Medicinal Chemistry
Author(s): Naoki Nishizawa, Ayumu Niida, Yusuke Adachi, Yoko Kanematsu-Yamaki, Yasushi Masuda, Satoshi Kumano, Kotaro Yokoyama, Yoko Noguchi, Tomoko Asakawa, Hideki Hirabayashi, Nobuyuki Amano, Shiro Takekawa, Tetsuya Ohtaki, Taiji Asami
Continuous administration of a 14-amino acid peptide YY (PYY) analog, Ac-[D-Pro²⁴,Pya(4)²⁶,Cha^27,36,Aib^28,31,Lys³⁰]PYY(23–36) (4), which has a high binding affinity and agonist activity for the neuropeptide Y2 receptor (Y2R), has previously shown an antiobesity effect in a 2-week diet-induced obesity (DIO) study in mice. However, there remained a possibility to obtain more potent analogs by further improving its pharmacokinetic profile. A combination of the N-terminal 4-imidazolecarbonyl moiety and three amino acid substitutions, trans-4-hydroxy-D-proline (D-Hyp)²⁴, isovaline (Iva)²⁵, and γ-methylleucine (γMeLeu)²⁸, not only improved the binding affinity of the peptide for Y2R but also increased its anorectic activity in lean mice. In a 2-week DIO study in mice, continuous administration of 4-imidazolecarbonyl-[D-Hyp²⁴,Iva²⁵,Pya(4)²⁶,Cha^27,36,γMeLeu²⁸,Lys³⁰,Aib³¹]PYY(23–36) (31, PYY-1119) at a dose of 0.03 mg/kg/day showed a highly potent antiobesity effect, with more than 10% body weight reduction.

Graphical abstract

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Seek & Destroy, use of targeting peptides for cancer detection and drug delivery

Publication date: Available online 1 September 2017
Source:Bioorganic & Medicinal Chemistry
Author(s): Vadim Le Joncour, Pirjo Laakkonen
Accounting for 16 million new cases and 9 million deaths annually, cancer leaves a great number of patients helpless. It is a complex disease and still a major challenge for the scientific and medical communities. The efficacy of conventional chemotherapies is often poor and patients suffer from off-target effects. Each neoplasm exhibits molecular signatures - sometimes in a patient specific manner - that may completely differ from the organ of origin, may be expressed in markedly higher amounts and/or in different location compared to the normal tissue. Although adding layers of complexity in the understanding of cancer biology, this cancer-specific signature provides an opportunity to develop targeting agents for early detection, diagnosis, and therapeutics. Chimeric antibodies, recombinant proteins or synthetic polypeptides have emerged as excellent candidates for specific homing to peripheral and central nervous system cancers. Specifically, peptide ligands benefit from their small size, easy and affordable production, high specificity, and remarkable flexibility regarding their sequence and conjugation possibilities. Coupled to imaging agents, chemotherapies and/or nanocarriers they have shown to increase the on-site delivery, thus allowing better tumor mass contouring in imaging and increased efficacy of the chemotherapies associated with reduced adverse effects. Therefore, some of the peptides alone or in combination have been tested in clinical trials to treat patients. Peptides have been well-tolerated and shown absence of toxicity. This review aims to offer a view on tumor targeting peptides that are either derived from natural peptide ligands or identified using phage display screening. We also include examples of peptides targeting the high-grade malignant tumors of the central nervous system as an example of the complex therapeutic management due to the tumor's location. Peptide vaccines are outside of the scope of this review.

Graphical abstract

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Synthesis of Damaged DNA Containing the Oxidative Lesion 3'-Oxothymidine

Publication date: Available online 1 September 2017
Source:Bioorganic & Medicinal Chemistry
Author(s): Mel F. Bedi, Weiye Li, Taylor Gutwald, Amanda C. Bryant-Friedrich
Oxidative events that take place during regular oxygen metabolism can lead to the formation of organic or inorganic radicals. The interaction of these radicals with macromolecules in the organism and with DNA in particular is suspected to lead to apoptosis, DNA lesions and cell damage. Independent generation of DNA lesions resulting from oxidative damage is used to promote the study of their effects on biological systems. An efficient synthesis of oligodeoxyribonucleotides (ODNs) containing the oxidative damage lesion 3'-oxothymidine has been accomplished via incorporation of C3'-hydroxymethyl thymidine as its corresponding 5'-phosphoramidite. Through oxidative cleavage using sodium periodate in aqueous solution, the lesion of interest is easily generated. Due to its inherent instability it cannot be directly isolated, but must be generated in situ. 3'-Oxothymidine is a demonstrated damage product formed upon generation of the C3'-thymidinyl radical in ODN.

Graphical abstract

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Rational design of conformationally constrained oxazolidinone-fused 1,2,3,4-tetrahydroisoquinoline derivatives as potential PDE4 inhibitors

Publication date: Available online 1 September 2017
Source:Bioorganic & Medicinal Chemistry
Author(s): Gaopeng Song, Xiang Zhu, Junhua Li, Dekun Hu, Dongsheng Zhao, Yixian Liao, Juntong Lin, Lian-Hui Zhang, Zi-Ning Cui
Improvement of subtype selectivity of an inhibitor's binding activity using the conformational restriction approach has become an effective strategy in drug discovery. In this study, we applied this approach to PDE4 inhibitors and designed a series of novel oxazolidinone-fused 1,2,3,4-tetrahydroisoquinoline derivatives as conformationally restricted analogues of rolipram. The bioassay results demonstrated the oxazolidinone-fused tetrahydroisoquinoline derivatives exhibited moderate to good inhibitory activity against PDE4B and high selectivity for PDE4B/PDE4D. Among these derivatives, compound 12 showed both the strongest inhibition activity (IC50 = 0.60 μM) as well as good selectivity against PDE4B and good in vivo activity in animal models of asthma/COPD and sepsis induced by LPS. The primary SAR study showed that restricting the conformation of the catechol moiety in rolipram with the scaffold of oxazolidinone-fused tetrahydroisoquinoline could lead to an increase in selectivity for PDE4B over PDE4D, which was consistent with the observed docking simulation.

Graphical abstract

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Current insight in the localized insulin-derived amyloidosis (LIDA): clinico-pathological characteristics and differential diagnosis

Publication date: Available online 1 September 2017
Source:Pathology - Research and Practice
Author(s): Amir Mehdi Ansari, Lais Osmani, Aerielle E. Matsangos, Qing K. Li
BackgroundIn diabetic patients, subcutaneous insulin injection may cause several types of injection site-related lesions, such as lipoatrophy, insulin-induced cutaneous lipohypertrophy (IICL), allergic reaction, and iatrogenic localized insulin-derived amyloidosis (LIDA). Among these complications, both IICL and LIDA present as tumor-like and slow growing lesions; and they may be confused with one another. The clinical implication and management of IICL and LIDA are different. LIDA causes poor blood glycemic controls due to inadequate absorption of the insulin. Thus, accurate diagnosis of the lesion is critical in diabetic patients.Review of literatureLIDA is an extremely rare complication and often overlooked, it is managed by a surgical intervention. Whereas, IICL is a common side effect and can be managed by a non-surgical approach. Furthermore, in long-standing diabetics, patients may develop hypertrophic cardiomyopathy, proteinuria, peripheral, and autonomic neuropathy; these symptoms can be mistaken for a systemic amyloidosis. It is also necessary to distinguish LIDA from the systemic amyloidosis, which requires a more aggressive systemic therapy. LIDA should also be distinguished from primary cutaneous amyloidosis, with high risk of progression to a systemic amyloidosis. In this effort we reviewed 25 published manuscripts, including case reports and case series studies. We also summarized the literature and discussed differential diagnosis, including the approach to diagnose LIDA.ConclusionThe identification of amyloid material and immunoreactivity with anti-insulin antibodies are key diagnostic features of LIDA. Although several clinical and animal studies were made in recent years, the lesion is still under-diagnosed and underreported. The clinical suspicion and knowledge of the lesion play a crucial role for the accurate diagnosis of LIDA. Surgical excision of the lesion can dramatically decrease insulin requirement and improve glycemic control.



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Superfetation increases total fecundity in a viviparous fish regardless of the ecological context

Publication date: October 2017
Source:Acta Oecologica, Volume 84
Author(s): J. Jaime Zúñiga-Vega, Claudia Olivera-Tlahuel, Alejandro Molina-Moctezuma
Superfetation is the ability of females to simultaneously carry multiple broods of embryos at different developmental stages. This is an uncommon reproductive strategy that has evolved independently several times in viviparous fishes. The ecological conditions that favor higher degrees of superfetation (the presence of more simultaneous broods) still remain unclear. In this study we tested hypotheses about the potential effects of three particular ecological factors (water flow velocity, population density, and adult mortality) on superfetation. We used data on six populations of one fish species from the family Poeciliidae (Poeciliopsis baenschi) and a multimodel inference framework to test these hypotheses. We found no clear associations between the degree of superfetation and these ecological factors. Instead, we found a positive relationship between the total number of embryos carried by females and superfetation. Females increased their total fecundity as they overlapped more broods and this pattern was independent of the particular ecological conditions. Thus, in P. baenschi superfetation may facilitate a greater reproductive output. In addition, this positive relationship between total number of embryos and superfetation was stronger in small- and medium-sized females, whereas large females produced few or no simultaneous broods regardless of their total fecundity. The observed lack of association between superfetation and ecological variables is noteworthy because previous studies on other congeneric species have found that superfetation may vary as a function of water flow velocity or food availability. Our results indicate that the effect of particular selective factors on the degree of superfetation may differ among closely related species.



