bluuebunny/crossref_metadata_2025 huggingface dataset:
Strain-GeMS: optimized subspecies identification from microbiome data based on accurate variant modeling
Authors: Tan Chongyang , Cui Wei , Cui Xinping , Ning Kang
Published: October 2018

Motivation

Subspecies identification is one of the most critical issues in microbiome studies, as it is directly related to their functions in response to the environmental stress and their feedbacks. However, identification of subspecies remains a challenge largely due to the small variation between different strains within the same species. Accurate identification of subspecies primarily relies on variant identification and categorization through microbiome data. However, current SNP calling and subspecies identification for microbiome data remain underdeveloped.

Results

In this work, we have proposed Strain-GeMS for subspecies identification from microbiome data, based on solid statistical model for SNP calling, as well as optimized procedure for subspecies identification. Results on simulated, ab initio and in vivo datasets have shown that Strain-GeMS could always generate more accurate results compared with other subspecies identification methods.

Availability and implementation

Strain-GeMS is available at: https://github.com/HUST-NingKang-Lab/straingems.

Supplementary information

Supplementary data are available at Bioinformatics online.
A new method bridging graph theory and residue co-evolutionary networks for specificity determinant positions detection
Authors: da Fonseca Néli José , Afonso Marcelo Querino Lima , de Oliveira Lucas Carrijo , Bleicher Lucas
Published: October 2018

Motivation

Computational studies of molecular evolution are usually performed from a multiple alignment of homologous sequences, on which sequences resulting from a common ancestor are aligned so that equivalent residues are placed in the same position. Residues frequency patterns of a full alignment or from a subset of its sequences can be highly useful for suggesting positions under selection. Most methods mapping co-evolving or specificity determinant sites are focused on positions, however, they do not consider the case for residues that are specificity determinants in one subclass, but variable in others. In addition, many methods are impractical for very large alignments, such as those obtained from Pfam, or require a priori information of the subclasses to be analyzed.

Results

In this paper we apply the complex networks theory, widely used to analyze co-affiliation systems in the social and ecological contexts, to map groups of functional related residues. This methodology was initially evaluated in simulated environments and then applied to four different protein families datasets, in which several specificity determinant sets and functional motifs were successfully detected.

Availability and implementation

The algorithms and datasets used in the development of this project are available on http://www.biocomp.icb.ufmg.br/biocomp/software-and-databases/networkstats/.

Supplementary information

Supplementary data are available at Bioinformatics online.
Inferring disease-associated long non-coding RNAs using genome-wide tissue expression profiles
Authors: Pan Xiaoyong , Jensen Lars Juhl , Gorodkin Jan
Published: October 2018

Motivation

Long non-coding RNAs (lncRNAs) are important regulators in wide variety of biological processes, which are linked to many diseases. Compared to protein-coding genes (PCGs), the association between diseases and lncRNAs is still not well studied. Thus, inferring disease-associated lncRNAs on a genome-wide scale has become imperative.

Results

In this study, we propose a machine learning-based method, DislncRF, which infers disease-associated lncRNAs on a genome-wide scale based on tissue expression profiles. DislncRF uses random forest models trained on expression profiles of known disease-associated PCGs across human tissues to extract general patterns between expression profiles and diseases. These models are then applied to score associations between lncRNAs and diseases. DislncRF was benchmarked against a gold standard dataset and compared to other methods. The results show that DislncRF yields promising performance and outperforms the existing methods. The utility of DislncRF is further substantiated on two diseases in which we find that top scoring candidates are supported by literature or independent datasets.

Availability and implementation

https://github.com/xypan1232/DislncRF

Supplementary information

Supplementary data are available at Bioinformatics online.
Contraceptive drugs mitigate experimental stroke-induced brain injury
Authors: El Amki Mohamad , Binder Nadine , Steffen Riccardo , Schneider Hannah , Luft Andreas R , Weller Michael , Imthurn Bruno , Merki-Feld Gabriele S , Wegener Susanne
Published: October 2018

Aims

Effective stroke treatments beyond reperfusion remain scant. The natural steroid hormone progesterone has shown protective effects in experimental models of brain injury and cardiovascular disease. However, unfavourable bioavailability limits its clinical use. Desogestrel and drospirenone are new generation progestins with progesterone-like properties, developed as oral contraceptives with excellent bioavailability and safety profile. We investigated the neuroprotective properties of these progestins in vivo using transient middle cerebral artery occlusion (MCAO) and in vitro using an oxygen-glucose deprivation and reoxygenation (OGD/R) model in primary neuronal cells.

Methods and results

MCAO was induced in female, female ovariectomized (modelling postmenopausal females) and male mice. Treatment with the progestins resulted in less severe strokes after MCAO and less neuronal death in OGD/R. Desogestrel and drospirenone induced higher expression levels of GABAAR α4 and delta subunits within the brain, suggesting changes in GABAAR configuration favouring tonic inhibition as potential mechanism of action. Treatment with the GABAAR blocker picrotoxin abolished the protection afforded by the progestins in vivo and in vitro.

