bluuebunny/crossref_metadata_2025 huggingface dataset:
A post-master's advanced certificate in gerontology for NPs
Authors: Greenberg Sherry A. , Squires Allison , Adams Jennifer , Altshuler Lisa , Oh So-Young , Blachman Nina L. , Cortes Tara A.
Published: August 2017

This article describes an innovative post-master's advanced certificate in gerontology program developed by the Hartford Institute for Geriatric Nursing at the New York University Rory Meyers College of Nursing. The program provides advanced practice registered nurses geriatric content to meet eligibility criteria for the Adult-Gerontology Primary Care NP certification exam and develops interprofessional care providers to care for complex older adults.
Assessment of Mesenteric Tissue Saturation, Oxygen Saturation, and Heart Rate Pre- and Post-Blood Transfusion in Very Low-Birth-Weight Infants Using Abdominal Site Near-Infrared Spectroscopy
Authors: Miller Harriet D. , Penoyer Daleen A. , Baumann Kari , Diaz Ann , Sole Mary Lou , Bowles Susan M.
Published: August 2017

Background:

Preterm infants often receive blood transfusions during hospitalization. Although transfusions are intended to enhance oxygen delivery, previous studies found decreases in tissue and mesenteric oxygen saturation during and after blood transfusions without changes in vital signs and hemoglobin oxygen saturation.

Purpose:

To study the effect of blood transfusions on regional mesenteric tissue oxygen saturation (rSo
2), hemoglobin saturation of oxygen (Spo
2), and heart rate (HR) in premature infants.

Method:

A prospective, observational, nonrandomized study using a repeated-measures design was done to evaluate changes in physiologic variables (HR, Spo
2, rSo
2) before, during, and after a blood transfusion in premature infants.

Results:

A convenience sample of 30 infants with a mean gestational age of 25.5 (2.1) weeks was recruited. Repeated-measures analysis of variance found no significant differences in HR (P = .06) and Spo
2 (P = .55) over time. However, significant differences occurred in rSo
2 over the 3 time periods (P < .001). The rSo
2 increased during the transfusion from 40.3% to 41.5%, but decreased to 34.9% in the posttransfusion period. Pairwise comparisons revealed statistically significant mean rSo
2 differences between pretransfusion and posttransfusion (P < .001), and during transfusion to posttransfusion (P < .001) periods.

Implications for Research:

This study supports previous findings of perfusion changes during blood transfusions in preterm infants.

Implications for Practice:

Measuring mesenteric tissue oxygenation during blood transfusion in very low-birth-weight infants can potentially add another physiologic parameter to guide further clinical assessment and interventions during transfusions.
Risks to the Superior Gluteal Neurovascular Bundle During Iliosacral and Transsacral Screw Fixation: A Computed Tomogram Arteriography Study
Authors: Maslow Jed , Collinge Cory A.
Published: August 2017

Objectives:

Iliosacral (IS) and transsacral (TS) screws are popular techniques to repair complicated injuries to the pelvis. The anatomy of the superior gluteal neurovasculature (SG NV bundle) is well described as running along the posterior ilium, providing innervation and perfusion to important abductor muscles. The method of pelvis fixation least likely to injure the SG NV bundle is unknown.

Methods:

Twenty uninjured patients with a contrasted computed tomogram of the pelvis and lower extremities (CTA) were evaluated. Starting points for an S1 IS screw and S1 and S2 TS screws were estimated on the “ghost” lateral CTA image for those pelvi with safe corridors (>9 mm diameter). The distance from the projected screw to the SG artery was measured. A distance of <3.65 mm (half of a 7.3-mm screw's diameter) was considered likely for NV bundle injury.

Results:

Of 40 pelvi CTAs (single sides), 10 pelvi (25%) were determined to be inappropriate for an S1 TS screw. The average distances from the screw starting point and the artery were 25.3 mm (±9.2) for S1 IS, 12.4 mm (±9.0) for S1 TS, and 23.5 mm (±10.7) for S2 TS screws, respectively. Ten S1 TS screws (25%) and no S1 IS or S2 TS screws were projected to have caused injury to the SG NV bundle (P < 0.001).

Conclusions:

Inserting S1 IS and S2 TS screws put the SG NV anatomy at significantly less risk than S1 TS screws. This information may aid in choosing the “best” fixation option for patients with pelvic ring trauma requiring surgery.
Mini-open Repair of Achilles Tendon Rupture With the Patient in the Supine Position
Authors: Cone Brent , Staggers Jackson , Shah Ashish
Published: August 2017

Surgical repair of the Achilles tendon is a common procedure for acute Achilles tendon ruptures. Variations in surgical technique and patient positioning exist, with the ultimate goal of achieving a durable repair while minimizing complications. Recently the use of a mini-open approach has been demonstrated to provide a durable repair that is comparable to using a larger traditional open approach. In this paper we describe a mini-open approach for surgical repair of the Achilles tendon while the patient is in the supine position.
Safety Hazards During Intrahospital Transport: A Prospective Observational Study
Authors: Bergman Lina M. , Pettersson Monica E. , Chaboyer Wendy P. , Carlström Eric D. , Ringdal Mona L.
Published: August 2017

Objective:

To identify, classify, and describe safety hazards during the process of intrahospital transport of critically ill patients.

Design:

A prospective observational study. Data from participant observations of the intrahospital transport process were collected over a period of 3 months.

Setting:

The study was undertaken at two ICUs in one university hospital.