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Methods and Considerations for Dynamic Analysis of Functional MR Imaging Data

Publication date: Available online 1 September 2017
Source:Neuroimaging Clinics of North America
Author(s): Jingyuan E. Chen, Mikail Rubinov, Catie Chang

Teaser

Functional MR imaging (fMR imaging) studies have recently begun to examine spontaneous changes in interregional interactions (functional connectivity) over seconds to minutes, and their relation to natural shifts in cognitive and physiologic states. This practice opens the potential for uncovering structured, transient configurations of coordinated brain activity whose features may provide novel cognitive and clinical biomarkers. However, analysis of these time-varying phenomena requires careful differentiation between neural and nonneural contributions to the fMR imaging signal and thorough validation and statistical testing. In this article, the authors present an overview of methodological and interpretational considerations in this emerging field.


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Bugging allergy; role of pre-, pro- and synbiotics in allergy prevention

Publication date: Available online 1 September 2017
Source:Allergology International
Author(s): Christina E. West, Majda Dzidic, Susan L. Prescott, Maria C. Jenmalm
Large-scale biodiversity loss and complex changes in social behaviors are altering human microbial ecology. This is increasingly implicated in the global rise in inflammatory diseases, most notably the "allergy epidemic" in very early life. Colonization of human ecological niches, particularly the gastrointestinal tract, is critical for normal local and systemic immune development and regulation. Disturbances in composition, diversity and timing of microbial colonization have been associated with increased allergy risk, indicating the importance of strategies to restore a dysbiotic gut microbiota in the primary prevention of allergic diseases, including the administration of probiotics, prebiotics and synbiotics. Here, we summarize and discuss findings of randomized clinical trials that have examined the effects of these microbiome-related strategies on short and long-term allergy preventative effects – including new guidelines from the World Allergy Organization which now recommend probiotics and prebiotics for allergy prevention under certain conditions. The relatively low quality evidence, limited comparative studies and large heterogeneity between studies, have collectively hampered recommendations on specific probiotic strains, specific timing and specific conditions for the most effective preventive management. At the same time the risk of using available products is low. While further research is needed before specific practice guidelines on supplement probiotics and prebiotics, it is equally important that the underlying dietary and lifestyle factors of dysbiosis are addressed at both the individual and societal levels.



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Development of a questionnaire to evaluate asthma control in Japanese asthma patients

Publication date: Available online 1 September 2017
Source:Allergology International
Author(s): Yuji Tohda, Soichiro Hozawa, Hiroshi Tanaka
BackgroundThe asthma control questionnaires used in Japan are Japanese translations of those developed outside Japan, and have some limitations; a questionnaire designed to optimally evaluate asthma control levels for Japanese may be necessary. The present study was conducted to validate the Japan Asthma Control Survey (JACS) questionnaire in Japanese asthma patients.MethodsA total of 226 adult patients with mild to severe persistent asthma were enrolled and responded to the JACS questionnaire, asthma control questionnaire (ACQ), and Mini asthma quality of life questionnaire (Mini AQLQ) at Weeks 0 and 4. The reliability, validity, and sensitivity/responsiveness of the JACS questionnaire were evaluated.ResultsThe intra-class correlation coefficients (ICCs) were within the range of 0.55–0.75 for all JACS scores, indicating moderate/substantial reproducibility. For internal consistency, Cronbach's alpha coefficients ranged from 0.76 to 0.92 in total and subscale scores, which were greater than the lower limit of internal consistency. As for factor validity, the cumulative contribution ratio of four main factors was 0.66. For criterion-related validity, the correlation coefficients between the JACS total score and ACQ5, ACQ6, and Mini AQLQ scores were −0.78, −0.78, and 0.77, respectively, showing a significant correlation (p < 0.0001).ConclusionsThe JACS questionnaire was validated in terms of reliability and validity. It will be necessary to evaluate the therapeutic efficacy measured by the JACS questionnaire and calculate cutoff values for the asthma control status in a higher number of patients.Clinical Trial registrationUMIN000016589



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Venous thromboembolism and hyperhomocysteinemia as first manifestation of pernicious anemia: a case series

Hyperhomocysteinemia has been suspected of favoring thrombosis. Several case–control studies and even a meta-analysis have confirmed a link between venous thrombosis and hyperhomocysteinemia. Homocysteine is d...

http://ift.tt/2erEpy7

Venous thromboembolism and hyperhomocysteinemia as first manifestation of pernicious anemia: a case series

Hyperhomocysteinemia has been suspected of favoring thrombosis. Several case–control studies and even a meta-analysis have confirmed a link between venous thrombosis and hyperhomocysteinemia. Homocysteine is d...

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Discriminative Confidence Estimation for Probabilistic Multi-atlas Label Fusion

Publication date: Available online 1 September 2017
Source:Medical Image Analysis
Author(s): Oualid M. Benkarim, Gemma Piella, Miguel Angel González Ballester, Gerard Sanroma, for the Alzheimer's Disease Neuroimaging Initiative
Quantitative neuroimaging analyses often rely on the accurate segmentation of anatomical brain structures. In contrast to manual segmentation, automatic methods offer reproducible outputs and provide scalability to study large databases. Among existing approaches, multi-atlas segmentation has recently shown to yield state-of-the-art performance in automatic segmentation of brain images. It consists in propagating the labelmaps from a set of atlases to the anatomy of a target image using image registration, and then fusing these multiple warped labelmaps into a consensus segmentation on the target image. Accurately estimating the contribution of each atlas labelmap to the final segmentation is a critical step for the success of multi-atlas segmentation. Common approaches to label fusion either rely on local patch similarity, probabilistic statistical frameworks or a combination of both. In this work, we propose a probabilistic label fusion framework based on atlas label confidences computed at each voxel of the structure of interest. Maximum likelihood atlas confidences are estimated using a supervised approach, explicitly modeling the relationship between local image appearances and segmentation errors produced by each of the atlases. We evaluate different spatial pooling strategies for modeling local segmentation errors. We also present a novel type of label-dependent appearance features based on atlas labelmaps that are used during confidence estimation to increase the accuracy of our label fusion. Our approach is evaluated on the segmentation of seven subcortical brain structures from the MICCAI 2013 SATA Challenge dataset and the hippocampi from the ADNI dataset. Overall, our results indicate that the proposed label fusion framework achieves superior performance to state-of-the-art approaches in the majority of the evaluated brain structures and shows more robustness to registration errors.

Graphical abstract

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Use of the hyphenated LC-MS/MS technique and NMR/IR spectroscopy for the identification of exemestane stress degradation products during the drug development

Publication date: 15 November 2017
Source:European Journal of Pharmaceutical Sciences, Volume 109
Author(s): Elżbieta U. Stolarczyk, Anna Rosa, Marek Kubiszewski, Joanna Zagrodzka, Marcin Cybulski, Łukasz Kaczmarek
Exemestane (6-Methyleneandrosta-1,4-diene-3,17-dione) active pharmaceutical ingredient (EE-3) was subjected to thermal, photolytic, oxidative, acidic and base stress conditions prescribed by the ICH (International Conference on Harmonization) guideline Q1A(R2). EE-3 was found to degrade in base, acidic and oxidative conditions. Eleven new degradation products of EE-3 were characterized by the LC-MS/MS technique. One of these impurities was isolated and identified by the LC-MS/MS, NMR and IR techniques. The LC-MS/MS studies were carried out to establish fragmentation pathways of EE-3 and its new impurity. Based on the results obtained from different spectroscopic studies, this impurity was characterized as 3-hydroxy-1,6-dimethyl-oestratetraen-(1, 3, 5(10), 6)-17-one (EE-3Z). The degradation pathway of EE-3 leading to the generation of eleven products was proposed and this has not been reported so far. The separation of EE-3 from its impurities (process-related and degradants) was achieved using a Gemini C18 column (150mm×4.6mm×3μm) with gradient elution. The degradation products were well resolved from the main peak and its impurities, thus proving the method's stability and indicating power of the method. The method was validated according to the ICH guidelines for parameters such as specificity, limit of detection, limit of quantitation, precision, linearity, accuracy, robustness and system suitability.

Graphical abstract

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Mannich base approach to 5-methoxyisatin 3-(4-isopropylphenyl)hydrazone: A water-soluble prodrug for a multitarget inhibition of cholinesterases, beta-amyloid fibrillization and oligomer-induced cytotoxicity

Publication date: 15 November 2017
Source:European Journal of Pharmaceutical Sciences, Volume 109
Author(s): Leonardo Pisani, Annalisa De Palma, Nicola Giangregorio, Daniela V. Miniero, Paolo Pesce, Orazio Nicolotti, Francesco Campagna, Cosimo D. Altomare, Marco Catto
Targeting protein aggregation for the therapy of neurodegenerative diseases remains elusive for medicinal chemists, despite a number of small molecules known to interfere in amyloidogenesis, particularly of amyloid beta (Aβ) protein. Starting from previous findings in the antiaggregating activity of a class of indolin-2-ones inhibiting Aβ fibrillization, 5-methoxyisatin 3-(4-isopropylphenyl)hydrazone 1 was identified as a multitarget inhibitor of Aβ aggregation and cholinesterases with IC50s in the low μM range. With the aim of increasing aqueous solubility, a Mannich-base functionalization led to the synthesis of N-methylpiperazine derivative 2. At acidic pH, an outstanding solubility increase of 2 over the parent compound 1 was proved through a turbidimetric method. HPLC analysis revealed an improved stability of the Mannich base 2 at pH2 along with a rapid release of 1 in human serum as well as an outstanding hydrolytic stability of the parent hydrazone. Coincubation of Aβ1–42 with 2 resulted in the accumulation of low MW oligomers, as detected with PICUP assay. Cell assays on SH-SY5Y cells revealed that 2 exerts strong cytoprotective effects in both cell viability and radical quenching assays, mainly related to its active metabolite 1. These findings show that 2 drives the formation of non-toxic, off-pathway Aβ oligomers unable to trigger the amyloid cascade and toxicity.

