International Review Board Research Articles

Association between imaging findings and microbiological findings for image‑guided biopsies for spine infections.

In the evaluation of spondylodiscitis, a number of factors are thought to contribute to the positive‑predictive‑value of spine biopsy including biopsy technique and equipment, number of sample obtained, timing of antibiotics, imaging findings and lab values. The purpose of this study was to examine which technical, magnetic resonance imaging (MRI), laboratory and clinical findings are most frequently associated with positive cultures or histopathology among patients receiving spine biopsies with a focus on the association of imaging findings and positive cultures/histopathology. Following International Review Board approval, we retrospectively reviewed a consecutive series of spine biopsies performed at our institution over a 28-month period in patients who received spine biopsies for radiographically and clinically suspicious spondylodiscitis. All patients underwent MRI prior to biopsy. Patient charts were reviewed for the following data: erythrocyte sedimentation rate (ESR), C‑reactive protein (CRP), and white blood cell level at the time of biopsy, prior back surgeries, timing of last dose of antibiotics prior to biopsy, and length of antibiotic therapy prior to biopsy. We also reviewed procedure notes from the biopsy and collected the following data: technique (transpedicular versus parapedicular), equipment used, type of imaging guidance (CT versus fluoroscopy) and number of samples obtained. MRI studies were evaluated by two radiologists and rated on an ordinal 1-4 scale based on increasing suspicion for spondylodiscitis (1 lowest, 4 highest). All categorical variables were compared using chi‑squared tests. All continuous variables were compared using Student's t‑tests. Seventy‑seven patients are included in this study. Overall, 62% (48/77) were positive for infection on pathological and/or microbiological studies. There was a significant association between radiological index of suspicion and biopsy positivity as 0% (0/3) with index of 1, 31% (4/13) with an index of 2, 59% (10/17) with an index of 3 and 83% (30/36) with an index of 4 had positive pathology (P=0.001). Biopsy approach, type of imaging guidance, CBC, and number of passes were not associated with biopsy positivity. Elevated CRP was associated with biopsy positivity (P=0.002) while elevated ESR was not (P=0.12). On multivariate analysis adjusting for the MRI scale, ESR and CRP, increasing degree of suspicion on MRI was independently associated with biopsy positivity (P<0.01) while CRP and ESR were not independently associated with biopsy positivity. In this study of 77 patients receiving spinal biopsy for diagnosis of spondylodiscitis, a high index of suspicion based on MRI imaging was strongly associated with positive biopsy samples on culture and/or histopathology. In addition, imaging findings were independently associated with positive biopsy findings while elevated CRP and ESR were not. These findings suggest that MRI findings should be used to guide practitioners in their pursuit of a causative organism among patients with suspected discitis‑osteomyelitis.

JBBM at 21 with a Tribute to David T. Wilson: Founding Editor of the Journal of Business-to-Business Marketing

ABSTRACTPurpose: This article documents the contributions of David T. Wilson to the field of business-to-business marketing in general and his contributions as founding editor of the Journal of Business-to-Business Marketing (JBBM).Methodology: In-depth interviews were conducted with David T. Wilson’s doctoral students to discuss the impact he had on their education in business-to-business marketing and in their personal lives. The list of dissertations, which Dr. Wilson chaired, co-chaired, or served on committee, was compiled through the cooperation of libraries at Texas A&M University and The Pennsylvania State University. This list was verified through ProQuest, a global information-content and technology company that provides solutions, applications, and products for libraries. Further, information in this article was derived from a literature review of David’s early JBBM editorials and scholarly articles, as well as those of the current sitting editor.Findings: Results of this research demonstrate David T. Wilson’s long-term commitment to the field of business-to-business marketing over his 33-year career at The Pennsylvania State University. His influence is demonstrated through his research, teaching, and service related to business-to-business marketing.Research implications: David T. Wilson’s vision for JBBM was to position it as a theoretical journal with an international editorial review board and a global impact, including handing the editorial reigns over to David Lichtenthal, the current sitting Editor since 1995 and Wilson’s 16th doctoral student out of a career total of 38.Practical implications: It is the responsibility of the editorial review board to understand the journal’s past to help guide the future. Therefore, understanding the contributions of David T. Wilson, as the founding editor, to JBBM and the field of business-to-business marketing is useful to scholars and managers alike. This understanding provides a valuable historical context.

Correlation of measured and calculated serum osmolality during mannitol or hypertonic saline infusion in patients after craniotomy: a study protocol and statistical analysis plan for a randomised controlled trial

IntroductionBrain oedema is a major complication after craniotomy. Hyperosmolar agents have been used as the medical treatment for this condition. Measurement and estimation of serum osmolality during hyperosmolar agent infusion...

