bluuebunny/crossref_metadata_2025 huggingface dataset:
Indian Mental Healthcare Act, 2017: CBR Matrix for Inclusive Implementation
Authors: Sethi Deepa
Published: May 2018

India has witnessed a major shift from the predominant seclusion in the Indian Lunacy Act, 1912, when there was no effectiveness in the treatment provided, to the Mental Health Act, 1987, when the focus was on the treatment and care of mentally ill patients along with some efforts to de-stigmatize and ensure human rights, to the recent Mental Healthcare Act, 2017, which primarily focuses on the human rights of people with mental illness.

This article analyses the Indian Healthcare Act, 2017, which was passed on April 7, 2017. The IMHA 2017 is a welcome Act after its predecessor Mental Health Act, 1987; however, it is not the ultimate solution. This article analyses the IMHA 2017, highlights the impediments in its implementation and suggests a win–win model for its implementation. A tailored version of CBR matrix is proposed for the inclusive implementation of the IMHA, 2017.
Bazex syndrome in a patient with head and neck malignancy
Authors: Adelman Megan L. , Ho Quoc-Anh , Agrawal Amit
Published: May 2018

Bazex syndrome (acrokeratosis paraneoplastica) is an uncommon dermatologic condition associated with an underlying malignancy, most commonly squamous cell carcinomas of the head and neck. This article describes Bazex syndrome in a 56-year-old woman who presented with bilateral cervical lymphadenopathy and a mass at the base of her tongue.
An Innovative Teaching Model Using Intraprofessional Simulations
Authors: Boothby Johanna , Gropelli Theresa , Succheralli Lauren
Published: May 2018

Nursing programs are challenged to develop innovative approaches for admitting more students while providing a quality education that prepares them for safe practice. A clinical teaching model using simulation was developed as an innovative way to improve intraprofessional collaboration among junior- and senior-level nursing students. Students enrolled in Adult Health, Critical Care, and Management clinical courses rotate into the simulation lab throughout the semester. These experiences, with modified standardized simulations and simulations developed by faculty, have assisted students with teamwork, effective communication skills, delegation, and prioritization of care.
Framing Medicine as a Moral Practice: An Introductory Medical School Course
Authors: Allos Ban Mishu , Yakes Elizabeth Ann , Fleming Amy , Cutrer William B. , Pilla Michael , Clair Walter , Fowler Michael , Miller Bonnie
Published: May 2018

Problem

The transition into medical school represents a time of profound professional development for medical students. Many medical schools manage this transition with brief orientations followed by abrupt moves into the anatomy laboratory. Recognizing that early introduction of key humanistic concepts could have a lasting impact on students’ attitudes, faculty at the Vanderbilt University School of Medicine created the Foundations of the Profession (FoP) course to frame medicine as a moral practice.

Approach

The FoP course, offered annually since 2012, occurs during the first week of medical school. Using coronary artery disease with a chief complaint of angina as a core example, teams of students create variations of five hypothetical patients and walk them through potential care episodes. This allows students to compare the impact of many factors on a provider’s ability to uphold fundamental professional obligations. Students engage in readings, lectures, small-group discussions, clinic visits, and research on insurance plans. Faculty engage with students in small groups and establish a safe environment for discussion of challenging moral dilemmas.

Outcomes

From 2013 to 2016, 356 (97%) of the 368 first-year medical students who took the course submitted summative course evaluations. Of the respondents, 349 (98%) indicated they believed the course contributed to their professional development and supported their learning.

Next Steps

Future iterations of this course may include increased exposure to key educational faculty to solidify the formation of a moral scaffold on which to build subsequent knowledge.
Training Pediatricians to Address Health Disparities: An Innovative Residency Track Combining Global Health With Community Pediatrics and Advocacy
Authors: Pak-Gorstein Suzinne , Batra Maneesh , Johnston Brian , Grow H. Mollie , Grant Abigail , Shugerman Richard , Lago Sylvia , Stapleton F. Bruder , McPhillips Heather
Published: May 2018

Problem

Pediatric residency programs have been tasked to train a workforce of pediatricians with skills in community pediatrics (CP) and advocacy, and knowledge of global child health priorities.

Approach

In 2009, the University of Washington (UW) Seattle Children’s Hospital pediatric residency program developed the Resident Education in Advocacy and Child Health (REACH) program, a combined pathway for global health (GH) and CP training. After participating in a combined curriculum, residents complete a community immersion either in Kisii, Kenya (GH) or rural Washington (CP). This approach provides an efficient use of faculty and administrative resources and delivers a sustainable and ethical strategy for inspiring pediatric residents to address child health problems at a systems level.

Outcomes

Between 2009 and 2013, the percentage of graduating residents from the UW pediatric residency program who rated GH training as “outstanding/excellent/good” increased from 58.4% to 100%, and the percentage rating community and population health training as “outstanding/excellent/good” increased from 56% to 88.8%. Annual applicant surveys in the period 2011–2014 revealed that the REACH program led a significant percentage of candidates to rank the UW pediatric residency more favorably because of its GH (37%–48%) and CP (55%–74%) training.

