bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of 60Coγ ray irradiation on adhesion of LIE coatings
Authors: Liu Ning , Xu Guoyue , Guo Tengchao , Meng Xue , Tan Shujuan
Published: July 2017

A new gamma-ray irradiation method was used to modify the inorganic silicate binder for improving the adhesion of low infrared emissivity (LIE) coatings. First, the spectral characteristic of the solidified irradiated inorganic silicate was characterised by FTIR and the cross-section morphology of the coatings was observed by SEM. Then, the adhesion of LIE coatings containing irradiated inorganic silicate was systematically investigated by the scratch test. In addition, the adhesion of coatings in high-temperature conditions was also studied. The results indicated that the LIE coatings could exhibit better adhesion after irradiated due to the Si–O–Fe chemical bonding. At last, the infrared emissivity of the LIE coatings at different temperature was measured by IR-2. The irradiated coatings still kept LIE and the lowest infrared emissivity (500°C) was 0.41.
miR-99 regulates normal and malignant hematopoietic stem cell self-renewal
Authors: Khalaj Mona , Woolthuis Carolien M. , Hu Wenhuo , Durham Benjamin H. , Chu S. Haihua , Qamar Sarah , Armstrong Scott A. , Park Christopher Y.
Published: July 2017

The microRNA-99 (miR-99) family comprises a group of broadly conserved microRNAs that are highly expressed in hematopoietic stem cells (HSCs) and acute myeloid leukemia stem cells (LSCs) compared with their differentiated progeny. Herein, we show that miR-99 regulates self-renewal in both HSCs and LSCs. miR-99 maintains HSC long-term reconstitution activity by inhibiting differentiation and cell cycle entry. Moreover, miR-99 inhibition induced LSC differentiation and depletion in an MLL-AF9–driven mouse model of AML, leading to reduction in leukemia-initiating activity and improved survival in secondary transplants. Confirming miR-99’s role in established AML, miR-99 inhibition induced primary AML patient blasts to undergo differentiation. A forward genetic shRNA library screen revealed Hoxa1 as a critical mediator of miR-99 function in HSC maintenance, and this observation was independently confirmed in both HSCs and LSCs. Together, these studies demonstrate the importance of noncoding RNAs in the regulation of HSC and LSC function and identify miR-99 as a critical regulator of stem cell self-renewal.
Anthropomorphism as Cognitive Bias
Authors: Dacey Mike
Published: July 2017

Philosophers and psychologists have long worried that the human tendency to anthropomorphize leads us to err in our understanding of nonhuman minds. This tendency, which I callintuitive anthropomorphism, is a heuristic used by our unconscious folk psychology to understand nonhuman animals. The dominant understanding of intuitive anthropomorphism underestimates its complexity. If we want to understand and control intuitive anthropomorphism, we must treat it as a cognitive bias and look to the empirical evidence. This evidence suggests that the most common control for intuitive anthropomorphism, Morgan’s Canon, should be rejected, while others are incomplete. It also suggests new approaches.
CrocoBLAST: Running BLAST efficiently in the age of next-generation sequencing
Authors: Tristão Ramos Ravi José , de Azevedo Martins Allan Cézar , da Silva Delgado Gabrielle , Ionescu Crina-Maria , Ürményi Turán Peter , Silva Rosane , Koča Jaroslav
Published: July 2017

CrocoBLAST is a tool for dramatically speeding up BLAST+ execution on any computer. Alignments that would take days or weeks with NCBI BLAST+ can be run overnight with CrocoBLAST. Additionally, CrocoBLAST provides features critical for NGS data analysis, including: results identical to those of BLAST+; compatibility with any BLAST+ version; real-time information regarding calculation progress and remaining run time; access to partial alignment results; queueing, pausing, and resuming BLAST+ calculations without information loss.

Availability and implementation

CrocoBLAST is freely available online, with ample documentation (webchem.ncbr.muni.cz/Platform/App/CrocoBLAST). No installation or user registration is required. CrocoBLAST is implemented in C, while the graphical user interface is implemented in Java. CrocoBLAST is supported under Linux and Windows, and can be run under Mac OS X in a Linux virtual machine.

Supplementary information

Supplementary data are available at Bioinformatics online.
Using uncertainty to link and rank evidence from biomedical literature for model curation
Authors: Zerva Chrysoula , Batista-Navarro Riza , Day Philip , Ananiadou Sophia
Published: July 2017

Motivation

In recent years, there has been great progress in the field of automated curation of biomedical networks and models, aided by text mining methods that provide evidence from literature. Such methods must not only extract snippets of text that relate to model interactions, but also be able to contextualize the evidence and provide additional confidence scores for the interaction in question. Although various approaches calculating confidence scores have focused primarily on the quality of the extracted information, there has been little work on exploring the textual uncertainty conveyed by the author. Despite textual uncertainty being acknowledged in biomedical text mining as an attribute of text mined interactions (events), it is significantly understudied as a means of providing a confidence measure for interactions in pathways or other biomedical models. In this work, we focus on improving identification of textual uncertainty for events and explore how it can be used as an additional measure of confidence for biomedical models.

Results

We present a novel method for extracting uncertainty from the literature using a hybrid approach that combines rule induction and machine learning. Variations of this hybrid approach are then discussed, alongside their advantages and disadvantages. We use subjective logic theory to combine multiple uncertainty values extracted from different sources for the same interaction. Our approach achieves F-scores of 0.76 and 0.88 based on the BioNLP-ST and Genia-MK corpora, respectively, making considerable improvements over previously published work. Moreover, we evaluate our proposed system on pathways related to two different areas, namely leukemia and melanoma cancer research.

