bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy and Safety of Transbrachial Access for Iliac Endovascular Interventions
Authors: Stavroulakis Konstantinos , Usai Marco V. , Torsello Giovanni , Schwindt Arne , Stachmann Arne , Beropoulis Efthymios , Bisdas Theodosios
Published: April 2016

Purpose: To evaluate the use of a brachial artery access for endovascular treatment of iliac artery disease. Methods: A retrospective review was conducted of 201 patients (mean age 73 years; 147 men) treated via a brachial artery access for iliac artery stenosis. The majority (n=141, 70%) presented with lifestyle-limiting claudication (Rutherford category 3), whereas the incidence of critical limb ischemia (Rutherford categories 4–6) was 30% (n=70). Diagnostic angiography revealed a TransAtlantic Inter-Society Consensus II (TASC) C/D lesion in 114 (57%) patients. The primary outcome was technical success achieved exclusively with a brachial artery access. Secondary outcomes were secondary technical success (adjunctive transfemoral access), access site complications, and stroke/transient ischemic attack (TIA). Results: In 17 (8%) patients, lesion crossing was unsuccessful, while an adjunctive transfemoral approach was necessary to restore iliac vessel patency in 23 (11%) cases. Thus, the primary and secondary technical success rates were 81% and 92%, respectively. Local hematomas (9, 4%) dominated the access site complications, followed by pseudoaneurysms (8, 4%), late brachial artery bleeding (4, 2%), brachial artery occlusion (2, 1%), and puncture site infection (2, 1%). No transient or permanent median nerve dysfunction was observed. The stroke/TIA rate was 2% (n=4). A single patient died due to acute coronary syndrome (0.5% mortality). TASC II class (p=0.58), sex (p=0.66), and target vessel (p>0.3 for all locations) had no effect on technical success. Female gender unfavorably influenced the incidence of access site complications (hazard ratio 6.7, 95% confidence interval 2.7 to 15, p<0.001), but sheath size did not (p=0.22). Conclusion: Brachial artery access enables endovascular treatment of iliac artery disease in the majority of patients, although an adjunctive transfemoral access may be required. However, the high incidences of access site complications and cerebral events remain a significant limitation of the transbrachial approach.
An Evaluation of Robotic and Conventional IMRT for Prostate Cancer: Potential for Dose Escalation
Authors: Pinnaduwage Dilini S. , Descovich Martina , Lometti Michael W. , Varad Badri , Roach Mack , Gottschalk Alexander R.
Published: April 2016

This study compares conventional and robotic intensity modulated radiation therapy (IMRT) plans for prostate boost treatments and provides clinical insight into the strengths and weaknesses of each. The potential for dose escalation with robotic IMRT is further investigated using the “critical volume tolerance” method proposed by Roach et al. Three clinically acceptable treatment plans were generated for 10 prostate boost patients: (1) a robotic IMRT plan using fixed cones, (2) a robotic IMRT plan using the Iris variable aperture collimator, and (3) a conventional linac based IMRT (c-IMRT) plan. Target coverage, critical structure doses, homogeneity, conformity, dose fall-off, and treatment time, were compared across plans. The average bladder and rectum V75 was 17.1%, 20.0%, and 21.4%, and 8.5%, 11.9%, and 14.1% for the Iris, fixed, and c-IMRT plans, respectively. On average the conformity index (nCI) was 1.20, 1.30, and 1.46 for the Iris, fixed, and c-IMRT plans. Differences between the Iris and the c-IMRT plans were statistically significant for the bladder V75 (P= .016), rectum V75 (P= .0013), and average nCI (P =.002). Dose to normal tissue in terms of R50 was 4.30, 5.87, and 8.37 for the Iris, fixed and c-IMRT plans, respectively, with statistically significant differences between the Iris and c-IMRT (P = .0013) and the fixed and c-IMRT (P = .001) plans. In general, the robotic IMRT plans generated using the Iris were significantly better compared to c-IMRT plans, and showed average dose gains of up to 34% for a critical rectal volume of 5%.
The Brief Student–Teacher Classroom Interaction Observation
Authors: Reinke Wendy M. , Herman Keith C. , Newcomer Lori
Published: April 2016

Measures that can be used to identify malleable, dynamic indicators of teacher practices that lead to or are associated with student outcomes are needed to inform classroom interventions and consultation practices with teachers. The purpose of this study was to evaluate and validate the Brief Student–Teacher Classroom Interaction Observation in elementary classrooms (Grades K–3). A universal sample of 896 students was observed during classroom instruction. The measure was utilized to gather information on how teachers interacted with students with regard to their use of positive versus negative feedback during a 5-min window at the start of the school year. Findings indicate that students who received more negative feedback than positive feedback from their teacher were rated at the end of the year as having a significant increase in problems with emotion regulation, concentration problems, and observed disruptive behavior, whereas students who received more positive feedback demonstrated significant increases in prosocial behaviors. Implications for how this brief 5-min observation can be used to inform teacher practice and identify students at the start of the year in need of additional supports are discussed.
The Use of Both Prolonged Exposure and Cognitive Processing Therapy in the Treatment of a Person With PTSD, Multiple Traumas, Depression, and Suicidality
Authors: Gurak Kayla K. , Freund Blanche , Ironson Gail
Published: April 2016

