bluuebunny/crossref_metadata_2025 huggingface dataset:
Endoscopic Infracochlear Approach for Drainage of Petrous Apex Cholesterol Granulomas: A Case Series
Authors: Wick Cameron C. , Hansen Alexander R. , Kutz Joe Walter , Isaacson Brandon
Published: May 2017

Objective:

To describe the feasibility and technical nuances of a transcanal endoscopic infracochlear approach for drainage of petrous apex cholesterol granulomas.

Study Design:

Retrospective case review.

Setting:

Tertiary care university hospital.

Patients:

A 32-year-old man with bilateral petrous apex cholesterol granulomas and a 54-year-old man with a left-sided petrous apex granuloma each with symptoms necessitating surgical intervention.

Interventions:

Transcanal endoscopic infracochlear approach for drainage of the cholesterol granulomas.

Main Outcome Measures:

Operation efficacy, corridor size, and perioperative morbidity.

Results:

All three cholesterol granulomas were successful drained without violating the cochlea, jugular bulb, or carotid artery. The dimensions of the infracochlear surgical corridor measured 5 mm × 6 mm, 3.5 mm × 3.5 mm, and 6 mm × 4 mm, respectively. All corridors facilitated visualization within the cyst and allowed lyses of adhesions for additional cyst content eradication. All patients had resolution of their acute symptoms. Two of the three subjects had serviceable hearing before and after their procedures. One patient required revision surgery 2-months after their initial procedure secondary to recurrent symptoms from acute hemorrhage within the cyst cavity. The infracochlear tract in this patient was noted to be patent.

Conclusions:

A transcanal endoscopic infracochlear approach is feasible for the management of cholesterol granuloma. The surgical access was wide enough to introduce the endoscope into the petrous apex cavity in each case. Further studies are needed to compare the efficacy and perioperative morbidity versus the traditional postauricular transtemporal approaches.
Age-Related Increase in Blood Levels of Otolin-1 in Humans
Authors: Tabtabai Ryan , Haynes Laura , Kuchel George A. , Parham Kourosh
Published: May 2017

Objective:

To test the hypothesis that age-related demineralization of otoconia will result in an age-related increase in blood levels of otoconia matrix protein, otolin-1.

Study Design:

Cross-sectional observational clinical trial.

Setting:

Clinical research center.

Patients:

Seventy nine men and women ranging in age from 22 to 95 years old.

Interventions:

Diagnostic.

Main Outcome Measures:

Blood levels of otolin-1 in relation to age.

Results:

Levels of otolin-1 of subjects divided into four age groups (1: 20–30 [n = 20], 2: 50–65 [n = 20], 3: 66–80 [n = 20], 4: 81–95 [n = 19] years old) demonstrated an increasing trend with age. The difference between otolin levels of groups 2 and 3, as well as, (p = 0.04) and 2 and 4 (p = 0.031) were statistically significant, but there was no significant difference between the two oldest groups.

Conclusions:

Otolin-1 blood levels are significantly higher in patients older than 65 years of age. This is consistent with previous scanning electron microscopy findings of age-related otoconia degeneration and increased prevalence of benign paroxysmal positional vertigo (BPPV) with age. Normative data provided here can serve as important reference values against which levels from BPPV patients can be compared with further evaluate otolin-1 as a circulatory biomarker for otoconia degeneration.
Paget's Disease of the Temporal Bone: A Single-Institution Contemporary Review of 27 Patients
Authors: Deep Nicholas L. , Besch-Stokes Jake G. , Lane John I. , Driscoll Colin L. W. , Carlson Matthew L.
Published: May 2017

Objectives:

To report a contemporary review from a single-institution series on Paget's disease of the temporal bone (PDTB).

Study Design:

Retrospective chart review of patients evaluated from 1998 to 2016.

Setting:

Quaternary referral center.

Patients:

Patients with radiographically confirmed PDTB.

Main Outcome Measures:

Clinical, audiological, and radiological features and management strategies of PDTB.

Results:

A total of 50 temporal bones in 27 patients (15 men) were diagnosed with PDTB. Symptoms at presentation included hearing loss (n = 23, 85%), headache (n = 18, 67%), dizziness (n = 14, 52%), tinnitus (n = 5, 19%), chronic otitis media (n = 2, 7%), hemifacial spasm without facial paralysis (n = 1, 4%), multiple cranial neuropathies (n = 1, 4%), and neoplastic transformation (n = 1, 4%). Of the 23 ears with audiometric data available for review, 65% exhibited sensorineural hearing loss, and 35% mixed hearing loss. Long-term audiometric follow-up was available on two patients, both of whom demonstrated hearing loss at a rate greater than would be expected for normal aging. Two patients underwent successful cochlear implantation, achieving open-set speech recognition. Radiographic features of temporal bone involvement are reviewed and illustrated.

