bluuebunny/crossref_metadata_2025 huggingface dataset:
Pregnancy Outcomes of Exacerbated Chronic Hypertension Compared with Superimposed Preeclampsia
Authors: Becker David A. , Machemehl Hannah C. , Biggio Joseph R. , Siegel Anne M. , Tita Alan T. , Harper Lorie M.
Published: November 2018

Objective Compare outcomes in women with chronic hypertension who remain normotensive, experience exacerbation, or meet laboratory criteria for superimposed preeclampsia.

Study Design This is a retrospective cohort study of singleton pregnancies with chronic hypertension from 2000 to 2014. Delivery admission records were used to categorize women into three groups: stable chronic hypertension, exacerbated hypertension, and superimposed preeclampsia. The primary outcomes were a neonatal composite of death, respiratory support, umbilical arterial pH < 7, 5-minute Apgar ≤3, and seizures, in addition to maternal severe hypertension requiring intravenous (IV) antihypertensives.

Results In total, 270 women (31.3%) had stable hypertension, 429 (49.8%) had exacerbated hypertension, and 163 (18.9%) had superimposed preeclampsia. Neonatal composite (10.7 vs. 11.2 vs. 21.5%; p < 0.01) and preterm birth <35 weeks (8.8 vs. 18.3 vs. 35.7%; p < 0.01) were highest in the superimposed preeclampsia group. Severe hypertension requiring the use of IV antihypertensives increased across groups (0 vs. 15.6 vs. 23.3% p < 0.01). With the exception of severe hypertension requiring IV antihypertensive use, outcomes in women with exacerbations were unchanged compared with those with stable hypertension.

Conclusion Superimposed preeclampsia is associated with an increased risk of adverse neonatal outcomes compared with stable chronic hypertension, whereas exacerbation of chronic hypertension is not.
Racial and Ethnic Disparities in Maternal Outcomes and the Disadvantage of Peripartum Black Women: A Multistate Analysis, 2007–2014
Authors: Tangel Virginia , White Robert S. , Nachamie Anna S. , Pick Jeremy S.
Published: November 2018

Objective Racial and ethnic disparities in obstetric care and delivery outcomes have shown that black women experience high rates of pregnancy-related mortality and morbidity, along with high rates of cesarean delivery, compared with other racial and ethnic groups. We aimed to quantify these disparities and test the effects of race/ethnicity in stratified statistical models by insurance payer and socioeconomic status, adjusting for comorbidities specific to an obstetric population.

Study Design We analyzed maternal outcomes in a sample of 6,872,588 delivery records from California, Florida, Kentucky, Maryland, and New York from 2007 to 2014 from the State Inpatient Databases, Healthcare Cost and Utilization Project. We compared present-on-admission characteristics of parturients by race/ethnicity, and estimated logistic regression and generalized linear models to assess outcomes of in-hospital mortality, cesarean delivery, and length of stay.

Results Compared with white women, black women were more likely to die in-hospital (odds ratio [OR]: 1.90, 95% confidence interval [CI]: 1.47–2.45) and have a longer average length of stay (incidence rate ratio: 1.10, 95% CI: 1.09–1.10). Black women also were more likely to have a cesarean delivery (OR: 1.12, 95% CI 1.12–1.13) than white women. These results largely held in stratified analyses.

Conclusion In most insurance payers and socioeconomic strata, race/ethnicity alone is a factor that predicts parturient outcomes.
Cooled Radio Frequency Ablation for the Treatment of Osteoarthritis-Related Knee Pain: Evidence, Indications, and Outcomes
Authors: Oladeji Lasun , Cook James
Published: November 2018

Knee osteoarthritis (OA) is a common condition associated with pain and physical impairment in a large segment of the population. The traditional treatment algorithm progresses from conservative modalities to nonsurgical options to surgical intervention. Surgical intervention often provides reliable pain relief but not all patients are surgical candidates and there are some patients who prefer not to have surgery. Cooled radio frequency ablation (C-RFA) is a treatment with the potential to provide pain relief for patients who no longer benefit from noninvasive modalities and who desire an alternative to surgery. The objective of this review article is to provide the rationale, available evidence, indications, and outcomes associated with C-RFA for the treatment of chronic knee OA. A total of eight reports that use C-RFA in the treatment of chronic knee pain were identified and analyzed. There were two prospective trials, one retrospective cohort study, and five case reports or case series. C-RFA is an emerging procedure with encouraging early results; however, additional long-term prospective clinical trials are necessary to further characterize how C-RFA can best be used to treat chronic knee pain.
The Treatment of Adult Osteochondritis Dissecans with Autologous Cartilage Implantation: A Systematic Review
Authors: Sacolick Davidson A. , Kirven James C. , Abouljoud Moneer M. , Everhart Joshua S. , Flanigan David C.
Published: November 2018

