bluuebunny/crossref_metadata_2025 huggingface dataset:
Leveraging Graduate Academic-Practice Partnerships to Transform Health System Outcomes
Authors: Wright Phyllis P. , Cranmer John N.
Published: September 2018

Academic and clinical site partnerships are not new. However, many of these have not resulted in graduates of nursing education programs who are prepared to fulfill their full potential as newly employed professionals. This article describes an education program for Doctorate of Nursing Practice (DNP) students in which the students, under the close supervision of academic faculty, utilize their statistical analyses and complex system coursework to study and address “wicked” problems faced by health care organizations. This partnership between academia and practice is benefitting practice partners, students, and patients.
Funding Academic and Clinical Nurse Strategies Through Joint Fund-raising Initiatives and Grateful Patient Engagement
Authors: Dorrill Amy
Published: September 2018

The Manatt report recommends a multipronged revenue portfolio to support academic health center (AHC) nursing*: tuition, clinical practice, and external support. Most AHC nursing enterprises rely only on the first two—student tuition and patient billing. Philanthropy is not generally viewed as a viable revenue stream, especially for clinical nursing operations, but it should be. While health care's operating margins are shrinking, philanthropy continues to rise. In 2016, joint hospital and medical school fund-raising programs received an average of $100 million per organization. Nursing schools and hospitals concentrate on alumni and staff giving. As a result, the largest contributors to health centers, grateful patients, are missed. This is unfortunate, because gifts from grateful patients would add to the revenue pool and because the ability to express gratitude in a meaningful way seems to aid in a patient's recovery process. Evidence suggests that patients who actively express gratitude have a stronger immune system, lower blood pressure, improved ability to heal, less loneliness, and more joy, optimism, and happiness. By working together, schools of nursing and the clinical nursing enterprises in AHCs can create projects and initiatives that are very attractive to patients and families who value the tripartite mission of caring, teaching, and discovery. These patients and families wish to honor the nurses who have sustained them through their illness. Their philanthropy serves to honor nurses, fund relevant programs, benefit future patients, and aid in the donors' recovery.
Nursing Partnerships in Research and Quality Improvement Within a Large Integrated Health Care System
Authors: Jang Hannah J. , Weberg Daniel , Dower Catherine
Published: September 2018

Within a large integrated health care system that includes local, regional, and national medical centers and offices, quality and patient safety teams, and research institutes, more than 58 000 nurses are employed, with the vast majority providing point-of-care service to patients and members. A small but increasingly important number of nurses are involved in quality improvement and research teams to improve patient care. Within this environment, a number of developments point to a growing need for nursing leadership in systems-level and delivery science policies and research. This article describes a partnership between clinical operations leaders and researchers (nurse scientists) to determine and utilize evidence-based practices to meet a system goal. The first objective of this article is to describe the barriers and potential solutions in combining practice, quality improvement, and research efforts across regions within a large integrated health care system. The second objective is to describe the uniqueness and importance of nurse leaders across interdisciplinary teams to simultaneously pursue research, quality improvement, and operational goals for the organization.
An Examination of Multilevel Factors Influencing Colorectal Cancer Screening in Primary Care Accountable Care Organization Settings: A Mixed-Methods Study
Authors: Kim Jungyoon , Wang Hongmei , Young Lufei , Michaud Tzeyu L. , Siahpush Mohammad , Farazi Paraskevi A. , Chen Li-Wu
Published: September 2018

Objective:

To identify patient, provider, and delivery system–level factors associated with colorectal cancer (CRC) screening and validate findings across multiple data sets.

Design:

A concurrent mixed-methods design using electronic health records, provider survey, and provider interview.

Setting:

Eight primary care accountable care organization clinics in Nebraska.

Measures:

Patients' demographic/social characteristics, health utilization behaviors, and perceptions toward CRC screening; provider demographics and practice patterns; and clinics' delivery systems (eg, reminder system).

Analysis:

Quantitative (frequencies, logistic regression, and t tests) and qualitative analyses (thematic coding).

Results:

At the patient level, being 65 years of age and older (odds ratio [OR] = 1.34, P < .001), being non-Hispanic white (OR = 1.93, P < .001), having insurance (OR = 1.90, P = .01), having an annual physical examination (OR = 2.36, P < .001), and having chronic conditions (OR = 1.65 for 1-2 conditions, P < .001) were associated positively with screening, compared with their counterparts. The top 5 patient-level barriers included discomfort/pain of the procedure (60.3%), finance/cost (57.4%), other priority health issues (39.7%), lack of awareness (36.8%), and health literacy (26.5%). At the provider level, being female (OR = 1.88, P < .001), having medical doctor credentials (OR = 3.05, P < .001), and having a daily patient load less than 15 (OR = 1.50, P = .01) were positively related to CRC screening. None of the delivery system factors were significant except the reminder system. Interview data provided in-depth information on how these factors help or hinder CRC screening. Discrepancies in findings were observed in chronic condition, colonoscopy performed by primary doctors, and the clinic-level system factors.

