bluuebunny/crossref_metadata_2025 huggingface dataset:
Changing Times, Changing Relationships At Work … Changing Law?
Authors: Langstaff Sir Brian
Published: May 2016

As employment law changes and develops, in sometimes surprising ways, this paper considers the possibility that employment law may not be keeping pace with the diversity of working patterns and practices which have rapidly evolved in the past few decades. It therefore poses the question whether labour law needs to change direction to accommodate the work and workers of the twenty-first century. It firstly makes and details the point, against a statistical base, that significant change in the labour market is nothing new, but then turns to the identification of quite radical recent and continuing changes, and goes on to ask whether they demand a changing law. It presents four cases to illustrate where the law appears to fall short, expressing unease that a discriminatory wrong can be done without the law being able to address it, and highlights different ways in which the law of contract may not provide an appropriate model to deal with today’s problems. The possibility is canvassed that if the expression ‘arrangement’ were used in place of the contractual model, the concentration might then be on industrial realities rather than legal niceties. In conclusion, it is emphasised that the answers are ones of policy which are critically dependent upon the guiding political philosophy of the time. (The paper was delivered as a lecture as a general election approached.)
Patient crossover and potentially avoidable repeat computed tomography exams across a health information exchange
Authors: Slovis Benjamin H , Lowry Tina , Delman Bradley N , Beitia Anton Oscar , Kuperman Gilad , DiMaggio Charles , Shapiro Jason S
Published: May 2016

Objective: The purpose of this study was to measure the number of repeat computed tomography (CT) scans performed across an established health information exchange (HIE) in New York City. The long-term objective is to build an HIE-based duplicate CT alerting system to reduce potentially avoidable duplicate CTs.

Methods: This retrospective cohort analysis was based on HIE CT study records performed between March 2009 and July 2012. The number of CTs performed, the total number of patients receiving CTs, and the hospital locations where CTs were performed for each unique patient were calculated. Using a previously described process established by one of the authors, hospital-specific proprietary CT codes were mapped to the Logical Observation Identifiers Names and Codes (LOINC®) standard terminology for inter-site comparison. The number of locations where there was a repeated CT performed with the same LOINC code was then calculated for each unique patient.

Results: There were 717 231 CTs performed on 349 321 patients. Of these patients, 339 821 had all of their imaging studies performed at a single location, accounting for 668 938 CTs. Of these, 9500 patients had 48 293 CTs performed at more than one location. Of these, 6284 patients had 24 978 CTs with the same LOINC code performed at multiple locations. The median time between studies with the same LOINC code was 232 days (range of 0 to 1227); however, 1327 were performed within 7 days and 5000 within 30 days.

Conclusions: A small proportion (3%) of our cohort had CTs performed at more than one location, however this represents a large number of scans (48 293). A noteworthy portion of these CTs (51.7%) shared the same LOINC code and may represent potentially avoidable studies, especially those done within a short time frame. This represents an addressable issue, and future HIE-based alerts could be utilized to reduce potentially avoidable CT scans.
Extreme asymmetry in the polarized disk of V1247 Orionis
Authors: Ohta Yurina , Fukagawa Misato , Sitko Michael L. , Muto Takayuki , Kraus Stefan , Grady Carol A. , Wisniewski John P. , Swearingen Jeremy R. , Shibai Hiroshi , Sumi Takahiro , Hashimoto Jun , Kudo Tomoyuki , Kusakabe Nobuhiko , Momose Munetake , Okamoto Yoshiko , Kotani Takayuki , Takami Michihiro , Currie Thayne , Thalmann Christian , Janson Markus , Akiyama Eiji , Follette Katherine B. , Mayama Satoshi , Abe Lyu , Brandner Wolfgang , Brandt Timothy D. , Carson Joseph C. , Egner Sebastian E. , Feldt Markus , Goto Miwa , Guyon Olivier , Hayano Yutaka , Hayashi Masahiko , Hayashi Saeko S. , Henning Thomas , Hodapp Klaus W. , Ishii Miki , Iye Masanori , Kandori Ryo , Knapp Gillian R. , Kuzuhara Masayuki , Kwon Jungmi , Matsuo Taro , McElwain Michael W. , Miyama Shoken , Morino Jun-Ichi , Moro-Martín Amaya , Nishimura Tetsuo , Pyo Tae-Soo , Serabyn Eugene , Suenaga Takuya , Suto Hiroshi , Suzuki Ryuji , Takahashi Yasuhiro H. , Takami Hideki , Takato Naruhisa , Terada Hiroshi , Tomono Daigo , Turner Edwin L. , Usuda Tomonori , Watanabe Makoto , Yamada Toru , Tamura Motohide
Published: May 2016

We present the first near-infrared scattered-light detection of the transitional disk around V1247 Ori, which was obtained using high-resolution polarimetric differential imaging observations with Subaru/HiCIAO. Our imaging in the H band reveals the disk morphology at separations of ∼0${^{\prime\prime}_{.}}$14–0${^{\prime\prime}_{.}}$86 (54–330 au) from the central star. The polarized intensity image shows a remarkable arc-like structure toward the southeast of the star, whereas the fainter northwest region does not exhibit any notable features. The shape of the arm is consistent with an arc of 0${^{\prime\prime}_{.}}$28 ± 0${^{\prime\prime}_{.}}$09 in radius (108 au from the star), although the possibility of a spiral arm with a small pitch angle cannot be excluded. V1247 Ori features an exceptionally large azimuthal contrast in scattered, polarized light; the radial peak of the southeastern arc is about three times brighter than the northwestern disk measured at the same distance from the star. Combined with the previous indication of an inhomogeneous density distribution in the gap at ≲46 au, the notable asymmetry in the outer disk suggests the presence of unseen companions and/or planet-forming processes ongoing in the arc.
Do Resting Plasma β-Endorphin Levels Predict Responses to Opioid Analgesics?
Authors: Bruehl Stephen , Burns John W. , Gupta Rajnish , Buvanendran Asokumar , Chont Melissa , Orlowska Daria , Schuster Erik , France Christopher R.
Published: May 2016