We sought to evaluate the effectiveness of autologous chondrocyte implantation (ACI) for the treatment of adult osteochondritis dissecans (OCD) lesions according to patient-reported outcomes, complication rates, and failure rates. A search of MEDLINE, Scopus, and Cochrane Library was performed to identify clinical studies (levels I–IV) reporting outcomes after ACI treatment for OCD in adult knees. Our inclusion criteria included the following: (1) published between January 2000 and April 2017, (2) stable and unstable OCD lesions of the knee, (3) use of ACI in at least one group, (4) subjects ≥18 years old or skeletally mature, (5) inclusion of at least one patient-reported clinical outcome measure, and (6) written in English. A total of nine studies (179 patients), mean age of 27.6 years (range: 18–49 years), were included. There were 227 OCD lesions with an average size of 4.1 cm2 (range: 1.2–9.4 cm2). The average follow-up was 61.3 months (range: 6.5–120 months). In general, there was significant improvement in symptoms, but better results occurred among active male patients with smaller lesions as well as younger patients. Statistically significant improvement in patient-reported outcomes was reported in all studies. There were 23 complications reported (15.6%), including 12 failures (8.2%). Significant improvement in clinical outcome measures demonstrates clinical efficacy of autologous cartilage therapies for the treatment of OCD in adult patients. Better outcomes are often observed with males, active patients, smaller lesion sizes, and younger age at the time of surgery.
Acyl-CoA synthetase 6 enriches the neuroprotective omega-3 fatty acid DHA in the brain
Authors: Fernandez Regina F. , Kim Sora Q. , Zhao Yingwei , Foguth Rachel M. , Weera Marcus M. , Counihan Jessica L. , Nomura Daniel K. , Chester Julia A. , Cannon Jason R. , Ellis Jessica M.
Published: November 2018

Significance

Neurodegenerative diseases are a leading cause of morbidity and mortality among older adults, the fastest-growing segment of the US population. Neurodegenerative disease risk is reduced by high dietary intake of the omega-3 fatty acid, docosahexaenoic acid (DHA), a highly abundant lipid in the brain. Yet the fundamental mechanisms regulating brain DHA enrichment remain unknown. Here, we have made a key discovery that Acyl-CoA synthetase 6 (Acsl6) is required to specifically enrich DHA in the brain. Of importance, mice lacking Acsl6 have impaired motor function and increased astrogliosis, demonstrating the critical need for Acsl6-mediated lipid metabolism in neurological health. This work provides critical insight into longstanding mysteries surrounding brain DHA metabolism and has broad-reaching health implications.
Common Law in an Uncommon Courtroom
Authors: Ng Eva N. S.
Published: November 2018

This book takes you into a common-law courtroom which is in no way similar to any other courtroom where common law is practised. This uniqueness is characterised, in particular, by the use of English as the trial language in a predominantly Cantonese-speaking society and by the presence of other bilinguals in court, thus presenting specific challenges for the interpreters who work in it, and at times rendering the interpretation service superfluous. This study, inter alia, problematises judges’ intervention in the court proceedings, Chinese witnesses testifying in English, as well as English-language trials heard by Chinese jurors. It demonstrates how the use of chuchotage proves to be inadequate and inappropriate in the Hong Kong courtroom, where interpreting in an English-language trial is arguably provided to cater for the need of the linguistic majority. This book is useful to interpreters, language educators, legal professionals, forensic linguists and policy makers alike.
Priority areas at the frontiers of ecology and energy
Authors: Chou S. K. , Costanza Robert , Earis Philip , Hubacek Klaus , Li B. Larry , Lu Yonglong , Span Roland , Wang Hao , Wu Jianping , Wu Yegang , Yan Jerry J.
Published: November 2018

The complexity of economic development and humanitarian crises means that energy science and technology should be involved in actions that address almost every major challenges of ecosystem health and sustainability. Energy is the engine of the world economy and the key to ecosystems’ functioning, which also has a great impact on global warming. The energy crisis, environmental pollution, overuse of natural resources, water supply shortages, global climate disruption, and deteriorating ecosystems are major challenges to address in order to achieve the United Nations Sustainable Development Goals (SDGs). In light of the frontiers in energy sciences and disruptive innovation in eco-tech, we recognize the need to review and establish working mechanisms that identify and examine issues that are critical to future sustainable development, to offer advice to decision-makers in different social sectors (public and private), to secure a shared future for mankind, and to achieve shared prosperity and common interests through international communications and collaborations.
Bilateral comparison of 1 Ω and 10 kΩ standards (ongoing BIPM key comparisons BIPM.EM-K13.a and 13.b) between the NSAI-NML (Ireland) and the BIPM
Authors: Rolland B , Stock M , Power O , Walsh R
Published: November 2018

This report gives the result of a bilateral comparison of resistance between the NSAI-NML (Ireland) and the BIPM carried out in 2018. Two 1 Ω and two 10 kΩ travelling standards belonging to the BIPM were used. The comparison was carried out with an 'A-B-A' pattern of measurements; the standards were measured first at the BIPM for a period of about one month, then also for a period of about one month at the NSAI-NML, and finally again at the BIPM. The measurand was the 4 terminal dc resistance at low power. The BIPM was the pilot laboratory, and the comparison forms part of the ongoing BIPM key comparisons BIPM.EM-K13.a (for 1 Ω) and BIPM.EM-K13.b (for 10 kΩ).

The results from the NSAI-NML and the BIPM were found to be in good agreement, with a difference smaller than the relative expanded uncertainty (95 % confidence, k = 2) of 0.17 × 10-6 for 1 Ω and 0.43 × 10-6 for 10 kΩ.

KEY WORDS FOR SEARCH

Resistance; ohm; NSAI-NML; Ireland; BIPM; CIPM MRA; comparison; K13; electricity

Main text

To reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database kcdb.bipm.org/.