Despite a high prevalence of comorbid disorders such as major depressive disorder (MDD), the empirical guidelines for how to manage co-occurring conditions in the treatment of posttraumatic stress disorder (PTSD) are lacking. In the context of a complicated presentation of PTSD, this case illustration demonstrates the application of an integrated treatment approach with “Amanda,” a 28-year-old female with a history of multiple traumas, undiagnosed PTSD for 10 years, and comorbid MDD. In addition, Amanda began having suicidal thoughts mid-treatment. This case study demonstrates how the integration of coping skills training and cognitive processing therapy, in conjunction with prolonged exposure, helped Amanda successfully complete treatment and be able to discuss her traumatic events with minimal distress. At discharge, Amanda no longer met criteria for PTSD, had experienced significant improvements in depression and anxiety symptoms, and was no longer experiencing suicidal thoughts. These improvements were maintained at both 3 and 6 months post treatment.
A novelin vitroplatform for the study of SN38-induced mucosal damage and the development of Toll-like receptor 4-targeted therapeutic options
Authors: Wardill Hannah R , Gibson Rachel J , Van Sebille Ysabella ZA , Secombe Kate R , Logan Richard M , Bowen Joanne M
Published: April 2016

Tight junction and epithelial barrier disruption is a common trait of many gastrointestinal pathologies, including chemotherapy-induced gut toxicity. Currently, there are no validated in vitro models suitable for the study of chemotherapy-induced mucosal damage that allow paralleled functional and structural analyses of tight junction integrity. We therefore aimed to determine if a transparent, polyester membrane insert supports a polarized T84 monolayer with the phenotypically normal tight junctions. T84 cells (passage 5–15) were seeded into either 0.6 cm2, 0.4 µm pore mixed-cellulose transwell hanging inserts or 1.12 cm2, 0.4 µm pore polyester transwell inserts at varying densities. Transepithelial electrical resistance was measured daily to assess barrier formation. Immunofluoresence for key tight junction proteins (occludin, zonular occludens-1, claudin-1) and transmission electron microscopy were performed to assess tight junction integrity, organelle distribution, and polarity. Reverse transcription-polymerase chain reaction was performed to determine expression of toll-like receptor 4 (TLR4). Liquid chromatography was also conducted to assess SN38 degradation in this model. Polyester membrane inserts support a polarized T84 phenotype with functional tight junctions in vitro. Transmission electron microscopy indicated polarity, with apico-laterally located tight junctions. Immunofluorescence showed membranous staining for all tight junction proteins. No internalization was evident. T84 cells expressed TLR4, although this was significantly lower than levels seen in HT29 cells ( P = .0377). SN38 underwent more rapid degradation in the presence of cells (−76.04 ± 1.86%) compared to blank membrane (−48.39 ± 4.01%), indicating metabolic processes. Polyester membrane inserts provide a novel platform for paralleled functional and structural analysis of tight junction integrity in T84 monolayers. T84 cells exhibit the unique ability to metabolize SN38 as well as expressing TLR4, making this an excellent platform to study clinically relevant therapeutic interventions for SN38-induced mucosal damage by targeting TLR4.
Evaluation of a bilayered, micropatterned hydrogel dressing for full-thickness wound healing
Authors: Magin Chelsea M , Neale Dylan B , Drinker Michael C , Willenberg Bradley J , Reddy Shravanthi T , La Perle Krista MD , Schultz Gregory S , Brennan Anthony B
Published: April 2016

Nearly 12 million wounds are treated in emergency departments throughout the United States every year. The limitations of current treatments for complex, full-thickness wounds are the driving force for the development of new wound treatment devices that result in faster healing of both dermal and epidermal tissue. Here, a bilayered, biodegradable hydrogel dressing that uses microarchitecture to guide two key steps in the proliferative phase of wound healing, re-epithelialization, and revascularization, was evaluated in vitro in a cell migration assay and in vivo in a bipedicle ischemic rat wound model. Results indicate that the Sharklet™-micropatterned apical layer of the dressing increased artificial wound coverage by up to 64%, P = 0.024 in vitro. In vivo evaluation demonstrated that the bilayered dressing construction enhanced overall healing outcomes significantly compared to untreated wounds and that these outcomes were not significantly different from a leading clinically available wound dressing. Collectively, these results demonstrate high potential for this new dressing to effectively accelerate wound healing.
Phospholipid transfer protein deficiency in mice impairs macrophage reverse cholesterol transportin vivo
Authors: Si Yanhong , Zhang Ying , Chen Xiaofeng , Zhai Lei , Zhou Guanghai , Yu Ailing , Cao Haijun , Shucun Qin
Published: April 2016