Graphical abstract

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Evaluation of carbon dioxide laser therapy for benign tumors of the eyelid margin

Abstract

Eyelid margin tumors require special attention based on both anatomical and histological perspectives. Our aim in this study was to evaluate carbon dioxide (CO₂) laser therapy for the treatment of eyelid margin tumors. Fifty-two patients with 55 eyelid margin tumors were included in this study. All tumors were removed with a CO₂ laser, and histopathological evaluation was obtained in 52 cases. All patients were followed up for a mean period of 8.5 months (range 6 to 14 months). There were no bleedings in the intra- and postoperative period; the wounds were dry and reepithelized after 10–14 days and no recurrence occurred during follow-up period. Compared to the surrounding tissue, the treated area was hypopigmented and maximum five eyelashes (average 2.5) were wasted during the procedure. We achieved complete patient and surgeon satisfaction with cosmetic and therapeutic results. CO₂ laser treatment of eyelid margin is a safe and effective procedure; its cosmetic result is beneficial as it does not cause malposition of the eyelid or damage to the lacrimal drainage system if the tumor is located in its proximity.

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Total reference air kerma can accurately predict isodose surface volumes in cervix cancer brachytherapy. A multicenter study

Publication date: Available online 1 September 2017
Source:Brachytherapy
Author(s): Karen S. Nkiwane, Else Andersen, Jerome Champoudry, Astrid de Leeuw, Jamema Swamidas, Jacob Lindegaard, Richard Pötter, Christian Kirisits, Kari Tanderup
PurposeTo demonstrate that V60 Gy, V75 Gy, and V85 Gy isodose surface volumes can be accurately estimated from total reference air kerma (TRAK) in cervix cancer MRI-guided brachytherapy (BT).Methods and Materials60 Gy, 75 Gy, and 85 Gy isodose surface volumes levels were obtained from treatment planning systems (VTPS) for 239 EMBRACE study patients from five institutions treated with various dose rates, fractionation schedules and applicators. An equation for estimating VTPS from TRAK was derived. Furthermore, a surrogate Point A dose (Point A*) was proposed and tested for correlation with V75 Gy.ResultsPredicted volumes Vpred = 4965 (TRAK/dref) 3/2 + 170 (TRAK/dref) − 1.5 gave the best fit to VTPS. The difference between VTPS and predicted volumes was 0.0% ± 2.3%. All volumes were predicted within 10%. The prediction was valid for (1) high-dose rate and pulsed dose rate, (2) intracavitary vs. intracavitary/interstitial applicators, and (3) tandem-ring, tandem-ovoid, and mold. Point A* = 14 TRAK was converted to total EQD2 and showed high correlation with V75 Gy.ConclusionsTRAK derived Isodose surface volumes may become a tool for assessment of treatment intensity. Furthermore, surrogate Point A^∗ doses can be applied for both intracavitary and intracavitary/interstitial BT and can be used to compare treatments across fractionation schedules.



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The mechanisms of action underlying the efficacy of psychological nightmare treatments: A systematic review and thematic analysis of discussed hypotheses

Studies of psychotherapeutic treatments for nightmares have yielded support for their effectiveness. However, no consensus exists to explain how they work. This study combines a systematic review with a qualitative thematic analysis to identify and categorize the existing proposed mechanisms of action (MA) of nightmare treatments. The systematic review allowed for a great number of scholarly publications on supported psychological treatments for nightmares to be identified. Characteristics of the study and citations regarding potential MAs were extracted using a standardized coding grid.

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Isotypes of autoantibodies against differentially expressed novel malondialdehyde-modified peptide adducts in serum of Taiwanese women with rheumatoid arthritis

Publication date: Available online 1 September 2017
Source:Journal of Proteomics
Author(s): Chen-Chung Liao, Yu-Sheng Chang, Chao-Wen Cheng, Wei-Ming Chi, Kai-Leun Tsai, Wei-Jung Chen, Ting-Shuan Kung, Chih-Chun Tai, Yi-Fang Lin, Hung-Tse Lin, Yi-Ying Lu, Ching-Yu Lin
This study identified and validated four differentially expressed novel malondialdehyde (MDA)-modified peptide adducts and evaluated autoantibodies against native and MDA-modified peptides among Taiwanese women patients with rheumatoid arthritis (RA), osteoarthritis (OA) and healthy controls (HCs). Ig kappa chain C region^76–99, alpha-1-antitrypsin^284–298, alpha-2-macroglobulin^824–841, and apolipoprotein B-100^4022–4040 exhibiting 2-fold differences in relative modification ratios were identified by concanavalin A (Con A) affinity chromatography, 1D SDS-PAGE, in-gel digestion, nano-LC/MS/MS and nano-LC/MS using pooled serum-derived Con A-captured proteins from 9 RA and 9 age-matched HCs. Furthermore, the levels of proteins, serum MDA, and MDA-modified protein adducts were further validated against individual serum from 20 RA and 20 HCs, and autoantibodies against native and their MDA-modified peptides used 45 RA, 30 OA and 45 HCs. Levels of serum MDA and MDA-modified protein adducts were significantly higher in RA than HCs but protein levels were not significantly different. Serum Igs G and M against MDA-modified peptides showed better diagnostic performance in differentiating among patients with RA, OA and HCs, with an area under the receiver operating characteristic curve of 0.96–0.98, sensitivity of 88.9%–97.8%, and specificity of 88.9%–100%. Autoantibodies against MDA-modified epitopes become useful clinical biomarkers for RA.Biological significanceBy using a label-free relative quantitative proteomic analysis of concanavalin A (Con A)-bound serum samples, the current study discovered and validated malondialdehyde (MDA)-modified peptide adducts as novel biomarkers for differentiating between rheumatoid arthritis (RA) patients and healthy controls (HCs). In addition, the serum levels of MDA, proteins, and MDA-modified protein adducts as well as the MDA modification of proteins were determined. Isotypes of autoantibodies against MDA-modified peptide adducts can be used as serological biomarkers for further discriminating among RA patients, osteoarthritis patients and HCs. This strategy can become the basis for identifying potential diagnostic and pathological biomarkers for RA.

Graphical abstract

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Cetuximab with radiotherapy as an alternative treatment for advanced squamous cell carcinoma of the temporal bone

Publication date: Available online 1 September 2017
Source:Auris Nasus Larynx
Author(s): Koji Ebisumoto, Kenji Okami, Masashi Hamada, Daisuke Maki, Akihiro Sakai, Kosuke Saito, Fukuko Shimizu, Shoji Kaneda, Masahiro Iida
The prognosis of advanced temporal bone cancer is poor, because complete surgical resection is difficult to achieve. Chemoradiotherapy is one of the available curative treatment options; however, its systemic effects on the patient restrict the use of this treatment. A 69-year-old female (who needed peritoneal dialysis) presented at our clinic with T4 left external auditory canal cancer and was treated with cetuximab plus radiotherapy (RT). The primary lesion showed complete response. The patient is currently alive with no evidence of disease two years after completion of the treatment and does not show any late toxicity. This is the first advanced temporal bone cancer patient treated with RT plus cetuximab. Cetuximab plus RT might be a treatment alternative for patients with advanced temporal bone cancer.



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Letter From the Guest Editor: Seminars 2017

Publication date: August 2017
Source:Seminars in Ultrasound, CT and MRI, Volume 38, Issue 4
Author(s): Tara M. Catanzano




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In memoriam: Dr. Robert William McCarley

Dr. Robert William McCarley, Professor of Psychiatry, was a world-renowned leader in the fields of sleep and schizophrenia research, and a past President of the Sleep Research Society. He passed away on May 27th, 2017 at the age of 79. Dr. McCarley's scientific pursuits and contributions have been recognized nationally and internationally. He was the recipient of many prestigious awards throughout his career including the Distinguished Scientist Award and the Mary A. Carskadon Outstanding Educator Award from the Sleep Research Society, the William C.

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Commentary to “Outcome After Turndown for Elective Abdominal Aortic Aneurysm Surgery”

Publication date: Available online 1 September 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): Edward Choke




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Commentary on “Follow-up on Small Abdominal Aortic Aneurysms Using Three Dimensional Ultrasound: Volume Versus Diameter”

Publication date: Available online 1 September 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): Regula S. von Allmen




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Collateral Circulation in Chronic Aortic Occlusive Disease

Publication date: Available online 1 September 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): Zhongzhi Jia, Guomin Jiang




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Symmetrical Peripheral Gangrene

Publication date: Available online 1 September 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): Ana Carina Ferreira, Vasco Fernandes




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Aortic Reconstruction in an Infected Field. Commentary on “Self-made Xeno-pericardial Aortic Tubes to Treat Native and Aortic Graft Infections”

Publication date: Available online 31 August 2017
Source:European Journal of Vascular and Endovascular Surgery
Author(s): Oliver Lyons




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Farm Exposure in Early Childhood is Associated with a Lower Risk of Severe Respiratory Illnesses

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Efficacy and safety of 4 months of sublingual immunotherapy with recombinant Mal d 1 and Bet v 1 in patients with birch pollen-related apple allergy

SLIT with recombinant Mal d 1 is a promising approach for the effective treatment of birch pollen-related apple allergy.

