bluuebunny/crossref_metadata_2025 huggingface dataset:
Barriers for Hospital-Based Nurse Practitioners Utilizing Clinical Decision Support Systems
Authors: Borum Cindy
Published: January 2018

There is a national focus on the adoption of healthcare technology to improve the delivery of safe, efficient, and high-quality patient care. Nurse practitioners fulfill an emerging strategic role in the hospital setting. A comprehensive literature review focused on the question: What are the barriers for nurse practitioners utilizing clinical decision support in the hospital setting? Nine studies conducted from 2011 to 2017 were the basis for this review, which identified 13 barriers for nurse practitioners utilizing clinical decision support in the hospital. Having the right information, including up-to-date evidence-based practice guidelines, accurate clinical pathways, and current clinical algorithms, was the most common barrier. Providing reliable clinical decision support is crucial as nurse practitioners become more dependent on hospital technology systems in the delivery of safe patient care. Eliminating barriers to the use of clinical decision support is important for informaticists and nurse practitioners because both groups concentrate on acceptance of decision support systems in the hospital to meet the goal of safe and high-quality patient care.
Association between insulin resistance and the magnetic resonance spectroscopy-determined marrow fat fraction in nondiabetic postmenopausal women
Authors: Li Guanwu , Xu Zheng , Lin Haiyang , Chen Yilei , Li Xuefeng , Chang Shixin
Published: January 2018

Objective:

The clinical consequences of insulin resistance and hyperinsulinemia on marrow lipid remain elusive. We aimed to explore the effects of anthropometric and biochemical measures, that is, estimates of insulin resistance, on marrow lipid accumulation in nondiabetic postmenopausal women using magnetic resonance (MR) spectroscopy.

Methods:

The study participants were 91 nondiabetic postmenopausal women. Marrow fat fraction (FF) at the L3 vertebral body by single-voxel MR spectroscopy and bone mineral density (BMD) by dual-energy x-ray absorptiometry were measured. Their glucose and lipid metabolism were determined by biochemical analysis, and their insulin sensitivity was evaluated using the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR).

Results:

Adjusted for multiple covariates including age, years since menopause, body mass index, alcohol intake, tobacco use, physical activity, and serum lipid profile, the mean FF was significantly increased, and BMD at the lumbar spine, femoral neck, and total hip decreased as quartiles of HOMA-IR increased (P for trends <0.01). HOMA-IR had a positive association with FF (mean difference 0.300, P < 0.001) and a negative association with BMD at the lumbar spine (mean difference −0.182, P = 0.016), total hip (mean difference −0.219, P = 0.001), and femoral neck (mean difference −0.195, P = 0.013). The above described associations of HOMA-IR with FF, lumbar spine, and total hip BMD remained essentially unchanged; however, the association with femoral neck BMD lost significance after adjusting for the aforementioned confounders.

Conclusion:

In nondiabetic postmenopausal women, insulin resistance is correlated with marrow lipid expansion. This association persists after adjusting for the body mass index and other potential covariates, suggesting an independent effect of insulin resistance on marrow adiposity.
Screening Internal Contamination of Inhaled and Ingested Radionuclides with Hand-held Survey Meters
Authors: Adams Grace G. , Casagrande Rocco
Published: January 2018

During the aftermath of a radiological accident or attack, the rapid identification of individuals who have internalized medically significant amounts of material is paramount to guide medical and public health decisions. This paper explores the utility of hand-held, pancake GM detectors to determine if an individual has inhaled 90Sr, 137Cs, 238Pu, 239Pu, or 241Am in quantities requiring treatment. Additionally, ingestion of 90Sr or 137Cs was considered. Both 90Sr and 137Cs were modeled in equilibrium with their progeny, but the progeny of 238Pu, 239Pu, and 241Am were excluded. Treatment thresholds are defined using the National Council on Radiation Protection & Measurements’ (NCRP) clinical decision guides (CDGs). Using Monte Carlo N-Particle (MCNP) modeling software, a human phantom and detector were modeled to determine the activity required to achieve a detector reading of twice background 1, 7, or 30 d post-ingestion or post-inhalation. Modeling found that inhaled 238Pu, 239Pu, and 241Am are detectable only if the contaminated individual inhaled thousands-fold more material than the CDG. This lack of detectability means that hand-held GM detectors are inappropriate for initial screening for americium or plutonium and that more intensive screening is necessary to confirm suspected contamination. Cesium-137, by contrast, could be detected at levels 10‐ to 100‐fold lower than the amount requiring treatment, allowing quick differentiation between contaminated and uncontaminated individuals. Surprisingly, 90Sr was detectable within a factor of 2 of the amount requiring treatment. Detection of 90Sr was due primarily to bremsstrahlung radiation from beta interactions with calcium in bone. While rapid screening could identify individuals contaminated by 137Cs and possibly with 90Sr, further screening of identified individuals is necessary to establish medical need. However, these contaminated individuals could still be prioritized for further testing and possible presumptive treatment. Based on the findings of this study, concepts of operation for the use of hand-held survey meters should be developed for the screening of individuals potentially internally contaminated with 137Cs and 90Sr.
Exploring Nitrous Oxide as Treatment of Mood Disorders
Authors: Nagele Peter , Zorumski Charles F. , Conway Charles
Published: January 2018

