bluuebunny/crossref_metadata_2025 huggingface dataset:
The political economy of universal health coverage: a systematic narrative review
Authors: Rizvi Syed Shahiq , Douglas Rundell , Williams Owain D , Hill Peter S
Published: December 2019

The uptake and implementation of universal health coverage (UHC) is primarily a political, rather than a technical, exercise, with contested ideas and diverse stakeholders capable of facilitation or resistance—even veto—of the policy uptake. This narrative systematic review, undertaken in 2018, sought to identify all peer-reviewed publications dealing with concepts relating to UHC through a political economy framing. Of the 627 papers originally identified, 55 papers were directly relevant, with an additional eight papers added manually on referral from colleagues. The thematic analysis adapted Fox and Reich’s framework of ideas and ideologies, interests and institutions to organize the analysis. The results identified a literature strong in its exploration of the ideologies and ideas that underpin UHC, but with an apparent bias in authorship towards more rights-based, left-leaning perspectives. Despite this, political economy analyses of country case studies suggested a more diverse political framing for UHC, with the interests and institutions engaged in implementation drawing on pragmatic and market-based mechanisms to achieve outcomes. Case studies offered limited detail on the role played by specific interests, though the influence of global development trends was evident, as was the role of donor organizations. Most country case studies, however, framed the development of UHC within a narrative of national ownership, with steps in implementation often critical political milestones. The development of institutions for UHC implementation was predicated largely on available infrastructure, with elements of that infrastructure—federal systems, user fees, pre-existing insurance schemes—needing to be accommodated in the incremental progress towards UHC. The need for technical competence to deliver ideological promises was underlined. The review concludes that, despite the disparate sources for the analyses, there is an emerging shared narrative in the growing literature around the political economy of UHC that offers an increasing awareness of the political dimensions to UHC uptake and implementation.
Environmental enrichment during the chronic phase after experimental stroke promotes functional recovery without synergistic effects of EphA4 targeted therapy
Authors: de Boer Antina , Storm Annet , Gomez-Soler Maricel , Smolders Silke , Rué Laura , Poppe Lindsay , B  Pasquale Elena , Robberecht Wim , Lemmens Robin
Published: December 2019

Worldwide, stroke is the main cause of long-term adult disability. After the initial insult, most patients undergo a subacute period with intense plasticity and rapid functional improvements. This period is followed by a chronic phase where recovery reaches a plateau that is only partially modifiable by rehabilitation. After experimental stroke, various subacute rehabilitation paradigms improve recovery. However, in order to reach the best possible outcome, a combination of plasticity-promoting strategies and rehabilitation might be necessary. EphA4 is a negative axonal guidance regulator during development. After experimental stroke, reduced EphA4 levels improve functional outcome with similar beneficial effects upon the inhibition of EphA4 downstream targets. In this study, we assessed the effectiveness of a basic enriched environment in the chronic phase after photothrombotic stroke in mice as well as the therapeutic potential of EphA4 targeted therapy followed by rehabilitation. Our findings show that environmental enrichment in the chronic phase improves functional outcome up to 2 months post-stroke. Although EphA4 levels increase after experimental stroke, subacute EphA4 inhibition followed by environmental enrichment does not further increase recovery. In conclusion, we show that environmental enrichment during the chronic phase of stroke improves functional outcome in mice with no synergistic effects of the used EphA4 targeted therapy.
On the Discretized Sum-Product Problem
Authors: Guth Larry , Katz Nets Hawk , Zahl Joshua
Published: December 2019

We give a new proof of the discretized ring theorem for sets of real numbers. As a special case, we show that if $A\subset \mathbb {R}$ is a $(\delta ,1/2)_1$-set in the sense of Katz and Tao, then either $A+A$ or $A.A$ must have measure at least $|A|^{1-\frac {1}{68}}$.
De Novo Genotypic Heterogeneity in the UL56 Region in Cytomegalovirus-Infected Tissues: Implications for Primary Letermovir Resistance
Authors: Jo Horim , Kwon Da Eun , Han Sang Hoon , Min Seo Yeon , Hong Yeon-Mi , Lim Beom Jin , Lee Kyoung Hwa , Jo Jeong-Hyeon
Published: December 2019

Background

Letermovir, an inhibitor of unique long (UL)56-encoded cytomegalovirus (CMV)-terminase, shows prophylactic effects with low-grade adverse events in hematopoietic stem cell transplant recipients. Despite few case reports on acquired letermovir resistance, the frequency of de novo amino acid (A.A.) changes encoded by UL56 in CMV-infected tissues is unclear.