Conclusion:

This is the largest single-institution clinical series examining patients with PDTB in the English literature. Variable patterns of temporal bone involvement by Paget's disease are observed leading to a diverse set of clinical symptoms, including slowly progressive hearing loss, tinnitus, compressive cranial neuropathies, and benign or malignant tumorigenesis. Involvement typically begins in the petrous apex and progresses laterally. Otic capsule bone demineralization occurs late in the disease process. Cochlear implantation appears to be an effective management strategy for patients with severe-to-profound hearing loss.
Cochlear Implantation in Patients With Usher Syndrome Type IIa Increases Performance and Quality of Life
Authors: Hartel Bas P. , van Nierop Josephine W. I. , Huinck Wendy J. , Rotteveel Liselotte J. C. , Mylanus Emmanuel A. M. , Snik Ad F. , Kunst Henricus P. M. , Pennings Ronald J. E.
Published: May 2017

Objectives:

Usher syndrome type IIa (USH2a) is characterized by congenital moderate to severe hearing impairment and retinitis pigmentosa. Hearing rehabilitation starts in early childhood with the application of hearing aids. In some patients with USH2a, severe progression of hearing impairment leads to insufficient speech intelligibility with hearing aids and issues with adequate communication and safety. Cochlear implantation (CI) is the next step in rehabilitation of such patients. This study evaluates the performance and benefit of CI in patients with USH2a.

Design:

Retrospective case-control study to evaluate the performance and benefit of CI in 16 postlingually deaf adults (eight patients with USH2a and eight matched controls). Performance and benefit were evaluated by a speech intelligibility test and three quality-of-life questionnaires.

Results:

Patients with USH2a with a mean age of 59 years at implantation exhibited good performance after CI. The phoneme scores improved significantly from 41 to 87% in patients with USH2a (p = 0.02) and from 30 to 86% in the control group (p = 0.001). The results of the questionnaire survey demonstrated a clear benefit from CI. There were no differences in performance or benefit between patients with USH2a and control patients before and after CI.

Conclusions:

CI increases speech intelligibility and improves quality of life in patients with USH2a.
Serum inhibitory factor 1, high-density lipoprotein and cardiovascular diseases
Authors: Martinez Laurent O. , Genoux Annelise , Ferrières Jean , Duparc Thibaut , Perret Bertrand
Published: May 2017

Purpose of review

The atheroprotective properties of HDL are supported by epidemiological and preclinical research. However, the results of interventional trials paradoxically indicate that drugs increasing HDL-cholesterol (HDL-C) do not reduce coronary artery disease (CAD) risk. Moreover, Mendelian randomization studies have shown no effect of HDL-C-modifying variants on CAD outcome. Thus, the protective effects of HDL particles are more governed by their functional status than their cholesterol content. In this context, any successful clinical exploitation of HDL will depend on the identification of HDL-related biomarkers, better than HDL-C level, for assessing cardiovascular risk and monitoring responses to treatment.

Recent findings

Recent studies have enlightened the role of ecto-F1-ATPase as a cell surface receptor for apoA-I, the major apolipoprotein of HDL, involved in the important metabolic and vascular atheroprotective functions of HDL. In the light of these findings, the clinical relevance of ecto-F1-ATPase in humans has recently been supported by the identification of serum F1-ATPase inhibitor (IF1) as an independent determinant of HDL-C, CAD risk and cardiovascular mortality in CAD patients.

Serum IF1 measurement might be used as a novel HDL-related biomarker to better stratify risk in high-risk populations or to determine pharmacotherapy.
Immunohistochemical Characterization of the Origins of Metastatic Well-differentiated Neuroendocrine Tumors to the Liver
Authors: Yang Zhaohai , Klimstra David S. , Hruban Ralph H. , Tang Laura H.
Published: May 2017

Metastatic neoplasms of unknown primary site pose a major challenge to patient management. As targeted therapies are now being tailored to neuroendocrine tumors (NETs) of different primary sites, identifying the origin of metastatic NETs has become increasingly important. Compared with more extensive efforts on metastatic adenocarcinomas of unknown primary, the literature on metastatic NETs (often to the liver) is relatively sparse and most studies are based on primary tumors. We sought to study metastatic well-differentiated NETs to the liver to identify markers that predict the site of origin. Eighty-five metastatic NETs to the liver were retrieved from the pathology archive. The primary sites were determined based on either pathologic review of the primary tumors (in most cases) or radiologic/clinical findings. Immunohistochemical labeling for TTF1, CDX2, ISL1, NKX2.2, and PDX1 was performed on either tissue microarrays or whole sections. The primary sites of the NETs in the study cohort included: pancreas (35%), small intestine (32%), rectum (8%), stomach (2%), bile duct (1%), lung (9%), and unknown primary (12%). We found predominant expression of TTF1 in lung carcinoid (63%), CDX2 in small intestinal (89%) and ISL1 in pancreatic NETs (77%), respectively. NKX2.2 was mainly expressed in NETs of the digestive organs. PDX1 was detected in a small percentage of pancreatic, small intestinal and the single bile duct NET. There was no statistically significant association between tumor grade (World Health Organization G1 vs. G2) and the expression of any of the above markers. The 3-marker panel (TTF1, CDX2, and ISL1) had sensitivities of 81%, 89%, and 63%, specificities of 100%, 94%, and 100%, positive predictive values of 100%, 89%, and 100%, and negative predictive values of 84%, 94%, and 96% in separating metastatic NETs into 3 major primary sites: pancreas/rectum, small intestine, and lung, respectively, with an overall accuracy of 82%. Furthermore, this panel predicted a primary site for 6 of the 10 NETs of unknown primary, which reduced the NETs of unknown primary from 12% to 5%. Thus, through immunohistochemical study of a large series of metastatic NETs to the liver, we have demonstrated the utility of a 3-marker panel for the identification of one or more potential primary sites of most metastatic NETs, which could provide practical guidance in patient management.
MYB Labeling by Immunohistochemistry Is More Sensitive and Specific for Breast Adenoid Cystic Carcinoma than MYB Labeling by FISH
Authors: Poling Justin S. , Yonescu Raluca , Subhawong Andrea P. , Sharma Rajni , Argani Pedram , Ning Yi , Cimino-Mathews Ashley
Published: May 2017