Space debris: Conjunction opportunities and opportunities for international cooperation

Space debris comprises all non-functional human-made objects in Earth orbit or re-entering the atmosphere. Potentially hazardous orbital debris is proliferating. If current trends continue, orbital debris will become a significant factor in constraining space activity. Space, however, is one of the most strategically important theatres of the 21st century. It is thus imperative, given humanity’s reliance on space, that the issue of space debris be addressed. This paper provides an overview of the existing space debris environment, sources of debris and international efforts to monitor it. It analyses space debris mitigation guidelines and the proposed International Code of Conduct for Outer Space Activities. It considers an international treaty to govern space debris as well as the establishment of an international review board to assist in regulating and reducing the amount of debris. It also assesses the challenges of remediation and other policy actions to increase international cooperation to preserve the space environment.

Coronal oblique imaging of the knee: Can it increase radiologists' confidence in diagnosing posterior root meniscal tears?

To investigate the utility of the coronal oblique sequence in the interrogation of posterior root meniscal lesions. Following international review board approval, 62 consecutive knee arthroscopy cases were referred to the musculoskeletal (MSK) radiologists from the same orthopaedic surgeon for imaging/surgical correlation of the posterior meniscal roots. Of 62 cases, 45 lateral and 46 medial menisci met the inclusion criteria. Imaging evaluation was performed with standard magnetic resonance imaging (MRI) sequences, including a coronal oblique proton density sequence. Two blinded fellowship-trained MSK radiologists independently evaluated the menisci on standard sequences indicating whether a tear was identified and then specifying a confidence score using a scale of 1-3 on each study interpreted. Immediately thereafter, the coronal oblique sequence was evaluated using the same method. Statistics were performed on meniscal lesions involving the posterior horn/root junction or isolated root tears comparing confidence scores. Reader A identified nine posterior horn/root junction tears and 14 isolated root tears. Following the addition of the coronal oblique sequence, confidence scores increased in three of 14 (21.4%) isolated root tears. All three final reads were concordant with arthroscopy. Reader B identified 10 posterior horn/root junction tears and 19 isolated root tears. The confidence score increased in six cases: five of 19 (26.3%) isolated root tears and one of 10 (10%) posterior horn/root junction tears. All six final reads were concordant with arthroscopy. Kappa coefficients indicated near perfect agreement. The coronal oblique sequence increased reader confidence in nearly 24% of the posterior root cases identified in this series.

국내 임상에서 실시된 아동간호중재 연구논문(2000-2011년) 동향 분석

Purpose: The purpose of this study was to analysis the research trends of pediatric nursing intervention studies in Korea form 2000 to 2011. Methods: A literature search was conducted from the databases. RISS and ``Infant``, ``Toddler``, ``Preschooler``, ``Schooler``, ``Adolescent``, ``Child``, ``Effect``, ``Program``, ``Intervention`` and ``Nursing`` were used for keyword searches to find relevant studies. A total of 37 published articles and dissertations in Korea from 2000 to 2011 were reviewed using a structured analytical frame. Results: A quasi-experimental design was more common at 91.9% with a true experimental design at 2.7%. The portion of studies in which theoretical framework was suggested was 27.0%. Only 8.1% mentioned International Review Board (IRB) approval and 78.4% received only the participant`s agreement. The participants` developmental stage was mostly preschool stage, and 37.0% of the child`s health problem was a chronic disease. Sensory interventions made up 45.9% of the types of intervention and most of the sensory interventions were distraction interventions. The contents of intervention outcomes were physiological (54.0%) and psychological (28.0%) categories mostly. Conclusion: This study will help in identifying current research trends of pediatric nursing intervention studies in Korea and provide basic data for the direction of developing pediatric nursing interventions.

Phosphate Binders in CKD

Hyperphosphatemia has long been considered an important contributor to the mineral and bone disorder associated with CKD (CKD-MBD).[1][1] Already 50 years ago, Slatopolsky et al. [2][2] showed that as GFR decreased, fractional phosphate excretion rose because of inhibition of tubular phosphate

Forehead Reconstruction with Microvascular Flaps: Utility of Aesthetic Subunits

Current literature describes the forehead as one aesthetic subunit of the face. We argue for the usefulness of aesthetic forehead subunits when microvascular flap reconstruction is required. Key to utilization of microvascular flaps for restoration of forehead subunits is an understanding of the patient population and defect characteristics most amiable to treatment. We conducted an International Review Board-approved retrospective chart review of nine consecutive patients who had undergone free flap reconstruction for large forehead defects. The patients' foreheads included one paramedian defect; one central and paramedian defect; four central, paramedian, and lateral defects; and three lateral defects. Seven patients had ulnar forearm flaps and two had anterolateral thigh flaps. The success rate was 100%. A forehead subunit classification system has been devised that provides a suitable option for cases that benefit from distant tissue replacement in a single stage, while preserving the principles of aesthetic replacement.