Availability and implementation

The leukemia pathway model used is available in Pathway Studio while the Ras model is available via PathwayCommons. Online demonstration of the uncertainty extraction system is available for research purposes at http://argo.nactem.ac.uk/test. The related code is available on https://github.com/c-zrv/uncertainty_components.git. Details on the above are available in the Supplementary Material.

Supplementary information

Supplementary data are available at Bioinformatics online.
myVCF: a desktop application for high-throughput mutations data management
Authors: Pietrelli Alessandro , Valenti Luca
Published: July 2017

Next-generation sequencing technologies have become the most powerful tool to discover genetic variants associated with human diseases. Although the dramatic reductions in the costs facilitate the use in the wet-lab and clinics, the huge amount of data generated renders their management by non-expert researchers and physicians extremely difficult. Therefore, there is an urgent need of novel approaches and tools aimed at getting the ‘end-users’ closer to the sequencing data, facilitating the access by non-bioinformaticians, and to speed-up the functional interpretation of genetic variants. We developed myVCF, a standalone, easy-to-use desktop application, which is based on a browser interface and is suitable for Windows, Mac and UNIX systems. myVCF is an efficient platform that is able to manage multiple sequencing projects created from VCF files within the system; stores genetic variants and samples genotypes from an annotated VCF files into a SQLite database; implements a flexible search engine for data exploration, allowing to query for chromosomal region, gene, single variant or dbSNP ID. Besides, myVCF generates a summary statistics report about mutations distribution across samples and across the genome/exome by aggregating the information within the VCF file. In summary, the myVCF platform allows end-users without strong programming and bioinformatics skills to explore, query, visualize and export mutations data in a simple and straightforward way.

Availability and implementation

https://apietrelli.github.io/myVCF/

Supplementary information

Supplementary data are available at Bioinformatics online.
Troubadours in Time: Remembering the Old Occitan Lyric in Catalonia
Authors: Price Emily Kate
Published: July 2017

This article examines the reception of troubadour song in
So fo e.l temps
, a thirteenth-century Occitan narrative by Catalan author Raimon Vidal. While in this work the Limousin troubadours are revered as authorities, their lyrics and the mistaken reception of them are also subject to scrutiny. In this,
So fo e.l temps
resembles Raimon’s earlier
Razos de trobar
, a grammar of the troubadour vernacular. In the
Razos de trobar
, Raimon complains that while the nouns (or substance) of troubadour lyric are good, its verbs (or predication) are faulty. Troubadour lyric therefore needs to be handled with expertise — which his grammar aims to teach to a select few. In
So fo e.l temps
, Catalan nobleman Uc de Mataplana models this connoisseurship, displaying his dialectical and rhetorical skills as he critiques the use made of troubadour lyric by a lovelorn trio in Limousin. He finds fault with the timeless substance of troubadour love doctrine, which does not translate to the context of lived experience, as the dilemma of the Limousin lovers attests. Uc’s surprising resolution of their situation reveals, however, the complexity of a cultural project that seeks to build — and profit from — the prestige of another vernacular culture, and to demonstrate the superiority of a newer, Catalan, one.
Pinning down the mass of Kepler-10c: the importance of sampling and model comparison
Authors: Rajpaul V. , Buchhave L. A. , Aigrain S.
Published: July 2017

Initial radial velocity (RV) characterization of the enigmatic planet Kepler-10c suggested a mass of ∼17 M⊕, which was remarkably high for a planet with radius 2.32 R⊕; further observations and subsequent analysis hinted at a (possibly much) lower mass, but masses derived using RVs from two different spectrographs (HARPS-N and HIRES) were incompatible at a 3σ level. We demonstrate here how such mass discrepancies may readily arise from suboptimal sampling and/or neglecting to model even a single coherent signal (stellar, planetary or otherwise) that may be present in RVs. We then present a plausible resolution of the mass discrepancy, and ultimately characterize Kepler-10c as having mass $7.37_{-1.19}^{+1.32}$ M⊕, and mean density $3.14^{+0.63}_{-0.55}$ g cm−3.
Precise surface gravities of δ Scuti stars from asteroseismology
Authors: García Hernández A. , Suárez J. C. , Moya A. , Monteiro M. J. P. F. G. , Guo Z. , Reese D. R. , Pascual-Granado J. , Barceló Forteza S. , Martín-Ruiz S. , Garrido R. , Nieto J.
Published: July 2017

The work reported here demonstrates that it is possible to accurately determine surface gravities of δ Scuti (δ Sct) stars using the frequency content from high-precision photometry and a measurement of the parallax. Using a sample of 10 eclipsing binary systems with a δ Sct component and the unique δ Sct star discovered with a transiting planet, WASP-33, we were able to refine the Δν–$\bar{\rho }$ relation. Using this relation and parallaxes, we obtained independent values for the masses and radii, allowing us to calculate the surface gravities without any constraints from spectroscopic or binary analysis. A remarkably good agreement was found between our results and those published, extracted from the analysis of the radial velocities and light curves of the systems. This reinforces the potential of Δν as a valuable observable for δ Sct stars and settles the degeneracy problem for the log g determination through spectroscopy.
Influence of Relative Residence Time on Side-Wall Aneurysm Inception
Authors: Riccardello Gerald J , Shastri Darshan N , Changa Abhinav R , Thomas Kiran G , Roman Max , Prestigiacomo Charles J , Gandhi Chirag D
Published: July 2017

BACKGROUND

Relative residence time (RRT) is a marker of disturbed blood flow, marked by low magnitude and high oscillatory wall shear stress (WSS). The relation between solute residence time in proximity to the vascular endothelium and the atherosclerotic process is well appreciated in the literature.

