bluuebunny/crossref_metadata_2025 huggingface dataset:
Colistin Resistance in Carbapenem-Resistant Klebsiella pneumoniae: Laboratory Detection and Impact on Mortality
Authors: Rojas Laura J. , Salim Madiha , Cober Eric , Richter Sandra S. , Perez Federico , Salata Robert A. , Kalayjian Robert C. , Watkins Richard R. , Marshall Steve , Rudin Susan D. , Domitrovic T. Nicholas , Hujer Andrea M. , Hujer Kristine M. , Doi Yohei , Kaye Keith S. , Evans Scott , Fowler Vance G. , Bonomo Robert A. , van Duin David ,   for the Antibacterial Resistance Leadership Group
Published: November 2016

Background.

Polymyxins including colistin are an important “last-line” treatment for infections caused by carbapenem-resistant Klebsiella pneumoniae (CRKp). Increasing use of colistin has led to resistance to this cationic antimicrobial peptide.

Methods.

A cohort nested within the Consortium on Resistance against Carbapenems in Klebsiella pneumoniae (CRACKLE) was constructed of patients with infection, or colonization with CRKp isolates tested for colistin susceptibility during the study period of December, 2011 to October, 2014. Reference colistin resistance determination as performed by broth macrodilution was compared to results from clinical microbiology laboratories (Etest) and to polymyxin resistance testing. Each patient was included once, at the time of their first colistin-tested CRKp positive culture. Time to 30-day in-hospital all-cause mortality was evaluated by Kaplan-Meier curves and Cox proportional hazard modeling.

Results.

In 246 patients with CRKp, 13% possessed ColR CRKp. ColR was underestimated by Etest (very major error rate = 35%, major error rate = 0.4%). A variety of rep-PCR strain types were encountered in both the ColS and the ColR groups. Carbapenem resistance was mediated primarily by blaKPC-2 (46%) and blaKPC-3 (50%). ColR was associated with increased hazard for in-hospital mortality (aHR 3.48; 95% confidence interval, 1.73-6.57; P < .001). The plasmid-associated ColR genes, mcr-1 and mcr-2 were not detected in any of the ColR CRKp.

Conclusions.

In this cohort, 13% of patients with CRKp presented with ColR CRKp. The apparent polyclonal nature of the isolates suggests de novo emergence of ColR in this cohort as the primary factor driving ColR. Importantly, mortality was increased in patients with ColR isolates.
Active surveillance for low-risk localized prostate cancer: what do men and their partners think?
Authors: Mallapareddi Arun , Ruterbusch Julie , Reamer Elyse , Eggly Susan , Xu Jinping
Published: November 2016

Background.

Active surveillance (AS) is recognized as a reasonable treatment option for low-risk localized prostate cancer (LPC) but continues to be chosen by a minority of men. To date, limited data are available regarding reasons why men with low-risk LPC adopt AS.

Purpose.

The aim of this study is to better understand conceptualizations, experiences and reasons why men with low-risk LPC and their partners adopt AS.

Methods.

We conducted five focus groups (FGs), three among men with low-risk LPC who had chosen AS and two with their partners. FGs were video/audio recorded, transcribed and analysed using qualitative thematic analysis.

Results.

A total of 12 men and 6 partners (all women) participated in FG discussions. The most common reasons for choosing AS were seeing the LPC as ‘small’ or ‘low grade’ without need for immediate treatment and trusting their physician’s AS recommendation. The most common concerns about AS were perceived unreliability of prostate specific antigen, pain associated with prostate biopsies and potential cancer progression. Partners saw themselves as very involved in their husbands’ treatment decision-making process, more than men acknowledged them to be. Multiple terms including ‘watchful waiting’ were used interchangeably with AS. There appeared to be a lack of understanding that AS is not simply ‘doing nothing’ but is actually a recognized management option for low-risk LPC.

Conclusions.

Emphasizing the low risk of a man’s LPC and enhancing physician trust may increase acceptability of AS. Standardizing terminology and presenting AS as a reasonable and recognized management option may also help increase its adoption.
Tinkering with a tanker—slow evolution of a Swedish ecosystem approach
Authors: Österblom Henrik , Hentati-Sundberg Jonas , Nevonen Nea , Veem Katarina
Published: November 2016

The ecosystem approach is a salient policy paradigm originating from a scientific understanding of the reality of complex ecosystem dynamics. In this article, we investigate how Swedish national marine policies and practice between 2002 and 2015 have changed towards an ecosystem approach. Government documents, the scientific literature, institutional changes, changes in legislation, pilot projects, and changes in science and public opinion were reviewed and combined with information from expert interviews. We found that changes in policy and practice have slowly stimulated the development of an ecosystem approach, but that limited political leadership, challenges of coordination, different agency cultures, and limited learning appears to be key barriers for further and more substantial change. We compare and contrast the Swedish national process of change with other documented experiences of implementing an ecosystem approach and find that several countries struggle with similar challenges. Substantial work still remains in Sweden and we provide suggestions for how to stimulate further and more substantial change at the national level.
Sensitivity and robustness of larval connectivity diagnostics obtained from Lagrangian Flow Networks
Authors: Monroy Pedro , Rossi Vincent , Ser-Giacomi Enrico , López Cristóbal , Hernández-García Emilio
Published: November 2016