Nitrous oxide (laughing gas) has shown early promise as a rapidly acting antidepressant in patients with treatment-resistant major depression and is currently investigated in several clinical trials. Because nitrous oxide is rarely administered outside operating rooms or dental practices, most psychiatrists are not familiar with how nitrous oxide is administered in a medical setting and what regulations guide its use. The goal of this brief review was to educate psychiatrists about the basic concepts of nitrous oxide administration and pharmacology. Furthermore, common misconceptions about nitrous oxide will be discussed.
Effects of a Psychoeducational Intervention in Patients With Breast Cancer Undergoing Chemotherapy
Authors: WU Pei-Hua , CHEN Shang-Wen , HUANG Wen-Tsung , CHANG Shu-Chan , HSU Mei-Chi
Published: January 2018

Background:

Compelling evidence has yet to be published regarding the positive effect of psychoeducational interventions (PEIs) on psychological distress in patients with breast cancer. The impact of PEIs on self-efficacy, resilience, and quality of life is also unclear.

Purpose:

The aim of this study was to assess the effects of a PEI on anxiety, depression, disease-specific care knowledge, self-efficacy, resilience and quality of life in patients with breast cancer during and after chemotherapy. The intervention was administered before and during five rounds of chemotherapy treatment.

Methods:

A randomized controlled trial was conducted. Patients with breast cancer (N = 40) were randomly assigned to either the experimental or control group. The experimental group participated in PEI, a brief and highly structured program consisting of two parts: (a) an educational manual that addressed depression, anxiety, disease-specific care knowledge, self-efficacy, and resilience and (b) a self-assessment of learning. The control group received only traditional pamphlet education. Data were collected at four time points: before the first chemotherapy session (T1), during the third chemotherapy session (T2), during the fifth chemotherapy session (T3), and at 2 weeks after the final chemotherapy session (T4).

Results:

Anxiety, depression, resilience, and quality of life in the experimental group showed significant differences at T4. Significant differences became apparent at T2 for knowledge and at T3 for self-efficacy. The effects of knowledge, resilience, and quality of life remained significant when group and time interactions were included in the model, showing a positive relationship between PEI and the variables of knowledge, resilience, and quality of life.

Conclusions/Implications for Practice:

Face-to-face PEI for patients with breast cancer is potentially effective in improving knowledge, resilience, and quality of life during and after chemotherapy. In the current study, PEI significantly improved disease care techniques, reduced chemotherapy-related discomfort, and improved quality of life for participants in the experimental group.
Comparative Assessment of Patient Preferences and Tolerability in Barrett Esophagus Screening
Authors: Blevins Christopher H. , Egginton Jason S. , Shah Nilay D. , Johnson Michele L. , Iyer Prasad G.
Published: January 2018

Goals:

To determine patient preference for the Barrett esophagus (BE) screening techniques.

Background:

Sedated esophagogastroduodenoscopy (sEGD) and unsedated transnasal endoscopy (uTNE) are both potential techniques for BE screening. However, systematic assessment of patient preference for these 2 techniques is lacking. As part of a comparative effectiveness randomized trial of BE screening modalities, we measured short-term patient preferences for the following approaches: in-clinic uTNE (huTNE), mobile-based uTNE (muTNE), and sEGD using a novel assessment instrument.

Study:

Consenting community patients without known BE were randomly assigned to receive huTNE, muTNE, or sEGD, followed by a telephone administered preference and tolerability assessment instrument 24 hours after study procedures. Patient preference was measured by the waiting trade-off method.

Results:

In total, 201 patients completed screening with huTNE (n=71), muTNE (n=71), or sEGD (n=59), and a telephone interview. Patients’ preferences for sEGD and uTNE using the waiting trade-off method were comparable (P=0.51). Although tolerability scores were superior for sEGD (P<0.001) compared with uTNE, scores for uTNE examinations were acceptable.

Conclusions:

Patient preference is comparable between sEGD and uTNE for diagnostic examinations conducted in an endoscopy suite or in a mobile setting. Given acceptable tolerability, uTNE may be a viable alternative to sEGD for BE screening.
Serum Pepsinogen as a Predictor for Gastric Cancer Death
Authors: Chiang Tsung-Hsien , Chiu Sherry Yueh-Hsia , Chen Sam Li-Sheng , Yen Amy Ming-Fang , Fann Jean Ching-Yuan , Liu Cheng-Ying , Chou Chu-Kuang , Chiu Han-Mo , Shun Chia-Tung , Wu Ming-Shiang , Lin Jaw-Town , Lee Yi-Chia , Chen Tony Hsiu-Hsi , Lin Ming-Wei
Published: January 2018

Goals:

The purpose of this article is to validate the long-term association between initial serum pepsinogen (PG) measurements and subsequent gastric cancer–specific deaths from a long-term longitudinal cohort.

Background:

Endoscopic surveillance can be effective and efficient in reducing gastric cancer mortality if a biomarker such as serum PG is available to identify high-risk individuals and if the biomarker also is specific to gastric cancer risk.

