bluuebunny/crossref_metadata_2025 huggingface dataset:
The effects of auditory training on dichotic listening
Authors: McCullagh Jennifer , Palmer Shannon B.
Published: January 2017

Background:

Individuals with neurological impairment have been shown to have deficits in auditory processing abilities. One auditory processing ability shown to be affected is dichotic listening. To date, limited evidence exists demonstrating the effectiveness of dichotic listening intervention on dichotic listening in individuals with neurological impairment. The purpose of this study was to determine the effects of the dichotic listening training on dichotic listening abilities over multiple training periods in an individual with a long-standing and stable neurological history.

Method:

This study used a case study design. Over the course of 3 years, an individual with dichotic listening deficits following a left cerebral vascular accident underwent multiple auditory training periods using a dichotic listening training paradigm. Initial assessments indicated a bilateral deficit on the Dichotic Digits test with the right ear performing more poorly than the left ear and a right ear deficit on the Dichotic Rhyme test. Training sessions took place 2–3 times per week for a period of 4–11 weeks in the years 2012, 2013 and 2014. Pre- and post-training assessments of dichotic listening and hearing in noise ability were completed for each training period.

Results:

Results indicated improvements in the trained (right) ear on the Dichotic Digits test following each of the three training periods. Results also indicated stable performance in the right ear on the Dichotic Rhyme test and variable performance on the Words-in-Noise (WIN) test following each training session. Performance on the Dichotic Digits test decreased slightly between training periods; however, overall performance showed improvement over time.

Conclusion:

These results suggest improved binaural integration abilities as measured by the Dichotic Digits test following dichotic listening training in an individual with neurological impairment. However, the effects of the training did not transfer to tasks of binaural fusion (Dichotic Rhyme test) or hearing in noise (WIN test) tasks.
Long gaps between primes
Authors: Ford Kevin , Green Ben , Konyagin Sergei , Maynard James , Tao Terence
Published: January 2017

Let

p
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denote the

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th prime. We prove that
\[
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\max _{p_{n} \leqslant X} (p_{n+1}-p_n) \gg \frac {\log X \log \log X\log \log \log \log X}{\log \log \log X}

\]
for sufficiently large

X
X

, improving upon recent bounds of the first, second, third, and fifth authors and of the fourth author. Our main new ingredient is a generalization of a hypergraph covering theorem of Pippenger and Spencer, proven using the Rödl nibble method.
KNIME4NGS: a comprehensive toolbox for next generation sequencing analysis
Authors: Hastreiter Maximilian , Jeske Tim , Hoser Jonathan , Kluge Michael , Ahomaa Kaarin , Friedl Marie-Sophie , Kopetzky Sebastian J , Quell Jan-Dominik , Mewes H.-Werner , Küffner Robert
Published: January 2017

Analysis of Next Generation Sequencing (NGS) data requires the processing of large datasets by chaining various tools with complex input and output formats. In order to automate data analysis, we propose to standardize NGS tasks into modular workflows. This simplifies reliable handling and processing of NGS data, and corresponding solutions become substantially more reproducible and easier to maintain. Here, we present a documented, linux-based, toolbox of 42 processing modules that are combined to construct workflows facilitating a variety of tasks such as DNAseq and RNAseq analysis. We also describe important technical extensions. The high throughput executor (HTE) helps to increase the reliability and to reduce manual interventions when processing complex datasets. We also provide a dedicated binary manager that assists users in obtaining the modules’ executables and keeping them up to date. As basis for this actively developed toolbox we use the workflow management software KNIME.

Availability and Implementation

See http://ibisngs.github.io/knime4ngs for nodes and user manual (GPLv3 license)

Supplementary information

Supplementary data are available at Bioinformatics online.
Early-Onset Invasive Candidiasis in Extremely Low Birth Weight Infants: Perinatal Acquisition Predicts Poor Outcome
Authors: Barton Michelle , Shen Alex , O’Brien Karel , Robinson Joan L. , Davies H. Dele , Simpson Kim , Asztalos Elizabeth , Langley Joanne , Le Saux Nicole , Sauve Reginald , Synnes Anne , Tan Ben , de Repentigny Louis , Rubin Earl , Hui Chuck , Kovacs Lajos , Yau Yvonne C. W. , Richardson Susan E. ,   for the Paediatric Investigators Collaborative Network on Infections in Canada (PICNIC)
Published: January 2017

Background.

Neonatal invasive candidiasis (IC) presenting in the first week of life is less common and less well described than later-onset IC. Risk factors, clinical features, and disease outcomes have not been studied in early-onset disease (EOD, ≤7 days) or compared to late-onset disease (LOD, >7 days).

Methods.

All extremely low birth weight (ELBW, <1000 g) cases with IC and controls from a multicenter study of neonatal candidiasis enrolled from 2001 to 2003 were included in this study. Factors associated with occurrence and outcome of EOD in ELBW infants were determined.

Results.

Forty-five ELBW infants and their 84 matched controls were included. Fourteen (31%) ELBW infants had EOD. Birth weight <750 g, gestation <25 weeks, chorioamnionitis, and vaginal delivery were all strongly associated with EOD. Infection with Candida albicans, disseminated disease, pneumonia, and cardiovascular disease were significantly more common in EOD than in LOD. The EOD case fatality rate (71%) was higher than in LOD (32%) or controls (15%) (P = .0001). The rate of neurodevelopmental impairment and mortality combined was similar in EOD (86%) and LOD (72%), but higher than in controls (32%; P = .007).