Patients:

Critically ill patients transported within the hospital by critical care nurses, unlicensed nurses, and physicians.

Interventions:

None.

Measurements and Main Results:

Content analysis was performed using deductive and inductive approaches. We detected a total of 365 safety hazards (median, 7; interquartile range, 4–10) during 51 intrahospital transports of critically ill patients, 80% of whom were mechanically ventilated. The majority of detected safety hazards were assessed as increasing the risk of harm, compromising patient safety (n = 204). Using the System Engineering Initiative for Patient Safety, we identified safety hazards related to the work system, as follows: team (n = 61), tasks (n = 83), tools and technologies (n = 124), environment (n = 48), and organization (n = 49). Inductive analysis provided an in-depth description of those safety hazards, contributing factors, and process-related outcomes.

Conclusions:

Findings suggest that intrahospital transport is a hazardous process for critically ill patients. We have identified several factors that may contribute to transport-related adverse events, which will provide the opportunity for the redesign of systems to enhance patient safety.
Six-Year Results From a Phase I/II Trial for Hypofractionated Accelerated Partial Breast Irradiation Using a 2-Day Dose Schedule
Authors: Wilkinson John B. , Chen Peter Y. , Wallace Michelle F. , Shah Chirag S. , Benitez Pamela R. , Martinez Alvaro A. , Vicini Frank A.
Published: August 2017

Background:

To report 6-year outcomes from a phase I/II trial using balloon-based brachytherapy to deliver APBI in 2 days.

Methods:

A total of 45 patients with early-stage breast cancer received adjuvant APBI in 2 days with high-dose rate (HDR) brachytherapy totaling 2800 cGy in 4 fractions (700 cGy BID) using a balloon-based applicator as part of a prospective phase I/II clinical trial. All patients had negative margins and skin spacing ≥8 mm. We evaluated toxicities (CTCAE v3) as well as ipsilateral breast tumor recurrence (IBTR), regional nodal failure (RNF), distant metastasis, disease-free survival, cause-specific survival, and overall survival.

Results:

Median age and tumor size were 66 years old (48 to 83) and 0.8 cm (0.2 to 2.3 cm), respectively. Four percent of patients were N1 (n=2) and 73% were estrogen receptor (ER) positive (n=32). Median follow-up was 6.2 years (2.4 to 8.0 y). Nearly all toxicities at 6 years were grade 1 to 2 except 1 instance of grade 3 telangiectasia (2%). Eleven percent (n=5) of patients had chronic asymptomatic fat necrosis whereas asymptomatic seromas were noted on mammogram in 13% of cases (n=6). Cosmesis at last follow-up was good or excellent in 91% of cases (n=40) and fair in 9% (n=4). Two of the previously reported rib fractures healed with conservative measures. There were no IBTR or RNF (6 y IBTR/RNF rate 0%); however, 2 patients experienced distant metastasis (4% at 6 y). The 6-year actuarial disease-free survival, cause-specific survival, and overall survival were 96%, 100%, and 93%, respectively.

Conclusions:

Hypofractionated 2-day APBI using brachytherapy resulted in excellent clinical outcomes with acceptable chronic toxicities.
Fertility preservation in children and adolescents: current options and considerations
Authors: McCracken Kate , Nahata Leena
Published: August 2017

Purpose of review

The purpose of this review is to outline current pediatric fertility preservation options, and discuss ethical and financial considerations impacting this rapidly expanding field.

Recent findings

With the improvement in treatment of pediatric malignancies and medical conditions that threaten fertility, survival rates are increasing. Therefore, minimizing long-term morbidities such as gonadal damage and infertility is of utmost importance. Impaired fertility not only has a significant negative impact on patient's quality of life; in women, gonadal damage puts patients at risk for premature menopause, and increased risk of cardiac, skeletal, and cognitive issues. Fortunately, fertility preservation options exist for both female and male prepubertal and pubertal patients, and discussion of such options with patients and their families prior to the initiation of therapy and/or before further deterioration of gonadal function is crucial. A multidisciplinary approach to fertility counseling, with attention to the patient's goals and cultural beliefs, is ideal.

Although several national organizations support integrating a fertility consultation into routine care, fertility preservation is still underutilized. Continued research is needed to understand barriers for patients/families and reduce the number of missed opportunities for fertility preservation.
Prevention of Mandible Reconstruction Plate Exposure by Costal Cartilage Wrapping
Authors: Iwasawa Motonao , Mishima Yoshito , Ohtsubo Miho
Published: August 2017

After mandibulectomy in cancer surgery, reconstruction is often performed with a reconstruction plate covered with a soft-tissue free flap in patients in poor condition. However, the rate of complications for mandibular reconstruction is higher with a reconstruction plate than with vascularized bone grafts. We have developed a costal cartilage wrapping method to prevent exposure of the mandible reconstruction plate. The eighth costal cartilage was removed and split into 2 pieces to wrap around the reconstruction plate. In our case, the artificial plate wrapped with costal cartilage graft was not exposed and the skin over the plate did not become atrophic over 27 months follow-up even after irradiation. Wrapping around an artificial reconstruction plate with autologous costal cartilage grafts may be more effective than using only a flap covering to prevent exposure of the plate after tumor ablation and radiation therapy.
Intermediate Term Outcomes of Early Posttrabeculectomy Bleb Leaks Managed by Large Diameter Soft Bandage Contact Lens
Authors: Gollakota SriRamani , Garudadri Chandra S. , Mohamed Ashik , Senthil Sirisha
Published: August 2017

Purpose:

To study the outcomes of large diameter soft bandage contact lens (BCL) in managing early trabeculectomy bleb leak.