The final report has been peer-reviewed and approved for publication by the CCEM, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).
Developments of Thermochromic VO2–Based Thin Films For Architectural Glazing
Authors: Muslim Noormariah , Soon Ying Woan , Lim Chee Ming , Voo Nyuk Yoong
Published: November 2018

Investigation on properties of vanadium dioxide (VO2) thin films has received significant attention as it is a thermochromic material potentially for applications on architectural glazing in order to reduce energy consumption from usage of air-conditioning system. Most studies have focused on the hysteresis behavior of thermochromic VO2 thin films that occurs at a certain phase transition temperature. Although large area coating techniques have recently been developed, there are still many obstacles in trying to deploy energy-efficient windows. Hence, this work concisely reviews on VO2 thin films as thermochromic materials, and developments on preparation methodologies in order to enhance the thermochromic characteristics of VO2 thin films.
Crystal Structure, Surface Topography, Surface Morphology and Optical Properties of DC Magnetron Sputtered VO2 Thin Films using VO2 Target
Authors: Muslim Noormariah , Md Idris Muhammad Nur Syafi’ie , Soon Ying Woan , Chau Yuan-Fong Chou , Lim Chee Ming , Voo Nyuk Yoong
Published: November 2018

Vanadium dioxide (VO2) thin films were deposited at room temperature on Corning 2947 glass substrates by direct current (DC) magnetron sputtering with a high purity VO2 target. Crystal structure, surface topography, surface morphology and optical properties of the deposited VO2 thin films were investigated. The deposited films exhibited a single orientation of (110) with a crystallite size of 41.3 nm as confirmed by the X-ray diffraction analysis and Scherrer formula, respectively. From the surface topography analysis, the film surface had root mean square surface roughness of ~6.8 nm and consisted of round-shaped grains. Similarly, from the surface morphology analysis, spherical-like grains were observed on the surface of the deposited VO2 thin films with estimated average grain size of 34.2 nm. The deposited thin films showed high transmittance and low reflectance in the visible and near-infrared wavelength regions at room temperature. In addition, from the optical transmittance against temperature measurements, only a few transmittance variation and a slight change in hysteresis loop were detected during heating and cooling between room temperature and 100 °C. Hence, the deposited VO2 thin films were found to exhibit lack of phase transition.
Computational modeling of cellular structures using conditional deep generative networks
Authors: Yuan Hao , Cai Lei , Wang Zhengyang , Hu Xia , Zhang Shaoting , Ji Shuiwang
Published: November 2018

Motivation

Cellular function is closely related to the localizations of its sub-structures. It is, however, challenging to experimentally label all sub-cellular structures simultaneously in the same cell. This raises the need of building a computational model to learn the relationships among these sub-cellular structures and use reference structures to infer the localizations of other structures.

Results

We formulate such a task as a conditional image generation problem and propose to use conditional generative adversarial networks for tackling it. We employ an encoder–decoder network as the generator and propose to use skip connections between the encoder and decoder to provide spatial information to the decoder. To incorporate the conditional information in a variety of different ways, we develop three different types of skip connections, known as the self-gated connection, encoder-gated connection and label-gated connection. The proposed skip connections are built based on the conditional information using gating mechanisms. By learning a gating function, the network is able to control what information should be passed through the skip connections from the encoder to the decoder. Since the gate parameters are also learned automatically, we expect that only useful spatial information is transmitted to the decoder to help image generation. We perform both qualitative and quantitative evaluations to assess the effectiveness of our proposed approaches. Experimental results show that our cGAN-based approaches have the ability to generate the desired sub-cellular structures correctly. Our results also demonstrate that the proposed approaches outperform the existing approach based on adversarial auto-encoders, and the new skip connections lead to improved performance. In addition, the localizations of generated sub-cellular structures by our approaches are consistent with observations in biological experiments.

Availability and implementation

The source code and more results are available at https://github.com/divelab/cgan/.
Evaluating for Human Herpesvirus 6 in the Liver Explants of Children With Liver Failure of Unknown Etiology
Authors: Yang Christine H , Sahoo Malaya K , Fitzpatrick Megan , Lau Audrey H , Pinsky Benjamin A , Martinez Olivia M
Published: November 2018

Background

Liver failure of unknown etiology (LFUE) has a transplant-free survival rate <25%. Human herpesvirus 6 (HHV-6) may be associated with LFUE, but studies are limited by small sample size.

Methods

We identified all children who underwent liver transplant for LFUE at a single quaternary children’s hospital; 51/65 cases could be age matched with controls (children who underwent liver transplant for metabolic liver disease). Quantitative polymerase chain reaction for HHV-6 was performed on DNA from formalin-fixed paraffin-embedded liver explant tissue.

Results

HHV-6 was detected in 34/51 cases (66.7%) and 19/51 controls (37.3%) (P = .005). Average HHV-6 viral load was 213207 copies/106 cells in positive cases (range: 7293–1102030) and 38115 copies/106 cells in positive controls (range: 1382–122375) (P = .0008). HHV-6 was present significantly more often in cases compared to controls in patients younger than 6 years. In particular, in patients younger than 3 years, HHV-6 was present in 13/27 cases (48.1%) and 2/27 controls (7.4%) (P = .0009).