Phospholipid transfer protein is expressed in various cell types and secreted into plasma, where it transfers phospholipids between lipoproteins and modulates the composition of high-density lipoprotein particles. Phospholipid transfer protein deficiency in vivo can lower high-density lipoprotein cholesterol level significantly and impact the biological quality of high-density lipoprotein. Considering high-density lipoprotein was a critical determinant for reverse cholesterol transport, we investigated the role of systemic phospholipid transfer protein deficiency in macrophage reverse cholesterol transport in vivo. After the littermate phospholipid transfer protein KO and WT mice were fed high-fat diet for one month, they were injected intraperitoneally with3H-cholesterol-labeled and acLDL-loaded macrophages. Then the appearance of3H-tracer in plasma, liver, bile, intestinal wall, and feces over 48 h was determined. Plasma lipid analysis indicated phospholipid transfer protein deficiency lowered total cholesterol, high-density lipoprotein-C and apolipoprotein A1 levels significantly but increased triglyceride level in mice. The isotope tracing experiment showed3H-cholesterol of plasma was decreased by 68% for male and 62% for female, and3H-tracer of bile was decreased by 37% for male and 21% for female in phospholipid transfer protein KO mice compared with WT mice. However, there was no difference in liver, and3H-tracer of intestinal wall was increased by 43% for male and 27% for female. Finally,3H-tracer of fecal excretion in phospholipid transfer protein KO mice was reduced significantly by 36% for male and 43% for female during 0–24 h period, but there was no significant difference during 24–48 h period. Meanwhile, Western Blot analysis showed the expressions of reverse cholesterol transport -related protein liver X receptor α (LXRα), ATP binding cassette transporter A1, and cholesterol 7α-hydroxylase A1 were upregulated in liver of phospholipid transfer protein KO mice compared with WT mice. These data reveal that systemic phospholipid transfer protein deficiency in mice impairs macrophage-specific reverse cholesterol transport in vivo.
Enhanced protection against renal ischemia–reperfusion injury with combined melatonin and exendin-4 in a rodent model
Authors: Chang Yi-Chih , Hsu Shu-Yuan , Yang Chih-Chao , Sung Pei-Hsun , Chen Yi-Ling , Huang Tien-Hung , Kao Gour-Shenq , Chen Sheng-Yi , Chen Kuan-Hung , Chiang Hsin-Ju , Yip Hon-Kan , Lee Fan-Yen
Published: April 2016

We tested the hypothesis that combined treatment with melatonin, an anti-oxidant, and exendin-4, an anti-inflammatory agent, was superior to either alone for protecting the kidney from ischemia–reperfusion (IR) injury. Male adult Sprague-Dawley rats (n=40) were equally divided into group 1 (sham-operated control), group 2 (IR only, IR=1h/72h), group 3 (IR–exendin-4, 10 µg/kg at 30 min, 24 h, 48 h after IR procedure), group 4 (IR–melatonin, i.p. 50 mg at 30 min, then 20 mg at 6 and 18 h after IR procedure), and group 5 (combined IR–exendin-4–melatonin). All animals were sacrificed by 72 h after IR/sham procedure. The results showed that the kidney injury score, plasma creatinine, and blood urea nitrogen (BUN) levels were highest in group 2 and lowest in group 1, significantly higher in groups 3 and 4 than those in group 5 and significantly higher in group 3 than those in group 4 (all p < 0.001). The protein expressions of inflammatory (toll-like receptor 4, inducible nitric oxide synthase, interleukin-1β), apoptotic (mitochondrial Bax, cleaved caspase-3 and poly(ADP-ribose) polymerase, p53), podocyte integrity (E-cadherin, P-cadherin), and cell survival (phosphatidylinositol-3-kinase/AKT/mammalian target of rapamycin) biomarkers, as well the podocyte dysfunction biomarkers (Wnt1/Wnt4/β-catenin) displayed a pattern identical to that of creatinine level among the five groups (all p < 0.001). Microscopic findings demonstrated that podocyte dysfunction (Wnt1/Wnt4/β-catenin expression) and inflammatory (CD14 and F4/80-positively stained cells) biomarkers exhibited an identical pattern, whereas that of antioxidant (HO-1+, NQO-1+ cells) biomarkers showed an opposite pattern compared to that of creatinine level among the five groups (all p < 0.001). Combined melatonin–exendin-4 therapy offered an additional benefit in protecting the kidney from acute IR injury.
Endovascular Treatment of a Dorsalis Pedis Artery Pseudoaneurysm
Authors: Kolber Marcin K. , Shukla Pratik A. , Kumar Abhishek , Berkowitz Eric
Published: April 2016

Pseudoaneurysm of the dorsalis pedis artery (DPA) is an extremely rare entity that most commonly occurs secondary to trauma or surgery. All reported cases describe surgical treatment. We illustrate a case of enlarging DPA pseudoaneurysm causing pain and disability in a 49-year-old woman who was treated with transcatheter embolization and pseudoaneurysm aspiration resulting in near-immediate resolution of symptoms.
Management of Acute Mesenteric Ischemia
Authors: Zhao Yang , Yin Henghui , Yao Chen , Deng Jiong , Wang Mian , Li Zilun , Chang Guangqi
Published: April 2016

Background:

Acute mesenteric ischemia (AMI) due to a sudden loss or decrease in blood perfusion to the mesentery represents a highly lethal condition. However, the optimal surgical management remains debatable and merits a more clear recommendation based on a higher level of evidence.

Methods:

A systematic review of articles published between 2000 and 2013 was performed. Patients were divided into endovascular treatment (ET), open surgery (OS), and hybrid technique (HT) groups. Data of patients’ demographics, procedural information, clinical outcomes including mortality, morbidity, primary patency rate, technique success, primary intestinal resection rate, and second-look laparotomy rate, and follow-up were all retrieved. Comparison between the ET and the OS groups was made using 2-sided Student t test and 2-sided χ2 test or Fisher exact test where appropriate.

Results:

Twenty-eight articles with a total of 1110 patients were included for the review. The ET group had lower in-hospital mortality and morbidity but similar survival rate during follow-up compared to the OS group. The primary patency rate was higher in the ET group. The overall bowel resection rate was lower in the ET group, and nearly every patient in the cohort who required second-look laparotomy required bowel resection. The HT group seemed to have the lowest mortality and acceptable second-look laparotomy rate and morbidity. Comparison between the HT group and other groups was not possible due to the limited number of cases available for review.