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Elevated IgE levels are linked to faster relapse in omalizumab-discontinued chronic spontaneous urticaria patients

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IL-12 and IL-7 synergise to control MAIT cell cytotoxic responses to bacterial infection

The mechanisms controlling the cytotoxic response of MAIT cells to NTHi infection are unknown. Our observations provide a new understanding of protective immune mechanisms and also potential new therapeutic opportunities to improve clinical outcome.

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Long-term Benefits of Optimal Asthma Control in Pregnancy

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Enhanced Plasmacytoid Dendritic Cell Antiviral Responses After Omalizumab

Omalizumab enhanced ex vivo antiviral IFNα responses and reduced pDC surface FcεRIα. Both effects were significantly associated with lower asthma exacerbation rate, highlighting a potential mechanism underlying the atopy-virus connection in promoting exacerbations of asthma.

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Food diversity during the first year of life and allergic diseases until 15 years

Higher food diversity during the first year of life appears to decrease the risk of allergic sensitization to aeroallergens up to 15 years only among children with early skin symptoms in German birth cohort.

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Inhibition of IL-17–committed T cells in a murine psoriasis model by a vitamin D analogue

A better understanding of the means by which topical vitamin D analogues exert their therapeutic effect on psoriasis is of theoretical and practical importance.

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Serum periostin, IgE and SE-IgE can be used as biomarkers to identify moderate to severe chronic rhinosinusitis with nasal polyps

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Nasal interleukin 25 as a novel biomarker for patients with chronic rhinosinusitis with nasal polyps and airway hypersensitiveness

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic inflammatory disease of the upper airway and is tightly linked with airway hyperresponsiveness (AHR) and asthma. However, the surrogate biomarkers for indicating AHR and asthma in patients with CRSwNP remain elusive.

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Assessing hypoxia risk during air travel after a severe asthma exacerbation in children

Decreased atmospheric cabin pressure in commercial aircrafts (cruising altitude 9,000–13,000 m), requiring cabin pressurization from 1,530 to 2,440 m, is equivalent to breathing a fraction of inspired oxygen (FiO2) of 15.1% at sea level.

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Nasal interleukin 25 as a novel biomarker for patients with chronic rhinosinusitis with nasal polyps and airway hypersensitiveness

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic inflammatory disease of the upper airway and is tightly linked with airway hyperresponsiveness (AHR) and asthma. However, the surrogate biomarkers for indicating AHR and asthma in patients with CRSwNP remain elusive.

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Assessing hypoxia risk during air travel after a severe asthma exacerbation in children

Decreased atmospheric cabin pressure in commercial aircrafts (cruising altitude 9,000–13,000 m), requiring cabin pressurization from 1,530 to 2,440 m, is equivalent to breathing a fraction of inspired oxygen (FiO2) of 15.1% at sea level.

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Cognitive ability across the life course and cortisol levels in older age

Publication date: November 2017
Source:Neurobiology of Aging, Volume 59
Author(s): Mathew A. Harris, Simon R. Cox, Caroline E. Brett, Ian J. Deary, Alasdair M.J. MacLullich
Elevated cortisol levels have been hypothesized to contribute to cognitive aging, but study findings are inconsistent. In the present study, we examined the association between salivary cortisol in older age and cognitive ability across the life course. We used data from 370 members of the 36-Day Sample of the Scottish Mental Survey 1947, who underwent cognitive testing at age 11 years and were then followed up at around age 78 years, completing further cognitive tests and providing diurnal salivary cortisol samples. We hypothesized that higher cortisol levels would be associated with lower cognitive ability in older age and greater cognitive decline from childhood to older age but also lower childhood cognitive ability. Few of the tested associations were significant, and of those that were, most suggested a positive relationship between cortisol and cognitive ability. Only 1 cognitive measure showed any sign of cortisol-related impairment. However, after correcting for multiple comparisons, no results remained significant. These findings suggest that cortisol may not play an important role in cognitive aging across the life course.



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Sponsoring Organizations and Liaisons

Publication date: September 2017
Source:The Journal of Prosthetic Dentistry, Volume 118, Issue 3





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Table of Contents

Publication date: September 2017
Source:The Journal of Prosthetic Dentistry, Volume 118, Issue 3





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Lay preferences for dentogingival esthetic parameters: A systematic review

Publication date: Available online 1 September 2017
Source:The Journal of Prosthetic Dentistry
Author(s): Stefano Del Monte, Kelvin I. Afrashtehfar, Elham Emami, Samer Abi Nader, Faleh Tamimi
Statement of problemAn objective definition of the characteristics that render a smile esthetically acceptable in the eye of laypeople is lacking.PurposeThe purpose of this systematic review was to identify, appraise, and synthesize the available evidence on the opinion of laypeople regarding the dentogingival characteristics that render a smile esthetically acceptable. The evidence was collected by surveying with standardized digitally modified smile images.Material and methodsFour databases were used to search English language studies published between January 1996 and December 2015. This was complemented by a manual search of 8 dental journals. Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, 2 independent reviewers extracted the relevant characteristics of lay evaluators, the images evaluated, and the outcomes measure. Included studies were assessed in agreement with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. Outcomes were treated as a continuous variable, and when more than 1 article provided information on a parameter, the weighted arithmetic mean was calculated.ResultsAfter 8851 articles were screened, 20 studies were included. Those studies addressed 20 different dentogingival esthetic parameters. The total number of participants interviewed was 3107. According to the Olmos classification, 6 studies had a high level of quality, and 14 studies had a moderate level of quality. The 2 reviewers agreed on all the quality assessments. In the articles reviewed, central incisors clearly played a key role in smile esthetics. Almost all dental, gingival, and occlusal parameters are related to the proportion, shape, and position of central incisors and their relation to the adjacent dental structures.ConclusionsThe present review provides the estimated thresholds of tolerability and ideal values of smile parameters determined by laypeople. This may guide clinicians in evidence-based diagnosis and the planning of dental esthetic treatments.



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The Essentials

Publication date: September 2017
Source:The Journal of Prosthetic Dentistry, Volume 118, Issue 3





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Editorial Board

Publication date: September 2017
Source:The Journal of Prosthetic Dentistry, Volume 118, Issue 3





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News and Notes

Publication date: September 2017
Source:The Journal of Prosthetic Dentistry, Volume 118, Issue 3





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The Self-Efficacy Scale for Adherence to the Mediterranean Diet (SESAMeD): A scale construction and validation

Publication date: 1 January 2018
Source:Appetite, Volume 120
Author(s): Esther Cuadrado, Tamara Gutiérrez-Domingo, Rosario Castillo-Mayen, Bárbara Luque, Alicia Arenas, Carmen Taberneroa
The Mediterranean diet has several beneficial impacts on health. Self-efficacy may be crucial for adhering to the diet. This study set out to develop a reliable and valid instrument that would enable measurement of the extent to which people are confident about their ability to adhere to the Mediterranean diet: the Self-Efficacy Scale for Adherence to the Mediterranean Diet (SESAMeD). The study was carried out in two stages. In Stage 1, a pilot questionnaire was administrated to 170 students to reduce and refine items. In Stage 2, the validity and reliability of the scale were evaluated among a sample of 348 patients who have suffered from cardiovascular disease. After items reduction, the scale consisted of 22 items. The factor structure of SESAMeD was tested across exploratory factorial analysis and confirmatory factorial analysis, with both analyses confirming a robust adjustment for the bi-factorial structure. The two factors identified were (a) self-efficacy for the avoidance of determined unhealthy foods not recommended in the Mediterranean diet and (b) self-efficacy for the consumption of determined healthy foods recommended in this diet. The pattern of relations between the SESAMeD and the SESAMeD subscales and other different psychological variables (outcome expectancies, motivation, affective balance, and life satisfaction) supported the validity of the bi-factorial structure and provided strong evidence of construct validity. The instrument can help health professionals and researchers to assess patients' confidence of their ability to adhere to the Mediterranean diet, a psychological variable that may affect adherence to this healthy food consumption pattern.



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Food addiction among sexual minorities

Publication date: 1 January 2018
Source:Appetite, Volume 120
Author(s): Jacob C. Rainey, Celina R. Furman, Ashley N. Gearhardt
Although sexual minorities represent a small proportion of the general population, this group has been observed to be at an increased risk of developing various pathologies, including substance use and eating disorders. Research suggests that foods high in added fat and refined carbohydrates may trigger an addictive response, especially in at-risk individuals. Consequently, food addiction is associated with elevated risk for obesity, diet-related disease, and psychological distress. However, there is limited research on whether food addiction, like substance use, may be elevated among sexual minorities, and whether self-compassion may be a protective factor. Thus, the current study aims to test whether food addiction is elevated in sexual minorities (relative to heterosexuals) and if discrimination and self-compassion may be related to food addiction among sexual minorities. In a community sample of 356 participants (43.3% sexual minority), sexual minorities had almost twice the prevalence of food addiction (16.9%) as heterosexuals (8.9%). Also, sexual minorities on average experienced more food addiction symptoms (M = 2.73, SD = 1.76) than heterosexuals (M = 1.95, SD = 1.59). For sexual minorities, heterosexist harassment was associated with increased food addiction, while self-compassion appeared to be a protective factor. Further research needs to examine between-group differences among sexual minorities for better treatment and interventions for food addiction.