Next Steps

A mixed-methods assessment will evaluate the impact on resident confidence in core areas of community health and advocacy including collaborating with community groups, setting professional career goals, addressing underlying determinants of health during patient encounters, communicating in cross-cultural settings, and advocating for child health. A survey will assess outcomes on graduates’ careers.
Reexamining the Call of Duty: Teaching Boundaries in Medical School
Authors: Chen Justin A. , Rosenberg Leah B. , Schulman Brian J. , Alpert Jonathan E. , Waldinger Robert J.
Published: May 2018

Although healthy physician–patient boundaries are essential to medical practice, published research on how to teach this important topic to medical students is lacking. Physician–patient boundaries, the interpersonal limits placed on behavior within a clinical relationship, protect providers and patients alike, and they represent a key component of professionalism. However, these boundaries may be difficult to teach and frequently are not presented as part of the formal curriculum, except in communication-focused specialties such as psychiatry and palliative care. Medical students may be particularly susceptible to boundary concerns due to the inherent ambiguities of their role within the medical team. In this Perspective, the authors present the adapted, anonymized case of a medical student who encountered a boundary issue during a clinical rotation. Following a brief review of the limited published literature regarding the teaching of boundaries during medical school, the authors define key concepts, including the clinical frame, boundary crossings and violations, fiduciary duty, and dual relationships. Next, they provide examples of common boundary challenges that arise during the course of undergraduate medical education and later during clinical practice. The authors present factors that may contribute to boundary concerns, including characteristics of providers and patients, and they describe some of the potential consequences of boundary violations. They propose a curriculum for teaching medical students about boundaries, providing concrete suggestions for how to do so at both the preclinical and clinical levels. Before closing, they apply insights from the Perspective to the example case.
Provider Perceptions of Bubble Continuous Positive Airway Pressure and Barriers to Implementation in a Level III Neonatal Unit in South India
Authors: Atreya Mihir R. , Lorenz John M. , Narendran Vivek
Published: May 2018

Background:

Bubble continuous positive airway pressure (bCPAP) is a simple, safe, and cost-effective strategy to provide respiratory support to newborns with respiratory distress syndrome in resource-limited settings.

Purpose:

To understand whether implementation of bCPAP, relative to other modes of respiratory support in the care of newborns with respiratory distress syndrome, increases positive attitudes about its potential for consistent and widespread use among providers in neonatal intensive care units (NICUs) of lower middle-income countries.

Methods:

Semistructured qualitative interviews with 14 healthcare providers, including 5 neonatal nurses, 2 respiratory therapists, 5 postgraduate trainees in pediatrics, and 2 attending physicians, were conducted at a level III NICU in south India where bCPAP had been in consistent use for 6 years. Interviews were transcribed and then coded and categorized using NVivo 10 Software (QSR International, Victoria, Australia).

Findings:

Categories that emerged from our data include (1) perceived indications, (2) learning curve, (3) perceived costs, (4) perceived shortages, and (5) barriers to use. Providers believed that bCPAP was easy to learn and that it helped empower neonatal nurses in decision-making process. Participants provided a nuanced perspective of cost-benefit associated with bCPAP and that it helped make optimal use of limited resources. Participants identified several barriers to the implementation of bCPAP.

Implications for Practice:

Providers of a level III NICU in a lower- to middle-income country viewed the use of bCPAP favorably. Addressing context-specific barriers will be important for the successful widespread implementation of bCPAP.

Implications for Research:

Further research will need to focus on whether bCPAP can be safely implemented at level II NICUs.

Video Abstract Available at https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?videoId=30&autoPlay=true.
Telephone-Based Progressive Tinnitus Management for Persons With and Without Traumatic Brain Injury: A Randomized Controlled Trial
Authors: Henry James A. , Thielman Emily J. , Zaugg Tara L. , Kaelin Christine , McMillan Garnett P. , Schmidt Caroline J. , Myers Paula J. , Carlson Kathleen F.
Published: May 2018

Objectives:

This randomized controlled trial evaluated the efficacy of delivering coping skills education from Progressive Tinnitus Management (PTM) by telephone (Tele-PTM). The trial followed a previous pilot study that showed positive results for Tele-PTM.

Design:

Participants included individuals with bothersome tinnitus (N = 205) located anywhere within the United States. A special emphasis was given to including individuals who had experienced one or more traumatic brain injuries (TBIs). Participants were randomized to either Tele-PTM intervention or 6-month wait-list control (WLC). The Tele-PTM intervention involved five telephone appointments—two led by an audiologist (teaching how to use therapeutic sound) and three by a psychologist (teaching coping skills derived from cognitive-behavioral therapy). It was hypothesized that Tele-PTM would be more effective than WLC in reducing functional effects of tinnitus as measured with the Tinnitus Functional Index. Additional outcome measures included the Self-Efficacy for Managing Reactions to Tinnitus questionnaire and the Hospital Anxiety and Depression Scale. The effect of Tele-PTM on outcomes was estimated using linear mixed models.

Results:

Overall results showed convincingly that the Tele-PTM group had significantly better outcomes than the WLC group. These results were consistent across all outcome measures, indicating not only a reduction of tinnitus functional distress but also increased self-efficacy. Improvements in measures of anxiety and depression were also observed. Tele-PTM participants in all TBI categories showed significant improvement.