Conclusions:

This study informs practitioners and policy makers on the effective multilevel strategies to promote CRC screening in primary care accountable care organization or equivalent settings. Some inconsistent findings between data sources require additional prospective cohort studies to validate those identified factors in question. The strategies may include (1) developing programs targeting relatively younger age groups or racial/ethnic minorities, (2) adapting multilevel/multicomponent interventions to address low demands and access of local population, (3) promoting annual physical examination as a cost-effective strategy, and (4) supporting organizational capacity and infrastructure (eg, IT system) to facilitate implementation of evidence-based interventions.
Improving Referrals for HIV Care Through Organizational Network Analysis
Authors: Thomas James C. , Agala Bernard , Xiong Khou , Powell Richard
Published: September 2018

Context:

The link between testing for HIV and obtaining antiretroviral therapy (ART) is central to the HIV/AIDS control strategies of UNAIDS (the “90-90-90” goals) and the International Association of Providers of AIDS Care (“Test and Start”). To ensure that 90% of those diagnosed with HIV/AIDS begin ART and 90% of those on ART achieve viral suppression, service providers not providing all services need to refer patients to other organizations.

Setting:

Homa Bay, Kenya.

Objective:

Homa Bay county's HIV/AIDS prevalence is one of the country's highest. We identified the organizations providing some aspect of HIV/AIDS care and investigated ways in which they work together, or do not, to cover the comprehensive needs of those they serve.

Design and Participants:

We identified 56 organizations and interviewed a representative from each about his or her organization's services and its connections with the other 55, with particular interest in referrals from sites that test for HIV but do not treat infections to sites that do treat infections.

Main Outcome Measure:

Referral connections.

Results:

Referral connections among the 56 in the past 30 days were relatively rare, averaging fewer than 2; 13 organizations made no referrals at all. Notably, 5 facilities that test for HIV did not refer their clients to an ART provider. We found 2 distinct clusters of connected organizations: one in Homa Bay Township and the other in Rangwe subcounty. When we convened the organizations and presented our results to them, they expressed interest in establishing better connections and referrals.

Conclusions:

Homa Bay has an opportunity to improve care for people with HIV/AIDS, in particular ensuring that those testing positive receive treatment, simply by making better use of the services already available. This can be achieved by informing each organization of the services provided by each of the others and by bringing the organizations together to plan and monitor the services' coordination. These steps could be implemented separately in each of the 2 organizational clusters.
Determinants of Community-Related Expenses of US Tax-Exempt Hospitals, 2013
Authors: Begun James W. , Trinh Hanh Q.
Published: September 2018

Context:

Tax-exempt hospitals in the United States are required to report community benefit expenses on their federal tax forms. Two categories of expenses critical to the public health mission of hospitals are the “community health improvement” and “community-building” expense categories. The community health improvement expenses formally qualify as a community benefit, whereas community-building expenses do not. Increasing both types of spending would be consistent with the growing evidence on the effects of social determinants on population health.

Objective:

To identify characteristics associated with the level of community health improvement and community-building expenses reported by tax-exempt hospitals.

Design:

The general acute care hospital is the unit of analysis. We utilize secondary data for all US general acute care hospitals that filed their own Internal Revenue Service Form 990 Schedule H for 2013 (n = 1508). We apply linear regression analysis to an explanatory model with 8 independent variables.

Measures:

The primary dependent variables are percentage of operating expenses devoted to community health improvement and to community building. The independent variables include 4 hospital-level measures, 3 county-level measures, and a measure of state requirements for community benefit.

Results:

The level of community health improvement expenses is positively associated with bed size, system membership, profit margin, and urban location. In states where tax-exempt hospitals are required to demonstrate community benefit to the state, there is lower community health improvement spending. Teaching hospitals also demonstrate lower community health improvement spending. Results for community-building expenses mirror those for community health improvement except that teaching hospital status and per capita income lose significance and hospital competition gains significance in the negative direction.

Conclusions:

Leaders among tax-exempt hospitals in community-related spending are hospitals that are larger, more profitable, members of systems, and located in urban areas and in states that do not have community benefit requirements.
A Clinical Informatics Approach to Reengagement in HIV Care in the Emergency Department
Authors: Ridgway Jessica P. , Almirol Ellen , Schmitt Jessica , Wesley-Madgett Lindsey , Pitrak David
Published: September 2018

Emergency department visits provide an opportunity to reengage people living with HIV (PLWH) who are out of care. We developed an electronic medical record–based algorithm to identify PLWH in the emergency department and inpatient settings and utilized a trained HIV care navigator to reengage PLWH in these settings. The algorithm identified 420 PLWH during the 14-month observation period. Of these, 56 patients were out of care. Out-of-care individuals were significantly younger than those in care (mean age: 38.6 ± 15.5 vs 46.3 ±14.8 years, P < .001) and more likely to be uninsured (7.1% [4/56] vs 1.8% [6/337], P = .02). Among out-of-care patients, 66.1% (37/56) were reengaged in care. Only 21.4% (12/56) of out-of-care patients had previously received outpatient HIV care at our institution. This project demonstrates the feasibility of using an electronic medical record alert and HIV care navigator to reengage PLWH seeking emergency medical care.
Is Theory Guiding Our Work? A Scoping Review on the Use of Implementation Theories, Frameworks, and Models to Bring Community Health Workers into Health Care Settings
Authors: Allen Caitlin G. , Barbero Colleen , Shantharam Sharada , Moeti Refilwe
Published: September 2018