Study:

Between 1995 and 1998, a gastric cancer–screening program was conducted in a high-risk population: The first stage involved PG testing, and the second stage involved upper endoscopy. The outcome was gastric cancer death, which was monitored until December 31, 2010; results were expressed as the hazard ratio (HR) and corresponding 95% confidence interval (CI) using the Cox proportional hazards regression model. Other causes of death were used as comparators.

Results:

Among participants (n=3514) aged ≥30 years, 1682 (47.9%) were screened to determine serum PG levels. After 16 years of follow-up, 14 deaths from gastric cancer were documented. Multivariate analyses adjusted for age, sex, and Helicobacter pylori serological positivity showed that PG-I <30 μg/L and PG-I <30 μg/L or PG-I/II ratio <3 were significantly associated with the risk of gastric cancer death (HR, 3.27; 95% CI, 1.11-9.61 and HR, 3.45; 95% CI, 1.18-10.12, respectively). In contrast, there were no significant associations between PG and other causes of death, including neoplastic and non-neoplastic diseases.

Conclusion:

This long-term cohort study shows the usefulness of PG measurement as a biomarker that is specific to the risk of gastric cancer death.
To Pull or to Scope
Authors: Khoury Tawfik , Daher Saleh , Yaari Shaul , Rmeileh Ayman Abu , Israeli Eran , Benson Ariel A. , Cohen Jonah , Arnon Ron , Mizrahi Meir
Published: January 2018

Background:

Percutaneous endoscopic gastrostomy (PEG) tubes are routinely used as an effective method for providing enteral nutrition. The need for their exchange is common.

Goals:

We aimed to examine the comparative safety and cost-effectiveness of PEG percutaneous counter-traction “pulling” approach or by endoscopically guided retrieval.

Study:

A prospective 215 consecutive patients undergoing PEG tube insertion were included. Fifty patients in total were excluded. The patients were examined for demographics, indications for PEG replacement, as well as procedure-related complications and procedural costs.

Results:

Group A included 70 patients (42%) with PEG tubes replaced endoscopically, whereas group B included 95 patients (58%) with PEG tubes replaced percutaneously. Baselines characteristics were similar between the 2 groups (P=NS). Group A and group B had similar immediate complication rates including 4 patients in group B (4.2%), and 2 patients in group A (2.8%) (P=0.24). Complications included a conservatively managed esophageal perforation, and self-limited mild bleeding groups A and group B, respectively. The mean procedure cost was significantly higher in the endoscopic PEG replacement group compared with the percutaneous PEG replacement group ($650 vs. $350, respectively).

Conclusion:

Percutaneous PEG replacement appears as safe as endoscopic PEG replacement, however, percutaneous tube exchange is less costly.
Rising Events and Improved Outcomes of Gastrointestinal Bleed With Shock in USA
Authors: Siddiqui Nauman S. , Paul Suman , Khan Zubair , Javaid Toseef , Hasan Syed S. , Khan Zarmina , Saleh Jamal , Federman Douglas J. , Khuder Sadik , Nawras Ali
Published: January 2018

Objective:

Limited information is available based on single-center studies on trends of incidence and outcomes in gastrointestinal (GI) bleed with shock.

Methods:

We analyzed data from 2002 to 2013 National Inpatient Sample. Using ICD-9 codes we identified 6.4 million hospital discharges of GI bleed from National Inpatient Sample database. Events were analyzed based on type of GI bleed, in-hospital mortality, hemodynamic status, and use of blood products.

Results:

GI bleed with shock results in higher hospital mortality (20.77% with shock vs. 2.6% without shock). Between 2002 and 2013, there has been an increase in the percentage of upper and lower GI bleed with shock (1.35% to 4.92% and 1.49% to 3.06%) along with a reduction in mortality in both upper GI bleed with shock (26.9% to 13.8%) and lower GI bleed with shock (54.7% to 19.7%). Consistent with the rise in GI bleed with shock was an increase in blood product utilization. Packed red blood cell (pRBC) transfusion was associated with reduction in mortality in both nonvariceal upper GI bleed with shock (18.3% without pRBC vs. 13.9% receiving pRBC) and lower GI bleed with shock (36.05% without pRBC vs. 22.13% receiving pRBC), but did not affect mortality in variceal upper GI bleed with shock (31.79% vs. 32.22%).

Conclusions:

GI bleed with shock carries a higher mortality and have been steadily increasing from 2002 to 2013. pRBC transfusion was associated in improved mortality in GI bleed with shock except variceal bleed.
Utilization of Services Provided by Village-Based Ethnic Minority Midwives in Vietnam: Lessons From Implementation Research
Authors: Doan Duong Thi Thuy , Mirzoev Tolib , Nguyen Canh Chuong , Bui Ha Thi Thu
Published: January 2018

Background:

Global progress in reducing maternal mortality requires improving access to maternal and child health services for the most vulnerable groups. This article reports results of implementation research that aimed to increase the acceptability of village-based ethnic minority midwives (EMMs) by local communities in Vietnam through implementing an integrated interventions package.

Methods:

The study was carried out in 2 provinces in Vietnam, Dien Bien and Kon Tum. A quasi-experimental survey with pretest/posttest design was adopted, which included 6 months of intervention implementation. The interventions package included introductory “launch” meetings, monthly review meetings at community health centers, and 5-day refresher training for EMMs. A mixed-methods approach was used involving both quantitative and qualitative data. A structured questionnaire was used in the pre- and posttest surveys, complemented by in-depth interviews and focus group discussions with EMMs, relatives of pregnant women, community representatives, and health managers.