OBJECTIVE

To assess the influence of RRT on side-wall aneurysm inception to better understand the role of atherosclerosis in aneurysm formation.

METHODS

Fourteen side-wall internal carotid artery aneurysms from the Aneurisk repository which met criteria for parent vessel reconstruction were reconstructed with Vascular Modeling Toolkit. Computational fluid dynamics analysis was carried out in Fluent. RRT was calculated in MATLAB (The MathWorks Inc, Natick, Massachusetts). We analyzed the results for correlations, defined as presence or absence of local elevations in RRT in specific regions of vasculature.

RESULTS

RRT was concluded to be negatively correlated with aneurysm inception in this study of side-wall internal carotid artery aneurysms, with 12/14 cases yielding the absence of local RRT elevations within or in close proximity of the removed ostium. Subsequent analysis of WSS showed that 11 of 14 aneurysms were formed in an atheroprotective environment, with only 1 of 14 formed in an atherogenic environment. Two models were found to be of indeterminate environment.

CONCLUSION

Atherogenesis and atherosclerosis have long been thought to be a major inciting factor responsible for the formation of aneurysms in the cerebral vasculature. We propose that inception of side-wall aneurysms occurs in hemodynamic environments that promote an atheroprotective endothelial phenotype and that the atheroprotective phenotype is therefore aneurysmogenic.
Developing Interactive Antimicrobial Stewardship and Infection Prevention Curricula for Diverse Learners: A Tailored Approach
Authors: Nori Priya , Madaline Theresa , Munjal Iona , Bhar Shubha , Guo Yi , Seo Susan K. , Porrovecchio Andrea , Gancher Elizabeth , Nosanchuk Joshua , Pirofski Liise-anne , Ostrowsky Belinda
Published: July 2017

Background

To impart principles of antimicrobial stewardship (AS) and infection prevention and control (IPC), we developed a curriculum tailored to the diverse aptitudes of learners at our medical center.

Methods

We integrated case-based modules, group learning activities, smartphone applications (apps), decision support tools, and prescription audit and feedback into curricula of the medical school, medicine residency program, infectious diseases (ID) fellowship program, and hospital medicine program operations. Interventions were implemented in 2012–2016 using a quasi-experimental before-and-after study design, and this was assessed using pre- and postintervention surveys or audit of antibiotic prescriptions.

Results

Over 180 medical students participated in the AS and IPC seminars. After smartphone app introduction, 69% reported using the app as their preferred source of antibiotic information. Approximately 70% of students felt comfortable prescribing antibiotics for a known infection compared with 40% at baseline (P = .02), and approximately 83% were able to identify the appropriate personal protective equipment for specific scenarios. Approximately 99% agreed that they have a role in promoting patient safety and preventing healthcare-associated infections as medical students. At 20 months, appropriateness of trainee antibiotic prescriptions increased by 20% (P < .01). Almost all ID fellows indicated that the AS and IPC seminar was a vital training supplement. Uptake of internist antibiotic recommendations using AS decision support tools was approximately 70%.

Conclusions

All 5 interventions addressed learning objectives and knowledge gaps and are applicable across a range of environments. Evaluating long-term impact of our curriculum is the focus of future study.
Power, policy, and top income shares
Authors: Huber Evelyne , Huo Jingjing , Stephens John D
Published: July 2017

The rise of the super-rich has attracted much political and academic attention in recent years. However, there have been few attempts to explain the cross-national along with the temporal variation in the rise of top incomes. Drawing on the World Wealth and Income Database, we study the income share of the top 1% in current postindustrial democracies from 1960 to 2012. We find that extreme income concentration at the top is a predominantly political phenomenon, not the result of increasing marginal productivity of top managers in markets of increasing size. Top income shares are largely unrelated to economic growth, increased knowledge-intensive production, export competitiveness, financialization and wealth accumulation, though they are related to stock market capitalization. Instead, they are closely associated with political and policy changes such as union density and centralization, secular-right governments, top marginal tax rates and investment in public tertiary education.
Physiological Traits Determining Yield Tolerance of Wheat to Foliar Diseases
Authors: van den Berg F. , Paveley N. D. , Bingham I. J. , van den Bosch F.
Published: July 2017

