bluuebunny/crossref_metadata_2025 huggingface dataset:
Changes in Use of Postacute Care Associated With Accountable Care Organizations in Hip Fracture, Stroke, and Pneumonia Hospitalized Cohorts
Authors: Colla Carrie H. , Lewis Valerie A. , Stachowski Courtney , Usadi Benjamin , Gottlieb Daniel J. , Bynum Julie P.W.
Published: April 2019

Objective:

To examine changes in more and less discretionary condition-specific postacute care use (skilled nursing, inpatient rehabilitation, home health) associated with Medicare accountable care organization (ACO) implementation.

Data Sources:

2009–2014 Medicare fee-for-service claims.

Study Design:

Difference-in-difference methodology comparing postacute outcomes after hospitalization for hip fracture and stroke (where rehabilitation is fundamental to the episode of care) to pneumonia, (where it is more discretionary) for beneficiaries attributed to ACO and non-ACO providers.

Principal Findings:

Across all 3 cohorts, in the baseline period ACO patients were more likely to receive Medicare-paid postacute care and had higher episode spending. In hip fracture patients where rehabilitation is standard of care, ACO implementation was associated with 6%–8% increases in probability of admission to a skilled nursing facility or inpatient rehabilitation (compared with home without care), and a slight reduction in readmissions. In a clinical condition where rehabilitation is more discretionary, pneumonia, ACO implementation was not associated with changes in postacute location, but episodic spending decreased 2%–3%. Spending decreases were concentrated in the least complex patients. Across all cohorts, the length of stay in skilled nursing facilities decreased with ACO implementation.

Conclusions:

ACOs decreased spending on postacute care by decreasing use of discretionary services. ACO implementation was associated with reduced length of stay in skilled nursing facilities, while hip fracture patients used institutional postacute settings at higher rates. Among pneumonia patients, we observed decreases in spending, readmission days, and mortality associated with ACO implementation.
Association Between Degrees of Separation in Physician Networks and Surgeons’ Use of Perioperative Breast Magnetic Resonance Imaging
Authors: Shi Yongren , Pollack Craig E. , Soulos Pamela R. , Herrin Jeph , Christakis Nicholas A. , Xu Xiao , Gross Cary P.
Published: April 2019

Background:

Perioperative magnetic resonance imaging (MRI) is frequently used in breast cancer despite unproven benefits. It is unclear whether surgeons’ use of breast MRI is associated with the practices of other surgeons to whom they are connected through shared patients.

Methods:

We conducted a retrospective study using Medicare data to identify physicians providing breast cancer care during 2007–2009 and grouped them into patient-sharing networks. Physician pairs were classified according to their “degree of separation” based on patient-sharing (eg, physician pairs that care for the same patients were separated by 1 degree; pairs that both share patients with another physician but not with each other were separated by 2 degrees). We assessed the association between the MRI use of a surgeon and the practice patterns of surgical colleagues by comparing MRI use in the observed networks with networks with randomly shuffled rates of MRI utilization.

Results:

Of the 15,273 patients who underwent surgery during the study period, 28.8% received perioperative MRI. These patients received care from 1806 surgeons in 60 patient-sharing networks; 55.1% of surgeons used MRI. A surgeon was 24.5% more likely to use MRI if they were directly connected to a surgeon who used MRI. This effect decreased to 16.3% for pairs of surgeons separated by 2 degrees, and 0.8% at the third degree of separation.

Conclusions:

Surgeons’ use of perioperative breast MRI is associated with the practice of surgeons connected to them through patient-sharing; the strength of this association attenuates as the degree of separation increases.
Opioid-prescribing Outcomes of Medicare Beneficiaries Managed by Nurse Practitioners and Physicians
Authors: Muench Ulrike , Spetz Joanne , Jura Matthew , Guo Chaoran , Thomas Cindy , Perloff Jennifer
Published: April 2019

Background:

Primary care providers are at the center of the opioid epidemic. Whether nurse practitioners (NPs) have different opioid-prescribing outcomes from physicians is not known.

Objective:

To examine opioid-prescribing outcomes of Medicare beneficiaries receiving care from NPs and physicians in primary care.

Research Design:

We used Medicare data from 2009 to 2013 and a propensity score–weighted analysis.

Subjects:

Beneficiaries residing in states in which NPs are able to prescribe controlled substances without physician oversight and who did not have a cancer diagnosis, hospice care, or end-stage renal disease.

Measures:

First, we measured whether beneficiaries received any opioid prescription. Second, for beneficiaries who received opioids, we measured acute (<90 d supply) and chronic (≥90 d supply) use at baseline (2009–2010) and follow-up (2012–2013). Third, we measured potential misuse of opioid prescribing using a daily morphine milligram equivalent dose of >100 mg, overlapping prescriptions of opioids >7 days, and overlapping prescriptions of opioids with benzodiazepines >7 days.

Results:

Beneficiaries managed by NPs were less likely to receive an opioid [odds ratio (OR), 0.87; P<0.001], were less likely to be acute users at baseline (OR, 0.84; P<0.001), and were more likely to receive a high daily opioid dose of morphine milligram equivalent >100 mg compared with physician-managed beneficiaries (OR, 1.11; P=0.048).