Lagrangian Flow Network (LFN) is a modelling framework in which ocean sub-areas are represented as nodes in a network interconnected by links representing transport of propagules (eggs and larvae) by currents. We asses the sensitivity and robustness of four LFN-derived connectivity metrics measuring retention and exchange. The most relevant parameters are tested over large ranges and a wide region with contrasting hydrodynamics: density of released particles, node size (spatial scale of discretization), Pelagic Larval Duration (PLD) and spawning modality. We find a minimum density of released particles that guarantees reliable values for most of the metrics examined. We also find that node size has a nontrivial influence on them. Connectivity estimates for long PLDs are more robust against biological uncertainties (PLD and spawning date) than for short PLDs. For mass-spawners releasing propagules over short periods (≈ 2-10 days), daily release must be simulated to properly consider connectivity fluctuations due to variable currents. In contrast, average connectivity estimates for species that spawn repeatedly over longer durations (few weeks to few months) remain robust even using longer periodicity (5-10 days). Our results have implications to design connectivity experiments with particle-tracking models and to evaluate the reliability of their results.
Using digital interventions to improve the cardiometabolic health of populations: a meta-review of reporting quality
Authors: O’Neil Adrienne , Cocker Fiona , Rarau Patricia , Baptista Shaira , Cassimatis Mandy , Barr Taylor C , Lau Annie YS , Kanuri Nitya , Oldenburg Brian
Published: November 2016

Objectives. We conducted a meta-review to determine the reporting quality of user-centered digital interventions for the prevention and management of cardiometabolic conditions.

Materials and Methods. Using predetermined inclusion criteria, systematic reviews published between 2010 and 2015 were identified from 3 databases. To assess whether current evidence is sufficient to inform wider uptake and implementation of digital health programs, we assessed the quality of reporting of research findings using (1) endorsement of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, (2) a quality assessment framework (eg, Cochrane risk of bias assessment tool), and (3) 8 parameters of the Consolidated Standards of Reporting Trials of Electronic and Mobile HEalth Applications and onLine TeleHealth (CONSORT-eHEALTH) guidelines (developed in 2010).

Results. Of the 33 systematic reviews covering social media, Web-based programs, mobile health programs, and composite modalities, 6 reported using the recommended PRISMA guidelines. Seven did not report using a quality assessment framework. Applying the CONSORT-EHEALTH guidelines, reporting was of mild to moderate strength.

Discussion. To our knowledge, this is the first meta-review to provide a comprehensive analysis of the quality of reporting of research findings for a range of digital health interventions. Our findings suggest that the evidence base and quality of reporting in this rapidly developing field needs significant improvement in order to inform wider implementation and uptake.

Conclusion. The inconsistent quality of reporting of digital health interventions for cardiometabolic outcomes may be a critical impediment to real-world implementation.
Public Mosquito Abatement: A Cluster Randomized Experiment
Authors: Thuilliez Josselin , Dumont Yves
Published: November 2016

Mosquito abatement is a public good. A simultaneous model of mosquito abundance and abatement response is developed. We then use data from a cluster randomized controlled experiment conducted over the period 2012–2014 in urban areas of Réunion in France to study the impact of WHO-recommended mechanical elimination techniques, which involve removing sources of stagnant water around the house, on a number of outcomes, including objective entomological indices and self-declared protective behaviors. Empirical results document that households reduce their protective behavior in response to public control. This study holds implications for arboviral disease control, including Zika control.
Time Interval Between Cover Crop Termination and Planting Influences Corn Seedling Disease, Plant Growth, and Yield
Authors: Acharya J. , Bakker M. G. , Moorman T. B. , Kaspar T. C. , Lenssen A. W. , Robertson A. E.
Published: November 2016

Experiments were established in a controlled-growth chamber and in the field to evaluate the effect of the length of time intervals between winter rye cover crop termination and corn planting on corn seedling disease, corn growth, and grain yield in 2014 and 2015. Rye termination dates ranged from 25 days before planting (DBP) to 2 days after planting (DAP) corn in the field and from 21 DBP to 1 DAP in controlled studies. Results were similar in both environments. In general, shorter intervals increased seedling disease and reduced corn emergence, shoot growth, and grain yield of corn following winter rye compared with corn planted 10 or more days after rye termination or without rye. Incidence of Pythium spp. increased with shorter intervals (less than 8 DBP); incidence of Fusarium spp. was not consistent between runs and experiments. In 2014, in the 1-DAP treatment, number of ears and grain yield were reduced (P = 0.05 and 0.02, respectively). In 2015, all termination intervals reduced plant population, number of ears, and yield (P = 0.01), with the 2-DBP treatment causing the biggest decrease. A 10- to 14-day interval between rye termination and corn planting should be followed to improve corn yield following a rye cover crop.
Effect of Plant Age and Leaf Position on Susceptibility to Wheat Stripe Rust
Authors: Farber D. H. , Mundt C. C.
Published: November 2016