Tolerance is defined as the ability of one cultivar to yield more than another cultivar under similar disease severity. If both cultivars suffer an equal loss in healthy (green) leaf area duration (HAD) over the grain filling period due to disease presence, then the yield loss per unit HAD loss is smaller for a more tolerant cultivar. Little is understood of what physiological and developmental traits of cultivars determine disease tolerance. In this study, we use a mathematical model of wheat to investigate the effect of a wide range of wheat phenotypes on tolerance. During the phase from stem extension to anthesis, the model calculates the assimilate source and sink potential, allowing for dynamic changes to the source–sink balance by partitioning assimilates between ear development and storage of water-soluble carbon (WSC) reserves, according to assimilate availability. To quantify tolerance, rates of epidemic progress were varied on each phenotype, leading to different levels of HAD loss during the postanthesis, grain-filling period. Model outputs show that the main determinant of tolerance is the total amount of assimilate produced per grain during the rapid grain-fill period, leading to a strong positive correlation between HAD per grain and tolerance. Reductions in traits that affect carbon assimilation rate and increases in traits that determine the amount of structural biomass in the plant increase disease tolerance through their associated reduction in number of grains per ear. Some of the most influential traits are the canopy green area index, carbon use efficiency, and leaf specific weight. Increased WSC accumulation can either increase or decrease tolerance. Furthermore, a cultivar is shown to be maximally tolerant when a crop is able to just fill its total sink size in the presence of disease. The model has identified influential functional traits and established that their associations with tolerance have a mechanistic basis.
Investigating the Impact of Different Suspicion of Infection Criteria on the Accuracy of Quick Sepsis-Related Organ Failure Assessment, Systemic Inflammatory Response Syndrome, and Early Warning Scores*
Authors: Churpek Matthew M. , Snyder Ashley , Sokol Sarah , Pettit Natasha N. , Edelson Dana P.
Published: July 2017

Objective:

Studies in sepsis are limited by heterogeneity regarding what constitutes suspicion of infection. We sought to compare potential suspicion criteria using antibiotic and culture order combinations in terms of patient characteristics and outcomes. We further sought to determine the impact of differing criteria on the accuracy of sepsis screening tools and early warning scores.

Design:

Observational cohort study.

Setting:

Academic center from November 2008 to January 2016.

Patients:

Hospitalized patients outside the ICU.

Interventions:

None.

Measurements and Main Results:

Six criteria were investigated: 1) any culture, 2) blood culture, 3) any culture plus IV antibiotics, 4) blood culture plus IV antibiotics, 5) any culture plus IV antibiotics for at least 4 of 7 days, and 6) blood culture plus IV antibiotics for at least 4 of 7 days. Accuracy of the quick Sepsis-related Organ Failure Assessment score, Sepsis-related Organ Failure Assessment score, systemic inflammatory response syndrome criteria, the National and Modified Early Warning Score, and the electronic Cardiac Arrest Risk Triage score were calculated for predicting ICU transfer or death within 48 hours of meeting suspicion criteria. A total of 53,849 patients met at least one infection criteria. Mortality increased from 3% for group 1 to 9% for group 6 and percentage meeting Angus sepsis criteria increased from 20% to 40%. Across all criteria, score discrimination was lowest for systemic inflammatory response syndrome (median area under the receiver operating characteristic curve, 0.60) and Sepsis-related Organ Failure Assessment score (median area under the receiver operating characteristic curve, 0.62), intermediate for quick Sepsis-related Organ Failure Assessment (median area under the receiver operating characteristic curve, 0.65) and Modified Early Warning Score (median area under the receiver operating characteristic curve 0.67), and highest for National Early Warning Score (median area under the receiver operating characteristic curve 0.71) and electronic Cardiac Arrest Risk Triage (median area under the receiver operating characteristic curve 0.73).

Conclusions:

The choice of criteria to define a potentially infected population significantly impacts prevalence of mortality but has little impact on accuracy. Systemic inflammatory response syndrome was the least predictive and electronic Cardiac Arrest Risk Triage the most predictive regardless of how infection was defined.
Sarcoidosis Following Anti-PD-1 and Anti-CTLA-4 Therapy for Metastatic Melanoma
Authors: Reddy Swathi B. , Possick Jennifer D. , Kluger Harriet M. , Galan Anjela , Han Dale
Published: July 2017

Immune checkpoint inhibitors represent the newest treatment for stage IV melanoma. These agents are generally well tolerated, however severe immune-related adverse effects have been noted in a small, but clinically significant percentage of patients. Specifically, sarcoidosis is a known potential complication following anti-CTLA-4 therapy. We present 2 cases of pulmonary and cutaneous sarcoidosis developing in patients with stage IV melanoma. Both patients were treated with ipilimumab and anti-PD-1 therapy, and both experienced good oncologic responses to treatment; neither had evidence of preexisting sarcoidosis. Of note, both patients developed sarcoidosis only after undergoing immune checkpoint inhibitor therapy. In 1 patient, sarcoidosis developed after initiation of anti-PD-1 therapy, 3 months after the last dose of anti-CTLA-4 monotherapy, suggesting a synergistic immune dysmodulating effect of both checkpoint inhibitors. Ultimately, both patients’ symptoms and radiologic findings resolved with corticosteroid treatment, and both patients have tolerated retreatment with PD-1 inhibitors. Sarcoidosis is a rare complication of immune checkpoint inhibitors and can manifest with severe pulmonary manifestations. However, sarcoidosis in this setting is responsive to corticosteroids and does not necessarily recur with retreatment. It is yet unclear whether the development of sarcoidosis in these patients represents unmasking of preexisting autoimmune tendencies or is a marker of oncologic response.
Online Family Problem Solving for Pediatric Traumatic Brain Injury: Influences of Parental Marital Status and Participation on Adolescent Outcomes
Authors: Raj Stacey P. , Zhang Nanhua , Kirkwood Michael W. , Taylor H. Gerry , Stancin Terry , Brown Tanya M. , Wade Shari L.
Published: July 2017

Objective:

To examine the moderating effects of parent marital status and participation on efficacy of an online family problem-solving intervention for pediatric traumatic brain injury (TBI).