Conclusion

For the first time, here, we delineate a potential role of desogestrel and drospirenone, both clinically approved and safe drugs in mitigating the consequences of stroke. Contraception with desogestrel and drospirenone in progestin-only preparations may be particularly beneficial for women at risk of stroke.
Additional appointments and discomfort associated with compliance-free fixed Class II corrector treatment: a systematic review
Authors: Phuong Ashley , Fagundes Nathalia Carolina Fernandes , Abtahi Sahar , Roberts Mary Roduta , Major Paul W , Flores-Mir Carlos
Published: October 2018

Objective

A critical analysis of the literature to determine the prevalence and type of emergency/additional appointments, and discomfort levels associated with fixed Class II correctors.

Methods

Studies examining patient’s sources of discomfort or emergency appointments associated with compliance-free Class II correctors were included. Comprehensive searches up to July 2018 were conducted using the following databases: MEDLINE (OvidSP), PubMed, Web of Science, and Embase. A partial grey literature search was taken using Google Scholar and OpenGrey. Two reviewers independently performed the selection process and risk of bias assessment. The Newcastle-Ottawa Scale for cross-sectional studies were used. A summary of the overall strength of evidence was presented using ‘Grading of Recommendations, Assessment, Development and Evaluation’ (GRADE) tool. Included studies were evaluated according to their design, study quality, consistency, and directness.

Results

The selected studies were published between 2001 and 2018, and the number of patients per studied group ranged from 8 to 182. One thousand five hundred forty-two patients were evaluated in total. The patients’ mean age at start of treatment ranged from 10 to 16.9 years and the fixed Class II corrector treatment duration ranged from 4 to 12 months. The included studies in this systematic review were too clinically heterogeneous (different appliances, different data recollection processes) to justify a meta-analysis.

Limitations

This review was not previously registered. A low level of evidence was observed among the two randomized trials, the 10 cohorts and three cross-sectional studies identified.

Conclusions

The main source of discomfort from Forsus-type appliances appears to be soreness in the cheeks (low level of evidence with a weak recommendation strength). Most evaluated patients treated with a Herbst appliance, regardless of design, will experience complications (fractures and/or dislodging) requiring emergency appointments (low level of evidence with a weak recommendation strength).

Registration

The review protocol was not registered.
An exact penalty method for semidefinite-box-constrained low-rank matrix optimization problems
Authors: Liu Tianxiang , Lu Zhaosong , Chen Xiaojun , Dai Yu-Hong
Published: October 2018

This paper considers a matrix optimization problem where the objective function is continuously differentiable and the constraints involve a semidefinite-box constraint and a rank constraint. We first replace the rank constraint by adding a non-Lipschitz penalty function in the objective and prove that this penalty problem is exact with respect to the original problem. Next, for the penalty problem we present a nonmonotone proximal gradient (NPG) algorithm whose subproblem can be solved by Newton’s method with globally quadratic convergence. We also prove the convergence of the NPG algorithm to a first-order stationary point of the penalty problem. Furthermore, based on the NPG algorithm, we propose an adaptive penalty method (APM) for solving the original problem. Finally, the efficiency of an APM is shown via numerical experiments for the sensor network localization problem and the nearest low-rank correlation matrix problem.
Topological Moduli Space for Germs of Holomorphic Foliations
Authors: Marín David , Mattei Jean-François , Salem Éliane
Published: October 2018

This work deals with the topological classification of germs of singular foliations on $(\mathbb{C}^{2},0)$. Working in a suitable class of foliations we fix the topological invariants given by the separatrix set, the Camacho–Sad indices, and the projective holonomy representations and we compute the moduli space of topological classes in terms of the cohomology of a new algebraic object that we call group-graph. This moduli space may be an infinite-dimensional functional space but under generic conditions we prove that it has finite dimension and we describe its algebraic and topological structure.
Mesenchymal Stem Cell-Seeded High-Density Collagen Gel for Annular Repair: 6-Week Results From In Vivo Sheep Models
Authors: Hussain Ibrahim , Sloan Stephen R , Wipplinger Christoph , Navarro-Ramirez Rodrigo , Zubkov Micaella , Kim Eliana , Kirnaz Sertac , Bonassar Lawrence J , Härtl Roger
Published: October 2018

BACKGROUND

Our group has previously demonstrated in vivo annulus fibrosus repair in animal models using an acellular, riboflavin crosslinked, high-density collagen (HDC) gel.

OBJECTIVE

To assess if seeding allogenic mesenchymal stem cells (MSCs) into this gel yields improved histological and radiographic benefits in an in vivo sheep model of annular injury.

METHODS

Fifteen lumbar intervertebral discs (IVDs) were randomized into 4 groups: intact, injury only, injury + acellular gel treatment, or injury + MSC-seeded gel treatment. Sheep were sacrificed at 6 wk. Disc height index (DHI), Pfirrmann grade, nucleus pulposus area, and T2 relaxation time (T2-RT) were calculated for each IVD and standardized to healthy controls from the same sheep. Quantitative histological assessment was also performed using the Han scoring system.

RESULTS

All treated IVDs retained gel plugs on gross assessment and there were no adverse perioperative complications. The MSC-seeded gel treatment group demonstrated statistically significant improvement over other experimental groups in DHI (P = .002), Pfirrmann grade (P < .001), and T2-RT (P = .015). There was a trend for greater Han scores in the MSC-seeded gel-treated discs compared with injury only and acellular gel-treated IVDs (P = .246).

