bluuebunny/crossref_metadata_2025 huggingface dataset:
Explaining energy efficiency behaviours among Argentinean citizens through the VBN model / Explicación de los comportamientos de eficiencia energética entre ciudadanos argentinos a través del modelo VCN
Authors: Jakovcevic Adriana , Reyna Cecilia
Published: October 2017

In Argentina, energy consumption is characterized by a high dependence on fossil fuels and a low cost for final consumers. Therefore, to encourage energy efficiency it is important to know which non-financial factors influence energy use. Numerous evidences suggest that the Value-Belief-Norm model (VBN) is an adequate framework to understand this behaviour. However, few studies tested VBN to predict energy efficiency behaviour and even fewer did so in Latin America. Our aim was to test whether a VBN model was successful for predicting household energy efficiency behaviours among Argentinian citizens ( n = 275). Results showed that the VBN model indeed explained self-reported energy efficiency. Importantly, a VBN model version assessed by means of a path analysis showed a good fit to the data. Biospheric values and personal norms were particularly strong predictors of household energy efficiency. These results indicate that personal norms, activated by values, are able to predict energy efficiency actions in an Argentinean sample. These evidences suggest that moral considerations should be promoted in order to increase energy efficiency actions in Argentina.
The α6β4 integrin promotes resistance to ferroptosis
Authors: Brown Caitlin W. , Amante John J. , Goel Hira Lal , Mercurio Arthur M.
Published: October 2017

Increases in lipid peroxidation can cause ferroptosis, a form of cell death triggered by inhibition of glutathione peroxidase 4 (GPX4), which catalyzes the reduction of lipid peroxides and is a target of ferroptosis inducers, such as erastin. The α6β4 integrin protects adherent epithelial and carcinoma cells from ferroptosis induced by erastin. In addition, extracellular matrix (ECM) detachment is a physiologic trigger of ferroptosis, which is evaded by α6β4. The mechanism that enables α6β4 to evade ferroptosis involves its ability to protect changes in membrane lipids that are proferroptotic. Specifically, α6β4-mediated activation of Src and STAT3 suppresses expression of ACSL4, an enzyme that enriches membranes with long polyunsaturated fatty acids and is required for ferroptosis. Adherent cells lacking α6β4 require an inducer, such as erastin, to undergo ferroptosis because they sustain GPX4 expression, despite their increase in ACSL4. In contrast, ECM detachment of cells lacking α6β4 is sufficient to trigger ferroptosis because GPX4 is suppressed. This causal link between α6β4 and ferroptosis has implications for cancer biology and therapy.
Strong Approximation and a Conjecture of Harpaz and Wittenberg
Authors: Browning Tim D , Schindler Damaris
Published: October 2017

We study strong approximation for some algebraic varieties over $\mathbb{Q}$ which are defined using norm forms. This allows us to confirm a special case of a conjecture due to Harpaz and Wittenberg.
Black holes on FIRE: stellar feedback limits early feeding of galactic nuclei
Authors: Anglés-Alcázar Daniel , Faucher-Giguère Claude-André , Quataert Eliot , Hopkins Philip F. , Feldmann Robert , Torrey Paul , Wetzel Andrew , Kereš Dušan
Published: October 2017

We introduce massive black holes (BHs) in the Feedback In Realistic Environments (FIRE) project and perform high-resolution cosmological hydrodynamic simulations of quasar-mass haloes [Mhalo(z = 2) ≈ 1012.5 M⊙] down to z = 1. These simulations model stellar feedback by supernovae, stellar winds and radiation, and BH growth using a gravitational torque-based prescription tied to the resolved properties of galactic nuclei. We do not include BH feedback. We show that early BH growth occurs through short (≲1 Myr) accretion episodes that can reach or even exceed the Eddington rate. In this regime, BH growth is limited by bursty stellar feedback continuously evacuating gas from galactic nuclei, and BHs remain undermassive in low-mass galaxies relative to the local MBH–Mbulgerelation. BH growth is more efficient at later times, when the nuclear stellar potential retains a significant gas reservoir, star formation becomes less bursty and galaxies settle into a more ordered state. BHs rapidly converge on to the observed scaling relations when the host reaches Mbulge ∼ 1010 M⊙. We show that resolving the effects of stellar feedback on the gas supply in the inner ∼100 pc of galaxies is necessary to accurately capture the growth of central BHs. Our simulations imply that bursty stellar feedback has important implications for BH–galaxy relations, AGN demographics and time variability, the formation of early quasars and massive BH mergers.
Impact of Procalcitonin-Guided Antibiotic Management on Antibiotic Exposure and Outcomes: Real-world Evidence
Authors: Broyles Michael R
Published: October 2017

Background

Delayed pathogen identification and nonspecific clinical findings make definitive decisions regarding antibiotics challenging. The stimuli of bacterial toxins and inflammation make procalcitonin (PCT) unique in its ability to differentiate bacterial infection from other causes of inflammation, and thus it is useful for antibiotic management. The objective of our study was to evaluate the impact of a PCT algorithm (PCT-A) on current practice.

Methods

A single-center, retrospective cohort study was conducted to evaluate the impact of adding PCT-A to stewardship practices. Data from 4 years prior to and after PCT-A implementation were compared in critical and acute care patients of all ages receiving parenteral antibiotics for a DRG coded for infection. A baseline PCT was obtained on admission in patients with suspected bacterial infection. Serial PCT measurements were repeated daily to evaluate effectiveness of therapy. Outcomes of interest were antibiotic exposure, hospital mortality, 30-day readmission, Clostridium difficile infection (CDI), and adverse drug events during hospitalization.