Results:

Introductions of EMMs to their local communities by local authorities and supervision of performance of EMMs contributed to significant increases in utilization of services provided by EMMs, from 58.6% to 87.7%. Key facilitators included information on how to contact EMMs, awareness of services provided by EMMs, and trust in services provided by EMMs. The main barriers to utilization of EMM services, which may affect sustainability of the EMM scheme, were low self-esteem of EMMs and small allowances to EMMs, which also affected the recognition of EMMs in the community.

Conclusions:

Providing continuous support and integration of EMMs within frontline service provision and ensuring adequate local budget for monthly allowances are the key factors that should allow sustainability of the EMM scheme and continued improvement of access to maternal and child health care among poor ethnic minority people living in mountainous areas in Vietnam.
Community-Based Screening for Cervical Cancer Using Visual Inspection With Acetic Acid: Results and Lessons Learned From a Pilot Study in Vietnam
Authors: Vu Lan T. H. , Tran Hanh T. D. , Nguyen Binh Th , Bui Ha T. T. , Nguyen Anh Duy , Pham Nha Ba
Published: January 2018

Context:

Vietnam still applies the opportunistic cytology-based screening model, which failed to have an impact on the increasing burden of cervical cancer in Vietnam.

Objectives:

To pilot a community-based screening model for cervical cancer using visual inspection with acetic acid (VIA) in Vietnam by training midwife and assistant physician working at grassroots level of health care system.

Design:

The study employed a pre-experimental design.

Setting:

Cases from 2 provinces of Vietnam.

Participants:

The study trained 36 assistant physicians/midwives working at commune health centers to do VIA screening for cervical cancer and provided screening services for 1945 women 30 to 65 years of age.

Intervention:

The pilot intervention had 2 aims: train health care workers to do VIA screening and assess the quality of screening services provided by the trained staffs by examining the diagnostics value of VIA.

Results:

All selected health care workers were able to perform VIA screening method after training. Their VIA services had high diagnostic value: positive predicted value of 11.5% and negative predicted value of 99%; for the detection of cervical intraepithelial neoplasia (CIN) 2, the sensitivity of VIA is 100%, specificity of 67.0%, positive predicted value of 5.7%, and negative predicted value of 100%; for the detection of CIN 3, the sensitivity of VIA is 100%, specificity of 66.5%, positive predicted value of 3.8%, and negative predicted value of 100%. The diagnostic value of VIA is comparable with Papanicolaou test but requires far fewer resources and suitable with community-based setting.

Conclusion:

Local midwives and assistant physicians who currently work at commune health centers and district health centers can be trained to do VIA efficiently. Regarding to implications for policy and practice, VIA can offer significant advantages over Papanicolaou test in low-resource settings like Vietnam, particularly in terms of increased screening coverage, improved follow-up care, and overall program quality.
Injury Mortality in Vietnam: Patterns and Trends, 2005-2013
Authors: Pham Cuong V. , Luong Anh M. , Bachani Abdulgafoor M. , Nguyen Tuan V. , Tran Ngan T. , La Quang N.
Published: January 2018

Context:

Injury is a growing public health problem worldwide. Deaths due to injuries account for 10% of the world's mortality. More than 90% of the world's injury-related deaths occur in low- and middle-income countries such as Vietnam. The public health burden has been recognized by government; however, there is a need to study and better understand the epidemiology and trends for injuries and injury-related mortality to be able to better address this burden.

Objectives:

In this article, we analyze the patterns and trends in injury mortality from 2005 to 2013 in Vietnam.

Design:

All registered deaths from injuries from January 2005 to December 2013 were extracted from the Ministry of Health death recording system (A6). Mortality rates per 100 000 population per year were calculated. A linear regression model was used to estimate the injury mortality trends.

Results:

In the 9-year period, 313 101 deaths due to injuries were recorded in the A6 system; this accounts for about 10% of all deaths. The leading causes of injury-related death were road traffic injuries among the entire population, while drowning was the leading cause of death among children. Other unintentional injuries including occupational, fall, poisoning, and exposure to electric current also accounted for a substantial proportion of the burden of injury. There is a significant reduction trend found in drowning among children 0 to 18 years of age and significant increasing trends in intentional injury causes.

Conclusions:

While injuries have been recognized as a public health problem in Vietnam in the last decade, as seen by our analysis, there is a need for concerted action to reduce their burden. Of particular concern is the increasing prominence of intentional injuries. Improved data systems, increasing the awareness in the community, and making appropriate policies and implementing them, as well as implementing effective, evidence-based interventions are all key to decreasing this burden. This is an important study describing injury mortality in Vietnam for the period 2005-2013. The results of the study show that injury death remains an important public health issue that needs more attention from government and relevant agencies.
Evaluation of an Ecohealth Approach to Public Health Intervention in Ha Nam, Vietnam
Authors: Pham Giang , Lam Steven , Dinh-Xuan Tung , Nguyen-Viet Hung
Published: January 2018

Context:

Ecohealth is a transdisciplinary research approach that considers socio-economic, cultural, and environmental factors. Ecohealth program assessment is sometimes unable to capture the process of change, especially when the evidence is not well documented. As such, there is a need to better understand how ecohealth approaches are understood, integrated, and adapted in practice to support the sustainability of the approach.