CONCLUSION

MSC-seeded HDC gel can be delivered into injured IVDs and maintained safely in live sheep to 6 wk. Compared with no treatment and acellular HDC gel, our data show that MSC-seeded HDC gel improves outcomes in DHI, Pfirrmann grade, and T2-RT. Histological analysis shows improved annulus fibrosus and nucleus pulposus reconstitution and organization over other experimental groups as well.
Pulsed Ultrasounds Reduce Pain and Disability, Increasing Rib Fracture Healing, in a Randomized Controlled Trial
Authors: Santana-Rodríguez Norberto , Clavo Bernardino , Llontop Pedro , Fiuza María D , Calatayud-Gastardi Joaquín , López Daniel , López-Fernández Daniel , Aguiar-Santana Ione A , Ayub Adil , Alshehri Khalid , Jordi Nagib A , Zubeldia José , Bröering Dieter C
Published: October 2018

Introduction

Rib fractures are an important health issue worldwide, with significant, pain, morbidity, and disability for which only symptomatic treatment exists.

Objectives

Based on our previous experimental model, the objective of the current study was to assess for the first time whether pulsed ultrasound (PUS) application could have beneficial effects on humans.

Methods

Prospective, double-blinded, randomized, controlled trial of 51 patients. Four were excluded, and 47 were randomized into the control group (N = 23) or PUS group (N = 24). The control group received a PUS procedure without emission, and the PUS group received 1 Mhz, 0.5 W/cm2 for 1 min/cm2. Pain level, bone callus healing rate, physical and work activity, pain medication intake, and adverse events were blindly evaluated at baseline and one, three, and six months.

Results

There were no significant differences at baseline between groups. PUS treatment significantly decreased pain by month 1 (P = 0.004), month 3 (P = 0.005), and month 6 (P = 0.025), significantly accelerated callus healing by month 1 (P = 0.013) and month 3 (P < 0.001), accelerated return to physical activity by month 3 (P = 0.036) and work activity (P = 0.001) by month 1, and considerably reduced pain medication intake by month 1 (P = 0.057) and month 3 (P = 0.017). No related adverse events were found in the PUS group.

Conclusions

This study is the first evidence that PUS treatment is capable of improving rib fracture outcome, significantly accelerating bone callus healing, and decreasing pain, time off due to both physical activity and convalescence period, and pain medication intake. It is a safe, efficient, and low-cost therapy that may become a new treatment for patients with stable rib fractures.
Characteristics associated with influenza vaccination uptake among adults
Authors: Tian Changwei , Wang Hua , Wang Wenming , Luo Xiaoming
Published: October 2018

Background

Annual influenza vaccination has been recommended for all adults since 2010. This study aimed to identify characteristics associated with influenza vaccination among adults.

Methods

Data from the National Health Interview Survey from 2011 to 2016 were analyzed.

Results

Influenza vaccination coverage among adults increased from 38.28% in 2011 to 44.75% in 2016 (1.50% per year on average). In multivariate analysis, the largest magnitude of association was found with pneumococcal vaccine (lowest and highest odds ratios from 2011 to 2016: 3.37–3.78), followed by physician visits ≥4 in the past 12 months (2.33–3.03), age ≥65 years (1.69–2.07), having a usual place for sick care (1.41–1.94), insurance coverage (1.52–1.79), hepatitis B vaccine (1.48–1.71), ratio of family income to the poverty threshold ≥4 (1.19–1.54), race of Asian (1.24–1.47), number of years on the job ≥21 (1.21–1.41), class of worker (Federal government: 1.23–1.32, State government: 1.15–1.38), high-risk conditions (1.13–1.26), physical activity ≥5 times/week (1.11–1.25) and being female (1.13–1.20). However, adults living in West, and adults of Black/African American, never married, high school education, self-employed and current smokers had lower vaccine uptake.

Conclusions

Several characteristics were identified to be associated with influenza vaccination uptake, which could be useful for targeted efforts to improve influenza vaccination coverage among adults.
OPTIMIZATION OF AN ADDITIONAL COLLIMATOR IN A BEAM DELIVERY SYSTEM FOR REDUCTION OF THE SECONDARY NEUTRON EXPOSURE IN PASSIVE CARBON-ION THERAPY
Authors: Komori Masataka , Takeuchi Akihiko , Niwa Maiko , Harada Takaomi , Oguchi Hiroshi
Published: October 2018

The aim of this work is to optimize an additional collimator in a beam delivery system to reduce neutron exposure to patients in passive carbon-ion therapy. All studies were performed by Monte Carlo simulation assuming the beam delivery system at Heavy-Ion Medical Accelerator in Chiba. We calculated the neutron ambient dose equivalent at patient positions with an additional collimator, and optimized the position, aperture size and material of the collimator to reduce the neutron ambient dose equivalent. The collimator located 125 and 470 cm upstream from the isocenter could reduce the dose equivalent near the isocenter by 35%, while the collimator located 813 cm upstream from the isocenter was ineffective. As for the material of the collimator, iron and nickel could conduct reduction slightly better than aluminum and polymethyl methacrylate. The additional collimator is an effective method for the reduction of the neutron ambient dose equivalent near the isocenter.
ASSESSMENT OF RADIOLOGICAL DOSES FOR PEOPLE LIVING IN KOREA FOLLOWING ACCIDENTAL RELEASES OF RADIONUCLIDES FROM NUCLEAR POWER PLANTS IN KOREA AND CHINA
Authors: Kim Sora , Park Kihyun , Min Byung-Il , Yang Byung-Mo , Kim Jiyoon , Suh Kyung-Suk
Published: October 2018