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An experiment assessing effects of personalized feedback about genetic susceptibility to obesity on attitudes towards diet and exercise

Publication date: 1 January 2018
Source:Appetite, Volume 120
Author(s): Woo-kyoung Ahn, Matthew S. Lebowitz
As increasing attention is paid to possible genetic influences on susceptibility to obesity, recent studies have examined how genetic attributions can impact laypeople's weight-related attitudes and eating behavior. Little consideration, however, has been devoted to understanding the potential effects of learning that one does not have a genetic predisposition to obesity. The present study investigated the possibility that such feedback might bring about negative consequences by making people feel invulnerable to weight gain, which is termed a genetic invincibility effect. After conducting a saliva test disguised as genetic screening, participants were randomly assigned to be told that there was either a very high or very low chance that they carried genes known to increase one's risk of developing obesity. Participants who were told that they were not genetically predisposed to obesity judged the efficacy of healthy diet and exercise habits to be significantly lower than did those who were told that they were genetically predisposed and those who did not receive any genetic feedback. When prompted to select a meal from a menu of options, participants who were told that they were not genetically predisposed to obesity were also more likely than others to select unhealthy foods. These findings demonstrate the existence of a genetic invincibility effect, suggesting that personalized feedback indicating the absence of a genetic liability could have negative psychological consequences with substantial health-related implications.



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Visual exposure and categorization performance positively influence 3- to 6-year-old children's willingness to taste unfamiliar vegetables

Publication date: 1 January 2018
Source:Appetite, Volume 120
Author(s): Camille Rioux, Jérémie Lafraire, Delphine Picard
The present research focuses on the effectiveness of visual exposure to vegetables in reducing food neophobia and pickiness among young children. We tested the hypotheses that (1) simple visual exposure to vegetables leads to an increase in the consumption of this food category, (2) diverse visual exposure to vegetables (i.e., vegetables varying in color are shown to children) leads to a greater increase in the consumption of this food category than classical exposure paradigms (i.e. the same mode of presentation of a given food across exposure sessions) and (3) visual exposure to vegetables leads to an increase in the consumption of this food category through a mediating effect of an increase in ease of categorization. We recruited 70 children aged 3–6 years who performed a 4-week study consisting of three phases: a 2-week visual exposure phase where place mats with pictures of vegetables were set on tables in school cafeterias, and pre and post intervention phases where willingness to try vegetables as well as cognitive performances were assessed for each child. Results indicated that visual exposure led to an increased consumption of exposed and non-exposed vegetables after the intervention period. Nevertheless, the exposure intervention where vegetables varying in color were shown to children was no more effective. Finally, results showed that an ease of categorization led to a larger impact after the exposure manipulation. The findings suggest that vegetable pictures might help parents to deal with some of the difficulties associated with the introduction of novel vegetables and furthermore that focusing on conceptual development could be an efficient way to tackle food neophobia and pickiness.



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Australian children's perceptions of discretionary foods

Publication date: 1 January 2018
Source:Appetite, Volume 120
Author(s): Stefania Velardo, Murray Drummond
Energy-dense nutrient poor foods and drinks, often referred to as discretionary choices, can contribute a significant amount of energy, fat, sodium and sugar to the diet if consumed in large quantities. Currently many Australian children are consuming a diet that is characterised by large quantities of discretionary items. We undertook a qualitative study to gain a descriptive account of preadolescent children's attitudes and perceptions towards health and nutrition. A series of 6 focus groups and 14 individual semi-structured interviews were conducted with thirty-eight children aged 11–12 years, across three state government schools in a socially disadvantaged region of metropolitan South Australia. The naturalistic manner of qualitative inquiry led to several unintended yet highly pertinent emergent themes, including children's perceptions and practices surrounding discretionary food consumption. Our results indicate that while Australian guidelines recommend that discretionary foods are consumed 'only sometimes and in small amounts', children generally held a different belief with respect to what constituted 'sometimes'. Many children identified that discretionary foods should be consumed in moderation to maintain a balanced diet, yet reported consuming these foods frequently. Self-reported discretionary food consumption was grounded in socially constructed experiences valued by the children, who made situational attributions to foods and legitimised discretionary food consumption in certain contexts, for example during the weekend. Overall, there is variability between children's opinions about the acceptable frequency of consumption of discretionary foods compared with national guidelines.



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Unsold is unseen … or is it? Examining the role of peripheral vision in the consumer choice process using eye-tracking methodology

Publication date: 1 January 2018
Source:Appetite, Volume 120
Author(s): Erik Wästlund, Poja Shams, Tobias Otterbring
In visual marketing, the truism that "unseen is unsold" means that products that are not noticed will not be sold. This truism rests on the idea that the consumer choice process is heavily influenced by visual search. However, given that the majority of available products are not seen by consumers, this article examines the role of peripheral vision in guiding attention during the consumer choice process. In two eye-tracking studies, one conducted in a lab facility and the other conducted in a supermarket, the authors investigate the role and limitations of peripheral vision. The results show that peripheral vision is used to direct visual attention when discriminating between target and non-target objects in an eye-tracking laboratory. Target and non-target similarity, as well as visual saliency of non-targets, constitute the boundary conditions for this effect, which generalizes from instruction-based laboratory tasks to preference-based choice tasks in a real supermarket setting. Thus, peripheral vision helps customers to devote a larger share of attention to relevant products during the consumer choice process. Taken together, the results show how the creation of consideration set (sets of possible choice options) relies on both goal-directed attention and peripheral vision. These results could explain how visually similar packaging positively influences market leaders, while making novel brands almost invisible on supermarket shelves. The findings show that even though unsold products might be unseen, in the sense that they have not been directly observed, they might still have been evaluated and excluded by means of peripheral vision. This article is based on controlled lab experiments as well as a field study conducted in a complex retail environment. Thus, the findings are valid both under controlled and ecologically valid conditions.



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“Doing our best to keep a routine:” How low-income mothers manage child feeding with unpredictable work and family schedules

Publication date: 1 January 2018
Source:Appetite, Volume 120
Author(s): Tara Agrawal, Tracy Jean Farrell, Elaine Wethington, Carol M. Devine
Significant changes in work and family conditions over the last three decades have important implications for understanding how young children are fed. The new conditions of work and family have placed pressures on families. The aim of this study was to explore the work and family pressures shaping the ways parents feed their young children on a day-to-day basis. Twenty-two purposively recruited low-income employed mothers of 3–4 year old children from a rural county Head Start program in Upstate New York reported details about the context of their children's eating episodes in a 24-h qualitative dietary recall. Participating mothers were employed and/or in school at least 20 h a week and varied in partner and household characteristics. Interview transcripts were open coded using the constant comparative method for usual ways of feeding children. A typology of three emergent child feeding routines was identified based on mothers' accounts of the recurring ways they fed their child. Mothers' feeding routines were distinguished by a combination of four recurring key strategies – planning ahead, delegating, making trade-offs, and coordinating. Work schedule predictability and other adults helped mothers maintain feeding routines. Unexpected daily events, such as working overtime or waking up late, disrupted child feeding routines and required modifications. These findings suggest that understanding how young children are fed requires recognizing the socio-ecological environments that involve working mothers' daily schedules and household conditions and the multiple ways that mothers manage food and feeding to fit environmental constraints. There is a need to look at more than just family meals to understand parents' daily strategies for feeding young children and their implications for child nutrition.



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Binary components of food reinforcement: Amplitude and persistence

Publication date: 1 January 2018
Source:Appetite, Volume 120
Author(s): Leonard H. Epstein, Jeffrey S. Stein, Rocco A. Paluch, James MacKillop, Warren K. Bickel
BackgroundDemand curves provide an index of how reinforcing a food is. Research examining the latent structure of alcohol and tobacco reinforcement identified two underlying components of reinforcement, amplitude and persistence. No research has assessed latent structure of food reinforcement and how these factors are related to BMI.Subjects and methodsParticipants were 297 adults from two studies that completed food purchasing tasks to assess the following measures of relative reinforcing efficacy (RRE) of food: intensity (Q0): purchases made when the food was free or of very minimal price, Omax: maximum expenditure (purchases*price), Pmax: price point where maximum expenditure was observed, breakpoint: first price where 0 purchases are made, and demand elasticity (α): quantitative non-linear relationship between purchasing and price. Principal components analysis was used to examine the factor structure of RRE for food across samples and types of food.ResultsBoth studies revealed two factor solutions, with Pmax, Omax, breakpoint and α loading on factor 1 (persistence) and intensity (Q0) loading on factor 2 (amplitude) across both high and low energy dense foods. Persistence reflects an aggregate measure of price sensitivity and amplitude reflects the preferred volume of consumption (how long vs. how much). The two factors accounted for between 91.7 and 95.4% of the variance in food reinforcement. Intensity for high energy dense foods predicted BMI for both studies (r = 0.18 and r = 0.22, p's < 0.05).ConclusionsThe latent factor structure was similar across two significantly different independent samples and across low and high energy dense snack foods. In addition, the amplitude of the demand curve, but not persistence, was related to BMI. These results suggest specific aspects of food reinforcement that can be targeted to alter food intake.



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Conservatism predicts lapses from vegetarian/vegan diets to meat consumption (through lower social justice concerns and social support)

Publication date: 1 January 2018
Source:Appetite, Volume 120
Author(s): Gordon Hodson, Megan Earle
Lapses from vegetarian and vegan (i.e., veg*n) food choices to meat consumption are very common, suggesting that sustaining veg*nism is challenging. But little is known about why people return to eating animals after initially deciding to avoid meat consumption. Several potential explanatory factors include personal inconvenience, meat cravings, awkwardness in social settings, or health/nutrition concerns. Here we test the degree to which political ideology predicts lapsing to meat consumption. Past research demonstrates that political ideology predicts present levels of meat consumption, whereby those higher in right-wing ideologies eat more animals, even after controlling for their hedonistic liking of meat (e.g., Dhont & Hodson, 2014). To what extent might political ideology predict whether one has lapsed from veg*n foods back to meat consumption? In a largely representative US community sample (N = 1313) of current and former veg*ns, those higher (vs. lower) in conservatism exhibited significantly greater odds of being a former than current veg*n, even after controlling for age, education, and gender. This ideology-lapsing relation was mediated (i.e., explained) by those higher (vs. lower) in conservatism: (a) adopting a veg*n diet for reasons less centered in justice concerns (animal rights, environment, feeding the poor); and (b) feeling socially unsupported in their endeavor. In contrast, factors such as differential meat craving or lifestyle inconvenience played little mediational role. These findings demonstrate that ideology and justice concerns are particularly relevant to understanding resilience in maintaining veg*n food choices. Implications for understanding why people eat meat, and how to develop intervention strategies, are discussed.