Conclusions.

ELBW infants with EOD have a very poor prognosis compared to those with LOD. The role of perinatal transmission in EOD is supported by its association with chorioamnionitis, vaginal delivery, and pneumonia. Dissemination and cardiovascular involvement are common, and affected infants often die. Empiric treatment should be considered for ELBW infants delivered vaginally who have pneumonia and whose mothers have chorioamnionitis or an intrauterine foreign body.
Hepatitis E Virus (HEV) Infection in Anti-HEV Immunoglobulin G-Carrying Patients After Successful Hepatitis C Virus Treatment: Reactivation or Reinfection?
Authors: Rivero-Juarez Antonio , Frias Mario , Lopez-Lopez Pedro , de Los Angeles Risalde María , Brieva Teresa , Machuca Isabel , Camacho Angela , Martinez-Peinado Antonio , Gomez-Villamandos Jose Carlos , Rivero Antonio
Published: January 2017

Although hepatitis E virus (HEV) is regarded as a self-limiting infection and anti-HEV antibodies seem to protect against reinfection, its pathogenesis is not well established. We describe 2 cases of acute symptomatic HEV infection after hepatitis C therapy in patients carrying anti-HEV immunoglobulin G antibodies, raising 2 major questions: reactivation or reinfection?
Organ-specific modulation complexity score for the evaluation of dose delivery
Authors: Sumida Iori , Yamaguchi Hajime , Das Indra J , Kizaki Hisao , Aboshi Keiko , Tsujii Mari , Yamada Yuji , Tamari Keisuke , Seo Yuji , Isohashi Fumiaki , Yoshioka Yasuo , Ogawa Kazuhiko
Published: January 2017

The purpose of this study was to correlate the modulation complexity score (MCS) with organ location and to predict potential dose errors for organs before beam delivery for intensity-modulated radiation therapy (IMRT) dosimetry. Sixteen head and neck cancer patients treated with IMRT were selected. Distribution of the relative dose error on each beam was performed using forward projection to the planned dose to compute the predicted dose after doing per-beam quality assurance. Original organ-specific modulation complexity score (oMCS) was created based on a modified MLC, which depended on organ location. First, MCS was calculated based on the change in leaf position between adjacent MLC leaves. Second, the segment edge map (SEM) calculated from the intensity map for each beam was applied to the calculation volume. The oMCS with segment edge (oMCSedge) was derived from the product of oMCS and SEM. The correlation between the dose errors (planned and predicted) and oMCSedge values was evaluated for the target and organs at risk. We have also expanded the original MCS concept to oMCSedge including the organ location. We observed a moderate correlation between the dose errors and oMCSedge for all organs and volumes of interest except the gross tumor volume, brain stem, and spinal cord. In other organs, a moderate improvement in sensitivity was observed on the SEM, which was correlated with dose errors. Although the implementation of oMCSedge would be impractical for normal clinical settings, it is expected that oMCSedge would help a treatment planner to judge whether or not the treatment plan would be acceptably delivered.
On significance of VLBI/Gaia position offsets
Authors: Petrov L. , Kovalev Y. Y.
Published: January 2017

We have cross matched the Gaia Data Release 1 secondary data set that contains positions of 1.14 billion objects against the most complete to date catalogue of very long baseline interferometry (VLBI) positions of 11.4 thousand sources, almost exclusively active galactic nuclei. We found 6064 matches, i.e. 53 per cent radio objects. The median uncertainty of VLBI positions is a factor of 4 smaller than the median uncertainties of their optical counterparts. Our analysis shows that the distribution of normalized arc lengths significantly deviates from Rayleigh shape with an excess of objects with small normalized arc lengths and with a number of outliers. We found that 6 per cent matches have radio-optical offsets significant at 99 per cent confidence level. Therefore, we conclude there exists a population of objects with genuine offsets between centroids of radio and optical emission.
Unconvergence of very-large-scale giant impact simulations
Authors: Hosono Natsuki , Iwasawa Masaki , Tanikawa Ataru , Nitadori Keigo , Muranushi Takayuki , Makino Junichiro
Published: January 2017

The giant impact (GI) hypothesis is one of the most important hypotheses both in planetary science and in geoscience, since it is related to the origin of the Moon and also the initial condition of the Earth. A number of numerical simulations have been done using the smoothed particle hydrodynamics (SPH) method. However, GI hypothesis is currently in a crisis. The “canonical” GI scenario failed to explain the identical isotope ratio between the Earth and the Moon. On the other hand, little has been known about the reliability of the result of GI simulations. In this paper, we discuss the effect of the resolution on the results of the GI simulations by varying the number of particles from 3 × 103 to 108. We found that the results does not converge, but show oscillatory behaviour. We discuss the origin of this oscillatory behaviour.
A possible giant planet orbiting the cataclysmic variable LX Ser
Authors: Li Kai , Hu Shaoming , Zhou Jilin , Wu Donghong , Guo Difu , Jiang Yunguo , Gao Dongyang , Chen Xu , Wang Xianyu
Published: January 2017