Community health workers (CHWs) are becoming a well-recognized workforce to help reduce health disparities and improve health equity. Although evidence demonstrates the value of engaging CHWs in health care teams, there is a need to describe best practices for integrating CHWs into US health care settings. The use of existing health promotion and implementation theories could guide the research and implementation of health interventions conducted by CHWs. We conducted a standard 5-step scoping review plus stakeholder engagement to provide insight into this topic. Using PubMed, EMBASE, and Web of Science, we identified CHW intervention studies in health care settings published between 2000 and 2017. Studies were abstracted by 2 researchers for characteristics and reported use of theory. Our final review included 50 articles published between January 2000 and April 2017. Few studies used implementation theories to understand the facilitators and barriers to CHW integration. Those studies that incorporated implementation theories used RE-AIM, intervention mapping, cultural tailoring, PRECEDE-PROCEED, and the diffusion of innovation. Although most studies did not report using implementation theories, some constructs of implementation such as fidelity or perceived benefits were assessed. In addition, studies that reported intervention development often cited specific theories, such as the transtheoretical or health belief model, that helped facilitate the development of their program. Our results are consistent with other literature describing poor uptake and use of implementation theory. Further translation of implementation theories for CHW integration is recommended.
Associations Between State Tobacco Control Policies and Adolescent ENDS Use
Authors: Hawkins Summer Sherburne , Ghiani Marco , Baum Christopher F.
Published: September 2018

Background:

Despite an increase in adolescent use of electronic nicotine delivery systems (ENDS), little is known about the role of tobacco control policies on ENDS use.

Objective:

For aim 1, we examined how trends in adolescent use of cigarettes were affected by the introduction of ENDS; for aim 2, we examined the associations between ENDS age restrictions, cigarette taxes, and smoke-free legislation and adolescent use of ENDS and cigarettes.

Design and Setting:

Repeated cross-sections of the 1999-2015 Youth Risk Behavior Surveys linked to state-level tobacco control policies.

Participants:

938 486 adolescents aged 14 to 18 years from 45 states.

Main Outcome Measures:

For aim 1, we examined adolescent use of cigarettes. For aim 2, we examined adolescent use of ENDS, only ENDS, and cigarettes.

Results:

We found there was an overall decreasing trend in adolescent use of cigarettes, but the actual decline was greater than the predicted decline for 17- and 18-year-olds. While we found no associations between ENDS use and ENDS age restrictions or cigarette taxes, ENDS use was 3.8 percentage points higher in those states with smoke-free legislation for combustible tobacco products.

Conclusions:

Our findings highlight that ENDS age restrictions may not be adequate to curb ENDS use and additional local- and state-level policies governing ENDS are needed.
Imaging Brain Metastasis Patients With 18F-(2S,4R)-4-Fluoroglutamine
Authors: Xu Xiaoxia , Zhu Hua , Liu Fei , Zhang Yan , Yang Jianhua , Zhang Lifang , Zhu Lin , Li Nan , Kung Hank F. , Yang Zhi
Published: September 2018

Purpose

There is a need for an alternative PET probe, which does not show normal brain tissue uptake in the evaluation of metastasis to the brain. Therefore, we investigate the feasibility of 18F-labeled glutamine analog, 18F-(2S,4R)-4-fluoroglutamine (18F-FGln), as a new metabolic probe to detect brain metastasis.

Methods

Patients (7 men and 7 women; age, 25–67 years) with suspected brain metastasis were enrolled for this study. All patients were imaged first with 18F-FGln PET (3 patients for 1-hour dynamic whole-body PET/CT scans, and 11 patients for static whole-body scans at 30 ± 10 minutes after injection), followed by a whole-body 18F-FDG PET performed in the same week. The characteristics of 18F-FGln PET imaging in brain metastasis patients were compared with that of 18F-FDG PET and/or contrast-enhanced MRI patient-by-patient. A composite of all functional and anatomic imaging studies served as the imaging comparator.

Results

Initial study in 3 patients using 1-hour dynamic scan showed that 30 ± 10 minutes after injection is optimal for identifying brain metastasis with a high-contrast ratio. All patients were positive for brain metastasis on this studies that demonstrated 38 lesions in 6 anatomic regions on the imaging comparator. The per-lesion detection rates for 18F-FGln PET and 18F-FDG PET were 81.6% and 36.8%, respectively. The average tumor-to-normal brain ratio of 18F-FGln PET was significantly better than that of 18F-FDG PET in all patients (4.97 ± 2.23 vs 1.22 ± 0.69, P < 0.05). Furthermore, our results suggest that 18F-FGln uptake in brain metastasis appeared to be independent of tumor size and peripheral edema. In addition, in 14 brain metastatic lesions visualized by both 18F-FDG PET and 18F-FGln PET imaging, a positive correlation of SUVmax was observed (r = 0.780, P < 0.01). As to the extracranial metastasis, both tracers showed a concordant increased radioactive uptake except in liver and bone.

Conclusions

The initial imaging of 18F-FGln presenting a promising new PET radiotracer for patients with brain metastasis and its utility in the liver and bone metastatic lesions may require more caution due to uptake in normal structures.
Chemokine Receptor 4 Expression in Primary Sjögren’s Syndrome
Authors: Cytawa Wojciech , Kircher Stefan , Schirbel Andreas , Shirai Takahiro , Fukushima Kazuhito , Buck Andreas K. , Wester Hans-Jürgen , Lapa Constantin
Published: September 2018

68Ga-pentixafor is a novel radioligand of C-X-C motif chemokine receptor 4. A 55-year-old woman with a history of primary Sjögren’s syndrome underwent 68Ga-pentixafor PET/CT for staging of lymphoma originating from mucosa-associated lymphoid tissue. Whereas no lymphoma manifestation could be detected, imaging revealed bilateral intense radiotracer uptake in both parotid and submandibular salivary glands, consistent with inflammatory cell infiltration.
Oropharyngeal Squamous Cell Carcinoma Metastasis to Distal Skeletal Muscle on FDG PET/CT
Authors: Drew Zachary James
Published: September 2018