In addition to pathogen propagule dispersal, disease spread requires successful infection of host tissue. In plant disease epidemiology, susceptibility of host tissue is often assumed to be constant. This assumption ignores changes in host phenology due to developmental stage. To examine this assumption, 3-, 4-, and 5-week-old wheat plants were inoculated with equal quantities of urediniospores of Puccinia striiformis f. sp. tritici, the causal agent of wheat stripe rust (WSR). Disease severity on each leaf was assessed and fit by mixed-effect linear model as a function of leaf position and plant age. Younger plants had significantly greater disease severity than older plants, with mean severities of 50.4, 30.1, and 12.9% on plants that were 3, 4, and 5 weeks old, respectively, at time of inoculation. This effect was greater on leaves higher on the plant. Within same-aged plants, younger leaves had significantly greater disease severity than older leaves, with mean severities of 40.2, 34.8, and 17.7% on the uppermost, second, and third leaf, respectively. These results suggest that the vertical distribution of WSR lesions in agricultural fields could be driven by differences in host susceptibility more so than propagule dispersal.
Prospects for Biological Soilborne Disease Control: Application of Indigenous Versus Synthetic Microbiomes
Authors: Mazzola Mark , Freilich Shiri
Published: November 2016

Biological disease control of soilborne plant diseases has traditionally employed the biopesticide approach whereby single strains or strain mixtures are introduced into production systems through inundative/inoculative release. The approach has significant barriers that have long been recognized, including a generally limited spectrum of target pathogens for any given biocontrol agent and inadequate colonization of the host rhizosphere, which can plague progress in the utilization of this resource in commercial field-based crop production systems. Thus, although potential exists, this model has continued to lag in its application. New omics’ tools have enabled more rapid screening of microbial populations allowing for the identification of strains with multiple functional attributes that may contribute to pathogen suppression. Similarly, these technologies also enable the characterization of consortia in natural systems which provide the framework for construction of synthetic microbiomes for disease control. Harnessing the potential of the microbiome indigenous to agricultural soils for disease suppression through application of specific management strategies has long been a goal of plant pathologists. Although this tactic also possesses limitation, our enhanced understanding of functional attributes of suppressive soil systems through application of community and metagenomic analysis methods provide opportunity to devise effective resource management schemes. As these microbial communities in large part are fostered by the resources endemic to soil and the rhizosphere, substrate mediated recruitment of disease-suppressive microbiomes constitutes a practical means to foster their establishment in crop production systems.
Ethnicity, Cortisol, and Experimental Pain Responses Among Persons With Symptomatic Knee Osteoarthritis
Authors: Herbert Matthew S. , Goodin Burel R. , Bulls Hailey W. , Sotolongo Adriana , Petrov Megan E. , Edberg Jeffrey C. , Bradley Laurence A. , Fillingim Roger B.
Published: November 2016

Objectives:

Although several factors are known to contribute to ethnic differences in pain, relatively little attention has been devoted to physiological factors. Our first aim was to examine the relationship between cortisol and pain responses during a cold-pressor task (CPT) among African American (AA) and non-Hispanic White (NHW) adults with knee osteoarthritis (OA). Our second aim was to assess the relationship between perceived racial discrimination and cortisol among AA participants.

Materials and Methods:

Participants were 91 (56 AA; 35 NHW) community-dwelling adults between the ages of 45 to 85 with knee OA based upon the American College of Rheumatology clinical criteria. Plasma cortisol was measured at 3 timepoints: (1) baseline, (2) before the CPT, and (3) 20 minutes following the CPT. Perceived racial discrimination was measured by the Experiences of Discrimination scale.

Results:

Using linear regression, we found a significant interaction between ethnicity and cortisol before the CPT with pain intensity ratings (β=−0.26; P=0.02). Analysis of simple slopes revealed that cortisol concentrations were negatively associated with pain intensity ratings in NHW participants (β=−0.54; P=0.001), but not in AA participants (β=−0.15; P=0.26). Perceived racial discrimination was not related to cortisol concentrations or pain ratings.

Discussion:

Consistent with previous findings in young healthy adults, cold-pressor pain responses are related to pre-CPT cortisol concentrations in NHW persons with knee OA but not in their AA counterparts. Additional studies are required to better understand this finding.
Histopathological and Clinical Findings in Cutaneous Manifestation of Erdheim–Chester Disease and Langerhans Cell Histiocytosis Overlap Syndrome Associated With the BRAFV600E Mutation
Authors: Liersch Julia , Carlson J. Andrew , Schaller Jörg
Published: November 2016

The overlap of Erdheim–Chester disease (ECD) and Langerhans cell histiocytosis (LCH) is more common than it was generally accepted. Both diseases seem to be linked by a mutation in oncogenic BRAFV600E, probably an early event which occurs in bone marrow progenitor cells. In this article are described the clinical and histological findings in 2 cases of ECD-LCH overlap syndrome bearing the BRAFV600E mutation in both ECD and LCH lesions in bone and skin. In one case, lesions of ECD and LCH were situated directly site-to-site in the same bone section leading to the assumption of a common myeloid precursor cell for these diseases. Furthermore, we focus on the histopathological diagnostic criteria of cutaneous involvement in ECD. Lesional tissue shows a dermal infiltrate of lipidized CD68+, CD163+, CD1a−, and langerin histiocytes admixed with Touton giant cells—a xanthogranulomatous phenotype. Often, this pattern of histopathology requires correlation with patterns of systemic involvement to differentiate ECD from other xanthogranulomatous infiltrates. This endeavor is of major importance to determine early diagnosis and treatment, because ECD often shows a poor prognosis compared with its differential diagnoses. Finally, adults who suffer from LCH and develop xanthogranulomatous infiltrates should always be screened for ECD-LCH overlap syndrome.
Pharmacokinetics of Mycophenolic Acid and Dose Optimization in Children After Intestinal Transplantation
Authors: Barau Caroline , Mellos Antonio , Chhun Stéphanie , Lacaille Florence , Furlan Valérie
Published: November 2016

Background:

Mycophenolate mofetil (MMF) or enteric-coated mycophenolate sodium (MPS) is now commonly used in pediatric intestinal transplantation (Tx), but to date, no clear recommendations regarding the dosing regimen have been made in this population. The aim of this study was to determine the MMF/MPS dosage required to achieve an area under the plasma concentration–time curve from 0 to 12 hours (AUC0–12) for mycophenolic acid (MPA) greater than 30 mg·h−1·L−1 in children after intestinal transplantation.