Accidentally released radionuclides are dispersed into the environment and cause human exposure through various pathways. Concerns about radiological impacts of a possible Nuclear power plant (NPP) accident in neighboring countries, especially in China, are increasing in Korea. Dose assessments for the hypothetical nuclear accidents in Korea (Hanbit and Wolsong NPPs) and China (Tianwan NPP) were conducted using the developed Korean code system. The results show that there is a possibility that a Tianwan NPP accident could have a slightly greater or similar impact on certain parts of Korea compared to accidents occurring at domestic NPPs, and could affect Korea within a few days of the accident. This research is expected to be used as basic material for preparing against nuclear accidents in neighboring countries.
EFFECTS OF FLIGHT ROUTE VARIATION AND GREAT-CIRCLE APPROXIMATION ON AVIATION DOSE ASSESSMENT FOR POPULAR FLIGHTS FROM TAIWAN
Authors: Yang Zi-Yi , Sheu Rong-Jiun
Published: October 2018

Galactic cosmic-ray-induced secondary particles in the atmosphere constitute an important source of radiation exposure to airline crews and passengers. In this study, a systematic dose assessment was conducted for 11 popular flights from Taiwan, with an emphasis on the effects of flight route variation and assumption. The case studies covered a broad range of commercial flights departing from Taipei, from a domestic flight of <1 h to a long-haul international flight of more than 14 h. For each route under study, information on 100 actual flight routes was retrieved from flight tracking data collected from June to September 2017, and the information was analyzed using a self-developed program called the ‘NTHU Flight Dose Calculator’. The resulting distribution of route doses provided not only the mean value and associated standard deviation but also information on the characteristics of aviation dose assessment and management. Furthermore, compared with actual flight routes, the dose differences introduced by great-circle approximation were evaluated, and the effects of solar activity on the dose assessment of these flights were reported.
The Conservative Tradition in British Thoracic and Cardiac Surgery 1900–1956
Authors: Lawrence Christopher
Published: October 2018

Guy’s Hospital was a major setting for the creation of heart surgery as a practice and speciality in immediate post-war Britain. Medical reformers of the twentieth century characterised much London hospital medicine as conservative and not organised for the production of modern research. Through the minutes of a hospital club formed to manage congenital heart disease, the paper explores how dynamic surgical research was carried out in an institution committed to traditional values and organisation. I trace the background to this development from around 1900.
Conceptualizing Neonatal Abstinence Syndrome as a Cascade of Care
Authors: Syvertsen Jennifer L. , Toneff Hannah , Madden Danielle R. , Clapp John D.
Published: October 2018

Background:

The opioid epidemic remains a serious issue in the United States and presents additional challenges for women of childbearing age. An increasingly common complication of opioid use is neonatal abstinence syndrome (NAS), or infant withdrawal from in utero exposure to opioids.

Purpose:

The objective of our qualitative study was to identify service needs and barriers to care in the NAS epidemic in Ohio, which has among the highest rates of opioid use and NAS in the nation.

Methods:

Drawing on interviews with 18 healthcare providers, we investigated the challenges, opportunities, and service gaps in treating NAS. Open-ended questions covered opioid misuse and drug treatment, provision of and barriers to healthcare, and suggestions to improve prevention and programming. Content analysis identified major themes.

Findings:

Providers were primarily women (67%) and included individuals working in healthcare administrative positions, hospital settings, clinics, and social support positions for pregnant women or new mothers. Our results suggest that rather than an acute diagnosis, NAS is better conceptualized as a “cascade of care” including (1) prevention, (2) prenatal care, including drug treatment, (3) labor and delivery, and (4) aftercare. Providers identified challenges and opportunities at each stage of the cascade that could influence NAS outcomes.

Implications for Practice:

Our results suggest that greater resources, coordination, and cross-disciplinary education are urgently needed across the cascade of care to effectively address NAS.

Implications for Research:

Framing NAS as a cascade of care allows researchers to identify points along a cascade where mothers and infants require enhanced care and access to social and health services.
Refinement of the Beliefs About Personal Weight Survey
Authors: Pickett Stephanie , Peters Rosalind M. , Templin Thomas
Published: October 2018

This study tested the revised Beliefs About Personal Weight Survey-2 (BPWS-2) in 200 African American women, 18 to 40 years of age. Confirmatory factor analysis of a priori hypothesized factors resulted in 5 subscales—weight acceptance (8 items); excess weight acknowledgment (5 items); conventional weight regulation (3 items); circumstantial weight regulation (9 items); and weight concern (10 items). The Cronbach α ranged from 0.67 to 0.89. The factors demonstrated patterns of association with eating behavior, body mass index, body image, and psychosocial (depression and perceived stress) variables associated with weight. The BPWS-2 is the first instrument designed to measure beliefs about one's personal weight, thus results make important new contributions to the understanding of weight management.
An Emancipatory Approach to Cultural Competency
Authors: Wesp Linda M. , Scheer Victoria , Ruiz Ashley , Walker Kimberly , Weitzel Jennifer , Shaw Leslie , Kako Peninnah M. , Mkandawire-Valhmu Lucy
Published: October 2018