Materials and Methods:

Of 972 eyes that underwent fornix-based trabeculectomy between 2011 and 2015, 19 eyes with bleb leak with at least 1 year follow-up were eligible. Bleb leak was conservatively managed using large diameter BCL (≥15.5 mm in diameter). Success was defined as complete, if bleb leak resolved and the intraocular pressure (IOP) was ≥5 and ≤18 mm Hg with no additional antiglaucoma medication and failure if surgical intervention was needed.

Results:

Mean age (±SD) of subjects was 43.5±11.9 years. Mitomycin C was used in 15/19 eyes. Median time (interquartile range) from trabeculectomy to bleb leak was 9 days (interquartile range: 8 to 19 d). Bleb leak was treated with 15.5 mm BCL in 16 eyes and 17 mm lens in 3 eyes. Bleb leak resolved with BCL in 17 [89.5%; 95% confidence interval (95% CI), 68.6-97] and 2 eyes (10.5%; 95% CI, 2-31) required bleb resuturing. Mean duration of BCL wear for bleb leak resolution was 23.7±8.9 days. Mean IOP increased from 5.8±2.7 to 12.5±3.1 mm Hg after resolution of bleb leak (P<0.05). At 16 months, complete success probability of trabeculectomy was 89.4% (95% CI, 75.6%-100%).

Conclusions:

Large diameter BCL was effective in the management of early bleb leak with good intermediate term success for IOP control. We suggest a trial of soft contact lens of appropriate diameter to manage early bleb leaks, before planning any invasive intervention.
Clinical Implications of In Vivo Lamina Cribrosa Imaging in Glaucoma
Authors: Kim Yong Woo , Jeoung Jin Wook , Kim Young Kook , Park Ki Ho
Published: August 2017

The lamina cribrosa (LC) is a multilayered, collagenous, sieve-like structure at the deep optic nerve head, and is presumed to be the primary site of axonal injury. According to biomechanical theory, intraocular pressure-induced posterior deformation of the LC causes blockage of axonal transport and alters the ocular blood flow, so that the axons of the retinal ganglion cells lead to apoptosis, which results in glaucomatous optic disc change. Although most of the research on the LC to date has been limited to experimental animal or histologic studies, the recent advances in optical coherence tomography devices and image processing techniques have made possible the visualization of the LC structure in vivo. LC deformation in glaucoma typically has been evaluated in terms of its position from a structural reference plane (LC depth), entire curvature or shape, thickness, or localized structural change (focal LC defects or LC pore change). In this review, we highlight the methods of assessing LC deformation from in vivo optical coherence tomography scans, and we discuss the clinical implications of the recent investigations of the in vivo structure of LC in glaucoma.
Outcome of Children With Presumptive Tuberculosis in Mbarara, Rural Uganda
Authors: Bonnet Maryline , Nansumba Margaret , Bastard Mathieu , Orikiriza Patrick , Kyomugasho Naomi , Nansera Denis , Boum Yap , de Beaudrap Pierre , Kiwanuka Julius , Kumbakumba Elias
Published: August 2017

Background:

Mortality among children with presumptive tuberculosis (TB) empiric TB treatment can be high. We describe the predictors of death among children with presumptive TB, and the relation between treatment and mortality.

Methods:

A prospective cohort of children with presumptive TB who underwent clinical assessment, chest radiograph, tuberculin skin test and sputum bacterial tests for TB was followed up for 3 months. TB diagnosis was based on mycobacterial, clinical and radiologic findings. Predictors of deaths were determined using cox regression model.

Results:

Of 360 children included in the analysis, 31.4% were younger than 2 years; 31.6% were HIV infected and 11.3% were severely malnourished. One hundred forty (38.9%) were diagnosed with TB, 18 (13%) of whom were bacteriologically confirmed. At 3 months of follow up, 25 of 360 (6.9%) children had died: 15 of 140 (10.7%) were receiving TB treatment versus 10 of 220 (4.5%) were not receiving treatment (P = 0.025). Severely malnourished children [adjusted hazard ratio (aHR), 9.86; 95% confidence interval (CI): 3.11–31.23] and those with chest radiographs suggestive of TB (aHR, 4.20; 95% CI: 0.93–19.01) were more likely to die. Children receiving empiric TB treatment had an increased risk of death (aHR, 2.37; 95% CI: 1.01–5.55) compared with children without treatment after adjustment for age, sex, HIV status and Bacillus Calmette-Guérin (BCG) vaccination.

Conclusions:

The high mortality in children receiving empirically TB treatment highlights the difficulty in diagnosing childhood TB, the increased likelihood of starting treatment in critically ill children and in children with chronic disease, and the possibility of misdiagnosis. It strengthens the need to invest further in early TB detection and diagnosing nonsevere illness.
Predictors of Infant Hepatitis B Immunization in Cameroon: Data to Inform Implementation of a Hepatitis B Birth Dose
Authors: Dionne-Odom Jodie , Westfall Andrew O. , Nzuobontane Divine , Vinikoor Michael J. , Halle-Ekane Gregory , Welty Thomas , Tita Alan T. N.
Published: August 2017

Background:

Although most African countries offer hepatitis B immunization through a 3-dose vaccine series recommended at 6, 10 and 14 weeks of age, very few provide birth dose vaccination. In support of Cameroon’s national plan to implement the birth dose vaccine in 2017, we investigated predictors of infant hepatitis B virus (HBV) vaccination under the current program.