Conclusions

HHV-6 was detected in liver explants significantly more often and in higher quantities in children transplanted for LFUE compared to controls, suggesting HHV-6 should be evaluated in young children who present with LFUE.
Dengue epidemic in Touba, Senegal: implications for the Grand Magal Pilgrimage for travellers
Authors: Diagne Cheikh Tidiane , Barry Mamadou Aliou , Ba Yamar , Faye Oumar , Sall Amadou Alpha
Published: November 2018

The Grand Magal of Touba is a 2–3 days pilgrimage gathering 3 million people, including 1.5 million residents and 1–2 million pilgrims from other regions in Senegal or from the Senegalese diaspora mostly from the USA, Africa and Europe. With the currently ongoing dengue epidemic in this area, concerns have been raised about the spread of dengue to non-affected areas in Senegal through travellers to and from the Grand Magal.
Higher Education for Police Professionals. The Dutch Case
Authors: Huisjes Henk , Engbers Fiona , Meurs Teun
Published: November 2018

In the Netherlands, already for some 20 years, a discourse on the relevance and nature of higher education for police professionals can be traced. To explain this discourse, the article consists of a reconstruction of the trajectory of change and an assessment of the current situation. Furthermore, a future perspective is included, which largely runs parallel with other forms of higher education for professions in the public sector. Key concepts, for instance, are the ‘reflective practitioner’ and the ‘hybrid professional’. Also, a case is presented on the education of reflective practices, which exemplifies a didactics of teaching and learning in police practice. More than ever a close cooperation between police practice and police education is needed, as well as a clear focus on how ‘learning by doing’ relates to the need of a solid knowledge base. Together, teachers and practitioners may challenge the student to develop a personal judgment on the connection between theories (concepts, words) and practice (experience, works).
Improvement of social support in empty-nest elderly: results from an intervention study based on the Self-Mutual-Group model
Authors: Zhang Chichen , Zhao Huining , Zhu Ruifang , Lu Jiao , Hou Lihong , Yang Xiaozhao Yousef , Yin Mei , Yang Tingzhong
Published: November 2018

Background

China has the world’s largest elderly population and an increasing number of empty-nest elderly. The purpose of this study is to evaluate the effectiveness of the Self-Mutual-Group model on social support of the empty-nest elderly, thus providing reference for improving their quality of life.

Methods

A intervention study was conducted between October 2016 and May 2017 at six communities in Taiyuan, Shanxi Province, China. A total of 350 empty-nest elderly aged 60–88 years were randomly assigned in the intervention group (n = 167) with a 7-month SMG-based intervention or to a control group (n = 183) with no intervention. The social support of the participating elderly (n = 350) was assessed by the Social Support Rating Scale (SSRS) at the baseline and 7 months later, respectively.

Results

A 7-month follow-up showed an increasing mean scores of SSRS, objective support, subjective support and support utilization of the intervention group, and reached statistical significance (P < 0.05).

Conclusions

The Self-Mutual-Group model was considered to be a positive intervention and was effective in increasing social support among the empty-nest elderly. Furthermore, future research should extend the intervention period and introduce multi-point measurement to better evaluate the intervention process and outcomes.

Trial registration

Study on the ‘SMG’ Health Management Model Based on Community Organization Theory among empty-nest elderly (ChiCTR1800015884).
A Toolbox for Nodule Development Studies in Chickpea: A Hairy-Root Transformation Protocol and an Efficient Laboratory Strain ofMesorhizobiumsp.
Authors: Mandal Drishti , Sinharoy Senjuti
Published: November 2018

A Mesorhizobium sp. produces root nodules in chickpea. Chickpea and model legume Medicago truncatula are members of the inverted repeat–lacking clade (IRLC). The rhizobia, after internalization into the plant cell, are called bacteroids. Nodule-specific cysteine-rich peptides in IRLC legumes guide bacteroids to a terminally differentiated swollen (TDS) form. Bacteroids in chickpea are less TDS than those in Medicago spp. Nodule development in chickpea indicates recent evolutionary diversification and merits further study. A hairy-root transformation protocol and an efficient laboratory strain are prerequisites for performing any genetic study on nodulation. We have standardized a protocol for composite plant generation in chickpea with a transformation frequency above 50%, as shown by fluorescent markers. This protocol also works well in different ecotypes of chickpea. Localization of subcellular markers in these transformed roots is similar to the localization observed in transformed Medicago roots. When checked inside transformed nodules, peroxisomes were concentrated along the periphery of the nodules, while endoplasmic reticulum and Golgi bodies surrounded the symbiosomes. Different Mesorhizobium strains were evaluated for their ability to initiate nodule development and efficiency of nitrogen fixation. Inoculation with different strains resulted in different shapes of TDS bacteroids with variable nitrogen fixation. Our study provides a toolbox to study nodule development in the crop legume chickpea.
Development and Evaluation of the Breast Cancer Online Rehabilitation (BRECOR) Program for Self-managed Upper-Body Rehabilitation for Women With Breast Cancer
Authors: Rafn Bolette S. , Nees Carina , Midtgaard Julie , Camp Pat G. , Vibe-Petersen Jette , Campbell Kristin L.
Published: November 2018

Background:

Survivors of breast cancer experience upper-body issues.

Objectives:

To develop and evaluate a rehabilitation program (BRECOR) to support self-managed upper-body rehabilitation after treatment for breast cancer.

Design:

Development and feasibility study.

Setting:

Community-based.

Participants:

Development of program elements (clinical assessment tool, education pamphlet, and Website) was informed by 17 physical therapists with experience in oncology rehabilitation and 10 women with breast cancer. Feasibility was evaluated by 35 women who had recently undergone surgery for breast cancer and 29 women who had completed surgery and radiation therapy for breast cancer.