Conclusion:

Endovascular treatment may serve as a first-line therapy for select patients when there is a low suspicion for intestinal necrosis. Open surgery should be reserved for emergency conditions requiring exploratory laparotomy. Hybrid technique may be an especially effective approach for treating AMI, with low morbidity and mortality, although further studies are required comparing it to OS and ET.
Association of Urinary Phthalate Metabolites With Erectile Dysfunction in Racial and Ethnic Groups in the National Health and Nutrition Examination Survey 2001-2004
Authors: Lopez David S. , Advani Shailesh , Tsilidis Konstantinos K. , Wang Run , Baillargeon Jacques , Dobs Adrian , Symanski Elaine , Canfield Steven
Published: April 2016

Phthalates are endocrine-disrupting compounds detectable in more than 75% of the U.S. population with differential distributions across racial and ethnic groups, and they have been linked with reduced levels of serum testosterone. This study aims to investigate the associations of phthalate metabolites with erectile dysfunction (ED) and to determine whether these associations vary by race/ethnicity among men in the United States. Analyzed data for 12 phthalate metabolites from 3,746 men (≥20 years old), who participated in the National Health and Nutrition Examination Survey 2001-2004 cross-sectional study, were included. Metabolites included MBP, MCHP, MEP, MEHP, MiNP, MBzP, MMP, MCPP, MEHHP, MEOHP, MiBP, and MECPP. Racial/ethnic groups included non-Hispanic Blacks ( n = 770), non-Hispanic Whites ( n = 2,147), and Mexican Americans ( n = 829). ED was assessed by a single question during a self-paced, computer-assisted self-interview. In racial/ethnic stratified analyses, there were higher MBP and MBzP concentrations that had a strong-dose response association with lower prevalence odds of ED among Mexican Americans, ptrend < .01, and ptrend = .03, respectively. Similarly, a significant inverse association between MEHHP and likelihood of ED among non-Hispanic Black men ( ptrend < .04) was observed. Furthermore, significant inverse associations between higher concentrations of phthalates and ED were identified only in minority populations. Further investigations, particularly prospective studies, are warranted to determine the role of phthalates on the biological mechanism(s) associated with ED. A focus may be placed on testosterone levels which are suggested to be affected by phthalates, and also low levels of testosterone are suggested to increase the risk of ED.
Defining an Overdue Requiem for Palliative Cardiovascular Medicine
Authors: Esselstyn Caldwell B.
Published: April 2016

During the past 40 years, we have witnessed significant advances in the pharmaceutical and interventional treatment of cardiovascular disease (CVD), which have helped achieve a decrease in morbidity and mortality for this illness. Nevertheless, CVD remains the number 1 killer of women and men in Western civilizations. This fact is in stark contrast to the scenario in multiple whole food, plant-based nutrition (WFPBN) cultures, where CVD is virtually nonexistent. The utility of plant-based nutrition to halt and prevent CVD has been demonstrated epidemiologically, during wartime deprivation, in large cohort and population transitioning studies, and through prospective randomized and nonrandomized investigations. A basic scientific study confirms that omnivores have intestinal bacteria capable of converting animal food to trimethylamine oxide (TMAO), which injures blood vessels, whereas those eating plants only do not have intestinal bacteria capable of producing TMAO. Despite this overwhelming evidence for the safety, simplicity, and efficacy of plant nutrition to halt and prevent coronary artery disease, the cardiovascular medicine community has failed to embrace this option of therapy and persists in palliative treatments associated with high morbidity, mortality, and expense. It is long overdue to question why.
Altered molecular expression of TLR-signaling pathways affects the steady-state release of IL-12p70 and IFN-α in patients with relapsing-remitting multiple sclerosis
Authors: Deckx Nathalie , Willekens Barbara , Wens Inez , Eijnde Bert O , Goossens Herman , Van Damme Pierre , Berneman Zwi N , Cools Nathalie
Published: April 2016

Recent evidence suggests a key role of dendritic cells (DC) in the immunopathogenesis of multiple sclerosis (MS). Whereas dysfunction of DC was reported in MS patients, the underlying cause for this is not fully elucidated yet. The aim of the present study was to compare the gene expression profile of molecules involved in TLR4 and TLR7 signaling in DC from patients with MS and healthy controls. For this, circulating DC subsets were purified from patients with relapsing-remitting MS (RRMS) and from healthy controls for quantitative real-time PCR analysis. Additionally, TLR responsiveness in peripheral blood was investigated. We observed an aberrant steady-state release of IL-12p70 and IFN-α in patients with RRMS compared with healthy controls. Expression of IRF1 and JUN was reduced in conventional DC from patients with RRMS. In plasmacytoid DC from patients with RRMS, expression of IRF7 and IFNGR1 was reduced, while higher expression levels of TLR4 and LY86 were found compared with DC from healthy controls. The observed alterations in the gene expression of molecules involved in the TLR4 and TLR7 signaling pathways in circulating DC subsets may underlie the impaired IL-12p70 and IFN-α secretion in patients with RRMS, thereby potentially contributing to the disease pathogenesis of MS.
Predicting durable response or resistance to antitumor necrosis factor therapy in inflammatory bowel disease
Authors: Kopylov Uri , Seidman Ernest
Published: April 2016