Results

A total of 985 patients (pre-PCT-A group) were compared with 1167 patients (post-PCT-A group). Antimicrobial stewardship alone (pre-PCT-A) resulted in a median days of therapy (DOT) of 17 (interquartile range [IQR], 8.5–22.5) vs 9.0 (IQR, 6.5–12) in the post-PCT-A group (P < .0001). Secondary outcomes were also significantly reduced in the post-PCT-A group.

Conclusion

The addition of PCT in a facility with an established stewardship program resulted in a significant reduction in antibiotic exposure and adverse outcomes. PCT may improve antibiotic management when diagnostic clarity and resolution of infection are lacking.
Analgesic-Related Medication Errors Reported to US Poison Control Centers
Authors: Eluri Madhulika , Spiller Henry A , Casavant Marcel J , Chounthirath Thitphalak , Conner Kristen A , Smith Gary A
Published: October 2017

Objective

This study investigates the characteristics and trends of medication errors involving analgesic medications.

Design and Methods

A retrospective analysis was conducted of analgesic-related medication errors reported to the National Poison Data System (NPDS) from 2000 through 2012.

Results

From 2000 through 2012, the NPDS received 533,763 reports of analgesic-related medication errors, averaging 41,059 medication errors annually. Overall, the rate of analgesic-related medication errors reported to the NPDS increased significantly by 82.6% from 2000 to 2009, followed by a 5.7% nonsignificant decrease from 2009 to 2012. Among the analgesic categories, rates of both acetaminophen-related and opioid-related medication errors reported to the NPDS increased during 2000–2009, but the opioid error rate leveled off during 2009–2012, while the acetaminophen error rate decreased by 17.9%. Analgesic-related medication errors involved nonsteroidal anti-inflammatory drugs (37.0%), acetaminophen (35.5%), and opioids (23.2%). Children five years or younger accounted for 38.8% of analgesics-related medication errors. Most (90.2%) analgesic-related medication errors were managed on-site, rather than at a health care facility; 1.6% were admitted to a hospital, and 1.5% experienced serious medical outcomes, including 145 deaths. The most common type of medication error was inadvertently taking/given the medication twice (26.6%).

Conclusion

Analgesic-related medication errors are common, and although most do not result in clinical consequences, they can have serious adverse outcomes. Initiatives associated with the decrease in acetaminophen-related medication errors among young children merit additional research and potential replication as a model combining government policy and multisectoral collaboration.
Phenotypic and Molecular Investigations on Hypovirulent Cryphonectria parasitica in Italy
Authors: Murolo Sergio , De Miccolis Angelini Rita Milvia , Faretra Francesco , Romanazzi Gianfranco
Published: October 2017

Chestnut blight is caused by the fungus Cryphonectria parasitica. As one of the most ecologically important diseases of Castanea spp., C. parasitica can rapidly kill trees. In Europe, mitigation of disease severity took place spontaneously through colonization of C. parasitica by mycoviruses, which reduced the virulence of the fungus. In the framework of a survey, 138 C. parasitica isolates were identified, and virulent/hypovirulent phenotypes were determined through morphological properties and pathogenicity tests. For a pool of four hypovirulent isolates, dsRNA was extracted, cDNA synthesized, and a library subjected to next-generation sequencing. The bioinformatics analysis allowed detecting and reconstructing the complete genome of Cryphonectria hypovirus 1 (CHV-1), denoted as CHV-1 Marche. When compared with the available genomes of other hypoviruses that affected the virulence of C. parasitica, available in databases, CHV-1 Marche showed some nucleotide diversity. The approach used in this study was effective to explore the virome inside a pool of hypovirulent C. parasitica isolates. Next-generation sequencing allowed us to exclude the presence of any other ssRNA and dsRNA viruses infecting the fungus and determine CHV-1 as the only responsible of hypovirulence of C. parasitica in the analyzed samples.
A Purpose-Driven Fourth Year of Medical School
Authors: Dewan Mantosh , Norcini John
Published: October 2017

The fourth year of medical school has been repeatedly found to be ineffective, and concerns exist about its purpose and academic quality, as well as grade inflation. Since Flexner, the purpose of undergraduate medical training has moved from readiness for independent practice to readiness for postgraduate training. However, training directors report that medical graduates are inadequately prepared to enter residency. The authors propose a fourth year with two components: first, a yearlong, longitudinal ambulatory experience of at least three days each week on an interprofessional team with consistent faculty supervision and mentoring, increasing independence, and a focus on education; and second, rigorous clinical-scales-based assessment of meaningful outcomes.

In the proposed model, the medical student has generous time with a limited panel of patients, and increasing autonomy, with faculty moving from supervising physicians to collaborating physicians. There is regular assessment and formative feedback. This more independent, longitudinal clinical experience uniquely allows assessment of the most meaningful work-based performance outcomes—that is, patient outcomes assessed by validated clinical scales. The proposed fourth year will require a realignment of resources and faculty time; however, models already exist. Barriers and possible solutions are discussed.

