bluuebunny/crossref_metadata_2025 huggingface dataset:
Thinking Developmentally: The Next Evolution in Models of Health
Authors: Garner Andrew S.
Published: July 2016

As the basic sciences that inform conceptions of human health advance, so must the models that are used to frame additional research, to teach the next generation of providers, and to inform health policy. This article briefly reviews the evolution from a biomedical model to a biopsychosocial (BPS) model and to an ecobiodevelopmental (EBD) model. Like the BPS model, the EBD model reaffirms the biological significance of psychosocial features within the patient's ecology, but it does so at the molecular and cellular levels. More importantly, the EBD model adds the dimension of time, forcing providers to “think developmentally” and to acknowledge the considerable biological and psychological consequences of previous experiences. For the health care system to move from a reactive “sick care” system to a proactive “well care” system, all providers must begin thinking developmentally by acknowledging the dynamic but cumulative dance between nature and nurture that drives development, behavior, and health, not only in childhood, but across the lifespan.
Management of Chondrodermatitis Nodularis Helicis: A Systematic Review and Treatment Algorithm
Authors: Kechichian Elio , Jabbour Samer , Haber Roger , Abdelmassih Youssef , Tomb Roland
Published: July 2016

BACKGROUND

Chondrodermatitis nodularis helicis (CNH) is an idiopathic benign inflammatory painful condition of the ear. Still, to date, no study has yet evaluated nor compared treatments regarding their safety and efficacy.

OBJECTIVE

The objective of this study is to review all available treatment modalities of CNH that were described in the literature, compare their efficacy and propose a treatment algorithm.

METHODS AND MATERIALS

A systematic review of the literature was conducted using Embase, Medline, and Cochrane databases. Articles studying the management of CNH that reported data on the cure rates were included in this review.

RESULTS

A total of 29 studies were included in the review. The 3 most commonly reported treatments for CNH are surgery, pressure relief, and topical nitroglycerin. Surgery has higher cure rate (82%) compared with pressure relief treatment (37%) or nitroglycerin (51%) (p< .0001). Surgery should be considered as the first-line treatment for CNH. Second-line treatments include nonsurgical therapies, particularly nitroglycerin and pressure relief techniques, alone or in combination. Third-line treatments include newer or less studied methods.

CONCLUSION

Among the treatment modalities, surgery showed the highest cure rates. Adequately designed randomized controlled trials are warranted to compare newer therapeutic methods.
Clinical Evaluation of Hyaluronic Acid Sponge with Zinc versus Placebo for Scar Reduction after Breast Surgery
Authors: Mahedia Monali , Shah Nilay , Amirlak Bardia
Published: July 2016

Background:

Scar formation is a major source of dissatisfaction among patients and surgeons. Individually, hyaluronan, or hyaluronic acid (HA), and zinc have been shown to reduce scarring. The authors evaluated the safety and efficacy of an HA sponge with zinc compared with placebo when applied to bilateral breast surgery scars; specifically, they evaluated whether the use of this product modulates inflammation and immediate scarring in treated patients after bilateral breast surgery.

Methods:

This double-blind, randomized, prospective study was approved by the local institutional review board. Bilateral breast surgery patients with right and left incision lines were randomly assigned to receive HA sponge with zinc or placebo within 2 to 4 days after their procedure. Participants were followed up at 6 weeks, 12 weeks, and 1 year and evaluated at 12 weeks. Three blinded evaluators reviewed photographs of the incision lines and assessed the scars using a visual analog scale, new scale, and a patient satisfaction survey.

Results:

Nineteen bilateral breast surgery patients were enrolled in the study. Statistical analysis was performed on 14 patients who completed the follow-up. The mean visual analog scale score was lower for the side receiving the HA sponge with zinc (2.6) than for the side receiving placebo (3.0), indicating a better outcome (t test; P = 0.08). The HA sponge with zinc was found to have significant positive findings on a patient satisfaction survey (P = 0.01).

Conclusions:

This is a preliminary study that shows zinc hyaluronan was associated with high patient satisfaction in achieving a better scar after bilateral breast surgery, irrespective of skin color. It seems to be safe and effective for early scars.
IMPACT OF RETINOPATHY SCREENINGS FOR PROSPECTIVE HEART TRANSPLANT CANDIDATES
Authors: Simon Shira S. , Wilcox Jane E. , Lyon Alice T. , Jampol Lee M.
Published: July 2016

Purpose:

To determine the prevalence of retinopathy among patients undergoing heart transplantation screening and to determine the impact of this finding on eligibility for transplantation.

Methods and Patients:

A retrospective case series was collected to perform an institutional review of all inpatient consults for dilated eye examinations on potential heart transplant candidates over 5.5 years—from March 27, 2008 to October 10, 2014. Measured outcomes included the presence or absence of retinopathy and the effect of retinopathy, if present, on a patient's eligibility for cardiac transplantation.

Results:

A total of 155 heart transplant candidates underwent bedside ophthalmologic examination as part of their heart transplant candidacy workup. Retinopathy was found in 16 (10%) of these patients: diabetic retinopathy in 13 (8.4%) and hypertensive retinopathy in 3 (1.9%). None of these patients were excluded from the transplant candidacy based on the presence of retinopathy.

