Assessment of the quality of online patient information resources for patients considering parastomal hernia treatment.

AIM: The aim was to examine the quality of online patient information resources for patients considering parastomal hernia treatment. METHODS: A Google search was conducted using lay search terms for patient facing sources on parastomal hernia. The quality of the content was assessed using the validated DISCERN instrument. Readability of written content was established using the Flesch-Kincaid score. Sources were also assessed against the essential content and process standards from the National Institute for Health and Care Excellence (NICE) framework for shared decision making support tools. Content analysis was also undertaken to explore what the sources covered and to identify any commonalities across the content. RESULTS: Fourteen sources were identified and assessed using the identified tools. The mean Flesch-Kincaid reading ease score was 43.61, suggesting that the information was difficult to read. The overall quality of the identified sources was low based on the pooled analysis of the DISCERN and Flesch-Kincaid scores, and when assessed against the criteria in the NICE standards framework for shared decision making tools. Content analysis identified eight categories encompassing 59 codes, which highlighted considerable variation between sources. CONCLUSIONS: The current information available to patients considering parastomal hernia treatment is of low quality and often does not contain enough information on treatment options for patients to be able to make an informed decision about the best treatment for them. There is a need for high-quality information, ideally co-produced with patients, to provide patients with the necessary information to allow them to make informed decisions about their treatment options when faced with a symptomatic parastomal hernia.

Disgust sensitivity and support for immigration across five nations.

Immigration has become a focal debate in politics across the world. Recent research suggests that anti-immigration attitudes may have deep psychological roots in implicit disease avoidance motivations. A key implication of this theory is that individual differences in disease avoidance should be related to opposition to immigration across a wide variety of cultural and political contexts. However, existing evidence on the topic has come almost entirely from the United States and Canada. In this article, we test the disease avoidance hypothesis using nationally representative samples from Norway, Sweden, Turkey, and Mexico, as well as two diverse samples from the United States. We find consistent and robust evidence that disgust sensitivity is associated with anti-immigration attitudes and that the relationship is similar in magnitude to education. Overall, our findings support the disease avoidance hypothesis and provide new insights into the nature of anti-immigration attitudes.

A functional neuroimaging investigation of Moral Foundations Theory.

Moral Foundations Theory (MFT) posits that the human mind contains modules (or "foundations") that are functionally specialized to moralize unique dimensions of the social world: Authority, Loyalty, Purity, Harm, Fairness, and Liberty. Despite this strong claim about cognitive architecture, it is unclear whether neural activity during moral reasoning exhibits this modular structure. Here, we use spatiotemporal partial least squares correlation (PLSC) analyses of fMRI data collected during judgments of foundation-specific violations to investigate whether MFT's cognitive modularity claim extends to the neural level. A mean-centered PLSC analysis returned two latent variables that differentiated between social norm and moral foundation violations, functionally segregated Purity, Loyalty, Physical Harm, and Fairness from the other foundations, and suggested that Authority has a different neural basis than other binding foundations. Non-rotated PLSC analyses confirmed that neural activity distinguished social norm from moral foundation violations, and distinguished individualizing and binding moral foundations if Authority is dropped from the binding foundations. Purity violations were persistently associated with amygdala activity, whereas moral foundation violations more broadly tended to engage the default network. Our results constitute partial evidence for neural modularity and motivate further research on the novel groupings identified by the PLSC analyses.

Ultrasound Neuromodulation of the Spleen Has Time-Dependent Anti-Inflammatory Effect in a Pneumonia Model.

Interfaces between the nervous and immune systems have been shown essential for the coordination and regulation of immune responses. Non-invasive ultrasound stimulation targeted to the spleen has recently been shown capable of activating one such interface, the splenic cholinergic anti-inflammatory pathway (CAP). Over the past decade, CAP and other neuroimmune pathways have been activated using implanted nerve stimulators and tested to prevent cytokine release and inflammation. However, CAP studies have typically been performed in models of severe, systemic (e.g., endotoxemia) or chronic inflammation (e.g., collagen-induced arthritis or DSS-induced colitis). Herein, we examined the effects of activation of the splenic CAP with ultrasound in a model of local bacterial infection by lung instillation of 105 CFU of Streptococcus pneumoniae. We demonstrate a time-dependent effect of CAP activation on the cytokine response assay during infection progression. CAP activation-induced cytokine suppression is absent at intermediate times post-infection (16 hours following inoculation), but present during the early (4 hours) and later phases (48 hours). These results indicate that cytokine inhibition associated with splenic CAP activation is not observed at all timepoints following bacterial infection and highlights the importance of further studying neuroimmune interfaces within the context of different immune system and inflammatory states.

Predicting Recidivism for Acquired Cholesteatoma: Evaluation of a Current Staging System.