Methods:

A pharmacokinetic study was conducted in 8 children (median, 9.4 years; range, 0.75–15.8 years) at a median time of 113 months (range, 1.5–160 months) after intestinal transplantation.

Results:

MMF was initially introduced at a low median starting dose of 687 mg·m−2·d−1 (range, 310–1414 mg·m−2·d−1). One of the 3 patients who received MPS and 2 of the 6 patients who received MMF had an MPA AUC0–12 value below 30 mg.h.L−1. The median MMF dosage had to be increased by 91% (1319 mg·m−2·d−1 versus 687 mg·m−2·d−1) to reach AUC0–12 values above the defined target level of 30 mg·h−1·L−1.

Conclusions:

When used in combination with tacrolimus and steroids, an initial MMF dose of 600 mg/m2 twice a day would be recommended to children after intestinal transplantation to achieve MPA exposure similar to those observed in adults and children after the transplantation of other organs. Further studies are required to recommend a suitable dosage for pediatric intestinal transplant recipients who receive MPA.
Implantable Doppler Probes for Postoperatively Monitoring Free Flaps: Efficacy. A Systematic Review and Meta-analysis
Authors: Chang Tzu-Yen , Lee Yao-Chou , Lin You-Cheng , Wong Stanley Thian-Sze , Hsueh Yuan-Yu , Kuo Yao-Lung , Shieh Shyh-Jou , Lee Jing-Wei
Published: November 2016

Background:

Although clinical assessment remains the gold standard for monitoring the circulation of free flaps, several adjunct techniques promote timely salvage by detecting circulation compromise early. The objective of this systematic review was to evaluate the efficacy of an implantable Doppler probe for postoperatively monitoring free flaps.

Materials and Methods:

English-language articles evaluating the efficacy of implantable Doppler probes compared with clinical assessment for postoperatively monitoring free flaps were analyzed. The outcome measures were total flap failure rates, salvage rates, sensitivity, false-positive rates, and positive likelihood ratios.

Results:

Of the 504 citations identified, 6 comparative studies were included for meta-analysis. An implantable Doppler probe significantly lowered the flap failure rate (risk ratio: 0.40; 95% confidence interval: 0.21–0.75) and raised the successful salvage rate (risk ratio: 1.73; 95% confidence interval: 1.16–2.59). Pooled sensitivity was higher (1.00 vs 0.98), the positive likelihood ratio was lower (72.16 vs 220.48), and the false-positive rate was higher (0.01 vs 0) in the implantable Doppler probe group than in the clinical assessment group.

Conclusion:

An implantable Doppler probe is significantly more efficacious than clinical assessment for postoperatively monitoring free flaps.
Divided and Sliding Superficial Temporal Artery Flap for Primary Donor-site Closure
Authors: Sugio Yuta , Kubo Tateki , Seike Shien , Hosokawa Ko
Published: November 2016

Superficial temporal artery (STA) flaps are often used for reconstruction of hair-bearing areas. However, primary closure of the donor site is not easy when the size of the necessary skin island is relatively large. In such cases, skin grafts are needed at the donor site, resulting in baldness. We have solved this issue by applying the divided and sliding flap technique, which was first reported for primary donor-site closure of a latissimus dorsi musculocutaneous flap. We applied this technique to the hair-bearing STA flap, where primary donor-site closure is extremely beneficial for preventing baldness consequent to skin grafting. The STA flap was divided into 3, and creation of large flap was possible. Therefore, we concluded that the divided and sliding STA flap could at least partially solve the donor-site problem. Although further investigation is necessary to validate the maximum possible flap size, this technique may be applicable to at least small defects that are common after skin cancer ablation or trauma.
A Novel Technique That Protects the Lips during Orthognathic Surgery
Authors: Kamochi Hideaki , Sugawara Yasushi , Uda Hirokazu , Sarukawa Shunji , Sunaga Ataru , Yoshimura Kotaro
Published: November 2016

Serious lip injuries can occur during orthognathic surgery. Although an Angle Wider device, which is commonly used during orthognathic surgery, provides some lip protection, it leaves more than half of the lip exposed to surgical instruments. Here, we describe a novel technique to protect the entire upper and lower lips during orthognathic surgery using a minilaparotomy wound edge protector (Lap-Protector). We used this method in 60 patients who have undergone orthognathic surgeries such as sagittal split ramus osteotomy and Le Fort I osteotomy since 2009, and no lip injuries have occurred. Although this technique can be somewhat challenging at first and creates some difficulty in exposing the surgical field on the lateral side, we believe that using a wound edge protector minimizes the risk of lip injury during orthognathic surgery.
Combined Use of an Anterolateral Thigh Flap and Superficial Inferior Epigastric Artery Flap for Reconstruction of an Extensive Abdominal Wall Defect
Authors: Miyamoto Shimpei , Kagaya Yu , Arikawa Masaki , Kobayashi Eisuke
Published: November 2016