Conclusion:

On bedside ophthalmologic examination, retinopathy is an uncommon finding among cardiac transplant candidates. Retinopathy did not preclude transplantation in these patients. We question the utility of the present system of bedside ophthalmic consultation of heart transplant candidates. This may not be an optimal allocation of provider resources. Further studies are warranted to determine an appropriate protocol for ocular evaluation of these patients.
Evaluation and Management of Chemotherapy-Induced Epiphora, Punctal and Canalicular Stenosis, and Nasolacrimal Duct Obstruction
Authors: Mansur Constanza , Pfeiffer Margaret L. , Esmaeli Bita
Published: July 2016

Purpose:

To describe the frequency, mechanisms, and treatment of epiphora caused by chemotherapeutic agents.

Methods:

Review of relevant articles published in PubMed.

Results:

The chemotherapeutic drugs best documented to cause epiphora are 5-fluorouracil and docetaxel; with both of these drugs, the main mechanism underlying epiphora is canalicular stenosis. Drugs less commonly reported to cause epiphora include S-1, capecitabine, imatinib, topical mitomycin C, and radioactive iodine for treatment of papillary thyroid carcinoma. While all the above-mentioned drugs can be associated with epiphora, some drugs and administration schedules cause only punctal and canalicular inflammation, whereas others cause significant canalicular stenosis. For example, weekly administration of docetaxel is far more likely to cause canalicular stenosis than every-3-weeks administration. The literature suggests that, in patients who receive weekly docetaxel, silicone stenting at the first sign of recurrent or progressive canalicular stenosis can prevent severe irreversible canalicular stenosis and avoid the need for a conjunctivodacryocystorhinostomy. S-1 and radioactive iodine have been reported to cause nasolacrimal duct obstruction. Early recognition of punctal and canalicular stenosis or nasolacrimal duct blockage and early intervention with topical steroids and canalicular stenting in patients at risk for permanent canalicular scarring are important to avoid the need for more invasive and complicated procedures.

Conclusion:

A variety of chemotherapeutic agents have been reported to cause epiphora, and some of these drugs have also been documented to cause obstructions of the lacrimal drainage system. Early recognition and management of epiphora is important and leads to better outcomes.
Depression Symptoms Facilitated Fibrinolytic Dysregulation and Future Coronary Artery Disease Risk in a Black Male Cohort
Authors: Malan Leoné , Mashele Nyiko , Malan Nicolaas T. , Harvey Brian H. , Potgieter Johan C. , Van Rooyen Johannes M.
Published: July 2016

Background:

Hypercoagulation is associated with coronary artery disease (CAD). Whether depression symptoms dysregulate inflammatory and hemostatic markers in an African cohort is not known; therefore, we assessed the relationship between depressive symptoms and inflammatory and hemostatic markers as potential CAD risk markers in an African sex cohort.

Material and Methods:

We included 181 black African urban-dwelling teachers (88 men, 93 women; aged 25–60 years) from the Sympathetic Activity and Ambulatory Blood Pressure in Africans Study. The Patient Health Questionnaire was used to assess depressive symptoms. Fasting plasma concentrations of C-reactive protein, fibrinogen, D-dimer, plasminogen activator inhibitor-1 (PAI-1) and 24-hour blood pressure measures were obtained.

Results:

Moderately severe depression symptom status was similar in the black sex groups. Both sex groups showed a mean hypertensive state and low-grade inflammation (C-reactive protein > 3 mg/L). Levels of PAI-1 were higher in depressed men, whereas D-dimer levels were lower in depressed women when considering concomitant confounders. In black men only, depressive symptoms were associated with levels of PAI-1 (adj.R2= 0.12;β= .22 [95% confidence interval, .0–.44];P= .04) and D-dimer (adj.R2= 0.12;β= .28 [95% confidence interval, .08–.48];P= .01), independent of confounders.

Conclusion:

In black men, depression symptoms accompanied by a mean hypertensive status may up-regulate inflammatory and thrombotic processes. Depression symptoms in black men facilitated hypercoagulation or fibrinolytic dysregulation and potentially increased their CAD risk. Early screening of fibrinolytic markers and for the presence of depressive symptoms is recommended.
Infantile Colic Is Associated With Low‐grade Systemic Inflammation
Authors: Pärtty Anna , Kalliomäki Marko , Salminen Seppo , Isolauri Erika
Published: July 2016

Objectives:

Dysbiosis, an imbalance in the taxonomic composition of the gut bacteria occurring during the critical stages of development, induces lasting shifts in the immunological and metabolic phenotype if accompanied by an inflammatory response. Because altered gut microbiota and successful treatment with probiotics have both been demonstrated in cases of colic, we hypothesized here that infants with colic might have low‐grade inflammation.

Methods:

In 28 infants with colic and in 12 healthy controls at the age of 1 month, we measured the following serum immunological biomarkers: cytokines interleukin 1β (IL‐1β); IL‐6; IL‐10; tumor necrosis factor α; interferon γ (IFN‐γ); chemokines IL‐8; monocyte chemotactic protein‐1 (MCP‐1); macrophage inflammatory protein 1β (MIP‐1β) and chemokine (C‐X‐C motif) ligand 16; and intestinal fatty acid–binding protein, a biomarker of enterocyte damage and zonulin, a biomarker of intestinal permeability. In addition, intestinal microbiota composition was correlated with immunological biomarkers.