LX Ser is a deeply eclipsing cataclysmic variable with an orbital period of 0.1584325 d. 62 new eclipse times were determined by our observations and the AAVSO International Data base. Combining all available eclipse times, we analyzed the O − C behavior of LX Ser. We found that the O − C diagram of LX Ser shows a sinusoidal oscillation with a period of 22.8 yr and an amplitude of 0.00035 d. Two mechanisms (i.e., the Applegate mechanism and the light-travel time effect) are applied to explain the cyclic modulation. We found that it is difficult to apply the Applegate mechanism to explain the cyclic oscillation in the orbital period. Therefore, the cyclic period change is most likely to be caused by the light-travel time effect due to the presence of a third body. The mass of the tertiary component was determined to be M3 ∼ 7.5 MJup. We supposed that the tertiary companion is plausibly a giant planet. The stability of the giant planet was checked, and we found that the multiple system is stable.
Can Plant Microbiome Studies Lead to Effective Biocontrol of Plant Diseases?
Authors: Ellis Jeffrey G.
Published: January 2017

In this review, the wisdom and efficacy of studies seeking disease attenuating microbes and microbiomes only in healthy plant communities is questioned and an alternative view is posited, namely that success in biocontrol of crop diseases may also come from studies of microbiota, or at least individual species isolates, associated with diseased plants. In support of this view, I summarize the current extensive knowledge of the biology behind what is probably the most successful biocontrol of a plant disease, namely the biocontrol of crown gall of stone fruit using non-pathogenic Rhizobium rhizogenes K84, in which the biocontrol agent itself came from a diseased plant.
Healthy Exercise Habits Are Associated With Lower Risk of Burnout and Higher Quality of Life Among U.S. Medical Students
Authors: Dyrbye Liselotte N. , Satele Daniel , Shanafelt Tait D.
Published: January 2017

Purpose

Although burnout and low quality of life (QOL) are common among medical students, little remains known about personal fitness habits of medical students that may promote well-being.

Method

In 2012 the authors conducted a cross-sectional study of U.S. medical students to explore relationships between burnout, QOL, and compliance with Centers for Disease Control and Prevention (CDC) exercise recommendations. Wilcoxon-Mann-Whitney tests, Fisher exact tests, and multivariate logistic regression were performed.

Results

Among approximately 12,500 medical students invited to participate, 4,402 (35.2%) completed surveys. Most (2,738/4,367; 62.7%) engaged in aerobic exercise in accordance with CDC recommendations, while fewer (1,685/4,376; 38.5%) adhered to muscle strengthening recommendations. Burnout prevalence was lower among students who exercised aerobically consistent with CDC recommendations compared with those who exercised less (53.1% vs. 60.8%, P < .0001). Similarly, rates of burnout were also lower among students who strength trained consistent with CDC recommendations (51.8% vs. 58.6%, P < .0001). Overall QOL scores were higher for medical students adhering to CDC recommendations for aerobic exercise (7.2 vs. 6.6, P < .0001), strength training (7.2 vs. 6.8, P < .0001), or both aerobic and strength training (8.0 vs. 7.0, P < .0001). Compliance with CDC exercise guidelines remained independently associated with lower risk of burnout and higher QOL on multivariate analysis controlling for age, sex, relationship status, children, and year in school.

Conclusions

Students whose aerobic exercise and/or strength training habits are consistent with CDC guidelines appear less likely to experience burnout and to have higher QOL.
The Impact of a Junior Faculty Fellowship Award on Academic Advancement and Retention
Authors: Connelly Maureen T. , Sullivan Amy M. , Chinchilla Manuel , Dale Margaret L. , Emans S. Jean , Nadelson Carol Cooperman , Notman Malkah Tolpin , Tarbell Nancy J. , Zigler Corwin M. , Shore Eleanor G.
Published: January 2017

Purpose

Academic faculty experience barriers to career development and promotion. In 1996, Harvard Medical School (HMS) initiated an intramural junior faculty fellowship to address these obstacles. The authors sought to understand whether receiving a fellowship was associated with more rapid academic promotion and retention.

Method

Junior faculty fellowship recipients and all other instructor and assistant professors at HMS between 1996 and 2011 were identified. Using propensity score modeling, the authors created a matched comparison group for the fellowship recipients based on educational background, training, academic rank, department, hospital affiliation, and demographics. Time to promotion and time to leaving were assessed by Kaplan-Meier curves.

Results

A total of 622 junior faculty received fellowships. Faculty who received fellowships while instructors (n = 480) had shorter times to promotion to assistant professor (P < .0001) and longer retention times (P < .0001) than matched controls. There were no significant differences in time to promotion for assistant professors who received fellowships (n = 142) compared with matched controls, but assistant professor fellowship recipients were significantly more likely to remain longer on the faculty (P = .0005). Women instructors advanced more quickly than matched controls, while male instructors’ rates of promotions did not differ.

Conclusions

Fellowships to support junior faculty were associated with shorter times to promotion for instructors and more sustained faculty retention for both instructors and assistant professors. This suggests that relatively small amounts of funding early in faculty careers can play a critical role in supporting academic advancement and retention.
Immune checkpoint inhibitors in first-line therapy of advanced non-small cell lung cancer
Authors: Remon Jordi , Besse Benjamin
Published: January 2017

Purpose of review

Evading immune destruction is a hallmark of cancer. The first therapeutic wave in immunotherapies comprised a series of monoclonal antibodies directed against the immune checkpoint molecules cytotoxic T-lymphocyte-associated protein 4, programmed death 1 (PD-1), and programmed death ligand-1 (PD-L1) revolutionizing the therapeutic landscape of advanced non-small cell lung cancer. They were validated initially as second-line treatment, becoming the new standard of care.