Objective:

To evaluate the use of an ecohealth approach to a community-based intervention to improve environmental sanitation and draw lessons learned for similar public health initiatives.

Design:

An iterative evaluation approach involving 27 in-depth interviews and 9 focus group discussions was used to gather feedback on the intervention activities and outcomes from all participants.

Setting and Participants:

The study site was Hoang Tay commune, Kim Bang district, Ha Nam province. The participants included 12 farmers, 4 local policy makers, and 7 researchers from Hanoi University of Public Health.

Results:

The farmers provided specific shortcomings of the biogas procedure steps, while the local authorities identified new and more effective ways to promote sanitation guidelines. Outcomes, as behavior changes, in 3 participant groups were captured.

Conclusion:

Participation in ecohealth interventions should be collegial to give opportunities for all related stakeholders to build capacity, support, and achieve the transdisciplinary principle. This also helps ensure that the community-based solutions are incorporated in public health interventions. Participatory monitoring and evaluation should support the understanding of the implementation process to capture intervention outcomes.
Alcohol Consumption and Binge Drinking Among Adult Population: Evidence From the CHILILAB Health and Demographic Surveillance System in Vietnam
Authors: Pham Cuong V. , Tran Hanh T. D. , Tran Ngan T.
Published: January 2018

Context:

Alcohol contributes to severe social and health problems and is a major risk factor for noncommunicable diseases in Vietnam. Over the years, there has been an increase in consumption per capita as well as a rapid expansion of commercially prepared alcohol.

Objective:

To describe the prevalence of alcohol consumption and binge drinking in a random sample of people 15 years of age and older living in Chi Linh who were also a part of the Chi Linh Health and Demographic Surveillance System (CHILILAB HDSS) and to determine the association between alcohol use and sociodemographic characteristics.

Design:

Data on alcohol consumption of 5438 people 15 years of age and older were extracted from the CHILILAB HDSS information collected in 2016. Descriptive statistics and multiple logistic regression were utilized to assess the association between current drinkers and binge drinkers with socioeconomic groups.

Results:

The overall prevalence of alcohol use 1 month prior to interview was 41.1%, which is composed of 75.1% males and 17.3% females. Among the 41% of alcohol drinkers, 31.7% reported binge drinking over the last 30 days. The proportion of binge drinking was also found to be higher among males than among females. The association between current drinkers, binge drinkers and gender, area of residence, education, and family income level was statistically significant.

Conclusions:

This study confirms that alcohol use among current and binge drinkers is common among males in Vietnam and that it is also a rising issue among females. Alcohol use is also associated with sociodemographic factors and income level. The results of this study provide evidence of harmful alcohol use among the Vietnamese population, which could help policy makers further advocate for the approval of the Vietnamese alcohol harm reduction law in the coming years. The results of this study reaffirm the need for public health strategies, including the formulation of laws and policies to reduce the harmful effects of alcohol consumption in Vietnam.
Strengthening Public Health Management Capacity in Vietnam: Preparing Local Public Health Workers for New Roles in a Decentralized Health System
Authors: Do Mai Hoa , Bui Thi Thu Ha , Phan Tuong , Nguyen Hoang Long , Duong Thuy Anh , Le Bao Chau , Pham Thi Thuy Linh , Nguyen Minh Hoang , Nguyen Phuong Thuy , Malison Michael
Published: January 2018

Health sector decentralization has created an urgent need to strengthen public health management capacity in many countries throughout the developing world. This article describes the establishment of a national management training network in Vietnam that used Project-Based Learning to strengthen management competencies of HIV program workers and linked training to measurable improvement in HIV/AIDS public health program outcomes. Skills were taught using a combination of classroom learning and mentored fieldwork. From 2005 to 2015, 827 HIV/AIDS program managers were trained with this method throughout Vietnam by trainers in 3 regional training centers. A total of 218 applied learning projects were carried out by trainees during this period; 132 resulted in measurable improvements in HIV/AIDS program outputs, and 86 produced well-organized plans for implementing, monitoring, and evaluating HIV/AIDS intervention strategies. Vietnam's management training network represents an important advancement in public health workforce development that helps prepare workers for new roles and responsibilities in a decentralized health system.
The Public Health Community Platform, Electronic Case Reporting, and the Digital Bridge
Authors: Cooney Mary Ann , Iademarco Michael F. , Huang Monica , MacKenzie William R. , Davidson Arthur J.
Published: January 2018

At the intersection of new technology advancements, ever-changing health policy, and fiscal constraints, public health agencies seek to leverage modern technical innovations and benefit from a more comprehensive and cooperative approach to transforming public health, health care, and other data into action. State health agencies recognized a way to advance population health was to integrate public health with clinical health data through electronic infectious disease case reporting. The Public Health Community Platform (PHCP) concept of bidirectional data flow and knowledge management became the foundation to build a cloud-based system connecting electronic health records to public health data for a select initial set of notifiable conditions. With challenges faced and lessons learned, significant progress was made and the PHCP grew into the Digital Bridge, a national governance model for systems change, bringing together software vendors, public health, and health care. As the model and technology advance together, opportunities to advance future connectivity solutions for both health care and public health will emerge.
Effects of Cane Use and Position on Performance of the Sit-to-Stand Task in Stroke Patients
Authors: Li Tung-Chou , Tu Keng-Hua , Shiue Huei-Sheng , Lin Mau-Roung
Published: January 2018

Objective

The aim of the study was to examine the effect of cane use and cane positions on the sit-to-stand performance of stroke patients.