Results:

Infants with colic had increased concentrations of IL‐8, MCP‐1, and MIP‐1β in serum as compared with healthy children. All the other immunological biomarkers were comparable between the groups. Fecal levels of Clostridium leptum correlated negatively with the proinflammatory markers MCP‐1 (r = –0.44, P = 0.02), MIP‐1β (r = –0.43, P = 0.02), and tumor necrosis factor α (r = –0.38, P = 0.04). In addition, C coccoides group levels correlated negatively with MCP‐1 (r = –0.43, P = 0.02) and Bifidobacterium breve levels positively with chemokine (C‐X‐C motif) ligand 16 (r = 0.38, P = 0.04).

Conclusions:

In addition to gut microbiota alterations, colic in infants is associated with low‐grade systemic inflammation. Specific bacterial species beyond conventional probiotics may have anti‐inflammatory properties that may help to modulate microbiota and alleviate colic‐related inflammation.
Antimicrobial Resistance and Neisseria gonorrhoeae Multiantigen Sequence Typing Profile of Neisseria gonorrhoeae in New Delhi, India
Authors: Mahajan Neeraj , Sood Seema , Singh Rajendra , Kapil Arti , Das Bimal Kumar , Sreenivas Vishnubhatla , Kar Hemanta Kumar , Sharma Vinod Kumar
Published: July 2016

Molecular epidemiology of 100 consecutive gonococcal isolates collected between April 2010 and October 2013 from New Delhi was investigated using Neisseria gonorrhoeae multiantigen sequence typing (NG-MAST) along with its association with antimicrobial resistance profiles. Neisseria gonorrhoeae isolates were assigned into 60 different sequence types and 43 (71.6%) were novel. Sole representation was seen in 76.6% sequence types. There was significant association between ST6058 and resistance to penicillin (P = 0.00) and tetracycline (P = 0.002).
Does Living Outside of a Major City Impact on the Timeliness of Chlamydia Treatment? A Multicenter Cross-Sectional Analysis
Authors: Foster Rosalind , Ali Hammad , Crowley Margaret , Dyer Roisin , Grant Kim , Lenton Joanne , Little Christine , Knight Vickie , Read Phillip , Donovan Basil , McNulty Anna , Guy Rebecca
Published: July 2016

Background

Timely treatment of Chlamydia trachomatis infection reduces complications and onward transmission. We assessed client, process, and clinic factors associated with treatment delays at sexual health clinics in New South Wales, Australia.

Methods

A retrospective review of 450 consecutive clients with positive chlamydia results (not treated at the time of the consultation) was undertaken at 6 clinics (1 urban, 3 regional, and 2 remote) from October 2013. Mean and median times to treatment were calculated, overall and stratified by process steps and clinic location.

Results

Nearly all clients (446, 99%) were treated, with 398 (88%) treated in ≤14 days and 277 (62%) in ≤7 days. The mean time-to-treatment was 22 days at remote clinics, 13 days at regional and 8 days at the urban clinic (P < 0.001). Mean time between the laboratory receipt of specimen and reporting of result was 4.9 in the remote clinics, 4.1 in the regional, and 2.7 days in the urban clinic (P < 0.001); and the mean time between the clinician receiving the result until client treatment was15, 5, and 3 days (P < 0.01), respectively.

Conclusions

At participating clinics, treatment uptake was high, however treatment delays were greater with increasing remoteness. Strategies to reduce the time-to-treatment should be explored such as point-of-care testing, faster specimen processing, dedicated clinical time to follow up recalls, SMS results to clients, and taking treatment out to clients.
Consideration of Cost of Care in Pediatric Emergency Transfer—An Opportunity for Improvement
Authors: Gattu Rajender K. , De Fee Ann-Sophie , Lichenstein Richard , Teshome Getachew
Published: July 2016

Background

Pediatric interhospital transfers are an economic burden to the health care, especially when deemed unnecessary. Physicians may be unaware of the cost implications of pediatric emergency transfers. A cost analysis may be relevant to reduce cost.

Objective

To characterize children transferred from outlying emergency departments (EDs) to pediatric ED (PED) with a specific focus on transfers who were discharged home in 12 hours or less after transfer without intervention in PED and analyze charges associated with them.

Methods

Charts of 352 patients (age, 0–18 years) transferred from 31 outlying EDs to PED during July 2009 to June 2010 were reviewed. Data were collected on the range, unit charge and volume of services provided in PED, length of stay, and final disposition. The average charge per patient transfer is calculated based on unit charge times total service units per 1000 patients per year and divided by 1000. Hospital charges were divided into fixed and variable.

Results

Of 352 patients transferred, 108 (30.7%) were admitted to pediatric inpatient service, 42 (11.9%) to intensive care; 36 (10.2%) went to the operating room, and 166 (47.2%) were discharged home. The average hospital charge per transfer was US $4843. Most (89%) of the charges were fixed, and 11% were variable. One hundred one (28.7%) patients were discharged home from PED in 12 hours or less without intervention. The hospital charges for these transfers were US $489,143.