Intervention:

Participants performed an individualized 12-week self-managed upper-body rehabilitation program informed by the clinical assessment tool, with support from the education pamphlet and the Website.

Measurements:

Recruitment/retention rates, adherence, capacity, and participant satisfaction were collected to establish feasibility.

Results:

Feedback from the physical therapists was instrumental in developing the program content. User testing refined the program elements. Participant feedback in the feasibility testing was positive with good recruitment (80%), retention (83%), and adherence (72%) to the self-managed upper-body rehabilitation program. Participants improved their upper-body function and reported benefit from the program.

Limitations:

The effectiveness of the BRECOR program in improving upper-body function cannot be determined, as this was a single-group feasibility study.

Conclusion:

A feasible, self-managed upper-body rehabilitation program was developed through iterative stages of program development and feasibility testing. The BRECOR program elements provide a toolkit to enforce qualified upper-body assessment, provide rehabilitation prescriptions, and support self-managed upper-body rehabilitation after treatment for breast cancer.
Multidimensional Outcome Measurement of Children and Youth With Neuropathy Following Treatment of Leukemia: Cross-sectional Descriptive Report
Authors: Wright Marilyn , Twose Donna , Gorter Jan Willem
Published: November 2018

Background:

Children/youth with chemotherapy induced peripheral neuropathy (CIPN) experience many impairments, activity limitations, and participation restrictions.

Objective:

The objective of this study was to describe the use and feasibility of selected multi-dimensional outcome measures of functioning, disability, and health in children/youth with CIPN following treatment for acute lymphoblastic leukemia.

Methods:

A selection of clinician evaluated and patient reported outcome measures encompassing all dimensions of the International Classification of Functioning, Disability and Health was collected from seventeen children/youth with CIPN within a study of 3D instrumented motion analysis. Measures included the pediatric modified Total Neuropathy Scale, ankle strength and range of motion, six-minute walk test, Edinburgh Visual Gait Score, Oxford Ankle and Foot Questionnaire, Bruininks-Oseretsky Test of Motor Proficiency running speed and agility subtest, and Pediatric Outcomes Data Collection Instrument Transfers and Basic Mobility, Sports/Physical Functioning, and Pain/Comfort scales.

Results:

The measures were shown to be feasible and were able to demonstrate differences compared to normative data. They showed variability within the group of children/youth with CIPN except for the running speed and agility test, which had a floor effect. The Edinburgh Visual Gait Scores correlated significantly (r = −0.668, p <0.001) with the Gait Deviation Index, a summary score of kinematic gait data from the 3D motion analysis study.

Conclusion:

These measures can contribute clinical practice, research, and the development of core outcome set registries.
Laparoscopic Radical Trachelectomy for Embryonal Rhabdomyosarcoma of the Cervix in a 2-Year-Old Girl
Authors: May Taymaa , Allen Lisa , Hogen Liat , King Carol , Lorenzo Armando J. , Browne-Farmer Chantelle , Gupta Abha , Shaikh Furqan
Published: November 2018

BACKGROUND:

Embryonal rhabdomyosarcoma of the cervix is a rare and aggressive malignancy that usually affects children and young adults.

CASE:

We describe a 2-year-old patient who presented with a mass protruding through the vaginal introitus. Preoperative investigations including vaginoscopy, hysteroscopy, magnetic resonance imaging, and biopsies confirmed embryonal rhabdomyosarcoma, botryoid subtype, arising from the cervix. She was successfully treated with neoadjuvant chemotherapy and interval laparoscopic radical trachelectomy to achieve remission.

CONCLUSION:

Collaboration between the pediatric and adult surgical and medical oncology teams was critical to implement this fertility-sparing treatment strategy in such a young girl having this rare tumor.
Preconception Coverage Before and After the Affordable Care Act Medicaid Expansions
Authors: Clapp Mark A. , James Kaitlyn E. , Kaimal Anjali J. , Daw Jamie R.
Published: November 2018

OBJECTIVE:

To estimate the effects of the Affordable Care Act Medicaid expansion provision that was largely implemented in 2014 on preconception insurance coverage among low-income women.

METHODS:

We used a quasiexperimental, difference-in-difference design to compare changes in preconception insurance coverage among low-income women living in expansion compared with nonexpansion states before and after the Medicaid expansions. Women with family incomes 138% the federal poverty level or less who participated in the Pregnancy Risk Assessment Monitoring System from 2009 to 2015 from states that did or did not expand their Medicaid programs on January 1, 2014, were included. The exposure of interest was the state Medicaid expansion. The primary outcome was insurance status 1 month before conception. We conducted additional subgroup and sensitivity analyses to test the assumptions of the model and the robustness of the findings.

RESULTS:

The study sample included 30,495 women from eight states that expanded Medicaid under the Affordable Care Act and 26,561 patients from seven states in that did not. The rate of preconception Medicaid coverage was 30.8% prepolicy and 35.6% postpolicy in nonexpansion states and 43.2% prepolicy and 56.8% postpolicy in expansion states. There was a significantly greater increase in Medicaid coverage in expansion states after the policy implementation (adjusted difference-in-difference estimate +8.6% points, 95% CI 1.1–16.0). Rates of preconception uninsurance were 44.2% prepolicy and 34.3% postpolicy in nonexpansion states and 37.4% prepolicy and 23.5% postpolicy in expansion states. There was no significant difference in the changes in uninsurance between the two groups in the postpolicy period (adjusted difference-in-difference estimate −4.1, 95% CI −11.1 to 2.9). Non-Medicaid insurance coverage was 25.3% prepolicy and 30.5% postpolicy in nonexpansion states and 19.4% prepolicy and 19.7% postpolicy in expansion states. Relative to nonexpansion states, there was a significant decrease in non-Medicaid coverage in the expansion states in the postpolicy period (adjusted difference-in-difference estimate −4.7, 95% CI −8.3 to −1.1). The results were robust to alternate model specifications and study period definitions.