Design

In a crossover study, 30 stroke patients performed sit-to-stand test in seven situations in a random sequence: without a cane, three positions with a regular cane (parallel to the ankle, parallel to the 5th toe, and 10 cm in front of the 5th toe), and the same three positions with a quad cane. The peak vertical ground reaction force and maximum vertical cane support force during sit-to-stand were recorded.

Results

Using a cane significantly reduced the peak ground reaction force by 3% to 9% of body weight compared with that without a cane (P = 0.000–0.023). Different cane positions strongly influenced the maximum cane support force and peak ground reaction force. When the cane was closer to the ankle, the maximal cane support force increased by 6.7% to 8.6% of body weight, which resulted in a decrease in the peak ground reaction force.

Conclusions

Both types of cane reduced lower limbs' load during sit to stand. When the cane was closer to the trunk, the load on legs was lessened, whereas the load on the upper limb increased. Upper limb's load during sit to stand was greater when using quad cane than using regular cane.
Clinical Development of PD-1 in Advanced Melanoma
Authors: Munhoz Rodrigo Ramella , Postow Michael Andrew
Published: January 2018

The development of new treatment options has dramatically improved the landscape for patients with advanced melanoma. Part of these advances emerged through the identification of the importance of factors that regulate the immune system, including proteins that negatively modulate T cell–mediated responses termed “immune checkpoints.” Indeed, blockade of the cytotoxic T lymphocyte–associated antigen 4 (CTLA-4) immune checkpoint served as a proof of principle that the manipulation of these molecules could induce robust anticancer effects, yet limited to a small percentage of patients. Targeting a distinct checkpoint, the PD-1 yielded improved outcomes and reduced toxicity compared with CTLA-4 blockade and, in separate studies, chemotherapy. More recently, combined CTLA-4/PD-1 blockade was shown to result in higher response rates, while accompanied by increased toxicity. In this article, we review the clinical development of anti–PD-1 monotherapy and combinations that may expand the benefit of immunotherapy for patients with advanced melanoma.
Blocking PD-1/PD-L1 in Genitourinary Malignancies
Authors: Dallos Matthew C. , Drake Charles G.
Published: January 2018

Genitourinary malignancies represent a diverse biologic and immunologic landscape. Recently, checkpoint blockade has transformed the treatment paradigms for bladder and kidney cancer. However, continued progress will be essential in bladder and kidney cancer, given response to inhibition of the PD-1/PD-L1 (PD-1/PD-L1) axis remains variable and only a minority of patients respond. In contrast with the clinical trial results in bladder and kidney cancer, studies of anti–PD-1/PD-L1 therapy in prostate cancer have generally been disappointing. Nevertheless, an exciting array of studies is underway that are translating lessons learned from tumor biology into promising clinical trials. Here we highlight important features of the immune tumor microenvironment of bladder, kidney, and prostate cancer and review key completed and ongoing clinical trials of anti–PD-1/PD-L1 therapy in these tumor types.
Intracorporeal Anastomosis Reduces Surgical Stress Response in Laparoscopic Right Hemicolectomy: A Prospective Randomized Trial
Authors: Mari Giulio M. , Crippa Jacopo , Costanzi Andrea T.M. , Pellegrino Roberta , Siracusa Claudia , Berardi Valter , Maggioni Dario
Published: January 2018

Total laparoscopic right hemicolectomy is a procedure that involves an intracorporeal anastomosis. This approach may reduce tissue injury resulting in a significant lower surgical stress response (SSR) compared with the same procedure performed with an extracorporeal anastomosis. The purpose of this study was to compare the SSR level between 2 groups of patients undergoing laparoscopic right hemicolectomy with intracorporeal or extracorporeal anastomosis. From June 2015 to December 2016, 60 patients were enrolled and randomized. Interleukin-6, C-reactive protein, procalcitonin, white blood cell count, cortisol, prolactin, prealbumin, albumin, triglycerides, and transferrin were analyzed preoperatively and at 1, 3, and 5 days postoperatively. Interleukin-6 and C-reactive protein levels were significantly lower in the intracorporeal group on days 1, 3, and 5 postoperatively compared with the extracorporeal group. Gastrointestinal recovery was significantly earlier in the intracorporeal group. The intracorporeal anastomosis in laparoscopic right hemicolectomy reduces SSR, which may play a role in bowel recovery.
Are the days of counting seizures numbered?
Authors: Karoly Philippa , Goldenholz Daniel M. , Cook Mark
Published: January 2018

Purpose of review

The estimation of seizure frequency is a cornerstone of clinical management of epilepsy and the evaluation of new therapies. Current estimation approaches are significantly limited by several factors. Comparing patient diaries and objective estimates (through both inpatient video-EEG monitoring of and long-term ambulatory EEG studies) reveal that patients document seizures inaccurately. So far, few practical alternative methods of estimation have been available.