A purpose-driven, assessment-rich fourth year with patient and supervisor continuity will provide real-world experience, making medical graduates more competent and confident on the first day of residency. Use of clinical scales will also allow educators new confidence that the performance-based competence of these more experienced and expert graduates leads to demonstrable collaboration, healing, and good patient outcomes.
Pan-tibial avascular necrosis in a 12-year-old boy: a case report
Authors: Gopinathan Nirmal R. , Saibaba Balaji , Santhanam Siva S. , Syam Kevin
Published: October 2017

We report a unique case of post-traumatic avascular necrosis of tibia in a 12-year-old boy following a Salter–Harris type II physeal injury of the proximal tibia. The diagnosis was made on the basis of classical radiological findings. The only clinical symptom was diffuse shin pain. The patient was managed conservatively. At our 2-year follow-up, there was clinical and radiological evidence of spontaneous resolution of avascular necrosis, but with sequelae. The child developed a limb-length discrepancy and genu valgum. The parents of the child refused further treatment.
Intraobserver and Interobserver Reliability of Radiographic Analysis of Proximal Humerus Fractures in Adolescents
Authors: Burke Michelle C. , Minnock Christopher , Robbins Christopher B. , Abbott Matthew D. , Caird Michelle S. , Farley Frances A. , Kirsch Jacob , Thomas Jared , Li Ying
Published: October 2017

Background:

Multiple studies have shown low intrarater and interrater agreement of radiographic classification systems for proximal humerus fractures (PHFs) in adults. There is no standardized method of measuring angulation of pediatric PHFs, nor is there consensus as to the amount of angulation and displacement that require operative fixation of adolescent PHFs. We propose a new standardized method to measure fracture angulation that is similar to the method used to measure the epiphyseal-shaft angle for slipped capital femoral epiphysis. The primary purpose of this study was to evaluate the intraobserver and interobserver reliability of our proposed method compared with a nonstandardized method. The secondary purpose was to evaluate the intrarater and interrater agreement of the Neer and Horowitz (NH), and Salter-Harris (SH) classification systems.

Methods:

Seven raters evaluated 26 deidentified anteroposterior shoulder radiographs of patients 10 to 16 years of age with PHFs. Raters classified each fracture using the NH and SH systems, and used their own method to measure fracture angulation. This process was repeated 2 weeks later. During the second round, raters also measured fracture angulation using our proposed standardized method. Two weeks after the second round, raters reevaluated the radiographs using the standardized method. Intraclass correlation coefficients were calculated.

Results:

Excellent intraobserver and interobserver agreement was achieved for the standardized method of measuring fracture angulation. All of the raters had an intrarater reliability classified as excellent (>0.80) using the standardized method. Good intrarater and excellent interrater agreement was achieved when raters used their own fracture angulation measurement method but wide confidence intervals suggested that the results were less precise. Fair to moderate intrarater and interrater reliability was seen for the NH and SH classifications.

Conclusions:

Our standardized method for measuring angulation in adolescent PHFs demonstrated excellent intrarater and interrater reliability. We propose that this technique may be a more precise method of measuring fracture angulation and this method should be used in future studies that evaluate indications for operative management of adolescent PHFs.

Level of Evidence:

Level III—diagnostic.
Intracorneal pustular drug eruption, a novel cutaneous adverse event in anti-programmed cell death-1 patients that highlights the effect of anti-programmed cell death-1 in neutrophils
Authors: Zhao Cathy Yunjia , Consuegra Germana , Chou Shaun , Fernández-Peñas Pablo
Published: October 2017

The introduction of anti-programmed cell death-1 (anti-PD1) monoclonal antibodies has revolutionized the treatment of various advanced malignancies. Despite its efficacy, anti-PD1 therapy is accompanied by a variety of cutaneous adverse events. A 79-year-old man developed erythematous scaly plaques and pustules of the forehead, legs and arms after four cycles of nivolumab infusions every 2 weeks. Histology showed intracorneal pustules with dermal neutrophils and eosinophils. He was treated successfully with topical corticosteroids without discontinuation of nivolumab. We report subcorneal pustular eruption as a novel cutaneous adverse event in patients on anti-PD1 therapy. Other neutrophilic eruptions (psoriasis, Sweet’s syndrome, acute generalized pustulosis) have been reported in patients on anti-PD1 treatments, suggesting the neutrophil as another cell type modulated by anti-PD1 antibodies.
It's in Your Hands
Authors: Chandonnet Celeste J. , Boutwell Kristan M. , Spigel Nadine , Carter Judith , DeGrazia Michele , Ozonoff Al , Flaherty Kathleen
Published: October 2017

Background:

Health care–associated infections contribute to increased morbidity and mortality, increased resource use, higher costs, and extended hospitalizations. Proper hand hygiene (HH) is essential to health care–associated infection prevention. Low compliance among parents in our neonatal intensive care unit (NICU) was identified and prompted development of an HH initiative.

Objective:

The objective of this quality improvement project was to improve parent HH practices with the ultimate goal of achieving 100% compliance with parent HH.

Methods:

Between December 2011 and November 2014, our NICU Infection Prevention Committee developed and implemented the parent/family HH initiative entitled “It's in Your Hands” and created learning materials based on the World Health Organization and Centers for Disease Control and Prevention recommendations. Materials included information sheets, posters, stickers, and checklists. Audits, based on the World Health Organization's Five Moments for Hand Hygiene, were performed several times per week to monitor compliance.

Results:

Before the intervention, only 71% (n = 1143) of all observed parents and family members performed proper HH. After the intervention, proper HH increased to 89% (n = 939). An average compliance of 89% was maintained throughout the intervention phase.

