bluuebunny/crossref_metadata_2025 huggingface dataset:
Estimation and Preparation of the Hypervariable Regions I/II Templates for Mitochondrial DNA Typing From Human Bones and Teeth Remains Using Singleplex Quantitative Polymerase Chain Reaction
Authors: Le Thien Ngoc , Van Phan Hieu , Dang Anh Tuan Mai , Nguyen Vy Thuy
Published: July 2016

A method was designed for estimating and sequencing of mitochondrial DNA (mtDNA) that effectively and more quickly provides a complete mtDNA profile. In this context, we have developed this novel strategy for typing mtDNA from 10 bones and teeth remains (3 months to 44 years). The quantification of mtDNA was achieved by singleplex real-time polymerase chain reaction of the hypervariable region I fragment (445 bp) and hypervariable region II fragment (617 bp). Combined with the melting curve analysis, we have determined as little as 10−4pg of mtDNA template that is suitable for sequence analysis. Furthermore, quantitative polymerase chain reaction products were directly used for following step of mtDNA typing by Sanger sequencing. This method allows the profile to be completely provided for faster human identification.
Diagnosis of a Cerebral Arteriovenous Malformation Using Isolated Brain Computed Tomography Angiography
Authors: Qian Hui , Shao Yu , Li Zhengdong , Huang Ping , Zou Donghua , Liu Ningguo , Chen Yijiu , Wan Lei
Published: July 2016

This report presents a case of a 40-year-old woman who was found dead in her house. The examination of the body revealed no external injuries. The whole body was scanned by multi–detector-row computed tomography (CT) before autopsy, revealing massive hemorrhage in the right frontal extending into the ventricular system. At autopsy, the brain parenchyma was removed. Then CT angiography was carried on the isolated brain. Computed tomography angiography suggested a mass of irregular, tortuous vessels in areas of hemorrhage in the right frontal lobe of the brain. Finally, histological examination confirmed the result of CT angiography due to an arteriovenous malformation. Hence, postmortem CT angiography played an important role in diagnosis of the cerebral arteriovenous malformation that was responsible for a massive hemorrhage in the skull.
A Pediatric Sedation Protocol for Mechanically Ventilated Patients Requires Sustenance Beyond Implementation*
Authors: Yaghmai Beryl F. , Di Gennaro Jane L. , Irby Gretchen A. , Deeter Kristina H. , Zimmerman Jerry J.
Published: July 2016

Objectives:

To reevaluate the effect of a nursing-driven sedation protocol for mechanically ventilated patients on analgesic and sedative medication dosing durations. We hypothesized that lack of continued quality improvement efforts results in increased sedation exposure, as well as mechanical ventilation days, and ICU length of stay.

Design:

Quasi-experimental, uncontrolled before-after study.

Setting:

Forty-five–bed tertiary care, medical-surgical-cardiac PICU in a metropolitan university-affiliated children’s hospital.

Patients:

Children requiring mechanical ventilation longer than 48 hours not meeting exclusion criteria.

Interventions:

During both the intervention and postintervention periods, analgesia and sedation were managed by nurses following an algorithm-based sedation protocol with a targeted comfort score.

Measurement and Main Results:

The intervention cohort includes patients admitted during a 12-month period following initial protocol implementation in 2008–2009 (n = 166). The postintervention cohort includes patients meeting identical inclusion and exclusion criteria admitted during a 12-month period in 2012–2013 (n = 93). Median duration of total sedation days (IV plus enteral) was 5 days for the intervention period and 10 days for the postintervention period (p < 0.0001). The postintervention cohort received longer duration of mechanical ventilation (6 vs 5 d; p = 0.0026) and ICU length of stay (10 vs 8.5 d; p = 0.0543). After adjusting for illness severity and cardiac and surgical status, Cox proportional hazards regression analysis demonstrated that at any point in time, patients in the postintervention group were 58% more likely to be receiving sedation (hazard ratio, 1.58; p < 0.001) and 34% more likely to remain in the ICU (hazard ratio, 1.34; p = 0.019).

Conclusions:

Sedation quality improvement measures related to the use of opiate infusions, total days of sedation exposure, PICU length of stay, and mechanical ventilation days all deteriorated following initial successful implementation of a PICU sedation protocol. Implementation of a protocol alone may not lead to sustained quality improvement without routine monitoring and ongoing education to ensure effectiveness.
Epidemiology of Sepsis in Children Admitted to PICUs in South America*
Authors: de Souza Daniela Carla , Shieh Huei Hsin , Barreira Eliane Roseli , Ventura Andrea Maria Cordeiro , Bousso Albert , Troster Eduardo Juan
Published: July 2016

Objectives:

To report the prevalence of sepsis within the first 24 hours at admission and the PICU sepsis-related mortality among critically ill children admitted to PICU in South America.

Design:

A prospective multicenter cohort study.

Setting:

Twenty-one PICU, located in five South America countries.

Patients:

All children from 29 days to 17 years old admitted to the participating PICU between June 2011 and September 2011. Clinical, demographic, and laboratory data were registered within the first 24 hours at admission. Outcomes were registered upon PICU discharge or death.

Interventions:

None.