Conclusions:

Results provide strong support for use of Tele-PTM methodology for persons with bothersome tinnitus, regardless of whether the person also has TBI symptoms. The effect size for Tele-PTM was high for the primary outcome measure, the Tinnitus Functional Index, and all other outcome measures showed significant improvement. Combined with our previous pilot study, the Tele-PTM method is validated for potential nationwide provision of tinnitus services.
Preparing Interprofessional Faculty to Be Humanistic Mentors for Medical Students: The GW-Gold Mentor Development Program
Authors: Blatt Benjamin , Plack Margaret M. , Simmens Samuel J.
Published: May 2018

Introduction:

The GW-Gold Humanistic Mentor Development Program addresses the challenge faced by medical schools to educate faculty to prepare students for humanistic practice. Grounded in Branch's Teaching Professional and Humanistic Values model, the program prepares interprofessional faculty mentoring teams in humanistic communities of practice. The teams consist of physician-psychosocial professional pairs, each mentoring a small student group in their professional development course. Through GW-Gold workshops, faculty mentors develop interprofessional humanistic communities of practice, preparing them to lead second such communities with their students. This article describes the program and its evaluation.

Methods:

To assess outcomes and better understand the mentor experience, we used a mixed-method validating triangulation design consisting of simultaneous collection of quantitative (mentor and student surveys) and qualitative (open-ended survey questions and focus group) data. Data were analyzed in parallel and merged at the point of interpretation, allowing for triangulation and validation of outcomes.

Results:

Mentors rated the program highly, gained confidence in their humanistic skills, and received high scores from students. Three themes emerged that validated program design, confirmed outcomes, and expanded on the mentor experience: (1) Interprofessional faculty communities developed through observation, collaboration, reflection, and dialogue; (2) Humanistic mentors created safe environments for student engagement; and (3) Engaging in interprofessional humanistic communities of practice expanded mentors' personal and professional identities.

Discussion:

Outcomes support the value of the GW-Gold program's distinctive features in preparing faculty to sustain humanism in medical education: an interprofessional approach and small communities of practice built on humanistic values.
Trace of survivin in cancer
Authors: Shojaei Fereshteh , Yazdani-Nafchi Farshad , Banitalebi-Dehkordi Mehdi , Chehelgerdi Mohammad , Khorramian-Ghahfarokhi Milad
Published: May 2018

Survivin is one of the most cancer-specific proteins overexpressed in almost all malignancies, but is nearly undetectable in most normal tissues in adults. Functionally, as a member of the inhibitor of apoptosis family, survivin has been shown to inhibit apoptosis and increase proliferation. The antiapoptotic function of survivin seems to be related to its ability to inhibit caspases directly or indirectly. Furthermore, the role of survivin in cell cycle division control is related to its role in the chromosomal passenger complex. Consistent with its determining role in these processes, survivin plays a crucial role in cancer progression and cancer cell resistance to anticancer drugs and ionizing radiation. On the basis of these findings, recently survivin has been investigated intensively as an ideal tumor biomarker. Thus, multiple molecular approaches such as use of the RNA interfering technique, antisense oligonucleotides, ribozyme, and small molecule inhibitors have been used to downregulate survivin regulation and inhibit its biological function consequently. In this review, all these approaches are explained and other compounds that induced apoptosis in different cell lines through survivin inhibition are also reported.
Metastatic acral lentiginous melanoma in a tertiary referral center in Switzerland: a systematic analysis
Authors: Häfliger Esther M. , Ramelyte Egle , Mangana Joanna , Kunz Michael , Kazakov Dmitry V. , Dummer Reinhard , Cheng Phil F.
Published: May 2018

Acral lentiginous melanoma (ALM) is a unique histopathological subtype of melanoma with a poorer prognosis than other cutaneous melanomas. This study aims to evaluate the clinicopathological characteristics, metastatic pattern, prognostic factors, response to systemic therapy, and overall survival (OS) of ALM in a White population. This is a retrospective study of patients who were diagnosed and/or treated for ALM at the Department of Dermatology of the University Hospital Zurich, Switzerland, from January 2005 to December 2015. Overall, 172 patients with histologically confirmed ALM were included in the study. In univariate Cox regression, Breslow thickness (P<0.001), age (P=0.003), status of sentinel lymph node (P=0.005), and ulceration (P=0.008) were identified as significant prognostic factors for OS in ALM. In multivariate analysis, only Breslow thickness (P=0.0003) showed statistical significance. The median OS (mOS) was 155.7 months in the entire cohort (n=172) and 11.2 months for stage IV patients (n=36), irrespective of treatment. When first treatment was considered (n=35), mOS for stage IV patients was 8.9, 16.6, 21.7, and 3.7 months, for patients who had received chemotherapy (ChT) (n=17), immunotherapy (n=9), targeted therapy (TT) (n=3), and no therapy (n=6), respectively. The overall response rate was 44% (7/16 patients) to ChT, 100% to TT (3/3), and 25% to ipilimumab (2/8). In our study, Breslow thickness represents the best prognostic factor for OS. In stage IV ALM patients treated with either immunotherapy or TT, there is a trend for extended mOS compared with ChT.
Reducing Intensive Care Unit Staff Musculoskeletal Injuries With Implementation of a Safe Patient Handling and Mobility Program
Authors: Ann Adamczyk Mary
Published: May 2018