Methods

We analyzed CMV UL56 sequences between the conserved region IV and variable region I in 175 formalin-fixed, paraffin-embedded tissues obtained from 147 patients showing positive CMV immunochemical staining between November 2012 and October 2016. Nucleotides 552–1330 of the open reading frame of UL56 were amplified with 5 primers and sequenced by a dideoxy fluorescence-based cycle.

Results

Six (3.4%) tissues from 4 (2.7%) patients harbored A.A. substitutions. There were no known potent resistant mutations. However, we found C325Y in 2 tissues from 1 patient, along with other mutations. Four novel A.A. changes, which have not been observed in previous in vitro experiments, were identified (T244I, S301T, G312V, and M434I). Most (9 of 11, 81.8%) of the A.A. changes occurred between the codons 301 and 325 present between the conserved regions V and VI.

Conclusions

The treatment difficulties associated with letermovir resistance in a clinical setting need to be verified before its widespread use.
The Interleukin (IL) 17R/IL-22R Signaling Axis Is Dispensable for Vulvovaginal Candidiasis Regardless of Estrogen Status
Authors: Peters Brian M , Coleman Bianca M , Willems Hubertine M E , Barker Katherine S , Aggor Felix E Y , Cipolla Ellyse , Verma Akash H , Bishu Srinivas , Huppler Anna H , Bruno Vincent M , Gaffen Sarah L
Published: December 2019

Candida albicans, a ubiquitous commensal fungus that colonizes human mucosal tissues and skin, can become pathogenic, clinically manifesting most commonly as oropharyngeal candidiasis and vulvovaginal candidiasis (VVC). Studies in mice and humans convincingly show that T-helper 17 (Th17)/interleukin 17 (IL-17)–driven immunity is essential to control oral and dermal candidiasis. However, the role of the IL-17 pathway during VVC remains controversial, with conflicting reports from human data and mouse models. Like others, we observed induction of a strong IL-17–related gene signature in the vagina during estrogen-dependent murine VVC. As estrogen increases susceptibility to vaginal colonization and resulting immunopathology, we asked whether estrogen use in the standard VVC model masks a role for the Th17/IL-17 axis. We demonstrate that mice lacking IL-17RA, Act1, or interleukin 22 showed no evidence for altered VVC susceptibility or immunopathology, regardless of estrogen administration. Hence, these data support the emerging consensus that Th17/IL-17 axis signaling is dispensable for the immunopathogenesis of VVC.
Quality healthcare in extreme adversity: Developing a framework for action
Authors: Leatherman Sheila , Tawfik Linda , Jaff Dilshad , Jaworski Grace , Neilson Matthew , Letaief Mondher , Syed Shamsuzzoha Babar
Published: December 2019

Quality issue: Improving quality of care has become a global health priority to improve health outcomes and strengthen health systems, particularly in the context of achieving universal health coverage. Initial assessment: The delivery of quality essential health services in settings of extreme adversity, such as fragile, conflict-affected, vulnerable or disaster contexts, has been identified as a high priority globally to address the massive level of need. Choice of solution: This paper provides an action framework to systematically address the quality of health services for state and non-state actors working in such settings. The framework is designed to be practical, comprehensible and simple in adoption and implementation. It describes challenges, a set of medical needs and population priorities, a menu of quality-related interventions, and a hierarchy of health system levels defining the roles and responsibilities of key actors. Conclusion: Optimizing the use of limited resources in delivering the best quality possible in ‘the hardest of the hard settings’ is imperative.
Use and impact of an online community for hospital patients
Authors: Haldar Shefali , Mishra Sonali R , Kim Yoojung , Hartzler Andrea , Pollack Ari H , Pratt Wanda
Published: December 2019

Objective

Although patient-peer support technologies have demonstrated effectiveness in a variety of health contexts—including diabetes, weight loss, and cancer—less is known about how hospitalized patients can benefit from this support. We investigated the nature of peer support in the hospital and the impact this support had on patients’ hospital stays.