Recent findings

Based on immunotherapies efficacy, different strategies are being successfully investigated in first-line treatment, including frontline immune checkpoint inhibitors, and combination with chemotherapy or with other immune checkpoint inhibitors. In accordance with recent results, US Food and Drug Administration approved a checkpoint inhibitor for first-line treatment of metastatic non-small cell lung cancer whose tumors have high PD-L1 expression, and European Medicines Agency approval is expected in early 2017.

In this review, we summarize the main results of the various strategic clinical development approaches used to date, as well as in ongoing clinical trials.
A review of serious adverse effects under treatment with checkpoint inhibitors
Authors: Heinzerling Lucie , Goldinger Simone M.
Published: January 2017

Purpose of review

The aim of this article is to raise awareness of physicians for the serious side-effects of immune-checkpoint blocking antibodies. As checkpoint inhibitors can induce severe side-effects and are increasingly being used also in subspecialties besides dermatology and oncology, with less experience with these drugs available, knowledge has to be spread. Early recognition and adequate management is essential.

Recent findings

Recent reports on side-effects document cases of serious side-effects involving all organ systems. These include formerly little referenced and life-threatening side-effects such as cardiotoxicity and neurotoxicity. Furthermore, important additional findings are the inclusion of CMV reactivation in the differential diagnosis or the side-effect profile in special patient populations, that is, in transplant patients, patients with autoimmune disease or previous toxicity to ipilimumab.

Checkpoint inhibitor treatment induces a wide range of serious side-effects. However, with prompt diagnosis and adequate treatment these can mostly be safely managed. Documentation and reporting of serious side-effects remains important to share knowledge and thus ensure optimal patient care.
Squamous Cell Carcinoma In Situ Upstaged to Invasive Squamous Cell Carcinoma: A 5-Year, Single Institution Retrospective Review
Authors: Eimpunth Sasima , Goldenberg Alina , Hamman Michael Shane , Oganesyan Gagik , Lee Robert A. , Hunnangkul Saowalak , Song Silvia Soohyun , Greywal Tanya , Jiang Shang I Brian
Published: January 2017

BACKGROUND

Shave biopsy may not be able to accurately distinguish squamous cell carcinoma in situ (SCCIS) from invasive squamous cell carcinoma (SCC). Information on the incidence of biopsy-proven SCCIS upstaged to SCC after a more complete histologic examination is limited.

OBJECTIVE

To determine the incidence and clinical risk factors associated with upstaging the biopsy diagnosis of SCCIS into invasive SCC based on findings during Mohs micrographic surgery (MMS).

METHODS

All MMS cases of SCCIS performed between March 2007 and February 2012 were identified, MMS operative notes were examined, and invasive dermal components were confirmed by the MMS slide review. Upstaged SCCIS was defined as biopsy-diagnosed SCCIS subsequently found to be an invasive SCC during MMS.

RESULTS

From 566 cases with the preoperative diagnosis of SCCIS, 92 (16.3%) cases were SCCIS upstaged to SCC. Location of ears, nose, lips, and eyelids, preoperative diameter >10 mm, and biopsy report mentioning a transected base were significant predictors of upstaged SCCIS.

CONCLUSION

Considering the possibility that over 16% of SCCIS may be truly invasive SCC, biopsy-proven SCCIS should be treated adequately with margin-assessed treatment modalities such as surgical excision or Mohs surgery when indicated.
Military-Civilian Collaborations for mTBI Rehabilitation Research in an Active Duty Population: Lessons Learned From the Assessment of Military Multitasking Performance Project
Authors: McCulloch Karen L. , Cecchini Amy S. , Radomski Mary V. , Scherer Matthew R. , Smith Laurel , Cleveland Caroline , McMillan Henry P. , Davidson Leslie F. , Weightman Margaret M.
Published: January 2017

This article describes lessons learned in the planning, development, and administration of a collaborative military-civilian research project, the Assessment of Military Multitasking Performance, which was designed to address a gap in clinical assessment for active duty service members with mild traumatic brain injury who wish to return to active duty. Our team worked over the course of multiple years to develop an assessment for military therapists to address this need. Insights gained through trial and error are shared to provide guidance for civilian researchers who may wish to collaborate with active duty researchers.
Epidemiology and Molecular Characteristics of Mycoplasma pneumoniae During an Outbreak of M. pneumoniae-associated Stevens-Johnson Syndrome
Authors: Watkins Louise K. Francois , Olson Daniel , Diaz Maureen H. , Lin Xia , Demirjian Alicia , Benitez Alvaro J. , Winchell Jonas M. , Robinson Christine C. , Bol Kirk A. , Glodé Mary P. , Dominguez Samuel R. , Miller Lisa A. , Kutty Preeta K.
Published: January 2017

Background:

An increase inMycoplasma pneumoniae-associated Stevens-Johnson syndrome (SJS) cases at a Colorado pediatric hospital led to an outbreak investigation. We describe the epidemiologic and molecular characteristics ofM. pneumoniaeamong SJS case-patients and surrounding community members during the outbreak.