Reconstruction of large abdominal wall defects is challenging. We herein report the successful reconstruction of an extensive abdominal wall defect using a novel combination of flaps after sarcoma resection. A 74-year-old man presented with a dedifferentiated liposarcoma on his abdominal wall. He underwent excision of the tumor, which resulted in an extensive abdominal wall defect. The defect was reconstructed with a pedicled anterolateral thigh flap with an iliotibial tract and a pedicled superficial inferior epigastric artery flap. No skin graft was necessary. The wounds healed successfully, and no herniation occurred. The combination of an anterolateral thigh flap and a superficial inferior epigastric artery flap is a versatile option for reconstruction of extensive abdominal wall defects.
Determining Length and Position of Pedicle Vessels Using a Flap Model with Vascular Tape
Authors: Ishii Naohiro , Kishi Kazuo
Published: November 2016

In free-flap surgery, if the appropriate length of the pedicle and the distance necessary for separation of the artery and vein are determined earlier during flap elevation, the operative time and the stress placed on the flap pedicle can be reduced. However, the pedicle of a flap passes through 3-dimensional structures, particularly in head and neck reconstructions, and because of the difference in body shapes between individuals, even experienced microsurgeons may misjudge the required distance. To date, no easy method to counteract this problem has been reported. Accordingly, we have developed a technique for estimating the required pedicle length necessary for safe vascular anastomosis, as well as the distance necessary for separation of the artery and vein, by using a flap model with vascular tapes. Between June 2014 and April 2016, we applied our technique to 12 patients undergoing head and neck reconstruction and 1 patient undergoing breast reconstruction. In the 13 cases in which the present technique was used, we could estimate the length of each pedicle smoothly and efficiently. Furthermore, considerable excess or deficiency did not occur in the vascular anastomosis. The present technique is recommended as it allows the effective tailoring of the flap pedicle in free-flap surgery.
Clinical Evaluation of Large Diameter Rigid-Gas Permeable Versus Soft Toric Contact Lenses for the Correction of Refractive Astigmatism. A MultiCenter Study
Authors: Michaud Langis , Bennett Edward S. , Woo Stephanie L. , Reeder Renee , Morgan Bruce W. , Dinardo Amy , Harthan Jennifer S.
Published: November 2016

Purpose:

This study aims to address the clinical performance of a large diameter rigid gas permeable lens (LRGP) in a group of subjects with low-to-moderate (0.75–2.75 D) refractive astigmatism. An additional goal was to determine whether soft toric or LRGP contact lenses performed better objectively in the correction of astigmatism and to determine which modality is preferred by subjects.

Methods:

This was a multisite prospective cross-over clinical study. Ten asymptomatic contact lens wearers per site (four university clinics) were recruited and randomly assigned to group A or group B. Group A was assigned to start wearing Comfilcon A soft toric lens first, for two weeks, and then crossed over to LRGP lenses (Boston XO, 14.3 mm diameter miniscleral lens). Group B initially wore LRGP lenses and then crossed over to soft toric lenses. For each type of lens worn, low-contrast and high-contrast visual acuity (VA) were evaluated at distance. At the conclusion of the study, after two months, all subjects completed a questionnaire in which they were asked to indicate their preference for one type of lens (soft toric or LRGP) and to rate the quality of vision in day-to-day activities.

Results:

Thirty-six of 38 (94.7%) subjects completed the study with 75% preferring the vision of the LRGP lens as compared to the soft toric lenses worn in the study. 52.7% expressed a preference to continue with this modality despite only 38.8% reporting that these LRGP lenses are easy or very easy to handle. Wear time, subjective comfort, and subjective vision ratings exhibited no significant difference between the two groups.

Conclusions:

In a population of asymptomatic contact lens wearers, LRGP lenses can be considered as a good alternative to soft toric lenses for the correction of refractive astigmatism.
Transcatheter Aortic Valve Implantation in Nonagenarians
Authors: Penkalla Adam , Kempfert Joerg , Unbehaun Axel , Buz Semih , Drews Thorsten , Pasic Miralem , Falk Volkmar
Published: November 2016

Objective

In this report, we assess the outcome of transcatheter aortic valve implantation (TAVI) in nonagenarians at our institution during a 6-year period.

Methods

Between April 2008 and July 2014, 40 patients with a mean ± SD age of 91.8 ± 2.3 years (range, 90–98 years) underwent TAVI. Thirty-three patients (82.5%) received transapical TAVI, and seven patients (17.5%) received transfemoral TAVI. Baseline characteristics were as follows: mean ± SD EuroSCORE II, 23.9 ± 14.21; mean ± SD Society of Thoracic Surgeons mortality score, 24.2 ± 11.4; mean ± SD SYNTAX score, 7.6 ± 9.3; mean ± SD NYHA class, 3.5 ± 0.5; mean ± SD transvalvular gradient, 46.8 ± 17.8 mm Hg; mean ± SD aortic valve area, 0.7 ± 0.2 cm2.

Results

Intraoperative mortality was 2.5% and 30-day all-cause mortality was 10%. The actuarial survival rates at 1 and 5 years were 58.6% and 30.4%, respectively. Seven patients (17.5%) underwent simultaneous elective TAVI and percutaneous coronary intervention. Three patients (7.5%) were operated on with the use of cardiopulmonary bypass. No conversion to open surgery occurred. In transesophageal echocardiography assessment, no moderate or severe prosthetic aortic valve regurgitation was observed. Four patients (10%) had postoperative acute renal failure stage 3 and needed new dialysis (P = 0.125). Three patients (7.5%) had a disabling stroke. Periprocedural myocardial infarction occurred in one patient (2.5%). Seven patients (17.5%) needed postoperative pacemaker implantation. Male sex and renal insufficiency were found to be predictors of mortality in univariable analysis.