Objectives:

Clinically feasible predictors of opioid analgesic responses for use in precision pain medicine protocols are needed. This study evaluated whether resting plasma β-endorphin (BE) levels predicted responses to an opioid analgesic, and whether chronic pain status or sex moderated these effects.

Methods:

Participants included 73 individuals with chronic low back pain (CLBP) and 88 pain-free controls, all using no daily opioid analgesics. Participants attended 2 identical laboratory sessions during which they received either intravenous morphine (0.08 mg/kg) or saline placebo, with blood samples obtained before drug administration to assay resting plasma BE levels. Once peak drug activity was achieved in each session, participants engaged in an ischemic forearm pain task (ISC) and a heat pain task. Morphine analgesic effects were derived reflecting the difference in pain outcomes between placebo and morphine conditions.

Results:

In hierarchical regressions, significant Type (CLBP vs. control)×BE interactions (Ps<0.05) were noted for morphine effects on ISC tolerance, ISC intratask pain ratings, and thermal VAS unpleasantness ratings. These interactions derived primarily from associations between higher BE levels and smaller morphine effects restricted to the CLBP subgroup. All other BE-related effects, including sex interactions, for predicting morphine analgesia failed to reach statistical significance.

Discussion:

BE was a predictor of morphine analgesia for only 3 out of 9 outcomes examined, with these effects moderated by chronic pain status but not sex. On the whole, results do not suggest that resting plasma BE levels are likely to be a clinically useful predictor of opioid analgesic responses.
Immunologic Consequences of Hypoxia during Critical Illness
Authors: Kiers Harmke D. , Scheffer Gert-Jan , van der Hoeven Johannes G. , Eltzschig Holger K. , Pickkers Peter , Kox Matthijs
Published: May 2016

AbstractAbstract

Hypoxia and immunity are highly intertwined at clinical, cellular, and molecular levels. The prevention of tissue hypoxia and modulation of systemic inflammation are cornerstones of daily practice in the intensive care unit. Potentially, immunologic effects of hypoxia may contribute to outcome and represent possible therapeutic targets. Hypoxia and activation of downstream signaling pathways result in enhanced innate immune responses, aimed to augment pathogen clearance. On the other hand, hypoxia also exerts antiinflammatory and tissue-protective effects in lymphocytes and other tissues. Although human data on the net immunologic effects of hypoxia and pharmacologic modulation of downstream pathways are limited, preclinical data support the concept of tailoring the immune response through modulation of the oxygen status or pharmacologic modulation of hypoxia-signaling pathways in critically ill patients.

Hypoxia affects molecular and cellular inflammatory processes and may thereby affect outcome in critical illness. Modulating oxygenation and pharmacologic interventions in hypoxia-singling pathways could support immunologic functions in these patients.
Cozen’s phenomenon revisited
Authors: Burton Alex , Hennrikus William
Published: May 2016

We retrospectively examined Cozen’s fractures in children treated with a cast in extension with a varus mold applied as described by Rang. To our knowledge, no study has examined the effectiveness of this treatment. Our review included 14 patients with an average age of 3 years. The average time to valgus deformity was 8.8 months (range 5–15 months). Follow-up was 16.2 months (range 6.7–42.8 months). Seven (50%) patients developed a 5° valgus deformity in addition to the normal valgus of the contralateral side. In conclusion, treatment with a long leg cast with the knee in extension and a varus mold minimized the valgus deformity compared with previous reports in the literature.
Psychometric evaluation of the Scoliosis Research Society-22 Revised questionnaire among adolescents with idiopathic scoliosis
Authors: Lee Hyejung , Choi Jihea , Hwang Jin-Ho , Park Jung Hyun
Published: May 2016

This cross-sectional descriptive study was carried out to develop and evaluate the reliability and validity of the Korean version of the Scoliosis Research Society-22 Revised (SRS-22r) questionnaire among adolescents with idiopathic scoliosis. Of the initial 122 adolescents surveyed, 87 adolescents returned the second questionnaire, which assessed test–retest reliability between SRS-22r and the pediatric quality of life inventory questionnaire (PedsQL 4.0). The results were found to be reliable and valid, with acceptable internal consistency, intraclass correlation, and moderate correlation with a similar questionnaire. The SRS-22r can be used to assess health-related quality of life internationally among adolescents with scoliosis.
Determinants of Urinary Output Response to IV Furosemide in Acute Kidney Injury: A Pharmacokinetic/Pharmacodynamic Study
Authors: Silbert Benjamin I. , Ho Kwok M. , Lipman Jeffrey , Roberts Jason A. , Corcoran Tomas B. , Morgan David J. , Pavey Warren , Mas Emilie , Barden Anne E. , Mori Trevor A.
Published: May 2016

Objectives:

This study assessed the determinants of urinary output response to furosemide in acute kidney injury; specifically, whether the response is related to altered pharmacokinetics or pharmacodynamics.