We present a case of a tongue squamous cell carcinoma (SCC) metastasizing to distal skeletal muscle detected on FDG PET/CT imaging. A 48-year-old man with locally recurrent tongue SCC underwent a restaging FDG PET/CT to investigate neck and unilateral leg pain. The PET scan showed large, intensely FDG-avid lesions in the right scalene and left hamstring muscles, which were biopsy proven as metastatic SCC. Skeletal muscle metastases from oropharyngeal SCCs are rare; however, PET/CT has allowed increased detection of atypical metastatic sites. Such cases support the consideration of metastasis for muscular lesions in head and neck cancer patients.
Accumulation of 131I in Esophageal Diverticulum Diagnosed by SPECT/CT
Authors: Rizzo Alessio , Zagaria Luca , Perotti Germano , Annunziata Salvatore , Salvatori Massimo
Published: September 2018

A 72-year-old man underwent total thyroidectomy and radioiodine remnant ablation for papillary thyroid cancer in 2016. The posttherapy whole-body scan showed uptake in the neck, classified as residual thyroid tissue. Two years later, the patient came to our observation to perform a second radioiodine therapy for high levels of thyroglobulin. The planar posttherapy scan showed a focal radioiodine area in the neck. SPECT/CT diagnosed a voluminous esophageal diverticulum located in the upper third of the esophagus. A CT performed to discover the source of thyroglobulin excluded locoregional or distant metastases and confirmed the presence of a Zenker diverticulum.
Congenital Penile Rhabdomyosarcoma on FDG PET/CT
Authors: Wu Chenxi , Zhuang Hongming
Published: September 2018

Primary penile malignancy is uncommon. Congenital primary penile rhabdomyosarcoma diagnosed in an infant is extremely rare. We present the FDG PET/CT findings in a 1-month-old boy with penile mass. The images showed hypermetabolic lesion at the base of the penis and left inguinal lymph node. Pathological examination demonstrated rhabdomyosarcoma.
The Coexistence of a Horseshoe Kidney and Meckel Diverticulum With Dramatic Mobility Revealed Through 99mTc Pertechnetate Imaging
Authors: Yang Jun , Dong Meng-jie , Xu Qin , Zhang Jun
Published: September 2018

A previously healthy 11-year-old boy with intermittent abdominal pain and bloody stool underwent Meckel scintigraphy. On the initial images, there was a faint U-shaped activity in the mid-abdominal region, which gradually faded and evolved into distinct foci of radiotracer accumulation in the later images. One of the foci changed its location during the study, suspected as moving Meckel diverticulum. A horseshoe kidney was noted by subsequent CT images, which corresponded to nonmoving foci. A Meckel diverticulum was confirmed after exploratory laparotomy, accounted for moving focus on Merkel scintigraphy.
Laparoscopic Versus Open Liver Resection for Centrally Located Hepatocellular Carcinoma in Patients With Cirrhosis: A Propensity Score-matching Analysis
Authors: Kim Wan-Joon , Kim Ki-Hun , Kim Seok-Hwan , Kang Woo-Hyung , Lee Sung-Gyu
Published: September 2018

This study aimed to compare the surgical and oncological outcomes of laparoscopic liver resection (LLR) and open liver resection (OLR) for centrally located hepatocellular carcinoma in patients with cirrhosis. Between May 2013 and December 2015, 26 patients underwent pure LLR (14 underwent laparoscopic right anterior sectionectomy and 12 underwent laparoscopic central bisectionectomy). In total, 18 patients in the laparoscopic group and 36 patients in the open group were matched. When the LLR and OLR groups were compared, the operation time was found to be longer in the LLR group. However, LLR was associated with less blood loss, a shorter hospital stay, and earlier time to diet resumption. In this study, we confirmed that LLR for centrally located hepatocellular carcinoma can be safely performed in selected patients with cirrhosis despite a longer operation time.
Uterosacral Ligament Suspension: A Radiographic Study of Suture Location in Live Subjects
Authors: Smith Benjamin C. , Herfel Charles V. , Yeung Jennifer , Shatkin-Margolis Abigail , Crisp Catrina C. , Kleeman Steven D. , Pauls Rachel N.
Published: September 2018

Objectives

This study aimed to describe uterosacral ligament suspension (USLS) suture location relative to the surrounding anatomy in a living model using computed tomographic imaging.

Methods

This was an institutional review board–approved prospective descriptive study. Women aged 18 to 85 years undergoing vaginal hysterectomy with USLS were eligible. A size ‘small’ titanium vascular clip was applied to the base of each USLS suture. Computed tomography of the pelvis was performed on postoperative day 1. Preoperative and postoperative neurologic questionnaires and physical examinations were performed. A sample size of 15 subjects was deemed appropriate for this pilot study.

Results

Seventeen subjects were enrolled: 2 excluded and 15 analyzed. The median (interquartile range) age of the subjects was 57 (22) years. The closest branch of the internal iliac complex was 2.6 (0.9) cm (median [interquartile range]) from the proximal suture on the right and 2.6 (0.5) cm on the left. The right ureter was 2.1 (0.7) cm from the right proximal suture. The left ureter was 2.3 (1.0) cm from the left proximal suture. The rectal lumen were 3.0 (1.6) cm from the right proximal suture and 2.8 (1.4) cm from the left proximal suture. No subjects were found to have neurologic involvement of the sutures based on neurologic questionnaire responses and physical examination.