Methods:

M. pneumoniaepolymerase chain reaction-positive respiratory specimens from 5 Colorado hospitals and 4 referral laboratories underwent confirmatory polymerase chain reaction testing; positive specimens then underwent multilocus variable-number tandem-repeat analysis (MLVA) and macrolide resistance testing. Three SJS-M. pneumoniaecase-patient households were surveyed using a standardized questionnaire, and nasopharyngeal/oropharyngeal swabs were obtained from all consenting/assenting household contacts. International Classification of Diseases, 9th revision codes were used to identify pneumonia cases among Colorado patients 5–21 years of age from January 2009 to March 2014.

Results:

Three differentM. pneumoniaeMLVA types were identified among the 5 SJS case-patients with confirmed infection; MLVA type 3-X-6-2 was seen more commonly in SJS case-patients (60%) than in 69 non-SJS community specimens (29%). Macrolide resistance was identified in 7% of community specimens but not among SJS case-patients. Of 15 household contacts, 5 (33%) wereM. pneumoniaepositive; all MLVA types were identical to those of the corresponding SJS case-patient, although the specimen from 1 contact was macrolide resistant. Overall pneumonia cases as well as those caused byM. pneumoniaespecifically peaked in October 2013, coinciding with the SJS outbreak.

Conclusions:

The outbreak ofM. pneumoniae-associated SJS may have been associated with a community outbreak ofM. pneumoniae; clinicians should be aware of theM. pneumoniae–SJS relationship. Household transmission ofM. pneumoniaewas common within the households investigated.
Serious Adverse Reactions From Anti-tuberculosis Drugs Among 599 Children Hospitalized for Tuberculosis
Authors: Li Yiyuan , Zhu Yu , Zhong Qin , Zhang Xiaojun , Shu Min , Wan Chaomin
Published: January 2017

Background:

The purpose of the study was to summarize the clinical characteristics of serious adverse reactions (ARs) related to anti-tuberculosis (TB) drugs in children hospitalized for TB. A comprehensive understanding of these drug-related ARs may serve to improve patient prognosis.

Methods:

Inpatients diagnosed with TB from 2008 to 2013 were enrolled retrospectively. The patients’ demographics, diagnosis and ARs were recorded and analyzed for comprehensive evaluation.

Results:

Of the 599 enrolled patients, 3.51% (21 of 599) developed serious ARs related to anti-TB drugs. Hepatotoxicity was the most common reaction (1.84%, 11 of 599). The incidence of rash with or without fever was 1% (6 of 599), and that of auditory impairments and renal injury was 0.33% (2 of 599) and 0.17% (1 of 599), respectively. One patient experienced hepatotoxicity, rash and fever. Hospital stay of inpatients with serious ARs was significantly longer (median: 24 days; range: 8–62 days) than that of those without reactions (median: 11 days; range: 1–83 days), though no distinctions were observed between the 2 groups with regard to average age, gender or involved organs. Hepatotoxicity occurred 6–30 days after the start of anti-TB treatment (median: 6 days) and 75% of the inpatients remained asymptomatic. Hepatotoxicity was traced to the drugs isoniazid, rifampin and pyrazinamide, while fever was mainly linked to pyrazinamide. In addition, streptomycin and amikacin led to auditory impairments and renal injury, respectively. Serious ARs of all inpatients were controlled and managed successfully.

Conclusions:

The incidence of serious ARs from anti-TB drugs among children inpatients was 3.5% and mainly consisted of hepatotoxicity. Inpatients with serious ARs tended to have longer hospital stays.
Estimating Pertussis Susceptibility Among 0–23-Month-Old Children in the United States
Authors: Childs Lana , Bednarczyk Robert A.
Published: January 2017

Background:

Despite high pertussis-containing vaccine coverage in the United States, children who are unvaccinated or not fully vaccinated remain susceptible to pertussis. Over multiple birth cohorts of incomplete vaccination, the number of children not immune to pertussis will accumulate because of factors such as age-specific vaccination status and dose-specific vaccine effectiveness. The total number of pertussis-susceptible children 0–23 months of age in the United States is unknown.

Methods:

Using data on age-specific pertussis-containing vaccine receipt among children evaluated in the 2013 National Immunization Survey (born between February 2011 and June 2012) and accounting for vaccine effectiveness and maternal transfer of antipertussis antibodies, we estimated the cumulative number of pertussis-susceptible children 0–23 months of age.

Results:

Of an estimated 7,905,672 children 0–23 months of age in the United States, we estimated that approximately 22% (1,716,429) are susceptible to pertussis. Age was a large factor in susceptibility, with 89% of children less than 2 months of age not immune to pertussis compared with 7% of children 21–23 months of age. In sensitivity analysis, increasing maternal pertussis vaccination coverage from 10% to 42% decreased susceptibility in children less than 2 months of age to 68%. When considering waning immunity after the fourth dose of vaccine, the herd protection threshold was no longer reached.