Materials and Methods

We created a technology, resembling an online health community, in which patients could exchange advice about their hospitalization. We deployed it at 1 pediatric hospital and 1 adult hospital. With 30 participants, we conducted bedside interviews, observed how they used the technology during their hospitalization, and completed follow-up phone interviews.

Results

Participants shared advice about several topics, including adjusting to the hospital and building relationships with providers. Contrary to concerns that such a system would primarily serve as a place for patients to “complain,” sentiment analysis showed that 23 of 36 (64%) of the shared advice reflected positive sentiment. Patients also reported positive impacts to their quality, safety, and hospital experience due to the inpatient peer support community.

Discussion

Participants benefited from peer support that transcended diagnoses and individual health conditions. The shared experience of being in the hospital was sufficient to yield valuable and practical peer support. Participants who did not contribute their own advice still experienced benefits from reading their peers’ advice.

Conclusions

Our study demonstrated the positive nature of peer advice exchanged, and the benefits of this advice on patients’ hospital stays. Inpatient peer support technologies could be an additional resource for patients to engage in their care.
Home Is Where the Heart Is: Identity, Return and the Toleka Bicycle Taxi Union in Congo’s Equateur
Authors: Carayannis Tatiana , Pangburn Aaron
Published: December 2019

Since the end of the 2006 post-war transition, the Democratic Republic of Congo (DRC) and the international community have struggled to design, finance and implement a host of national and regional disarmament, demobilization and reintegration (DDR) programmes. The weak capacity of implementing institutions, widespread corruption, funding gaps, Western-driven processes and a misdiagnosis of local needs have all been raised as core reasons behind failures. Little is known about how processes of ex-combatant return shape and reshape public authority, where former combatants return to, how they negotiate and experience ‘return’ and how viable ways of life are successfully constituted post return. While many ex-combatants in the DRC continue to be re-recruited into militia groups, one group that has reintegrated successfully is the Toleka—a several-thousand-strong group of ex-combatants who returned (or remained) in the provincial capital of Mbandaka (Equateur province). The Toleka formed a bicycle-taxi organization and unionized its membership, providing protections and collective-bargaining authority to the group, while providing a public good. It also helped to reshape identities, produce a sense of civilian solidarity and provide a bridging function from life in the military. This article looks at how this organization was formed, how the former fighters identified and capitalized on a local need and the conditions that allowed them to successfully unionize and protect their rights as they re-entered civilian life. Based on extensive fieldwork and interviews, this article seeks to understand a case of ‘successful’ return in a region with few such successes.
Education and devices to prevent blood and body fluid exposures
Authors: Cheetham S , Ngo H , Liira J , Lee E , Pethrick C , Andrews A , Liira H
Published: December 2019

Background

Healthcare workers are at risk of blood and body fluid exposures (BBFE) while delivering care to patients. Despite recent technological advances such as safety-engineered devices (SEDs), these injuries continue to occur in healthcare facilities worldwide.

Aims

To assess the impact of an education and SEDs workplace programme on rates of reported exposures.

Methods

A retrospective cohort study, utilizing interrupted time series analysis to examine reported exposures between 2005 and 2015 at a 600-bed hospital in Perth, Western Australia. The hospital wards were divided into four cohorts.

Results

A total of 2223 records were available for analysis. The intervention was most effective for the first cohort, with significant improvements both short-term (reduction of 12 (95% CI 7–17) incidents per 1000 full-time equivalent (FTE) hospital staff) and long-term (reduction of 2 (CI 0.6–4) incidents per 1000 FTE per year). Less significant or consistent impacts were observed for the other three cohorts. Overall, the intervention decreased BBFE exposure rates at the hospital level from 19 (CI 18–20) incidents per 1000 FTE pre-intervention to 11 (CI 10–12) incidents per 1000 FTE post-intervention, a 41% reduction. No exposures resulted in a blood-borne virus infection.