Design:

Prospective cohort.

Setting:

Tertiary ICU.

Patients:

Thirty critically ill patients with acute kidney injury without preexisting renal impairment or recent diuretic exposure.

Intervention:

A single dose of IV furosemide.

Measurements and Main Results:

Baseline markers of intravascular volume status were obtained prior to administering furosemide. Six-hour creatinine clearance, hourly plasma/urinary furosemide concentrations, and hourly urinary output were used to assess furosemide pharmacokinetics/pharmacodynamics parameters. Of 30 patients enrolled, 11 had stage-1 (37%), nine had stage-2 (30%), and 10 had stage-3 (33%) Acute Kidney Injury Network acute kidney injury. Seventy-three percent were septic, 47% required norepinephrine, and 53% were mechanically ventilated. Urinary output doubled in 20 patients (67%) following IV furosemide. Measured creatinine clearance was strongly associated with the amount of urinary furosemide excreted and was the only reliable predictor of the urinary output after furosemide (area under the receiver-operating-characteristic curve, 0.75; 95% CI, 0.57–0.93). In addition to an altered pharmacokinetics (p < 0.01), a reduced pharmacodynamics response to furosemide also became important when creatinine clearance was reduced to less than 40 mL/min/1.73 m2 (p = 0.01). Acute kidney injury staging and markers of intravascular volume, including central venous pressure, brain-natriuretic-peptide concentration, and fractional urinary sodium excretion were not predictive of urinary output response to furosemide.

Conclusions:

The severity of acute kidney injury, as reflected by the measured creatinine clearance, alters both pharmacokinetics and pharmacodynamics of furosemide in acute kidney injury, and was the only reliable predictor of the urinary output response to furosemide in acute kidney injury.
Physiological Responses of the Modified Shuttle Test in Adults With Cystic Fibrosis
Authors: Vallier Jean-Marc , Rouissi Mehdi , Mely Laurent , Gruet Mathieu
Published: May 2016

PURPOSE:

The modified shuttle test (MST) is increasingly used in clinical practice to assess functional capacity in patients with cystic fibrosis (CF). The purpose of this study was to evaluate the physiological responses of the MST in adults with CF as compared with the gold standard cardiopulmonary exercise test (CPET).

METHODS:

Participants performed an MST and a CPET on a cycle ergometer in random order. Oxygen (O2) uptake (

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2), carbon dioxide (CO2) retention (end-tidal Pco
2; Petco
2), minute ventilation, heart rate, and peripheral O2 saturation (Spo
2) were continuously monitored. Whole blood lactate, dyspnea, and leg discomfort were recorded immediately after both exercises.

RESULTS:

Twenty patients with CF (aged 33 ± 8 years; forced expiratory volume in 1 second = 48% ± 17%) completed both tests. Peak values for

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2 (27 ± 7 vs 24 ± 6 mL/kg/min), heart rate (169 ± 19 vs 163 ± 16 bpm), end Petco
2 (42 ± 7 vs 39 ± 8 mm Hg), and O2 desaturation (end Spo
2, 86% ± 7% vs 90% ± 6%) were significantly higher during the MST than during the CPET (all Ps < .05). Leg discomfort and whole blood lactate were significantly higher after the CPET (both Ps < .05). Thirty-five percent and 40% of patients showed significant O2 desaturation and CO2 retention, respectively, during the MST, which was not detected during the CPET. A strong relationship was found between MST peak

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2 and body weight walking distance product (r = 0.90; P < .01).

CONCLUSIONS:

The MST may provide a strong indicator of exercise tolerance in adults with CF as indicated by high peak

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2 values. In clinical practice, body weight walking distance should be considered as the primary outcome. This test is also better than cycle ergometry CPET for detecting O2 desaturation and CO2 retention, further emphasizing its clinical interest.
Lower Experiential Avoidance Is Associated With Psychological Well-being and Improved Cardiopulmonary Endurance Among Patients in Cardiac Rehabilitation
Authors: Goodwin Christina L. , Emery Charles F.
Published: May 2016

PURPOSE:

Patients with a diagnosis of cardiac disease are often asked to make significant lifestyle changes, but they may experience difficulty initiating and maintaining lifestyle changes, especially when engaging in experiential avoidance (EA), the tendency to push away unpleasant emotions and sensations. This study examined the relationship between EA, psychological functioning, cardiac-quality of life (cardiac-QOL), program adherence, and cardiopulmonary endurance among patients entering an outpatient cardiac rehabilitation (CR) program.

METHODS:

Patients completed study questionnaires pre-CR, including 2 measures of EA (general and cardiac-specific), and assessments of psychological functioning and cardiac-QOL. Adherence was calculated as the proportion of insurance-approved CR sessions attended. Thirty participants completed stress testing pre-CR and post-CR.

RESULTS:

Forty-seven patients completed the questionnaires. General EA was associated with greater depression (r = 0.73, P < .001), anxiety (r = 0.56, P < .001), and stress (r = 0.65, P < .001) and lower cardiac-QOL (r =−0.69, P < .001). In addition, when controlling for the influence of general EA, greater cardiac-specific EA was associated with depression (∆R
2 = 0.05, P = .01), anxiety (∆R
2 = 0.18, P < .001), and poorer cardiac-QOL (∆R
2 = 0.04, P = .04). However, lower cardiac-specific EA predicted greater increases in cardiopulmonary endurance (

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2peak) during the CR program (b =−0.18, P = .002; ∆adjusted R
2 = 0.07). Experiential avoidance was not associated with adherence.