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What determines the fruit and vegetables intake of primary school children? - An analysis of personal and social determinants

Publication date: 1 January 2018
Source:Appetite, Volume 120
Author(s): Julia Haß, Monika Hartmann
The high prevalence of childhood obesity is a major concern in developed and developing countries. An increase in fruit and vegetable (F&V) intake is perceived as one of the numerous strategies to prevent and reduce the risk of adiposity. The purpose of this study was to investigate the relevance of personal and social determinants in explaining children's F&V intake. Written questionnaire data were collected from 702 parent-child pairs that included 3rd and 4th graders (aged 7 to 10) and their parents. Children's F&V intake was recorded over three food records. Hierarchical linear regression models were applied to assess the impact of personal and social determinants on children's F&V intake. Regression models focusing on personal and social determinants revealed that the most promising personal determinants pertained to the knowledge of different types of F&V and preferences for F&V. Moreover, an exclusive focus on social determinants indicated that parental modeling and peer influence had significant and positive relationships with children's F&V intake, whereas verbal directives to eat F&V exhibited a significant and negative relationship. In combination, the following four personal and social determinants were demonstrated to be significant: knowledge of different types of F&V, preferences for F&V and parental modeling, all of which had positive relationships, and verbal directives to eat F&V, which had a negative impact. The results identify important associative determinants of children's F&V intake. These are in part personal and in part social and are shown by our analysis to be of equal and perhaps mutual importance. Therefore, we suggest that interventions aimed at improving children's F&V intake should address children's preferences for F&V, impart knowledge concerning the variety of F&V and encourage parents to act as role models.



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Acute effects of monosodium glutamate addition to whey protein on appetite, food intake, blood glucose, insulin and gut hormones in healthy young men

Publication date: 1 January 2018
Source:Appetite, Volume 120
Author(s): G. Harvey Anderson, Hrvoje Fabek, Rajadurai Akilen, Diptendu Chatterjee, Ruslan Kubant
AimsThis study investigated the effects of adding monosodium glutamate (MSG) to carrot soup with or without whey protein, on subjective appetite, food intake (FI) and satiety hormones in healthy young men.MethodsTwo experiments were conducted using a repeated-measures, within-subject, crossover design. In exp-1 healthy young men (n = 28) consumed water alone (500 mL), or carrot soup (500 g) with or without MSG (5 g, 1% w/w) or whey protein enriched (36 g) carrot soup with or without MSG (5 g, 1% w/w). Subjective appetite was measured post-treatment and FI measured at a meal at 120 min. In exp-2 (n = 15) the same treatments except for water were used. In addition to subjective appetite and FI, blood glucose, insulin, glucose like peptide 1 (GLP-1), C-peptide and ghrelin were measured.ResultsAdding MSG to carrot soup or whey protein enriched carrot soup did not affect FI. However, in exp-1 the addition of both MSG and protein increased fullness, and when MSG was added to carrot soup reduced desire to eat. In exp-2, average post-treatment appetite (5–120 min) was lower after carrot soup with MSG and protein than all other treatments (P < 0.05). In exp-2, carrot soup with MSG and protein, but not with protein alone, increased post-treatment insulin and C-peptide, and lowered blood glucose in comparison to carrot soup with no additions (P < 0.05).ConclusionAdding MSG alone, or in combination with whey protein, to carrot soups did not affect FI. However, MSG increased fullness and reduced desire to eat, as well as subjective appetite, and when added to protein decreased blood glucose and increased insulin and C-peptide, offering some support for the hypothesis that MSG in the gut signals protein consumption.



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Acute effects of video-game playing versus television viewing on stress markers and food intake in overweight and obese young men: A randomised controlled trial

Publication date: 1 January 2018
Source:Appetite, Volume 120
Author(s): Mario Siervo, Jason Gan, Mary S. Fewtrell, Mario Cortina-Borja, Jonathan C.K. Wells
BackgroundSedentary or near-sedentary activities are associated with overweight/obesity in epidemiological studies. This has traditionally been attributed to physical activity displacement. A little-explored area is whether behavioural stresses alter sensations of appetite and eating behaviour. We examined whether behaviours conducted seated (television viewing, video gaming) induce different eating patterns, associated with differential levels of stress response.Methods and findingsWe conducted a randomized controlled trial in 72 overweight/obese adult males, assigned to three groups (24 per group): (i) non-violent television (control group); (ii) non-violent game (FIFA); (iii) violent game (Call of Duty). Following a standardized breakfast, the 1-h intervention was followed by 25-min rest, with sweet and savoury snacks and drinks available ad libitum. Stress markers (heart rate, blood pressure, visual analogue scale (VAS)) were measured throughout. Heart rate, systolic blood pressure, and stress by VAS were significantly higher (p < 0.05) playing video games than watching non-violent television, though the two game groups did not differ. Considered separately, only the violent video game group consumed more energy (Δ = 208.3 kcal, 95%CI 16, 400), sweet foods (Δ = 25.9 g, 95%CI 9.9, 41.9) and saturated fat (Δ = 4.36 g, 95%CI 0.76, 7.96) than controls.ConclusionPlaying video games in overweight/obese adult males is associated with an acute stress response relative to watching non-violent television, associated with greater subsequent food intake. These findings highlight the need to focus on the metabolic effects, as well as the energy costs, of activities involving sitting in relation to obesity risk.



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Increased Vascular Permeability in the Bone Marrow Microenvironment Contributes to Disease Progression and Drug Response in Acute Myeloid Leukemia

Publication date: Available online 1 September 2017
Source:Cancer Cell
Author(s): Diana Passaro, Alessandro Di Tullio, Ander Abarrategi, Kevin Rouault-Pierre, Katie Foster, Linda Ariza-McNaughton, Beatriz Montaner, Probir Chakravarty, Leena Bhaw, Giovanni Diana, François Lassailly, John Gribben, Dominique Bonnet
The biological and clinical behaviors of hematological malignancies can be influenced by the active crosstalk with an altered bone marrow (BM) microenvironment. In the present study, we provide a detailed picture of the BM vasculature in acute myeloid leukemia using intravital two-photon microscopy. We found several abnormalities in the vascular architecture and function in patient-derived xenografts (PDX), such as vascular leakiness and increased hypoxia. Transcriptomic analysis in endothelial cells identified nitric oxide (NO) as major mediator of this phenotype in PDX and in patient-derived biopsies. Moreover, induction chemotherapy failing to restore normal vasculature was associated with a poor prognosis. Inhibition of NO production reduced vascular permeability, preserved normal hematopoietic stem cell function, and improved treatment response in PDX.

Graphical abstract

Teaser

Passaro et al. show that acute myeloid leukemia, mainly via nitric oxide (NO), causes bone marrow vascular abnormalities and that failure to restore normal vasculature after induction chemotherapy is associated with a poor prognosis. Importantly, inhibition of NO production improves treatment response in vivo.


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Growth curves for intracranial volume in normal Asian children fortify management of craniosynostosis

Craniosynostosis alters the morphology of cranial vault, prevents normal cranial growth, and can elevate intracranial pressure over time. Surgical goals in the event of craniosynostosis are to reduce intracranial pressure and to achieve aesthetic cranial contours, but the timing of such surgery is open to debate. Although excess intracranial pressure must be avoided, premature surgical interventions may necessitate secondary revisions. Also, direct attempts to measure intracranial pressure are invasive by design and thus may not be feasible in every case.

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From Original Antigenic Sin to the Universal Influenza Virus Vaccine

Publication date: Available online 31 August 2017
Source:Trends in Immunology
Author(s): Carole Henry, Anna-Karin E. Palm, Florian Krammer, Patrick C. Wilson
Antibody responses are essential for protection against influenza virus infection. Humans are exposed to a multitude of influenza viruses throughout their lifetime and it is clear that immune history influences the magnitude and quality of the antibody response. The 'original antigenic sin' concept refers to the impact of the first influenza virus variant encounter on lifelong immunity. Although this model has been challenged since its discovery, past exposure, and likely one's first exposure, clearly affects the epitopes targeted in subsequent responses. Understanding how previous exposure to influenza virus shapes antibody responses to vaccination and infection is critical, especially with the prospect of future pandemics and for the effective development of a universal influenza vaccine.