Conclusions

The intervention was most effective in reducing exposures at a time when incidence rates were increasing. The overall effect was short-term and did not further reduce an already stabilized trend, which was likely due to improved safety awareness and practice, induced by the first cohort intervention.
Social and spatial networks in labour markets
Authors: Topa Giorgio
Published: December 2019

Social connections and referrals are ubiquitous in the labour market, both on the job-seeker side and on the employer side. This article reviews recent developments in the study of referrals, highlighting what we have learned regarding the use and impact of referrals on various labour market outcomes and pointing out the increasingly nuanced picture we are gaining on the effects of referrals. It then discusses directions for future research, emphasizing the importance of using newly available data (and combinations of datasets) and of making tighter connections with the burgeoning macro-labour research that is based on a search and matching framework. Finally, it evaluates the role of referrals from the point of view of policy-makers, discussing their social welfare implications and ways in which they could be explicitly incorporated into various labour market policies. The importance of tighter collaboration between policy-makers, researchers, employers and practitioners is stressed, to conduct more rigorous experimentation and evaluation of potential referral-based policies and programmes.
The Implications of Lineage-Specific Rates for Divergence Time Estimation
Authors: Carruthers Tom , Sanderson Michael J , Scotland Robert W
Published: December 2019

Rate variation adds considerable complexity to divergence time estimation in molecular phylogenies. Here, we evaluate the impact of lineage-specific rates—which we define as among-branch-rate-variation that acts consistently across the entire genome. We compare its impact to residual rates—defined as among-branch-rate-variation that shows a different pattern of rate variation at each sampled locus, and gene-specific rates—defined as variation in the average rate across all branches at each sampled locus. We show that lineage-specific rates lead to erroneous divergence time estimates, regardless of how many loci are sampled. Further, we show that stronger lineage-specific rates lead to increasing error. This contrasts to residual rates and gene-specific rates, where sampling more loci significantly reduces error. If divergence times are inferred in a Bayesian framework, we highlight that error caused by lineage-specific rates significantly reduces the probability that the 95% highest posterior density includes the correct value, and leads to sensitivity to the prior. Use of a more complex rate prior—which has recently been proposed to model rate variation more accurately—does not affect these conclusions. Finally, we show that the scale of lineage-specific rates used in our simulation experiments is comparable to that of an empirical data set for the angiosperm genus Ipomoea. Taken together, our findings demonstrate that lineage-specific rates cause error in divergence time estimates, and that this error is not overcome by analyzing genomic scale multilocus data sets. [Divergence time estimation; error; rate variation.]
Influence of ractopamine hydrochloride and days on feed on feedlot performance and red meat yield in thin cull beef cows targeted for a lean market
Authors: DeClerck Jonathan C , Lucherk Loni W , Reeves Nathan R , Miller Mark F , Bernhard Bryan C , Rathmann Ryan J
Published: December 2019

Thin, beef, cull cows [n = 144; initial body weight (BW) = 465.8 ± 56.9 kg, initial body condition score (BCS) = 2.13 ± 0.68] were serially slaughtered to evaluate the relationship between ractopamine hydrochloride (RH) administration and days on feed (DOF) on feedlot performance and carcass cutout value in a lean cow market. Cows were organized into a 3 × 2 factorial arrangement of treatments (48 pens, 8 pens per treatment, 3 cows per pen) and blocked by BW nested within pregnancy status. Treatment pens were top-dressed 400 mg per cow per day of RH (Actogain 45; Zoetis, Parsippany, NJ) for the final 28 d prior to slaughter to cows spending 28, 42, or 56 DOF. Pen served as the experimental unit, for all calculations. No RH × DOF interactions were detected (P ≥ 0.11), indicating that despite a majority of compensatory gain occurring during the first 28 d of the trial, the magnitude of the RH response was not affected by DOF. Compared to controls, RH incited improvements in feedlot performance, but had a greater extent on carcass weight gain and efficiency. Specifically, RH improved average daily gain (ADG) by 13.7% (P = 0.04) and carcass ADG by 16.9% (P = 0.02) Cattle fed RH displayed a 15.5% improved gain to feed ratio (P = 0.02) and a 20% improved carcass gain to feed ratio (P = 0.05). Inclusion of RH in the finishing diet increased hot carcass weight by 4.5% (P = 0.05; 12.9 kg). However, supplementation of RH did not alter red meat yield (P ≥ 0.16), but provoked a 11.1% improvement in lean maturity (P < 0.01). Evaluation of the main effect of DOF provided insight into the compensatory state of beef cull cows on a high-concentrate diet. Serial slaughter offal weights presented confounding results. With additional DOF, a numerical increase in liver weights (P = 0.20) suggested that organ tissue replenishment occurred throughout the trial, and cattle experienced compensatory gain during the entire feeding phase. In contrast, lung and heart weights were not altered, while kidney tended to decrease linearly (P = 0.08) despite additional DOF. Furthermore, extending DOF generated a linear increase in dry matter intake (P < 0.01) yet a tendency for a decline in ADG (P = 0.10), reinforcing the premise that most of compensatory gain occurred during the first 28 d of the trial. If thin (BCS ≤ 4), healthy candidates can be finished, feeders can reap the benefits of an additive relationship between compensatory gain and RH.
Avian and serpentine endogenous foamy viruses, and new insights into the macroevolutionary history of foamy viruses
Authors: Aiewsakun Pakorn
Published: December 2019