Measurements and Main Results:

Of the 1,090 patients included in this study, 464 had sepsis. The prevalence of sepsis, severe sepsis, and septic shock were 42.6%, 25.9%, and 19.8%, respectively. The median age of sepsis patients was 11.6 months (interquartile range, 3.2–48.7) and 43% had one or more prior chronic condition. The prevalence of sepsis was higher in infants (50.4%) and lower in adolescents (1.9%). Sepsis-related mortality was 14.2% and was consistently higher with increased disease severity: 4.4% for sepsis, 12.3% for severe sepsis, and 23.1% for septic shock. Twenty-five percent of deaths occurred within the first 24 hours at PICU admission. Multivariate analysis showed that higher Pediatric Risk of Mortality and Pediatric Logistic Organ Dysfunction scores, the presence of two or more chronic conditions, and admission from pediatric wards were independently associated with death.

Conclusions:

We observed high prevalence of sepsis and sepsis-related mortality among this sample of children admitted to PICU in South America. Mortality was associated with greater severity of illness at admission and potentially associated with late PICU referral.
Screening Criteria Improve Access to Palliative Care in the PICU*
Authors: Lutmer Jeffrey E. , Humphrey Lisa , Kempton Tanya Maria , Moore-Clingenpeel Melissa , Ayad Onsy
Published: July 2016

Objectives:

To test the ability of palliative care screening criteria to improve access to palliative care services in the PICU and examine the association between palliative care team involvement and ICU and hospital length of stay.

Design:

Prospective interventional quality improvement study.

Setting:

PICU at a quaternary academic medical center.

Patients:

All patients admitted to the PICU who met criteria for palliative care referral over a 9-month period.

Intervention:

Consensus palliative care consultation criteria were created by pediatric critical care medicine and palliative care providers, and palliative care referral was encouraged for all PICU patients meeting criteria.

Measurements and Main Results:

Palliative care referral rates increased significantly after screening criteria implementation. We identified 100 patients who were eligible for palliative care services, and referrals were made for 70 patients (70%). Patients were divided into three groups based on palliative care status: patients new to the palliative care team, patients with an existing palliative care relationship, and patients who did not have a palliative care referral. By the end of study, patients who had an existing relationship with the palliative care team were more likely to still be alive and to have limitations of medical interventions in place, whereas patients who did not have a palliative care referral were more likely to be deceased and to have died in the PICU. After correcting for other factors, including severity of illness, patients who were new to the palliative care team experienced greater delay in palliative care referral and had significantly longer PICU and hospital length of stay than those who were already known to the palliative care team.

Conclusions:

Palliative care screening criteria are effective tools for improving access to palliative care services in the PICU; however, widespread adoption may produce a significant increase in palliative care demand. The association between an existing palliative care relationship and reduction in resource utilization deserves further investigation as does the perceived benefit of palliative care involvement in the patient, family, and staff experience.
Temporal Trends of Respiratory Syncytial Virus–Associated Hospital and ICU Admissions Across the United States*
Authors: Gupta Punkaj , Beam Brandon W. , Rettiganti Mallikarjuna
Published: July 2016

Objectives:

To describe the regionality and seasonality of respiratory syncytial virus–associated hospital and ICU admissions for 10 consecutive years using a national database.

Design:

Post hoc analysis of data from an existing national database, Pediatric Health Information System. We modeled the adjusted odds of hospital and ICU admissions for varied seasons (fall, winter, spring, and summer) and regions (Northeast, South, Midwest, and West) using a mixed-effects logistic regression model after adjusting for several patient and center characteristics.

Setting:

Forty-two children’s hospitals across the Unites States.

Patients:

Patients 1 day through 24 months old with inpatient admission (ward and/or ICU) for respiratory syncytial virus– associated infection at a Pediatric Health Information System–participating hospital were included (2004–2013).

Interventions:

None.

Measurements and Main Results:

Of 1,937,994 inpatient admissions during the study period, 146,357 children were admitted for respiratory syncytial virus–associated acute respiratory illness. Of these inpatient admissions, 32,470 children(22%) were admitted to ICU during their hospital stay. Overall adjusted odds of respiratory syncytial virus–associated hospital and ICU admissions in recent years (2010–2013) were higher than previous years (2004–2006 and 2007–2009). In recent years, respiratory syncytial virus–associated hospital and ICU admissions have increased in winter and spring seasons. Regionally in recent years, the overall adjusted odds of both respiratory syncytial virus–associated hospital and ICU admissions have increased in the South and West regions.

Conclusions:

Wide variations in regional and seasonal patterns in hospital and ICU admissions were noted in children with respiratory syncytial virus–associated acute respiratory illness across the United States. Results from our study help us better understand the seasonality and regionality of respiratory syncytial virus infection in the United States with the goal to decrease the financial impact on our already stressed healthcare system by being better prepared for respiratory syncytial virus season.
Sevoflurane Therapy for Severe Refractory Bronchospasm in Children
Authors: Palacios Alba , Mencía Santiago , Llorente Ana M. , Cruz Jaime , Toledo Blanca , Ordóñez Olga , Olmedilla Marta , Lopez-Herce Jesus
Published: July 2016

Objectives:

To describe the effect of inhaled sevoflurane in the treatment of severe refractory bronchospasm in children.

Design:

Retrospective case series.

Setting:

Two PICUs of tertiary general university hospitals in Spain.

Patients:

Ten patients ranging from 5 months to 14 years old with severe bronchospasm and acute respiratory failure requiring tracheal intubation and mechanical ventilation and treated with sevoflurane from 2008 to 2015.