Conclusions

Significant number of transfers was discharged 12 hours or less without any additional intervention in PED. Fixed charges contribute to majority of total charges. Cost saving can be achieved by preventing unnecessary transfer.
Feasibility and Effectiveness of a Peer Referral Incentive Intervention to Promote Male Circumcision Uptake in Zambia
Authors: Zanolini Arianna , Bolton Carolyn , Lyabola Lane-Lee , Phiri Gabriel , Samona Alick , Kaonga Albert , Thirumurthy Harsha
Published: July 2016

Background:

Medical male circumcision is a promising HIV prevention tool in countries with generalized HIV epidemics, but demand creation interventions are needed to support scale-up. We piloted a peer referral intervention in which circumcision clients were offered incentives for referring their peers for circumcision.

Methods:

The intervention was implemented between June 2014 and February 2015 in 6 randomly selected health facilities in Southern Province, Zambia. For the first 5 months, circumcision clients ≥18 years of age were given referral vouchers that allowed them to refer up to 5 peers for circumcision within a 3-month period. An incentive of US$2 was offered for each referral. The primary outcome was the number of circumcisions performed per month in each facility. To assess the effect of the intervention, a difference-in-difference analysis was performed using longitudinal data from the intervention facilities and 22 nonintervention facilities. A questionnaire was also implemented to understand men's perceptions of the intervention.

Results:

During the 8-month intervention period, 1222 men over 18 years of age were circumcised in intervention facilities. In the first 5 months, 699 circumcision clients were enrolled and 385 clients brought a referral voucher given to them by an enrolled client. Difference-in-difference analyses did not show a significant increase in circumcisions performed in intervention facilities. However, circumcision clients reported that the referral incentive motivated them to encourage their friends to seek male circumcision. Peer referrals were also reported to be an important factor in men's decisions because 78% of clients who were referred reported that talking with a circumcised friend was important for their decision to get circumcised.

Conclusions:

The peer referral incentive intervention for male circumcision was feasible and acceptable. However, the intervention did not have a significant effect on demand for male circumcision. Barriers to circumcision and features of the intervention may have limited the effect of the intervention. Further efforts regarding encouraging male-to-male communication and evaluations with larger sample sizes are needed.
Inferring HIV-1 Transmission Dynamics in Germany From Recently Transmitted Viruses
Authors: Pouran Yousef Kaveh , Meixenberger Karolin , Smith Maureen R. , Somogyi Sybille , Gromöller Silvana , Schmidt Daniel , Gunsenheimer-Bartmeyer Barbara , Hamouda Osamah , Kücherer Claudia , von Kleist Max
Published: July 2016

Background:

Although HIV continues to spread globally, novel intervention strategies such as treatment as prevention (TasP) may bring the epidemic to a halt. However, their effective implementation requires a profound understanding of the underlying transmission dynamics.

Methods:

We analyzed parameters of the German HIV epidemic based on phylogenetic clustering of viral sequences from recently infected seroconverters with known infection dates. Viral baseline and follow-up pol sequences (n = 1943) from 1159 drug-naïve individuals were selected from a nationwide long-term observational study initiated in 1997. Putative transmission clusters were computed based on a maximum likelihood phylogeny. Using individual follow-up sequences, we optimized our clustering threshold to maximize the likelihood of co-clustering individuals connected by direct transmission.

Results:

The sizes of putative transmission clusters scaled inversely with their abundance and their distribution exhibited a heavy tail. Clusters based on the optimal clustering threshold were significantly more likely to contain members of the same or bordering German federal states. Interinfection times between co-clustered individuals were significantly shorter (26 weeks; interquartile range: 13–83) than in a null model.

Conclusions:

Viral intraindividual evolution may be used to select criteria that maximize co-clustering of transmission pairs in the absence of strong adaptive selection pressure. Interinfection times of co-clustered individuals may then be an indicator of the typical time to onward transmission. Our analysis suggests that onward transmission may have occurred early after infection, when individuals are typically unaware of their serological status. The latter argues that TasP should be combined with HIV testing campaigns to reduce the possibility of transmission before TasP initiation.
Improving CT-Based PET Attenuation Correction in the Vicinity of Metal Implants by an Iterative Metal Artifact Reduction Algorithm of CT Data and Its Comparison to Dual-Energy–Based Strategies
Authors: Schabel Christoph , Gatidis Sergios , Bongers Malte , Hüttig Fabian , Bier Georg , Kupferschlaeger Juergen , Bamberg Fabian , la Fougère Christian , Nikolaou Konstantin , Pfannenberg Christina
Published: July 2016

Objective

The aim of this study was to evaluate the potential of iterative metal artifact reduction (IMAR) for the improvement of computed tomography (CT)–based position emission tomography (PET) attenuation correction in the vicinity of metal implants and compare it with dual-energy–based metal artifact reduction strategies.

Methods

A dedicated dental phantom was constructed consisting of a cylindrical tube filled with [18-F]FDG solution (5300 mL and 50.9 MBq) containing 2 artificial jaws with 1 nonprecious alloy fixed dental prosthesis and 3 single tooth crowns in the lower jaw.

Computed tomography measurements of the phantom were acquired on a stand-alone dual-energy CT scanner equipped with IMAR capabilities. A series of 24 CT data sets were obtained using different scan parameters and monoenergetic extrapolation of dual-energy CT acquisitions with and without IMAR reconstruction.

Position emission tomography measurements of the phantom were performed on a state-of-art PET/CT scanner. Position emission tomography data were reconstructed using all 24 previously acquired CT data sets.