This study reports and characterises two novel distinct lineages of foamy viruses (FVs) in the forms of endogenous retroviruses (ERVs). Several closely related elements were found in the genome of oriental stork (Ciconia boyciana) and other was found in the genome of spine-bellied sea snake (Hydrophis hardwickii), designated ERV-Spuma.N-Cbo (where 'N' runs from one to thirteen) and ERV-Spuma.1-Hha, respectively. This discovery of avian and serpentine endogenous FVs adds snakes, and perhaps more crucially, birds to the list of currently known hosts of FVs, in addition to mammals, reptiles, amphibians, and fish. This indicates that FVs are, or at least were, capable of infecting all major lineages of vertebrates. Moreover, together with other FVs, phylogenetic analyses showed that both of them are most closely related to mammalian FVs. Further examination revealed that reptilian FVs form a deep paraphyletic group that is basal to mammalian and avian FVs, suggesting that there were multiple ancient FV cross-class transmissions among their hosts. Evolutionary timescales of various FV lineages were estimated in this study, in particular, the timescales of reptilian FVs and that of the clade of mammalian, avian, and serpentine FVs. This was accomplished by using the recently established time-dependent rate phenomenon models, inferred using mainly the knowledge of the co-speciation history between FVs and mammals. It was found that the estimated timescales matched very well with those of reptiles. Combined with the observed phylogenetic patterns, these results suggested that FVs likely co-speciated with ancient reptilian animals, but later jumped to a protomammal and/or a bird, which ultimately gave rise to mammalian and avian FVs. These results contribute to our understanding of FV emergence, specifically the emergence of mammalian and avian FVs, and provide new insights into how FVs co-evolved with their non-mammalian vertebrate hosts in the distant past.
Four-step Augmentation Mastopexy: Lift and Augmentation at Single Time (LAST)
Authors: Ono Marcelo T. , Karner Bruno M.
Published: December 2019

Background:

Augmentation mastopexy is one of the most difficult challenges plastic surgeons face, especially concerning sustainability of upper pole fullness and lower pole ptosis correction. We describe our technique for augmentation mastopexy that provides inferolateral muscular support for the implant and standardizes a sequence of surgical stages to resolve multiple situations and present the outcomes of patients who underwent such an approach.

Methods:

Our technique proposes the following: (a) modified subpectoral pocket, with muscular inferolateral support for the implant; (b) independent approaches to the submuscular (implant) pocket and parenchymal resection/reshaping; and (c) pre-established 4-step surgical sequence. Data from office files of our private practice were collected for 266 patients who underwent the technique from October 2015 to January 2019. Patient perception about esthetic outcomes, photographs from multiple postoperative follow-ups, and surgical complications/reoperation rates were analyzed.

Results:

Overall mid-term and long-term results (39 months) were positive for lift and augmentation at single time mastopexy; >90% of patients reported satisfaction with their esthetic outcomes, including absence of ptosis. No major complications occurred. The total revision rate was 16%, but it became <5% in 2018 as the learning curve progressed.