CONCLUSIONS:

Lower EA is associated with better psychological well-being among patients entering a CR program and with better exercise outcomes. Strategies for reducing EA may be important to consider in future clinical studies.
Effect of Baseline Red Blood Cell Distribution Width on Short- and Intermediate-term Mortality of Patients Under Primary Percutaneous Coronary Intervention
Authors: Bozorgi Ali , Khaki Siavash , Mortazavi Seyedeh Hamideh , Sadeghian Saeed , Khoshnevis Maryam , Tofighi Salar , Khaki Arash
Published: May 2016

Objective:

Considering the limited studies specifically evaluating the role of Red blood cell distribution width (RDW) in primary percutaneous coronary intervention (PCI), we aimed to investigate the role of baseline RDW in short- and intermediate-term cardiovascular events in ST-elevation myocardial infarction patients under primary PCI.

Methods:

This is a historical cohort registry analysis of 1161 patients with ST-elevation myocardial infarction under primary PCI. According to inclusion criteria, 838 patients were allocated for analysis. Patients with RDW levels of 13.6% or higher were considered as high RDW group (third tertile). All the individuals were followed up for in-hospital and 6-month mortality along with readmission and composite major adverse cardiac events.

Results:

In-hospital deaths occurred in 53 (6.3%) patients and at 6-month follow-up 79 (9.4%) cases of mortality were documented. In-hospital and 6-month mortalities showed a significant trend in favor of high RDW group (13.3% vs. 5.9%,P= 0.003; 19.7% vs. 7.9%,P< 0.001, respectively). Multivariate analysis showed that high RDW was significantly and independently associated with higher rates of 6-month mortality (hazard ratio: 2.909; 95% confidence interval: 1.166–7.257;P= 0.022). RDW was also a significant predictor for 6-month mortality independent of anemia (hazard ratio: 2.811; 95% confidence interval: 1.047–7.551;P= 0.040).

Conclusions:

We found a significant association between high RDW and in-hospital and 6-month mortality as well as the occurrence of major adverse cardiac event. Meanwhile RDW was found to be a significant predictor for 6-month mortality independent of anemia. Thus, it would be beneficial to use RDW as a risk stratification index to identify high risk intent-to-treat patients.
Association of Early Stress Testing with Outcomes for Emergency Department Evaluation of Suspected Acute Coronary Syndrome
Authors: Sun Benjamin C. , Laurie Amber , Fu Rongwei , Ferencik Maros , Shapiro Michael , Lindsell Christopher J. , Diercks Deborah , Hoekstra James W. , Hollander Judd E. , Kirk J. Douglas , Peacock W. Frank , Gibler W. Brian , Anantharaman Venkataraman , Pollack Charles V.
Published: May 2016

Background:

Professional society guidelines suggest early stress testing (within 72 hours) after an emergency department (ED) evaluation for suspected acute coronary syndrome (ACS). However, there is increasing concern that current practice results in over-testing without evidence of benefit. We test the hypothesis that early stress testing improves outcomes.

Methods:

We analyzed prospectively collected data from 9 EDs on patients with suspected ACS, 1999–2001. We excluded patients with an ED diagnosis of ACS. The primary outcome was 30-day major adverse cardiac events (MACEs), including all-cause death, acute myocardial infarction, and revascularization. We used the HEART score to determine pretest ACS risk (low, intermediate, and high). To mitigate potential confounding, patients with and without early stress testing were matched within pretest risk strata in a 1:2 ratio using propensity scores.

Results:

Of 7127 potentially eligible patients, 895 (13%) received early stress testing. The analytic cohort included 895 patients with early stress testing matched to 1790 without early stress testing. The overall 30-day MACE rate in both the source and analytic population was 3%. There were no baseline imbalances after propensity score matching (P > 0.1 for more than 30 variables). There was no association between early stress testing and 30-day MACE [odds ratio, 1.0; 95% confidence interval (CI), 0.6–1.7]. There was no effect modification by pretest risk (low: odds ratio, 1.0; 95% CI, 0.2–3.7; intermediate: 1.2; 95% CI, 0.6–2.6; high: 0.4; 95% CI, 0.1–1.6).

Conclusions:

Early stress testing is not associated with reduced MACE in patients evaluated for suspected ACS. Early stress testing may have limited value in populations with low MACE rate.
Utility of the Diamond-Forrester Classification in Stratifying Acute Chest Pain in an Academic Chest Pain Center
Authors: Hamburger Robert F. , Spertus John A. , Winchester David E.
Published: May 2016

Background:

Because the Diamond–Forrester (DF) model is predictive of obstructive coronary artery disease (CAD), it is often used to risk stratify acute chest pain patients. We sought to further evaluate the clinical utility of the DF model within a chest pain evaluation center.

Methods:

Consecutive patients with chest pain and no known CAD or evidence of active ischemia were asked to participate in a prospective registry. Patients were classified based on cardiovascular risk factors, age, and DF classification. We compared data from the emergency department course, Duke Activity Status Index (DASI) and Seattle Angina Questionnaire (SAQ), hospitalization rates, and results of testing between patients with typical angina and all others. Multivariate logistic regression was also used to assess for predictors of CAD by computed tomography coronary angiography (CTCA) or positive exercise treadmill testing (ETT).

