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Paradigm shift

Bhavana Sharma, Aditi Dubey, Gaurav Prakash, Rasik B Vajpayee
Surgical management of keratoconus (KC) has undergone a paradigm shift in the last two decades and component corneal transplantation technique of deep anterior lamellar keratoplasty has established itself as a modality of choice for management of advanced cases of KC. Every now and then, new minimalist modalities are being innovated for the management of KC. On the same lines, a new technique, Bowman's layer transplantation, for surgical management of moderate to advanced KC has been reported in recent years...
2018: Clinical Ophthalmology
Gabriele Gäbler, Michaela Coenen, Deborah Lycett, Tanja Stamm
BACKGROUND: High quality, continuity and safe interdisciplinary healthcare is essential. Nutrition and dietetics plays an important part within the interdisciplinary team in many health conditions. In order to work more effectively as an interdisciplinary team, a common terminology is needed. This study investigates which categories of the ICF-Dietetics are used in clinical dietetic care records in Austria and which are most relevant to shared language in different medical areas. METHOD: A national multicenter retrospective study was conducted to collect clinical dietetic care documentation reports...
March 3, 2018: Clinical Nutrition: Official Journal of the European Society of Parenteral and Enteral Nutrition
Hayley E Billingsley, Salvatore Carbone
Cardiovascular disease (CVD) is the leading global cause of death. Diet is known to be important in the prevention of CVD. The PREDIMED trial tested a relatively low-fat diet versus a high-fat Mediterranean diet (MedDiet) for the primary prevention of CVD. The resulting reduction of the CV composite outcome resulted in a paradigm shift in CV nutrition. Though many dietary factors likely contributed to this effect, this review focuses on the influence of the MedDiet on endogenous antioxidant systems and the effect of dietary polyphenols...
March 9, 2018: Nutrition & Diabetes
Houfu Liu, Kelly Dong, Wandong Zhang, Scott G Summerfield, Georg C Terstappen
Recent years have seen a paradigm shift away from optimizing the brain:blood concentration ratio toward the more relevant brain:blood unbound concentration ratio (Kp,uu,br ) in CNS drug discovery. Here, we review the recent developments in the in silico and in vitro model systems to predict the Kp,uu,br of discovery compounds with special emphasis on the in-vitro-in-vivo correlation. We also discuss clinical 'translation' of rodent Kp,uu,br and highlight the future directions for improvement in brain penetration prediction...
March 13, 2018: Drug Discovery Today
Christine Prouty, Shima Mohebbi, Qiong Zhang
Given the increasing vulnerability of communities to the negative impacts of untreated wastewater, resource recovery (RR) systems provide a paradigm shift away from a traditional approach of waste separation and treatment towards a productive recovery of water, energy and nutrients. The aim of this research is to understand the relationships between factors that influence the adoption and sustainability of wastewater-based RR systems to inform technology implementation strategies. The study presents a theory-informed, community-influenced system dynamics (SD) model to provide decision-makers with an adaptable tool that simulates system-level responses to the strategies that are developed for the coastal town of Placencia, Belize...
March 7, 2018: Water Research
David Williams, Joanne L Fothergill, Benjamin Evans, Jessica Caples, Sam Haldenby, Martin J Walshaw, Michael A Brockhurst, Craig Winstanley, Steve Paterson
Pseudomonas aeruginosa chronic infections of cystic fibrosis (CF) airways are a paradigm for within-host evolution with abundant evidence for rapid evolutionary adaptation and diversification. Recently emerged transmissible strains have spread globally, with the Liverpool Epidemic Strain (LES) the most common strain infecting the UK CF population. Previously we have shown that highly divergent lineages of LES can be found within a single infection, consistent with super-infection among a cross-sectional cohort of patients...
March 16, 2018: Microbial Genomics
Deepali Jain, Sinchita Roy-Chowdhuri
CONTEXT: - There has been a paradigm shift in the understanding of molecular pathogenesis of lung cancer. A number of oncogenic drivers have been identified in non-small cell lung carcinoma, such as the epidermal growth factor receptor ( EGFR) mutation and anaplastic lymphoma kinase ( ALK) gene rearrangement. Because of the clinical presentation at an advanced stage of disease in non-small cell lung carcinoma patients, the use of minimally invasive techniques is preferred to obtain a tumor sample for diagnosis...