Relative errors in the quantification of activity concentrations using the different CT scanning and reconstruction parameters were quantified by placement of regions of interest within the phantom.

Results

Metal artifacts of different extent were observed in all CT data sets. A marked reduction in CT metal artifacts was observed using IMAR. In general, activity concentrations were overestimated/underestimated in areas of high/low-density metal artifacts, respectively.

Relative errors in PET quantification ranged between −71% and +70% without IMAR. Using IMAR, these errors were reduced to a range between −40% and +12%. Averaged absolute values of relative PET quantification errors were 27% and 7% without and with the use of IMAR (P < 0.001), respectively. Iterative metal artifact reduction was superior compared with dual-energy–based metal artifact reduction strategies, and the combination of both strategies did not result in further significant improvement of PET quantification.

Conclusions

The use of IMAR in PET/CT is a promising approach for markedly improving image quality and PET quantification in the vicinity of metal implants. Further clinical studies are necessary to assess the clinical performance of this algorithm in patients.
Risk Stratification For Axillary Lymph Node Metastases in Breast Cancer Patients
Authors: Yun Seong Jong , Sohn Yu-Mee , Seo Mirinae
Published: July 2016

This study was to investigate clinicopathological features including immunohistochemical subtype and radiological factors of primary breast cancer to predict axillary lymph node metastasis (ALNM) and preoperative risk stratification.

From June 2004 to May 2014, 369 breast cancer patients (mean age, 54.7 years; range, 29–82 years) who underwent surgical axillary node sampling were included. Two radiologists retrospectively reviewed clinicopathological features, initial mammography, and initial breast ultrasonography (US). Univariate and multivariate logistic regression analyses were used to evaluate associations between ALNM and variables. Odds ratio with 95% confidence interval and risk of ALNM were calculated.

Among 369 patients, 117 (31.7%) had ALNM and 252 (68.3%) had no ALNM revealed surgically. On multivariate analysis, four factors showed positive association with ALNM: the presence of symptoms (P < 0.001), triple-negative breast cancer subtype (P = 0.001), mass size on US (>10 mm, P < 0.001), and Breast Imaging Reporting and Data System category on US (≥4c, P < 0.001). The significant risk of ALNM was particularly seen in patients with two or more factors (2, P = 0.013; 3, P < 0.001; 4, P < 0.001).The estimated risks of ALNM increased in patients with two, three, and four factors with odds ratios of 5.5, 14.3, and 60.0, respectively.

The presence of symptoms, triple-negative breast cancer subtype, larger size mass on US (>10 mm), and higher Breast Imaging Reporting and Data System category on US (≥4c) were positively associated with ALNM. Radiologically, US findings are significant factors that can affect the decision making process regarding ALNM. Based on risk stratification, the possibility of ALNM can be better predicted if 2 or more associated factors existed preoperatively.
Post-Bariatric Body Contouring Surgery After Weight Loss
Authors: Wong Michael S.
Published: July 2016

With the rise in obesity in the United States, there has been a similar increase in bariatric surgery. This has resulted in numerous patients losing significant weight with accompanying circumferential body contouring issues. This has led to an amazing increase in the number of body contouring procedures performed, both traditional excisional techniques as well as new emerging techniques emphasizing tissue preservation, rearrangement, and dermal reshaping. Although China's rates of obesity lag behind the United States, there is a recipe for obesity that will eventually surpass the United States. Thus, China has the opportunity to learn from the United States experience with regards to obesity treatment and contouring procedures after significant weight loss. Time will tell whether China will choose to use similar tissue preservation techniques to address issues of soft tissue ptosis and volume deficiency seen after significant weight loss, make refinements of these techniques, or develop new uniquely Chinese solutions.
Workforce Analysis of Female Pelvic Medicine and Reconstructive Surgery, 2015 to 2045
Authors: Brueseke Taylor , Muffly Tyler , Rayburn William , Connolly AnnaMarie , Nieto Maria , De La Cruz Jacquia , Wu Jennifer
Published: July 2016

Objectives

The aim of this study was to assess how the projected increase in prevalence of pelvic floor disorders (PFDs) will impact the number of patients per female pelvic medicine and reconstructive surgery (FPMRS) subspecialist between 2015 and 2045.

Methods

We performed a workforce analysis of FPMRS subspecialists in the United States by developing a model to predict the number of FPMRS subspecialists in 5-year increments from 2015 to 2045. Our model allowed for selection of the number of current FPMRS subspecialists, the number and sex of new FPMRS subspecialists added per year, and retirement age of FPMRS subspecialists. The number of women with PFDs from 2015 to 2045 was then predicted by applying published, age-specific prevalence rates to the 2012 US Census Projections for women aged 20 years or older. For our primary outcome, we divided the projected number of patients by the projected number of FPMRS subspecialists every 5 years from 2015 to 2045.

Results

The model predicts the number of FPMRS subspecialists will increase from 1133 to 1514 with a sex shift from 46% female to 81% female between 2015 and 2045. The number of women with ≥1 PFD is predicted to increase from 31.4 million in 2015 to 41.9 million in 2045. For our primary outcome, the number of patients per FPMRS subspecialist is projected to range from 27,870 in 2015 to 27,650 in 2045.