Results:

Among 209 patients, 163 had atypical/noncardiac and 46 had typical chest pain. The SAQ and DASI scores were lower in the typical chest pain group (indicating more severe impairment), which were not statistically significantly different. There were no significant differences in risk factors or the results of CTCA, ETT, or cardiac catheterization. In the regression analysis, SAQ score, DASI score, and DF classification were not predictive of CAD by CTCA. Worsening angina frequency scores on the SAQ were marginally associated with positive ETT (OR, 1.04; P=0.04).

Conclusion:

In a contemporary low-risk acute chest pain population, typical angina, as defined by the DF classification, was not predictive of CAD or useful for identifying patients with higher symptom burden.
Postgraduate Education in Quality Improvement Methods
Authors: Winchester David E. , Burkart Thomas A. , Choi Calvin Y. , McKillop Matthew S. , Beyth Rebecca J. , Dahm Phillipp
Published: May 2016

Objective:

Training in quality improvement (QI) is a pillar of the next accreditation system of the Accreditation Committee on Graduate Medical Education and a growing expectation of physicians for maintenance of certification. Despite this, many postgraduate medical trainees are not receiving training in QI methods. We created the Fellows Applied Quality Training (FAQT) curriculum for cardiology fellows using both didactic and applied components with the goal of increasing confidence to participate in future QI projects.

Methods and Results:

Fellows completed didactic training from the Institute for Healthcare Improvement’s Open School and then designed and completed a project to improve quality of care or patient safety. Self-assessments were completed by the fellows before, during, and after the first year of the curriculum. The primary outcome for our curriculum was the median score reported by the fellows regarding their self-confidence to complete QI activities. Self-assessments were completed by 23 fellows. The majority of fellows (15 of 23, 65.2%) reported no prior formal QI training. Median score on baseline self-assessment was 3.0 (range, 1.85–4), which was significantly increased to 3.27 (range, 2.23–4; P = 0.004) on the final assessment. The distribution of scores reported by the fellows indicates that 30% were slightly confident at conducting QI activities on their own, which was reduced to 5% after completing the FAQT curriculum. An interim assessment was conducted after the fellows completed didactic training only; median scores were not different from the baseline (mean, 3.0; P = 0.51).

Conclusion:

After completion of the FAQT, cardiology fellows reported higher self-confidence to complete QI activities. The increase in self-confidence seemed to be limited to the applied component of the curriculum, with no significant change after the didactic component.
Prognostic Factors in Chest Pain Patients
Authors: Backus Barbra E. , Six A. Jacob , Doevendans Pieter A. , Kelder Johannes C. , Steyerberg Ewout W. , Vergouwe Yvonne
Published: May 2016

Objectives:

Risk stratification for chest pain patients at the emergency department is recommended in several guidelines. The history, ECG, age, risk factors, and troponin (HEART) score is based on medical literature and expert opinion to estimate the risk of a major adverse cardiac event. We aimed to assess the predictive effects of the 5 HEART components and to compare performances of the original HEART score and a model based on regression analysis.

Methods:

We analyzed prospectively collected data from 2388 patients, of whom 407 (17%) had a major adverse cardiac event within 6 weeks (acute myocardial infarction, percutaneous coronary intervention, coronary artery bypass graft, significant stenosis with conservative treatment and death due to any cause).

Results:

Univariate regression analysis showed the same ordering of predictive effects as used in the HEART score. Based on multivariable logistic regression analysis, an adjusted score showed slightly better calibration and discrimination (c statistic HEART, 0.83, HEART-adj, 0.85). In comparison to HEART, HEART-adj proved in a decision curve analysis clinically useful for decision thresholds over 25%. Nevertheless, the original HEART classified patients better than HEART-adj (net reclassification improvement = 14.1%).

Conclusion:

The previously chosen weights of the 5 elements of the HEART score are supported by multivariable statistical analyses, although some improvement in calibration and discrimination is possible by adapting the score. The gain in clinical usefulness is relatively small and supports the use of either the original or adjusted HEART score in daily practice.
Collection of Patients' Disability Status by Healthcare Organizations: Patients' Perceptions and Attitudes
Authors: Morris Megan A. , Schliep Megan , Liesinger Juliette , Cameron Kenzie A.
Published: May 2016

Recent policies call for healthcare organizations to consistently document patients' disability status for the purpose of tracking the quality of care experienced by patients with disabilities. The purpose of the study was to explore patients' attitudes toward healthcare organizations collecting disability status. We surveyed a convenience sample of patients in three outpatient clinics, including primary care and rehabilitation clinics. A total of 303 patients participated; 49% self-identified as disabled, 59% were female and the mean age was 52 years. The majority of participants (88%) either agreed or strongly agreed that it is important for healthcare organizations to collect information about disabilities; 77% stated that they were comfortable or very comfortable with healthcare organizations collecting this information. By contrast, we found that almost a quarter of participants had concerns with front desk staff collecting disability status information. When we presented disability questions endorsed by the Health and Human Services Department, over a quarter of participants (28%) felt that the questions were not inclusive of all disability categories. Although patients are supportive of healthcare organizations collecting disability status information, concerns exist regarding how the information is collected and which categories are included, suggesting the need for continued development of evidence-based, patient-centered methods and questions.
Domperidone is Commonly Prescribed With QT-Interacting Drugs
Authors: Ehrenpreis Eli D. , Roginsky Grigory , Alexoff Aimee , Smith Dylan G.
Published: May 2016

Introduction:

Domperidone, a peripheral D2 dopamine receptor antagonist, has efficacy for treatment of nausea, dyspepsia, and gastroparesis. Domperidone prolongs the QT interval (QTc), and may cause life-threatening arrhythmias.