Methods:

Using the 2011 Demographic Health Survey in Cameroon, we identified women with at least one living child (age 12–60 months) and information about the hepatitis B vaccine series. Vaccination rates were calculated, and logistic regression modeling was used to identify factors associated with 3-dose series completion. Changes over time were assessed with linear logistic model.

Results:

Among 4594 mothers analyzed, 66.7% (95% confidence interval [CI]: 64.1–69.3) of infants completed the hepatitis B vaccine series; however, an average 4-week delay in series initiation was noted with median dose timing at 10, 14 and 19 weeks of age. Predictors of series completion included facility delivery (adjusted odds ratio [aOR]: 2.1; 95% CI: 1.7–2.6), household wealth (aOR: 1.9; 95% CI: 1.2–3.1 comparing the highest and lowest quintiles), Christian religion (aOR: 1.8; 95% CI: 1.3–2.5 compared with Muslim religion) and older maternal age (aOR: 1.4; 95% CI: 1.2–1.7 for 10 year units).

Conclusions:

Birth dose vaccination to reduce vertical and early childhood transmission of hepatitis B may overcome some of the obstacles to timely and complete HBV immunization in Cameroon. Increased awareness of HBV is needed among pregnant women and high-risk groups about vertical transmission, the importance of facility delivery and the effectiveness of prevention beginning with monovalent HBV vaccination at birth.
An Open-Label Pilot Study of Combined Augmentation With Creatine Monohydrate and 5-Hydroxytryptophan for Selective Serotonin Reuptake Inhibitor– or Serotonin-Norepinephrine Reuptake Inhibitor–Resistant Depression in Adult Women
Authors: Kious Brent M. , Sabic Hana , Sung Young-Hoon , Kondo Douglas G. , Renshaw Perry
Published: August 2017

Purpose

Many women with major depressive disorder (MDD) respond inadequately to standard treatments. Augmentation of conventional antidepressants with creatine monohydrate and 5-hydroxytryptophan (5-HTP) could correct deficits in serotonin production and brain bioenergetics associated with depression in women, yielding synergistic benefit. We describe an open-label study of 5-HTP and creatine augmentation in women with MDD who had failed selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake inhibitor (SNRI) monotherapy.

Methods

Fifteen women who were adequately adherent to an SSRI or SNRI and currently experiencing MDD, with a 17-item Hamilton Depression Rating Scale (HAM-D) score of 16 or higher, were treated with 5 g of creatine monohydrate daily and 100 mg of 5-HTP twice daily for 8 weeks, with 4 weeks of posttreatment follow-up. The primary outcome was change in mean HAM-D scores.

Results

Mean HAM-D scores declined from 18.9 (SD, 2.5) at pretreatment visits to 7.5 (SD, 4.4) (P < 0.00001), a decrease of 60%. Participants did not experience any serious treatment-related adverse events.

Conclusions

Combination treatment with creatine and 5-HTP may represent an effective augmentation strategy for women with SSRI- or SNRI-resistant depression. Given the limitations of this small, open-label trial, future study in randomized, placebo-controlled trials is warranted.
The Utility of Noninvasive Scores in Assessing the Prevalence of Nonalcoholic Fatty Liver Disease and Advanced Fibrosis in Type 2 Diabetic Patients
Authors: Singh Amandeep , Le Phuc , Peerzada Maajid M. , Lopez Rocio , Alkhouri Naim
Published: August 2017

Goals:

The aim of our study is to assess the prevalence of nonalcoholic fatty liver disease (NAFLD) and advanced hepatic fibrosis in patients with type 2 diabetes mellitus (T2DM) using simple noninvasive scores.

Background:

In individuals with T2DM, there is a very high prevalence of NAFLD. Moreover, T2DM is a risk factor for advanced disease in NAFLD patients.

Study:

Using International Classification of Diseases, Ninth Revision codes all patients with the diagnosis of T2DM were reviewed and a retrospective chart analysis was performed on 169,910 patients between the ages of 18 to 80. To predict the prevalence of NAFLD, we calculated the hepatic steatosis index. To estimate the prevalence of advanced fibrosis, NAFLD fibrosis score (NFS), fibrosis-4 index, aspartate aminotransferase (AST) to platelet ratio index (APRI), and AST/alanine aminotransferase (ALT) ratio were calculated.

Results:

Of the 121,513 patients included in the analysis, 89.4% were above normal weight limit. NAFLD based on Hepatic Steatosis Index>36 was present in 87.9% of patients. Advanced fibrosis was present in 35.4% based on NFS>0.676, 8.4% based on fibrosis-4>2.67, 1.9% based on APRI>1.5, and 16.9% based on AST/ALT>1.4% indicating advanced fibrosis and high risk of developing cirrhosis related to NAFLD.

Conclusions:

In this large cohort of patients with T2DM, we detected high prevalence of hepatic steatosis and advanced fibrosis using noninvasive scores. These scores are easy and nonexpensive tools to screen for NAFLD and advanced fibrosis, although the significant variability of the percentage of patients with advanced fibrosis using these scores indicates the need for further validation in diabetic populations.
(Can’t Get No) Patient Satisfaction
Authors: Quigley Brian M. , Sova Christopher C. , Brenner Darren M. , Keefer Laurie A. , Sitrin Michael D. , Radziwon Christopher D. , Krasner Susan S. , Lackner Jeffrey M.
Published: August 2017

Goals:

The goal of this study is to assess: (1) the relative contribution of patient factors to satisfaction ratings in irritable bowel syndrome (IBS) patients and (2) the relationship between patient satisfaction (PS) and the number of diagnostic tests patients underwent prior to receiving IBS diagnosis.