Recent findings

We review the systems of counting currently utilized and their limitations, as well as the limitations imposed by problems defining clinical events. Alternative methodologies that permit the volatility of seizure rates to be accommodated, and possible alternative measures of brain excitability will be outlined. Recent developments in technologies around data capture, such as wearable and implantable devices, as well as significant advances in the ability to analyse the large data-sets supplied by these systems have provided a wealth of information.

There are now unprecedented opportunities to utilize and apply these insights in routine clinical management and assessment of therapies. The rapid adoption of long-term, wearable monitoring systems will permit major advances in our understanding of the natural history of epilepsy, and lead to more effective therapies and improved patient safety.
Cosmological implications of Higgs near-criticality
Authors: Espinosa J. R.
Published: January 2018

The Standard Model electroweak (EW) vacuum, in the absence of new physics below the Planck scale, lies very close to the boundary between stability and metastability, with the last option being the most probable. Several cosmological implications of this so-called ‘near-criticality’ are discussed. In the metastable vacuum case, the main challenges that the survival of the EW vacuum faces during the evolution of the Universe are analysed. In the stable vacuum case, the possibility of implementing Higgs inflation is critically examined.

This article is part of the Theo Murphy meeting issue ‘Higgs cosmology’.
Signatures of Higgs dilaton and critical Higgs inflation
Authors: García-Bellido Juan
Published: January 2018

We test the Higgs dilaton inflation model (HDM) using the latest cosmological datasets, including the cosmic microwave background temperature, polarization and lensing data from thePlancksatellite (2015), the BICEP and Keck Array experiments, the type Ia supernovae from the JLA catalogue, the baryon acoustic oscillations from CMASS, LOWZ and 6dF, the weak lensing data from the CFHTLenS survey and the matter power spectrum measurements from the latest SDSS data release. We find that the values of all cosmological parameters allowed by the HDM are well within thePlancksatellite (2015) constraints. In particular, we determine,,,and(at 95.5% c.l.). We also place new stringent constraints on the couplings of the HDM,ξχ<0.00328 and(at 95.5% c.l.). We find that the HDM is only slightly better than thew0waCDM model, with. Given that the HDM has two fewer parameters, we find Bayesian evidence favouring the HDM over thew0waCDM model. We also study the critical Higgs inflation model, taking into account the running of both the self-coupling λ(μ) and the non-minimal coupling to gravityξ(μ). We find peaks in the curvature power spectrum at scales corresponding to the critical valueμthat re-enter during the radiation era and collapse to form a broad distribution of clustered primordial black holes, which could constitute today the main component of dark matter.

This article is part of the Theo Murphy meeting issue ‘Higgs cosmology’.
The serendipity of electroweak baryogenesis
Authors: Servant Géraldine
Published: January 2018

The origin of the matter–antimatter asymmetry of the universe remains unexplained in the Standard Model (SM) of particle physics. The origin of the flavour structure is another major puzzle of the theory. In this article, we report on recent work attempting to link the two themes through the appealing framework of electroweak (EW) baryogenesis. We show that Yukawa couplings of SM fermions can be the source of CP violation for EW baryogenesis if they vary at the same time as the Higgs is acquiring its vacuum expectation value, offering new avenues for EW baryogenesis. The advantage of this approach is that it circumvents the usual severe bounds from electric dipole moments. These ideas apply if the mechanism explaining the flavour structure of the SM is connected to EW symmetry breaking, as motivated for instance in Randall–Sundrum or Composite Higgs models. We compute the resulting baryon asymmetry for different configurations of the Yukawa coupling variation across the bubble wall and show that it can naturally be of the right order.

This article is part of the Theo Murphy meeting issue ‘Higgs cosmology’.
Meta-Analysis of ERP Investigations of Pain Empathy underlines methodological issues in ERP research
Authors: Coll Michel-Pierre
Published: January 2018

Empathy has received considerable attention from the field of cognitive and social neuroscience. A significant portion of these studies used the event-related potential (ERP) technique to study the mechanisms of empathy for pain in others in different conditions and clinical populations. These show that specific ERP components measured during the observation of pain in others are modulated by several factors and altered in clinical populations. However, issues present in this literature such as analytical flexibility and lack of type 1 error control raise doubts regarding the validity and reliability of these conclusions. The current study compiled the results and methodological characteristics of 40 studies using ERP to study empathy of pain in others. The results of the meta-analysis suggest that the centro-parietal P3 and late positive potential component are sensitive to the observation of pain in others, while the early N1 and N2 components are not reliably associated with vicarious pain observation. The review of the methodological characteristics shows that the presence of selective reporting, analytical flexibility and lack of type 1 error control compromise the interpretation of these results. The implication of these results for the study of empathy and potential solutions to improve future investigations are discussed.
Facilitated event-related power-modulations during transcranial alternating current stimulation (tACS) revealed by concurrent tACS-MEG
Authors: Kasten Florian H. , Maess Burkhard , Herrmann Christoph S.
Published: January 2018