Monoclonal antibodies to tumor necrosis factor (TNF) have become a mainstay of the therapeutic armamentarium in inflammatory bowel disease (IBD) over the last 15 years. Although highly effective, primary and secondary nonresponse are common and associated with poor clinical outcomes and significant costs. Multiple clinical, genetic and immunopharmacological factors may impact the response to anti-TNFs. Early stratification of IBD patients by the expected risk of therapeutic failure during the induction and maintenance phases of treatment may allow for treatment optimization and potentially optimal short- and long-term outcomes. The aim of this review is to summarize the current data concerning the potential predictors of therapeutic success and failure of anti-TNFs in IBD.
Bone repair with skeletal stem cells: rationale, progress to date and clinical application
Authors: Jones Elena A. , Giannoudis Peter V. , Kouroupis Dimitrios
Published: April 2016

Bone marrow (BM) contains stem cells for both hematopoietic and nonhematopoietic lineages. Hematopoietic stem cells enable hematopoiesis to occur in a controlled manner in order to accurately compensate for the loss of short- as well as long-lived mature blood cells. The physiological role of nonhematopoietic BM stem cells, often referred to as multipotential stromal cells or skeletal stem cells (SSCs), is less understood. According to an authoritative current opinion, the main function of SSCs is to give rise to cartilage, bone, marrow fat and hematopoiesis-supportive stroma, in a specific sequence during embryonic and postnatal development. This review outlines recent advances in the understanding of origins and homeostatic functions of SSCs in vivo and highlights current and future SSC-based treatments for skeletal and joint disorders.
The Dynamicity of Steenbeek Foot Abduction Brace for Clubfoot in Dorsiflexion and Pronation
Authors: Agarwal Anil , Kumar Anubrat , Shaharyar Abbas , Mishra Madhusudan
Published: April 2016

Purpose. Steenbeek foot abduction brace (SFAB) has been widely used in various national clubfoot programs. The aim of the study was to define effectiveness and dynamicity of SFAB in terms of dorsiflexion and pronation for the corrected clubfoot. Methods. Differences in foot dorsiflexion and pronation measurement with brace in knee flexed and extended position were recorded as dynamicity1 and dynamicity2, respectively. The residual soft tissue stretch lag despite brace use was calculated by determining the difference between maximum foot dorsiflexion (stretchlag1) and pronation (stretchlag2) achievable without and with brace in knee flexed. Statistical difference between measurements were calculated using paired t tests. Results. There were a total of 63 feet in 40 patients. The mean foot dorsiflexion with brace on in knee extension was 7.57° and in flexion was 15.20°. The foot pronation with brace on in knee extension was 9.46° and in flexion was 16.77°. Thus, SFAB exerted statistically significant differences in foot dorsiflexion and pronation between the knee extended and flexed positions. Dynamicity1 and dynamicity2 were 7.63° and 7.31°, respectively. Stretchlag1 was 18.47° and stretchlag2 was 17.63°. Conclusions. SFAB demonstrates effective dynamicity in maintaining corrected foot dorsiflexion and pronation. There is a residual soft tissue stretch lag both in dorsiflexion and pronation in corrected clubfoot despite use of SFAB.

Levels of Evidence: Therapeutic, Level IV: Case series
Medicinal Use of Marijuana
Authors: DeWitt-Parker Christene
Published: April 2016

The subject of medical marijuana is complex and currently of interest and concern to patients and health care providers. Legislators throughout the United States have passed state-specific laws and regulations that impact medical practice and the use of marijuana as a therapeutic modality. In November 2015, New Jersey became the first state to specifically allow the administration of medical marijuana for students and persons with developmental disabilities. The purpose of this article is to provide a frame of reference for school nurses and to encourage awareness of the implications for student health and relevant nursing interventions in the school setting.
Medicaid Managed Care
Authors: Limper Heather M. , Caskey Rachel N.
Published: April 2016

Managed care coordination for Medicaid beneficiaries is being implemented in states across the country. Recently, 1.5 million Medicaid beneficiaries in five regions of Illinois began this transition. This article presents the findings of a study to learn if immunizations would continue to be a reimbursable service if provided to beneficiaries outside of the designated primary care setting. The findings revealed a lack of clarity among health plan representatives and billing personnel in how to obtain coverage information. Five contacted plans (25%) stated they were unable to verify coverage and unclear where to acquire this information. Similarly, six (30%) representatives could not answer the question and recommended calling the Illinois Department of Healthcare and Family Services hot line. Despite the potential benefit of improved coordination of care gained by transitioning to managed care entity model, this infrastructure change may inadvertently introduce barriers to services obtained outside the medical home, like school-located immunization.
Propofol-associated QTc prolongation
Authors: Scalese Michael J. , Herring Holly R. , Rathbun R. Chris , Skrepnek Grant H. , Ripley Toni L.
Published: April 2016

Objectives:

Propofol is a preferred agent for sedation in patients in the intensive care unit (ICU) due, in part, to its established safety profile. Despite this, recent case reports have suggested a potential for prolongation of the corrected QT interval (QTc) in ICU patients receiving propofol, though limited empirical work has been conducted to evaluate this association. As such, the purpose of this study was to assess the relationship between propofol infusion and QTc prolongation in a historical cohort of ICU patients.