Nurses teach, work, and conduct research in an increasingly hostile sociopolitical climate where health inequities persist among marginalized communities. Current approaches to cultural competency do not adequately equip nurses to address these complex factors and risk perpetuating stereotypes and discrimination. A theory-driven emancipatory approach to cultural competency will instead lead to lasting change and uphold the core nursing value of commitment to social justice. This article explicates key tenets of critical race, postcolonial feminist, and intersectionality theories and then applies them, using an emancipatory approach to cultural competency that can reshape nursing education, research, and practice.
Bimodal Hearing or Bilateral Cochlear Implants? Ask the Patient
Authors: Gifford René H. , Dorman Michael F.
Published: October 2018

Objective:

The objectives of this study were to assess the effectiveness of various measures of speech understanding in distinguishing performance differences between adult bimodal and bilateral cochlear implant (CI) recipients and to provide a preliminary evidence-based tool guiding clinical decisions regarding bilateral CI candidacy.

Design:

This study used a multiple-baseline, cross-sectional design investigating speech recognition performance for 85 experienced adult CI recipients (49 bimodal, 36 bilateral). Speech recognition was assessed in a standard clinical test environment with a single loudspeaker using the minimum speech test battery for adult CI recipients as well as with an R-SPACETM 8-loudspeaker, sound-simulation system. All participants were tested in three listening conditions for each measure including each ear alone as well as in the bilateral/bimodal condition. In addition, we asked each bimodal listener to provide a yes/no answer to the question, “Do you think you need a second CI?”

Results:

This study yielded three primary findings: (1) there were no significant differences between bimodal and bilateral CI performance or binaural summation on clinical measures of speech recognition, (2) an adaptive speech recognition task in the R-SPACETM system revealed significant differences in performance and binaural summation between bimodal and bilateral CI users, with bilateral CI users achieving significantly better performance and greater summation, and (3) the patient’s answer to the question, “Do you think you need a second CI?” held high sensitivity (100% hit rate) for identifying likely bilateral CI candidates and moderately high specificity (77% correct rejection rate) for correctly identifying listeners best suited with a bimodal hearing configuration.

Conclusions:

Clinics cannot rely on current clinical measures of speech understanding, with a single loudspeaker, to determine bilateral CI candidacy for adult bimodal listeners nor to accurately document bilateral benefit relative to a previous bimodal hearing configuration. Speech recognition in a complex listening environment, such as R-SPACETM, is a sensitive and appropriate measure for determining bilateral CI candidacy and also likely for documenting bilateral benefit relative to a previous bimodal configuration. In the absence of an available R-SPACETM system, asking the patient whether or not s/he thinks s/he needs a second CI is a highly sensitive measure, which may prove clinically useful.
Reducing cost by using a smaller instrument tray in hand surgery
Authors: Kirn Philip T. , Angermeier Eric , Kokko Kyle P.
Published: October 2018

Background:

The cost of US healthcare continues to rise at an unsustainable rate. A significant amount of waste occurs in the operating room. One way to reduce cost is by using trays with fewer instruments. The purpose of our study was to determine the cost to sterilize and process an instrument at our institution and calculate the expected savings when using a smaller tray for selected hand procedures.

Methods:

This was a single-site, observational study conducted at an academic medical center. The cost to sterilize an instrument was determined by dividing relevant labor and operating expenses by the total number of instruments processed. The ambulatory hand set was decreased from 105 to 16 instruments. Using the calculated cost to process an instrument, we determined cost savings per tray. By multiplying this value with the total number of cases for which the new tray would be used, we were able to determine expected cost savings per year. We also surveyed operating room staff with regards to work flow and satisfaction with the smaller tray.

Results:

Using the observed time to decontaminate and package an instrument, the labor cost was calculated to be $0.14 per instrument. The cost increased to $0.60 per instrument after including operating expenses. Decreasing the hand tray in selected procedures was calculated to save $31,500 per year. The smaller tray resulted in improved work flow and high satisfaction scores among operating room staff.

Conclusions:

Our calculated expense to sterilize and process an instrument is similar to prior studies. Processing fewer instruments in selected hand procedures is expected to result in significant cost savings and improvement in operating room workflow and satisfaction.
The opioid epidemic and patient satisfaction: a review of one institution’s experience
Authors: Hagedorn John C. , Myers Mitchell , Holihan Julie , Choo Andrew , Achor Timothy , Munz John , Gary Joshua
Published: October 2018

Background:

The opioid crisis caused the Drug Enforcement Administration (DEA) to reschedule hydrocodone to schedule II from III. Other narcotics (i.e. codeine) were not reclassified, becoming the narcotic medications for many surgeons. We wanted to review how this rescheduling of hydrocodone influenced prescribing practices and Press Ganey scores.

Methods:

A retrospective review from April 6, 2014, to April 5, 2015, was conducted on all orthopaedic trauma patients at a level I trauma center. Patient charts were abstracted for the type and amount of narcotic prescribed. Press Ganey scores for the surgeons were collected during the same period. The data were used to determine the percentage of hydrocodone prescription before and after reclassification as well as the effect on Press Ganey Scores.