Discussion:

This initiative led to sustained improvements in HH compliance among NICU parents. It has empowered parents to speak up and request proper HH from health care providers when interacting with their child. This initiative has been adopted as a hospital-wide standard of care.
Validated LC-MS/MS Method for the Simultaneous Determination of Amlodipine and Its Major Metabolites in Human Plasma of Hypertensive Patients
Authors: Taguchi Reina , Naito Takafumi , Sato Hikaru , Kawakami Junichi
Published: October 2017

Background:

No information on the pharmacokinetic characteristics of amlodipine (AML) metabolites is available. This study aimed to develop a method based on isocratic liquid chromatography coupled to tandem mass spectrometry for the simultaneous determination of AML and its 2 major metabolites, dehydroamlodipine (DH-AML) and O-des[2-aminoethyl]-O-carboxymethyl DH-AML (CM-DH-AML), and to use it for monitoring this drug in hypertensive patients.

Methods:

Acetonitrile-deproteinized plasma specimens were separated using an octadecyl-silica column (3-μm particle size) with a mobile phase consisting of 50% methanol containing 0.15% of formic acid in water. The run time was 9 minutes. The mass spectrometer was run in the positive ion electrospray ionization mode. This method was applied for the determination of AML and its metabolites in plasma samples from patients treated with this drug.

Results:

The calibration curves in human plasma of AML, DH-AML, and CM-DH-AML were linear over the concentration ranges of 0.5–64, 1–64, and 0.5–64 ng/mL, respectively, and their lower limits of quantification were 0.5, 1, and 0.5 ng/mL, respectively. Their extraction recovery rates and matrix factors in human plasma were 94.8%–109.0% and 97.0%–101.4%, respectively. The intra-assay and interassay imprecisions and accuracies were within 10.8% and 95.4%–111.2%, respectively. The plasma concentration ranges of AML, DH-AML, and CM-DH-AML were 6.5–20.9, 1.4–10.9, and 5.6–38.3 ng/mL, respectively.

Conclusions:

The present method with acceptable analytical performance can be helpful for monitoring the plasma concentration of AML, including the determination of its metabolites in patients with hypertension.
EFFECT OF PATIENTS' CLINICAL INFORMATION ON THE DIAGNOSIS OF AND DECISION TO TREAT RETINOPATHY OF PREMATURITY
Authors: Gschlieber Andreas , Stifter Eva , Neumayer Thomas , Moser Elisabeth , Papp Andrea , Pircher Niklas , Dorner Guido , Egger Stefan , Vukojević Nenad , Oberacher-Velten Isabel , Schmidt-Erfurth Ursula
Published: October 2017

Purpose:

To evaluate the effect of patients' clinical information on experts' diagnoses of retinopathy of prematurity (ROP) and decisions to treat.

Methods:

Seven experts assessed wide-field fundus photographs of eyes of 52 premature infants of ≤30 weeks' gestational age or ≤1,500 g birthweight (BW) for ROP diagnosis (stage, plus disease, and aggressive posterior ROP) and the necessity for treatment for 2 days. On Day 1, they were masked to all patient data. On Day 2, they were given information on gestational age and BW.

Results:

A significant shift in the experts' ratings toward a less aggressive ROP grading stage (P = 0.006) and less frequent decision for intervention (P = 0.021) was observed after receipt of patients' clinical information. This was truer for heavier/less premature infants (gestational age ≥ 28 0/7 weeks or BW ≥ 900 g) than those with very low BWs/high prematurity (gestational age < 24 0/7 weeks or BW < 600 g) (ROP stage P = 0.009 vs. P = 0.399, treatment decision P = 0.022 vs. P = 0.648).

Conclusion:

These results suggest knowledge of patients' clinical information influences the grading of ROP disease and decision for treatment. Retinopathy of prematurity staging seemed to be set at a lower level and the decision for treatment at a higher threshold for heavier/less premature babies. Our findings may have implications for further refinements in ROP assessment.
INTRAVITREAL INJECTION OF AIR FOR THE TREATMENT OF VITREOMACULAR TRACTION
Authors: Primavera Vito , Agea Luciana , Cicinelli Maria Vittoria , Centoducati Teresa , Alessio Giovanni , Querques Giuseppe
Published: October 2017

Purpose:

To study the efficacy of a single intravitreal injection of air as a valuable alternative to current treatment options (conservative, pharmacological, and surgical) in patients with symptomatic, focal vitreomacular traction.

Methods:

Interventional, nonrandomized clinical study including a consecutive series of patients who underwent a single injection of 0.3 mL of air for vitreomacular traction. Each patient underwent best-corrected visual acuity, and spectral domain optical coherence tomography before and after the procedure. Mean maximal horizontal vitreomacular adhesion and a maximal foveal thickness were measured manually.

Results:

Four eyes of four patients, all males, were included in the study. Mean age was 71 ± 6.7 years; mean best-corrected visual acuity was 0.3 ± 0.08 logarithm of the minimum angle of resolution (logMAR) (20/40 Snellen equivalent). One month following treatment, complete resolution of vitreomacular traction was achieved in 100% of eyes. Mean visual acuity postinjection was 0.18 ± 0.09 logMAR (20/32 Snellen equivalent) (Student's t test for repeated measures P = 0.03). No correlation has been found between horizontal vitreomacular adhesion and best-corrected visual acuity or maximal foveal thickness and best-corrected visual acuity (P = 0.7 and P = 0.9, respectively).