OBJECTIVE: Assess the utility and prognostic capabilities of the European Academy of Otology and Neurotology (EAONO) and Japanese Otological Society (JOS) cholesteatoma classification system, specifically for retraction pocket cholesteatoma. STUDY DESIGN: Retrospective. SETTING: Tertiary referral hospital. PATIENTS: Adults and children with retraction pocket cholesteatoma. INTERVENTIONS: Primary and planned second-look tympanoplasty with mastoidectomy. MAIN OUTCOME MEASURES: Incidence of recurrent or residual cholesteatoma at planned second-look surgery. Independent variables of age, gender, size of canal defect, and mucosa status were assessed. Additionally, the cholesteatoma classification, stage, and extent according to the EAONO/JOS system were recorded during the primary surgery. RESULTS: A total of 125 cases were included. Twelve (9.6%) cases had recidivism over an average time of 7.5 months: the recurrence rate was 4% (n = 5), residual rate was 5% (n = 6), and one patient had both recurrent and residual disease (0.8%). Residual cholesteatoma occurred more frequently in children (p = 0.04, RR = 7.9 [1.0, 63.6]). Supratubal recess (S1) disease was associated with both recurrent cholesteatoma (p = 0.04, RR = 5.9 [1.3, 27.2]) and recidivism (p = 0.01, RR = 4.2 [1.5, 11.9]). Larger canal defects also showed an association with residual disease (p = 0.017). CONCLUSION: Younger patients and those with large ear canal defects tend to have residual disease at second-look surgery. Supratubal recess disease is also associated with recurrence. Despite the utility of the EAONO/JOS classification and staging system for cholesteatoma description and type, the prognostic value remains uncertain.

Associations of Vestibular Tests With Penn Acoustic Neuroma Quality of Life Scores After Resection of Vestibular Schwannoma.

OBJECTIVE: Determine associations between preoperative caloric testing and video head impulse testing (vHIT) with baseline and postoperative Penn Acoustic Neuroma Quality of Life (PANQOL) scores following resection of vestibular schwannoma (VS). STUDY DESIGN: Retrospective case series. SETTING: Two tertiary referral hospitals. PATIENTS: Adult patients with unilateral VS, preoperative calorics, vHIT, and dizziness handicap inventory (DHI) score. INTERVENTIONS: Surgical resection of VS and postoperative surveys. MAIN OUTCOME MEASURES: PANQOL scores. RESULTS: Forty-three patients were included (58.1% women) with a median age of 54 years (range, 28-82). Mean tumor size was 14.8 mm (σ=8.6), and 28 (65.1%) were right-sided. Average preoperative vHIT gain was 0.7 (σ = 0.3). Covert and overt saccades were present in 8 (25%) and 14 (42.4%) patients, respectively. Average preoperative unilateral weakness was 47% (σ = 33.2). Translabyrinthine approach was performed in 26 (60.5%) patients. No significant difference of PANQOL scores was noted at baseline or over time between patients with normal (>0.8) or abnormal (<0.8) gain. Patients with more unilateral weakness (>50%) had significantly higher baseline PANQOL scores compared with those with < 25% or 25 to 50% (p = 0.02), but had significant improvement in scores over time (p = 0.01). Higher preoperative DHI preoperatively was significantly associated with worse PANQOL scores at all timepoints (ß=0.57, p = 0.0064). No differences in PANQOL scores amongst surgical approaches were observed. CONCLUSION: Preoperative vestibular testing with vHIT, calorics, DHI, and baseline PANQOL surveys may allow for patient counseling regarding postoperative quality of life over time.

Management of epistaxis in patients with ventricular assist device: a retrospective review.

BACKGROUND: Patients with a ventricular assist device (VAD) are at risk for epistaxis due to the need for anticoagulation. Additionally, these patients develop acquired von Willebrand syndrome (AvWS) due to these devices. Management is complicated by the risk of thrombosis if anticoagulation is reversed. This study sought to characterize the clinical features and management of epistaxis in this high-risk population. METHODS: Retrospective review of adults with VAD and epistaxis necessitating inpatient consultation with the otolaryngology service were included. RESULTS: 49 patients met inclusion criteria. All patients had a presumed diagnosis of AvWS. An elevated INR (> 2.0) was present in 18 patients (36.7%). Anticoagulation was held in 14 (28.6%) patients, though active correction was not necessary. Multiple encounters were required in 16 (32.7%) patients. Spontaneous epistaxis was associated with multiple encounters (p = 0.02). The use of hemostatic material was associated with a lower likelihood of bleeding recurrence (p = 0.05), whereas cauterization with silver nitrate alone was associated with a higher likelihood of re-intervention (p = 0.05). Surgery or embolization was not required urgently for any patient. Endoscopy under general anesthesia was performed for one patient electively. Mean follow up time was 16.6 months (σ = 6.3). At six months, 18 (36.7%) patients were deceased. CONCLUSION: While these patients are at risk for recurrent spontaneous epistaxis, nonsurgical treatment without active correction of INR or AvWS was largely successful. Placement of hemostatic material, as opposed to cautery with silver nitrate, should be considered as a first-line treatment in this group. Multidisciplinary collaboration is critical for successful management.

Global Hearing Loss Prevention.

Hearing loss is the fourth leading contributor to years lived with a disability worldwide. Most recent estimates indicate that one-half of a billion people suffer from disabling hearing loss worldwide. The social and economic burden is significant. When attributing monetary value to years lived with disability owing to hearing loss, there is greater than $US750 billion lost each year globally. There are numerous contributors to hearing loss, including congenital, infectious, noise exposure, age-related, traumatic, and immune-mediated causes. Understanding the pathophysiology of these factors allows for the development of preventative and treatment strategies specific to the underlying cause.