Methods:

Participants were 132 adolescents (12-17 years) who had sustained a recent (<6 months) TBI and their parents. Participants were randomly assigned to the intervention (Counselor-Assisted Problem Solving, CAPS) or an Internet resource comparison (IRC) condition. CAPS was designed to support families in the initial phase following TBI, by teaching problem-solving skills and addressing common challenges. To examine the moderating effect of parent marital status, participants were divided into 4 groups (ie, CAPS married household, CAPS unmarried household, IRC married household, and IRC unmarried household). Family income and caregiver education were controlled in analyses.

Results:

Parent marital status moderated treatment effects on adolescent externalizing behavior problems. Adolescents from married households in CAPS displayed fewer behavior problems at 6 and 18 months postbaseline compared with adolescents from unmarried households in CAPS. Among married CAPS families, there were no differences in outcomes among families where 1 or 2 parents actively participated.

Conclusions:

Web-based interventions for pediatric TBI, such as CAPS, are a viable option for some although not all families. Further research is needed to investigate factors that influence efficacy to match families to the most beneficial treatments.
Perinatal Chikungunya Virus–associated Encephalitis Leading to Postnatal-Onset Microcephaly and Optic Atrophy
Authors: Ramos Regina , Viana Rafaela , Brainer-Lima Alessandra , FloreÂncio Telma , Carvalho Maria Durce , van der Linden Vanessa , Amorim Antonio , Rocha Maria AÂngela , Medeiros Fabíola
Published: July 2017

Chikungunya virus is capable of affecting the nervous system of children and adults. We describe a case of sepsis and encephalitis triggered by this agent in a newborn whose mother developed symptoms of acute infection 2 days before delivery. Consequently, the infant had severe encephalitis that evolved with postnatal-onset microcephaly, bilateral optic atrophy, epilepsy and cerebral palsy.
Two familial intrachromosomal insertions with maternal dup(6)(p22.3p25.3) or dup(2)(q24.2q32.1) in recombinant offspring
Authors: Domínguez María G. , Rivera Horacio , Aguilar-Lemarroy Adriana , Jave-Suarez Luis F. , Ramírez-Velazco Azubel , González-Ramos Isaura A. , Barros-Núñez Patricio , Partida-Pérez Miriam , Gutiérrez-Amavizca Bianca E. , Brambila-Tapia Aniel JL. , Figuera Luis E.
Published: July 2017

In this study, we describe two patients with a recombinant chromosome secondary to a maternal intrachromosomal insertion. Patient 1 was a girl with dup(6)(p22.3p25.3). Patient 2 was a boy with dup(2)(q24.2q32.1). Both familial rearrangements were characterized by means of GTG-bands, fluorescence in-situ hybridization, and comparative genomic hybridization microarray analyses. Patient 1 had an ∼23 Mb gain that involved the bands 6p22.3-6p25.3. Patient 2 had an ∼23 Mb gain (cytobands 2q24.2–2q32.1) and a further ∼1.9 Mb gain of 2p16.2–p16.3. The phenotype of each patient was in agreement with the typical 6p duplication or 2q24.2q32.1 duplication syndrome. The compound macular lesion in patient 1 suggests that retinal anomalies may be a part of the 6p trisomy phenotype. Among the 70 intrachromosomal insertions compiled here (including 68 from the literature), four were submicroscopic unbalanced insertions inherited from a balanced carrier and 66 were detectable on banded chromosomes (with or without array comparative genomic hybridization or other high-resolution assessment) and therefore spanned at least 5 Mb. Pericentric insertions are found in most chromosomes, whereas the paracentric ones are mainly observed in large and medium chromosome arms. That the former outnumber the latter in almost a 2 : 1 ratio appears to be related to the technique of diagnosis, size of the insertion, and size of the involved chromosome. Regardless of the apparent excess of carrier mothers, carriers of an intrachromosomal insertion beget almost twice as many children with a duplication than with a deletion.
Risk of Cancer Recurrence Among Individuals Exposed to Antitumor Necrosis Factor Therapy
Authors: Micic Dejan , Komaki Yuga , Alavanja Aleksandar , Rubin David T. , Sakuraba Atsushi
Published: July 2017

Background:

Patients with immune-mediated disorders such as ankylosing spondylitis, inflammatory bowel disease, psoriasis and rheumatoid arthritis are increasingly treated with tumor necrosis factor (TNF) inhibitors. The safety of anti-TNF therapy in patients with a history of cancer requires further evaluation. We conducted a systematic review and a meta-analysis of observational studies including patients with a history of cancer exposed to anti-TNF therapy assessing for a risk of new cancer or cancer recurrence.

Materials and Methods:

A computerized literature search of MEDLINE, Google scholar, and Cochrane Database of Systematic Reviews was performed through September 1, 2015. Study characteristics, quality, and risk of bias were assessed. Random-effects model meta-analyses were used to estimate the risk of new cancer development or cancer recurrence.

Results:

Nine English-language observational studies including patients with a history of cancer and exposed to anti-TNF therapy were idenitifed. The pooled incidence rate ratio of new or recurrent cancer among individuals with a history of cancer exposed to anti-TNF therapy was not significantly different compared with control therapies (incidence rate ratio, 0.90; 95% confidence interval, 0.59-1.37). Subgroup analyses were performed according to disease type, underlying cancer diagnosis, time to initiation of anti-TNF therapy and study quality. Heterogeneity of study populations, heterogeneity of the included cancer subtypes and utilization of observational studies limits the study quality.