Conclusions

Transcatheter aortic valve implantation can be performed in nonagenarians despite very high preoperative risk scores and substantial multimorbidity, with acceptable outcomes.
Child Care Providers' Competence and Confidence in Referring Children at Risk for Developmental Delays
Authors: Branson Diane , Bingham Ann
Published: November 2016

Despite the benefits of early intervention for children, the majority of children with developmental delays are not identified prior to the age of 5 years. Child care providers could aid in recognition of children at risk for developmental delays; however, there is little research on this topic. This article reports on a qualitative research study used to investigate child care providers' ability to accurately assess child development and make appropriate referrals to Child Find agencies. Initial data analysis suggested that child care providers were able to recognize children at risk for developmental delays with or without using a standardized screening tool. The child care participants did not, however, always indicate that they would refer those children with whom they were concerned. Qualitative interview results revealed important supports that aid in child care providers identifying children at risk for developmental delays, as well as barriers that interfere with child care providers making appropriate referrals to Child Find agencies.
How Does the Narrowing of Eligibility Criteria Affect Enrollment in Part C Early Intervention?
Authors: Elbaum Batya , Celimli-Aksoy Seniz , Marshall Jennifer T. , Berkovits Michelle D.
Published: November 2016

In recent years, many states have narrowed their eligibility criteria for participation in the IDEA Part C early intervention (EI) program for infants and toddlers with or at risk for developmental delays. However, there is scant research on the effects of such a policy change on the population of children served or on the timing of children's access to EI services. Using data from an EI program serving a diverse, urban population in a large southeastern state, we compared characteristics of children who enrolled in EI the year before (n = 432) and the year after (n = 399), the state adopted more restrictive eligibility criteria for its EI program. Results indicated that following the policy change, children served in the program represented a smaller percentage of the resident birth-to-3 population; a smaller proportion of children enrolling in EI had mild delays; and children were 1.5 months older, on average, when they enrolled in services. The findings not only provide evidence that the narrowing of eligibility criteria achieved the intended effect of reducing EI enrollment but also raise concerns that the new policy may delay access to needed services for children with emergent developmental delays.
Effects of a Dialogue-Based Program to Improve Emotion Knowledge in Spanish Roma Preschoolers
Authors: Giménez-Dasí Marta , Quintanilla Laura , Ojeda Vanesa , Lucas-Molina Beatriz
Published: November 2016

Romas are one of the largest minority groups in Spain and Europe, but no specific data on children's socioemotional learning are available. Our goal was to determine the level of socioemotional knowledge of a group of 4- and 5-year-old Roma children and to implement an intervention program at school. Forty-three Roma children participated (experimental: N = 21; control: N = 22). We implemented the intervention program Thinking emotions (M. Giménez-Dasí, M. Fernández-Sánchez, & M.-F. Daniel, 2013a). This program is based on Philosophy for Children (M. Lipman, A. M. Sharp, & F. S. Oscanyan, 1980) and aims to promote emotion knowledge, regulation strategies, and social competencies through peer-to-peer dialogue. Pre- and posttest measures were taken. Results showed low levels of initial knowledge and a clear pattern of improvement after the intervention.
Dorsal root ganglion neurons become hyperexcitable and increase expression of voltage-gated T-type calcium channels (Cav3.2) in paclitaxel-induced peripheral neuropathy
Authors: Li Yan , Tatsui Claudio Esteves , Rhines Laurence D. , North Robert Y. , Harrison Daniel S. , Cassidy Ryan M. , Johansson Caj A. , Kosturakis Alyssa K. , Edwards Denaya D. , Zhang Hongmei , Dougherty Patrick M.
Published: November 2016

Here, it is shown that paclitaxel-induced neuropathy is associated with the development of spontaneous activity (SA) and hyperexcitability in dorsal root ganglion (DRG) neurons that is paralleled by increased expression of low-voltage–activated calcium channels (T-type; Cav3.2). The percentage of DRG neurons showing SA and the overall mean rate of SA were significantly higher at day 7 in rats receiving paclitaxel treatment than in rats receiving vehicle. Cav3.2 expression was increased in L4-L6 DRG and spinal cord segments in paclitaxel-treated rats, localized to small calcitonin gene-related peptide and isolectin B4 expressing DRG neurons and to glial fibrillary acidic protein–positive spinal cord cells. Cav3.2 expression was also co-localized with toll-like receptor 4 (TLR4) in both the DRG and the dorsal horn. T-type current amplitudes and density were increased at day 7 after paclitaxel treatment. Perfusion of the TLR4 agonist lipopolysaccharide directly activated DRG neurons, whereas this was prevented by pretreatment with the specific T-type calcium channel inhibitor ML218 hydrochloride. Paclitaxel-induced behavioral hypersensitivity to mechanical stimuli in rats was prevented but not reversed by spinal administration of ML218 hydrochloride or intravenous injection of the TLR4 antagonist TAK242. Paclitaxel induced inward current and action potential discharges in cultured human DRG neurons, and this was blocked by ML218 hydrochloride pretreatment. Furthermore, ML218 hydrochloride decreased firing frequency in human DRG, where spontaneous action potentials were present. In summary, Cav3.2 in concert with TLR4 in DRG neurons appears to contribute to paclitaxel-induced neuropathy.
Health utilities in people with chronic pain using a population-level survey and linked health care administrative data
Authors: Hogan Mary-Ellen , Taddio Anna , Katz Joel , Shah Vibhuti , Krahn Murray
Published: November 2016