Background:

Although PS is regarded as an important indicator of quality of care, little is known about its determinants.

Study:

A total of 448 Rome III-diagnosed patients (M age=41 y; 79% F), whose GI symptoms were at least moderate in severity completed patient-reported outcome measures as part of pretreatment evaluation of an NIH-funded clinical trial. PS was measured with the 11-point Hospital Consumer Assessment of Healthcare Providers and Systems global rating scale modified to assess for IBS treatments. A series of multiple regression analyses were conducted for demographic, IBS-specific, general physical health, and psychological predictors before running a final model of significant predictors from each domain.

Results:

The final regression model was significant, F
6,419=6.34, P<0.001, R
2=0.08, with race, insurance, number of diagnostic tests, and lower neuroticism predicting PS. Medical tests were rendered nonsignificant when history of seeking care from a gastroenterologist was introduced into the equation.

Conclusions:

Contrary to hypotheses, neither the IBS symptom severity nor quality of life impairment predicted PS. Patient factors such as a neurotic personality style and sociodemographic profile had a significant but modest impact on PS. Pattern of regression analyses suggests that patients may turn to their gastroenterologist for testing for reassurance, which may in the long-term fuel demand for more testing.
Improved Correction of Misclassification Bias With Bootstrap Imputation
Authors: van Walraven Carl
Published: August 2017

Objective:

Diagnostic codes used in administrative database research can create bias due to misclassification. Quantitative bias analysis (QBA) can correct for this bias, requires only code sensitivity and specificity, but may return invalid results. Bootstrap imputation (BI) can also address misclassification bias but traditionally requires multivariate models to accurately estimate disease probability. This study compared misclassification bias correction using QBA and BI.

Study Design:

Serum creatinine measures were used to determine severe renal failure status in 100,000 hospitalized patients. Prevalence of severe renal failure in 86 patient strata and its association with 43 covariates was determined and compared with results in which renal failure status was determined using diagnostic codes (sensitivity 71.3%, specificity 96.2%). Differences in results (misclassification bias) were then corrected with QBA or BI (using progressively more complex methods to estimate disease probability).

Results:

In total, 7.4% of patients had severe renal failure. Imputing disease status with diagnostic codes exaggerated prevalence estimates [median relative change (range), 16.6% (0.8%–74.5%)] and its association with covariates [median (range) exponentiated absolute parameter estimate difference, 1.16 (1.01–2.04)]. QBA produced invalid results 9.3% of the time and increased bias in estimates of both disease prevalence and covariate associations. BI decreased misclassification bias with increasingly accurate disease probability estimates.

Conclusions:

QBA can produce invalid results and increase misclassification bias. BI avoids invalid results and can importantly decrease misclassification bias when accurate disease probability estimates are used.
Y Chromosome DNA in Women's Vaginal Samples as a Biomarker of Recent Vaginal Sex and Condom Use With Male Partners in the HPV Infection and Transmission Among Couples Through Heterosexual Activity Cohort Study
Authors: Malagón Talía , Burchell Ann , El-Zein Mariam , Guénoun Julie , Tellier Pierre-Paul , Coutlée François , Franco Eduardo L.
Published: August 2017

Background

Y chromosome DNA from male epithelial and sperm cells was detected in vaginal samples after unprotected sex in experimental studies. We assessed the strength of this association in an observational setting to examine the utility of Y chromosome DNA as a biomarker of recent sexual behaviors in epidemiological studies.

Methods

The HPV (human papillomavirus) Infection and Transmission Among Couples Through Heterosexual Activity cohort study enrolled 502 women attending a university or college in Montréal, Canada, and their male partners from 2005 to 2010. Participants completed self-administered questionnaires. We used real-time polymerase chain reaction to test women's baseline vaginal samples for Y chromosome DNA and assessed which sexual behaviors were independent predictors of Y chromosome DNA positivity and quantity with logistic and negative binomial regression.

Results

Y chromosome DNA positivity decreased from 77% in women in partnerships reporting vaginal sex 0 to 1 day ago to 13% in women in partnerships reporting last vaginal sex of 15 or more days ago (adjusted odds ratio, 0.09; 95% confidence interval, 0.02–0.36). The mean proportion of exfoliated vaginal sample cells with Y chromosome DNA was much lower for women who reported always using condoms (0.01%) than for women who reported never using condoms (2.07%) (adjusted ratio, 26.8; 95% confidence interval, 8.9–80.5). No association was found with reported oral/digital sex frequency or concurrency of partnerships.