Conclusion:

Intravitreal injection of air could offer a minimally invasive, low-cost alternative treatment in patients with symptomatic, persisting vitreomacular traction. Additional studies on a larger number of patients are required.
Amniotic Membrane Grafts to Reduce Pterygium Recurrence
Authors: Rosen Ronald
Published: October 2017

Purpose:

To demonstrate the long-term outcome of pterygium surgery with adjunctive amniotic membrane transplantation (AMT) and intraoperative mitomycin C (MMC) in a large case series.

Methods:

Medical records were retrieved for this noncomparative retrospective study of all patients who had pterygium excision with adjunctive AMT and intraoperative MMC, from October 2010 to June 2016 with at least 6 months of follow-up.

Results:

There were a total of 556 eyes of 535 patients (291 males and 244 females) with average age of 51.9 ± 13 years who had pterygium excision (527 primary and 29 recurrent). For an average follow-up period of 17.3 ± 0.8 months (range 6–74 months), corneal recurrence occurred in 20 eyes (3.6%) and conjunctival recurrence in 12 (2.2%) in a total of 32 eyes (5.8%). Eleven eyes (2%) underwent reoperation. Other complications included granuloma (0.5%), diplopia (1.1%), and steroid-induced ocular hypertension (4.3%).

Conclusions:

Adjunctive use of AMT and short exposure of MMC can reduce recurrence after pterygium surgery. The procedure is less tedious and less time consuming, resulting in early recovery while saving the conjunctiva for future surgeries.
Measurement of Optic Disc Cup Surface Depth Using Cirrus HD-OCT
Authors: Kim Young Kook , Ha Ahnul , Lee Won June , Jeoung Jin Wook , Park Ki Ho
Published: October 2017

Purpose:

To introduce the measurement method of optic disc cup surface depth using spectral-domain optical coherence tomography (SD-OCT) and then evaluate the rates of cup surface depression at 3 different stages of glaucoma.

Materials and Methods:

We retrospectively identified 52 eyes with preperimetric glaucoma, 56 with mild-or-moderate glaucoma and 50 with severe glaucoma and followed them for at least 48 months. Eyes were imaged using SD-OCT (Cirrus HD-OCT) at 12-month intervals. The mean cup surface depth was calculated using the following formula: Cup volume/(disc area×average cup-to-disc ratio2)−200 μm.

Results:

The rates of mean cup surface depression (μm/y) were significantly greater in mild-or-moderate glaucoma (−7.96±1.03) than in preperimetric (−3.11±0.61) and severe glaucoma (−0.70±0.12; all P<0.001). The percentile rates of mean cup surface depression (%/y) were significantly greater than those of average of retinal nerve fiber layer (RNFL) thinning (%/y) in preperimetric glaucoma (−1.64±0.12 vs. −1.11±0.07; P<0.001) and mild-or-moderate glaucoma (−4.20±0.33 vs. −3.14±0.19; P<0.001); and conversely, in severe glaucoma, mean cup surface depth changed slower than did average RNFL thickness (−0.64±0.06 vs. −0.75±0.08%/y; P<0.001).

Conclusions:

In early-to-moderate glaucoma, the cup surface depth changed faster than did the RNFL thickness. These results signify the possibility that SD-OCT–based estimation of cup surface depth might be useful for monitoring of glaucoma development and progression.
Would Parents Consent to a Comparative Effectiveness Trial of Oral Doxycycline Versus Intravenous Ceftriaxone for the Treatment of Children with Lyme Meningitis?
Authors: Garro Aris , Koster Michael , LaRue Molly , Hipolito Evelyn , Congdon Elizabeth , Burnett Kathleen , Cullen Nicole , Nigrovic Lise E.
Published: October 2017

Children with Lyme meningitis are often treated with intravenous ceftriaxone, although oral doxycycline may be effective. Parents were surveyed after observing a video describing a hypothetical Lyme meningitis treatment trial. Eighty-four of 102 (82%) would consent to their child participating. Parents would accept 2 additional days of symptoms (noninferiority margin) with doxycycline even if ceftriaxone hastened symptom resolution.
Late Reduction of Cocaine Cravings in a Randomized, Double-Blind Trial of Aripiprazole vs Perphenazine in Schizophrenia and Comorbid Cocaine Dependence
Authors: Beresford Thomas , Buchanan Jennifer , Thumm Elizabeth Brie , Emrick Chad , Weitzenkamp David , Ronan Patrick J.
Published: October 2017

Purpose

Co-occurring schizophrenia spectrum disorder andInternational Statistical Classification of Diseases, 10th Revisioncocaine dependence present a particularly destructive constellation that is often difficult to treat. Both conditions raise dopamine transmission effects in the brain. Traditional neuroleptics block dopamine receptors, whereas aripiprazole modulates dopamine activity as an agonist/antagonist. We tested whether dopamine modulation is superior to dopamine blocking in dual-diagnosis patients.

Methods

In a randomized, double-blind, comparison design, cocaine-dependent schizophrenic subjects actively using cocaine received either aripiprazole or perphenazine in an 8-week trial. Primary outcome targeted cocaine-free urine sample proportions, whereas cocaine craving scores were a secondary variable.

Results

Subjects (N = 44) randomized (n = 22 per group) did not differ at baseline. The proportion of cocaine-free urine samples did not differ by medication group. Contrasting weeks 3 to 5 vs 6 to 8 revealed significant late reductions in craving with aripiprazole. On the respective 5-point subscales, craving intensity decreased by 1.53 ± 0.43 (P< 0.0005) points, craving frequency by 1.4 ± 0.40 (P> 0.0004) points, and craving duration by 1.76 ± 0.44 (P> 0.0001) points.