Noninvasive optical spectroscopy for identification of non-melanoma skin cancer: Pilot study.

OBJECTIVE: Optical spectroscopy offers a noninvasive alternative to biopsy as a first-line screening tool for suspicious skin lesions. This study sought to define several optical parameters across malignant and benign tissue types. STUDY DESIGN: Prospective pilot trial utilizing the Zenalux IM1 optical spectroscopy device from April 2016 to February 2017. For each skin lesion, provider pre-biopsy probability of malignancy was compared to histolopathologic diagnosis. Optical data were characterized across basal cell carcinoma (BCC; n = 9), squamous cell carcinoma (SCC; n = 5), actinic keratosis (AK; n = 4), scar tissue (n = 6), nevus (n = 2), and neurofibroma (NF; n = 1). Across all patients, agreement was determined between control measurements collected adjacent to the lesion and from the upper extremity. METHODS: Prospective single center pilot study. The optical properties of 27 cutaneous lesions were collected from 18 adult patients presenting to Otolaryngology and Dermatology clinics with suspicious skin lesions warranting biopsy. Spectroscopy measurements were recorded for each lesion: two at the lesion site, two at an adjacent site (internal control), and one at the central medial upper extremity (arm control). Variables of interest included absolute oxygenated hemoglobin (Hb), Hb saturation, total Hb concentration, and Eumelanin concentration. For each lesion, internal control averages were subtracted from lesion averages to provide delta parameter values, and lesion averages were divided by internal control averages to provide ratio parameter values. RESULTS: Mean percent difference between pre-biopsy probability of malignancy and histology was 29%, with a difference of 75% or greater seen in 5 of 25 lesions. Mean values for BCC, SCC, AK, and scar tissue varied most between extracted mean reduced scatter estimate (µa'; cm- ) delta values (BCC: -2.2 ± 3.8; SCC: -3.9 ± 2.0; AK: -3.3 ± 4.2, Scar: -1.7 ± 1.2) and total Hb (µM) ratio (BCC: 2.0 ± 3.3; SCC: 3.0 ± 1.3; AK: 1.1 ± 0.6; Scar: 1.4 ± 1.1). Agreement between local and arm controls was poor. CONCLUSION: This pilot trial utilizes optical spectroscopy as a noninvasive method for determining cutaneous lesion histology. Effect sizes observed across optical parameters for benign and malignant tissue types will guide larger prospective studies that may ultimately lead to prediction of lesional histology without need for invasive biopsy. Lasers Surg. Med. 50:246-252, 2018. © 2018 Wiley Periodicals, Inc.

Moral foundations vignettes: a standardized stimulus database of scenarios based on moral foundations theory.

Research on the emotional, cognitive, and social determinants of moral judgment has surged in recent years. The development of moral foundations theory (MFT) has played an important role, demonstrating the breadth of morality. Moral psychology has responded by investigating how different domains of moral judgment are shaped by a variety of psychological factors. Yet, the discipline lacks a validated set of moral violations that span the moral domain, creating a barrier to investigating influences on judgment and how their neural bases might vary across the moral domain. In this paper, we aim to fill this gap by developing and validating a large set of moral foundations vignettes (MFVs). Each vignette depicts a behavior violating a particular moral foundation and not others. The vignettes are controlled on many dimensions including syntactic structure and complexity making them suitable for neuroimaging research. We demonstrate the validity of our vignettes by examining respondents' classifications of moral violations, conducting exploratory and confirmatory factor analysis, and demonstrating the correspondence between the extracted factors and existing measures of the moral foundations. We expect that the MFVs will be beneficial for a wide variety of behavioral and neuroimaging investigations of moral cognition.

Monte carlo simulation of carboxylic acid phase equilibria.

Configurational-bias Monte Carlo simulations were carried out in the Gibbs ensemble to generate phase equilibrium data for several carboxylic acids. Pure component coexistence densities and saturated vapor pressures were determined for acetic acid, propanoic acid, 2-methylpropanoic acid, and pentanoic acid, and binary vapor-liquid equilibrium (VLE) data for the propanoic acid + pentanoic acid and 2-methylpropanoic acid + pentanoic acid systems. The TraPPE-UA force field was used, as it has recently been extended to include parameters for carboxylic acids. To simulate the branched compound 2-methylpropanoic acid, certain minor assumptions were necessary regarding angle and torsion terms involving the -CH- pseudo-atom, since parameters for these terms do not exist in the TraPPE-UA force field. The pure component data showed good agreement with the available experimental data, particularly with regard to the saturated liquid densities (mean absolute errors were less than 1.1%). On average, the predicted critical temperature and density were within 1% of the experimental values. All of the binary simulations showed good agreement with the experimental x-y data. However, the TraPPE-UA force field predicts saturated vapor pressures of pure components that are larger than the experimental values, and consequently the P-x-y and T-x-y data of the binary systems also deviate from the measured data.