Conclusions

In live subjects, our study confirms that the vasculature, ureter, and rectum of the pelvic side wall are near suture placement for USLS. This information highlights the importance of careful dissection and awareness of anatomic landmarks.
Effect of Bariatric Surgery on Urinary Incontinence in Obese Women: A Meta-analysis and Systematic Review
Authors: Zhang Jindong , Gao Liang , Liu Maoyu , Liu Chuan
Published: September 2018

Objectives

The aim of this study was to explore the effectiveness of bariatric surgery in obese women with urinary incontinence (UI) through meta-analysis.

Methods

Searches of PubMed, the Cochrane Library, and EMBASE databases were performed using “weight loss surgery/bariatric surgery/gastric bypass surgery” and “incontinentia urinae/uracratia/urinary incontinence/uroclepsia” in the title/abstract before January 2018. Then, meta-analysis was analyzed by Review Manager 5.3 (Cochrane Collaboration, Oxford, United Kingdom). The standardized mean difference (SMD) and odds ratio (OR) were used to describe results of continuous variables and dichotomous variables, respectively.

Results

Pooled data showed that bariatric surgery reduced the incidence of UI in obese women at the follow-up of 6 months (OR, 3.27; 95% confidence interval [CI], 2.55–4.21; P < 0.00001) and 12 months (OR, 4.04; 95% CI, 2.62–6.22; P < 0.00001) and significantly reduced the body mass index at 6 months (SMD, 1.86; 95% CI, 1.19–2.53; P < 0.00001) and 12 months (SMD, 2.04; 95% CI, 1.44–2.64; P < 0.00001). In addition, bariatric surgery could also significantly increase the quality of life (SMD, 0.53; 95% CI, 0.27–0.80; P < 0.00001) and improve the function of pelvic floor disorders (SMD, 0.55; 95% CI, 0.38–0.72; P < 0.00001) based on quality-of-life questionnaires and Pelvic Floor Distress Inventory 20, respectively.

Conclusions

This meta-analysis demonstrated that bariatric surgery is an effective choice for obese women with UI. However, more randomized controlled trials are required to confirm this result.
Perioperative Complication Rates After Colpopexy in African American and Hispanic Women
Authors: Roberts Kasey , Sheyn David , Emi Bretschneider C. , Mahajan Sangeeta T. , Mangel Jeffrey
Published: September 2018

Objectives

The objective of this study was to determine if race affects complication rates after colpopexy.

Methods

This was an observational study exempt from institutional review board review. Data were obtained from the American College of Surgeons National Surgical Quality Improvement Program database from 2010 to 2015. Current Procedural Terminology codes were used to identify patients with a history of colpopexy. Patients were stratified into 3 groups: White, Hispanic, and African American. Descriptive statistics were reported as means with standard deviations. Three-group comparison was performed using Kruskal-Wallis or 1-way analysis of variance. Pairwise analysis was performed with Student t test, Wilcoxon rank sum test, χ2test, or Fisher exact test. Stepwise backward multivariable logistic regression was used to identify factors associated with the composite complication rate.

Results

A total of 13,206 patients met the inclusion and exclusion criteria. Seven hundred thirty-eight patients (5.5%) were African American, and 1210 (9.2%) were Hispanic. The overall complication rate for African Americans, Hispanics, and Whites was 15.0%, 12.0%, and 11.5% (P = 0.006), respectively. The most common complication in the African American group was postoperative transfusion. Multivariable logistic regression found significant associations with perioperative complications and being African American (adjusted odds ratio [aOR], 1.29), higher body mass index (aOR, 1.02), inpatient status (aOR, 1.45), coagulopathy (aOR, 2.77), preoperative transfusion (aOR, 5.09), American Society of Anesthesiologists class 3 or higher (aOR, 1.45), higher preoperative white blood cell count (aOR, 1.04), concomitant sling placement (aOR, 1.19), longer operating time (aOR, 1.003), and longer length of stay (aOR, 1.05).

Conclusions

African Americans are at an increased risk of perioperative complications after colpopexy, although the reason for this increase is unknown.
Anterior Ischemic Optic Neuropathy After Dental Extraction
Authors: Kravitz Elizabeth , Foroozan Rod
Published: September 2018

Background:

While often idiopathic, anterior ischemic optic neuropathy occasionally may occur from an identifiable cause.

Methods:

Observational case report.

Results:

A 19-year-old woman with unremarkable medical and ophthalmic histories developed visual loss from nonarteritic anterior ischemic optic neuropathy in her right eye after otherwise uneventful dental extraction of the inferior third molars.

Conclusions:

Anterior ischemic optic neuropathy may rarely occur after dental extraction. Potential pathophysiologic mechanisms of this rare occurrence are discussed.
Using Google Trends to explore the New Zealand public's interest in bariatric surgery
Authors: Rahiri Jamie‐Lee , Barazanchi Ahmed , Furukawa Sai , MacCormick Andrew D. , Harwood Matire , Hill Andrew G.
Published: September 2018

Background

Bariatric surgery, in recent times, has gained media attention that has influenced individual, healthcare provider and wider societal attitudes towards bariatric surgery. Studies exploring public and media levels of interest in bariatric surgery have been performed overseas but studies within New Zealand (NZ) are scarce. Analysis of Google Trends data may be a useful source of information in investigating public interest levels in bariatric surgery. We aimed to analyse Google Trends information on Internet searches in NZ and to explore sequential relationships with relevant changes in policy.