Intervention:

Inhaled sevoflurane therapy was initiated after failure of conventional medical management and mechanical ventilation. In two patients, sevoflurane was administered through a Servo 900C ventilator (Maquet, Bridgewater, NJ) equipped with a vaporizer and in the other eight patients via the Anesthetic Conserving Device (AnaConDa; Sedana medical, Uppsala, Sweden) with a critical care ventilator.

Measurements and Main Results:

Inhaled sevoflurane resulted in statistically significant decreases of Paco
2 of 34.2 torr (95% CI, 8.3–60), peak inspiratory pressure of 14.3 cm H2O (95% CI, 8.6–19.9), and improvement in pH of 0.17 (0.346–0.002) within 6 hours of administration. Only one patient presented hypotension responsive to volume administration at the beginning of the treatment. All patients could be extubated within a median time of 120 hours (interquartile range, 46–216).

Conclusions:

Inhaled sevoflurane therapy decreases the levels of Paco
2 and peak inspiratory pressure values, and it may be considered as a rescue therapy in patients with life-threatening bronchospasm refractory to conventional therapy.
Factors Associated With Continuous Low-Dose Heparin Infusion for Central Venous Catheter Patency in Critically Ill Children Worldwide
Authors: Onyeama Sara-Jane N. , Hanson Sheila J. , Dasgupta Mahua , Hoffmann Raymond G. , Faustino Edward Vincent S.
Published: July 2016

Objectives:

To identify patient, hospital, and central venous catheter factors that may influence the use of low-dose heparin infusion for central venous catheter patency in critically ill children.

Design:

Secondary analysis of an international multicenter observational study.

Setting:

Fifty-nine PICUs over four study dates in 2012, involving seven countries.

Patients:

Children less than 18 years old with a central venous catheter who were admitted to a participating unit and enrolled in the completed Prophylaxis against Thrombosis Practice study were included. All overflow patients were excluded.

Interventions:

None.

Measurements and Main Results:

Of the 2,484 patients in the Prophylaxis against Thrombosis Practice study, 1,312 patients had a central venous catheter. Five hundred seven of those patients used low-dose heparin infusion. The frequency of low-dose heparin infusion was compared across various patient, hospital, and central venous catheter factors using chi-square, Mann-Whitney U, and Fisher exact tests. In the multivariate analysis, age was not a significant factor for low-dose heparin infusion use. Patients with pulmonary hypertension had decreased low-dose heparin infusion use, whereas those with active surgical or trauma diagnoses had increased low-dose heparin infusion use. All centrally inserted central venous catheters were more likely to use low-dose heparin infusion when compared with peripherally inserted central venous catheters. The Asia-Pacific region showed increased low-dose heparin infusion use, along with community hospitals and smaller ICUs (< 10 beds).

Conclusions:

Patient, central venous catheter, and hospital factors are associated with the use of low-dose heparin infusion in critically ill children. Further study is needed to evaluate the efficacy and persistence of low-dose heparin infusion use.
A Cross-Sectional Study of Emergency Department Visits by Children After All-Terrain Vehicle Crashes, Motor Vehicle Crashes, and Sports Activities
Authors: Nabaweesi Rosemary , Robbins James M. , Goudie Anthony , Onukwube Jennifer I. , Bowman Stephen M. , Aitken Mary E.
Published: July 2016

Objectives

All-terrain vehicle (ATV) crashes have been responsible for significant injuries among children, despite public education efforts. Our study examined pediatric ATV injury patterns in US emergency departments (EDs) compared with injuries after motor vehicle crash (MVC) and sports activities.

Methods

We studied 2006 to 2011 data from the Nationwide Emergency Department Sample. Children younger than 18 years and involved in ATV crashes, MVC, or sports activities were included. The primary outcome analyzed was a constructed binary measure identifying severe trauma, defined as injury severity score greater than 15. Logistic regression models were fit to determine the association between mechanism of injury and severe trauma.

Results

A total of 6,004,953 ED visits were identified. Of these, ATV crashes accounted for 3.4%, MVC accounted for 44.7%, and sports activities accounted for 51.9%. Emergency department visits after ATV crashes were more likely to result in admission (8%) and incur higher median charges ($1263) compared with visits after sports activities (1%, $1013). Visits after sports activities were 90% less likely to result in severe trauma when compared with ATV crash visits. Emergency department visits after ATV crashes result in severe injuries similar to those sustained in MVC (odds ratio, 1.03; P = 0.626).

Conclusions

Pediatric ED visits after ATV crashes result in significant injuries and charges. Public health interventions such as education, legislation, and engineering are needed to reduce injuries among children and the subsequent ED visits for care. The impact of proven interventions may be greatest for children living in rural areas and among older children, 10 to 17 years old.
Elevated Baseline Cortisol Levels Are Predictive of Bad Outcomes in Critically Ill Children
Authors: Levy-Shraga Yael , Pinhas-Hamiel Orit , Molina-Hazan Vered , Tamir-Hostovsky Liran , Eini Zeev Motti , Lerner-Geva Liat , Paret Gideon
Published: July 2016

Objective

The definition of an adequate adrenal response in critically ill children continues to be controversial. We aimed to evaluate the cortisol levels at baseline and after adrenocorticotropin (ACTH) stimulation and determine their association to clinical outcome of critically ill children.