Repeatability and Reproducibility of Quantitative Whole-lung Perfusion Magnetic Resonance Imaging

Magnetic resonance imaging (MRI) allows for quantitative evaluation of pulmonary perfusion and has shown high clinical usefulness for the evaluation and differentiation of different lung pathologies. The reproducibility of quantitative analysis of whole-lung perfusion has not been investigated previously. Our aim was to assess the intraobserver and interobserver repeatability and reproducibility of perfusion MRI to prove the concept that perfusion is suitable for therapy monitoring. The study was approved by the International Review Board. Fourteen healthy volunteers were examined using a time-resolved FLASH 3-dimensional perfusion sequence (1.5-T MRI, TREAT, GRAPPA 2, coronal orientation, voxel size 3.9×3.9×6.3 mm(3)). Perfusion was assessed initially and after 24 hours during an inspiratory and an expiratory breath hold. For each examination, 0.05 mmol/kg BW of Gd-DTPA was injected. Perfusion parameters such as pulmonary blood flow (PBF), pulmonary blood volume, and mean transit time were calculated. The evaluation was performed independently by 2 blinded observers. Intraobserver and interobserver differences were determined. The intraobserver differences between the initial and follow-up examinations for pulmonary blood volume, mean transit time, and time to peak were not significantly different for observers 1 and 2. PBF showed a significant difference for both observers only on inspiration (P<0.006 for observer 1 and P<0.009 for observer 2). For interobserver evaluation, all parameters, except inspiratory PBF, were significantly different (P<0.0001). Intraobserver quantitative perfusion MRI showed reproducible results. However, the evaluation is highly dependent on the observer. Therefore, quantitative analysis of the serial examinations should be performed by the same observer.

Letter from the Editor in Chief

Dear JAAHA Readers,In January 2007, I accepted the position of Editor in Chief of the Journal of the American Animal Hospital Association. Since that time, I have been exploring with JAAHA staff ways in which the Journal might better serve its readers, authors, and the profession. As a result of these discussions we are instituting a number of changes that we would like to introduce at this time.Our first objective is to improve the review process for the Journal. We intend both to make the process more timely and user-friendly for our authors and to improve the quality and relevance of our published manuscripts for our readers. Because of the broad range of subject matter submitted for consideration to the Journal, we have decided to identify a group of content experts to serve as Section Editors and to expand the size of our Editorial Review Board. The purpose of these changes is both to expedite the review process and to ensure that all submissions can receive fair and critical review by knowledgeable experts. The names of our new Section Editors will now be published with each Journal volume. When the completed list of the Editorial Review Board is available, these names will also be included on the Journal’s title page.Our Section Editors have already been hard at work revising our Publication Guidelines. Collectively, the Section Editors and I believe that our readership will best be served by the publication of well-designed clinical trials and retrospective clinical studies of significant numbers of patients with the same disease syndrome. Reports of single cases of new syndromes or unusual presentations of more commonly observed phenomena will continue to be published but will be handled as brief communications rather than fully developed manuscripts.We also intend to publish review articles on topics of importance to practicing companion animal veterinarians. These reviews can be expected to cover a wide range of subjects from basic pathophysiology of complex syndromes to new approaches to disease diagnosis, to issues in public health and epidemiology. Section Editors will conference several times per year to identify significant topics for invited reviews from internationally renowned experts. The submission of author-initiated reviews is also being enthusiastically encouraged.Another goal of JAAHA is to increase its national and global visibility and impact. Accordingly, we intend to continue to solicit international authors and readers and over time will add international Section Editors and Editorial Review Board Members to the Journal leadership team. Where appropriate, we will publish highlights from international conferences and events and will feature commentaries addressing issues of significance to the global companion animal practice community.The mission of JAAHA is clear. We seek to be the most relevant, most widely read, and most cited scientific journal for companion animal practitioners in the world. We intend to build upon the solid foundation established by previous editors to raise the Journal to an even higher standard of excellence. The changes being instituted now represent the first steps along this pathway. We seek your support and counsel as we work together to reach our goal.Sincerely,