Methods

Key search terms for our Google Trends query were retrieved by independently reviewing news articles relating to bariatric surgery in NZ published between January 2007 and December 2017 and following a brainstorming session. Trend analyses were performed using Microsoft Excel 14.7.2. Data were captured for both NZ and worldwide search interests in Google Trends.

Results

Trend analyses showed that total search volumes for ‘lap band’ and ‘lap band surgery’ declined while ‘gastric sleeve’ and ‘gastric sleeve surgery’ increased exponentially over the 10‐year period. Furthermore, search interests for key terms in NZ were comparable with those worldwide.

Conclusion

Our findings reveal that search interests related to bariatric surgery in NZ mirror those worldwide. This includes the popularity of some bariatric procedures over others. The use of Google Trends may provide us with an additional tool to evaluate public interest levels related to bariatric surgery in NZ and could add value in examining the socio‐cultural and political contexts of obesity and bariatric surgery.
Usability of femoral head bone marrow to verify reference ranges for the assessment of myelodysplasia by flow cytometry
Authors: van Gammeren Adriaan J. , van Rijckevorsel M. , Bras Anne E. , Brandt‐Hagens Claudia , te Marvelde Jeroen G. , de Visser Carin , Joosen Annemiek M. C. P. , Ermens Anton A. M. , van der Velden Vincent H. J.
Published: September 2018

Background

A flow cytometry score (FCS) based on four parameters has been proposed for analysis of myelodysplastic syndromes patients with <5% blasts. We evaluated whether bone marrow aspirate samples isolated from femoral heads could be used for verification of cutoff values of the individual parameters score (IPS), contributing to the FCS and compared the applicability of FCS parameters in two centers.

Study design and methods

Bone marrow cells were obtained from femoral heads of patients who underwent hip replacement surgery. The score of the 4 individual parameters of the cell samples were obtained independently in two centers, using their own facilities and methods. Flow cytometry data files were subsequently exchanged and reanalyzed in the other center. The resulting four data sets were compared to assess reproducibility and outcomes in both centers.

Results

Twenty‐nine of 40 bone marrow samples contained sufficient cells for analysis. Proposed cutoff values for 3 of 4 individual parameters were appropriate. All 29 samples showed a positive individual parameters score (IPS:1) in 1 of the 4 obtained data sets. Most differences in IPS scores were a result of reanalyzing the data file in the other center, rather than data acquisition. FCS: ≥2 were observed in 11 samples.

Conclusion

Bone marrow samples from femoral heads are appropriate for verification of the proposed reference cutoff values of the individual parameters. Proposed reference cutoff values needed to be adjusted for reliable interpretation. Standardization of both data acquisition and data analysis is necessary for obtaining uniform results.
A comparative study of three different forecasting methods for trial of labor after cesarean section
Authors: Yang Min , Guo Zhi‐Wei , Deng Cai‐Juan , Liang Xiong , Tan Gong‐Jun , Jiang Jie , Zhong Zhi‐Xuan
Published: September 2018

Aim

This study aims to establish a convenient and practical predelivery scoring system for trial of labor after cesarean section (TOLAC).

Methods

The data of 498 patients undergoing TOLAC were retrospectively studied. Indices with statistically significant differences, including cervical score, fetal weight, fetal pelvic index, body mass index and age, were selected. Combined with the presence of vaginal delivery history and indications of the previous cesarean section in these patients, three prenatal forecast scales for vaginal birth after cesarean (VBAC) were established. The receiver operating characteristic curve was drawn, and the best cut‐off point was determined. Then, the areas under the curve of the three forecasting methods were compared. The scoring method with the largest area under the curve was considered the best method.

Results

The six indications of cesarean section used for the forecasting scale were as follows: cervical score, fetal weight, body mass index, age, presence of vaginal delivery history and the presence of previous obstructive dystocia. The scale that had the largest area under the curve was considered the best forecasting scale.

Conclusion

The prenatal forecasting method for TOLAC was preliminarily investigated. It was determined that the scale with six indicators, such as the cervical score, could be used for the prenatal evaluation of TOLAC, providing a predictive basis for the possible success of the trial production for pregnant women. The method and process of VBAC section in our hospital was safe and effective.
New Contributions to Asarum Powder on Immunology Related Toxicity Effects in Lung
Authors: Li Yamin , Han Lintao , Huang Chunhua , Dai Wangqiang , Tian Guangyu , Huang Fang , Li Jingjing , Liu Jinwei , Wang Qiong , Zhou Zhenxiang
Published: September 2018