Methods:

A single-center, historical, observational, pre-post cohort analysis of medical records from admitted patients ⩾18 years old with cardiovascular disease was conducted, involving cases who received propofol infusion for ⩾3 hours with sequential electrocardiogram monitoring from 2006 to 2012. A multivariable, generalized linear model regression was employed to assess the primary outcome of on-propofol QTc interval (QTc2), controlling for various demographic and clinical factors.

Results:

A total of 96 patients met inclusion criteria, averaging 56.1 ± 14.1 years of age and 86.1 ± 25.0 kg, with 37.5% being female. A mean prolongation in QTc interval of 30.4 ± 55.5 ms ( p < 0.001) was observed during the propofol infusion, with 43.8% of cases exhibiting an on-infusion QTc2 of ⩾ 500 ms. Regression analyses suggested that prolongation in on-propofol QTc was independently associated with baseline QTc interval and amiodarone use, while weight as inversely associated with QTc2 ( p < 0.05).

Conclusion:

This historical cohort analysis of adult ICU patients receiving propofol suggests that on-infusion QTc prolongation was associated with increasing baseline QTc interval and with amiodarone use. Further research is needed to evaluate the clinical significance and cause-and-effect relationship between potential QTc changes and propofol use in the ICU.
Factors associated with antidepressant use in residents with and without dementia in Australian aged care facilities
Authors: Hiltunen Henna , Tan Edwin C. K. , Ilomäki Jenni , Hilmer Sarah N. , Visvanathan Renuka , Emery Tina , Robson Leonie , Jones Mary J. , Hartikainen Sirpa , Bell J. Simon
Published: April 2016

Objective:

Depressive symptoms are highly prevalent in residential aged care facilities (RACFs). The prevalence of antidepressant use is increasing but the effectiveness of antidepressants in people with dementia is uncertain. The objective of the study was to investigate factors associated with antidepressant use in residents with and without dementia.

Methods:

This was a prospective cross-sectional study of 383 residents in six Australian RACFs. Data on health status, medications and demographics were collected by trained study nurses from April to August 2014. Logistic regression was used to compute adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for factors associated with antidepressant use. Analyses were stratified by dementia and depression.

Results:

Overall, 183 (47.8%) residents used antidepressants. The prevalence of antidepressant use was similar among residents with and without dementia. Clinician-observed pain was inversely associated with antidepressant use in the main analysis (AOR = 0.56, 95% CI = 0.32–0.99) and in subanalyses for residents with documented depression (AOR = 0.51, 95% CI = 0.27–0.96). In residents with dementia, moderate quality of life was associated with a lower odds of antidepressant use compared with poor quality of life (AOR = 0.35, 95% C I= 0.13–0.95). In residents without dementia, analgesic use was associated with antidepressant use (AOR = 2.34, 95% CI = 1.07–5.18).

Conclusions:

The prevalence of antidepressant use was similar in residents with and without dementia. Clinician-observed pain was inversely associated with antidepressant use but there was no association between self-reported pain and antidepressant use.
Medication safety in neonatal care: a review of medication errors among neonates
Authors: Krzyzaniak Natalia , Bajorek Beata
Published: April 2016

Objective:

The objective of this study was to describe the medication errors in hospitalized patients, comparing those in neonates with medication errors across the age spectrum.

Method:

In tier 1, PubMed, Embase and Google Scholar were searched, using selected MeSH terms relating to hospitalized paediatric, adult and elderly populations. Tier 2 involved a search of the same electronic databases for literature relating to hospitalized neonatal patients.

Results:

A total of 58 articles were reviewed. Medication errors were well documented in each patient group. Overall, prescribing and administration errors were most commonly identified across each population, and mostly related to errors in dosing. Errors due to patient misidentification and overdosing were particularly prevalent in neonates, with 47% of administration errors involving at least tenfold overdoses. Unique errors were identified in elderly patients, comprising duplication of therapy and unnecessary prescribing of medicines. Overall, the medicines most frequently identified with error across each patient group included: heparin, antibiotics, insulin, morphine and parenteral nutrition. While neonatal patients experience the same types of medication errors as other hospitalized patients, the medication-use process within this group is more complex and has greater consequences resulting from error. Suggested strategies to help overcome medication error most commonly involved the integration of a clinical pharmacist into the treating team.

Conclusion:

This review highlights that each step of the medication-use process is prone to error across the age spectrum. Further research is required to develop targeted strategies relevant to specific patient groups that integrate key pharmacy services into wards.
Seasonal variations in calcidiol and parathyroid hormone levels in healthy children and adolescents in Navarre, Spain: a cross-sectional study
Authors: Durá-Travé Teodoro , Gallinas-Victoriano Fidel
Published: April 2016

Objective

To analyze the seasonal variations in calcidiol and parathyroid hormone serum levels along a natural year in a paediatric population living in a region of the north of Spain considering a normal nutrition status.

Design

A cross-sectional study.

Setting

Navarra Hospital Complex, Pamplona, Spain.

Participants

A total of 413 Caucasian individuals (aged 3.1 to 15.4 years): 227 school children (96 males and 131 females) and 186 adolescents (94 males and 92 females), with normal nutritional status.

Main outcome measures

Clinical examination (sex, age, weight, height and body mass index) and blood testing (calcium, phosphate, alkaline phosphatase, calcidiol and parathyroid hormone) during the year 2014.