Methods

All children who underwent an ACTH test in the pediatric intensive care unit (PICU) in a tertiary medical center between 2006 and 2013 were included in the study. Data on age, sex, diagnosis, vasoactive-inotropic score, length of pediatric intensive care unit stay, and mortality were obtained. Laboratory variables included hematologic and chemistry data, arterial lactate, and total plasma cortisol levels at baseline and after ACTH stimulation.

Results

Ninety-nine patients (61 males; median [range] age, 2 [0–204] months) were enrolled. The mortality rate of children with a baseline cortisol level of 600 nmol/L or greater was 36% (12/33 patients) versus 18% (12/66 patients) for children with a baseline cortisol level of less than 600 nmol/L (odds ratio, 2.6 [95% confidence interval, 1–6.6]; P = 0.05). There was a positive correlation between baseline cortisol and lactate levels (r = 0.40, P < 0.0001), vasoactive-inotropic scores (r = 0.24, P = 0.02), and mortality (P = 0.05). There was no correlation between peak cortisol measured at the ACTH test or the delta increment of cortisol from baseline and mortality.

Conclusions

A high baseline cortisol level in critically ill children was associated with more severe illness, higher lactate level, and a higher mortality rate. Routine baseline cortisol assessment is recommended to identify patients at high mortality risk.
Traumatic Pulmonary Herniation at the Diaphragmatic Junction in a Pediatric Patient
Authors: Orlik Kseniya , Simon Erin Leslie , Hemmer Carrie , Ramundo Maria
Published: July 2016

We present a case of traumatic intercostal pulmonary herniation in an 11-year-old boy after blunt trauma to the chest, without associated chest wall disruption or pneumothorax. This condition is especially uncommon in children, with only 5 previously reported cases and most occurring after penetrating chest trauma. To date, there are no reports in literature describing traumatic intercostal lung herniation at the diaphragmatic junction with a closed chest cavity in a child. The number of traumatic lung herniation diagnoses may be expanded by a more liberal use of computed tomography when serious injury is suspected. Computed tomography and advanced imaging should be considered in pediatric trauma patients presenting with concern for intrathoracic injury that may not be seen on plain film. Traumatic blunt intrathoracic and intra-abdominal injuries in the pediatric population that are within proximity of diaphragmatic insertion should be thoroughly evaluated to rule out diaphragmatic injury. As in our case, invasive surgical intervention such as thoracoscopy may be necessary.
Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in the Pediatric Population
Authors: Alerhand Stephen , Cassella Courtney , Koyfman Alex
Published: July 2016

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe dermatologic reactions with mucocutaneous involvement that carry elevated mortality rates. They differ along a spectrum of severity based upon body surface area affected. These conditions, usually caused by a drug or infection, are believed to result from cell-mediated and often drug-specific cytotoxic reactions against keratinocytes, leading to widespread dermal-epidermal detachment. Studies attempting to identify potential curative therapies such as intravenous immune globulin (IVIG) and corticosteroids remain inconclusive. However, improved outcomes have been demonstrated by early withdrawal of offending medications, early transfer to an intensive care unit or burn unit, and aggressive supportive care. Due to the rare incidence of SJS and TEN, its recurrence among survivors hints at future vulnerability for these patients, and notorious offending medications should thus be avoided. This clinical review will highlight the diagnostic and therapeutic challenges posed by SJS and TEN, while emphasizing the need to maintain them high on the emergency medicine physician's differential. The review will also detail the supportive measures to take for preventing the rapid progression of mucocutaneous complications and subsequent sepsis-related mortality.
PD-L1 Expression in Human Placentas and Gestational Trophoblastic Diseases
Authors: Veras Emanuela , Kurman Robert J. , Wang Tian-Li , Shih Ie-Ming
Published: July 2016

One of the major immune checkpoints responsible for immune evasion in cancer cells is the interaction between programmed cell death-1 (PD-1) and its ligand (PD-L1). As human trophoblastic cells display many of the features of malignant cells such as the ability to invade normal tissue including blood vessels and are apparently not eradicated by the host immune system, we undertook the present study to determine whether PD-L1 was upregulated in different types of trophoblastic cells during normal pregnancy and in gestational trophoblastic diseases. Immunohistochemistry using an anti–PD-L1-specific antibody demonstrated that in early and term normal placentas, PD-L1 was highly expressed in syncytiotrophoblast and to a much lower extent in intermediate trophoblastic cells located in the chorion laeve and implantation site. PD-L1 immunoreactivity was undetectable in cytotrophoblastic cells. This staining pattern in normal placenta was recapitulated in various types of gestational trophoblastic disease. PD-L1 was highly expressed by syncytiotrophoblast in complete moles and choriocarcinomas. The intermediate trophoblastic neoplasms, placental site trophoblastic tumors, and epithelioid trophoblastic tumors showed variable PD-L1 immunoreactivity but at a lower intensity than in the neoplastic syncytiotrophoblast in choriocarcinoma. In addition, we observed PD-1-positive lymphocytes located within the implantation site and in trophoblastic tumors. In summary, this study describes a novel mechanism for trophoblastic cells to create a tolerogenic feto-maternal interface by upregulating PD-L1 in syncytiotrophoblast and in intermediate trophoblast. Trophoblastic tumors may also use PD-L1 expression to evade the host immune response thereby promoting their survival.
Minimal-deviation Endometrioid Adenocarcinoma of the Cervix: A Case Report With Ultrastructural Analysis Demonstrating Abnormal Ciliation of the Tumor Cells
Authors: Gould Paul R. , Stewart Colin J.R. , Papadimitriou John M.
Published: July 2016