Objective. Asarum is widely used in clinical practice of Chinese medicine in the treatment of respiratory diseases. Many toxic ingredients (safrole, etc.) had been found in Asarum that show multiple visceral toxicities. In this study, we performed systematic investigation of expression profiles of genes to take a new insight into unclear mechanism of Asarum toxicities in lung. Methods. mRNAs were extracted from lungs of rats after intragastric administration with/without Asarum powders, and microarray assays were applied to investigate gene expression profiles. Differentially expressed genes with significance were selected to carry out GO analysis. Subsequently, quantitative PCRs were performed to verify the differential expression of Tmprss6, Prkag3, Nptx2, Antxr11, Klk11, Rag2, Olr77, Cd7, Il20, LOC69, C6, Ccl20, LOC68, and Cd163 in lung. Changes of Ampk, Bcl2, Caspase 3, Il1, Il20, Matriptase2, Nfκb, Nptx2, and Rag2 in the lung on protein level were verified by western blotting and immunohistochemistry. Results. Compared with control group, the estimated organ coefficients were relatively increased in Asarum group. Results of GO analysis showed that a group of immune related genes in lung were expressed abnormally. The result of PCRs showed that Ccl20 was downregulated rather than other upregulated genes in the Asarum group. Western blotting and immunohistochemistry images showed that Asarum can upregulate the expression of Ampk, Caspase 3, Il1, Il20, Matriptase2, Nfκb, and Rag2 and downregulate the expression of Bcl2 in lung. Conclusion. Our data suggest that expressions of immune related genes in lung were selectively altered by Asarum. Therefore, inflammatory response was active, by regulating Caspase 3, Il1, Il20, Matriptase2, Nfκb, Rag2, Tmprss6, Prkag3, Nptx2, Antxr1, Klk11, Olr77, Cd7, LOC69, C6, LOC68, Cd163, Ampk, Bcl2, and Ccl20. Our study indicated that inflammatory factors take effect in lung toxicity caused by Asarum, which provides a new insight into molecular mechanism of Asarum toxicities in lung.
Global Analysis of a Liénard System with Quadratic Damping
Authors: Guo Feng
Published: September 2018

In this paper, the global analysis of a Liénard equation with quadratic damping is studied. There are 22 different global phase portraits in the Poincaré disc. Every global phase portrait is given as well as the complete global bifurcation diagram. Firstly, the equilibria at finite and infinite of the Liénard system are discussed. The properties of the equilibria are studied. Then, the sufficient and necessary conditions of the system with closed orbits are obtained. The degenerate Bogdanov-Takens bifurcation is studied and the bifurcation diagrams of the system are given.
A Systematic Review of the Efficacy and Safety of Fecal Microbiota Transplant for Clostridium difficile Infection in Immunocompromised Patients
Authors: Shogbesan Oluwaseun , Poudel Dilli Ram , Victor Samjeris , Jehangir Asad , Fadahunsi Opeyemi , Shogbesan Gbenga , Donato Anthony
Published: September 2018

Background. Fecal microbiota transplantation (FMT) has been shown to be effective in recurrent Clostridium difficile (CD) infection, with resolution in 80% to 90% of patients. However, immunosuppressed patients were often excluded from FMT trials, so safety and efficacy in this population are unknown. Methods. We searched MEDLINE and EMBASE for English language articles published on FMT for treatment of CD infection in immunocompromised patients (including patients on immunosuppressant medications, patients with human immunodeficiency virus (HIV), inherited or primary immunodeficiency syndromes, cancer undergoing chemotherapy, or organ transplant, including-bone marrow transplant) of all ages. We excluded inflammatory bowel disease patients that were not on immunosuppressant medications. Resolution and adverse event rates (including secondary infection, rehospitalization, and death) were calculated. Results. Forty-four studies were included, none of which were randomized designs. A total of 303 immunocompromised patients were studied. Mean patient age was 57.3 years. Immunosuppressant medication use was the reason for the immunocompromised state in the majority (77.2%), and 19.2% had greater than one immunocompromising condition. Seventy-six percent were given FMT via colonoscopy. Of the 234 patients with reported follow-up outcomes, 207/234 (87%) reported resolution after first treatment, with 93% noting success after multiple treatments. There were 2 reported deaths, 2 colectomies, 5 treatment-related infections, and 10 subsequent hospitalizations. Conclusion. We found evidence that supports the use of FMT for treatment of CD infection in immunocompromised patients, with similar rates of serious adverse events to immunocompetent patients.
Heuristic Evaluation: Comparing Generic and Specific Usability Heuristics for Identification of Usability Problems in a Living Museum Mobile Guide App
Authors: Othman Mohd Kamal , Sulaiman Muhd Nur Shaful , Aman Shaziti
Published: September 2018

This paper reports on an empirical study that compares two sets of heuristics, Nielsen’s heuristics and the SMART heuristics in the identification of usability problems in a mobile guide smartphone app for a living museum. Five experts used the severity rating scales to identify and determine the severity of the usability issues based on the two sets of usability heuristics. The study found that Nielsen’s heuristics set is too general to detect usability problems in a mobile application compared to SMART heuristics which focuses on the smartphone application in the product development lifecycle instead of the generic Nielsen’s heuristics which focuses on a wide range of interactive system. The study highlights the importance of utilizing domain specific usability heuristics in the evaluation process. This ensures that relevant usability issues were successfully identified which could then be given immediate attention to ensure optimal user experience.
Visible Light Assisted Photocatalytic Degradation of Chromium (VI) by Using Nanoporous Fe2O3
Authors: Mavinakere Ramesh Abhilash , Shivanna Srikantaswamy
Published: September 2018