Health utilities are a preference-based measure of health-related quality of life that facilitates comparison of disease burden across conditions. We estimated utilities using a population-based, matched sample of adolescents and adults with and without chronic pain, controlling for comorbidity. Ontarians aged ≥12 years with and without chronic pain were identified from the Canadian Community Health Survey (CCHS) 2000-2001 and 2009-2010 and linked to their provincial health care administrative data. Individuals with chronic pain were matched to those without using age, sex, survey year, and a propensity score for having chronic pain estimated from a rurality index, income quintile, and comorbidity. The Health Utilities Index Mark 3 instrument, included in the Canadian Community Health Survey, was used. Mean utilities were calculated for each group. Utility decrement for chronic pain was also calculated for each matched pair. A total of 65,246 responses were available for analysis. After matching, there were 12,146 matched pairs with and without pain. In the matched cohort, mean age was 54 years (SD 12); 61% were female. The matched cohort with chronic pain had a mean utility of 0.59 (95% confidence interval 0.58-0.59), and the decrement associated with chronic pain was 0.32 (95% confidence interval 0.31-0.32). Utilities in people with chronic pain were lower than, and decrements larger than, those seen with most other chronic diseases including heart disease, diabetes, and chronic obstructive pulmonary disease. These data will be useful to inform priorities and future strategies for the prevention and control of chronic pain.
Preprotachykinin A is expressed by a distinct population of excitatory neurons in the mouse superficial spinal dorsal horn including cells that respond to noxious and pruritic stimuli
Authors: Gutierrez-Mecinas Maria , Bell Andrew M. , Marin Alina , Taylor Rebecca , Boyle Kieran A. , Furuta Takahiro , Watanabe Masahiko , Polgár Erika , Todd Andrew J.
Published: November 2016

The superficial dorsal horn, which is the main target for nociceptive and pruritoceptive primary afferents, contains a high density of excitatory interneurons. Our understanding of their roles in somatosensory processing has been restricted by the difficulty of distinguishing functional populations among these cells. We recently defined 3 nonoverlapping populations among the excitatory neurons, based on the expression of neurotensin, neurokinin B, and gastrin-releasing peptide. Here we identify and characterise another population: neurons that express the tachykinin peptide substance P. We show with immunocytochemistry that its precursor protein (preprotachykinin A, PPTA) can be detected in ∼14% of lamina I-II neurons, and these are concentrated in the outer part of lamina II. Over 80% of the PPTA-positive cells lack the transcription factor Pax2 (which determines an inhibitory phenotype), and these account for ∼15% of the excitatory neurons in this region. They are different from the neurotensin, neurokinin B, or gastrin-releasing peptide neurons, although many of them contain somatostatin, which is widely expressed among superficial dorsal horn excitatory interneurons. We show that many of these cells respond to noxious thermal and mechanical stimuli and to intradermal injection of pruritogens. Finally, we demonstrate that these cells can also be identified in a knock-in Cre mouse line (Tac1Cre), although our findings suggest that there is an additional population of neurons that transiently express PPTA. This population of substance P–expressing excitatory neurons is likely to play an important role in the transmission of signals that are perceived as pain and itch.
Analysis of Hospital Readmission Patterns in Medicare Fee-for-Service and Medicare Advantage Beneficiaries
Authors: Oh Joobong June Park
Published: November 2016

Purpose of Study:

The study was conducted to examine the hospital readmission patterns of two groups of Medicare beneficiaries—those covered by traditional Medicare (Medicare fee-for-service [FFS]) and those enrolled in a Medicare risk plan (Medicare Advantage [MA])—and to determine the characteristics that significantly increase the likelihood of multiple hospital readmissions.

Primary Practice Setting:

The study setting is the Hospital of the University of Pennsylvania (HUP) located in Philadelphia, PA.

Methodology and Sample:

A retrospective descriptive study design was used to analyze the electronic data from the HUP information technology system for Medicare beneficiaries, 65 years and older, who had an index hospital admission at the HUP during 2012 (January 1, 2012, through December 31, 2012), and were subsequently readmitted one or more times to the HUP during the observation period.

Results:

FFS and MA beneficiaries were hospitalized an average of 1.5 (±1.0) times; 69% were rehospitalized once and 30% were rehospitalized two or more times. Characteristics that increased the likelihood of multiple hospital readmissions included being discharged on a weekend, admitted through the emergency department with a diagnosis of injury and poisoning, being diagnosed with a new problem of the circulatory system, having an exacerbation of a circulatory system illness, and having an infection related to a previous admission. Characteristics that decreased the likelihood of multiple hospital readmissions included being discharged to a skilled nursing facility and being discharged home with home health services.