CONCLUSION:

Medicaid expansion was associated with increased enrollment in Medicaid before pregnancy among low-income women; however, there were no changes in the rates of uninsurance. Additional years of postpolicy data are needed to fully assess the effects of the policy change.
Chromosomal Microarray Analysis Results From Pregnancies With Various Ultrasonographic Anomalies
Authors: Sagi-Dain Lena , Maya Idit , Reches Adi , Frumkin Ayala , Grinshpun-Cohen Julia , Segel Reeval , Manor Esther , Khayat Morad , Tenne Tamar , Banne Ehud , Shalata Adel , Yonath Hagith , Berger Racheli , Singer Amihood , Ben-Shachar Shay
Published: November 2018

OBJECTIVE:

To examine chromosomal microarray analysis results in pregnancies with various ultrasonographic anomalies and to characterize the copy number variants in diverse fetal phenotypes.

METHODS:

We retrospectively examined chromosomal microarray analyses of amniocenteses performed nationwide as a result of fetal ultrasonographic anomalies (structural defects, fetal growth restriction, and polyhydramnios) between January 2013 and September 2017. The rate of abnormal chromosomal microarray findings was compared between the different phenotypes and with a previously described control population of 15,225 pregnancies with normal ultrasonographic findings.

RESULTS:

Clinically significant chromosomal microarray aberrations were detected in 272 of 5,750 pregnancies (4.7%): 115 (2%) karyotype-detectable and 157 (2.7%) submicroscopic. Most commonly detected copy number variants were 22q11.21 deletions (0.4%) followed by 22q11.21 gain of copy number (0.2%). Specific copy number variants detected among pregnancies with abnormal ultrasonographic findings were up to 20-fold more prevalent compared with low-risk pregnancies. Some variants were associated with specific phenotypes (eg, 22q11.21 microdeletions with cardiovascular and 17q12 microdeletions with genitourinary defects).

CONCLUSION:

The rate of abnormal amniotic chromosomal microarray analysis results is twice that of karyotypic abnormalities in pregnancies with various abnormal ultrasonographic findings.
Terminal Complement Activation in Preeclampsia
Authors: Burwick Richard M. , Velásquez Jesús A. , Valencia Catalina M. , Gutiérrez-Marín Jorge , Edna-Estrada Francisco , Silva Jaime L. , Trujillo-Otálvaro Juliana , Vargas-Rodríguez Johanna , Bernal Yamile , Quintero Alvaro , Rincón Mónica , Tolosa Jorge E.
Published: November 2018

OBJECTIVE:

To evaluate whether C5b-9 concentrations in blood and urine are increased in preeclampsia with severe features.

METHODS:

The Complement and Preeclampsia in the Americas study is a prospective, multicenter case–control study performed at six centers in Colombia from November 2015 to July 2016. The case group included women with preeclampsia with severe features, and the control group included women who were healthy or had chronic hypertension, gestational hypertension, or preeclampsia without severe features. We enrolled two women in the control group for every woman in the case group. Soluble C5b-9 concentrations were measured by enzyme-linked immunosorbent assays in blood and urine. The primary outcome was C5b-9 concentrations in women in the case group compared with all women in the control group, and the secondary outcome was C5b-9 levels in women in the case group compared with individual control subgroups. Differences were assessed by test of medians, and associations were further evaluated by receiver operating characteristic curve analysis and logistic regression with α=0.05.

RESULTS:

Three hundred fifty-two patients were enrolled. Plasma C5b-9 concentrations did not differ significantly between women in the case group and those in the control group, but urine C5b-9 concentrations were higher in women in the case group (median [interquartile range] 9.9 [1.6–43.7] vs 1.8 [0.54–4.1] ng/mL, P<.001). In subgroup analysis, plasma C5b-9 concentrations were increased in women in the case group compared with healthy women in the control group (median [interquartile range] 2,778 [1,633–4,230] vs 1,374 [1,064–2,332] ng/mL, P<.001), and urine C5b-9 concentrations were increased in women in the case group compared with all control subgroups (P<.001). Using receiver operating characteristic analysis, urine C5b-9 concentrations differentiated preeclampsia with severe features from hypertensive women in the control group (area under the receiver operating characteristic curve 0.74, 95% CI 0.68–0.80). Urine C5b-9 22 ng/mL or greater (range 0–158.4 ng/mL) was the optimal cut point for diagnosis of preeclampsia with severe features with adjusted odds ratio of 10.0 (95% CI 3.5–28.8, P<.001).

CONCLUSION:

Urinary excretion of terminal complement effector C5b-9 is higher in women with preeclampsia with severe features compared with women with other hypertensive disorders of pregnancy and women without hypertension.
Does Gender Influence Postoperative Outcomes in Minimally Invasive Transforaminal Lumbar Interbody Fusion?
Authors: Khechen Benjamin , Haws Brittany E. , Patel Dil V. , Cardinal Kaitlyn L. , Guntin Jordan A. , Singh Kern
Published: November 2018

Study Design:

Retrospective cohort.