Conclusions

A drug effect of aripiprazole on craving items appeared at week 6 of treatment, on average, and was not seen before that length of drug exposure. The data suggest that dopamine modulation reduces cocaine cravings but requires an acclimation period. To understand the mechanism of action better, a trial of depot aripiprazole may be useful. Clinically, a reduction in craving potentially offers a clearer focus for ongoing behavioral treatment. It may also offer a longer-term treatment effect with respect to the severity of relapse.
S100P in Duodenal Fluid Is a Useful Diagnostic Marker for Pancreatic Ductal Adenocarcinoma
Authors: Matsunaga Taketo , Ohtsuka Takao , Asano Koichi , Kimura Hideyo , Ohuchida Kenoki , Kitada Hidehisa , Ideno Noboru , Mori Yasuhisa , Tokunaga Shoji , Oda Yoshinao , Guha Sushovan , Raimondo Massimo , Nakamura Masafumi , Tanaka Masao
Published: October 2017

Objectives

The development of an effective screening method for pancreatic ductal adenocarcinoma (PDAC) is of paramount importance. This study assessed the diagnostic utility in pancreatic diseases of duodenal markers during upper gastrointestinal endoscopy (GIE) or endoscopic ultrasonography.

Methods

This study prospectively enrolled 299 consecutive participants, including 94 patients with PDACs, 144 patients with other pancreatic diseases, and 61 normal individuals as control subjects. All subjects underwent upper GIE or endoscopic ultrasonography either at Kyushu University Hospital (Fukuoka, Japan) or the Mayo Clinic (Jacksonville, Fla) from October 2011 to July 2014. Duodenal fluid (DF) was collected without secretin stimulation and of carcinoembryonic antigen and S100 calcium-binding protein P (S100P) concentrations were measured.

Results

Concentrations of S100P in DF were significantly higher in patients with PDAC and chronic pancreatitis than in control subjects (P < 0.01). A logistic regression model that included age found that the sensitivity and specificity of S100P concentration in diagnosing stages 0/IA/IB/IIA PDAC were 85% and 77%, respectively, with an area under the receiver operating characteristic curve of 0.82. Carcinoembryonic antigen concentrations in DF of patients with pancreatic disease did not differ significantly from control subjects.

Conclusions

Analysis of S100P concentration in DF, in combination with routine screening upper GIE, may facilitate the detection of PDAC.
Pediatric Weight Errors and Resultant Medication Dosing Errors in the Emergency Department
Authors: Hirata Kristin M. , Kang Ann H. , Ramirez Gina V. , Kimata Chieko , Yamamoto Loren G.
Published: October 2017

Background

An accurate weight is critical for dosing medications in children. Weight errors can lead to medication-dosing errors.

Objectives

This study examined the frequency and consequences of weight errors occurring at 1 children's hospital and 2 general hospitals.

Methods

Using an electronic medical record database, 79,000 emergency department encounters of children younger than 5 years were analyzed. Extreme weights were first identified using weight percentiles. Encounters with potential weight errors were further evaluated using a retrospective chart review to determine whether a weight error and medication-dosing error occurred.

Results

The percentage of weight errors of total encounters at all 3 institutions was low (0.63% on average), but a large proportion of weight errors led to subsequent medication-dosing errors (34% on average). The children's hospital did not have clinically significantly lower occurrences of weight errors or weight-based medication errors. Common weight errors included the weight in pounds being substituted for the weight in kilograms and decimal placement errors.

Conclusions

Weight errors were uncommon at the 3 emergency departments that we studied, but they led to weight-based medication-dosing errors that had the potential to cause harm.
Research on Somatization and Somatic Symptom Disorders: Ars longa, vita brevis
Authors: Dimsdale Joel E.
Published: October 2017

The new Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition defines somatic symptom and related disorders as long-standing somatic symptoms that are associated with disproportionate thoughts, feelings, and behaviors, irrespective of whether or not a medical cause for these symptoms can be determined. In this Special Section of Psychosomatic Medicine, several articles address diagnostic issues and the central nervous system correlates of somatic symptom and related disorder and document new developments in its treatment.
Diagnostic Value of Magnetic Resonance Neurography in Cervical Radiculopathy
Authors: Schwarz Daniel , Kele Henrich , Kronlage Moritz , Godel Tim , Hilgenfeld Tim , Bendszus Martin , Bäumer Philipp
Published: October 2017

Objective

The aim of this study was to assess the imaging appearance and diagnostic value of plexus and peripheral nerve magnetic resonance neurography (MRN) in cervical radiculopathy.

Materials and Methods

This prospective study was approved by our institutional ethics committee and written informed consent was obtained from all participants. A total of 24 patients were included with a diagnosis of cervical radiculopathy based on clinical examination, supporting electrophysiological examinations and spinal imaging consistent with the clinical syndrome. All patients then underwent a high-resolution MRN protocol including the brachial plexus from nerve roots to plexus cords using a 3-dimensional turbo spin echo with variable flip angle short tau inversion recovery and sagittal-oblique T2-weighted spectral adiabatic inversion recovery sequence, and ulnar, median, and radial nerves at the upper arm and elbow in T2-weighted fat saturated sequences. Two readers independently rated plexus elements regarding the presence of lesions at neuroforaminal levels, roots, trunks, and cord segments. Median, ulnar, and radial nerves were likewise rated. Findings were then compared to a referenced standard of cervical radiculopathy that was defined as the combined diagnosis of clinical syndrome including supporting electrophysiological exams and matching positive spinal imaging, and diagnostic performance parameters were calculated. Additional quantitative and qualitative analysis assessed peripheral nerve caliber and normalized T2-signal at arm level in cervical radiculopathy and compared them to 25 inflammatory neuropathy controls.