Conclusions

Y chromosome DNA quantity is strongly associated with days since last vaginal sex and lack of condom use in observational settings. Y chromosome DNA quantity may prove useful as a correlate of recent vaginal sex in observational studies lacking data on sexual behavior, such as surveillance studies of human papillomavirus infection prevalence.
Myxoid Mesenchymal Tumors of the Uterus: An Update on Classification, Definitions, and Differential Diagnosis
Authors: Busca Aurelia , Parra-Herran Carlos
Published: August 2017

Tumors with a predominant myxoid stroma are rare in the uterus. When encountered, however, they pose a diagnostic challenge. Traditionally myxoid leiomyosarcoma has been the most important consideration in this category, given its adverse prognosis and deceptively bland morphology. Conventional features of malignancy are variably present; in contrast, an infiltrative tumor border is a consistent pathologic characteristic. More recently, previously under-recognized lesions have been identified, in part due to our growing knowledge of their underlying molecular alterations: uterine inflammatory myofibroblastic tumor frequently harbors ALK rearrangements and a novel ZC3H7B-BCOR gene fusion has been described in a subset of myxoid high-grade endometrial stromal sarcomas. These tumors need to be distinguished from myxoid leiomyosarcoma, as by comparison have a less aggressive course and are amenable to targeted treatments. In addition, uterine mesenchymal tumors with malignant potential need to be distinguished from benign tumors and epithelial and mixed malignancies. This review aims to discuss our current understanding of the most common uterine myxoid neoplasms: their clinical features, their distinguishing histopathologic, immunohistochemical, and molecular features and the clues and pitfalls in their diagnosis.
Everyday Discrimination and Metabolic Syndrome Incidence in a Racially/Ethnically Diverse Sample: Study of Women's Health Across the Nation
Authors: Beatty Moody Danielle L. , Chang Yuefang , Brown Charlotte , Bromberger Joyce T. , Matthews Karen A.
Published: August 2017

Objective

Everyday discrimination may contribute to incident metabolic syndrome (MetS) in the United States and related racial/ethnic differences in MetS. The study investigated whether everyday discrimination predicted MetS in a diverse sample.

Methods

A longitudinal, cohort study of 2132 women (mean [standard deviation] = 45.8 [2.7] years) who self-reported as black (n = 523), white (n = 1065), Chinese (n = 194), Japanese (n = 227), or Hispanic (n = 123) at baseline drawn from seven cities across the United States was conducted. MetS was defined in accordance with the National Cholesterol Education Program Adult Treatment Panel III criteria. The Everyday Discrimination scale was used to assess exposure to and level of everyday discrimination.

Results

Everyday discrimination exposure at baseline predicted a 33% greater incidence of MetS during the 13.89-year (standard deviation = 3.83, hazard ratio (HR) = 1.33, 95% confidence interval [CI] = 1.11–1.64, p = .001) follow-up in the full sample and was most pronounced in black, Hispanic, and Japanese women. Each 1-point increase in the continuous everyday discrimination score (HR = 1.03, 95% CI =1.01–1.05, p = .001) predicted a 3% greater incidence of MetS and, specifically, blood pressure (HR = 1.01, 95% CI = 1.00–1.03, p = .04), waist circumference (HR = 1.05, 95% CI =1.03–1.06, p < .001), and triglyceride level (HR = 1.02, 95% CI =1.00–1.04, p = .01). These associations were independent of risk factors including physical activity, socioeconomic status, smoking, and alcohol consumption.

Conclusions

Everyday discrimination contributes to poorer metabolic health in midlife women in the United States. These findings have clinical implications for the development of MetS and, ultimately, cardiovascular disease and diabetes, and intervention strategies to reduce these outcomes.
Making Patient Safety Event Data Actionable: Understanding Patient Safety Analyst Needs
Authors: Puthumana Joseph Stephen , Fong Allan , Blumenthal Joseph , Ratwani Raj M.
Published: August 2017

Objectives

The increase in patient safety reporting systems has led to the challenge of effectively analyzing these data to identify and mitigate safety hazards. Patient safety analysts, who manage reports, may be ill-equipped to make sense of report data. We sought to understand the cognitive needs of patient safety analysts as they work to leverage patient safety reports to mitigate risk and improve patient care.

Methods

Semistructured interviews were conducted with 21 analysts, from 11 hospitals across 3 healthcare systems. Data were parsed into utterances and coded to extract major themes.

Results

From 21 interviews, 516 unique utterances were identified and categorized into the following 4 stages of data analysis: input (15.1% of utterances), transformation (14.1%), extrapolation (30%), and output (14%). Input utterances centered on the source (35.9% of inputs) and preprocessing of data. Transformation utterances centered on recategorizing patient safety events (57.5% of transformations) or integrating external data sources (42.5% of transformations). The focus of interviews was on extrapolation and trending data (56.1% of extrapolations); alarmingly, 16.1% of trend utterances explicitly mentioned a reliance on memory. The output was either a report (56.9% of outputs) or an action (43.1% of outputs).

Conclusions

Major gaps in the analysis of patient safety report data were identified. Despite software to support reporting, many reports come from other sources. Transforming data are burdensome because of recategorization of events and integration with other data sources, processes that can be automated. Surprisingly, trend identification was mostly based on patient analyst memory, highlighting a need for new tools that better support analysts.
Anti-LGBT and Anti-immigrant Structural Stigma: An Intersectional Analysis of Sexual Minority Men's HIV Risk When Migrating to or Within Europe
Authors: Pachankis John E. , Hatzenbuehler Mark L. , Berg Rigmor C. , Fernández-Dávila Percy , Mirandola Massimo , Marcus Ulrich , Weatherburn Peter , Schmidt Axel J.
Published: August 2017

Objective:

Gay, bisexual, and other men who have sex with men (MSM) might be particularly likely to migrate to experience freedoms unavailable in their home countries. Structural stigma (eg, laws and policies promoting the unequal treatment of oppressed populations) in MSM migrants' sending and receiving countries represent potential barriers to HIV prevention among this intersectional population. This study represents the first investigation of structural determinants of HIV risk in a large, geographically diverse sample of MSM migrants.