Conclusions

The current ratio of patients per FPMRS subspecialist appears high and is predicted to remain near current levels over the next 30 years. These projections support the need for continued training of physicians skilled in treating PFDs.
Therapeutic Index Estimation of Antiepileptic Drugs: A Systematic Literature Review Approach
Authors: Greenberg Rachel G. , Melloni Chiara , Wu Huali , Gonzalez Daniel , Ku Lawrence , Hill Kevin D. , Hornik Christoph P. , Cohen-Wolkowiez Michael , Guptill Jeffrey T.
Published: July 2016

Objectives

Our study aimed to determine whether data obtained from the medical literature can be used to estimate the therapeutic index of 5 antiepileptic drugs (AEDs): carbamazepine, lamotrigine, phenobarbital, phenytoin, and valproate.

Methods

We performed a literature search using PubMed and EMBASE to collect published safety, efficacy, and therapeutic monitoring data for 5 AEDs and extracted all relevant information into a drug- and study-specific drug database. For each AED, we summarized (1) type, severity, and incidence of toxicity-related adverse events and toxicity-associated range of drug doses or concentrations; (2) effective versus toxic concentration and dose (therapeutic range); and (3) therapeutic drug monitoring practices. We defined therapeutic index as the ratio of the minimum toxic concentration to the minimum effective concentration.

Results

We reviewed a total of 810 full-text articles and extracted data from 163. The literature suggests that the therapeutic index of phenytoin is 2. The therapeutic indices of phenobarbital and valproate exceed 2. There were insufficient data to precisely quantify the therapeutic indices of carbamazepine and lamotrigine.

Conclusions

For some drugs, this approach offers a low-cost method of therapeutic index estimation. Our results can serve as preliminary data for future trials and as guidance for US Food and Drug Administration decision making regarding narrow therapeutic index classification.
Ancient coexistence of norepinephrine, tyramine, and octopamine signaling in bilaterians
Authors: Bauknecht Philipp , Jékely Gáspár
Published: July 2016

Norepinephrine/noradrenaline is a neurotransmitter implicated in arousal and other aspects of vertebrate behavior and physiology. In invertebrates, adrenergic signaling is considered absent and analogous functions are performed by the biogenic amines octopamine and its precursor tyramine. These chemically similar transmitters signal by related families of GPCR in vertebrates and invertebrates, suggesting that octopamine/tyramine are the invertebrate equivalents of vertebrate norepinephrine. However, the evolutionary relationships and origin of these transmitter systems remain unclear. Using phylogenetic analysis and receptor pharmacology, here we establish that norepinephrine, octopamine, and tyramine receptors coexist in some marine invertebrates. In the protostomesPlatynereis dumerilii(an annelid) andPriapulus caudatus(a priapulid) we identified and pharmacologically characterized adrenergic α1 and α2 receptors that coexist with octopamine α, octopamine β, tyramine type 1, and tyramine 2 receptors. These receptors represent the first examples of adrenergic receptors in protostomes. In the deuterostomeSaccoglossus kowalewskii(a hemichordate), we identified and characterized octopamine α, octopamine β, tyramine type 1, and tyramine 2 receptors, representing the first example of these receptors in deuterostomes.S. kowalewskiialso has adrenergic α1 and α2 receptors, indicating that all three signaling systems coexist in this animal. In phylogenetic analysis, we also identified adrenergic and tyramine receptor orthologs in xenacoelomorphs. Our results clarify the history of monoamine signaling in bilaterians. Since all six receptor families (two each for octopamine and tyramine and three for norepinephrine) can be found in representatives of the two major clades of Bilateria, the protostomes and the deuterostomes, all six receptors coexisted in the protostome-deuterostome last common ancestor. Adrenergic receptors were lost from most insects and nematodes and tyramine and octopamine receptors were lost from most deuterostomes. This complex scenario of differential losses cautions that octopamine signaling in protostomes is not a good model for adrenergic signaling in deuterostomes, and that the studies of marine animals where all three transmitter systems coexist will be needed for a better understanding of the origin and ancestral functions of these transmitters.
The EFQM Model as a framework for total quality management in healthcare
Authors: van Schoten Steffie , de Blok Carolien , Spreeuwenberg Peter , Groenewegen Peter , Wagner Cordula
Published: July 2016

Purpose

– To guide organizations toward total quality management (TQM), various models have been developed such as the European Foundation for Quality Management Excellence Model (EFQM Model). The purpose of this paper is to conduct a longitudinal investigation of whether the EFQM Model can serve as a framework for TQM in healthcare.

Design/methodology/approach

– Data on a national representative survey about quality management (QM) in the hospital population in the Netherlands were used to conduct this study. The survey had five measurement points between 1995 and 2011.

Findings

– The results of the study show that applying the EFQM Model in hospitals is related to improvement in organizational performance over time, a feedback loop in which hospitals use their results to further improve their organizational processes is established, and improvement is stronger when all the model’s elements are considered simultaneously.

Practical implications

– The results of the study can be applied by quality managers of healthcare institutions to achieve higher quality of care.