Objective:

The objective of this study was to determine if an association exists between gender and postoperative improvements in patient-reported outcomes (PRO) measures following minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).

Summary of Background Data:

Current spine literature presents conflicting findings regarding the influence of gender on clinical outcomes.

Methods:

Patients undergoing primary, single-level MIS TLIF were retrospectively reviewed. PRO measures including Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) back and leg pain scores were collected preoperatively and 6-week, 12-week, and 6-month postoperatively. Rates of minimum clinically important difference (MCID) achievement were determined at 6-months postoperative. Statistical analysis was performed using Pearson χ2 analysis or Student t test.

Results:

In total, 169 patients, 40.83% females and 59.17% males, were included. Females experienced greater inpatient pain scores than males (POD 0: 5.30 vs. 4.69, P=0.041; POD 1: 4.80 vs. 4.13, P=0.019). Females demonstrated significantly greater ODI (43.77 vs. 36.22; P=0.002) and VAS leg (6.20 vs. 5.27; P=0.039) scores than males. No differences in postoperative improvements in ODI, VAS back or VAS leg pain scores were identified between genders, with exception to females demonstrating greater improvement in VAS leg pain at 6 months postoperatively (female: −4.40 vs. male: −3.32; P=0.033). Furthermore, no differences in MCID achievement for PROs were identified between cohorts.

Conclusions:

Females demonstrated greater preoperative pain and disability as well as inpatient VAS pain scores compared to males. Furthermore, gender was not associated with differences in length of stay, perioperative complication rates, or narcotics consumption. Improvements in pain and disability, as well as rates of MCID achievement were similar between genders. These findings suggest that gender is not associated with surgical or clinical outcomes and should not be used as a predictor of outcomes following MIS TLIF.

Level of Evidence:

Level III.
Survival, Quality of Life, and Functional Status Following Prolonged ICU Stay in Cardiac Surgical Patients: A Systematic Review
Authors: Trivedi Vatsal , Bleeker Helena , Kantor Navot , Visintini Sarah , McIsaac Daniel I. , McDonald Bernard
Published: November 2018

Objectives:

Compared with noncardiac critical illness, critically ill postoperative cardiac surgical patients have different underlying pathophysiologies, are exposed to different processes of care, and thus may experience different outcome trajectories. Our objective was to systematically review the outcomes of cardiac surgical patients requiring prolonged intensive care with respect to survival, residential status, functional recovery, and quality of life in both hospital and long-term follow-up.

Data Sources:

MEDLINE, Embase, CINAHL, Web of Science, and Dissertations and Theses Global up to July 21, 2017.

Study Selection:

Studies were included if they assessed hospital or long-term survival and/or patient-centered outcomes in adult patients with prolonged ICU stays following major cardiac surgery. After screening 10,159 citations, 114 articles were reviewed in full; a final 34 articles met criteria for data extraction.

Data Extraction:

Two reviewers independently extracted data and assessed risk of bias using the National Institutes of Health Quality Assessment Tool for Observational Studies. Extracted data included the used definition of prolonged ICU stay, number and characteristics of prolonged ICU stay patients, and any comparator short stay group, length of follow-up, hospital and long-term survival, residential status, patient-centered outcome measure used, and relevant score.

Data Synthesis:

The definition of prolonged ICU stay varied from 2 days to greater than 14 days. Twenty-eight studies observed greater in-hospital mortality among all levels of prolonged ICU stay. Twenty-five studies observed greater long-term mortality among all levels of prolonged ICU stay. Multiple tools were used to assess patient-centered outcomes. Long-term health-related quality of life and function was equivalent or worse with prolonged ICU stay.

Conclusions:

We found consistent evidence that patients with increases in ICU length of stay beyond 48 hours have significantly increasing risk of hospital and long-term mortality. The significant heterogeneity in exposure and outcome definitions leave us unable to precisely quantify the risk of prolonged ICU stay on mortality and patient-centered outcomes.
Clinicopathologic Correlation With Expression of PD-L1 on Both Tumor Cells and Tumor-infiltrating Immune Cells in Patients With Non–Small Cell Lung Cancer
Authors: Song Peng , Guo Lei , Li Wenbin , Zhang Fan , Ying Jianming , Gao Shugeng
Published: November 2018