Conclusions:

The risk of new cancer or cancer recurrence among patients with a history of cancer and use of anti-TNF therapy is similar to the risk with nonbiological disease modifying therapies. These results support the use of anti-TNF medications in select populations despite prior diagnosis of cancer.
Race, Age, and Geography Impact Hepatitis C Genotype Distribution in the United States
Authors: Gordon Stuart C. , Trudeau Sheri , Li Jia , Zhou Yueren , Rupp Loralee B. , Holmberg Scott D. , Moorman Anne C. , Spradling Philip R. , Teshale Eyasu H. , Boscarino Joseph A. , Daida Yihe G. , Schmidt Mark A. , Lu Mei
Published: July 2017

Goals:

To determine the impact of geography and patient characteristics on hepatitis C virus (HCV) genotype and subtype distribution in a large sample of patients under routine clinical care

Background:

HCV genotype impacts disease course and response to treatment. Although several studies have reported genotype distribution within specific US populations, there are no comprehensive descriptions in large, geographically diverse cohorts.

Study:

Using data from the Chronic Hepatitis Cohort Study, we present the distribution of HCV genotypes (GT) and subtypes (ST) among a racially diverse cohort of over 8000 HCV-infected patients from four large US health systems.

Results:

Genotype distribution varied significantly by geographic and demographic factors. In age-adjusted analyses, African American patients had significantly higher prevalence of GT1 (85%) than other racial categories, largely driven by a markedly higher proportion of GT1 subtype b (∼34%) than in Asian/other (24%) and white (21%) patients. GT3 represented an increasing proportion of infections as birth decade progressed, from 4% in patients born before 1946 to 18% of those born after 1976. Within the cohort of “living/uncured” patients, highly elevated alanine aminotransferase (>2 times the upper limit of normal) was significantly more common in GT3 patients, whereas Fibrosis-4 Index scores indicative of cirrhosis were most common in the combined group of GT4&6 patients.

Conclusion:

Distribution of HCV genotypes and subtypes in the United States is more variable than suggested by previous national-level estimates and single-center studies. “Real-world” prevalence data may improve targeting of prevention, screening, and treatment efforts for hepatitis C.
Risk Factors for 30-day Hospital Readmission for Diverticular Hemorrhage
Authors: Rubin Jonah N. , Shoag Daniel , Gaetano John N. , Micic Dejan , Sengupta Neil
Published: July 2017

Introduction:

The 2010 Affordable Care Act introduced the Hospital Readmissions Reduction Program to reduce health care utilization. Diverticular disease and its complications remain a leading cause of hospitalization among gastrointestinal disease. We sought to determine risk factors for 30-day hospital readmissions after hospitalization for diverticular bleeding.

Materials and Methods:

We utilized the 2013 National Readmission Database sponsored by the Agency for Healthcare Research and Quality focusing on hospitalizations with the primary or secondary discharge diagnosis of diverticular hemorrhage or diverticulitis with hemorrhage. We excluded repeat readmissions, index hospitalizations during December and those resulting in death. Our primary outcome was readmission within 30 days of index hospital discharge. Secondary outcomes of interest included medical and procedural comorbid risk factors. The data were analyzed using logistic regression analysis.

Results:

In total, 29,090 index hospitalizations for diverticular hemorrhage were included. There were 3484 (12%) 30-day readmissions with recurrent diverticular hemorrhage diagnosed in 896 (3%).

Index admissions with renal failure [odds ratio (OR), 1.31; 95% confidence interval (CI), 1.19-1.43], congestive heart failure (OR, 1.30; 95% CI, 1.17-1.43), chronic pulmonary disease (OR, 1.19; 95% CI, 1.09-1.29), coronary artery disease (OR, 1.12; 95% CI, 1.03-1.21), atrial fibrillation (OR, 1.12; 95% CI, 1.02-1.22) cirrhosis (OR, 1.95; 95% CI, 1.29-2.93, performance of blood transfusion (OR, 1.23; 95% CI, 1.15-1.33), and abdominal surgery (OR, 1.24; 95% CI, 1.03-1.49) had increased risk of 30-day readmission.

Conclusions:

The 30-day readmission rate for diverticular hemorrhage was 12% with multiple identified comorbidities increasing readmission risk.
Treatment of Congenital Thrombotic Thrombocytopenia Purpura: A New Paradigm
Authors: Aledort Louis M. , Singleton Tammuella C. , Ulsh Paula J.
Published: July 2017

Congenital thrombotic thrombocytopenia purpura (cTTP) is a very rare disorder worldwide. Standard treatment of recognized cases has been to administer fresh frozen plasma as the source of ADAMTS13, to replenish the absent ADAMTS13 enzyme. An alternative source, a plasma-derived factor VIII concentrate used for hemophilia A, and found to contain this enzyme, was reported to be effective in 1 patient in the United States. We now report details on a US cohort of 8 cTTP patients who have been successfully treated for varying periods with a marketed antihemophilic factor concentrate Koate-DVI. This biological product has been used successfully on demand in varying doses to treat acute exacerbations, as well as prophylactically (3 to 6 U ADAMTS13 every 3 to 21 d). Self-infused at home, in lieu of fresh frozen plasma therapy in the hospital setting, this product has effectively prevented episodes of thrombocytopenia, microangiopathic hemolytic anemia, and the concomitant organ damage in these patients. This specific virus inactivated product can be used to prevent further manifestations of this congenital enzyme deficiency.
The Case for Focusing on Millennial Retention
Authors: Koppel Jenna , Deline Marisa , Virkstis Katherine
Published: July 2017

A concern for nurse leaders is rapid turnover of engaged, early-tenure millennial nurses. In this 1st article in a 2-part series, the authors describe why leaders should supplement their organization’s current investments in engagement with retention strategies targeted at millennial nurses.
Decreasing Stress and Burnout in Nurses
Authors: Magtibay Donna L. , Chesak Sherry S. , Coughlin Kevin , Sood Amit
Published: July 2017

OBJECTIVE

The study’s purpose was to assess efficacy of blended learning to decrease stress and burnout among nurses through use of the Stress Management and Resiliency Training (SMART) program.