The purpose of this safety initiative was to reduce work-related injuries through the implementation of a safe patient handling and mobility (SPHM) program in a medical intensive care unit. An SPHM program was implemented on a critical care medicine unit in February of 2017. Nursing and assistive personnel completed education via hands-on and online educational modules regarding SPHM equipment and techniques and an SPHM policy. All staff were expected to follow SPHM practices. Critical care medicine unit nursing leadership and unit-based SPHM peer coaches rounded to ensure staff compliance with the program. A 1-year evaluation demonstrated a reduction of 86% in work-related injuries. In 2016, there were 7 injuries while in 2017, only 1 injury occurred. Lost and restricted days away from work were reduced by 54% or from a total of 112 days in 2016 to 52 days in 2017. The implementation of an SPHM program in a medical intensive care unit appears to be highly effective at reducing health care worker injuries. More research is needed to identify the best and most effective ways to provide care to our most critical patients. Positive behaviors from the staff regarding the SPHM program have helped reduce injuries and lost workdays.
Joint Hypermobility Classes in 9-Year-Old Children from the General Population and Anxiety Symptoms
Authors: Ezpeleta Lourdes , Navarro José Blas , Osa Núria de la , Penelo Eva , Bulbena Antoni
Published: May 2018

Objective:

To obtain joint hypermobility classes in children from the general population and to study their characteristics in relation to anxiety measures.

Methods:

A total of 336 nine-year-old children from the general population were clinically assessed through 9 items of hypermobility, and their parents reported about the severity of anxiety symptoms. Latent class analysis was estimated to group the children according to the presence of hypermobility symptoms, and the obtained classes were related to anxiety.

Results:

A 2-class solution, labeled as high hypermobility and low hypermobility, best fitted the data. Children in the high hypermobility group scored higher in separation anxiety, social phobia, physical injury fears, and total anxiety than did those in the low group. When applying the threshold reference scores to the total anxiety score, 7.4% of children in the high hypermobility group versus 6% in the low group were reported to experience clinical elevations on total anxiety.

Conclusion:

High symptoms of hypermobility are associated with higher scores in anxiety symptoms in children from the general population. Children with frequent symptoms of hypermobility may benefit from screening for anxiety symptoms because a subset of them are experiencing clinical elevations and may need comprehensive physical and psychological treatment.
Integrating a Mobility Champion in the Intensive Care Unit
Authors: Bruce Rose , Forry Cheryl
Published: May 2018

In recent years, early progressive mobilization programs have become mainstays in intensive care units (ICUs). Significant evidence exists that early mobility programs decrease length of stay, reduce time on the ventilator, and decrease the development of delirium in ICU patients. Yet, current literature still describes many barriers to performing early mobility, such as the time required, staffing pressures, and increased workload. Our critical care leaders found that defining and implementing a dedicated mobility champion team member was successful in improving the effectiveness of our early mobility program. This article describes how to define the mobility champion role, consider options for the person in the role, and integrate this new role into the ICU team.
Nurse Satisfaction With Medical Emergency Team Nurses
Authors: Halupa Colleen M. , Halupa Michael S. , Warren Marty S.
Published: May 2018

Background

This 3-year study measured the satisfaction of staff nurses with medical emergency team (MET) nurse services at a 573-bed hospital in the south from 2015 through 2017. Nurse satisfaction is a key management issue. Barriers to effective MET use can negatively impact patient outcomes, staffing, and nurse turnover.

Objectives

The purpose of this study was to assess nurse satisfaction with MET nurses at a large county hospital in the south over a 3-year period.

Methods

Satisfaction was analyzed by shift, nurse role, the number of times the nurse contacted the MET nurse, and the way in which contact was initiated (MET nurse initiated vs nurse initiated). In addition, nurses responded to open-ended questions.

Results

Nurse satisfaction with MET nurse services was improved with both education and communication over time and stabilized over the 3-year period. More than 95% of nurses were satisfied or very satisfied overall with MET nurse services. There were statistically significant differences in satisfaction by shift worked, nurse role, and method of activation. There were no statistically significant differences by nursing floor.

Discussion

Nurse leaders can consider this MET nurse service as a potential model to help with increasing staff satisfaction, staff engagement, and, potentially, staff retention. More than 95% of nurses were satisfied or very satisfied overall with MET nurse services.
Patient Preferences for the Treatment of Basal Cell Carcinoma: A Mapping Review of Discrete Choice Experiments
Authors: Neal Donald E. , Feit Elea M. , Etzkorn Jeremy R.
Published: May 2018

BACKGROUND

Treatment options for skin cancer differ in several attributes including efficacy, convenience, cost, scarring, and side effects. Discrete choice experiments (DCEs) provide insight into how patients value the attributes of their treatment options.

OBJECTIVE

To review published DCE data on skin cancer treatment.

METHODS

PubMed database was systematically searched using predefined keyword combinations for articles pertaining to skin cancer treatment and DCEs through October 2017. Three hundred seventy unique article titles were evaluated, and titles that did not mention skin cancer treatment were excluded leaving 44 studies. Abstracts of 44 studies were examined, and studies that used DCEs to query preference for skin cancer treatment were included in this mapping review.

RESULTS

Six articles that used DCEs to query patient preference for skin cancer treatment were reviewed. All DCE studies identified focused on basal cell carcinoma.