Breast adenoid cystic carcinoma (ACC) is a primary breast carcinoma that, like salivary gland ACC, displays the t(6;9) translocation resulting in the MYB-NFIB gene fusion and immunopositivity for MYB by immunohistochemistry (IHC). However, it is not well established whether MYB immunoreactivity or rearrangement can be used to support a diagnosis of ACC in a malignant basaloid or benign cribriform breast lesion. Whole sections of primary breast ACC (n=11), collagenous spherulosis (CS; n=7), and microglandular adenosis (MGA; n=5) and tissue microarrays containing 16 basal-like, triple-negative breast carcinomas (TNBC) were labeled for MYB by IHC and underwent MYB fluorescence in situ hybridization using a break-apart probe. Strong, diffuse nuclear MYB labeling was seen in 100% ACC compared with no cases of basal-like TNBC, CS, or MGA (P=0.0001). Any degree of nuclear MYB labeling was seen in 100% ACC compared with 54% of all other cases (P=0.007), with any labeling seen in 71% CS, 63% basal-like TNBC, and 0% MGA. MYB rearrangement was detected in 89% (8/9) of evaluable ACC compared with 4% (1/26) of all other evaluable cases (P=0.0001), with a rearrangement detected in 1 (7%; n=1/15) evaluable basal-like TNBC. Strong, diffuse nuclear labeling for MYB is more sensitive than MYB fluorescence in situ hybridization for breast ACC and can be used to support a diagnosis of ACC in a cribriform or basaloid lesion in the breast. However, weak and focal labeling should be interpreted with caution as it can be seen in other benign cribriform and malignant basaloid lesions.
Metrics to Assess Extracorporeal Membrane Oxygenation Utilization in Pediatric Cardiac Surgery Programs*
Authors: Bratton Susan L. , Chan Titus , Barrett Cindy S. , Wilkes Jacob , Ibsen Laura M. , Thiagarajan Ravi R.
Published: May 2017

Objectives:

Only a small fraction of pediatric cardiac surgical patients are supported with extracorporeal membrane oxygenation following cardiac surgery, but extracorporeal membrane oxygenation use is more common among those undergoing higher complexity surgery. We evaluated extracorporeal membrane oxygenation metrics indexed to annual cardiac surgical volume to better understand extracorporeal membrane oxygenation use among U.S. cardiac surgical programs.

Design:

Retrospective analysis

Setting:

Forty-three U.S. Children’s Hospitals in the Pediatric Health Information System that performed cardiac surgery and used extracorporeal membrane oxygenation.

Patients:

All patients (< 19 yr) undergoing cardiac surgery during January 2003 to July 2014.

Interventions:

None.

Measurements and Main Results:

Both extracorporeal membrane oxygenation use and surgical mortality were risk adjusted using Risk Adjustment for Congenital Heart Surgery 1. Extracorporeal membrane oxygenation metrics indexed to annual cardiac surgery cases were calculated for each hospital and the metric values divided into quintiles for comparison across hospitals. Among 131,786 cardiac surgical patients, 3,782 (2.9%) received extracorporeal membrane oxygenation. Median case mix adjusted rate of extracorporeal membrane oxygenation use was 2.8% (interquartile range, 1.6–3.4%). Median pediatric cardiac case mix adjusted surgical mortality was 3.5%. Extracorporeal membrane oxygenation-associated surgical mortality was 1.3% (interquartile range, 0.7–1.6%); without extracorporeal membrane oxygenation, median case mix adjusted surgical mortality would increase from 3.5% to 5.0%. Among patients who died, 36.7% (median) were supported with extracorporeal membrane oxygenation. The median reduction in case mix adjusted surgical mortality from extracorporeal membrane oxygenation surgical survival was 30.1%. The median extracorporeal membrane oxygenation free surgical survival was 95% (interquartile range, 94–96%). Centers with less than 150 annual surgical cases had significantly lower median extracorporeal membrane oxygenation use (0.78%) than centers with greater than 275 cases (≥ 2.8% extracorporeal membrane oxygenation use). Extracorporeal membrane oxygenation use and mortality varied within quintiles and across quintiles of center annual surgical case volume.

Conclusions:

Risk adjusted extracorporeal membrane oxygenation metrics indexed to annual surgical volume provide potential for benchmarking as well as a greater understanding of extracorporeal membrane oxygenation utilization, efficacy, and impact on cardiac surgery mortality.
Depression and Survival in a 17-Year Longitudinal Study of People With HIV: Moderating Effects of Race and Education
Authors: Ironson Gail , Fitch Calvin , Stuetzle Rick
Published: May 2017

Objective

The prevalence of clinically significant depressive symptoms is three times higher in people living with HIV than in the general population. Although studies have shown that depression predicts worse course with HIV, few have investigated its relationship with mortality, and none have had a 17-year follow-up period and been conducted entirely during the time since the advent of protease inhibitors.