Minimal-deviation endometrioid adenocarcinoma (MDEA) of the uterine cervix is a rare tumor that may be confused histologically with a number of benign lesions as well as other types of endocervical neoplasia. The histologic and immunohistochemical features of MDEA have been described in case reports and in small series, but correlation of these findings with ultrastructural examination has not been documented. Herein we report a 51-yr-old patient who underwent hysterectomy for menorrhagia and was found to have a clinically unsuspected, stage IB cervical MDEA. The light microscopic, immunohistochemical, and electron microscopic features of the tumor are described, with the most significant ultrastructural abnormality being the presence of abnormal cilia and ciliogenesis.
The Role of Occupational Status in the Association Between Job Strain and Ambulatory Blood Pressure During Working and Nonworking Days
Authors: Joseph Nataria T. , Muldoon Matthew F. , Manuck Stephen B. , Matthews Karen A. , MacDonald Leslie A. , Grosch James , Kamarck Thomas W.
Published: July 2016

Objectives

The objectives of this study were to determine whether job strain is more strongly associated with higher ambulatory blood pressure (ABP) among blue-collar workers compared with white-collar workers, to examine whether this pattern generalizes across working and nonworking days and across sex, and to examine whether this pattern is accounted for by psychosocial factors or health behaviors during daily life.

Methods

A total of 480 healthy workers (mean age = 43 years, 53% female) in the Adult Health and Behavior Project–Phase 2 completed ABP monitoring during 3 working days and 1 nonworking day. Job strain was operationalized as high psychological demand (> sample median) combined with low decision latitude (<sample median; Karasek model; Job Content Questionnaire).

Results

Covariate-adjusted multilevel random coefficient regressions demonstrated that associations between job strain and systolic and diastolic ABP were stronger among blue-collar workers compared with white-collar workers (b = 6.53 [F(1,464) = 3.89, p = .049] and b = 5.25 [F(1,464) = 6.09, p = .014], respectively). This pattern did not vary by sex, but diastolic ABP findings were stronger when participants were at work. The stronger association between job strain and ABP among blue-collar workers was not accounted for by education, momentary physical activity, or substance use, but was partially accounted for by covariation between higher hostility and blue-collar status.

Conclusions

Job strain is associated with ABP among blue-collar workers. These results extend previous findings to a mixed-sex sample and nonworking days and provide, for the first time, comprehensive exploration of several behavioral and psychosocial explanations for this finding.
Sex and Gender Roles in Relation to Mental Health and Allostatic Load
Authors: Juster Robert-Paul , Pruessner Jens C. , Desrochers Alexandra Bisson , Bourdon Olivier , Durand Nadia , Wan Nathalie , Tourjman Valérie , Kouassi Edouard , Lesage Alain , Lupien Sonia J.
Published: July 2016

Objectives

Beyond male/female binaries, gender roles represent masculine and feminine traits that we assimilate and enact throughout life span development. Bem proposed that “androgynous” individuals adeptly adapt to different contexts by alternating from a strong repertoire of both masculine and feminine gender roles. By contrast, “undifferentiated” individuals may not adapt as well to social norms because of weak self-endorsed masculinity and femininity.

Methods

Among 204 adults (mean [standard error] age = 40.4 [0.9] years; 70% women) working in a psychiatric hospital, we hypothesized that androgynous individuals would present better mental health and less physiological dysregulations known as allostatic load (AL) than undifferentiated individuals. AL was indexed using 20 biomarkers using the conventional “all-inclusive” formulation that ascribes cutoffs without regard for sex or an alternative “sex-specific” formulation with cutoffs tailored for each sex separately while controlling for sex hormones (testosterone, estradiol, progesterone). Well-validated questionnaires were used.

Results

Independent of sex, androgynous individuals experienced higher self-esteem and well-being and lower depressive symptoms than did undifferentiated individuals. Men manifested higher AL than did women using the all-inclusive AL index (p = .044, η
2
P = 0.025). By contrast, the sex-specific AL algorithm unmasked a sex by gender roles interaction for AL (p = .043, η
2
P = 0.048): with the highest AL levels in undifferentiated men. Analysis using a gender index based on seven gendered constructs revealed that a greater propensity toward feminine characteristics correlated only with elevated sex-specific AL (r = 0.163, p = .025).

Conclusions

Beyond providing psychobiological evidence for Bem's theory, this study highlights how sex-specific AL formulations detect the effects of sociocultural gender.
Molecular Mechanisms of Stress-Induced Myocardial Injury in a Rat Model Simulating Posttraumatic Stress Disorder
Authors: Liu Mi , Xu Feifei , Tao Tianqi , Song Dandan , Li Dong , Li Yuzhen , Guo Yucheng , Liu Xiuhua
Published: July 2016

Objective

Posttraumatic stress disorder (PTSD) is an independent risk factor for cardiovascular diseases. This study investigated the molecular mechanisms underlying myocardial injury induced by simulated PTSD.