Results

Calcidiol levels were lower during spring (25.96 ± 6.64 ng/mL) and reached its maximum level in summer (35.33 ± 7.51 ng/mL); parathyroid hormone levels were lower in summer (27.13 ± 7.89 pg/mL) and reached maximum level in autumn (34.73 ± 15.38 pg/mL). Hypovitaminosis D prevalence was 14.3% in summer and 75.3% in spring. Parathyroid hormone levels were compatible with secondary hyperparathyroidism in eight individuals (1.9%). There is a correlation ( p < 0.01) between calcidiol and parathyroid hormone ( r = −0.336). Logistic regression showed significant increased risk of hypovitaminosis in females (OR:1.63) and adolescents (OR:1.77), and when blood samples taken in autumn (OR:12.22), winter (OR:8.54) and spring (OR:19.72).

Conclusions

There is a high prevalence of hypovitaminosis D in the paediatric population with a healthy nutrition situation in Navarre, mainly during the months of autumn and winter, and, especially, in spring time. Given the difficulties in maintaining a sufficient amount of body vitamin D content along the year, it should be considered to give vitamin supplements and/or increase the intake of its natural dietary sources or vitamin D fortified foods.
The association between trainee demographic factors and self-reported experience: Analysis of General Medical Council National Training Survey 2014 and 2015 data
Authors: Gill Dipender
Published: April 2016

Objectives

To investigate whether demographic factors are associated with self-reported experience amongst medical trainees in the UK.

Design

Retrospective analysis of survey data.

Setting

General Medical Council (UK) National Training Survey data for 2014 and 2015.

Participants

A total of 105,549 responses were provided from 68,551 participants when no data were removed. After removing data to preserve participant anonymity, there were 64,278 participants providing 99,076 responses.

Main outcome measures

Considered trainee factors were gender, ethnicity, country of primary medical qualification, grade, post specialty and deanery. Self-reported outcome measures were ‘overall satisfaction’, ‘adequate experience’, ‘workload’, ‘clinical supervision’, ‘educational supervision’, and ‘access to educational resources’.

Results

The experience of medical trainees across various indicators is differentially related to gender, ethnicity, country of primary medical qualification, grade, post specialty and deanery.

Conclusions

It is demonstrated here that trainee factors are associated with subjective experience across different indicators. Further work is required to explore the reasons behind this, and how this relates to trainee quality of life, work performance and career progression.
Working as a doctor when acutely ill: comments made by doctors responding to United Kingdom surveys
Authors: Smith Fay , Goldacre Michael J , Lambert Trevor W
Published: April 2016

Summary

Objectives

We undertook multi-purpose surveys of doctors who qualified in the United Kingdom between 1993 and 2012. Doctors were asked specific questions about their careers and were asked to comment about any aspect of their training or work. We report doctors’ comments about working whilst acutely ill.

Design

Self-completed questionnaire surveys.

Setting

United Kingdom.

Participants

Nine cohorts of doctors, comprising all United Kingdom medical qualifiers of 1993, 1996, 1999, 2000, 2002, 2005, 2008, 2009 and 2012.

Main outcome measures

Comments made by doctors about working when ill, in surveys one, five and 10 years after graduation.

Results

The response rate, overall, was 57.4% (38,613/67,224 doctors). Free-text comments were provided by 30.7% (11,859/38,613). Three-hundred and twenty one doctors (2.7% of those who wrote comments) wrote about working when feeling acutely ill. Working with Exhaustion/fatigue was the most frequent topic raised (195 doctors), followed by problems with Taking time off for illness (112), and general comments on Physical/mental health problems (66). Other topics raised included Support from others, Leaving or adapting/coping with the situation, Bullying, the Doctor’s ability to care for patients and Death/bereavement. Arrangements for cover due to illness were regarded as insufficient by some respondents; some wrote that doctors were expected to work harder and longer to cover for colleagues absent because of illness.

Conclusions

We recommend that employers ensure that it is not unduly difficult for doctors to take time off work when ill, and that employers review their strategies for covering ill doctors who are off work.
‘Everything just seems much more right in nature’: How veterans with post-traumatic stress disorder experience nature-based activities in a forest therapy garden
Authors: Poulsen Dorthe Varning , Stigsdotter Ulrika K , Djernis Dorthe , Sidenius Ulrik
Published: April 2016

Available evidence shows that an increasing number of soldiers are seeking help for post-traumatic stress disorder. The post-traumatic stress disorder condition has big emotional and psychological consequences for the individual, his/her family and the society. Little research has been done to explore the impact of nature-based therapy for veterans with post-traumatic stress disorder although there is a growing amount of evidence pointing towards positive outcome. This qualitative study aims to achieve a deeper understanding of this relationship from the veteran’s perspective. Eight Danish veterans participated in a 10-week nature-based therapy. Qualitative interviews were conducted and analysed using the interpretative phenomenological method. The results indicated that the veterans have achieved tools to use in stressful situations and experienced an improvement in their post-traumatic stress disorder symptoms.
An Unusual Clinical Presentation of Gastrointestinal Metastasis From Invasive Lobular Carcinoma of Breast
Authors: Balakrishnan Bathmapriya , Shaik Sufiya , Burman-Solovyeva Irina
Published: April 2016