Conclusions:

These estimates underscore the need to monitor age-specific pertussis vaccine coverage, to increase childhood and maternal pertussis vaccine coverage, to maintain population-level immunity and to prevent the spread of pertussis among young children.
Chikungunya Infection in Hospitalized Febrile Infants Younger Than 3 Months of Age
Authors: Elenga Narcisse , Folin Marion , Vandamme Yves-Marie , Cuadro-Alvarez Emma , Long Laurence , Njuieyon Falucar , Martin Elise , Kom-Tchameni Rémi , Defo Antoine , Herinantenaina Razafindrakoto Sitraka , Mrsic Yajaira , Couppie Pierre , Nacher Mathieu , Dufour Julie
Published: January 2017

Background:

Fever in infants younger than 3 months is generally a cause for concern because of the risk for a serious bacterial infection. The aim of this study was to describe clinical and biologic features of Chikungunya infection in infants <3 months of age hospitalized in Cayenne Hospital during the 2014–2015 outbreak.

Methods:

We performed a preliminary retrospective study followed by a prospective study from March 2014 to February 2015. All infants younger than 3 months presenting with fever and hospitalized in Cayenne Hospital were included. The main diagnostic criteria were fever and positive Chikungunya polymerase chain reaction.

Results:

One hundred and twenty infants were hospitalized with fever. The mean age was 46 days (standard deviation ± 22 days). The mean hospitalization duration was 7.4 days (standard deviation ± 6.1 days). Chikungunya infection was diagnosed in 26 children. The most important clinical findings were high [80.8% (77.5–84)] and prolonged fever [76.9% (73.4–80.4)], irritability [96.2% (94.5–97.7)] and skin rash [69.2% (65.4–73)]. Half of the infants presented edema of the extremities (hands and feet principally). However, in 15% of infants, Chikungunya infection was associated with a serious bacterial infection. Infants who presented with irritability, high fever and elevated PCT were at high risk for Chikungunya: OR 39 (9.2–243; P < .001), with a specificity of 96.7% and a negative predictive value of 89.4%. The area of the receiver operating characteristic curve was 0.96.

Conclusions:

Our results confirm that Chikunguyna infection is a cause of high fever in infants younger than 3 months. Our data should be confirmed by larger studies.
Therapeutic benefits of the methyl donor S-adenosylmethionine on nerve injury–induced mechanical hypersensitivity and cognitive impairment in mice
Authors: Grégoire Stéphanie , Millecamps Magali , Naso Lina , Do Carmo Sonia , Cuello A. Claudio , Szyf Moshe , Stone Laura S.
Published: January 2017

Despite considerable advances in understanding mechanisms involved in chronic pain, effective treatment remains elusive. Comorbid conditions including anxiety, depression, and cognitive impairment further impact quality of life. Chronic pain is associated with reversible changes in brain anatomy and function and with long-term changes in gene expression. Epigenetic mechanisms, including DNA methylation, contribute to wide-spread and long-lasting reprogramming of gene expression. We previously reported decreases in global DNA methylation in the mouse frontal cortex 6 months after induction of neuropathic pain using the spared nerve injury (SNI) model. Here, we examined the therapeutic effect of increasing DNA methylation using the methyl donor S-adenosylmethionine (SAM). S-adenosylmethionine is marketed as a nutritional supplement for a range of conditions including liver disease, depression, osteoarthritis, fibromyalgia, and dementia. Three months after SNI or sham surgery, animals were treated with SAM (20 mg/kg, 3×/week) or saline orally for 4 months, and the impact on sensory, motor, motivational, and cognitive indices was measured. S-adenosylmethionine attenuated SNI-induced mechanical hypersensitivity and reduced active avoidance of mechanical stimuli but had no effect on cold sensitivity or motor capacity. S-adenosylmethionine completely blocked nerve injury–induced cognitive impairment and attenuated SNI-induced decreases in global DNA methylation in the frontal cortex. In summary, chronic oral administration of the methyl donor, SAM, attenuated sensory and cognitive symptoms associated with nerve injury in mice. These effects may be mediated, in part, through modulation of DNA methylation in the central nervous system by systemic administration of the methyl donor SAM.
Dorsal root ganglion stimulation yielded higher treatment success rate for complex regional pain syndrome and causalgia at 3 and 12 months: a randomized comparative trial
Authors: Deer Timothy R. , Levy Robert M. , Kramer Jeffery , Poree Lawrence , Amirdelfan Kasra , Grigsby Eric , Staats Peter , Burton Allen W. , Burgher Abram H. , Obray Jon , Scowcroft James , Golovac Stan , Kapural Leonardo , Paicius Richard , Kim Christopher , Pope Jason , Yearwood Thomas , Samuel Sam , McRoberts W. Porter , Cassim Hazmer , Netherton Mark , Miller Nathan , Schaufele Michael , Tavel Edward , Davis Timothy , Davis Kristina , Johnson Linda , Mekhail Nagy
Published: January 2017