Results

Cervical radiculopathy resulted in distinct plexus lesion patterns for each level of neuroforaminal stenosis. Overall, brachial plexus MRN in cervical radiculopathy reached a sensitivity of 81%, a specificity of 96%, a positive predictive value of 87%, and overall diagnostic accuracy of 87%. Initial spinal magnetic resonance imaging showed multiple positive findings for clinically unaffected root levels and resulted in a specificity of 69%, a positive predictive value of 54%, and an overall diagnostic accuracy of 78%.

T2-weighted peripheral nerve lesions were detected in 79% of cervical radiculopathy cases and imitated imaging appearance of inflammatory neuropathies both quantitatively and qualitatively.

Conclusions

Complementing spine imaging in cervical radiculopathy with brachial plexus MRN can improve diagnostic accuracy by increasing specificity and positive predictive value. T2-weighted lesions of peripheral nerves can be caused by cervical radiculopathy, which must be considered a relevant diagnostic pitfall in MRN of peripheral neuropathies.
Operationalizing Healthcare Simulation Psychological Safety
Authors: Henricksen Jared W. , Altenburg Catherine , Reeder Ron W.
Published: October 2017

Introduction

Despite efforts to prepare a psychologically safe environment, simulation participants are occasionally psychologically distressed. Instructing simulation educators about participant psychological risks and having a participant psychological distress action plan available to simulation educators may assist them as they seek to keep all participants psychologically safe.

Methods

A Simulation Participant Psychological Safety Algorithm was designed to aid simulation educators as they debrief simulation participants perceived to have psychological distress and categorize these events as mild (level 1), moderate (level 2), or severe (level 3). A prebrief dedicated to creating a psychologically safe learning environment was held constant. The algorithm was used for 18 months in an active pediatric simulation program. Data collected included level of participant psychological distress as perceived and categorized by the simulation team using the algorithm, type of simulation that participants went through, who debriefed, and timing of when psychological distress was perceived to occur during the simulation session. The Kruskal-Wallis test was used to evaluate the relationship between events and simulation type, events and simulation educator team who debriefed, and timing of event during the simulation session.

Results

A total of 3900 participants went through 399 simulation sessions between August 1, 2014, and January 26, 2016. Thirty-four (<1%) simulation participants from 27 sessions (7%) were perceived to have an event. One participant was perceived to have a severe (level 3) psychological distress event. Events occurred more commonly in high-intensity simulations, with novice learners and with specific educator teams. Simulation type and simulation educator team were associated with occurrence of events (P < 0.001). There was no association between event timing and event level.

Conclusions

Severe psychological distress as categorized by simulation personnel using the Simulation Participant Psychological Safety Algorithm is rare, with mild and moderate events being more common. The algorithm was used to teach simulation educators how to assist a participant who may be psychologically distressed and document perceived event severity.
Exposure to Simulated Mortality Affects Resident Performance During Assessment Scenarios
Authors: Goldberg Andrew , Samuelson Stefan , Khelemsky Yury , Katz Daniel , Weinberg Alan , Levine Adam , Demaria Samuel
Published: October 2017

Background

The utility of simulated mortality remains controversial in the literature. We therefore sought primarily to determine whether there was a difference in performance for residents exposed to varying levels of simulated mortality during training scenarios. As a secondary objective, we also sought to determine whether their self-reported anxiety levels, attitudes toward, and engagement in the simulated encounters differed based on group assignment.

Methods

Fifty junior anesthesiology residents were randomized to one of the three simulation cohorts. The residents were broken into groups that either always experienced simulated patient survival (never death), always experienced simulated mortality (always death), or had a variable result based on performance (variable death). All residents experienced 12 identical training simulations with only the predetermined outcome as the variable. Residents were brought back 6 weeks after initial training for four assessment scenarios and subsequently rated on nontechnical skills and anxiety levels.

Results

Residents in the always and never death groups showed no difference in nontechnical skills using the Anesthetists' Nontechnical Skills Score before and after the simulations. Residents in the variable death group, however, had improved nontechnical skill scores when brought back for the assessment (45.2 vs 41.5 and 42.9 respectively, P = 0.01). Although all three groups had higher State-Trait Anxiety Index scores from baseline after training, only the always death group had higher anxiety scores during the assessment (43 vs 37 vs 37 P = 0.008).

Conclusions

We found that participants who experienced simulated mortality that was variably delivered, and more directly related to performance, performed better on later assessment scenarios.
Laparoscopic Appendectomy in Pregnancy With Acute Appendicitis: Single Center Experience With World Review
Authors: Maimaiti Abudukaiyoumu , Aierkin Amina , Mahmood Khan Muddassar , Apaer Shadike , Maimaiti Yilihamu , Yibulayin Xiaokaiti , Li Tao , Zhao Jin-Ming , Tuxun Tuerhongjiang
Published: October 2017

Objectives:

This clinical study is aiming to discuss the therapeutic benefit of laparoscopic appendectomy (LA) by comparing with conventional open appendectomy (OA) in pregnancy.