March 16, 2018: Archives of Pathology & Laboratory Medicine
Marcella Kelly, Maura Dowling, Michelle Millar
BACKGROUND: Kuhn's ( 1962 ) acknowledgement of a paradigm as a way that scientists make sense of their world and its reality gave recognition to the idea of 'paradigm shift'. This shift exposes the transience of paradigm development shaped by societal and scientific evolution. This ongoing evolutionary development provides the researcher with many paradigms to consider regarding how research is undertaken and the search for understanding achieved. AIM: An understanding of paradigm development is necessary when planning a study and can shape the search for understanding...
March 16, 2018: Nurse Researcher
Vivek Murthy, Janna Minehart, Daniel H Sterman
Modern cancer immunotherapies represent a major shift in paradigm with respect to how we understand innate and adaptive responses to malignancy. Successful tumors co-opt normal immunosurveillance mechanisms by potent interactions between the tumor and local draining lymph nodes. Tumor cells mediate a complex and dynamic immunoediting procedure that results in increased vascular efflux into the draining lymphatics, an immunosuppressive microenvironment rich in regulatory T-lymphocytes, dysfunctional antigen presentation, and downregulation of normal effector lymphocyte responses...
December 1, 2017: Journal of the National Cancer Institute
David Perez-Callejo, Lorea Zurutuza, Ana Royuela, Maria Torrente, Beatriz Núñez, Virginia Calvo, Miriam Méndez, Fernando Franco, María Auxiliadora Brenes, Juan Cristobal Sánchez, Mariano Provencio
Background: Hodgkin lymphoma (HL) is the paradigm of curable disease. This study analyzed the overall survival (OS) of patients with HL and compared their survival between decades and with the expected survival of a general population. Results: The median follow-up was 22 years. The median OS was 33 years. The incidence mortality rate for all causes is 2 per every 100 patients per year. The OS of our cohort at 10 years from diagnosis was 76% (95% CI: 72-79) and 52% at 30 years (95% CI: 48-57)...
February 20, 2018: Oncotarget
Aeris Jane D Nacion, Youn Young Park, Nam Kyu Kim
Advancements in rectal cancer treatment have resulted in improvement only in locoregional control and have failed to address distant relapse, which is the predominant mode of treatment failure in rectal cancer. As the efficacy of conventional chemoradiotherapy (CRT) followed by total mesorectal excision (TME) reaches a plateau, the need for alternative strategies in locally advanced rectal cancer (LARC) has grown in relevance. Several novel strategies have been conceptualized to address this issue, including: 1) neoadjuvant induction and consolidation chemotherapy before CRT; 2) neoadjuvant chemotherapy alone to avoid the sequelae of radiation; and 3) nonoperative management for patients who achieved pathological or clinical complete response after CRT...
February 2018: Chinese Journal of Cancer Research, Chung-kuo Yen Cheng Yen Chiu
Hiske W Helleman, Hilde Eising, Jacqueline Limpens, Wouter A Dreschler
Objectives The objective of this systematic review was to compare otoacoustic emissions (OAE) with audiometry in their effectiveness to monitor effects of long-term noise exposure on hearing. Methods We conducted a systematic search of MEDLINE, Embase and the non-MEDLINE subset of PubMed up to March 2016 to identify longitudinal studies on effects of noise exposure on hearing as determined by both audiometry and OAE. Results This review comprised 13 articles, with 30-350 subjects in the longitudinal analysis...
March 15, 2018: Scandinavian Journal of Work, Environment & Health
Akhil Kumar, Ashish Tiwari, Ashok Sharma
Alzheimer disease (AD) is now considered as a multifactorial neurodegenerative disorder and rapidly increasing to an alarming situation and causing higher death rate. One target one ligand hypothesis is not able to provide complete solution of AD due to multifactorial nature of disease and one target one drug seems to fail to provide better treatment against AD. Moreover, current available treatments are limited and most of the upcoming treatments under clinical trials are based on modulating single target...
March 15, 2018: Current Neuropharmacology
Julian Cespedes-Guevara, Tuomas Eerola
Basic Emotion theory has had a tremendous influence on the affective sciences, including music psychology, where most researchers have assumed that music expressivity is constrained to a limited set of basic emotions. Several scholars suggested that these constrains to musical expressivity are explained by the existence of a shared acoustic code to the expression of emotions in music and speech prosody. In this article we advocate for a shift from this focus on basic emotions to a constructionist account. This approach proposes that the phenomenon of perception of emotions in music arises from the interaction of music's ability to express core affects and the influence of top-down and contextual information in the listener's mind...