Methods

Sprague-Dawley rats were randomly divided into two groups: control group (n = 18) and PTSD group (n = 30). The PTSD model was replicated using the single prolonged stress (SPS) method. On the 14th day poststress, the apoptotic cells in myocardium were assessed using both TUNEL method and transmission electron microscopy; the protein levels of the endoplasmic reticulum stress (ERS) molecules were measured by using Western blotting analysis.

Results

Exposure to SPS resulted in characteristic morphologic changes of apoptosis in cardiomyocytes assessed by transmission electron microscopy. Moreover, TUNEL staining was also indicative of the elevated apoptosis rate of cardiomyocytes from the SPS rats (30.69% versus 7.26%, p < .001). Simulated PTSD also induced ERS in myocardium, demonstrated by up-regulation of protein levels of glucose-regulated protein 78 (0.64 versus 0.26, p = .017), calreticulin (p = .040), and CCAAT/enhancer-binding protein-homologous protein (0.95 versus 0.43, p = .047), phosphorylation of protein kinase RNA–like ER kinase (p = .003), and caspase 12 activation (0.30 versus 0.06, p < .001) in myocardium from the SPS rats. The ratio of Bcl-2 to Bax decreased significantly in myocardium from the SPS rats (p = .005).

Conclusions

The ERS-related apoptosis mediated by the protein kinase RNA–like ER kinase/CCAAT/enhancer-binding protein-homologous protein and caspase 12 pathways may be associated with myocardial injury in a rat model simulating PTSD. This study may advance our understanding of how PTSD contributes to myocardial injury on a molecular level.
Structural Remodeling of Sympathetic Innervation in Atherosclerotic Blood Vessels: Role of Atherosclerotic Disease Progression and Chronic Social Stress
Authors: Noller Crystal M. , Mendez Armando J. , Szeto Angela , Boulina Marcia , Llabre Maria M. , Zaias Julia , Schneiderman Neil , McCabe Philip M.
Published: July 2016

Objective

The sympathetic nervous system (SNS) can undergo dramatic structural plasticity in response to behavioral factors and/or the presence of disease, leading to SNS hyperinnervation of peripheral tissues. The SNS has been proposed as an important mediator between stressful behavior and the progression of atherosclerosis in the vasculature. The present study examined whether structural remodeling of the SNS occurs in the vasculature in a genetically hyperlipidemic animal model of atherosclerosis, the Watanabe heritable hyperlipidemic rabbit (WHHL; relative to normolipidemic New Zealand white rabbits [NZW]), and whether SNS plasticity is driven by the progression of disease and/or by stressful social behavior.

Methods

WHHL and NZW rabbits were assigned to an unstable or stable social environment for 4 months. Aortic atherosclerosis was assessed and SNS aortic innervation quantified using immunofluorescent microscopy.

Results

Numerous SNS varicosities were observed throughout the aorta in WHHLs and NZWs, extending into the vascular media and intima, an innervation pattern not previously reported. WHHLs exhibited significantly greater innervation than NZWs (F(1,41) = 55.3, p < .001), with extensive innervation of the atherosclerotic neointima. The innervation density was highly correlated with the extent of disease in the WHHLs (r(21) = 0.855, p < .001). Social environment did not influence innervation in NZWs (aortic arch: p = .078, thoracic aorta: p = .34) or WHHLs (arch: p = .97, thoracic: p = .61).

Conclusions

The findings suggest that hyperinnervation is driven largely by the progression of disease rather than social environment. SNS innervation patterns observed in atherosclerotic human and mouse aortas were consistent with the rabbit, suggesting that SNS hyperinnervation of the diseased vessel wall is a general feature across mammalian species.
Departmental Workload and Physician Errors in Radiation Oncology
Authors: Tariq Muhammad B. , Meier Tim , Suh John H. , Reddy Chandana A. , Godley Andrew , Kittel Jeff , Hugebeck Brian , Kolar Matt , Barrett Patty , Chao Samuel T.
Published: July 2016

Purpose

The purpose of this work was to evaluate measures of increased departmental workload in relation to the occurrence of physician-related errors and incidents reaching the patient in radiation oncology.

Materials and Methods

All data were collected for the year 2013. Errors were defined as forms received by our departmental process improvement team; of these forms, only those relating to physicians were included in the study. Incidents were defined as serious errors reaching the patient requiring appropriate action; these were reported through a separate system. Workload measures included patient volumes and physician schedules and were obtained through departmental records for daily and monthly data. Errors and incidents were analyzed for relation with measures of workload using logistic regression modeling.

Results

Ten incidents occurred in the year. The number of patients treated per day was a significant factor relating to incidents (P < 0.003). However, the fraction of department physicians off-duty and the ratio of patients to physicians were not found to be significant factors relating to incidents. Ninety-one physician-related errors were identified, and the ratio of patients to physicians (rolling average) was a significant factor relating to errors (P < 0.03). The number of patients and the fraction of physicians off-duty were not significant factors relating to errors.

A rapid increase in patient treatment visits may be another factor leading to errors and incidents. All incidents and 58% of errors occurred in months where there was an increase in the average number of fields treated per day from the previous month; 6 of the 10 incidents occurred in August, which had the highest average increase at 26%.