BACKGROUND

Job-related stress in nurses leads to high rates of burnout, compromises patient care, and costs US healthcare organizations billions of dollars annually. Many mindfulness and resiliency programs are taught in a format that limits nurses’ attendance.

METHODS

Consistent with blended learning, participants chose the format that met their learning styles and goals; Web-based, independent reading, facilitated discussions. The end points of mindfulness, resilience, anxiety, stress, happiness, and burnout were measured at baseline, postintervention, and 3-month follow-up to examine within-group differences.

RESULTS

Findings showed statistically significant, clinically meaningful decreases in anxiety, stress, and burnout and increases in resilience, happiness, and mindfulness.

CONCLUSIONS

Results support blended learning using SMART as a strategy to increase access to resiliency training for nursing staff.
System-Level Shared Governance Structures and Processes in Healthcare Systems With Magnet®-Designated Hospitals
Authors: Underwood Carlisa M. , Hayne Arlene N.
Published: July 2017

OBJECTIVE

The purpose was to identify and describe structures and processes of best practices for system-level shared governance in healthcare systems.

BACKGROUND

Currently, more than 64.6% of US community hospitals are part of a system. System chief nurse executives (SCNEs) are challenged to establish leadership structures and processes that effectively and efficiently disseminate best practices for patients and staff across complex organizations, geographically dispersed locations, and populations.

METHODS

Eleven US healthcare SCNEs from the American Nurses Credentialing Center’s repository of Magnet®-designated facilities participated in a 35-multiquestion interview based on Kanter’s Theory of Organizational Empowerment.

RESULTS

Most SCNEs reported the presence of more than 50% of the empowerment structures and processes in system-level shared governance.

CONCLUSIONS

Despite the difficulties and complexities of growing health systems, SCNEs have replicated empowerment characteristics of hospital shared governance structures and processes at the system level.
Associations of Organizational Safety Practices and Culture With Physical Workload, Perceptions About Work, and Work-Related Injury and Symptoms Among Hospital Nurses
Authors: Lee Soo-Jeong , Lee Joung Hee
Published: July 2017

OBJECTIVE

The study aim was to examine the relationships of organizational safety practices with nurses’ perceptions about job and risk and experiences of work-related injury and symptoms.

BACKGROUND

Nursing professions report high rates of work-related injuries. Organizational safety practices have been linked to workers’ safety outcomes and perceptions about work.

METHODS

This study analyzed data from a random sample of 280 California RNs in a cross-sectional statewide survey. Data were collected by both postal and online surveys.

RESULTS

Higher perceptions of organizational safety practices (safety climate, ergonomic practices, people-oriented culture) were significantly associated with lower physical workload, lower job strain, higher job satisfaction, lower risk perception, and lower work-related injury and symptom experiences. Ergonomic practices and people-oriented culture were associated with less intention of leaving job.

CONCLUSIONS

Organizational safety practices may play a pivotal role in improving positive perceptions about jobs, reducing injury risks, and promoting nurse retention.
Inflammatory Myofibroblastic Tumors of the Female Genital Tract Are Under-recognized
Authors: Pickett Justine L. , Chou Angela , Andrici Juliana A. , Clarkson Adele , Sioson Loretta , Sheen Amy , Reagh Jessica , Najdawi Fedaa , Kim Yoomee , Riley Denise , Maidens Jayne , Nevell David , McIlroy Kirsten , Valmadre Susan , Gard Greg , Hogg Russell , Turchini John , Robertson Gregory , Friedlander Michael , Gill Anthony J.
Published: July 2017

Inflammatory myofibroblastic tumor (IMT) of the female genital tract is under-recognized. We investigated the prevalence of ALK-positive IMT in lesions previously diagnosed as gynecologic smooth muscle tumors. Immunohistochemistry (IHC) for ALK was performed on tissue microarrays of unselected tumors resected from 2009 to 2013. Three of 1176 (0.26%) “leiomyomas” and 1 of 44 (2.3%) “leiomyosarcomas” were ALK IHC positive, confirmed translocated by fluorescence in situ hybridization (FISH) and therefore more appropriately classified as IMT. On review significant areas of all 4 tumors closely mimicked smooth muscle tumors morphologically, but all showed at least subtle/focal features suggesting IMT. Recognizing that the distinction between IMT and leiomyoma/leiomyosarcoma can be subtle, we then reviewed 1 hematoxylin and eosin slide from each patient undergoing surgery for “leiomyoma” from 2014 to 2017 and selected cases for ALK IHC with a low threshold. Of these, 30 of 571 (5.3%) underwent IHC. Two were confirmed to be IHC positive and FISH rearranged. Of the 6 IMTs, only 1 tumor with a previous diagnosis of leiomyosarcoma, an infiltrative margin and equivocal necrosis, metastasized. Of note it demonstrated a less aggressive clinical course compared with most metastatic leiomyosarcomas (alive with disease at 6 y). The patient was subsequently offered crizotinib to which she responded rapidly. In conclusion, IMTs may closely mimic gynecologic smooth muscle tumors. IMTs account for at least 5 of 1747 (0.3%) tumors previously diagnosed as leiomyoma and 1 of 44 (2.3%) as leiomyosarcoma. These tumors may be recognized prospectively with awareness of subtle/focal histologic clues, coupled with a low threshold for ALK IHC.
Time of Admission to the PICU and Mortality*
Authors: McCrory Michael C. , Spaeder Michael C. , Gower Emily W. , Nakagawa Thomas A. , Simpson Sean L. , Coleman Mary A. , Morris Peter E.
Published: July 2017

Objectives:

To evaluate for any association between time of admission to the PICU and mortality.