CONCLUSION

Discrete choice experiments are a rigorous method of eliciting patient preference for skin cancer surgery. Recurrence was the most important attribute in 4 of the 6 studies reviewed. Appearance was the most important attribute in 1 study and the second most important in 3 studies. Comparisons between studies are limited by the heterogeneity of the treatment attributes and levels included in DCEs.
Mediation of Neighborhood Effects on Adolescent Substance Use by the School and Peer Environments
Authors: Rudolph Kara E. , Sofrygin Oleg , Schmidt Nicole M. , Crowder Rebecca , Glymour M. Maria , Ahern Jennifer , Osypuk Theresa L.
Published: May 2018

Background:

Evidence suggests that aspects of the neighborhood environment may influence risk of problematic drug use among adolescents. Our objective was to examine mediating roles of aspects of the school and peer environments on the effect of receiving a Section 8 housing voucher and using it to move out of public housing on adolescent substance use outcomes.

Methods:

We used data from the Moving to Opportunity (MTO) experiment that randomized receipt of a Section 8 housing voucher. Hypothesized mediators included school climate, safety, peer drug use, and participation in an after-school sport or club. We applied a doubly robust, semiparametric estimator to longitudinal MTO data to estimate stochastic direct and indirect effects of randomization on cigarette use, marijuana use, and problematic drug use. Stochastic direct and indirect effects differ from natural direct and indirect effects in that they do not require assuming no posttreatment confounder of the mediator–outcome relationship. Such an assumption would be at odds with any causal model that reflects an intervention affecting a mediator and outcome through adherence to treatment assignment.

Results:

Having friends who use drugs and involvement in after-school sports or clubs partially mediated the effect of housing voucher receipt on adolescent substance use (e.g., stochastic indirect effect 0.45% [95% confidence interval: 0.12%, 0.79%] for having friends who use drugs and 0.04% [95% confidence interval: −0.02%, 0.10%] for involvement in after-school sports or clubs mediating the relationship between housing voucher receipt and marijuana use among boys). However, these mediating effects were small, contributing only fractions of a percent to the effect of voucher receipt on probability of substance use. No school environment variables were mediators.

Conclusions:

Measured school- and peer-environment variables played little role in mediating the effect of housing voucher receipt on subsequent adolescent substance use.
Transmissibility of Norovirus in Urban Versus Rural Households in a Large Community Outbreak in China
Authors: Tsang Tim K. , Chen Tian-Mu , Longini Ira M. , Halloran M. Elizabeth , Wu Ying , Yang Yang
Published: May 2018

Background:

Norovirus is a leading cause of outbreaks of acute infectious gastroenteritis worldwide, yet its transmissibility within households and associated risk factors remain unknown in developing countries.

Methods:

Household, demographic, and clinical data were collected from a semi-urban area in south China where an outbreak occurred in the winter of 2014. Using a Bayesian modeling framework, we assessed the transmissibility and potential risk modifiers in both urban and rural households.

Results:

In urban apartment buildings, the secondary attack rates were 84% (95% credible interval [CI] = 60%, 96%) among households of size two and 29% (95% CI = 9.6%, 53%) in larger households. In the rural village, secondary attack rate estimates were lower than the urban setting, 13% (0.51%, 54%) for households of size two and 7.3% (0.38%, 27%) for larger households. Males were 31% (95% CI = 3%, 50%) less susceptible to the disease than female. Water disinfection with chlorine was estimated to reduce environmental risk of infection by 60% (95% CI = 26%, 82%), and case isolation was estimated to reduce person-to-person transmission by 65% (95% CI = 15%, 93%). Nausea and vomiting were not associated with household transmission.

Conclusions:

Norovirus is highly contagious within households, in particular in small households in urban communities. Our results suggest that water disinfection and case isolation are associated with reduction of outbreaks in resource-limited communities.
Evaluation of the Danish AirGIS air pollution modeling system against measured concentrations of PM2.5, PM10, and black carbon
Authors: Hvidtfeldt Ulla Arthur , Ketzel Matthias , Sørensen Mette , Hertel Ole , Khan Jibran , Brandt Jørgen , Raaschou-Nielsen Ole
Published: May 2018

Background:

Adverse health effects of air pollution have been reported in previous studies with varying methodological approaches to the exposure assessment. Measuring individual air pollution exposure for large-scale epidemiological studies is infeasible, calling for refined modeling tools. We evaluated the performance of the Geographical Information System–based air pollution and human exposure modeling system (AirGIS).

Methods:

Modeled concentrations were evaluated against measured concentrations of particulate matter (PM) less than 10 and 2.5 μm in aerodynamic diameter (PM10/PM2.5) from two fixed-site monitoring stations (background and street) and from two measurement campaigns in Copenhagen, Denmark. Modeled concentrations of black carbon (BC) were evaluated against measured PM2.5 absorbance and PM10 absorbance.

Results:

Mean concentrations measured in the four series were in the range of 10.4–15.3 μg/m3 for PM2.5 and 17.8–25.1 μg/m3 for PM10. The model underestimated by 7%–13% in comparison to the fixed-site monitoring stations. Correlation coefficients of 0.82 and 0.73 were observed for monthly and daily averages of measured and modeled PM2.5 at the background site and, correspondingly, 0.85 and 0.74 at the street site. The spatial variation, as evaluated from the two measurement campaigns, was also well reproduced. Correlation coefficients of 0.77 and 0.79 were observed for BC and PM2.5 absorbance and 0.76 for PM10 absorbance.