Methods

We followed a diverse sample of HIV-positive people (N = 177) in the mid-range of illness for a study on stress and coping. Participants were assessed every 6 months (for 12 years) via blood draw, questionnaires, and interview. Depression was measured using the Beck Depression Inventory. The study began in March 1997 and mortality was assessed in April 2014.

Results

In the primary analysis depression, analyzed as a continuous variable, significantly predicted all-cause mortality (hazard ratio = 1.038, 95% confidence interval = 1.008–1.068). With Beck Depression Inventory scores dichotomized, the hazard ratio was 2.044 (95% confidence interval = 1.176–3.550). Furthermore, this result was moderated by race and educational attainment such that depression only predicted worse survival for non-African Americans and those with a college education or higher.

Conclusion

Depression is associated with worse long-term survival in people with HIV during 17 years of follow-up. Interventions targeting depression may improve well-being and potentially survival in individuals with HIV. However, since depression did not predict survival in African Americans or those with low education, more research is needed to identify risk factors for long term outcomes in these groups.
Influence of Acute Multispecies and Multistrain Probiotic Supplementation on Cardiovascular Function and Reactivity to Psychological Stress in Young Adults: A Double-Blind, Randomized, Placebo-Controlled Trial
Authors: Möller Clara M. , Olsa Eamon J.A. , Ginty Annie T. , Rapelje Alyssa L. , Tindall Christina L. , Holesh Laura A. , Petersen Karen L. , Conklin Sarah M.
Published: May 2017

Objective

The potential influence of probiotic supplementation on cardiovascular health and stress responsivity remains largely unexplored. Some evidence suggests the possibility that probiotics may influence blood pressure. A separate body of research suggests that exaggerated cardiovascular reactions to acute psychological stress in the laboratory predict cardiovascular morbidity and mortality. The current investigation explored the effect of acute probiotic use on (1) resting cardiovascular measures in healthy young adults and (2) cardiovascular and psychological reactions to an acute psychological stressor in the laboratory.

Method

Participants (N = 105, M [SD] age = 20.17 [1.26], 84.8% white) completed a 2-week, double-blind, and placebo-controlled trial of a multispecies and multistrain probiotic. Exclusion criteria included previous probiotic use, diagnosed gastrointestinal disorder, and/or current antibiotic use. At visits 1 and 2, participants completed the Paced Auditory Serial Addition Test, a widely used psychological stress task. Participants were randomly assigned to a probiotic blend or matched placebo.

Results

Compared with placebo, 2-week probiotic supplementation did not affect resting measures of cardiovascular function, cardiovascular responses during or recovery from stress, or psychological reactions to acute psychological stress.

Conclusions

Contrary to expectations, short-term use of a probiotic supplement in healthy participants did not influence measures of cardiovascular function or responsivity to psychological stress. Future research is needed to determine species- and strain-specific effects of probiotics in healthy participants with various degrees of stress responsiveness, as well as in diseased populations.
Patterns of Attendance at Mother Support Groups in Zimbabwe. The EPAZ Trial (2014–2016)
Authors: Orne-Gliemann Joanna , Font Hélène , Maphosa Talent , Kangwende Abigail , Rusakaniko Simba , Magezi Vhumani , Sengai Tonderai , Shumba Bridget , Zambezi Pemberai , Foster Geoff ,   for the EPAZ trial study group
Published: May 2017

Background:

In Southern Africa, groups of mothers living with HIV successfully provide peer psychosocial support during pregnancy and early childhood. We report patterns of attendance at Mother Support Groups (MSGs) sessions among women and mothers living with HIV in rural Zimbabwe.

Methods:

In the Elimination of Pediatric AIDS cluster-randomized trial, MSGs were established in 14 health facilities in Mutare and Makoni districts. Patterns of attendance at MSG sessions were categorized by calendar attendance from delivery to 6-month postpartum using a Dynamic Time Warping clustering method. Baseline characteristics of women and postpartum MSG attendance patterns were described. Linkages between these patterns and 12-month postpartum retention in care were explored using mixed-effects models.

Results:

Most women (88%) attended at least 1 MSG session between enrollment and 6-month postpartum. Two patterns of postpartum MSG attendance, “Regular Attendance” and “Non-Regular Attendance,” were readily identified. Being older than 32 (P= 0.01), booking for antenatal care before 22 weeks gestational age (P= 0.02), and being on antiretroviral therapy at first antenatal care booking (P= 0.01) were significantly associated with “Regular Attendance.” “Regular Attendance” at MSG sessions during the 6-month postpartum period was significantly associated with better retention in care at 12 months, compared with “Non-Regular Attendance” (P< 0.01).

Discussion:

Women living with HIV attended MSG sessions. However, few attended regularly. Younger and newly diagnosed women were less likely to attend postpartum MSG sessions or remain in care at 12 months postpartum. Peer support models should consider specific needs of these women, especially in rural areas, in order for MSGs to contribute to improve maternal and child health outcomes.
The Effect of a Continuous Quality Improvement Intervention on Retention-In-Care at 6 Months Postpartum in a PMTCT Program in Northern Nigeria: Results of a Cluster Randomized Controlled Study
Authors: Oyeledun Bolanle , Phillips Abimbola , Oronsaye Frank , Alo Oluwafemi David , Shaffer Nathan , Osibo Bamidele , Imarhiagbe Collins , Ogirima Francis , Ajibola Abiola , Ezebuka Obioma , Ojong-Etta Bebia , Obi Adaobi , Falade John , Uthman Adunbi Kareem , Famuyide Busuyi , Odoh Deborah , Becquet Renaud
Published: May 2017

Background:

Retention in care is critical for improving HIV-infected maternal outcomes and reducing vertical transmission. Health systems' interventions such as continuous quality improvement (CQI) may support health services to address factors that affect the delivery of HIV-related care and thereby influence rates of retention-in-care.