Results:

Surgeons significantly decreased the percentage of hydrocodone prescriptions, 70% versus 44% (P < 0.001), after reclassification. Two surgeons, A (76% vs. 11%) and B (69% vs. 30%), had a significant decrease in the percentage of hydrocodone (P < 0.0001), surgeon C’s percentage (67% vs. 67%) did not change (P =0.96), and surgeon D significantly increased (67% vs. 86%) (P =0.009). No significant changes were seen for overall Press Ganey scores for the group aggregate or individual providers, 91 versus 91 (P =0.993) after reclassification.

Conclusions:

The results show that the percentage of hydrocodone to all narcotic prescriptions decreased after rescheduling hydrocodone. This did vary by individual surgeon, with one surgeon’s percentage being significantly increased. Press Ganey scores did not appear to be influenced by rescheduling hydrocodone.
Barriers to the identification of fragility fractures for secondary fracture prevention in an orthopaedic clinic-based fracture liaison service: a prospective cohort study
Authors: Senay Andréa , Delisle Josée , Banica Andreea , Laflamme G. Yves , Leduc Stéphane , Mac-Thiong Jean-Marc , Ranger Pierre , Rouleau Dominique , Fernandes Julio C.
Published: October 2018

Background:

The goal of this study was to determine the identification and participation rates of fragility fracture patients in a Fracture Liaison Service (FLS). We also identified factors affecting performance in patient identification.

Methods:

Surgeons, staff, and FLS nurses of an outpatient orthopaedic clinic from a hospital (Montreal, Canada) identified patients 50 yr of age or older with a fragility fracture eligible to join an FLS from January 2014 to March 2015. The list of orthopaedic referrals for the same period was retrieved and compared to our list of patients in the FLS to determine the participation rate. An in-house questionnaire was dispensed to volunteer staff to identify gaps in fragility fracture identification.

Results:

We identified 1011 patients with fractures from the orthopaedic referral list. Two hundred forty-nine patients (24.6%) were not identified because of nonreferral by surgeons or staff. Of the 762 remaining patients, 288 were excluded for high-energy trauma (n = 126), fracture of the face, skull, foot, or hand (n = 87), and other reasons (n = 75). Out of 474 patients with fragility fracture, 295 (62.2%) joined the FLS (178 refusals (37.6%). FLS managers only accessed 46.9% (474/1011) of eligible patients. The highest difficulty reported by the staff was about the time allocated to patient identification considering their workload.

Conclusions:

Major barriers to diagnosis and treatment of underlying osteoporosis in fragility fractures are nonreferral from orthopaedic surgeons or staff, and patient refusal. Challenges reside in implementing an institutional policy for optimal screening, better surgeon, staff, and patient education combined with improved systematic clinical management programs.
Subtrochanteric femoral fractures in osteopetrotic patients: problematic cases to handle
Authors: Diab Ramy Ahmed , Ghafar Khaled Abd EL
Published: October 2018

Background:

Osteopetrosis is characterized by abnormally diminished osteoclast mediated skeletal resorption that leads to excessive accumulation of bone matrix, causing hard, dense bones with obliteration of the medullary canal, but with fragile, brittle bone. Osteopetrosis is endemic in North Sinai. The aim of the study was to assess the results of treatment of osteopetrotic subtrochanteric femoral fracture by open reduction and internal fixation using a locked plate combined with intramedullary reaming, describing the difficulties and the technical tips during fixation.

Methods:

Eight patients with osteopetrotic subtrochanteric femoral fractures (bilateral in two patients but not simultaneous) were treated. Osteosynthesis with internal fixation was performed using proximal femoral locked plates (in eight femora) or a dynamic hip screw (in two femora). Proper preoperative planning, presence of spare drill bits, patience during opening the medullary canal, and extra care with the sterilization rules are necessary. Delayed or nonunion and infection should be included in the informed consent.

Results:

No perioperative complications including infection, implant failure, or nonunion were observed during the follow-up period. All fractures healed at an average of 6.4 mo (6-8.4 mo) with no patients requiring bone grafting or additional procedures. All the patients were able to walk without pain and without assistance at the final follow-up.

Conclusions:

Management of osteopetrotic subtrochanteric femoral fractures by open reduction and internal fixation using locked plates combined with medullary canal reaming with extra care of the perioperative and intraoperative challenges and complications achieve successful results.
Synthesis: Causal Models, Causal Knowledge
Authors: Collins Sean M.
Published: October 2018

This article presents the 2018 Linda Crane Memorial Lecture Award on Synthesis: Causal Models, Causal Knowledge. The synthesis is that practice is based on causal knowledge and that we can encode causal knowledge with causal models. It proposes the use of causal models to provide a synthesis of what we know to develop causal knowledge from which to further develop with empirical evidence and from which knowledge we can practice. The synthesis is founded on critical realist epistemology that explicitly identifies the human mind as part of the process of knowledge and where the models that are constructed fit with reality even when we cannot empirically verify every component of such models; but where knowledge assumptions are encoded in the models clearly, combine knowledge with reasoning and are subject to empirical verification when possible.
Epithelioid Fibrous Histiocytoma: A Concise Review
Authors: Felty Cameron C. , Linos Konstantinos
Published: October 2018