Conclusion:

The AirGIS framework showed an overall high degree of accuracy and will be applicable to future epidemiological studies on health effects of PM and BC.
Neuroprotective effects of Danshensu in Parkinson’s disease mouse model induced by 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine
Authors: Han Bing , Che Xin , Zhao Yue , Li Cuiting , He Jie , Lu Yan , Wang Zhenhua , Wang Tian
Published: May 2018

Parkinson’s disease (PD) causes major changes in dopaminergic neurons of the brain, resulting in motor symptoms in older adults. A previous study showed that Danshensu alleviates the cognitive decline by attenuating neuroinflammation. In the present study, we investigated the neuroprotective effect of Danshensu in the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) mouse model of PD. C57BL/6 mice were randomly divided into the following four groups: control, MPTP, Danshensu at 15 mg/kg, and Danshensu at 60 mg/kg. The mice were administered Danshensu intragastrically for 14 days. In the behavioral tests, Danshensu treatment alleviated motor dysfunction induced by MPTP. The number of tyrosine hydroxylase-positive neurons in the substantia nigra was significantly reduced in the MPTP group, relative to the control group; Danshensu partially blocked this reduction in tyrosine hydroxylase-positive neurons. In addition, Danshensu attenuated the reductions in striatal dopamine and 5-HT levels induced by MPTP. Danshensu also diminished the increase in Iba1-positive cells in the substantia nigra and reduced the levels of interleukin-1β and tumor necrosis factor-α in the striatum. These findings suggest that Danshensu exerts neuroprotective effects and improves motor function in PD mice, at least in part, by reducing neuroinflammation.
Development of an Enzyme-Linked Immune Sorbent Assay to Measure Nivolumab and Pembrolizumab Serum Concentrations
Authors: Basak Edwin A. , Wijkhuijs Annemarie J. M. , Mathijssen Ron H. J. , Koolen Stijn L. W. , Schreurs Marco W. J.
Published: May 2018

Background:

Treatment with monoclonal antibodies (mAbs) against programmed cell death protein 1 receptor is subject to high variation in treatment outcome among cancer patients. For these agents, no exposure–response (ER) relationships have been investigated in routine health care settings. However, ER relationships have been identified for several other mAbs used in oncology. Methods to conveniently measure serum concentrations of anti–programmed cell death protein 1 mAbs in routine health care may clarify possible ER relationships. Therefore, the authors aimed to develop an enzyme-linked immune sorbent assay (ELISA) for the measurement of both nivolumab and pembrolizumab serum concentrations of treated cancer patients.

Methods:

Optimal capture antigen and detection antibody concentrations were selected based on titrations. Nivolumab calibration standards ranging from 0.2 to 300 ng/mL were tested in duplicate. Accuracy was assessed in 2 recovery experiments. Intra- and interassay variations were assessed on 3 different days by 2 independent technicians. The developed ELISA was also set up for pembrolizumab calibration curves. Cross-reactivity of nivolumab measurements with ipilimumab was assessed. Of one nivolumab treated patient, serum concentrations in follow up samples were measured and presented.

Results:

Nivolumab calibration standards of 0.20–25 ng/mL were used. Nivolumab trough concentrations after 1 cycle in 8 patients ranged from 17.3 to 31.1 mcg/mL. The range of accuracy was 84%–105%, whereas intra- and interassay variations showed a coefficient of variation of 5.5% and 10.1%, respectively. No cross-reactivity with ipilimumab was detected. Pembrolizumab trough concentrations (n = 8) ranged from 9.1 to 19.7 mcg/mL after 1 infusion.

Conclusions:

The in-house–developed ELISA provides the opportunity to measure both nivolumab and pembrolizumab serum concentrations. This may help identify possible ER relationships in treated cancer patients and may potentially lead to dose adjustments in the future.
Comparison of Epithelium-Off Versus Transepithelial Corneal Collagen Cross-Linking for Keratoconus: A Systematic Review and Meta-Analysis
Authors: Wen Daizong , Song Benhao , Li Qi , Tu Ruixue , Huang Yingying , Wang Qinmei , McAlinden Colm , O'Brart David , Huang Jinhai
Published: May 2018

Purpose:

To systematically compare standard epithelium-off corneal collagen cross-linking (SCXL) and transepithelial corneal collagen cross-linking (TECXL) for treating keratoconus.

Methods:

PubMed, EMBASE, the Cochrane Library, the US trial registry (ClinicalTrials.gov), VIP Database, Wanfang Databse, and China National Knowledge Infrastructure searches up to February 2017 were conducted. Primary outcomes were changes at 1 year in uncorrected distance visual acuity, maximum keratometry (Kmax), and mean keratometry (mean K). Secondary outcomes were changes at 1 year in corrected distance visual acuity, mean refractive spherical equivalent, central corneal thickness, endothelial cell density, and the occurrence of adverse events.

Results:

Eight studies with a total of 455 eyes were included. For primary outcomes, SCXL showed a greater reduction in mean K [standardized mean difference (SMD) 0.28; 95% confidence interval (CI), 0.03–0.53; P = 0.03] compared with TECXL. Subgroup analysis indicated that SCXL had a comparable effect on reducing mean K with TECXL protocols using chemical enhancers (SMD 0.05; 95% CI, −0.36 to 0.45; P = 0.82) but a greater reduction in mean K compared with TECXL with current iontophoretic protocols (SMD 0.43; 95% CI, 0.10–0.75; P = 0.01). For the other outcomes, there were no statistically significant differences.