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The Relationship Between Physical Activity and Vitamin D Status in Postpartum Lactating and Formula-Feeding Women

Publication date: Available online 1 September 2017
Source:The Journal of Steroid Biochemistry and Molecular Biology
Author(s): Jordan T. Hall, Myla Ebeling, Judy R. Shary, Nina Forestieri, Carol L. Wagner
Existing research shows an association between physical activity levels and vitamin D status in the elderly, men, women, children, and adolescent populations. This association has not yet been investigated in postpartum women. We hypothesized that based on the relationship between vitamin D and physical activity found in other populations, greater physical activity levels in postpartum women will be associated with higher serum 25(OH)D levels. A post hoc analysis of 286 postpartum women with self reported physical activity data from the America on the Move survey, and measured circulating serum 25(OH)D (measured by RIA) as an indicator of vitamin D status, was gathered at baseline (4-6 weeks postpartum), 4 months, and 7 months postpartum. The data were analyzed using SAS 9.4 (Cary, NC). 39.9% of women at visit 1 (baseline), 52.8% of women at visit 4 (month 4), and 55.9% of women at visit 7 (month 7) were meeting the NIH recommendation of 150minutes of moderate intensity (3-6 METs) physical activity per week. Significant differences were seen in physical activity by race (p=0.007). Caucasians were more likely to meet the standard recommendation than African Americans or Hispanics. Using multiple regression models to examine associations between duration of physical activity and 25(OH)D concentration, controlling for race, BMI, feeding type, and METs, it was found that at visit 1, an increase in physical activity was associated with an increase in 25(OH)D of 1.3 nmol/L (p=0.03) and achieving at least 2.5hrs/wk of physical activity had a trending association with an increase in 25(OH)D of 7.23 nmol/L (p=.05). At visit 4 (also controlling for treatment group and sun exposure) achieving at least 1.5hrs/wk of physical activity was associated with an increase in 25(OH)D of 11.73 nmol/L (p=.04). By visit 7, no association between physical activity and maternal 25(OH)D was observed. In a repeated measures, mixed model analysis predicting maternal 25(OH)D during the study, achieving at least the recommended 150minutes per week of physical activity (>2.5hours) was not significantly associated with vitamin D status (pNS). Postpartum physical activity levels differ across race/ethnicity. Consistent with existing data of other population groups, greater physical activity was associated with higher serum 25(OH)D levels at postpartum visits 1 and 4. While no definitive conclusions can be drawn regarding precise levels of physical activity influencing 25(OH)D levels in postpartum women, the data suggest that increased activity during the first 4 months after birth is associated with improved vitamin D status. Additional research is needed because of the inconsistency seen at visit 7.



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Relationship of SULT1A1 Copy Number Variation with Estrogen Metabolism and Human Health

Publication date: Available online 1 September 2017
Source:The Journal of Steroid Biochemistry and Molecular Biology
Author(s): Jixia Liu, Ran Zhao, Zhan Ye, Alexander J. Frey, Emily R. Schriver, Nathaniel W. Snyder, Scott J. Hebbring
Human cytosolic sulfotransferase 1A1 (SULT1A1) is considered to be one of the most important SULT isoforms for metabolism, detoxification, and carcinogenesis. This theory is driven by observations that SULT1A1 is widely expressed in multiple tissues and acts on a wide range of phenolic substrates. SULT1A1 is subject to functional common copy number variation (CNV) including deletions or duplications. However, it is less clear how SULT1A1 CNV impacts health and disease. To better understand the biological role of SULT1A1 in human health, we genotyped CNV in 14,275 Marshfield Clinic patients linked to an extensive electronic health record. Since SULT1A1 is linked to steroid metabolism, select serum steroid hormones were measured in 100 individuals with a wide spectrum of SULT1A1 CNV genotypes. Furthermore, comprehensive phenome-wide association studies (PheWAS) were conducted using diagnostic codes and clinical text data. For the first time, individuals homozygous null for SULT1A1 were identified in a human population. Thirty-six percent of the population carried >2 copies of SULT1A1 whereas 4% had≤1 copy. Results indicate SULT1A1 CNV was negatively correlated with estrone-sulfate to estrone ratio predominantly in males (E1S/E1; p=0.03, r=−0.21) and may be associated with increased risk for common allergies. The effect of SULT1A1 CNV on circulating estrogen metabolites was opposite to the predicted CNV-metabolite trend based on enzymatic function. This finding, and the potential association with common allergies reported herein, warrants future studies.



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A Self-Reported Needs Assessment Survey of Pediatric Orthopaedic Education in Haiti

Publication date: Available online 31 August 2017
Source:Journal of Surgical Education
Author(s): Rameez A. Qudsi, Heather J. Roberts, Abhiram R. Bhashyam, Elena Losina, Donald S. Bae, Francel Alexis, George S. Dyer
ObjectiveThe burden of musculoskeletal disease remains high in low-income countries, with a high rate of pediatric disease. Efforts continue for orthopedic education, but there is little guidance on local needs and desires. Our aim was to determine the specific content and modalities that would be most useful for pediatric orthopedic educational programs abroad, and we demonstrate a practical method of identifying country-specific educational deficits through a self-reported needs survey in Haiti.DesignA cross-sectional survey was administered using an automated response system. We obtained demographic information as well as training and practice patterns, comfort levels with pediatric diagnoses, and desired topics for education using a 5-point Likert Scale.SettingHaitian Annual Assembly for Orthopaedic Trauma (HAAOT), the only national, continuing medical education conference for orthopedic providers in Haiti.ParticipantsOf 60 eligible participants, 51 were included in the final analysis.ResultsTime spent on pediatric orthopedics varied widely, centered at 10% to 25%. Median comfort level with pediatric orthopedics was 3 of 5. Skills with lowest self-reported competence included spica casting, clubfoot casting, and management of supracondylar humerus fractures. Skills with highest self-reported competence were long-leg casting and Salter-Harris classification. Modes of education highly requested included didactics/lectures, hands-on sessions, dedicated rotations, and exchanges with foreign peers/mentors. Diagnoses most encountered were osteomyelitis, trauma, and clubfoot; lowest comfort levels were in neuromuscular, spine, lower extremity deformity, congenital hip, and clubfoot; and most requested for future teaching were congenital hip, neuromuscular, and spine.ConclusionsHaitian orthopedic providers express a strong desire and need for ongoing pediatric orthopedic education. They describe a high prevalence of trauma and infection, but convey a requirement for more comprehensive, multimodal teaching that also includes congenital deformities/dysplasias, neuromuscular, and spine. Our results demonstrate the importance of assessing country-specific needs and involving local care providers in curriculum development.



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The Colorado Humanitarian Surgical Skills Workshop: A Cadaver-Based Workshop to Prepare Residents for Surgery in Austere Settings

Publication date: Available online 31 August 2017
Source:Journal of Surgical Education
Author(s): Yihan Lin, Swagoto Mukhopadhyay, Robert A. Meguid, David P. Kuwayama
ObjectiveInterest in humanitarian surgery is high among surgical and obstetric residents. The Colorado Humanitarian Surgical Skills Workshop is an annual 2-day course exposing senior residents to surgical techniques essential in low- and middle-income countries but not traditionally taught in US residencies. We evaluated the course's ability to foster resident comfort, knowledge, and competence in these skills.DesignThe cohort of course participants was studied prospectively. Participants attended didactic sessions followed by skills sessions using cadavers. Sample areas of focus included general surgery (mesh-free hernia repair), orthopedics (powerless external fixation), and neurosurgery (powerless craniotomy). Before and after the course, participants answered a questionnaire assessing confidence with taught skills; took a knowledge-based test composed of multiple choice and open-ended questions; and participated in a manual skills test of tibial external fixation.SettingThe Center for Surgical Innovation, University of Colorado School of Medicine.ParticipantsA total of 12 residents (11 general surgical and 1 obstetric) from ten US institutions.ResultsAfter the course, participants perceived increased confidence in performing all 27 taught procedures and ability to practice in low- and middle-income countries. In knowledge-based testing, 10 of 12 residents demonstrated improvement on multiple choice questioning and 9 of 12 residents demonstrated improvement on open-ended questioning with structured scoring. In manual skills testing, all external fixator constructs demonstrated objective improvement on structured scoring and subjective improvement on stability assessment.ConclusionsFor senior residents interested in humanitarian surgery, a combination of skills-focused teaching and manual practice led to self-perceived and objective improvement in relevant surgical knowledge and skills. The Colorado Humanitarian Surgical Skills Workshop represents an effective model for transmitting essential surgical principles and techniques of value in low-resource settings.



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Using GoPro to Give Video-Assisted Operative Feedback for Surgery Residents: A Feasibility and Utility Assessment

Publication date: Available online 31 August 2017
Source:Journal of Surgical Education
Author(s): Maureen D. Moore, Jonathan S. Abelson, Paul O'Mahoney, Iskander Bagautdinov, Heather Yeo, Anthony C. Watkins
ObjectiveAs an adjunct to simulation-based teaching, laparoscopic video-based surgical coaching has been an effective tool to augment surgical education. However, the wide use of video review in open surgery has been limited primarily due to technological and logistical challenges. The aims of our study were to (1) evaluate perceptions of general surgery (GS) residents on video-assisted operative instruction and (2) conduct a pilot study using a head-mounted GoPro in conjunction with the operative performance rating system to assess feasibility of providing video review to enhance operative feedback during open procedures.DesignGS residents were anonymously surveyed to evaluate their perceptions of oral and written operative feedback and use of video-based operative resources. We then conducted a pilot study of 10 GS residents to assess the utility and feasibility of using a GoPro to record resident performance of an arteriovenous fistula creation with an attending surgeon. Categorical variables were analyzed using the chi-square test.SettingAcademic, tertiary medical center.ParticipantsGS residents and faculty.ResultsA total of 59 GS residents were anonymously surveyed (response rate = 65.5%). A total of 40% (n = 24) of residents reported that structured evaluations rarely or never provided meaningful feedback. When feedback was received, 55% (n = 32) residents reported that it was only rarely or sometimes in regard to their operative skills. There was no significant difference in surveyed responses among junior postgraduate year (PGY 1-2), senior (PGY 3-4), or chief residents (PGY-5). A total of 80% (n = 8) of residents found the use of GoPro video review very or extremely useful for education; they also deemed video review more useful for operative feedback than written or communicative feedback. An overwhelming majority (90%, n = 9) felt that video review would lead to improved technical skills, wanted to review the video with the attending surgeon for further feedback, and desired expansion of this tool to include additional procedures.ConclusionsAlthough there has been progress toward improving operative feedback, room for further improvement remains. The use of a head-mounted GoPro is a dynamic tool that provides high-quality video for operative review and has the potential to augment the training experience of GS residents. Future studies exploring a wide array of open procedures involving a greater number of trainees will be needed to further define the use of this resource.