Originality/value

– Previous research on the relationship between the EFQM excellence model and TQM neglects two essential characteristics of the TQM philosophy, namely, the holistic perspective on QM and the presumed feedback loop of organizational performance that feeds a cycle of continuous quality improvement. The study provides new insights into the long-term benefits of applying the EFQM Model as a framework for TQM in healthcare.
Operational antecedents of integrated patient planning in hospitals
Authors: Drupsteen Justin , van der Vaart Taco , Van Donk Dirk Pieter
Published: July 2016

Purpose

– Hospitals struggle to integrate the planning from different departments; resulting in unacceptable waiting times for patients. The literature mainly addresses general, organizational factors inhibiting or enabling integration and omits important factors stemming from the care delivery process. Therefore, the purpose of this paper is to uncover operational antecedents and to assess their effect on the integration of hospital planning.

Design/methodology/approach

– The study is based on a three-hospital multi-case study. The main findings stem from over 40 in-depth interviews with specialists, nurses, planners, and managers of four specialties that are all involved in the orthopedic internal supply chain.

Findings

– This study identifies five critical operational antecedents: performance management, shared resources, information technology, process visibility, and uncertainty/variability. The latter two are of specific importance in a healthcare context. Three distinctive roles are identified; initiating (performance management and process visibility), facilitating (information technology), and inhibiting (shared resources and uncertainty/variability).

Practical implications

– The authors address how integration can be achieved, rather than merely prescribing integration as a means to improve performance. The identification of specific operational antecedents and their role help managers to find tangible ways to effectively integrate hospital planning which increases hospital performance.

Originality/value

– First, the identified operational antecedents are essential supplementary factors to more common organizational and behavioral antecedents. Second, in contrast to earlier contributions the authors show the effects of antecedents on three different stages of integration, rather than on integration in general.
Recycling as a result of “cultural greening”?
Authors: Flagg Julia A. , Bates Diane C.
Published: July 2016

Purpose

This study aims to test whether faculty and students who have developed the most pro-environmental values and concerns are also the most likely to reduce the on-campus waste stream. It does so by using the theory of ecological modernization.

Design/methodology/approach

Questionnaires were created and disseminated to a representative sample of 590 undergraduate students and faculty on one college campus. This research took place after widespread efforts were made to increase faculty and student knowledge of the college’s recycling guidelines.

Findings

Among the measures of environmental orientation (values, concern about pollution and green consumption), only environmental values were associated with claiming to know guidelines and self-reporting higher levels of recycling effort. None was associated with knowledge about local recycling guidelines.

Research limitations/implications

Research on recycling programs at other campuses would help move beyond this specific case. The use of longitudinal surveys would help establish time-order.

Originality/value

This research makes an important contribution by measuring the impact well-intentioned people have on the waste stream. Without thorough knowledge of local recycling guidelines, even the most environmentally oriented people with the best of intentions may contribute to the waste stream by throwing away things that can be recycled and contaminating recycling bins with non-recyclable materials. The authors conclude that activist interventions are necessary to teach about campus recycling guidelines to reduce the waste produced on campus.
Beneficial Effect of Endovascular Therapy and Low‐Density Lipoprotein Apheresis Combined Treatment in Hemodialysis Patients With Critical Limb Ischemia due to Below‐Knee Arterial Lesions
Authors: Ohtake Takayasu , Mochida Yasuhiro , Matsumi Junya , Tobita Kazuki , Ishioka Kunihiro , Oka Machiko , Maesato Kyoko , Moriya Hidekazu , Hidaka Sumi , Saito Shigeru , Kobayashi Shuzo
Published: July 2016

To assess the clinical benefit of combined treatment of below‐knee endovascular therapy (BK‐EVT) plus low‐density lipoprotein apheresis (LDLA) compared with BK‐EVT monotherapy, we retrospectively evaluated the clinical outcome of hemodialysis (HD) patients with critical limb ischemia (CLI) due to isolated BK arterial lesions who underwent BK‐EVT or BK‐EVT plus short‐term LDLA. Between October 2011 and September 2014, 62 HD patients underwent isolated BK‐EVT monotherapy (BK‐EVT group), and 25 HD patients underwent BK‐EVT plus LDLA (BK‐EVT + LDLA group). LDLA was started within 1 week after BK‐EVT and performed four times in total within next 2 weeks. Major adverse limb events (MALE) including major amputation and re‐intervention, and all‐cause mortality were examined by Kaplan–Meier method and the log‐rank test. Baseline characteristics were not different other than low ABI and low dorsal SPP in BK‐EVT + LDLA group. Cumulative MALE‐free rate was significantly improved in BK‐EVT + LDLA group over the BK‐EVT group (72.0% and 45.1% respectively at 30 months after treatment, P = 0.04). All‐cause mortality did not differ between the two groups. Major causes of death were heart failure and sepsis in both groups. Short‐term LDLA hybrid treatment immediately after BK‐EVT might improve the outcome of ischemic limbs after re‐vascularization therapy.
Cold hardiness in the pre‐imaginal stages of the great web‐spinning pine‐sawfly Acantholyda posticalis
Authors: Voolma Kaljo , Hiiesaar Külli , Williams Ingrid H. , Ploomi Angela , Jõgar Katrin
Published: July 2016

The great web‐spinning pine‐sawfly Acantholyda posticalis Mats. (Hymenoptera: Pamphiliidae) is one of the major defoliating insects of pine forests. Mass outbreaks of this species have occurred in Scots pine (Pinus sylvestris L.) stands in Central Europe and in the southern parts of Eastern Europe and Siberia. Recently, the outbreak range has shifted northward and new outbreaks have been recorded in Estonia and Finland.