Conclusions:

With the exception of less reduction in mean K with current iontophoretic protocols, analysis of the limited number of comparative studies available seems to demonstrate that SCXL and TECXL have a comparable effect on visual, refractive, pachymetric, and endothelial parameters at 1 year after surgery. Further follow-up is required to determine whether these techniques are comparable in the long-term.
Newborn Glaucoma: Do not Forget Infections
Authors: Kaushik Sushmita , Kataria Pankaj , Joshi Gunjan , Singh Mini P. , Ram Jagat
Published: May 2018

Intrauterine infections can affect various structures of the developing fetal eye. Rubella infection results in congenital cataracts, keratopathy, retinopathy and less commonly, glaucoma. Ophthalmic manifestations of intrauterine cytomegalovirus (CMV) infection have been reported to be chorioretinitis, optic nerve colobomas, and corneal opacities, but have not been implicated in congenital cataract or congenital glaucoma. Concurrent infection with both rubella and CMV virus has not been reported. We report concurrent rubella and CMV infection in a baby born with corneal opacification, severe congenital glaucoma, and congenital cataract. It is important to recognize these babies early and investigate for intrauterine infections rather than assume they are all primary congenital glaucoma. Involvement of the cornea, glaucoma, and cataract make management of these babies a major challenge requiring a multidisciplinary team approach.
Using Practice-Based Coaching to Increase Use of Language Facilitation Strategies in Early Head Start and Community Partners
Authors: Donegan-Ritter Mary , Van Meeteren Beth
Published: May 2018

This article describes how practice-based coaching was used with Early Head Start infant and toddler teachers to support their use of evidence-based language facilitation strategies. Video-based self-reflection and focused feedback allowed teachers to recognize what they were already doing well and increased the fidelity of evidence-based practices. Observational data show changes that took place over the course of the 3 monthly coaching cycles and 6-month follow-up. Teachers increased their use of encouraging back-and-forth exchanges and parallel talk to varying extents. Goal setting was associated with infant–toddler teachers increasing their use of specific strategies. Coach use of nonjudgmental “I notice” statements contributed to a safe and supportive experience. In this pilot study, infant–toddler teachers benefitted from video-based self-reflection and coaching to transfer the use of language facilitation strategies. Focusing on teacher strengths and creating opportunities for skill development through goal setting, individualized support and performance-based feedback facilitated the use of language facilitation strategies in infant–toddler care settings.
Selective deficiencies in descending inhibitory modulation in neuropathic rats: implications for enhancing noradrenergic tone
Authors: Patel Ryan , Qu Chaoling , Xie Jennifer Y. , Porreca Frank , Dickenson Anthony H.
Published: May 2018

Pontine noradrenergic neurones form part of a descending inhibitory system that influences spinal nociceptive processing. Weak or absent descending inhibition is a common feature of chronic pain patients. We examined the extent to which the descending noradrenergic system is tonically active, how control of spinal neuronal excitability is integrated into thalamic relays within sensory-discriminative projection pathways, and how this inhibitory control is altered after nerve injury. In vivo electrophysiology was performed in anaesthetised spinal nerve–ligated (SNL) and sham-operated rats to record from wide dynamic range neurones in the ventral posterolateral thalamus (VPL). In sham rats, spinal block of α2-adrenoceptors with atipamezole resulted in enhanced stimulus-evoked and spontaneous firing in the VPL, and produced conditioned place avoidance. However, in SNL rats, these conditioned avoidance behaviours were absent. Furthermore, inhibitory control of evoked neuronal responses was lost, but spinal atipamezole markedly increased spontaneous firing. Augmenting spinal noradrenergic tone in neuropathic rats with reboxetine, a selective noradrenergic reuptake inhibitor, modestly reinstated inhibitory control of evoked responses in the VPL but had no effect on spontaneous firing. By contrast, clonidine, an α2 agonist, inhibited both evoked and spontaneous firing, and exhibited increased potency in SNL rats compared with sham controls. These data suggest descending noradrenergic inhibitory pathways are tonically active in sham rats. Moreover, in neuropathic states, descending inhibitory control is diminished, but not completely absent, and distinguishes between spontaneous and evoked neuronal activity. These observations may have implications for how analgesics targeting the noradrenergic system provide relief.
What Is It Like to Experience Improved Care Coordination Through a Community Outreach Program? A Qualitative, Descriptive Study
Authors: Baur Karen , Smith Tracey , Wendler M. Cecilia
Published: May 2018

Community-based programs deploying community health workers (CHWs) who collaborate with other entities are beginning to emerge as the US health system evolves. Although these programs have used various evaluation criteria to determine program success, little research has been completed to examine the experiences of program participants as they receive these services. The purpose of this qualitative descriptive study was to describe what it was like to experience the benefit of improved care coordination through a community-based program featuring CHWs, in collaboration with community-based interprofessional providers. Knowing the help I needed emerged as the overarching theme.
Improving Adherence to Mediterranean-Style Diet With a Community Culinary Coaching Program
Authors: Polak Rani , Pober David , Morris Avigail , Arieli Rakefet , Moore Margaret , Berry Elliot , Ziv Mati
Published: May 2018