Design:

The 2010 European MSM Internet Survey (n = 23,371 migrants) was administered across 38 European countries.

Methods:

Structural stigma was assessed using (1) national laws and policies promoting unequal treatment of sexual minorities across 181 countries worldwide and (2) national attitudes against immigrants in the 38 receiving countries. We also assessed linguistic status, time since migrating, and 5 HIV-prevention outcomes.

Results:

Structural stigma toward sexual minorities (in sending and receiving countries) and toward immigrants (in receiving countries) was associated with a lack of HIV-prevention knowledge, service coverage, and precautionary behaviors among MSM migrants. Linguistic status and time since migrating moderated some associations between structural stigma and lack of HIV prevention.

Conclusions:

Structural stigma toward MSM and immigrants represents a modifiable structural determinant of the global HIV epidemic.
Long-term evaluation of a hospital-based violence intervention program using a regional health information exchange
Authors: Bell Teresa M. , Gilyan Dannielle , Moore Brian A. , Martin Joel , Ogbemudia Blessing , McLaughlin Briana E. , Moore Reilin , Simons Clark J. , Zarzaur Ben L.
Published: August 2017

BACKGROUND

Hospital-based violence intervention programs (HVIP) aim to reduce violent-injury recidivism by providing intensive case management services to high-risk patients who were violently injured. Although HVIP have been found effective at reducing recidivism, few studies have sought to identity how long their effects last. Additionally, prior studies have been limited by the fact that HVIP typically rely on self-report or data within their own healthcare system to identify new injuries. Our aim was to quantify the long-term recidivism rate of participants in an HVIP program using more objective and comprehensive data from a regional health information exchange.

METHODS

The study included 328 patients enrolled in Prescription for Hope (RxH), an HVIP, between January 2009 and August 2016. We obtained RxH participants’ emergency department (ED) encounter data from a regional health information exchange database from the date of hospital discharge to February 2017. Our primary outcome was violent-injury recidivism rate of the RxH program. We also examined reasons for ED visits that were unrelated to violent injury.

RESULTS

We calculated a 4.4% recidivism rate based on 8 years of statewide data, containing 1,575 unique encounters. More than 96% of participants were matched in the state database. Of the 15 patients who recidivated, only five were admitted for their injury. More than half of new violence-related injuries were treated outside of the HVIP-affiliated trauma center. The most common reasons for ED visits were pain (718 encounters), followed by suspected complications or needing additional postoperative care (181 encounters). Substance abuse, unintentional injuries, and suicidal ideation were also frequent reasons for ED visits.

CONCLUSION

The low, long-term recidivism rate for RxH indicates that HVIPs have enduring positive effects on the majority of participants. Our results suggest that HVIP may further benefit patients by partnering with organizations that work to prevent suicide, substance use disorders, and other unintentional injuries.

LEVEL OF EVIDENCE

Therapeutic study, level III.
Catecholamines Alter the Intrinsic Variability of Cortical Population Activity and Perception
Authors: Pfeffer Thomas , Avramiea Arthur-Ervin , Nolte Guido , Engel Andreas K. , Linkenkaer-Hansen Klaus , Donner Tobias H.
Published: August 2017

The ascending modulatory systems of the brainstem are powerful regulators of global brain state. Disturbances of these systems are implicated in several major neuropsychiatric disorders. Yet, how these systems interact with specific neural computations in the cerebral cortex to shape perception, cognition, and behavior remains poorly understood. Here, we probed into the effect of two such systems, the catecholaminergic (dopaminergic and noradrenergic) and cholinergic systems, on an important aspect of cortical computation: its intrinsic variability. To this end, we combined placebo-controlled pharmacological intervention in humans, magnetoencephalographic (MEG) recordings of cortical population activity, and psychophysical measurements of the perception of ambiguous visual input. A low-dose catecholaminergic, but not cholinergic, manipulation altered the rate of spontaneous perceptual fluctuations as well as the temporal structure of “scale-free” population activity of large swaths of visual and parietal cortex. Computational analyses indicate that both effects were consistent with an increase in excitatory relative to inhibitory activity in the cortical areas underlying visual perceptual inference. We propose that catecholamines regulate the variability of perception and cognition through dynamically changing the cortical excitation-inhibition ratio. The combined read-out of fluctuations in perception and cortical activity we established here may prove useful as an efficient, and easily accessible marker of altered cortical computation in neuropsychiatric disorders.
From brain noise to syntactic structures: A formal proposal within the oscillatory rhythms perspective
Authors: Grimaldi Mirko
Published: August 2017

The neurobiology investigation of language seems limited by the impossibility to link directly linguistic computations with neural computations. To address this issue, we need to explore the hierarchical interconnections between the investigated fields trying to develop an inter-field theory. Considerable research has realized that event-related fluctuations in rhythmic, oscillatory EEG/MEG activity may provide a new window on the dynamics of functional neuronal networks involved in cognitive processing. Accordingly, this paper aims to outline a formal proposal on neuronal computation and representation of syntactic structures within the oscillatory neuronal dynamics. I briefly present the nature of event-related oscillations and how they work on the base of synchronization and de-synchronization processes. Then, I discuss some theoretical premises assuming that reentrant (hierarchical) properties of synchronized oscillatory rhythms constitute the biological endowment that allow the development of language in humans when exposed to appropriate inputs. The main rhythms involved in language and speech processing are examined: i.e. theta, alpha, beta, and gamma bands. A possible formal representation of the syntactic structures on the base of these oscillatory rhythms is discussed: in this model, the theta-gamma rhythms are cross-frequency coupled into the alpha-gamma-beta and into the gamma-beta-theta rhythms to generate the sentence along reentrant cortico-thalamic pathways through Merge, Label and Move operations. Finally, I present few conclusive remarks within an evolutionary perspective.