The dynamics of the supercooling capability of pre‐imaginal stages of A. posticalis (eonymphs, pronymphs, pupae) collected from the soil in a pine forest on the Island of Saaremaa, Estonia, were determined.

The supercooling points (SCP) of overwintering eonymphs and pronymphs changed during the winter, although there were no significant differences between the mean SCPs of either larval stage on any measuring date. The mean SCPs decreased from October (−8 to −10 °C) to January and March (−15 to −17 °C) and increased once again in May (−9 to −11 °C). The average SCP of pupae was considerably higher (−5.3 °C).

Overwintering larvae in the soil are potentially covered by an insulating layer of forest litter, moss and snow, thus avoiding direct exposure to low temperatures. Cold‐hardiness in both overwintering larval stages of A. posticalis is sufficient for successful survival during winter in the northern Baltic region.

At present, outbreaks of A. posticalis in higher latitudes are concentrated in milder maritime regions near the coast of the Baltic Sea, although these may expand in the future as a result of climate warming, with the sawfly possibly becoming a serious pest of pine forests of northern Europe.
Pricing a rural development program: uncertainty, indifference, and protest behaviors
Authors: Domínguez‐Torreiro Marcos , Soliño Mario
Published: July 2016

This article presents an econometric approach to modeling uncertainty, unwillingness to pay, and protest behavior in contingent valuation studies. For that purpose, a mixture model with sample selection is developed for a multiple‐bounded uncertainty elicitation format. The proposed theoretical framework is applied to evaluate the social welfare impact of implementing a sustainable rural development program. Results show that a “naive” analytical approach that excludes protesters from the analysis would result in significantly higher willingness to pay estimates for those individuals who favor the implementation of the program and agree to reveal their true reservation prices.
Chronology and stratigraphy of the Magdalen Islands archipelago from the last glaciation to the early Holocene: new insights into the glacial and sea‐level history of eastern Canada
Authors: Rémillard Audrey M. , St‐Onge Guillaume , Bernatchez Pascal , Hétu Bernard , Buylaert Jan‐Pieter , Murray Andrew S. , Vigneault Benoit
Published: July 2016

The Magdalen Islands (Québec, Canada) are a key location for unravelling the glacial and sea‐level history of the Maritime Provinces of eastern Canada. Although many sedimentary sequences have been described in the literature, absolute ages are lacking, impeding an accurate interpretation of the deposits and the establishment of a precise chronological framework. This study provides a detailed description of 21 stratigraphical sequences located throughout the archipelago, as well as the first comprehensive luminescence chronology from the Last Glacial Maximum (LGM) to c. 10 ka. In addition to the five samples collected for age control purposes, 34 luminescence samples were taken from 17 different sites in glacial, periglacial and coastal deposits. The stratigraphical and chronological data reveal that the islands were at the crossroads of two icecaps during the LGM; the southern islands were glaciated by the Escuminac icecap located in the western Gulf of St. Lawrence whereas the northern archipelago was glaciated at the end of the LGM by an ice flow from Newfoundland. The glacial deposit covering the northern Magdalen Islands was associated with the Newfoundland icecap; here it is named the Grande‐Entrée till and is dated to c. 20 ka. OSL ages between c. 23 and 17 ka acquired from cryopediment and coastal deposits on the southern islands indicate that this part of the archipelago was deglaciated shortly after the LGM and was affected by a high sea level and periglacial processes. Around 15 ka, the entire archipelago was deglaciated and partially submerged until c. 10 ka. This data set is the first major contribution to a detailed chronology of the Magdalen Islands and constitutes the first step towards interpreting the glacial and sea‐level history of the central area of the Gulf of St. Lawrence; this new understanding will provide input to regional marine and glacial modelling.
Commentary: An Asian Americanist Perspective on Child Development
Authors: Lee Richard M. , Y.J. Kim Adam , Zhou Xiang
Published: July 2016

In this commentary, we put forth an Asian Americanist perspective on child development that frames, expands upon, and at times challenges the contextual, conceptual, and methodological ideas put forward by Kiang et al., Mistry et al., and Yoshikawa et al. (this volume). This Asian Americanist perspective draws upon scholarship in Asian American Studies and critical race theory to bridge the historical, conceptual, and methodological contributions of the three articles. We also aim to challenge current and future generations of scholars studying Asian American child development to look at Asian American youth and families as autonomous, self‐determining agents who are capable of challenging, resisting, and affecting change in a racialized society.
An Integrated Conceptual Framework for the Development of Asian American Children and Youth
Authors: Mistry Jayanthi , Li Jin , Yoshikawa Hirokazu , Tseng Vivian , Tirrell Jonathan , Kiang Lisa , Mistry Rashmita , Wang Yijie
Published: July 2016

The diversity of circumstances and developmental outcomes among Asian American children and youth poses a challenge for scholars interested in Asian American child development. This article addresses the challenge by offering an integrated conceptual framework based on three broad questions: (a) What aretheory‐predicated specifications of contextsthat are pertinent for the development of Asian American children? (b) What are thedomains of development and socializationthat are particularly relevant? (c) How canculture as meaning‐making processesbe integrated in conceptualizations of development? The heuristic value of the conceptual model is illustrated by research on Asian American children and youth that examines the interconnected nature of specific features of context, pertinent aspects of development, and interpretive processes.