Epithelioid fibrous histiocytoma (EFH) is a rare lesion believed to arise from dermal microvascular unit fibroblasts and dendritic histiocytes. EFH has long been considered a morphologic variant of benign fibrous histiocytoma (dermatofibroma), with prominent epithelioid cytomorphology that can mimic both vascular and melanocytic neoplasms. The molecular basis for the relationship between EFH and benign fibrous histiocytoma has remained largely unknown, with some authors suggesting that EFH represents an entity that is biologically distinct from benign fibrous histiocytoma. Recent molecular studies have identified the presence of recurrent anaplastic lymphoma kinase (ALK) gene rearrangements, a phenomenon that has not been described in benign fibrous histiocytoma. These new molecular findings highlight the uniqueness of this rare tumor and may prove useful as a diagnostic tool for differentiation from other histologic mimics.
Patient and Physician Preferences for Nonoperative Management for Low Rectal Cancer: Is It a Reasonable Treatment Option?
Authors: Kennedy Erin D. , Borowiec Anna M. , Schmocker Selina , Cho Charles , Brierley James , Li Shirley , Victor J. Charles , Baxter Nancy N.
Published: October 2018

BACKGROUND:

Although the body of evidence supporting nonoperative management for rectal cancer has been accumulating, there has been little systematic investigation to explore how physicians and patients value the tradeoffs between oncologic and functional outcomes after abdominal perineal resection and nonoperative management.

OBJECTIVE:

The purpose of this study was to elicit patient and physician preferences for nonoperative management relative to abdominal perineal resection in the setting of low rectal cancer.

DESIGN:

We conducted a standardized interviews of patients and a cross-sectional survey of physicians.

SETTINGS:

Patients from 1 tertiary care center and physicians from across Canada were included.

PATIENTS:

The study involved 50 patients who were previously treated for rectal cancer and 363 physicians who treat rectal cancer.

INTERVENTIONS:

Interventions included standardized interviews using the threshold technique with patients and surveys mailed to physicians.

MAIN OUTCOMES MEASURES:

We measured absolute increase risk in local regrowth and absolute decrease in overall survival that patients and physicians would accept with nonoperative management relative to abdominal perineal resection.

RESULTS:

Patients were willing to accept a 20% absolute increase for local regrowth (ie, from 0% to 20%) and a 20% absolute decrease in overall survival (ie, from 80% to 60%) with nonoperative management relative to abdominal perineal resection, whereas physicians were willing to accept a 5% absolute increase for local regrowth (ie, from 0% to 5%) and a 5% absolute decrease in overall survival (ie, from 80% to 75%) with nonoperative management relative to abdominal perineal resection.

LIMITATIONS:

Data were subject to response bias and generalizable to only a select group of patients with low rectal cancer.

CONCLUSIONS:

Offering nonoperative management as an option to patients, even if oncologic outcomes are not equivalent, may be more consistent with the values of patients in this setting. See Video Abstract at http://links.lww.com/DCR/A688.
Anal High-Grade Squamous Intraepithelial Lesions in Pharmacologically Immunocompromised Patients Followed in a Referral Center
Authors: Albuquerque Andreia , Cappello Carmelina , Cuming Tamzin , De Masi Anke , Bowring Julie , Rosenthal Adam N. , Nathan • Mayura
Published: October 2018

BACKGROUND:

Information is lacking regarding anal/perianal precancerous lesions in referral cohorts of pharmacologically immunocompromised patients.

OBJECTIVE:

The aim of this study is to evaluate the prevalence of anal/perianal high-grade squamous intraepithelial lesions in a referral cohort of patients on immunomodulator/immunosuppressive medications, who were assessed and followed with high-resolution anoscopy.

DESIGN:

This is a retrospective study.

SETTING:

This study was conducted in a single anal neoplasia service from January 2012 to June 2017.

PATIENTS:

Patients on chronic immunomodulator/immunosuppressive medications were included. Cases of concomitant immunosuppression due to HIV infection were excluded, and immunosuppression due to chemotherapy was not considered for this analysis.

INTERVENTION:

High-resolution anoscopy was performed.

MAIN OUTCOME:

The primary outcome measured was the prevalence of anal/perianal high-grade squamous intraepithelial lesions in a referral cohort of pharmacologically immunocompromised patients.

RESULTS:

Fifty-four patients were included, of whom 40 were women (74%), with a mean age of 48 ± 17 years. A total of 232 high-resolution anoscopy examinations were performed in this cohort. At the first evaluation, 28 patients (52%) were diagnosed with anal and/or perianal high-grade squamous intraepithelial lesions (including 2 cases of perianal squamous cell carcinoma); 11 cases (20%) were new diagnoses. Ten of 46 patients (22%) with follow-up developed a new lesion (high-grade/cancer) during a median follow-up period of 17 (interquartile range, 6–28) months. Overall, 37 patients (69%) in our cohort had anal/perianal high-grade squamous intraepithelial lesions ever diagnosed (including previous history, first visit, and follow-up); 5 patients had perianal squamous cell carcinoma. At our center, 6% of the new referrals were known to be pharmacologically immunocompromised patients.

LIMITATIONS:

The retrospective nature of this study, the heterogeneity of the cohort, and the absence of human papillomavirus testing were limitations of this study.