Methodology:

We evaluated the effect of a CQI intervention on retention-in-care at 6 months postpartum of pregnant women and mothers living with HIV who had been started on lifelong antiretroviral treatment. Thirty-two health care facilities were randomized to either implement the intervention or not. We considered women fully retained in care when they attended the 6-month postpartum visit and did not miss any previous scheduled visit by more than 30 days.

Results:

Five hundred eleven women living with HIV attending antenatal clinics at 26 facilities were included in the analysis. Median age at enrolment was 27 years and gestational age was 20 weeks. Seventy-one percent of women were seen at 6-month postpartum irrespective of missing any scheduled visit. However, 43% of women were fully retained at 6-month postpartum and did not miss any scheduled visit based on our stringent study definition of retention. There was no significant difference in retention at 6 months between the intervention and control arms [44% vs. 41%, relative risk: 1.08; 95% confidence interval (CI): 0.78 to 1.49]. Initiation of ARV prophylaxis among infants within 72 hours was not different by study arm (66.0% vs. 74.7%, relative risk = 0.95; 95% CI: 0.84 to 1.07) but rates of early infant testing at 4–6 weeks were higher in intervention sites (48.8% vs. 25.3%, adjusted relative risk: 1.76; 95% CI: 1.27 to 2.42).

Conclusions:

CQI as implemented in this study did not differ across study arms in the rates of retention. Several intervention design or implementation issues or other contextual constraints may explain the absence of effect.
Viral Suppression and HIV Drug Resistance at 6 Months Among Women in Malawi's Option B+ Program: Results From the PURE Malawi Study
Authors: Hosseinipour Mina , Nelson Julie A. E. , Trapence Clement , Rutstein Sarah E. , Kasende Florence , Kayoyo Virginia , Kaunda-Khangamwa Blessings , Compliment Kara , Stanley Christopher , Cataldo Fabian , van Lettow Monique , Rosenberg Nora E. , Tweya Hannock , Gugsa Salem , Sampathkumar Veena , Schouten Erik , Eliya Michael , Chimbwandira Frank , Chiwaula Levison , Kapito-Tembo Atupele , Phiri Sam ,   the PURE Malawi Consortium
Published: May 2017

Background:

In 2011, Malawi launched Option B+, a program of universal antiretroviral therapy (ART) treatment for pregnant and lactating women to optimize maternal health and prevent pediatric HIV infection. For optimal outcomes, women need to achieve HIVRNA suppression. We report 6-month HIVRNA suppression and HIV drug resistance in the PURE study.

Methods:

PURE study was a cluster-randomized controlled trial evaluating 3 strategies for promoting uptake and retention; arm 1: Standard of Care, arm 2: Facility Peer Support, and arm 3: Community Peer support. Pregnant and breastfeeding mothers were enrolled and followed according to Malawi ART guidelines. Dried blood spots for HIVRNA testing were collected at 6 months. Samples with ART failure (HIVRNA ≥1000 copies/ml) had resistance testing. We calculated odds ratios for ART failure using generalized estimating equations with a logit link and binomial distribution.

Results:

We enrolled 1269 women across 21 sites in Southern and Central Malawi. Most enrolled while pregnant (86%) and were WHO stage 1 (95%). At 6 months, 950/1269 (75%) were retained; 833/950 (88%) had HIVRNA testing conducted, and 699/833 (84%) were suppressed. Among those with HIVRNA ≥1000 copies/ml with successful amplification (N = 55, 41% of all viral loads > 1000 copies/ml), confirmed HIV resistance was found in 35% (19/55), primarily to the nonnucleoside reverse transcriptase inhibitor class of drugs. ART failure was associated with treatment default but not study arm, age, WHO stage, or breastfeeding status.

Conclusions:

Virologic suppression at 6 months was <90% target, but the observed confirmed resistance rates suggest that adherence support should be the primary approach for early failure in option B+.
Using Small Tests of Change to Improve PMTCT Services in Northern Nigeria: Experiences From Implementation of a Continuous Quality Improvement and Breakthrough Series Program
Authors: Osibo Bamidele , Oronsaye Frank , Alo Oluwafemi D. , Phillips Abimbola , Becquet Renaud , Shaffer Nathan , Ogirima Francis , Imarhiagbe Collins , Ameh Bernice , Ezebuka Obioma , Sodzi-Tettey Sodzi , Obi Adaobi , Afolabi Olusegun T. , Inedu Abutu , Anyaike Chukwuma , Oyeledun Bolanle
Published: May 2017

Background:

Continuous Quality Improvement (CQI) is a process where health teams systematically collect and regularly reflect on local data to inform decisions and modify local practices and so improve delivery of services. We implemented a cluster randomized trial to examine the effects of CQI interventions on Prevention of Mother-to-Child Transmission (PMTCT) services. Here, we report our experiences and challenges establishing CQI in 2 high HIV prevalence states in northern Nigeria.