2018: Frontiers in Psychology
Carl D Stevens
The sudden, dramatic collapse of the seven-year struggle in Congress to repeal and replace the Affordable Care Act holds important lessons for all would-be reformers, including those advocating fundamental changes in medical education. In this Invited Commentary, the author draws parallels between reform initiatives in health policy and those in medical education, highlighting that, in both settings, stakeholders rarely support "repeal" in the absence of a superior replacement, even when they view the status quo as deeply flawed...
March 13, 2018: Academic Medicine: Journal of the Association of American Medical Colleges
Kevin A Day, Kristan A Leech, Ryan T Roemmich, Amy J Bastian
Acquiring new movements requires the capacity of the nervous system to remember previously experienced motor patterns. The phenomenon of faster re-learning after initial learning is termed 'savings'. Here we studied how savings of a novel walking pattern develops over several days of practice, and how this process can be accelerated. We introduced participants to a split-belt treadmill adaptation paradigm for 30 minutes for 5 consecutive days. After 5 training days, participants were able to produce near-perfect performance when switching between split and tied-belt environments...
March 14, 2018: Journal of Neurophysiology
Sam Hanna, Anneke Andriessen, Jennifer Beecker, Martin Gilbert, Eric Goldstein, Sunil Kalia, Aaron King, John Kraft, Carrie Lynde, Davindra Singh, Irina Turchin, Catherine Zip
BACKGROUND: Recently, experience and knowledge have been gained using effective topical treatment for onychomycosis, a difficult-to-treat infection. METHODS: This project aims to help understand and improve patient-focused quality of care for fungal nail infections. A panel of dermatologists who treat onychomycosis convened on several occasions to review and discuss recent learnings in the treatment of onychomycosis. The panel developed and conducted a survey on diagnosis, treatment and prevention, discussed the results, and provided recommendations...
March 1, 2018: Journal of Drugs in Dermatology: JDD
Jeong-Ik Park, Ki-Hun Kim, Hong-Jin Kim, Daniel Cherqui, Olivier Soubrane, David Kooby, Chinnusamy Palanivelu, Albert Chan, Young Kyoung You, Yao-Ming Wu, Kuo-Hsin Chen, Goro Honda, Xiao-Ping Chen, Chung-Ngai Tang, Ji Hoon Kim, Yang Seok Koh, Young-In Yoon, Kai Chi Cheng, Tran Cong Duy Long, Gi Hong Choi, Yuichiro Otsuka, Tan To Cheung, Taizo Hibi, Dong-Sik Kim, Hee Jung Wang, Hironori Kaneko, Dong-Sup Yoon, Etsuro Hatano, In Seok Choi, Dong Wook Choi, Ming-Te Huang, Sang Geol Kim, Sung-Gyu Lee
The application of laparoscopy for liver surgery is rapidly increasing and the past few years have demonstrated a shift in paradigm with a trend towards more extended and complex resections. The development of instruments and technical refinements with the effective use of magnified caudal laparoscopic views have contributed to the ability to overcome the limitation of laparoscopic liver resection. The Endoscopic and Laparoscopic Surgeons of Asia (ELSA) Visionary Summit 2017 and the 3rd Expert Forum of Asia-Pacific Laparoscopic Hepatectomy organized hepatobiliary pancreatic sessions in order to exchange surgical tips and tricks and discuss the current status and future perspectives of laparoscopic hepatectomy...
February 2018: Annals of Hepato-Biliary-Pancreatic Surgery
Saul N Rajak, Shyamala C Huilgol, Masahiro Murakami, Dinesh Selva
PURPOSE: Propeller flaps are island flaps that reach the recipient site through an axial rotation. The flap has a subcutaneous pedicle on which it pivots, thereby resembling a helicopter propeller. We present our series of propeller flaps for the reconstruction of large eyelid defects. METHODS: This is a retrospective review of the clinical case notes of eight patients that underwent tumour excision with reconstruction with a cutaneous propeller flap supplied by a non-perforator orbicularis pedicle between July and December 2016...
March 14, 2018: Eye
Arvind Sehgal, Patrick J McNamara
Whereas association between a patent ductus arteriosus (PDA) and neonatal morbidities has been well described, consensus has not been reached on whether the relationship is causal, on benefit of (or lack of) treatment, on factors guiding the 'need to treat', and on treatment strategies. Trials to date have primarily focused on the narrow outcome of successful ductal closure. Evidence from several retrospective studies has suggested that management may be modified with increased use of conservative treatment...
March 7, 2018: Seminars in Fetal & Neonatal Medicine
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