Conclusions:

Findings suggest educational programs and clinical guidelines may require approaches tailored to different providers. Future research should examine the contributing factors of these patterns to ensure high-quality pain management and guide policy makers on NP-controlled substance-prescribing regulations.
Apolipoprotein M/sphingosine-1-phosphate: novel effects on lipids, inflammation and kidney biology
Authors: Bisgaard Line S. , Christoffersen Christina
Published: April 2019

Purpose of review

In 2011, the crystal structure of apolipoprotein M (apoM) and its capacity to bind sphingosine-1-phosphate (S1P) was characterized. Since then, a variety of studies has increased our knowledge on apoM biology and functionality. From being an unknown and hardly significant player in overall metabolism, apoM has gained significant interest.

Recent findings

Key discoveries in the last 2 years have indicated that the apoM/S1P complex has important roles in lipid metabolism (affecting triglyceride turnover), inflammation (a marker of severe sepsis and potentially providing anti-inflammatory signaling) and kidney biology (potential to protect against immunoglobulin A nephropathy).

Several studies suggest a potential for apoM/S1P as biomarkers for inflammation, sepsis and nephropathy. Also, a novel chaperone is characterized and could have potential as a drug for treatment in inflammation and nephropathy.
Balancing the risk and rewards of utilizing organs from hepatitis C viremic donors
Authors: Sise Meghan E. , Strohbehn Ian A. , Bethea Emily , Gustafson Jenna L. , Chung Raymond T.
Published: April 2019

Purpose of review

Owing to long waitlist times and high waitlist morbidity and mortality, strategies to increase utilization of hepatitis C viremic-deceased donor organs are under investigation in kidney, liver, heart, and lung transplantation.

Recent findings

Direct-acting antiviral medications for hepatitis C virus infection have high cure rates and are well tolerated. Small, single-center trials in kidney and heart transplant recipients have demonstrated that with early posttransplant direct-acting antiviral therapy, 100% of uninfected recipients of hepatitis C viremic organs have been cured of infection after transplantation.

In this manuscript, we review the risks and rewards of utilizing hepatitis C viremic organs for transplantation.
Does the antibody mediated rejection grading scale have prognostic prediction? Yes, but the picture is still blurry
Authors: Potena Luciano , Moriconi Veronica , Sabatino Mario , Agostini Valentina , Leone Ornella
Published: April 2019

Purpose of review

Antibody-mediated rejection (ABMR) is a condition difficult to diagnose and treat, which may significantly impair the outcome of heart transplant recipients. In clinical practice, diagnosis is based on immunopathology grading of endomyocardial biopsies (EMB). Despite its value, the current diagnostic system has several pitfalls that have been addressed in recent literature.

Recent findings

Pathology grading of ABMR (pAMR) has a relevant prognostic factor. However, it does not capture several nuances, such as chronic vs. acute ABMR, mixed rejection or microvascular inflammation. Molecular biology-based assays are shedding new light on the mechanisms of ABMR, which could improve the precision of ABMR diagnosis.

These new findings have the potential to rearrange EMB grading system and to guide more precisely decision-making, but studies validating the therapeutic management based on molecular-pathology coupling are still missing.
Presacral Medulloepithelioma: Case Report and Literature Review
Authors: Honnorat Marion , Al-Karmi Salma , Hawkins Cynthia , Johnston Donna , Gerstle Ted , Schechter Tal , Huang Annie , Bouffet Eric
Published: April 2019

Medulloepithelioma is a rare early childhood tumor typically presenting in the intraocular region and neuroaxis. We report a rare case of a 2-year-old girl that presented with a peripheral medulloepithelioma in the presacral region. Examination of the tumor revealed that it lacked amplification of the 19q13.42 locus yet was positive for LIN28A. The patient was treated with intensive and high-dose chemotherapy as per 99703 protocol followed by complete surgical resection of the tumor and rapamycin maintenance and remains disease-free 5 years postinitial diagnosis. Ten previous cases were reported, including 5 patients who were alive disease free at the time of the publication. Optimal management of this rare condition is still controversial, particularly with regard to the respective role of chemotherapy and radiation.
Steroid-induced Bradycardia During Induction Chemotherapy in Children and Young Adults Diagnosed With Acute Lymphoblastic Leukemia and Lymphoblastic Lymphoma
Authors: Duffy Caitlyn , Hall Laura , Godown Justin , Koyama Tatsuki , Borinstein Scott C.
Published: April 2019

Systemic corticosteroids are widely used for the treatment of acute lymphoblastic leukemia (ALL) and lymphoblastic lymphoma. Anecdotal case reports demonstrate bradycardia in patients receiving corticosteroids; however, a more in-depth analysis is lacking. This study aimed to describe the incidence, timing, and outcomes of bradycardia in children with ALL receiving corticosteroids during induction chemotherapy at our center from 2010 to 2016. A total of 153 children were included, with 150 (98%) demonstrating decreased heart rate following steroid administration with a median HR decrease of 23 beats per minute. Bradycardia ≤first percentile for age developed in 90 (59%) patients, with nadir occurring, on average, 7 doses into treatment, corresponding to 79 hours after initiation of therapy. No patient experienced adverse events related to bradycardia. Resolution of bradycardia at outpatient follow-up occurred in 62 of 71 (87%). Examination of nadir heart rate during subsequent hospitalizations in which steroids were not being administered did not demonstrate a significant incidence of bradycardia. Corticosteroid-induced bradycardia is common in children with ALL receiving induction chemotherapy. It was not associated with clinical adverse events and self-resolved without intervention. Therefore, further cardiac assessment may not be warranted in the presence of asymptomatic bradycardia suspected to be secondary to steroid administration.
Angiopoietin-2 as a Marker of Retinopathy in Children and Adolescents With Sickle Cell Disease: Relation to Subclinical Atherosclerosis
Authors: Andrawes Nevine G. , Ismail Eman A. , Roshdy Maged M. , Ebeid Fatma S.E. , Eissa Deena S. , Ibrahim Amna M.
Published: April 2019