The Community Culinary Coaching Program is a community-based participatory program aimed at improving communal settlement residents' nutrition. The residents, central kitchens, preschools, and communal dining rooms were identified as areas for intervention. Evaluation included goals accomplishment assessed by food purchases by the central kitchens, and residents' feedback through focus groups. Purchasing included more vegetables (mean (standard error) percent change), (+7% (4); P = .32), fish (+115% (11); P < .001), whole grains, and legumes (+77% (9); P < .001); and less soup powders (−40% (9); P < .05), processed beef (−55% (8); P < .001), and margarine (−100% (4); P < .001). Residents recommended continuing the program beyond the project duration. This model might be useful in organizations with communal dining facilities.
Characteristics of Involuntarily Admitted Patients and Treatment Patterns Over a 21-Year Observation Period
Authors: Welte Anna-Sophia , Edlinger Monika , Kemmler Georg , Yalcin-Siedentopf Nursen , Fleischhacker W. Wolfgang , Hofer Alex
Published: May 2018

Background

Patients suffering from psychiatric disorders are often treated in locked psychiatric units owing to psychomotor agitation, hostility and aggressive behavior, or suicidality. Because of legal conditions, investigations of these acutely ill patients are difficult, and many studies do not represent real-life psychiatry. In Austria, admission to a locked psychiatric unit is regulated by a national law for involuntary admission, which came into effect in 1991. The current retrospective study investigated the management of patients who were admitted involuntarily to an academic treatment center after the inauguration of this law.

Methods

Data collection comprised all admissions to a locked unit at the Department of Psychiatry, Psychotherapy and Psychosomatics of the Medical University Innsbruck in the years 1992, 1997, 2002, 2007, and 2012. Demographics, admission diagnosis, current danger posed to self or others, and the initial psychopharmacological intervention were assessed.

Results

The rate of admissions to a locked unit increased significantly throughout the course of the study, and the length of stay decreased from 8.57 days in 1997 to 6.43 days in 2012. Most patients received medication orally. Dosage of antipsychotics and benzodiazepines decreased throughout the investigation period. Self-endangering patients were treated with somewhat (nonsignificantly) higher benzodiazepine and significantly lower antipsychotic mean doses than patients posing danger to others.

Conclusions

Although dosage of medication was reduced, the duration of stay in a locked unit decreased significantly over the investigated years. These findings suggest that a carefully considered pharmacological treatment may be at least as effective as a more aggressive approach.
Multidisciplinary management of oculo-auriculo-vertebral spectrum
Authors: Vong Angela , Funamura Jamie
Published: May 2018

Purpose of review

Oculo-auriculo-vertebral spectrum (OAVS) is a complex disorder that is represented by wide variations in phenotypic presentation. Recent publications and systematic reviews of the available literature are presented here.

Recent findings

Treatment strategies vary among craniofacial centers across the country. Advances in presurgical planning, virtual surgical planning, and computer-aided manufacturing have been incorporated in the treatment of patients. The psychosocial effect of OAVS with longitudinal follow-up is now being studied.

Optimal evaluation and management of the OAVS patient requires an awareness of the phenotypic and genetic differences and involves a multidisciplinary team in order to effectively and appropriately diagnose and treat such patients.
Factors Associated With Length of Stay and 30‐Day Revisits in Pediatric Acute Pancreatitis
Authors: Gay Anna C. , Barreto Nicolas B. , Schrager Sheree M. , Russell Christopher J.
Published: May 2018

Objective:

The objective of the study was to identify factors associated with length of stay (LOS) and 30‐day hospital revisit for patients hospitalized with acute pancreatitis (AP).

Method:

Multicenter, retrospective cohort study using the Pediatric Health Information System database. Multilevel linear and logistic regression was used to identify factors independently associated with the primary outcome variables of LOS and 30‐day hospital revisit in children aged 1 and 18 years discharged with a primary discharge diagnosis of AP from participating hospitals between 2008 and 2013.

Results:

For the 7693 discharges, median LOS was 4 days (interquartile range 3–7 days) and 30‐day revisit rate 17.6% (n = 1356). Discharges were primarily girls (55%), Caucasian (46%), and 6 years old or older (85%). On multilevel regression, factors independently associated with both longer LOS and higher revisit odds included malignant and gastrointestinal complex chronic conditions (CCCs) and total parenteral nutrition use while hospitalized. Male gender was associated with both lower LOS (adjusted length of stay = −0.6 days, 95% confidence interval [CI] = −0.8 to −0.4) and decreased revisit odds (aOR 0.85; 95% CI = 0.74 to 0.97). Hispanic ethnicity was associated with increased LOS (adjusted length of stay = +0.8 days, 95% CI = +0.5 to +1.1), but no change in revisit odds.

Conclusions:

Certain demographic and clinical factors, including gender, ethnicity, and type of CCC, were independently associated with LOS and risk of 30‐day hospital revisit for pediatric AP. Children with malignant and gastrointestinal CCCs who require total parenteral nutrition are at highest risk for both longer LOS and hospital revisit when admitted with AP. These patient populations may benefit from intensive care coordination when hospitalized for AP.