Conclusions:

Augmentation mastopexy is complex, and the myriad of approaches and possibilities may cause confusion when selecting the most suitable one. The 4-step sequence provides a reliable option, offering a predefined execution plan, whereas inferolateral muscular support prevents recurrence of lower pole ptosis. Other surgeons’ experience with lift and augmentation at single time mastopexy and further studies are necessary to validate these findings.
When the Mesh Goes Away: An Analysis of Poly-4-Hydroxybutyrate Mesh for Complex Hernia Repair
Authors: Messa Charles A. , Kozak Geoffrey , Broach Robyn B. , Fischer John P.
Published: December 2019

Background:

Mesh reinforcement is a cornerstone of modern ventral hernia repair (VHR); yet, complications with synthetic mesh and cost of biologic have created a need for alternative options. Biosynthetic mesh is a resorbable scaffold that theoretically leverages the benefits and minimizes deficiencies of existing mesh types. This study evaluates 2-year outcomes following poly-4-hydroxybutyrate (P4HB) mesh reinforcement for complex VHR.

Methods:

A retrospective review of all consecutive VHR with P4HB (n = 70) was conducted from 2015 to 2018 by a single surgeon. Clinical outcomes, quality of life (QoL; and cost were assessed.

Results:

Seventy patients were included with an average age and body mass index of 58.6 years and 33 kg/m2, respectively. High-risk comorbidities included hypertension (59%), and smoking history (50%). Cases were primarily modified Ventral Hernia Working Group class 2 (50%), or 3 (36%), with average defect size of 323 cm2 (25–972 cm2). P4HB was placed in the retromuscular (80%) or onlay (20%) plane. Mean follow-up was 24 months (12.2–41 months). Hernia recurrence rate was 5.7% (n = 4) and occurred an average of 285 days (209–368 days) post-repair. Of the 21 surgical site occurrences (SSO), 5 (7%) required surgical intervention. A significant improvement in overall QoL (P = 0.001) was noted following repair. Defect size and SSOPI were independently associated with increased direct cost.

Conclusions:

P4HB mesh for complex VHR is associated with favorable 2-year clinical outcomes, acceptable hernia recurrence rate, and a significant improvement in QoL. This study supports the use of biosynthetic mesh as an effective biomaterial for complex VHR.
The Advantages and Disadvantages of Medication-Assisted Treatment in Primary Care Offices
Authors: Padgett Tonja M.
Published: December 2019

Substance use disorder (SUD), more specifically opioid use disorder, is a national epidemic. Although there is an emphasis on treatment and increasing treatment locations, there continues to be a gap between the number of people with SUD and the number of treatment centers. To help narrow this gap, some primary care clinicians started providing medication-assisted treatment (MAT) on an outpatient basis in their offices. This option enables clinicians to provide treatment in their own communities, which increases access to treatment and decreases costs. It also enables the clinician and the person with SUD/opioid use disorder to build a relationship, which many clinicians believe is the foundation of successful treatment. The clinician, whether a doctor, a physician assistant, or an advanced practice nurse, has to obtain a Drug Addiction Treatment Act 2000 waiver to provide MAT beyond naltrexone, which has a required educational program and includes a limitation on the number of clients. Conversely, a possible drawback to this type of treatment is the potential for the disruption of continuity of care with regard to psychotherapy treatment. Federal law mandates that therapy is available and provided to people receiving MAT. The clinician may not be able to provide this service and would need to refer the person with SUD for psychotherapy treatment. It may be clinically significant for a type of follow-up communication to be implemented so that the clinician and the therapy provider can maximize SUD treatment success.
Assessment Protocol for Older Adults With Substance Use
Authors: McRae Kenneth R.
Published: December 2019

This quality improvement project focuses on geriatric syndromes in patients 55 years and older admitted to a Minnesota substance abuse treatment center. Age-specific assessments identify abnormal conditions or geriatric syndromes, which prompt earlier nursing and medical interventions. Nursing staff attended a training program that focused on older adults and the use of the Fulmer SPICES tool for patients over the age of 55 years. Pretest and posttest scores showed a positive change in nursing knowledge with an increase in mean test scores of 10.32 (SD= 1.763) to 12.81 (SD= 1.545),p= .000. A 2-month preimplementation and postimplementation chart audit identified changes in assessment findings using the SPICES tool with an increase in adverse outcomes (1.03%) including sleep problems in 75.4% (n= 43) of the target population.
Perceptions and Experiences of Methadone Maintenance Treatment
Authors: Jeske Courtney Pearson , O’Byrne Patrick
Published: December 2019