Materials and Methods:

The clinical data of 26 pregnant women who underwent appendectomy from 2012 to 2016 was retrospectively analyzed. The variables analyzed included baseline information, operation characteristics, maternal complications, and infant health outcomes. The patients were divided in 2 LA and OA groups according to the surgical approach and their clinical characteristics were compared.

Results:

Of reported 26 patients, 7 underwent LA whereas the remaining 19 patients underwent OA. The median age of the patients was 28 years (range, 19 to 39 y). The median gestational period was 21.5 weeks (range, 5 to 33 wk). The postoperative pathology showed complicated appendicitis 7 cases. The result showed significantly shorter operation time (42.14±8.63 vs. 65.21±26.58 min, P=0.003), hospital stay (4.14±1.77 vs. 6.47±2.72 d, P=0.021), and earlier recovery of gastrointestinal function in the LA group compared with OA group. There were no maternal and fetal deaths occurred in perioperative period in both groups.

Conclusions:

LA has not increased morbidity and mortality but displayed shorter hospital stay, operation time and recovery of gastrointestinal function to OA as well as good cosmetic results. Therefore, LA in patients with pregnancy can be considered as preferred approach in sophisticated hands without increased risks.
Parvovirus B19 in the Context of Hematopoietic Stem Cell Transplantation: Evaluating Cell Donors and Recipients
Authors: Gama Bianca E. , Emmel Vanessa E. , Oliveira-Silva Michelle , Gutiyama Luciana M. , Arcuri Leonardo , Colares Marta , de Cássia Tavares Rita , Bouzas Luis F. , Abdelhay Eliana , Hassan Rocio
Published: October 2017

Background

Parvovirus B19 (B19V) is a common human pathogen, member of the family Parvoviridae. Typically, B19V has been found to infect erythroid progenitors and cause hematological disorders, such as anemia and aplastic crisis. However, the persistence of genomic deoxyribonucleic acid (DNA) has been demonstrated in tonsils, liver, skin, brain, synovial, and testicular tissues as well as bone marrow, for both symptomatic and asymptomatic subjects. Although the molecular and cellular mechanisms of persistence remain undefined, it raises questions about potential virus transmissibility and its effects in the context of allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients.

Methods

With this aim, we retrospectively screened allogeneic stem cell donors from 173 patients admitted for allo-HSCT from January 2008 to May 2013 using a seminested polymerase chain reaction approach.

Results

We found 8 positive donor samples, yielding a 4.6% of parvovirus prevalence (95% confidence interval, 2.36-8.85). Pre- and post-HSCT samples (n = 51) from the 8 recipients of the positive donors were also investigated, and 1 case exhibited B19V DNA in the post-HSCT follow-up (D + 60). Direct DNA sequencing was performed to determine the genotype of isolates and classification, performed by phylogenetic reconstruction, showed a predominance of genotype 1a, whereas the rare genotype 3b was detected in 2 additional patients. By molecular cloning, different B19V 1a substrains polymorphisms were evidenced in the single case in which donor and its recipient were B19V+.

Conclusions

Our results suggest that HSCT allografts are not a main source for B19V transmission, pointing to potential events of reinfection or endogenous viral reactivation.
Electroconvulsive Therapy in a Patient With a Recent Subarachnoid Hemorrhage
Authors: Doddi Seshagiri Rao , Lotz Matthew , Regenold William T. , Adler Lawrence
Published: October 2017

The safety of electroconvulsive therapy (ECT) is improving with advances in anesthesia and ECT technique. There are published case reports of successful treatment of depression in patients who were once considered at high medical risk. Recent cerebral hemorrhage is one of the conditions considered to significantly increase the risk of ECT treatment. Literature search did not indicate any case reports of ECT treatment in patients with recent subarachnoid hemorrhage. We report the successful ECT treatment of depression in an older man who had developed a subarachnoid hemorrhage after a suicide attempt by ingestion of antifreeze.
Short-term stabilities of 21 amino acids in dried blood spots
Authors: Han Jun , Higgins Rehan , Lim Mark D. , Lin Karen , Yang Juncong , Borchers Christoph H.
Published: October 2017

BACKGROUND

Dried blood spots (DBSs) have potential use in remote health applications for individual and population diagnosis, and can enable epidemiological surveillance for known and unknown diseases. The preparation and transportation of DBSs from remote settings often exposes these cards to extreme environmental stress that may impact the quality of the diagnostic data. Given these risks, it is essential to investigate the individual stabilities of biomarkers in DBSs. This paper details the stability of routinely-analyzed amino acids (AAs) on DBSs under environmental conditions that simulate a global health workflow.

METHODS

The extractions of 21 AAs from three sets of DBSs prepared on cellulose and cotton filter paper were optimized for quantitation by dansylation-UPLC/MRM-MS. The effects of sunlight exposure, temperature, humidity, and storage time were studied.

RESULTS

The AAs were stable in DBSs after 4-hour sunlight exposure, and after storage at -20 and 4 °C for 30 days. At 25 and 40 °C, only 7 AAs showed significant concentration decreases over time, while 2 showed concentration increases. The changes were accelerated by high humidity. Histidine was the least stable AA under the conditions tested.

CONCLUSIONS

This study provides quantitative data on the short-term stabilities of 21 AAs in DBSs on cellulose and cotton-based filter paper, under environmental conditions that simulate a global-health workflow. These results highlight the importance of assessing the stability of clinically-relevant biomarkers in DBSs. Based on the measured stabilities, we recommend that higher-temperature and high-humidity storage of DBS samples be avoided for AA analysis in remote health applications.