Conclusions

Increases in departmental workload, especially rapid changes, may lead to higher occurrence of errors and incidents in radiation oncology. When the department is busy, physician errors may be perpetuated owing to an overwhelmed departmental checks system, leading to incidents reaching the patient. Insights into workload and workflow will allow for the development of targeted approaches to preventing errors and incidents.
Effectiveness of Shared Medical Appointments Versus Traditional Clinic Visits for Adolescents With Type 1 Diabetes
Authors: Everest Erica , Akhtar Sara , Sumego Marianne , Zeizoun Alaa , Worley Sarah , Tang Anne S. , Dorsey Allison , Smith Ann , Schweiger Bahareh
Published: July 2016

Shared medical appointments began in the United States in 1996 to advance quality of care and enhance patients' ability to self-manage. Group visits gather patients with the same diagnosis for individual examinations followed by group education sessions taught by the provider. This leads to the opportunity to learn from the experiences of others. The Cleveland Clinic Department of Pediatric Endocrinology offers a shared medical appointment group for pediatric patients with type 1 diabetes called the ESCALAIT clinic (Enrichment Services and Care for Adolescents Living with Autoimmune Insulin Dependent Type 1 Diabetes). The objective of this study was to compare the effectiveness of traditional clinic visits with shared medical appointments for adolescents with type 1 diabetes in terms of hemoglobin A1c (HbA1c) improvement. Eighty ESCALAIT patients, aged 11 to 19 years were compared with 516 clinic controls of the same age. Visits were approximately 3 months apart for both patient groups. Changes in HbA1c between groups were calculated from the first to fourth visits. There was a statistically significant difference between the ESCALAIT clinic patients and the control patients. Our results revealed that the group visit patients had less improvement in HbA1c values at the last visit approximately 1 year later, but we would argue that the difference is not clinically significant. However, there were many benefits to shared medical appointment visits including increased access to care as well as peer support. Shared medical appointments are therefore a valid alternative to traditional clinic visits in this patient population.
The Impact of Cross-Unit Coordination and Process Improvement Efforts in Anatomic Pathology: A Systems Perspective
Authors: Bonzo Sarah M. , Liker Jeffrey K.
Published: July 2016

Background:

The impact of coordination and problem solving on health care quality has become increasingly prevalent within the literature. However, few studies have empirically investigated the impact of these factors across organizational boundaries.

Methods:

This was an embedded, single-case study conducted within a large, academic Anatomic Pathology department. We surveyed 96 team members within 18 distinct processing or specialty units within the department and forward the Network Alignment Approach to measure coordination between units. In addition, we measure perceived safety culture and frequency of error in specimen documentation and preparation.

Results:

Regression results suggest that downstream cross-unit coordination between units (clarity of customer requirements) significantly improves safety culture (P < .001). In addition, within-unit process improvement efforts improved safety culture (P < .001). These 2 factors alone accounted for 30% of the variation in the regression model, with safety culture as our dependent variable.

Conclusion:

Clarity of customer requirements and process improvement efforts significantly improve safety culture within the system. This approach to understanding and analyzing connections within complex systems provides insight into specific ways that leaders can begin to understand how each unit or department can improve as both a customer and a supplier within the larger system.
Magnetic Resonance Imaging Findings After Percutaneous Irreversible Electroporation of Liver Metastases
Authors: Barabasch Alexandra , Distelmaier Martina , Heil Philipp , Krämer Nils Andreas , Kuhl Christiane K. , Bruners Philipp
Published: July 2016

Objective

The aim of this study was to systematically investigate the course of magnetic resonance (MR) signal intensity (SI) changes that occur in noncirrhotic livers after irreversible electroporation (IRE) of liver metastases.

Methods

This study is an institutional review board–approved prospective longitudinal follow-up study on 27 patients with 37 liver metastases who underwent computed tomography–guided percutaneous IRE and a standardized follow-up protocol by serial hepatic MR imaging studies that consisted of a gadobutrol-enhanced dynamic series, axial T2-weighted (T2w) turbo spin echo, and diffusion-weighted imaging (b = 0/50/800), acquired before, within 2, and at 24 hours after IRE; at 1, 2, 4, 6, 8, and 12 weeks after IRE; and every 3 months thereafter for a follow-up of at least 12 months.

Results

The ablated target lesion remained visible within the ablation zone in 23 (62%) of 37 of cases for a mean time of 21 ± 20 weeks (median, 12 weeks). The ablation zone appeared homogeneously hyperintense on T2w turbo spin echo images on the day of IRE in 37 of 37 cases. By 24 hours after IRE, the ablation zone inverted its SI in 35 of 37 cases to intermediately hypointense, with a rim of T2w bright SI that exhibited arterial phase enhancement; this persisted for 7 ± 5 weeks (median, 4 weeks). The rim resolved in 35 (95%) of 37 cases within 3 months. The ablation zone increased slightly over the first 48 hours, then shrank progressively. Complete healing of the ablation zone was observed in 57% (21/37) after an average of 14 ± 15 (median, 8 weeks).

Average apparent diffusion coefficient values of the ablation zone decreased from 0.74 ± 0.36 × 10−3 mm2/s pre-IRE to 0.63 ± 0.27 × 10−3 mm2/s within the first 24 hours (P < 0.05), followed by a progressive normalization to 0.91 ± 0.30 × 10−3 mm2/s at 2 months.