Objectives:

Angiopoietin-2 (Ang-2) is a multifaceted cytokine that functions in both angiogenesis and inflammation. A proangiogenic state has been found in adults with sickle cell disease (SCD), mainly because of elevated Ang-2 levels. We determined Ang-2 level in 40 children and adolescents with SCD compared with 40 healthy controls and assessed its relation to retinopathy as well as carotid intimamedia thickness (CIMT).

Methods:

Hematologic profile, serum ferritin, and serum Ang-2 were measured. CIMT was assessed using high-resolution ultrasound. Fundus examination was performed followed by fundus fluorescein angiography. Optical coherence tomography angiography (OCTA) was used to find small vascular changes not clinically manifested.

Results:

Ang-2 levels and CIMT were significantly higher in SCD patients compared with controls. The incidence of nonproliferative retinopathy was 45%. SCD patients with retinopathy were older in age with a history of sickling crisis of >3 attacks per year and had a higher incidence of sickle cell anemia than sickle β-thalassemia. Ang-2 cutoff value 9000 pg/mL could significantly detect the presence of retinopathy among SCD patients with 100% sensitivity and specificity. Serum Ang-2 levels were positively correlated with HbS and CIMT. Logistic regression analysis revealed that Ang-2 and HbS significantly contribute to retinopathy among patients with SCD.

Conclusions:

Elevated Ang-2 highlights the role of angiogenesis in the pathophysiology of SCD and may be considered a promising marker for screening of patients at risk of sickle retinopathy and vascular dysfunction.
A Case of Childhood Blastic Phase Chronic Myeloid Leukemia With Minor BCR-ABL
Authors: Yamanaka Junko , Shimizu Mariko , Sato Maho , Inoue Masami , Matsui Motohiro , Shimada Hiroyuki , Shichino Hiroyuki
Published: April 2019

Chronic myeloid leukemia (CML) is commonly associated with major BCR-ABL transcript. We present a child with blastic phase CML associated with minor BCR-ABL transcript without prior CML diagnosis. Diagnosis was achieved by fluorescence in situ hybridization of peripheral blood neutrophils, which identified 90% as BCR-ABL positive. The patient received chemotherapy with imatinib followed by dasatinib and underwent reduced-intensity hematopoietic allogeneic stem cell transplantation with prophylactic posttransplant dasatinib for 2 years and has remained in complete molecular remission. Our intensified treatment regimen was effective compared with previous studies on minor BCR-ABL CML describing inferior outcomes with tyrosine kinase inhibitor therapy.
The Cutoff of Ferritin for Evaluation of Hypothyroidism in Patients With Thalassemia
Authors: Baghersalimi Adel , Rad Afagh H. , Koohmanaee Shahin , Darbandi Bahram , Mirzaee Morteza M. , Aminzadeh Vahid , Medghalchi Abdolreza , Dalili Setila
Published: April 2019

Background:

Thalassemia major is a genetic disease with a recessive autosomal pattern of inheritance that occurs as a result of disorder in hemoglobin synthesis. Researchers aimed to investigate the cutoff of ferritin for the development of hypothyroidism in patients with thalassemia major.

Materials and Methods:

This was a retrospective analytic cross-sectional study that was conducted on the medical records of patients with thalassemia major. Overt hypothyroidism was defined as thyroid stimulating hormone (TSH) level of >6.5 mIU/L and T4 level of < 4.2 ng/dL and subclinical hypothyroidism was defined as TSH level of >6.5 mIU/L and T4 level of >4.2 ng/dL. Data were gathered by a form including age, sex, weight, height, body mass index, thyroid test results, and the mean of last 3 consecutive hemoglobin and ferritin levels.

Results:

In this study, 67 patients were evaluated. The mean age of the participants was 15.37±3.73 years. The frequency of subclinical hypothyroidism was 10.4%, and no cases of clinical hypothyroidism were noted as well as secondary hypothyroidism. Although there was a significant linear correlation between mean ferritin level and TSH (P=0.008), no significant correlation was noted between levels of ferritin and T4 levels. As ferritin was significantly correlated with TSH, the results showed that the mean serum level of ferritin in β-thalassemia major patients with hypothyroidism was higher than that in β-thalassemia major patients with normal thyroid status (P=0.013). The cutoff point for ferritin was 1953 ng/mL (sensitivity=85.7%, specificity=60%).

Conclusion:

It seems that considering the development of hypothyroidism by reaching the ferritin cutoff point, intensification of the iron chelation regimen along with a shorter interval for laboratory endocrine examinations can be recommended.
Prevent Compassion Fatigue and Burnout With a Magnet Culture
Authors: Graystone Rebecca
Published: April 2019

Compassion fatigue and burnout are 2 of the most serious issues facing the nursing profession today. Both can lead to emotional exhaustion and job disillusionment. Both contribute to lowered productivity and quality of care. Healthcare providers around the world are on the lookout for ways to prevent and mitigate these critical issues. In this month's Magnet Perspectives column, we take a deep dive into the latest research on nurse burnout and compassion fatigue, examine contributing factors, and consider steps organizations can take to make sure their nurses are not running on empty. We also explore how the fundamentals of a Magnet® culture, especially an autonomous practice environment, strong nursing leadership, and meaningful recognition, can keep nurses engaged and build a resilient workforce.
North Carolina Nurse Leader Project
Authors: Williams Megan P. , Li Yin
Published: April 2019

OBJECTIVES

The study examined nurse leader roles, barriers, and the need for nurse leader succession planning in North Carolina (NC).