Implications for Case Management Practice:

Identification of the risk factors and characteristics that increase the likelihood of multiple hospital readmissions will permit early interventions in discharge planning, as evidenced by decreasing the rate of hospital readmissions and the length of hospital stays, increasing in time to hospital readmission, and preventing the first readmission and a subsequent return to the hospital.
Implementing Huddles Improves Care Coordination in an Academic Health Center
Authors: Townsend Carolyn S. , McNulty Mary , Grillo-Peck Adria
Published: November 2016

Purpose of the Study:

To determine whether routinely scheduled, organized interdisciplinary huddles result in decreased length of stay and readmissions.

Primary Practice Setting:

The study was conducted in an academic health center (AHC) that also fills a community hospital need for a diverse inner-city population. Results are applicable in other care settings.

Methodology and Sample:

Daily interdisciplinary huddles were piloted on 5 medical/surgical units. The 2015 readmission and length of stay data were compared with the 2013 baseline.

Results:

There was a mean readmission reduction of 0.56%. A paired t test comparing the 2013 and 2015 readmission rates of the 5 units was significant (p < .05). There was a 0.42-day increase in the mean LOS between the 2013 baseline and the 2015 follow-up. A paired t test comparing 2013 and 2015 readmission rates of the 5 units was not significant at the .05 level.

Implications for Case Management Practice:

Daily interdisciplinary sessions can result in reduced readmissions. Long-lasting positive outcomes related to enhanced communication are possible. Requirements for success include consistency in the standard huddle content reviewed. Data should be followed closely throughout an extended period of time to identify trends and support sustainment. Creative means to obtain input from services that cover multiple units and not be able to attend huddles may be necessary. Staff turnover will impact success. Variation in physician engagement can be addressed by frequent communication on the “why” behind the significance of the huddles, as well as sharing of change data highlighting success stories.
It's a Question of Balance
Authors: Powell Suzanne K.
Published: November 2016

Life is full of unexpected, unplanned, and often unwanted events. They often leave us feeling “out of control.” This column discusses the “law of control,” “losing-control anxiety,” and practical applications to move forward.
Sexually Transmitted Infections and Associated Risk Factors Among Street-Based and Residence-Based Female Sex Workers in Dhaka, Bangladesh
Authors: Khanam Rasheda , Reza Masud , Ahmed Dilruba , Rahman Mustafizur , Alam M. Shah , Sultana Salima , Alam Anadil , Khan Sharful I. , Mayer Kenneth H. , Azim Tasnim
Published: November 2016

Background

Female sex workers (FSWs) in Bangladesh remain at elevated risk of sexually transmitted infections (STIs) although the human immunodeficiency virus (HIV) prevalence among them is low. Recent information on the burden and etiological diagnosis of STIs among them has been lacking. This study examines prevalence and risk behaviors of selected STIs among FSWs in Dhaka in 2014.

Methods

Between August and October 2014, a cross-sectional study was conducted among street-based and residence-based FSWs receiving HIV prevention services at 24 drop in centers in Dhaka. Participants underwent behavioral interview, clinical examination, and laboratory testing for selected STIs using cervical swabs and blood.

Results

The sample consisted of 371 streets and 329 residence FSWs. Prevalence of gonorrhea, chlamydia, and active syphilis were 5.1%, 4.6%, 1.3% in street FSWs and were 5.8%, 8.2%, and 0.6% for residence FSWs which are lower compared with the previously reported rates. The following factors were associated with having any STI: being ≤5 years in sex trade (odds ratio, 2.2; 95% confidence interval, 1.2–3.9; P < 0.01), and having a cervical discharge (odds ratio, 2.6, 95% confidence interval, 1.5–4.6; P < 0.01). Resistance to cefixime and azithromycin was observed for 1 and 3 Neisseria gonorrhoeae strains, respectively.

Conclusions

Despite receiving HIV/STI prevention services, bacterial STIs remain prevalent among FSWs suggesting the need for more effective management of STIs. The guidelines for management of STIs need revision in view of the emerging resistance.
Single-Dose Compared With Multidose Metronidazole for the Treatment of Trichomoniasis in Women: A Meta-Analysis
Authors: Howe Katharine , Kissinger Patricia J
Published: November 2016

Background

Trichomonas vaginalis is the most common curable sexually transmitted infection worldwide. Although the Centers for Disease Control and Prevention and the World Health Organization recommend a single 2-g dose of metronidazole for the first line of treatment for T. vaginalis among human immunodeficiency virus (HIV) negative women, high rates of repeat infections are found. The purpose of this meta-analysis was to compare treatment failure between single versus multidose metronidazole for the treatment of T. vaginalis.

Methods

A systematic literature search was performed using search terms including metronidazole AND trichomoniasis AND women. Embase, MEDLINE, and Clinicaltrials.gov were used to search for relevant studies as well as hand searching relevant articles. These databases were last searched on January 25, 2016. To be included in this meta-analysis, the study had to be a clinical trial, evaluate T. vaginalis, use oral metronidazole, and compare single dose metronidazole to multidose metronidazole.

Results

There were 487 articles that were assessed for relevance and quality. Of these articles, 6 met the eligibility criteria and were included in the final results. The pooled risk ratio indicated higher treatment failure for single dose compared to multidose 1.87 (95% confidence interval, 1.23–2.82; P < 0.01). When the one study that included HIV+ women was excluded from analysis, the findings were similar with a pooled risk ratio of 1.80 (95% confidence interval, 1.07–3.02; P < 0.03).

Conclusions

Centers for Disease Control and Prevention recently changed treatment recommendations for HIV+ women to multidose rather than single-dose. These data suggest that those recommendations should be considered for all women.