Animal and human studies indicate that electrical stimulation of dorsal root ganglion (DRG) neurons may modulate neuropathic pain signals. ACCURATE, a pivotal, prospective, multicenter, randomized comparative effectiveness trial, was conducted in 152 subjects diagnosed with complex regional pain syndrome or causalgia in the lower extremities. Subjects received neurostimulation of the DRG or dorsal column (spinal cord stimulation, SCS). The primary end point was a composite of safety and efficacy at 3 months, and subjects were assessed through 12 months for long-term outcomes and adverse events. The predefined primary composite end point of treatment success was met for subjects with a permanent implant who reported 50% or greater decrease in visual analog scale score from preimplant baseline and who did not report any stimulation-related neurological deficits. No subjects reported stimulation-related neurological deficits. The percentage of subjects receiving ≥50% pain relief and treatment success was greater in the DRG arm (81.2%) than in the SCS arm (55.7%, P < 0.001) at 3 months. Device-related and serious adverse events were not different between the 2 groups. Dorsal root ganglion stimulation also demonstrated greater improvements in quality of life and psychological disposition. Finally, subjects using DRG stimulation reported less postural variation in paresthesia (P < 0.001) and reduced extraneous stimulation in nonpainful areas (P = 0.014), indicating DRG stimulation provided more targeted therapy to painful parts of the lower extremities. As the largest prospective, randomized comparative effectiveness trial to date, the results show that DRG stimulation provided a higher rate of treatment success with less postural variation in paresthesia intensity compared to SCS.
The role of calcitonin gene–related peptide in peripheral and central pain mechanisms including migraine
Authors: Iyengar Smriti , Ossipov Michael H. , Johnson Kirk W.
Published: January 2017

Calcitonin gene–related peptide (CGRP) is a 37-amino acid peptide found primarily in the C and Aδ sensory fibers arising from the dorsal root and trigeminal ganglia, as well as the central nervous system. Calcitonin gene–related peptide was found to play important roles in cardiovascular, digestive, and sensory functions. Although the vasodilatory properties of CGRP are well documented, its somatosensory function regarding modulation of neuronal sensitization and of enhanced pain has received considerable attention recently. Growing evidence indicates that CGRP plays a key role in the development of peripheral sensitization and the associated enhanced pain. Calcitonin gene–related peptide is implicated in the development of neurogenic inflammation and it is upregulated in conditions of inflammatory and neuropathic pain. It is most likely that CGRP facilitates nociceptive transmission and contributes to the development and maintenance of a sensitized, hyperresponsive state not only of the primary afferent sensory neurons but also of the second-order pain transmission neurons within the central nervous system, thus contributing to central sensitization as well. The maintenance of a sensitized neuronal condition is believed to be an important factor underlying migraine. Recent successful clinical studies have shown that blocking the function of CGRP can alleviate migraine. However, the mechanisms through which CGRP may contribute to migraine are still not fully understood. We reviewed the role of CGRP in primary afferents, the dorsal root ganglion, and in the trigeminal system as well as its role in peripheral and central sensitization and its potential contribution to pain processing and to migraine.
Multicenter Study of Adverse Events After Intravenous Tissue-Type Plasminogen Activator Treatment of Acute Ischemic Stroke
Authors: Fernandez-Gotico Hannah , Lightfoot Tiffany , Meighan Melissa
Published: January 2017

Background and Purpose: The approved treatment by the Food and Drug Administration for acute ischemic stroke is intravenous tissue-type plasminogen activator (IV tPA). After IV tPA administration, patients are monitored for adverse events using an American Heart Association/American Stroke Association guideline instituted in 1996. There is limited evidence describing the safest and most efficient method to monitor patients during the first 24 hours after tPA administration. Although the overall rates of adverse events have been reported, the time when patients may be at most risk for an event has not been studied. The purpose of this study was to identify the time of adverse event occurrences in the first 24 hours after IV tPA administration. Method: This was a descriptive, retrospective chart review study of patients admitted to an integrated health system and treated with IV tPA for acute stroke between July 2010 and July 2012. Charts were reviewed for adverse events using the Institute for Healthcare Improvement’s Global Trigger Tool for Measuring Adverse Events. Possible chart indicators of adverse events or “triggers” included neurological decline, vital signs elevated above specified parameters, and emergent imaging. Adverse events included episodes of neurological decline, angioedema, allergic reactions, bleeding, and intracerebral hemorrhage (ICH). The timing of each detected event was determined, and descriptive statistics were used for data analysis. Results: Fourteen adverse events (2.8%) were detected in a population of 498 patients. Reactions consisted of allergic reaction (n = 1), angioedema (n = 1), neurological decline without ICH (n = 1), gastrointestinal bleeding (n = 1), bleeding gums (n = 1), and high-risk ICH (n = 9). Thirteen of the 14 adverse events (92.9%) occurred within the first 12 hours after IV tPA administration. Conclusion: Close monitoring during the first 12 hours after IV tPA treatment may be essential. However, close monitoring after 12 hours may not contribute significantly to improved patient outcomes. Larger studies may provide evidence for the safest and most efficient monitoring protocol for patients treated with IV tPA for ischemic stroke.
Safety-net Hospitals Face More Barriers Yet Use Fewer Strategies to Reduce Readmissions
Authors: Figueroa Jose F. , Joynt Karen E. , Zhou Xiner , Orav Endel J. , Jha Ashish K.
Published: January 2017

Objective:

US hospitals that care for vulnerable populations, “safety-net hospitals” (SNHs), are more likely to incur penalties under the Hospital Readmissions Reduction Program, which penalizes hospitals with higher-than-expected readmissions. Understanding whether SNHs face unique barriers to reducing readmissions or whether they underuse readmission-prevention strategies is important.

Design:

We surveyed leadership at 1600 US acute care hospitals, of whom 980 participated, between June 2013 and January 2014. Responses on 28 questions on readmission-related barriers and strategies were compared between SNHs and non-SNHs, adjusting for nonresponse and sampling strategy. We further compared responses between high-performing SNHs and low-performing SNHs.