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Developing the Blueprint for a General Surgery Technical Skills Certification Examination: A Validation Study

Publication date: Available online 31 August 2017
Source:Journal of Surgical Education
Author(s): Sandra de Montbrun, Marisa Louridas, Peter Szasz, Kenneth A. Harris, Teodor P. Grantcharov
IntroductionThere is a recognized need to develop high-stakes technical skills assessments for decisions of certification and resident promotion. High-stakes examinations requires a rigorous approach in accruing validity evidence throughout the developmental process. One of the first steps in development is the creation of a blueprint which outlines the potential content of examination. The purpose of this validation study was to develop an examination blueprint for a Canadian General Surgery assessment of technical skill certifying examination.MethodsA Delphi methodology was used to gain consensus amongst Canadian General Surgery program directors as to the content (tasks or procedures) that could be included in a certifying Canadian General Surgery examination. Consensus was defined a priori as a Cronbach's α ≥ 0.70. All procedures or tasks reaching a positive consensus (defined as ≥80% of program directors rated items as ≥4 on the 5-point Likert scale) were then included in the final examination blueprint.ResultsTwo Delphi rounds were needed to reach consensus. Of the 17 General Surgery Program directors across the country, 14 (82.4%) and 10 (58.8%) program directors responded to the first and second round, respectively. A total of 59 items and procedures reached positive consensus and were included in the final examination blueprint.ConclusionsThe present study has outlined the development of an examination blueprint for a General Surgery certifying examination using a consensus-based methodology. This validation study will serve as the foundational work from which simulated model will be developed, pilot tested and evaluated.



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The Perfect Storm Is on the Horizon!

Publication date: Available online 31 August 2017
Source:Journal of Surgical Education
Author(s): Dawn Fountain, Chi Quach, Darlene Norton, SuAnn White, Susan Ratliff, Kim Molteg, Donna Heyduk, Jessica Roof, Lillian Badurina
PurposeProvide analysis of data identifying the impending mass turnover of Directors and Coordinators of General Surgery residency programs and the potential effect on successful continuing accreditation including the ACGME Next Accreditation System (NAS) and associated self study.MethodsThe Association of Residency Coordinators in Surgery, Executive Committee (ARCS EC) anonymously surveyed 254 general surgery Program Coordinators in September/October 2016. This represents 60`% of all the members within the Association of Residency Coordinators in Surgery. Survey was accomplished using SurveyMonkey. Questions included demographics and experience of the Director and Coordinator, accreditation status, significant job stressors, and potential retirements or position changes planned or possible.Results153 (60%) respondents completed the survey. Data from the survey indicates that 67% of Program Directors have been in their position less than six (6) years. 34% of Program Coordinators have been in their position less than five (5) years. 56% of coordinators have been on the job less than ten (10) years. Coordinators in 76% of programs reported significant levels of burnout. 59% have considered resigning from their position in the past year. Participants consistently reported increasing responsibilities and expectations combined with declining or inadequate levels of support as sources of job stress. Other contributors to Coordinator burnout were identified as related to the additional ACGME accreditation requirements and salaries not commensurate with workload.ConclusionThis survey represents a sentinel preliminary look at the possible impending manning crisis in general surgery residency program leadership. A Program Director is supported by a Program Coordinators who are burned out and considering a job change. The resultant potential turnover in personnel and loss of collective program knowledge may have devastating ramifications to program accreditation. Subsequent survey of the workforce will evaluate proposed solutions and interventions to prevent this outcome and secure the future success of general surgery programs.



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Coalition for Global Clinical Surgical Education: The Alliance for Global Clinical Training

Publication date: Available online 1 September 2017
Source:Journal of Surgical Education
Author(s): Jahanara Graf, Mackenzie Cook, Samuel Schecter, Karen Deveney, Paul Hofmann, Douglas Grey, Larry Akoko, Ali Mwanga, Kitembo Salum, William Schecter
ObjectiveAssessment of the effect of the collaborative relationship between the high-income country (HIC) surgical educators of the Alliance for Global Clinical Training (Alliance) and the low-income country surgical educators at the Muhimbili University of Health and Allied Sciences/Muhimbili National Hospital (MUHAS/MNH), Dar Es Salaam, Tanzania, on the clinical global surgery training of the HIC surgical residents participating in the program.DesignA retrospective qualitative analysis of Alliance volunteer HIC faculty and residents' reports, volunteer case lists and the reports of Alliance academic contributions to MUHAS/MNH from 2012 to 2017. In addition, a survey was circulated in late 2016 to all the residents who participated in the program since its inception.ResultsTwelve HIC surgical educators provided rotating 1-month teaching coverage at MUHAS/MNH between academic years 2012 and 2017 for a total of 21 months. During the same time period 11 HIC residents accompanied the HIC faculty for 1-month rotations. HIC surgery residents joined the MUHAS/MNH Department of Surgery, made significant teaching contributions, performed a wide spectrum of "open procedures" including hand-sewn intestinal anastomoses. Most had had either no or limited previous exposure to hand-sewn anastomoses. All of the residents commented that this was a maturing and challenging clinical rotation due to the complexity of the cases, the limited resources available and the ethical and emotional challenges of dealing with preventable complications and death in a resource constrained environment.ConclusionsThe Alliance provides an effective clinical global surgery rotation at MUHAS/MNH for HIC Surgery Departments wishing to provide such an opportunity for their residents and faculty.



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Immediate Auditory Feedback is Superior to Other Types of Feedback for Basic Surgical Skills Acquisition

Publication date: Available online 31 August 2017
Source:Journal of Surgical Education
Author(s): Mohammed J. Al Fayyadh, Ramy A. Hassan, Zachary K. Tran, Jason W. Kempenich, Leonid Bunegin, Daniel L. Dent, Ross E. Willis
ObjectiveWe examined the effect of timing and type of feedback on medical students' knot-tying performance using visual versus auditory and immediate versus delayed feedback. We hypothesized that participants who received immediate auditory feedback would outperform those who received delayed and visual feedback.MethodsSixty-nine first- and second-year medical students were taught to tie 2-handed knots. All participants completed 3 pretest knot-tying trials without feedback. Participants were instructed to tie a knot sufficiently tight to stop the "blood" flow while minimizing the amount of force applied to the vessel. Task completion time was not a criterion. Participants were stratified and randomly assigned to 5 experimental groups based on type (auditory versus visual) and timing (immediate versus delayed) of feedback. The control group did not receive feedback. All groups trained to proficiency. Participants completed 3 posttest trials without feedback.ResultsThere were fewer trials with leak (p < 0.01) and less force applied (p < 0.01) on the posttest compared to the pretest, regardless of study group. The immediate auditory feedback group required fewer trials to achieve proficiency than each of the other groups (p < 0.01) and had fewer leaks than the control, delayed auditory, and delayed visual groups (p < 0.02).ConclusionsIn a surgical force feedback simulation model, immediate auditory feedback resulted in fewer training trials to reach proficiency and fewer leaks compared to visual and delayed forms of feedback.



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Effect of Continuous Motion Parameter Feedback on Laparoscopic Simulation Training: A Prospective Randomized Controlled Trial on Skill Acquisition and Retention

Publication date: Available online 31 August 2017
Source:Journal of Surgical Education
Author(s): Julian Frederik Buescher, Anne-Sophie Mehdorn, Philipp-Alexander Neumann, Felix Becker, Ann-Kathrin Eichelmann, Ulrich Pankratius, Ralf Bahde, Daniel Foell, Norbert Senninger, Emile Rijcken
ObjectiveTo investigate the effect of motion parameter feedback on laparoscopic basic skill acquisition and retention during a standardized box training curriculum.DesignA Lap-X Hybrid laparoscopic simulator was designed to provide individual and continuous motion parameter feedback in a dry box trainer setting. In a prospective controlled trial, surgical novices were randomized into 2 groups (regular box group, n = 18, and Hybrid group, n = 18) to undergo an identical 5-day training program. In each group, 7 standardized tasks on laparoscopic basic skills were completed twice a day on 4 consecutive days in fixed pairs. Additionally, each participant performed a simulated standard laparoscopic cholecystectomy before (day 1) and after training (day 5) on a LAP Mentor II virtual reality (VR) trainer, allowing an independent control of skill progress in both groups. A follow-up assessment of skill retention was performed after 6 weeks with repetition of both the box tasks and VR cholecystectomy.SettingMuenster University Hospital Training Center, Muenster, Germany.ParticipantsMedical students without previous surgical experience.ResultsLaparoscopic skills in both groups improved significantly during the training period, measured by the overall task performance time. The 6 week follow-up showed comparable skill retention in both groups. Evaluation of the VR cholecystectomies demonstrated significant decrease of operation time (p < 0.01), path length of the left and right instrument, and the number of movements of the left and right instruments for the Hybrid group (all p < 0.001), compared to the box group. Similar results were found at the assessment of skill retention.ConclusionSimulation training on both trainers enables reliable acquisition of laparoscopic basic skills. Furthermore, individual and continuous motion feedback improves laparoscopic skill enhancement significantly in several aspects. Thus, training systems with feedback of motion parameters should be considered to achieve long-term improvement of motion economy among surgical trainees.



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