BACKGROUND

This study was conducted to assess leadership capacity in NC and further the efforts of the Future of Nursing report, which calls for nurses to lead change and advance health.

METHODS

This study employed an exploratory research design using the Florida Action Coalition 56-item survey of active RNs and advanced practice RNs in NC.

RESULTS

Key findings include nurse leader demographics, roles, barriers, retirement and succession plans, and development needs of current leaders in NC. NC nurse leaders are predominately female, white, non-Hispanic, and older than 50 years; plan to retire within the next 10 years; and report that their organizations do not have succession plans for nursing leadership.

CONCLUSIONS

Attention toward assessing nurse leadership capacity should be a priority to meet workforce needs.
Nurse Staffing and Healthcare-Associated Infection, Unit-Level Analysis
Authors: Shang Jingjing , Needleman Jack , Liu Jianfang , Larson Elaine , Stone Patricia W.
Published: April 2019

OBJECTIVE

To examine whether healthcare-associated infections (HAIs) and nurse staffing are associated using unit-level staffing data.

BACKGROUND

Previous studies of the association between HAIs and nurse staffing are inconsistent and limited by methodological weaknesses.

METHODS

Cross-sectional data between 2007 and 2012 from a large urban hospital system were analyzed. HAIs were diagnosed using the Centers for Disease Control and Prevention's National Healthcare Safety Network definitions. We used Cox proportional-hazards regression model to examine the association of nurse staffing (2 days before HAI onset) with HAIs after adjusting for individual risks.

RESULTS

Fifteen percent of patient-days had 1 shift understaffed, defined as staffing below 80% of the unit median for a shift, and 6.2% had both day and night shifts understaffed. Patients on units with both shifts understaffed were significantly more likely to develop HAIs 2 days later.

CONCLUSIONS

Understaffing is associated with increased risk of HAIs.
C-Suite Strategies for Nurse Empowerment and Executive Accountability
Authors: Bogue Richard J. , Joseph M. Lindell
Published: April 2019

OBJECTIVE

We examined C-suite executives' strategies to empower the nursing workforce and to ensure their own accountability for nursing empowerment.

BACKGROUND

Leadership affects workforce empowerment. The literature provides little formal guidance on optimal strategies C-suite executives can adopt for improving nurse empowerment or ensuring leadership accountability for empowering the workforce.

METHODS

A system's top 47 executives were invited to be panelists in a Delphi study. Two Delphi rounds revealed leadership strategies for embedding empowerment and strategies for assessing leadership performance in workforce empowerment.

RESULTS

C-suite executives rated specific strategies higher for nursing workforce empowerment and for holding themselves accountable. Specific strategies were rated high as easier to implement and more likely to have a major impact.

CONCLUSIONS

C-suite executives implementing strategies with greater impact may accelerate nursing empowerment, especially when executives also adopt their own strategies for holding themselves accountable.
The DNP Degree
Authors: Bowie Bonnie H. , DeSocio Janiece , Swanson Kristen M.
Published: April 2019

OBJECTIVE

This study addressed how recently graduated doctor of nursing practice (DNP) nurses describe their current practice, how their supervisors describe the DNP's current practice, and whether nurse and supervisor descriptions of the practices reflect the American Association of Colleges of Nursing (AACN) DNP Essentials and, if so, how?

BACKGROUND

Introduced in 2004, the goal of DNP programs was to educate advanced practice RNs for effective leadership in complex healthcare environments. The value of the DNP degree for nurses in healthcare systems is evolving.

METHODS

We used conventional content analysis to inductively describe how DNP graduates from 7 different schools and their supervisors described the practice of the recently graduated DNPs. Interviews were reviewed to assess whether the AACN DNP Essentials were enacted in practice.

RESULTS

The overarching theme was “becoming more: re-envisioning self as an agent of change.”

CONCLUSIONS

Results support the claim that DNP education prepares advanced practice nurses for leadership across complex healthcare systems. Evidence of the DNP Essentials is realized when graduates perceive themselves as equal to other leaders and capable of driving change using evidence and effective collaboration.
Mycoplasma genitalium, Chlamydia trachomatis, and Neisseria gonorrhoeae Detected With Aptima Assays Performed on Self-Obtained Vaginal Swabs and Urine Collected at Home and in a Clinic
Authors: Chernesky Max , Jang Dan , Martin Irene , Arias Manuel , Shah Anika , Smieja Marek , Ratnam Sam , Getman Damon , Schachter Julius
Published: April 2019

Self-obtained vaginal swabs, first-void urine and pooled specimens were collected at home and in a clinic. Percent prevalence and collection site concordance was 30.3 and 100 for Mycoplasma genitalium (74.4% azithromycin resistant) 15.1 and 96.7 for Chlamydia trachomatis and 6.6 and 100 for Neisseria gonorrhoeae (27% ciprofloxacin-resistant).
Addressing Gaps in the Management of Chlamydia trachomatis and Neisseria gonorrhoeae in Primary Care: Lessons Learned in a Pilot Intervention Study
Authors: Rose Sally B. , Garrett Susan M. , Hutchings Deborah , Lund Kim , Kennedy Jane , Pullon Susan R.H.
Published: April 2019

Background

We aimed to test the acceptability and utility of strategies designed to facilitate the delivery of clinical best practice for patients diagnosed with chlamydia or gonorrhea in primary care.