Results:

We achieved a 62% response rate. SNHs were more likely to report patient-related barriers, including lack of transportation, homelessness, and language barriers compared with non-SNHs (P-values<0.001). Despite reporting more barriers, SNHs were less likely to use e-tools to share discharge summaries (70.1% vs. 73.7%, P<0.04) or verbally communicate (31.5% vs. 39.8%, P<0.001) with outpatient providers, track readmissions by race/ethnicity (23.9% vs. 28.6%, P<0.001), or enroll patients in postdischarge programs (13.3% vs. 17.2%, P<0.001). SNHs were also less likely to use discharge coordinators, pharmacists, and postdischarge programs. When we examined the use of strategies within SNHs, we found trends to suggest that high-performing SNHs were more likely to use several readmission strategies.

Conclusions:

Despite reporting more barriers to reducing readmissions, SNHs were less likely to use readmission-reduction strategies. This combination of higher barriers and lower use of strategies may explain why SNHs have higher rates of readmissions and penalties under the Hospital Readmissions Reduction Program.
Children With Intellectual Disability and Hospice Utilization
Authors: Lindley Lisa C. , Colman Mari Beth , Meadows John T.
Published: January 2017

More than 42,000 children die each year in the United States, including those with intellectual disability (ID). Survival is often reduced when children with ID also have significant motor dysfunction, progressive congenital conditions, and comorbidities. Yet, little is known about hospice care for children with ID. The purpose of this study was to explore the relationship between ID and hospice utilization. In addition, we explored whether ID combined with motor dysfunction, progressive congenital conditions, and comorbidities influenced pediatric hospice utilization. Using a retrospective cohort design and data from the 2009 to 2010 California Medicaid claims files, we conducted a multivariate analysis of hospice utilization. This study shows that ID was negatively related to hospice enrollment and length of stay. We also found that when children had both ID and comorbidities there was a positive association with enrolling in hospice care. A number of clinical implications can be drawn from the study findings that hospice and palliative care nurses use to improve their clinical practice of caring for children with ID and their families at end of life.
Critical Care Nurses’ Perceptions of and Experiences With Chaplains
Authors: Kim Kyounghae , Bauck Aubrey , Monroe April , Mallory Marva , Aslakson Rebecca
Published: January 2017

We explored critical care nurses’ experiences with chaplains and perceptions of spiritual care. This was a qualitative study, using in-depth interviews and focus groups with critical care nurses at an academic medical center. Data were audio recorded, transcribed verbatim, and analyzed using inductive coding methods. The study included 31 nurses (19 interviews and 2 focus groups). Participants did not feel completely prepared for spiritual assessments; they felt the urge to consult with spiritual providers predominantly for end-of-life situations. Respondents reflected several factors in the provision of spiritual care to patients and their families, such as patient’s and/or family’s spiritual needs, resources available at an institution, and the nurse’s own religious and/or spiritual beliefs. Nurses’ perceived role of chaplains overlapped what nurses can offer as part of holistic care, such as listening, praying, and counseling. Yet, participants acknowledged they paid more attention to the physical facets of a patient’s illness. Participants noted a need for better system-wide approaches to enhance nurses’ capacity for spiritual care, as well as earlier spiritual assessments of patient and family spiritual needs. Future research should address how integration of the spiritual care providers into the care team can improve spiritual support of patients, families, and clinicians.
Assessment and Intervention for Patients With Hearing Loss in Hospice
Authors: Olson Anne D. , McKeich Mary A.
Published: January 2017

The purpose of this article is to describe the unique needs of patients with hearing loss who are receiving hospice care. Hearing loss is the third most chronic condition in older adults and is often untreated. Such losses can interfere with critical communication exchanges that occur during admissions to hospice as well as during home or inpatient care. Three case scenarios are provided to illustrate these points. A comprehensive plan of options from screening to specific interventions is summarized. Options can be implemented to improve the overall communication for persons with hearing loss and their providers and family members. Improving communication may lead to improved quality of life and quality of care at end of life.
The importance of forest structure to biodiversity–productivity relationships
Authors: Bohn Friedrich J. , Huth Andreas
Published: January 2017

While various relationships between productivity and biodiversity are found in forests, the processes underlying these relationships remain unclear and theory struggles to coherently explain them. In this work, we analyse diversity–productivity relationships through an examination of forest structure (described by basal area and tree height heterogeneity). We use a new modelling approach, called ‘forest factory’, which generates various forest stands and calculates their annual productivity (above-ground wood increment). Analysing approximately 300 000 forest stands, we find that mean forest productivity does not increase with species diversity. Instead forest structure emerges as the key variable. Similar patterns can be observed by analysing 5054 forest plots of the German National Forest Inventory. Furthermore, we group the forest stands into nine forest structure classes, in which we find increasing, decreasing, invariant and even bell-shaped relationships between productivity and diversity. In addition, we introduce a new index, called optimal species distribution, which describes the ratio of realized to the maximal possible productivity (by shuffling species identities). The optimal species distribution and forest structure indices explain the obtained productivity values quite well (
R
2
between 0.7 and 0.95), whereby the influence of these attributes varies within the nine forest structure classes.