Methods:

Facility-based teams were trained to implement CQI activities, including structured assessments, developing change packages, and participation in periodic collaborative learning sessions. Locally evolved solutions (change ideas) were tested and measured using process data and intermediate process indicators were agreed including overall time spent accessing services, client satisfaction, and quality of data.

Results:

Health workers actively participated in clinic activities and in the collaborative learning sessions. During the study, the mean difference in time spent accessing services during clinic visits increased by 40 minutes (SD = 93.4) in the control arm and decreased by 44 minutes (SD = 73.7) in the intervention arm. No significant difference was recorded in the mean client satisfaction assessment score by study arm. The quality of data was assessed using a standardized tool scored out of 100; compared with baseline data, quality at the end of study had improved at intervention sites by 6 points (95% CI: 2.0 to 10.1).

Conclusions:

Health workers were receptive to CQI process. A compendium of “change ideas” compiled into a single change package can be used to improve health care delivery.
The Roles of Expert Mothers Engaged in Prevention of Mother-to-Child Transmission (PMTCT) Programs: A Commentary on the INSPIRE Studies in Malawi, Nigeria, and Zimbabwe
Authors: Cataldo Fabian , Sam-Agudu Nadia A. , Phiri Sam , Shumba Bridget , Cornelius Llewellyn J. , Foster Geoff
Published: May 2017

Introduction:

Several initiatives aiming to improve retention and adherence in Prevention of Mother-to-Child Transmission of HIV (PMTCT) programs include “expert mothers” (EMs) as a central tenet of their interventions. This article compares the role of EMs in 3 implementation research studies examining approaches for improving retention in care among mothers living with HIV.

Methods:

We compared and synthesized qualitative data and lessons learned from 3 studies (MoMent in Nigeria, PURE in Malawi, and EPAZ in Zimbabwe) with respect to the involvement of EMs in supporting PMTCT clients. The frame of reference for the comparison is the role that EMs play in PMTCT service delivery for individuals, at the health facility, within the health system, and in the community.

Results:

EMs' role was positively perceived by PMTCT clients and health care workers, as EMs provided an expanded range of services directly benefiting clients and enabling health care workers to share their workload. Common challenges included difficulties in reaching male partners and fear of stigma. The lack of structure and standardization in EM interventions in relation to eligibility criteria, training, certification, and remuneration were identified as important barriers to EMs' role development within existing health systems.

Conclusions:

The role of EMs within PMTCT programs continues to expand rapidly. There is a need for coordinated action to develop shared standards and principles commensurate with the new roles and additional demands placed on EMs to support PMTCT services, including EM certification, mentoring and supervision standards, standardized PMTCT-specific training curricula, and, where appropriate, agreed remuneration rates.
Hydrogen Sulfide: A Potential Novel Therapy for the Treatment of Ischemia
Authors: Jensen Amanda R. , Drucker Natalie A. , Khaneki Sina , Ferkowicz Michael J. , Yoder Mervin C. , DeLeon Eric R. , Olson Kenneth R. , Markel Troy A.
Published: May 2017

Hydrogen sulfide (H2S) is a novel signaling molecule most recently found to be of fundamental importance in cellular function as a regulator of apoptosis, inflammation, and perfusion. Mechanisms of endogenous H2S signaling are poorly understood; however, signal transmission is thought to occur via persulfidation at reactive cysteine residues on proteins. Although much has been discovered about how H2S is synthesized in the body, less is known about how it is metabolized. Recent studies have discovered a multitude of different targets for H2S therapy, including those related to protein modification, intracellular signaling, and ion channel depolarization. The most difficult part of studying hydrogen sulfide has been finding a way to accurately and reproducibly measure it. The purpose of this review is to: elaborate on the biosynthesis and catabolism of H2S in the human body, review current knowledge of the mechanisms of action of this gas in relation to ischemic injury, define strategies for physiological measurement of H2S in biological systems, and review potential novel therapies that use H2S for treatment.
Target Serum Sodium Levels During Intensive Care Unit Management of Aneurysmal Subarachnoid Hemorrhage
Authors: Okazaki Tomoya , Hifumi Toru , Kawakita Kenya , Shishido Hajime , Ogawa Daisuke , Okauchi Masanobu , Shindo Atsushi , Kawanishi Masahiko , Tamiya Takashi , Kuroda Yasuhiro
Published: May 2017

Introduction:

Dysnatremia commonly occur in the intensive care unit (ICU) management of patients with aneurysmal subarachnoid hemorrhage (SAH). However, detailed management strategies have not been provided even by current guidelines. The purposes of this study were to examine the association of abnormal serum sodium levels with unfavorable neurologic outcomes and to identify the target range of serum sodium in patients with SAH.

Methods:

We retrospectively reviewed all patients who were consecutively hospitalized with a confirmed diagnosis of SAH between January 2009 and December 2015. Univariate/multivariate analyses were performed to identify the independent predictors of an unfavorable neurologic outcome (modified Rankin scale of 3–6 upon hospital discharge).

Results:

There were 131 patients included in this study. Unfavorable neurologic outcomes occurred in 45% of patients. On multiple regression analysis, age, Hunt and Kosnik grade, and serum sodium levels in the ICU at the maximum [odds ratio (OR), 1.18; 95% CI, 1.05–1.35; P < 0.01] and minimum (OR, 0.88; 95% CI, 0.77–0.99; P = 0.048) values were significantly associated with unfavorable neurologic outcomes. The receiver operating characteristic curve analysis showed that the cut-off serum sodium levels were 145 mmol/L for maximum value and 132 mmol/L for minimum value. Patients with hyponatremia and hypernatremia during the first 2 weeks in the ICU accounted for 88.2% of patients with an unfavorable neurologic outcome; whereas, those with normal sodium levels accounted for only 15.6%.