Methods

A nonrandomized pilot intervention study with a historic control period was run over 9 months in six primary health care clinics (2 youth services, 3 low-fee clinics, and 1 student health service) in Wellington, New Zealand. “Study nurses” in participating clinics oversaw the implementation of strategies designed to facilitate partner notification and follow-up for patients diagnosed with chlamydia or gonorrhea. Clinics chose which of 2 approaches they wished to trial—either managing all study processes themselves or drawing on the assistance of an external specialist sexual health advisor. Outcome measures included acceptability and utility of study processes ascertained via structured interviews with study nurses and collection of clinical data.

Results

Outcomes for 287 patients seen during the intervention were compared with 240 historic controls. Participant views on study processes were positive overall, and all clinics intended to continue all or most of the study processes implemented. During the intervention, substantial improvements were observed in documented patient management (sexual history, partner notification, and outcomes, P < 0.05). Increases were observed in percentages of patients reached for follow-up (74% vs. 26% at baseline, P < 0.05) and partners reported to have been notified (79% vs. 23%, P < 0.05).

Conclusions

Nurse-led strategies implemented were deemed acceptable and appeared to facilitate delivery of best practice care for patients diagnosed with bacterial sexually transmitted infections in participating primary care practices.
Serological Markers for Syphilis Among Persons Presenting With Syndromes Associated With Sexually Transmitted Infections: Results From the Zimbabwe STI Etiology Study
Authors: Rietmeijer Cornelis A. , Mungati More , Kilmarx Peter H. , Barr Beth Tippett , Gonese Elizabeth , Kularatne Ranmini S. , Lewis David A. , Klausner Jeffrey D. , Rodgers Luanne , Handsfield H. Hunter
Published: April 2019

Background

Syphilis prevalence in sub-Saharan Africa appears to be stable or declining but is still the highest globally. Ongoing sentinel surveillance in high-risk populations is necessary to inform management and detect changes in syphilis trends. We assessed serological syphilis markers among persons with sexually transmitted infections in Zimbabwe.

Methods

We studied a predominantly urban, regionally diverse group of women and men presenting with genital ulcer disease (GUD), women with vaginal discharge and men with urethral discharge at clinics in Zimbabwe. Syphilis tests included rapid plasma reagin and the Treponema pallidum hemagglutination assay.

Results

Among 436 evaluable study participants, 36 (8.3%) tested positive for both rapid plasma reagin and Treponema pallidum hemagglutination assay: women with GUD: 19.2%, men with GUD: 12.6%, women with vaginal discharge: 5.7% and men with urethral discharge: 1.5% (P < 0.0001).

Conclusions

Syphilis rates in Zimbabwe are high in sentinel populations, especially men and women with GUD.
Trends and Characteristics Associated With Human Papillomavirus Vaccination Uptake Among Men Who Have Sex With Men in the United States, 2014–2017
Authors: Loretan Caitlin , Chamberlain Allison T. , Sanchez Travis , Zlotorzynska Maria , Jones Jeb
Published: April 2019

Background

Human papillomavirus (HPV) and HPV-associated cancer rates are high among men who have sex with men (MSM). The US Advisory Committee on Immunization Practices recommends HPV vaccination for all MSM through age 26 years. We examined trends in HPV vaccine uptake among young US MSM between 2014 and 2017.

Methods

Cochran-Armitage tests and estimated annual percentage changes were used to examine annual trends (2014–2017) in HPV vaccination initiation among US MSM ≤26 years as of 2011 who participated in a nationwide annual cross-sectional online survey. We identified independent correlates of HPV vaccination in 2017 using Poisson regression modeling.

Results

There were 2,381 participants in 2014; 4,143 in 2015; 3,926 in 2016; and 3,407 in 2017. Mean age was 23.5 years, 39% lived in metropolitan areas, and 37% lived in the South. HPV vaccination significantly increased (P < 0.0001) from 22.5% in 2014 to 37.6% in 2017 (estimated annual percentage change = 17.4%). HPV vaccination was significantly greater for MSM who were younger, had health insurance, saw a healthcare provider in the past 12-months, resided in the Northeast, resided in metropolitan areas, had higher household income, disclosed their sexual identity to health care provider, and had gonorrhea/chlamydia diagnosis in the past 12-months.

Conclusions

Human papillomavirus vaccination among MSM increased from 2014 to 2017, but vaccine uptake varied significantly by MSM subgroup. Despite favorable trends, the HPV vaccination coverage for this population (37.6%) is less than half of the Healthy People 2020 target (80%). Additional efforts are needed to increase coverage.
The Consequences of Foster Care Versus Institutional Care in Early Childhood on Adolescent Cardiometabolic and Immune Markers: Results From a Randomized Controlled Trial
Authors: Slopen Natalie , Tang Alva , Nelson Charles A. , Zeanah Charles H. , McDade Thomas W. , McLaughlin Katie A. , Fox Nathan A.
Published: April 2019

Objective

Children exposed to institutional rearing often exhibit problems across a broad array of developmental domains. We compared the consequences of long-term, high-quality foster care versus standard institution-based care, which began in early childhood on cardiometabolic and immune markers assessed at the time of adolescence.