CONCLUSIONS:

The presence of anal and/or perianal high-grade squamous intraepithelial lesions or cancer detected by high-resolution anoscopy in this referral population was high, and the detection of new lesions suggests that long-term follow-up is needed. Patients on immunomodulator/immunosuppressive drugs represented only a small percentage of the new referrals to our center. See Video Abstract at http://links.lww.com/DCR/A748.
Air pollution and autism in Denmark
Authors: Ritz Beate , Liew Zeyan , Yan Qi , Cuia Xin , Virk Jasveer , Ketzel Matthias , Raaschou-Nielsen Ole
Published: October 2018

Background:

Previous autism spectrum disorder (ASD) and air pollution studies focused on pregnancy exposures, but another vulnerable period is immediate postnatally. Here, we examined early life exposures to air pollution from the pre- to the postnatal period and ASD/ASD subtypes in the Danish population.

Methods:

With Danish registers, we conducted a nationwide case–control study of 15,387 children with ASD born 1989–2013 and 68,139 population controls matched by birth year and sex identified from the birth registry. We generated air dispersion geographic information system (AirGIS) model estimates for nitrogen dioxide (NO2), sulfur dioxide (SO2), particulate matter 2.5 (PM2.5), and particulate matter 10 (PM10) at mothers’ home from 9 months before to 9 months after pregnancy and calculated odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for parental age, neighborhood socioeconomic indicators, and maternal smoking using conditional logistic regression.

Results:

In models that included all exposure periods, we estimated adjusted ORs for ASD per interquartile range (IQR) increase for 9 months after pregnancy with NO2of 1.08 (95% CI = 1.01, 1.15) and with PM2.5of 1.06 (95% CI = 1.01, 1.11); associations were smaller for PM10(1.04; 95% CI = 1.00, 1.09) and strongest for SO2(1.21; 95% CI = 1.13, 1.29). Also, associations for pollutants were stronger in more recent years (2000–2013) and in larger cities compared with provincial towns/rural counties. For particles and NO2, associations were only specific to autism and Asperger diagnoses.

Conclusions:

Our data suggest that air pollutant exposure in early infancy but not during pregnancy increases the risk of being diagnosed with autism and Asperger among children born in Denmark.
Family planning as a contributor to environmental sustainability: weighing the evidence
Authors: Gaffikin Lynne , Engelman Robert
Published: October 2018

Purpose of review

To highlight recent evidence that family planning, readily accessible to all who seek it and exercised as a human right, can contribute to environmental sustainability. As global concern increases about the health of our planet, better understanding of the role family planning programs play in maintaining a sustainable environment could bolster public and policymaker support for access to family planning.

Recent findings

A recent Worldwatch Institute review of scientific literature (FPESA) exploring this relationship covered two potential cause–effect pathways: one demographic, one personal. Although nonconfirmatory, a decade of reviewed studies overwhelmingly supported the hypothesis that family planning benefits environmental sustainability. A complementary review by the Evidence Project of population, health and environment projects over a similar time period strongly suggests that transdisciplinary efforts including family planning can yield multiple benefits – health, empowerment, economic and environmental.

Cumulative research generally supports but cannot confirm the thesis that family planning contributes to efforts to achieve environmental sustainability. This does not equate to no relationship but rather a lack of adequate methodologies. For research on complex relationships like this, novel research designs may prove more effective.
Health outcomes associated with use of hormonal contraception: breast cancer
Authors: Schneyer Rebecca , Lerma Klaira
Published: October 2018

Purpose of review

To review recent literature on health outcomes associated with use of hormonal contraception with a focus on breast cancer.

Recent findings

A large cohort study documented an increased risk of breast cancer among hormonal contraceptive users compared to those who had never used hormonal contraception. The overall relative risk of breast cancer among current or recent users was 1.2 [95% confidence interval (CI), 1.14–1.26]. Overall, this translates into one additional case of breast cancer for every 7690 users of hormonal contraception. Recent publications have also documented a decrease in risk for endometrial, ovarian, and colorectal cancers among hormonal contraceptive users. Based on these data, it is estimated that a third of endometrial and ovarian cancers and a fifth of colorectal cancers were prevented with combined oral contraceptive use.

Several factors must be taken into consideration regarding the risk of breast cancer associated with hormonal contraceptive use. Contraceptive benefits related to preventing unintended pregnancy are protective against associated maternal morbidity and mortality. Noncontraceptive benefits of protecting against other types of cancers must also be considered. Overall, breast cancer risk is low among hormonal contraceptive users and women should be counseled accordingly.
Evaluation and management of defecatory dysfunction in women
Authors: Pratt Toya , Mishra Kavita
Published: October 2018

Purpose of review

To summarize the current recommendations for the evaluation and management of defecatory dysfunction in women and highlight key relationships between defecatory dysfunction and other pelvic floor disorders, including pelvic organ prolapse, fecal incontinence, and voiding dysfunction.

Recent findings

Conservative measures including lifestyle modifications, pharmacotherapy, and biofeedback continue to be the mainstay of treatment with newer therapies emerging. Physiologic testing and/or radiologic imaging should be considered for those who fail conservative therapy or are clinically complex. Surgical management is appropriate for carefully selected patients with anatomic causes of defecatory dysfunction. Further research is needed on surgical outcomes and patient expectations.

Pelvic floor disorders, including defecatory dysfunction, have a significant societal impact and are highly prevalent among women. Given its potential complexity, a broader focus is needed when evaluating women with defecatory symptoms and effective treatment may require multidisciplinary care.