Conclusions:

In patients with SAH, both hyponatremia and hypernatremia during ICU management were significantly associated with unfavorable neurologic outcomes.
Interleukin-22 Prevents Microbial Dysbiosis and Promotes Intestinal Barrier Regeneration Following Acute Injury
Authors: Hammer Adam M. , Morris Niya L. , Cannon Abigail R. , Khan Omair M. , Gagnon Robin C. , Movtchan Nellie V. , van Langeveld Ilse , Li Xiaoling , Gao Bin , Choudhry Mashkoor A.
Published: May 2017

Intestine barrier disruption and bacterial translocation can contribute to sepsis and multiple organ failure, leading causes of mortality in burn-injured patients. In addition, findings suggest that ethanol (alcohol) intoxication at the time of injury worsens symptoms associated with burn injury. We have previously shown that interleukin-22 (IL-22) protects from intestinal leakiness and prevents overgrowth of gram-negative bacteria following ethanol and burn injury, but how IL-22 mediates these effects has not been established. Here, utilizing a mouse model of ethanol and burn injury, we show that the combined insult results in a significant loss of proliferating cells within small intestine crypts and increases Enterobacteriaceae copies, despite elevated levels of the antimicrobial peptide lipocalin-2. IL-22 administration restored numbers of proliferating cells within crypts, significantly increased Reg3β, Reg3γ, lipocalin-2 AMP transcript levels in intestine epithelial cells, and resulted in complete reduction of Enterobacteriaceae in the small intestine. Knockout of signal transducer and activator of transcription factor-3 (STAT3) in intestine epithelial cells resulted in complete loss of IL-22 protection, demonstrating that STAT3 is required for intestine barrier protection following ethanol combined with injury. Together, these findings suggest that IL-22/STAT3 signaling is critical to gut barrier integrity and targeting this pathway may be of beneficial clinical relevance following burn injury.
Theory for transitions between exponential and stationary phases: universal laws for lag time
Authors: Himeoka Yusuke , Kaneko Kunihiko
Published: May 2017

The quantitative characterization of bacterial growth has attracted substantial research attention since Monod’s pioneering study. Theoretical and experimental work have uncovered several laws for describing the exponential growth phase, in which the number of cells grows exponentially. However, microorganism growth also exhibits lag, stationary, and death phases under starvation conditions, in which cell growth is highly suppressed, for which quantitative laws or theories are markedly underdeveloped. In fact, the models commonly adopted for the exponential phase that consist of autocatalytic chemical components, including ribosomes, can only show exponential growth or decay in a population, and thus phases that halt growth are not realized. Here, we propose a simple, coarse-grained cell model that includes an extra class of macromolecular components in addition to the autocatalytic active components that facilitate cellular growth. These extra components form a complex with the active components to inhibit the catalytic process. Depending on the nutrient condition, the model exhibits the typical transitions among the lag, exponential, stationary, and death phases. Furthermore, the lag time needed for growth recovery after starvation follows the square root of the starvation time and is inversely related to the maximal growth rate. This is in agreement with experimental observations, in which the length of time of cell starvation is memorized in the slow accumulation of molecules. Moreover, the lag time distributed among cells is skewed with a long time tail. If the starvation time is longer, an exponential tail appears, which is also consistent with experimental data. Our theory further predicts a strong dependence of lag time on the speed of substrate depletion, which can be tested experimentally. The present model and theoretical analysis provide universal growth laws beyond the exponential phase, offering insight into how cells halt growth without entering the death phase.
Pushing The Limits Of Detection Of Weak Binding Using Fragment Based Drug Discovery: Identification Of New Cyclophilin Binders
Authors: Georgiou Charis , McNae Iain W. , Wear Martin A. , Ioannidis Harris , Michel Julien , Walkinshaw Malcolm D.
Published: May 2017

Fragment Based Drug Discovery (FBDD) is an increasingly popular method to identify novel small-molecule drug candidates. One of the limitations of the approach is the difficulty of accurately characterizing weak binding events. This work reports a combination of X-ray diffraction, surface plasmon resonance (SPR) experiments and molecular dynamics (MD) simulations, for the characterisation of binders to different isoforms of the cyclophilin (Cyp) protein family. Although several Cyp inhibitors have been reported in the literature, it has proven challenging to achieve high binding selectivity for different isoforms of this protein family. The present studies have led to the identification of several structurally novel fragments that bind to diverse Cyp isoforms in distinct pockets with low millimolar dissociation constants. A detailed comparison of the merits and drawbacks of the experimental and computational techniques is presented, and emerging strategies for designing ligands with enhanced isoform specificity are described.
Crystal structure of phenyl N-(3,5-dimethylphenyl)carbamate
Authors: AaminaNaaz Y. , Sathiyaraj Subramaniyan , Kalaimani Sundararaj , Nasar A. Sultan , SubbiahPandi A.
Published: May 2017