Methods

The Bucharest Early Intervention Project is a longitudinal investigation of children institutionalized during early childhood (ages 6 to 30 months at baseline) who were subsequently randomized to either high-quality foster care or continued institutional care. At the age of 16 years, 127 respondents participated in a biomarker collection protocol, including 44 institutionalized children randomly assigned to receive care as usual, 41 institutionalized children randomized to be removed from institutional care and placed in high-quality foster care in infancy, and a control group of 42 demographically matched children raised in biological families. Outcomes included body mass index (BMI), systolic and diastolic blood pressure, C-reactive protein, interleukin (IL)-6, IL-8, IL-10, tumor necrosis factor α, glycosylated hemoglobin A1c, and Epstein-Barr virus antibody titers.

Results

Early institutional rearing was not associated with differences in cardiometabolic or immune markers. Randomization to foster care and age of placement into foster care were also unrelated to these markers, with the exception of BMI z-score, where children assigned to care as usual had lower BMI z-scores relative to children assigned to foster care (−0.23 versus 0.08, p = .06), and older age at placement was associated with lower BMI (β = −0.07, p = .03).

Conclusions

The impact of institutional rearing on measures of cardiometabolic health and immune system functioning is either absent or not evident until later in development. These findings provide new insights into the biological embedding of adversity and how it varies developmentally and across regulatory systems and adversity type.

Clinical Trial Registration

NCT00747396
Resting-State Functional Connectivity Between Centromedial Amygdala and Insula as Related to Somatic Symptoms in Depressed Patients: A Preliminary Study
Authors: Zu Meidan , Wang Anzhen , Bai Tongjian , Xie Wen , Guan Jianjun , Tian Yanghua , Wang Kai
Published: April 2019

Objective

Somatic symptoms are prevalent in patients with depression. The centromedial amygdala (CMA) is a key brain region that mediates autonomic and somatic responses. Abnormal function in the CMA may contribute to the development of somatic symptoms in depressed patients.

Methods

We compared the resting-state functional connectivity (RSFC) based on the seed of the left and right CMA between 37 patients with depression and 30 healthy controls. The severity of depressive and somatic symptoms was assessed using the Hamilton Depression Rating Scale (HDRS) and the 15-item somatic symptom severity scale of the Patient Health Questionnaire (PHQ-15). Correlation analysis was performed to investigate the relationship between the RSFC and clinical variables (HDRS and PHQ-15) in depressed patients.

Results

Compared with healthy controls, patients with depression exhibited decreased RSFC between the CMA and insula, and superior temporal gyrus. In addition, functional connectivity between the left CMA and left insula was negatively correlated with PHQ-15 (r = −0.348, p = .037) in depressed patients. No significant relation was found between the RSFC and HDRS in depressed patients.

Conclusions

Functional connectivity between the CMA and insula is reduced in depressive patients, which is associated with the severity of somatic symptoms. Our findings may provide a potential neural substrate to interpret the co-occurrence of depression with somatic symptoms.
Ambulatory Blood Pressure Trajectory and Perceived Stress in Relation to Birth Outcomes in Healthy Pregnant Adolescents
Authors: Spicer Julie , Giesbrecht Gerald F. , Aboelela Sally , Lee Seonjoo , Liu Grace , Monk Catherine
Published: April 2019

Objective

An early decline in resting blood pressure (BP), followed by an upward climb, is well documented and indicative of a healthy pregnancy course. Although BP is considered both an effector of stress and a clinically meaningful measurement in pregnancy, little is known about its trajectory in association with birth outcomes compared with other stress effectors. The current prospective longitudinal study examined BP trajectory and perceived stress in association with birth outcomes (gestational age (GA) at birth and birth weight (BW) percentile corrected for GA) in pregnant adolescents, a group at risk for stress-associated poor birth outcomes.

Methods

Healthy pregnant nulliparous adolescents (n = 139) were followed from early pregnancy through birth. At three time points (13–16, 24–27, and 34–37 gestational weeks ±1 week), the Perceived Stress Scale was collected along with 24-hour ambulatory BP (systolic and diastolic) and electronic diary reporting of posture. GA at birth and BW were abstracted from medical records.

Results

After adjustment for posture and pre-pregnancy body mass index, hierarchical mixed-model linear regression showed the expected early decline (B = −0.18, p = .023) and then increase (B = 0.01, p < .001) of diastolic BP approximating a U-shape; however, systolic BP displayed only an increase (B = 0.01, p = .010). In addition, the models indicated a stronger systolic and diastolic BP U-shape for early GA at birth and lower BW percentile and an inverted U-shape for late GA at birth and higher BW percentile. No effects of perceived stress were observed.