Introduction. We present an unusual case of metastatic lobular breast carcinoma. Typical areas of metastasis include bone, gynecological organs, peritoneum, retroperitoneum, and gastrointestinal (GI) tract, in order of frequency. With regard to GI metastasis, extrahepatic represents a rare site. Case. Two years after being diagnosed with invasive lobular breast carcinoma, a 61-year-old female complained of 3 months of nonspecific abdominal pain and diarrhea. A colonoscopy revealed 5 tubular adenomatous polyps in the ascending and transverse colon. Contrast computed tomography (CT) of the abdomen and pelvis was done 7 months after the colonoscopy to further evaluate persistent diarrhea. The CT results were consistent with infectious or inflammatory enterocolitis. Despite conservative management, symptoms failed to improve and a repeat diagnostic colonoscopy was obtained. Random colonic biopsies revealed metastatic high-grade adenocarcinoma of the colon. Discussion. Metastatic lobular breast carcinoma to the GI tract can distort initial interpretation of endoscopic evaluation with lesions mimicking inflammation. The interval between discovery of GI metastasis and diagnosis of lobular breast cancer can vary widely from synchronous to 30 years; however, progression is most often much sooner. Nonspecific symptoms and subtle appearance of metastatic lesions may confound the diagnosis. A high index of suspicion is needed for possible metastatic spread to the GI tract in patients with a history of invasive lobular breast carcinoma. Perhaps, patients with nonspecific GI symptoms should have an endoscopic examination with multiple random biopsies as invasive lobular carcinoma typically mimics macroscopic changes consistent with colitis.
Deep Disquiet: Israel and the Iran Nuclear Deal
Authors: Rajiv S. Samuel C.
Published: April 2016

The Iran nuclear issue has been the most significant regional security challenge that Israel had to grapple with in the recent times. Israel was skeptical of the efficacy of the dominant diplomatic strategy (pursued by the P5+1) to address the Iranian nuclear challenge. Israel continues to express its concerns on the Joint Comprehensive Plan of Action (JCPOA) of July 2015 to effectively address its core concerns vis-à-vis Iran. Significant policy differences with the United States over Iran did not prevent both countries from maintaining a steady stream of high level contacts. While both sides are currently negotiating the terms of the 10-year defence cooperation agreement that would improve its qualitative military edge (QME) vis-à-vis Iran and regional rivals, Israel’s Iran dilemma would play out to uncertain consequences.
Iran Returns to Global Energy Market: Issues and Prospects
Authors: Pant Girijesh
Published: April 2016

Iran is set to join the global energy market with the signing of the Joint Comprehensive Plan of Action in July 2015. However, the new geography of energy is changing the power dynamics in global energy market taking away the leverage from the traditionally dominant Middle East. Moreover, OPEC envisages severe loss to its share in the global energy market by 2020 and the intra-regional conflicts are further fuelling uncertainties and radicalization. Nevertheless, hydrocarbon will continue to be the principal component of global energy mix and Iran, which has the fourth largest reserves of oil and the second largest deposits of natural gas, will remain an important player but it will require a huge investment and technological support from the external suppliers to monetize its energy assets. Thus, a new script is going to be framed, that of energy-geopolitics equation, but, ironically, Iran will not be its lead author.
The JCPOA and Changing Dimensions of the Russia–Iran Relations
Authors: Paulraj Nansi
Published: April 2016

Relations between Russia and Iran have always been complex and subtle. On one hand, Iran and Russia have enjoyed wide economic, military and nuclear strategic cooperation and the latter has played a major role in Iran’s nuclear program and provided the former with nuclear experts and technical know-how. Hence, Russia has been embroiled in many controversies as the West realized that it did not share their political concerns of security over Iran. On the other hand, although Russia was overtly interested in developing nuclear cooperation with Iran, it was more an attempt to save its own nuclear industry from collapse than to strengthen Iran’s nuclear capability. Thus, in reality, Russia was as skeptical as the other P5+1 nations about a nuclear armed Iran as it realized that the latter could destabilize the situation in the Middle East. The US openly criticized Russia’s strategic partnership with Iran and demanded that it should cut off all ties with Iran. Russia was apprehensive that if the nuclear talks failed, the US might take military action against Iran which in turn would have a destabilizing effect on regional security.
Reproducibility of Illumina platform deep sequencing errors allows accurate determination of DNA barcodes in cells
Authors: Beltman Joost B. , Urbanus Jos , Velds Arno , van Rooij Nienke , Rohr Jan C. , Naik Shalin H. , Schumacher Ton N.
Published: April 2016

Background

Next generation sequencing (NGS) of amplified DNA is a powerful tool to describe genetic heterogeneity within cell populations that can both be used to investigate the clonal structure of cell populations and to perform genetic lineage tracing. For applications in which both abundant and rare sequences are biologically relevant, the relatively high error rate of NGS techniques complicates data analysis, as it is difficult to distinguish rare true sequences from spurious sequences that are generated by PCR or sequencing errors. This issue, for instance, applies to cellular barcoding strategies that aim to follow the amount and type of offspring of single cells, by supplying these with unique heritable DNA tags.

Results

Here, we use genetic barcoding data from the Illumina HiSeq platform to show that straightforward read threshold-based filtering of data is typically insufficient to filter out spurious barcodes. Importantly, we demonstrate that specific sequencing errors occur at an approximately constant rate across different samples that are sequenced in parallel. We exploit this observation by developing a novel approach to filter out spurious sequences.

Conclusions

Application of our new method demonstrates its value in the identification of true sequences amongst spurious sequences in biological data sets.