A Fe2O3 nanoporous structure was prepared by using hydrothermal route; its physicochemical properties were effectively characterized using XRF, BET, FT-IR, VSM, SEM and EDX, DLS, XRD, and PL techniques. The surface area of the magnetic nanoporous structure Fe2O3 was higher than the normally synthesized Fe2O3 nanoparticle. The outcome of the photocatalytic removal of the chromium (VI) below the visible light irradiation confirmed that 82.11% of Cr(VI) was degraded by the Fe2O3 nanomaterials at 120 min of irradiation time. The improved photocatalytic activity of the nanoparticle was ascribed to efficient electron-hole separation. Fe2O3 was set up to be a tough and constant photocatalyst throughout recycling experiments. The conceivable mechanism for the electron-hole separation process on the heterojunction was probable. The synthesized samples own low band gap energy and a hollow structure appropriate for the improved photocatalytic activity. The toxicity of the samples was measured by using Mus musculus skin melanoma cells (B16-F10 (ATCC®, CRL-6475TM) which are set up to be safe for human cells; as a result, this systematic approach provides a better alternative upconversion material for integral photoabsorption.
Enhanced Adaptive Cloudlet Placement Approach for Mobile Application on Spark
Authors: Zhang Yiwen , Wang Kaibin , Zhou Yuanyuan , He Qiang
Published: September 2018

The applications of mobile devices are increasingly becoming computationally intensive while the computing capability of the user’s mobile device is limited. Traditional approaches offload the tasks of mobile applications to the remote cloud. However, the rapid growth of mobile devices has made it a challenge for the remote cloud to provide computing and storage capacities with low communication delays due to the fact that the remote cloud is geographically far away from mobile devices. Reducing the completion time of applications in mobile devices through the technical expending mobile cloudlets which are moving collocated with Access Points (APs) is necessary. To address the above issues, this paper proposes EACP-CA (Enhanced Adaptive Cloudlets Placement approach based on Covering Algorithm), an enhanced adaptive cloudlet placement approach for mobile applications in a given network area. We apply the CA (Covering Algorithm) to adaptively cluster the mobile devices based on their geographical locations, the aggregation regions of the mobile devices are identified, and the cloudlet destination locations are also confirmed according to the clustering centers. In addition, we can also obtain the traces between the original and destination locations of these mobile cloudlets. To increase the efficiency, we parallelize CA on Spark. Extensive experiments show that the proposed approach outperforms the existing approach in both effectiveness and efficiency.
Application and Optimal Control for an HBV Model with Vaccination and Treatment
Authors: Zhang Jing , Zhang Suxia
Published: September 2018

In this study, we formulate a model for hepatitis B virus with control strategies of newborn vaccination and treatment. Mathematical analysis is done theoretically and numerically. The results indicate that the stability of equilibria and persistence of the disease are determined by the basic reproductive number R0. Using the least squares method, the model is applied to simulate yearly new infected cases of hepatitis B in China from 2004 to 2016. Moreover, optimal control problem with newborn vaccination and treatment appearing as functions of time is analyzed by classical optimal theory. The existence of the solution to optimality system is proved, and the simulations are conducted to show the results when optimal control or current intervention is used.
Gamma-Glutamyltransferase and Risk of Acute Coronary Syndrome in Young Chinese Patients: A Case-Control Study
Authors: Huang Yuli , Luo Jianjin , Liu Xinyue , Wu Yu , Yang You , Li Wensheng , Lv Weibiao , Hu Yunzhao
Published: September 2018

Background. Serum gamma-glutamyltransferase (GGT) is a biomarker of hepatic disease. Recent studies have shown that GGT may also associate with the risk of coronary artery disease. However, the underlying mechanisms of this association are still unclear. Methods. This study included 216 young patients with acute coronary syndrome (aged ≤55years) and 227 age-matched controls with normal findings by coronary angiography or coronary computed tomography angiography. We use standard colorimetric techniques and sandwich enzyme-linked immunosorbent assay to measure the levels of GGT and oxidized low-density lipoprotein (ox-LDL), respectively. Traditional risk factors of coronary artery disease, including smoking, diabetes mellitus, hypertension, dyslipidemia, and obesity/overweight, were evaluated according to the current guidelines. Results. The levels of GGT were significantly correlated with body mass index and levels of triglyceride, fasting plasma glucose, aspartate aminotransferase, and ox-LDL (all P<0.05). Multivariate logistic regression analysis showed that GGT was significantly associated with the risk of acute coronary syndrome in young Chinese patients (OR = 1.53, 95% CI = 1.09–2.15) after adjusting for traditional risk factors, including sex, age, quantity of smoking, hypertension, diabetes, body mass index, dyslipidemia, and high-sensitivity C-reactive protein. However, this association was significantly attenuated (OR = 1.20, 95% CI = 0.91–1.58) after further adjusting for the levels of ox-LDL. Conclusions. GGT was associated with the risk of ACS in relatively young patients. The link between GGT and the risk of ACS may be dependent on ox-LDL levels, indicating that the prooxidant action is an important pathway for GGT in the development of cardiovascular disease.
Preparation and Characterization of Rubber Blends for Industrial Tire Tread Fabrication
Authors: Mensah B. , Agyei-Tuffour B. , Nyankson E. , Bensah Y. D. , Dodoo-Arhin D. , Bediako J. K. , Onwona-Agyeman B. , Yaya A.
Published: September 2018

The physico-mechanical properties of variable rubber blends including epoxide natural rubber (ENR), polybutadiene rubber (BR), and solution polymerized styrene-butadiene rubber (SBR) filled with silanized silica and carbon black mixtures were explored. The tensile, hardness, resilience, abrasion, and fatigue behavior were investigated. An optimized composition involving 30 phr of ENR and 70 phr SBR filled with mixtures of carbon blacks and silanized silica was proposed to be a suitable composition for the future development of green passenger truck tires, with low rolling resistance (fuel saving ability), high wear resistance, and desired fatigue failure properties.