Vascular anomalies of the female external genitalia

Background/Purpose Vascular tumors and malformations are rare. This large series describes vascular anomalies of the female genitalia and their management. Methods An international review board–approved retrospective database and a record review from 1994 through 2004 was conducted. Results Of the 3186 female patients with a vascular anomaly, 82 (2.6%) had a lesion in the external genitalia. There were 60 malformations and 22 tumors. The most common malformations were combined capillary-lymphaticovenous, venous, and lymphatic. Tumors included 20 infantile hemangiomas, 1 kaposiform hemangioendothelioma, and 1 kaposiform lymphangioendothelioma. The referring diagnosis was incorrect in 56% of patients. Cutaneous stains, swelling, deformity, bleeding, fluid leakage, or infection were the prominent symptoms. Magnetic resonance imaging, ultrasonography, angiography, and computed tomography were used for diagnostic clarification. Malformation treatment consisted of sclerotherapy, embolization, and operative resection. Tumor management included observation, surgical excision, and antiangiogenic pharmacotherapy. Conclusions Vascular anomalies of the female external genitalia are uncommon, and the initial diagnosis is often inaccurate. Correct diagnosis using clinical and radiographic data is feasible and leads to meaningful intervention for these frequently devastating lesions. Whereas tumors may respond to excision or antiangiogenic drugs, malformations require ablation or resection. Evaluation and management of these lesions is complex and benefits from interdisciplinary care.

Homeopathy and The Lancet.

The Lancet of August 27, 2005 featured a cluster of articles highly critical of homeopathy which attracted considerable media attention. The media reports echoed The Lancet's press release: ‘homeopathy is no better than placebo’. The centerpiece was a meta-analysis of clinical trials of homeopathy compared with clinical trials of allopathy (conventional medicine) (1). The first author is Aijing Shang, but the leader of the research group is Prof. Matthias Egger of the Department of Social and Preventive Medicine, University of Berne, Switzerland. The meta-analysis formed part of the Complementary Medicine Evaluation Programme (Programm Evaluation Komplementarmedizin, PEK) financed by the Swiss Federal government. The international review board of PEK has publicly protested at political interference in the scientific process: ‘There is a consensus among the review board members that the final PEK process deviated from what would have been expected by conventional standards. Especially disconcerting was the fact that the products of the PEK process—health technology assessment (HTA) reports, single description of studies, manuscripts for publication and the condensed final report—were sent to the board members but no discussion, comment, or review was solicited by the responsible agencies’ (2). The meta-analysis was accompanied by a short, anonymous editorial entitled ‘The end of homoeopathy’ calling for ‘doctors to be bold and honest with their patients about homeopathy's lack of benefit, and with themselves about the failings of modern medicine’ (3); and a more thoughtful commentary from the Dutch epidemiologist Jan Vandenbroucke, reflecting on the ‘growth of truth’, including the relationship between bias, background knowledge and the concordance of clinical results with laboratory science findings (4). Vandenbroucke concludes that the proof of the pudding is in the eating: the ultimate proof of the validity of a scientific or medical idea is extent to which it changes reality. The same issue of The Lancet featured a leak of the World Health Organisation's (WHO) draft report on homeopathy. The WHO document was apparently leaked to The Lancet by Dutch and Belgian doctors hostile to homeopathy; their comments and the (hostile) comments of Prof. Edzard Ernst of the University of Exeter were published. Dr Xiaorui Zhang, Traditional Medicine Coordinator of WHO, who is responsible for the report, was also interviewed, but declined to comment on a leaked, confidential draft. This leak came only 2 days after The Times of London published, as its front page lead, a remarkably similar story: a leak of the Smallwood Enquiry on The Role of Complementary and Alternative Medicine in the NHS commissioned by The Prince of Wales' Foundation for Integrated Health. It is ironic that the editor of The Lancet, Dr Richard Horton, wrote to The Times accusing Prof. Ernst of having ‘broken every code of scientific behaviour’ for leaking the draft report of the Smallwood Enquiry (and incidentally describing complementary medicine as ‘a largely pernicious influence… preying on the fears and uncertainties of the sick’), while simultaneously doing the same to the WHO report in his own journal! Dr Horton also wrote an open letter to the UK Secretary of State for Health, Patricia Hewitt and the Chairman of the National Institute for Clinical Excellence (NICE) Prof. Sir Michael Rawlings, calling for the use of homeopathy in the NHS to be reviewed in light of this publication.

Summary consensus statement of the Review Board of the Swiss Complementary Medicine Evaluation Programme, (Programm Evaluation Komplementärmedizin, PEK) regarding the PEK process and products

The international review board was set up as the scientific advisory body of the Swiss Complementary Medicine Evaluation Programme (PEK) in 2002. It has met several times and has given advice with respect to the most important aspects of the programme. It would have been the normal procedure for the review board to have had the opportunity to comment on the drafts of the final scientific products as well as the draft of the summary report, in order to advise on them, before the documents became publicly available and formed the basis for political decision making. But the responsible authorities changed this process. In the following, the review board comments both on this process and on the products.