Design:

Retrospective cohort study of admissions to PICUs in the Virtual Pediatric Systems (VPS, LLC, Los Angeles, CA) database from 2009 to 2014.

Setting:

One hundred and twenty-nine PICUs in the United States.

Patients:

Patients less than 18 years old admitted to participating PICUs; excluding those post cardiac bypass.

Interventions:

None.

Measurements and Main Results:

A total of 391,779 admissions were included with an observed PICU mortality of 2.31%. Overall mortality was highest for patients admitted from 07:00 to 07:59 (3.32%) and lowest for patients admitted from 14:00 to 14:59 (1.99%). The highest mortality on weekdays occurred for admissions from 08:00 to 08:59 (3.30%) and on weekends for admissions from 09:00 to 09:59 (4.66%). In multivariable regression, admission during the morning 06:00–09:59 and midday 10:00–13:59 were independently associated with PICU death when compared with the afternoon time period 14:00–17:59 (morning odds ratio, 1.15; 95% CI, 1.04–1.26; p = 0.006 and midday odds ratio, 1.09; 95% CI; 1.01–1.18; p = 0.03). When separated into weekday versus weekend admissions, only morning admissions were associated with increased odds of death on weekdays (odds ratio, 1.13; 95% CI, 1.01–1.27; p = 0.03), whereas weekend admissions during the morning (odds ratio, 1.33; 95% CI, 1.14–1.55; p = 0.004), midday (odds ratio, 1.27; 95% CI, 1.11–1.45; p = 0.0006), and afternoon (odds ratio, 1.17; 95% CI, 1.03–1.32; p = 0.01) were associated with increased risk of death when compared with weekday afternoons.

Conclusions:

Admission to the PICU during the morning period from 06:00 to 09:59 on weekdays and admission throughout the day on weekends (06:00–17:59) were independently associated with PICU death as compared to admission during weekday afternoons. Potential contributing factors deserving further study include handoffs of care, rounds, delays related to resource availability, or unrecognized patient deterioration prior to transfer.
Creating a Controlled Arterio-Venous Shunt by Reversing the Extracorporeal Membrane Oxygenation Blood Flow: A Strategy for Weaning Patients Off Veno-Arterial Extracorporeal Membrane Oxygenation
Authors: Mattke Christian Adrian , Haisz Emma , Pandya Nischal , Black Anthony , Venugopal Prem
Published: July 2017

Objectives:

To assess whether reversing the veno-arterial extracorporeal membrane oxygenation blood flow (thereby creating a controlled arterio-venous shunt) can be used to wean children off extracorporeal membrane oxygenation. The standard practice for weaning patients off VA extracorporeal membrane oxygenation is to gradually reduce the blood flows delivered through the extracorporeal membrane oxygenation pump to a minimum level followed by either insertion of an “arterio-venous bridge” and clamping of the blood flow to the patient or direct decannulation. “Pump controlled retrograde flow trial off” is a technique where the revolutions in the centrifugal pump are reduced to the point where the patient will drive the blood retrograde through the extracorporeal membrane oxygenation circuit, effectively turning the circuit into a controlled arterio-venous shunt. The revolutions per minute control the amount of shunt flow. This eliminates any cardiorespiratory support the extracorporeal membrane oxygenation circuit may provide to the patient.

Design:

Feasibility study.

Setting:

Pediatric intensive care.

Patients:

Extracorporeal membrane oxygenation-dependent pediatric patients, who were ready for weaning, and possible separation from extracorporeal membrane oxygenation entered the trial.

Intervention:

Pump controlled retrograde flow trial off.

Measurement and Main Results:

During 2016, pump controlled retrograde flow trial off was used in 17 patients, for a total of 23 episodes. One episode was unsuccessful in a patient with a body weight of 2.2 kg, where cardiac output was insufficient to provide blood flow to both body and extracorporeal membrane oxygenation circuit, though from 2.8 kg body weight upward, the technique was tolerated. The duration of pump controlled retrograde flow trial off was 15 minutes to 2.5 hours. Five cases led to a continuation of the extracorporeal membrane oxygenation run, as they were not ready to be decannulated. Fifteen patients were decannulated after the pump controlled retrograde flow trial off. No patient needed to be recommenced on extracorporeal membrane oxygenation after decannulation.

Conclusions:

Pump controlled retrograde flow trial off is an easy to use and easily reversible technique to assess patient readiness for separation from extracorporeal membrane oxygenation. Given pump controlled retrograde flow trial off can easily be stopped and—in our experience—is not associated with complications, it lowers the threshold to attempt coming off extracorporeal membrane oxygenation and facilitates accurate assessment of whether a patient will need further ongoing extracorporeal membrane oxygenation support.