Conclusions

These results replicate the pregnancy BP trajectory from previous studies of adults and indicate that the degree to which the trajectory emerges in adolescence may be associated with variation in birth outcomes, with a moderate U-shape indicating the healthiest outcomes.
Between the Error Bars: How Modern Theory, Design, and Methodology Enrich the Personality-Health Tradition
Authors: Segerstrom Suzanne C.
Published: April 2019

The study of relationships between personality traits and health has a long history in psychosomatic research. However, personality science has evolved from an understanding of personality as fixed traits to one that acknowledges that personality is dynamic. Dynamic approaches to conceptualizing and measuring personality and individual differences can enrich personality-health research. In this Presidential Address (American Psychosomatic Society, 2018), I consider how different formulations of personality—stable traits, stable signals in a noisy or variable measure, within-person changes, and intraindividual variability—can be implemented to better understand how personality is related to health and particularly to immune function. These approaches recognize and, in some cases, capitalize on the fact that personality factors can display variability as well as stability over time. They also require repeated measurement and therefore greater methodological sophistication that considers reliability and generalizability, Simpson's paradox, and the difference between variability and flexibility. Dynamic qualities of personality and individual differences potentially influence health, and designs and methodology that incorporate them can illuminate the important processes that occur inside the error bars.
Human prion diseases
Authors: Wang Han , Rhoads Daniel D. , Appleby Brian S.
Published: April 2019

Purpose of review

Prion diseases are rapidly progressive neurodegenerative conditions that can be difficult to diagnose and are transmissible under specific circumstances. The authors will provide background regarding prion disease and focus on diagnostic tools.

Recent findings

Prion disease is caused by misfolded prion protein. The three possible causes of prion disease include sporadic (85%), genetic (10–15%), and acquired (<1%). Acquired prion diseases include kuru, iatrogenic, and variant Creutzfeldt–Jakob disease. Prion diseases differ in their clinical manifestation, neuropathology, and diagnostic test results. A variety of recent diagnostic tools have evolved that allow more reliable antemortem diagnosis of prion disease such as brain MRI and cerebrospinal fluid real-time quaking-induced conversion. Special infectivity guidelines must be followed when dealing with central nervous system tissue, but only standard precautions are needed for routine clinical care of patients with prion disease.

The only way to definitely diagnose prion disease and determine its type is via neuropathologic examination. However, brain MRI and cerebrospinal fluid real-time quaking-induced conversion have drastically increased diagnostic accuracy and are important tests to use when evaluating patients with suspected prion disease.
The Sonographic Spectrum of Pelvic Endometriosis
Authors: Jones Lisa P. , Morgan Matthew A. , Chauhan Anil
Published: April 2019

Endometriosis is a common disease of reproductive-age women that is often first encountered with ultrasound. Therefore, familiarity with the variety of manifestations of endometriosis is important for appropriate diagnosis and management. The aim of this article is to review the spectrum of appearance of pelvic endometriosis and to discuss potential mimics on ultrasound. Given that magnetic resonance imaging is an important problem-solving tool in female pelvic imaging, magnetic resonance imaging correlation is also provided.
Spectral Doppler Ultrasound Can Help Diagnose Children With Hepatic Sinusoidal Obstructive Syndrome After Hematopoietic Stem Cell Transplantation
Authors: Thumar Vishal D. , Vallurupalli Vivek M. , Robinson Amie L. , Staggs Vincent S. , Shah Vidhi , Dalal Jignesh , Chan Sherwin S.
Published: April 2019

Background

Hepatic sinusoidal obstruction syndrome (SOS) is a potentially fatal complication after hematopoietic stem cell transplantation (HSCT). Current clinical guidelines state that spectral Doppler changes occur late in the disease, and imaging is only useful for confirming SOS diagnosis.

Objective

Our primary objective was to examine abdominal ultrasound variables as predictors of development of SOS in pediatric HSCT patients.

Materials and Methods

A single-center cohort retrospective study was conducted on patients aged 0 to 21 years who underwent HSCT between September 2001 and May 2017 at our institution. Patients were excluded if they did not have abdominal ultrasounds after HSCT. Clinical, demographic, grayscale, and spectral Doppler liver ultrasound findings were evaluated. We modeled the odds of SOS diagnosis within 100 days after HSCT as a function of each of the 15 ultrasound variables.

Results

A total of 333 patients received an HSCT. One hundred forty subjects had ultrasound data available. Thirty-two patients developed SOS, and 9 of these patients died. Sinusoidal obstruction syndrome odds more than double per 1-SD increase in peak systolic velocity in common hepatic artery or left hepatic artery and more than triple per 1-SD decrease in main portal vein velocity or change in ascites severity. Several ultrasound variables were statistically significant predictors in the Cox models for time to SOS diagnosis.

Conclusion

Several ultrasound variables can be used as predictors for a patient's risk of developing SOS. The strongest predictors are ascites severity, main portal vein velocity, common hepatic artery peak systolic velocity, and left hepatic artery peak systolic velocity.
Diaphragmatic Ultrasonography, a Novel Approach in Critical Care
Authors: Garrido-Aguirre Eduardo , Ñamendys-Silva Silvio A. , del Moral Oscar Rojo , Cortés-Soto Carlos A. , Romero-González Juan P.
Published: April 2019