The asymmetric unit of the title compound, C15H15NO2, contains two independent molecules (A and B). The dimethylphenyl ring, the phenyl ring and the central carbamate N—C(=O)—O group are not coplanar. In molecule A, the dimethylphenyl and phenyl rings are inclined to the carbamate group mean plane by 27.71 (13) and 71.70 (4)°, respectively, and to one another by 84.53 (13)°. The corresponding dihedral angles in molecule B are 34.33 (11), 66.32 (13) and 85.48 (12)°, respectively. In the crystal, the A and B molecules are arranged alternately linked through N—H...O(carbonyl) hydrogen bonds, forming –A–B–A–B– chains, which extend along [100]. Within the chains and linking neighbouring chains there are C—H...π interactions present, forming columns along the a-axis direction. The columns are linked by offset π–π stacking interactions, forming a three-dimensional network [shortest centroid–centroid distance = 3.606 (1) Å].
Does individual heterogeneity shape retail investor behaviour?
Authors: Chandra Abhijeet , Sanningammanavara Kantesha , Nandini A. Satya
Published: May 2017

Purpose

The purpose of this paper is to survey retail investors to study the determinants of their investment behaviour and show that individual heterogeneity and financial factors such as gender, age, educational status, income, and investment levels determine their trading behaviour across three domains; however, features such as marital status and occupation do not play any significant role in shaping their trading behaviour.

Design/methodology/approach

Structured surveys are conducted on retail and small investors using the brokerage services of a firm. Data collected from primary methods are used for statistical analysis in ANOVA and multiple regression frameworks.

Findings

The authors also report that retail investors’ self-perceived confidence as a function of both expected and unexpected changes in the market and personal factors largely determines trading behaviour of retail investors and that self-perceived confidence level and self-reported portfolio size are positively associated implying that (over-)confident retail investors tend to believe that their investment skills being superior are bound to perform better and thus they typically hold larger than average investment portfolios.

Practical implications

These findings are significant because research on cross-sectional variance of individual investment behaviour explains how investor heterogeneity plays a critical role in investment and asset allocation decisions. Investors, researchers, and practitioners would use the results for financial decision making specifically related to personal finance, behavioural portfolio management, and investment advisory.

Originality/value

This paper is an empirical approach to explore the retail investor behaviour using psychometric approach with respect to self-perceived confidence and other perceived measures of investor behaviour. The authors contribute to the emerging set of literature on investor behaviour and behavioural finance.
Factors determining child mortality in Uganda
Authors: Kaberuka Will , Mugarura Alex , Tindyebwa Javan , Bishop Debra S.
Published: May 2017

Purpose

The purpose of this paper is to establish socio-economic factors and maternal practices that determine child mortality in Uganda.

Design/methodology/approach

The paper examines the role of sex, birth weight, birth order and duration of breastfeeding of a child; age, marital status and education of the mother; and household wealth in determining child mortality. The study employs a logistic regression model to establish which of the factors significantly impacts child mortality in Uganda.

Findings

The study established that education level, age and marital status of the mother as well as household wealth significantly impact child mortality. Also important are the sex, birth weight, birth order and breastfeeding duration.

Research limitations/implications

Policies aimed at promoting breastfeeding and education of female children can make a significant contribution to the reduction of child mortality in Uganda.

Practical implications

Health care intervention programs should focus on single, poor and uneducated mothers as their children are at great risk due to poor and inadequate health care utilization.

Originality/value

This paper could be the first effort in examining child mortality status in Uganda using a logistic regression model.
Economic impact of the Canadian co-operative sector (2009 and 2010)
Authors: Karaphillis George , Duguid Fiona , Lake Alicia
Published: May 2017

Purpose

Little research exists on the economic impact of the co-operative sector in Canada, and changes in the sector over time. The purpose of this paper is to fill-in the gaps in the knowledge about the size of the sector and its performance over time using a comparative analysis.

Design/methodology/approach

The authors of this paper conducted an input-output analysis of co-operatives in Canada for the years 2009 and 2010. First, the authors quantified the size of the sector for each year and then these two data points were compared to analyze the changes in this one-year period.

Findings

This paper demonstrates that co-operatives in Canada are significant to the national economy and remain stable over time.

Originality/value

This is the first time such a study has been done in Canada for the co-operative sector.
The effects of higher education on childrearing fertility behavior in Japan
Authors: Nozaki Yuko
Published: May 2017

Purpose

Cost-benefit theory cannot explain the inverse relationship between education and fertility behavior among developed countries. The purpose of this paper is to examine psychological factors in fertility decisions, focusing on the number of children and determinants involved in the decision to have three or more children.

Design/methodology/approach

Two empirical models were employed utilizing data from the Japanese General Social Survey of 2005 and 2006. An ordered logit model was used to examine how educational background impacts the number of children people choose to have. A logit model focused on psychological factors was used to investigate the effect of the burden of childcare on the decision to have more children.

Findings

The probability of a third birth declines as the number of years of education increases for women, but not for men. Women whose mothers were housewives tended to have fewer children, whereas women who live in families and are homeowners were likely to have more children. For women, the most influential factor in the decision to have a child was awareness of childrearing costs. Men from higher-class, higher-income families tended to have more children.

Practical implications

The analysis indicates that maternal leave or systemic re-employment support can impact a woman’s decision to have a child.

Social implications

The inverse relationship between women’s fertility behavior and education can be partially explained by the awareness among educated women of the duties and burdens of childrearing.

Originality/value

This study contributes to practical information concerning the role of psychological factors in fertility decisions.