Methods:

Electronic medical records for all patients receiving domperidone in the NorthShore University HealthSystem from January 1, 2008 to December 1, 2013 were reviewed. All concomitant medications were noted. The coadministration of QT-interacting medications was determined. Electrocardiogram (EKG) evaluation before and during domperidone therapy was noted. A query of the FDA Adverse Event Reporting System (FAERS) database was also performed. Individual reports from the FAERS Web site from January 2008 to June 2014 were downloaded and analyzed. The database was queried for all reports of adverse events with domperidone. Coadministration of QT-interacting medications was noted. Cardiac events that potentially were related to prolongation of the QTc were examined.

Results:

In total, 108 of 155 patients (69.7%) were coprescribed QT-interacting drugs along with domperidone. Fifty-nine of 155 patients (38.1%) underwent a baseline EKG and 9 (15.3%) had prolongation of the QTc at initiation. Forty patients (25.8%) had a follow-up EKG and 13 (32.5%) had prolongation of the QTc. All 13 were coprescribed QT-interacting medications. On the FAERS, 221 nonfatal cardiac events were reported in domperidone patients; of these, 162 (73.3%) occurred in patients receiving QT-interacting medications. Coprescription occurred in 53 of 151 deaths (35.1%) and in 16 of 61 cardiac arrests (26.2%).

Conclusions:

Coprescribing of QT-prolonging medications and inconsistent EKG monitoring occur in patients receiving domperidone, placing these patients at risk for arrhythmias.
Histologic Disease in Chinese Chronic Hepatitis B Patients With Low Viral Loads and Persistently Normal Alanine Aminotransferase Levels
Authors: Wang Hong , Ru Guo Qing , Yan Rong , Zhou Yin , Wang Ming Shan , Cheng Mei Juan
Published: May 2016

Background/Aim:

We aimed to evaluate the histopathologic characteristics of HBeAg-negative chronic hepatitis B patients with low hepatitis B virus (HBV) DNA levels (<2000 IU/mL) and persistently normal ALT levels and to determine indicators of significant liver disease.

Methods:

We examined 102 consecutive subjects who underwent percutaneous liver biopsy. Significant predictors of liver disease (stage ≥2 fibrosis or stage 1 fibrosis plus grade ≥2 inflammation), including demographic, clinical, and laboratory variables, were evaluated by means of univariate and multivariate logistic regression analyses.

Results:

Among the patients, 75.5% (77/102) had grade 0-1 inflammation and 77.5% (79/102) had stage 0-1 fibrosis. However, 38.2% (39/102) had significant liver disease. There were no statistically significant differences in clinical parameters such as age, biochemical profile, HBV DNA levels, HBsAg levels, and platelet count between patients with significant and those with nonsignificant liver disease. Patients with significant liver disease had higher values of aspartate transferase-to-platelet ratio index (APRI) and FIB-4 index compared with those with nonsignificant liver disease (0.35±0.21 vs. 0.27±0.12, P=0.02; 1.58±0.97 vs. 1.13±0.54, P=0.009, respectively). The area under the receiver operating characteristic (AUROC) curve of APRI for identifying active liver histology was 0.64 (95% CI, 0.53-0.75; P=0.019); the cutoff value was 0.24 with a sensitivity of 74% and specificity of 55%. In comparison, FIB-4 had equal power (the AUROC was 0.66) in predicting active liver histology.

Conclusion:

Among patients presenting with low HBV DNA levels and normal ALT levels, about 38.2% had significant liver disease. Neither serum HBsAg nor HBV DNA levels correlate with liver histology. However, APRI≥0.24 might be considered an indicator of liver biopsy.
The role of small bowel capsule endoscopy and ileocolonoscopy in patients with nonspecific but suggestive symptoms of Crohn’s disease
Authors: Mitselos Ioannis V. , Christodoulou Dimitrios K. , Katsanos Konstantinos H. , Tatsioni Athina , Rapti Aleksandra , Eliakim Rami , Tsianos Epameinondas V.
Published: May 2016

Objectives

Ileocolonoscopy (IC) and small bowel capsule endoscopy (SBCE) are essential tools in the investigation of suspected small bowel Crohn’s disease (CD). Overutilization of SBCE should be avoided as it leads to unwanted healthcare expenses; thus, it is recommended when IC is normal and CD is still highly suspected. Our aim was to compare the role of SBCE and IC in the investigation of suspected CD irrespective of its location and assess the additional diagnostic benefit of SBCE over IC.

Methods

This was a retrospective study of 91 patients with chronic abdominal pain and/or diarrhea. All patients were evaluated with both colonoscopy (with terminal ileum intubation where possible) and SBCE. The severity of inflammation on SBCE was assessed using the Lewis Score. Endoscopic findings were analyzed toward CD diagnosis.