Non-invasive approaches to modulate oscillatory activity in the brain receive growing popularity in the scientific community. Transcranial alternating current stimulation (tACS) has been shown to modulate neural oscillations in a frequency specific manner. Due to a massive stimulation artifact at the targeted frequency, only little is known about effects of tACS during stimulation. I.e. it remains unclear how the continuous application of tACS affects event-related oscillations during cognitive tasks. Depending on whether tACS merely affects pre‐ or post-stimulus oscillations or both, stimulation can alter patterns of event-related oscillatory dynamics in various directions or may not affect them at all. Thus, knowledge about these directions is crucial to plan, predict and understand outcomes of solely behavioral tACS experiments. Here, a recently proposed procedure to suppress tACS artifacts by projecting MEG data into source space using spatial filtering was utilized to recover event-related power modulations in the alpha band during a mental rotation task. MEG of twenty-five volunteers was continuously recorded. After 10 minutes of baseline measurement, they received either 20 minutes of tACS at individual alpha frequency or sham stimulation. Another 40 minutes of MEG were acquired thereafter. Data were projected into source space and carefully examined for residual artifacts. Results revealed strong facilitation of event-related power modulations in the alpha band during tACS application. Data provide first direct evidence, that tACS does not counteract top-down suppression of intrinsic oscillations, but rather enhances pre-existent power modulations within the range of the individual alpha (=stimulation) frequency.

Significance

Transcranial alternating current stimulation (tACS) is increasingly used in cognitive neuroscience to study the causal role of brain oscillations and cognition. However, online effects of tACS so far largely remain a ‘black box’ due to an intense electromagnetic artifact encountered during stimulation. The current study is the first to employ a spatial filtering approach to recover and systematically study event-related oscillatory dynamics during tACS, which can potentially be altered in various directions. TACS facilitated pre-existing patterns of oscillatory dynamics during the employed mental rotation task, but does not counteract or overwrite them. In addition, control analysis and a measure to quantify tACS artifact suppression are provided that can enrich future studies investigating tACS online effects.
The frontal aslant tract (FAT) and its role in speech, language and executive function
Authors: Dick Anthony Steven , Garic Dea , Graziano Paulo , Tremblay Pascale
Published: January 2018

In this review, we examine the structural connectivity of a recently-identified fiber pathway, the frontal aslant tract (FAT), and explore its function. We first review structural connectivity studies using tract-tracing methods in non-human primates, and diffusion-weighted imaging and electrostimulation in humans. These studies suggest a monosynaptic connection exists between the lateral inferior frontal gyrus and the pre-supplementary and supplementary motor areas of the medial superior frontal gyrus. This connection is termed the FAT. We then review research on the left FAT’s putative role in supporting speech and language function, with particular focus on speech initiation, stuttering and verbal fluency. Next, we review research on the right FAT’s putative role supporting executive function, namely inhibitory control and conflict monitoring for action. We summarize the extant body of empirical work by suggesting that the FAT plays a domain general role in the planning, timing, and coordination of sequential motor movements through the resolution of competition among potential motor plans. However, we also propose some domain specialization across the hemispheres. On the left hemisphere, the circuit is proposed to be specialized for speech actions. On the right hemisphere, the circuit is proposed to be specialized for general action control of the organism, especially in the visuo-spatial domain. We close the review with a discussion of the clinical significance of the FAT, and suggestions for further research on the pathway.

Highlights

The frontal aslant tract (FAT) is a recently identified fiber pathway

It connects inferior frontal gyrus with medial frontal motor areas

The left FAT has been associated with speech and language function

The right FAT has been associated with inhibitory control

Both FAT pathways may function in sequential motor planning
EEG-triggered TMS reveals stronger brain state-dependent modulation of motor evoked potentials at weaker stimulation intensities
Authors: Schaworonkow Natalie , Triesch Jochen , Ziemann Ulf , Zrenner Christoph
Published: January 2018

Background

Corticospinal excitability depends on the current brain state. The recent development of real-time EEG-triggered transcranial magnetic stimulation (EEG-TMS) allows studying this relationship in a causal fashion. Specifically, it has been shown that corticospinal excitability is higher during the scalp surface negative EEG peak compared to the positive peak of µ-oscillations in sensorimotor cortex, as indexed by larger motor evoked potentials (MEPs) for fixed stimulation intensity.

Objective

We further characterize the effect of µ-rhythm phase on the MEP input-output (IO) curve by measuring the degree of excitability modulation across a range of stimulation intensities. We furthermore seek to optimize stimulation parameters to enable discrimination of functionally relevant EEG-defined brain states.

Methods

A real-time EEG-TMS system was used to trigger MEPs during instantaneous brain-states corresponding to µ-rhythm surface positive and negative peaks with five different stimulation intensities covering an individually calibrated MEP IO curve in 15 healthy participants.

Results

MEP amplitude is modulated by µ-phase across a wide range of stimulation intensities, with larger MEPs at the surface negative peak. The largest relative MEP-modulation was observed for weak intensities, the largest absolute MEP-modulation for intermediate intensities. These results indicate a leftward shift of the MEP IO curve during the µ-rhythm negative peak.

Conclusion

The choice of stimulation intensity influences the observed degree of corticospinal excitability modulation by µ-phase. Lower stimulation intensities enable more efficient differentiation of EEG µ-phase-defined brain states.