Conclusions

Knowledge of the broad spectrum of MR imaging findings after IRE is important to avoid diagnostic errors in the follow-up of patients after IRE.
A positive risk approach when clients choose to live at risk: a palliative case discussion
Authors: De Bono Christopher E. , Henry Blair
Published: July 2016

Purpose of review

The article discusses recent approaches in the literature about clients who chose to live at risk in their homes. It argues for a positive risk-based approach and a tool to help manage risk in the home, and applies these to a hypothetical end-of-life scenario.

Recent findings

Historically, safety plans to consider risk management involved a culture of risk aversion supported by sometimes paternalistic motives intended to protect vulnerable clients. New findings in the literature engage in a process that respects the ethical principles underlying harm reduction philosophies. The literature also argues for a perspective that moves away from viewing risk as only harmful, to one that supports a positive understanding of risk as part of a client's informed choice.

A risk support management plan, based on a positive approach, can provide a way to both support a client's choice to live at risk, anticipate for expected complications, and inform the creation of a contingency plan to address concerns as they may arise. The added value of a structured approach like the one proposed here for risk support management plans is that it provides adequate due diligence and informed decision-making when planning for risk-taking in complex situations.
Service delivery of complex interventions for refractory breathlessness
Authors: Booth Sara , Ryan Richella , Spathis Anna
Published: July 2016

Purpose of review

The review considers the evidence for different service models existing for helping people manage the chronic, irreversible breathlessness that accompanies advanced disease.

Recent findings

Many of the service models that are delivering care have not yet published their results in the scientific literature because these ideas, and the methods to evaluate them, are relatively new. There are three randomized controlled trials published which demonstrate the effectiveness of this approach and one which suggests that more episodes of some intervention components are not necessarily better.

Breathlessness severity gives a better guide to a patient's prognosis than physiological measures in many diseases and the general population. Randomized controlled trial evidence confirms that a complex intervention for breathlessness can improve quality of life, reduce symptom impact, and support carers. Some preliminary data suggest prognosis improvement in some people. Integrated care is needed for both rapidly progressive disease, where death is inevitable, and chronic illness, when health improvement is possible.
Expanded Safety and Efficacy Data for a New Method of Performing Electroconvulsive Therapy
Authors: Sahlem Gregory L. , Short E. Baron , Kerns Suzanne , Snipes Jon , DeVries William , Fox James B. , Burns Carol , Schmidt Matthew , Nahas Ziad H. , George Mark S. , Sackeim Harold A.
Published: July 2016

Objective

Electroconvulsive therapy (ECT) is the most rapid and effective antidepressant treatment but with concerns about cognitive adverse effects. A new form of ECT, focal electrically administered seizure therapy (FEAST), was designed to increase the focality of stimulation and better match stimulus parameters with neurophysiology. We recently reported on the safety and feasibility of FEAST in a cohort (n = 17) of depressed patients. We now report on the safety, feasibility, preliminary efficacy, and cognitive effects of FEAST in a new cohort.

Methods

Open-label FEAST was administered to 20 depressed adults (6 men; 3 with bipolar disorder; age 49.1 ± 10.6 years). Clinical and cognitive assessments were obtained at baseline and end of course. Time to orientation recovery was assessed at each treatment. Nonresponders switched to conventional ECT.

Results

Participants tolerated the treatment well with no dropouts. Five patients (25%) transitioned from FEAST to conventional ECT due to inadequate response. After FEAST (mean, 9.3 ± 3.5 sessions; range, 4–14), there was a 58.1% ± 36.0% improvement in Hamilton Rating Scale for Depression scores compared with that in the baseline (P < 0.0001); 13 (65%) of 20 patients met response criteria, and 11 (55%) of 20 met remission criteria. Patients achieved reorientation (4 of 5 items) in 4.4 ± 3.0 minutes (median, 4.5 minutes), timed from eyes opening. There was no deterioration in neuropsychological measures.

Conclusions

These findings provide further support for the safety and efficacy of FEAST. The remission and response rates were in the range found using conventional ECT, and the time to reorientation may be quicker. However, without a randomized comparison group, conclusions are tentative.
Fostering social sustainability management through safety controls and accounting
Authors: Gunarathne Nuwan , Samudrage Dileepa , Wijesinghe Dinushi Nisansala , Lee Ki-Hoon
Published: July 2016

Purpose

This paper aims to identify the usefulness of safety controls and accounting in corporate social sustainability management in response to various stakeholders’ demands and expectations in the mining sector.

Design/methodology/approach

The case study approach is followed in this study as it provides in-depth understanding of complex social phenomena. Data collection is mainly based on semi-structured interviews, on-site assessments and documentation reviews. Visits were repeated and cross-checked to ensure the validity of data collection and analysis.

Findings

The study identifies a reciprocal relationship between stakeholder management strategies and the safety control system that encapsulates a mix of leading and lagging key safety performance indicators (KSPIs). A safety control system with the right mix of KSPIs drives corporate value-creation by instigating internal organizational changes. Yet, the stakeholders’ expectations and pressures are dependent on national, historical, cultural and social settings and institutions that will impact on the safety controls and safety accounting in a substantial way.

Originality/value

The paper demonstrates the usefulness of safety controls and accounting in corporate stakeholder management in the mining sector in Sri Lanka. The paper, by addressing how safety control systems and accounting meet various stakeholder demands and expectations, provides new insights into corporate social sustainability performance in mining companies and the role and implications of sustainability (management) accounting.