Results

The sensitivity of IC and SBCE in the diagnosis of either small bowel or colonic CD was 81.82 and 63.64%, whereas the specificity was 77.50 and 92.50%, respectively. Positive and negative predictive value was 33.33 and 96.88% for IC, as well as 53.85 and 94.87% for SBCE. Area under receiver operating characteristic curve was 0.797 for IC and 0.781 for SBCE. IC was superior to SBCE in diagnosing small and large bowel CD. SBCE showed the true extent of CD in one patient missed by IC. It identified lesions suggestive of CD in three patients with normal IC, one of whom was finally diagnosed with CD.

Conclusion

IC should be the initial diagnostic test in patients with nonspecific, but suggestive symptoms of CD. SBCE offers additional information on small bowel mucosa and disease extent.
Clostridium Difficile Infection in Children
Authors: Borali Elena , De Giacomo Costantino
Published: May 2016

Clostridium difficile is a sporogenic, anaerobic, Gram‐positive, emerging enteric pathogen. It represents the most common cause of health care‐associated diarrhoea in the United States, with significantly associated morbidity, mortality, and health care costs. Historically regarded as a little more than an innocent coloniser bystander of the gastrointestinal tract of children, C difficile has increasingly demonstrated its behaviour as a true pathogen in the paediatric age groups. This organism may be responsible for a broad spectrum of diseases in children, ranging from self‐limiting secretory diarrhoea to life‐threatening conditions, such as pseudomembranous colitis, toxic megacolon, intestinal perforation, and septic shock. The incidence and severity of C difficile infection are, however, not completely understood in this population. In particular, although asymptomatic carriage remains high among infants, the clinical significance of detecting C difficile in children aged 1 to 3 years is not fully understood. Moreover, recent epidemiological surveillance has demonstrated a rise in the incidence of C difficile infection, particularly in the community and in low‐risk settings. Interestingly, such cases may not show the disease pattern to be associated with typical risk factors, such as recent exposure to antimicrobial drugs or on‐going contacts with the health care system.

The purpose of the present review is to present the features of C difficile infection that are unique to paediatric patients and to update paediatricians on information and recommendations regarding C difficile infection in children.
The effectiveness of a self-management occupational therapy intervention on activity performance in individuals with multiple sclerosis-related fatigue: a randomized-controlled trial
Authors: Kos Daphne , Duportail Marijke , Meirte Jill , Meeus Mira , D’hooghe Marie B. , Nagels Guy , Willekens Barbara , Meurrens Tom , Ilsbroukx Stephan , Nijs Jo
Published: May 2016

Purpose to evaluate the effectiveness of an individual self-management occupational therapy intervention program (SMOoTh) versus relaxation on the performance of and satisfaction with relevant daily activities in individuals with multiple sclerosis (MS)-related fatigue. in a single-blind randomized-controlled trial, 31 patients with MS (SMOoTh: n=17, relaxation: n=14) were randomly allocated to three individual sessions focusing on pacing, prioritizing, ergonomics, and self-management (SMOoTh) or on stress management and relaxation (relaxation). Outcomes (blind assessor): Canadian Occupational Performance Measure (COPM) (primary), Modified Fatigue Impact Scale, Checklist Individual Strength and Short-Form Health Measure. COPM improved in the SMOoTh and relaxation group after the intervention and 3 months later (COPM performance: F=13.1, P=0.001 and COPM satisfaction: F=10.4, P=0.001); nonsignificant group differences showed a trend in favor of SMOoTh. Modified Fatigue Impact Scale, Checklist Individual Strength, and most of the Short-Form Health Measure subscales did not change. Clinically relevant changes in COPM performance scores were found in 71 and 27% of patients in the SMOoTh versus the relaxation group. Both interventions seem to be feasible approaches to improve performance of and satisfaction with relevant daily activities in people with MS, with a sustained effect after 3 months. Neither program altered change fatigue (impact) or quality of life. Future studies with larger sample sizes are needed.
A Qualitative Study Exploring Moral Distress Among Pediatric Resuscitation Team Clinicians: Challenges to Professional Integrity*
Authors: Thomas Tessy A. , Thammasitboon Satid , Balmer Dorene F. , Roy Kevin , McCullough Laurence B.
Published: May 2016

Objective:

Our study objectives were to explore moral distress among pediatric team clinicians within the context of resuscitation experiences, and determine whether there were any distinctively ethical perspectives on moral distress that could be conceptualized as challenges to professional integrity, rather than to previously described psychological responses of clinicians.

Design:

Descriptive, exploratory qualitative study.

Setting:

A large tertiary pediatric academic hospital in Houston, TX.

Subjects:

Twenty-five PICU resuscitation team clinicians were interviewed from December 2012 to April 2013.

Interventions:

None.

Measurements and Main Results:

All clinicians reported experiencing moral distress during certain resuscitations. Twenty-one of 25 clinicians reflected and acknowledged that their sense of professional integrity had been challenged during those resuscitation events. Four main components of resuscitation experience that induced moral distress were identified: 1) experiences where there was lack of understanding of the big picture; 2) experiences where there was suboptimal team leadership; 3) experiences where there was variable meanings to the word “resuscitation”; and 4) experiences were there was uncertainty of role responsibility.