“…The whole burden of philosophy seems to consist in this, from the phenomena of motions to investigate the forces of nature, and from these forces to demonstrate the other phenomena.”(Newton, 1687/1726)
Task Demands Predict a Dynamic Switch in the Content of Awake Hippocampal Replay
Authors: Olafsdottir H. Freyja , Carpenter Francis , Barry Caswell
Published: August 2017

Reactivation of hippocampal place cell sequences during behavioural immobility and rest has been linked with both memory consolidation and navigational planning. Yet it remains to be investigated whether these functions are temporally segregated; occurring during different behavioural states. During a self-paced spatial task, awake hippocampal replay occurring immediately before movement towards a reward location, or just after arrival at a reward location, preferentially involved cells consistent with the current trajectory. In contrast, during periods of extended immobility, no such biases were evident. Notably, the occurrence of task-focused reactivations predicted the accuracy of subsequent spatial decisions. Additionally, during immobility but not periods preceding or succeeding movement, grid cells in deep layers of entorhinal cortex replayed coherently with the hippocampus. Thus, hippocampal reactivations dynamically and abruptly switch operational mode in response to task demands; plausibly moving from a state favouring navigational planning to one geared towards memory consolidation.
The Impact of Education on Myopia: A bidirectional Mendelian randomisation analysis in UK Biobank
Authors: Mountjoy Edward J. , Davies Neil M. , Plotnikov Denis , Davey Smith George , Rodriguez Santiago , Williams Cathy , Guggenheim Jeremy A. , Atan Denize
Published: August 2017

Myopia, or short-sightedness, is one of the leading causes of visual disability in the World. The prevalence of myopia has risen steadily over recent decades, reaching epidemic levels in Southeast Asia. Observational studies have reported associations between educational attainment and myopia. Whether education causes myopia, myopic children are more intelligent, or another factor, like higher socioeconomic status, causes both is unclear since observational studies are prone to confounding and randomised trials of education are unethical. Using bidirectional Mendelian Randomisation, a form of instrumental variable (IV) analysis free from confounding, we show that every additional year in education leads to an increase in myopic refractive error, but that myopia does not lead to higher educational attainment. Our results suggest that current educational methods contribute to the global burden of myopia, and argue that educational policies and practices should take account of this to reduce future visual disability in the population.
Protein phosphatase V ensures timely cell cycle remodeling during the mid-blastula transition in Drosophila
Authors: Liu Boyang , Sung Hung-wei , Gregor Ingo , Müller H.-Arno , Großhans Jörg
Published: August 2017

Cell cycle remodeling from fast nuclear cycles to a generic cell cycle mode is a major feature of the mid-blastula transition (MBT) inDrosophila.Remodeling occurs when Twine/Cdc25 falls below a critical threshold. Timing is based on Twine destabilization induced by zygotic transcription. It is conceivable that appropriate starting levels are also important for timely reaching the threshold. Mechanisms for controlling Twine levels at the onset of MBT are unknown. Here we identify a function of the protein phosphatase V in this mechanism. Twine was increased inPpVmutants, whereas the decay rate was comparable to wildtype.PpVmutants frequently underwent an extra nuclear division. We detected PpV-dependent phosphosites in Twine. Phosphosite mutants contain higher Twine levels and frequently underwent an extra nuclear division, comparable toPpVmutants. Our data support a model that the cell cycle remodeling is controlled by induced destabilization and PpV-d ependent control of Twine levels.
Uncovering Medical Insights from Vast Amounts of Biomedical Data in Clinical Case Reports
Authors: Zhou Yijiang , Liem David A. , Lee Jessica M. , Cao Quan , Bleakley Brian , Caufield J. Harry , Murali Sanjana , Wang Wei , Zhang Li , Bui Alex , Sun Yizhou , Watson Karol E. , Han Jiawei , Ping Peipei
Published: August 2017

Clinical case reports (CCRs) have a time-honored tradition in serving as an important means of sharing clinical experiences on patients presenting with atypical disease phenotypes or receiving new therapies. However, the huge amount of accumulated case reports are isolated, unstructured, and heterogeneous clinical data, posing a great challenge to clinicians and researchers in mining relevant information through existing indexing tools. In this investigation, in order to render CCRs more findable, accessible, interoperable, and reusable (FAIR) by the biomedical community, we created a resource platform, including the construction of a test dataset consisting of 1000 CCRs spanning 14 disease phenotypes, a standardized metadata template and metrics, and a set of computational tools to automatically retrieve relevant medical information and to analyze all published PubMed clinical case reports with respect to trends in publication journals, citations impact, MeSH Terms, drug use, distributions of patient demographics, and relationships with other case reports and databases. Our standardized metadata template and CCR test dataset may be valuable resources to advance medical science and improve patient care for researchers who are using machine learning approaches with a high-quality dataset to train and validate their algorithms. In the future, our analytical tools may be applied towards other large clinical data sources as well.