Our study was to evaluate the concordance of programmed cell death-ligand 1 (PD-L1) expression between 22C3 and SP263 assay and explore the association of clinicopathologic features with expression of PD-L1 on both tumor cells (TC) and tumor-infiltrating immune cells (IC). We retrospectively assessed the PD-L1 expression in 305 patients with lung adenocarcinoma or adenosquamous carcinoma by 22C3 and SP263 assay. The association of PD-L1 expression by 22C3 assay with clinicopathologic features was also analyzed. The prevalence of PD-L1 expression by 22C3 assay was 20.7% with a ≥50% cutoff and 46.6% with a ≥1% cutoff. The concordance rates between 2 PD-L1 assays while using 1%, 5%, 25%, and 50% positive TC as the cutoffs were 91.8%, 93.1%, 95.1% and 99.0%, respectively. For PD-L1 expression on IC, the concordance rate was 93.4% using a 1% cutoff. According to the results of 22C3 assay, high PD-L1 expression (using a ≥50% cutoff) on TC was significantly associated with smoking, advanced stage disease, and KRAS mutation. PD-L1 expression on IC was significantly associated with smoking and KRAS mutation. PD-L1 expression on TC and IC were both significantly associated with average number of cigarettes smoked ≥20 per day. The 22C3 and SP263 assays were highly concordant for assessment of PD-L1 expression on TC and IC. Patients with KRAS mutation and smoking history, particularly those having a large number of cigarettes smoked per day, were more likely to have PD-L1 expression on both TC and IC.
Syringocystadenoma Papilliferum of the Anogenital Area and Buttocks: A Report of 16 Cases, Including Human Papillomavirus Analysis and HRAS and BRAF V600 Mutation Studies
Authors: Konstantinova Anastasia M. , Kyrpychova Liubov , Nemcova Jana , Sedivcova Monica , Bisceglia Michele , Kutzner Heinz , Zamecnik Michal , Sehnalkova Eva , Pavlovsky Michal , Zateckova Kamila , Shvernik Sergej , Spurkova Zuzana , Michal Michal , Kerl Katrin , Kazakov Dmitry V.
Published: November 2018

Syringocystadenoma papilliferum (SCAP) is a benign tumor most commonly located on the head and neck area often associated with nevus sebaceus. In its usual location, the human papillomavirus (HPV) DNA and mutations in the RAS/mitogen-activated protein kinase signaling pathway have been detected in SCAP. We studied 16 cases of SCAP in the anogenital areas and buttock where this neoplasm is rare and attempted to find out whether SCAP in these sites have different histopathological and molecular biological features. It seems that there is no significant difference between the morphology of anogenital SCAP and SCAP in other locations. Several tumors in our cohort demonstrated features resembling those seen in warts, but HPV DNA was not found in these lesions. On the contrary, we identified DNA of HPV high-risk types in some tumors without HPV-related morphology. Our study confirms the role of HRAS and BRAF V600 mutations in the pathogenesis of SCAP, including SCAP in the anogenital areas and buttock.
Opioid Use in the Postoperative Arena: Global Reduction in Opioids After Surgery Through Enhanced Recovery and Gynecologic Surgery
Authors: MOULDER JANELLE K. , BOONE JONATHAN D. , BUEHLER JASON M. , LOUIE MICHELLE
Published: November 2018

Enhanced recovery programs aim to reduce surgical stress to improve the patient perioperative experience. Through a combination of multimodal analgesia and maintaining a physiological state, postoperative recovery is improved. Many analgesic adjuncts are available that improve postoperative pain control and limit opioid analgesia requirements. Adjuncts are often used in combination, but different interventions may be incorporated for patient-specific and procedure-specific needs. Postoperative pain control can be optimized by continuing nonopioid adjuncts, and prescribing opioid analgesia to address breakthrough pain. Prescribing practices should balance optimizing pain relief, minimizing the risk of chronic pain, while limiting the potential for opioid misuse.
Differential Susceptibility to the Environment and Borderline Personality Disorder
Authors: Rioux Charlie , Séguin Jean R. , Paris Joel
Published: November 2018

Evolutionary models of psychopathology can shed light on gene-environment interactions. Differential susceptibility to the environment means that heritable traits can have positive or negative effects, depending on environmental context. Thus, traits that increase risk for mental disorders when the environment is negative can be adaptive when the environment is positive. This model can be applied to borderline personality disorder, with predictors such as emotional dysregulation and impulsivity seen as temperamental variations leading to negative effects in an unfavorable environment but to positive effects in a favorable environment. This model may also be useful in conceptualizing the mechanisms of effective therapy for borderline personality disorder.
Pain and Depression: A Systematic Review
Authors: IsHak Waguih William , Wen Raymond Y. , Naghdechi Lancer , Vanle Brigitte , Dang Jonathan , Knosp Michelle , Dascal Julieta , Marcia Lobsang , Gohar Yasmine , Eskander Lidia , Yadegar Justin , Hanna Sophia , Sadek Antonious , Aguilar-Hernandez Leslie , Danovitch Itai , Louy Charles
Published: November 2018

Background

Pain comorbid with depression is frequently encountered in clinical settings and often leads to significant impaired functioning. Given the complexity of comorbidities, it is important to address both pain and depressive symptoms when evaluating treatment options.

Aim

To review studies addressing pain comorbid with depression, and to report the impact of current treatments.

Method

A systematic search of the literature databases was conducted according to predefined criteria. Two authors independently conducted a focused analysis of the full-text articles and reached a consensus on 28 articles to be included in this review.

Results

Overall, studies suggested that pain and depression are highly intertwined and may co-exacerbate physical and psychological symptoms. These symptoms could lead to poor physical functional outcomes and longer duration of symptoms. An important biochemical basis for pain and depression focuses on serotonergic and norepinephrine systems, which is evident in the pain-ameliorating properties of serotonergic and norepinephrine antidepressants. Alternative pharmacotherapies such as ketamine and cannabinoids appear to be safe and effective options for improving depressive symptoms and ameliorating pain. In addition, cognitive-behavioral therapy may be a promising tool in the management of chronic pain and depression.

Conclusion

The majority of the literature indicates that patients with pain and depression experience reduced physical, mental, and social functioning as opposed to patients with only depression or only pain. In addition, ketamine, psychotropic, and cognitive-behavioral therapies present promising options for treating both pain and depression.