Conclusions:

The perception of moral distress exists among pediatric clinicians during resuscitations and could be conceptualized as challenges to professional integrity. This ethical framework offers an alternative approach to understanding and investigating the complex layers of moral distress.
The last common ancestor of most bilaterian animals possessed at least 9 opsins
Authors: Ramirez MD , Pairett AN , Pankey MS , Serb JM , Speiser DI , Swafford AJ , Oakley TH
Published: May 2016

The opsin gene family encodes key proteins animals use to sense light and has expanded dramatically since it originated early in animal evolution. Understanding the origins of opsin diversity can offer clues to how separate lineages of animals have repurposed different opsin paralogs for different light-detecting functions. However, the more we look for opsins outside of eyes and from additional animal phyla, the more opsins we uncover, suggesting we still do not know the true extent of opsin diversity, nor the ancestry of opsin diversity in animals. To estimate the number of opsin paralogs present in both the last common ancestor of the Nephrozoa (bilaterians excluding Xenoacoelomorpha), and the ancestor of Cnidaria + Bilateria, we reconstructed a reconciled opsin phylogeny using sequences from 14 animal phyla, especially the traditionally poorly-sampled echinoderms and molluscs. Our analysis strongly supports a repertoire of at least nine opsin paralogs in the bilaterian ancestor and at least four opsin paralogs in the last common ancestor of Cnidaria + Bilateria. Thus, the kernels of extant opsin diversity arose much earlier in animal history than previously known. Further, opsins likely duplicated and were lost many times, with different lineages of animals maintaining different repertoires of opsin paralogs. This phylogenetic information can inform hypotheses about the functions of different opsin paralogs and be used to understand how and when opsins were incorporated into complex traits like eyes and extraocular sensors.
Comprehensive analysis of RNA-sequencing to find the source of 1 trillion reads across diverse adult human tissues
Authors: Mangul Serghei , Yang Harry Taegyun , Strauli Nicolas , Gruhl Franziska , Porath Hagit T. , Hsieh Kevin , Chen Linus , Daley Timothy , Christenson Stephanie , Wesolowska-Andersen Agata , Spreafico Roberto , Rios Cydney , Eng Celeste , Smith Andrew D. , Hernandez Ryan D. , Ophoff Roel A. , Santana Jose Rodriguez , Levanon Erez Y. , Woodruff Prescott G. , Burchard Esteban , Seibold Max A. , Shifman Sagiv , Eskin Eleazar , Zaitlen Noah
Published: May 2016

High throughput RNA sequencing technologies have provided invaluable research opportunities across distinct scientific domains by producing quantitative readouts of the transcriptional activity of both entire cellular populations and single cells. The majority of RNA-Seq analyses begin by mapping each experimentally produced sequence (i.e., read) to a set of annotated reference sequences for the organism of interest. For both biological and technical reasons, a significant fraction of reads remains unmapped. In this work, we develop Read Origin Protocol (ROP) to discover the source of all reads originating from complex RNA molecules, recombinant T and B cell receptors, and microbial communities. We applied ROP to 8,641 samples across 630 individuals from 54 tissues. A fraction of RNA-Seq data (n=86) was obtained in-house; the remaining data was obtained from the Genotype-Tissue Expression (GTEx v6) project. To generalize the reported number of accounted reads, we also performed ROP analysis on thousands of different, randomly selected, and publicly available RNA-Seq samples in the Sequence Read Archive (SRA). Our approach can account for 99.9% of 1 trillion reads of various read length across the merged dataset (n=10641). Using in-house RNA-Seq data, we show that immune profiles of asthmatic individuals are significantly different from the profiles of control individuals, with decreased average per sample T and B cell receptor diversity. We also show that immune diversity is inversely correlated with microbial load. Our results demonstrate the potential of ROP to exploit unmapped reads in order to better understand the functional mechanisms underlying connections between the immune system, microbiome, human gene expression, and disease etiology. ROP is freely available athttps://github.com/smangul1/ropand currently supports human and mouse RNA-Seq reads.
Parasites and invasions: changes in gastrointestinal helminth assemblages in invasive and native rodents in senegal
Authors: Diagne Christophe , Ribas Alexis , Charbonnel Nathalie , Dalecky Ambroise , Tatard Caroline , Gauthier Philippe , Haukisalmi Voitto , Fossati-Gaschignard Odile , Bâ Khalilou , Kane Mamadou , Niang Youssoupha , Diallo Mamoudou , Sow Aliou , Piry Sylvain , Sembène Mbacké , Brouat Carine
Published: May 2016

Understanding why some exotic species become widespread and abundant in their colonized range is a fundamental issue that still needs to be addressed. Among many hypotheses, newly established host populations may benefit from a parasite loss (“enemy release” hypothesis) through impoverishment of their original parasite communities or reduced infection levels. Moreover, the fitness of competing native hosts may be affected by the acquisition of exotic taxa from invaders (“parasite spillover”) and/or by an increased transmission risk of native parasites due to their amplification by invaders (“parasite spillback”). We focused on gastrointestinal helminth communities to determine whether these predictions could explain the ongoing invasion success of the commensal house mouse (Mus musculus domesticus) and black rat (Rattus rattus), as well as the associated drop of native Mastomys species, in Senegal. For both invasive species, our results were consistent with the predictions of the enemy release hypothesis. A decrease of helminth overall prevalence and individual species richness was observed along the invasion gradients as well as lower specific prevalence/abundance (Aspiculuris tetraptera in M. m. domesticus, Hymenolepis diminuta in R. rattus) on the invasion fronts. Conversely, we did not find strong evidence of helminth spill-over or spill-back in invasion fronts, where native and invasive rodents co-occurred. Further experimental research is needed to determine whether and how the loss of helminths and reduced infection levels along invasion routes may result in any advantageous effects on invader fitness and competitive advantage.