The evaluation of the diaphragm in critically ill patients is simple and noninvasive and has shown good repeatability. The aim of the study was to generate a predictive index for successful weaning (ULDIMex) from invasive mechanical ventilation (IMV) based on an ultrasonographic diaphragmatic assessment before performing a spontaneous breathing test. We recruited patients who required IMV and who were candidates for weaning from ventilation. The measurement of diaphragmatic excursion and time during inspiration and expiration was obtained with a 3- to 5-MHz probe in the M mode. Using the formula (a + b)c/2, the value for the ULDIMex was obtained to evaluate its impact on predicting the successful weaning of IMV, where a is the time during the inspiratory phase, b is the time during expiration, and c is the diaphragmatic excursion during the inspiratory phase, which corresponds to the highest point of the curve from the baseline. We recruited 114 patients, of whom 86 (76%) were successfully weaned from IMV. The patients who were successfully weaned from the IMV had a cutoff value greater than 4.06 cm/s for the ULDIMex index, with a sensitivity of 92.8% (95% confidence interval, 76.5–99.1), specificity of 63.9% (95% confidence interval, 52.9–74.0), positive predictive value of 45.6%, and negative predictive value of 96.5%. The ULDIMex index demonstrated a good level of discrimination for successful weaning prediction. Considering the excellent negative likelihood ratio of the ULDIMex index of greater than 4.06, this index may be considered before performing an spontaneous breathing test to identify critically ill adult patients who will extubate successfully.
The Normal Fetal Cephalic Index in the Second and Third Trimesters of Pregnancy
Authors: Constantine Sarah , Kiermeier Andreas , Anderson Peter
Published: April 2019

The cephalic index (CI) is used in the evaluation of individuals with craniosynostosis. There is little agreement as to the normal range and stability of the CI during the fetal period, partly due to limited literature. We sought to determine the range, distribution and stability of the fetal CI in the second half of pregnancy. We also aimed to identify any relationship to delivery complications such as obstructed labor and malpresentation.

The fetal head circumference, biparietal diameter (BPD) and occipitofrontal diameter (OFD) measurements were obtained from standard ultrasound images. Each of 4304 fetuses had measurements taken at morphology scan performed between 17 and 22 weeks' gestation, and at growth scanning at 28 to 33 weeks' gestation. The cephalic index was calculated using the formula: CI = BPD/OFD × 100. The distribution of the CI at both scans is very close to a normal distribution. The mean CI at 17 to 22 weeks was 75.9 (SD, 3.7); the mean CI at 28 to 33 weeks was 77.8 (SD, 3.5). The mean change in CI was 1.9 (SD, 4.28), which is not statistically significantly different from zero (t = 0.656, P = 0.512, 95% confidence interval). No relationship was found between the CI in normal fetuses and delivery complications. There is a wide variation in the change in CI in the third trimester. A value below the normal range in the third trimester or a progressive reduction in CI during the latter half of pregnancy should provoke detailed scanning of the fetal cranial sutures to check for craniosynostosis.
Deceased Donor–initiated Chains: First Report of a Successful Deliberate Case and Its Ethical Implications
Authors: Furian Lucrezia , Cornelio Cristina , Silvestre Cristina , Neri Flavia , Rossi Francesca , Rigotti Paolo , Cozzi Emanuele , Nicolò Antonio
Published: April 2019

Background.

It has been suggested that deceased donor kidneys could be used to initiate chains of living donor kidney paired donation, but the potential gains of this practice need to be quantified and the ethical implications must be addressed before it can be implemented.

Methods.

The gain of implementing deceased donor–initiated chains was measured with an algorithm, using retrospective data on the pool of incompatible donor/recipient pairs, at a single center. The allocation rules for chain-ending kidneys and the characteristics and quality of the chain-initiating kidney are described.

Results.

The benefit quantification process showed that, with a pool of 69 kidneys from deceased donors and 16 pairs enrolled in the kidney paired donation program, it was possible to transplant 8 of 16 recipients (50%) over a period of 3 years. After obtaining the approval of the Veneto Regional Authority’s Bioethical Committee and the revision of the Italian National Transplant Center’s allocation policies, the first successful case was completed. For the recipient (male, aged 53 y), who entered the program for a chain-initiating kidney with a Kidney Donor Risk Index of 0.61 and a Kidney Donor Profile Index of 3%, the waiting time was 4 days. His willing donor (female, aged 53 y) with a Living Kidney Donor Profile Index of 2, donated 2 days later to a chain-ending recipient (male, aged 47 y) who had been on dialysis for 5 years.

Conclusions.

This is the first report of a successfully completed, deliberate deceased donor–initiated chain, which was made possible after a thorough assessment of the ethical issues and the impact of allocation policies. This article includes a preliminary efficacy assessment and describes the development of a dedicated algorithm.
Metrics for Graph Comparison: A Practitioner’s Guide
Authors: Wills Peter , Meyer François G.
Published: April 2019

Comparison of graph structure is a ubiquitous task in data analysis and machine learning, with diverse applications in fields such as neuroscience [1], cyber security [2], social network analysis [3], and bioinformatics [4], among others. Discovery and comparison of structures such as modular communities, rich clubs, hubs, and trees in data in these fields yields insight into the generative mechanisms and functional properties of the graph.

Often, two graphs are compared via a pairwise distance measure, with a small distance indicating structural similarity and vice versa. Common choices include spectral distances (also known asλdistances) and distances based on node affinities (such asDeltaCon[5]). However, there has of yet been no comparative study of the efficacy of these distance measures in discerning between common graph topologies and different structural scales.

In this work, we compare commonly used graph metrics and distance measures, and demonstrate their ability to discern between common topological features found in both random graph models and empirical datasets. We put forward a multi-scale picture of graph structure, in which the effect of global and local structure upon the distance measures is considered. We make recommendations on the applicability of different distance measures to empirical graph data problem based on this multi-scale view. Finally, we introduce the Python libraryNetCompwhich implements the graph distances used in this work.