Over the past 10 years, there has been a consistent increase in opioid use, which has resulted in an increase in methadone maintenance treatment (MMT). With retention in MMT being a key factor, to understand the process of retention, it is important to better understand individual perceptions and experiences. Little research in Ottawa, Ontario, has addressed the perspective of MMT from people enrolled in MMT; therefore, nursing-based research was undertaken. The objective was to understand the process and experiences associated with MMT from the perspective of persons who are enrolled in treatment. Twelve participants were engaged in semistructured interviews. These participants described that, although MMT can positively affect the people who use such a treatment option, multiple barriers, including social perceptions, physical environment, and healthcare delivery practices, continue to affect MMT initiation and delivery.
Mobile Phone Addiction Among Children and Adolescents
Authors: Sahu Maya , Gandhi Sailaxmi , Sharma Manoj Kumar
Published: December 2019

Objectives

Mobile phone addiction among children and adolescents has become a concern for all. To date, focuses have been given to Internet addiction, but comprehensive overview of mobile phone addiction is lacking. The review aimed to provide a comprehensive overview of mobile phone addiction among children and adolescents.

Methods

Electronic databases search included Medline, Proquest, Pubmed, EBSCO host, EMBASE, CINAHL, PsycINFO, OVID, Springer, Wiley online library, and Science Direct. Inclusion criteria were studies including children and adolescents, studies published in peer-reviewed journals, and studies focusing on mobile phone addiction or problematic use of mobile phone. A systematic search identified 12 descriptive studies, which met inclusion criteria, but no interventional study met the criteria.

Results

The prevalence of problematic mobile phone use was found to be 6.3% in the overall population (6.1% among boys and 6.5% among girls), whereas another study found 16% among the adolescents. The review finds that excessive or overuse of mobile phone was associated with feeling insecurity; staying up late at night; impaired parent–child relationship; impaired school relationships; psychological problems such as behavioral addiction like compulsive buying and pathological gambling, low mood, tension and anxiety, leisure boredom, and behavioral problems, among which most pronounced association was observed for hyperactivity followed by conduct problems and emotional symptoms.

Conclusions

Though mobile phone use helps in maintaining social relationship, mobile phone addiction among children and adolescents needs urgent attention. Interventional studies are needed to address these emerging issues.
The effect of emphysema on survival in patients with idiopathic pulmonary fibrosis: A retrospective study in Taiwan
Authors: Lai Ruay-Sheng , Chen Chiu-Fan , Chu Kuo-An , Lin Min-Hsi
Published: December 2019

Background:

Idiopathic pulmonary fibrosis (IPF) is a rare and chronic fibrosing interstitial lung disease. However, the clinical features and outcomes of IPF in Taiwan have not been well studied. In addition, the survival difference between patients with IPF alone and combined pulmonary fibrosis and emphysema (CPFE) remains controversial.

Methods:

Patients diagnosed with IPF between 2006 and 2016 were retrospectively enrolled in this study. IPF was defined according to the 2011 American Thoracic Society/European Respiratory Society guideline. The clinical features, comorbidities, and outcomes of CPFE group and IPF-alone group were compared. The extents of emphysema and fibrosis were evaluated.

Results:

In total, 114 patients with IPF were enrolled, and 86.8% of them were men with a mean age of 77.8 years. The median survival was 3.33 years in all patients with IPF. Moreover, 30 patients (26.3%) met the CPFE criteria. The CPFE group had a higher percentage of smokers (90% vs 50%, p < 0.001), higher forced vital capacity (82% vs 59%, p < 0.001), and lower fibrosis scores (8.5 ± 2.9 vs 10 ± 3.2, p = 0.022) than did the IPF-alone group. The baseline room air saturation and percentage of pulmonary hypertension were similar between the two groups. The survival time was not significantly different between the CPFE and IPF-alone groups (median survival, 3.58 vs 2.39 years, p = 0.163). In the multivariate analysis, higher fibrosis score, room air saturation < 90%, and lung cancer were significant factors associated with mortality.

Conclusion:

Our study showed that emphysema had no significant effect on the survival of patients with IPF. The outcome of IPF was mainly determined by the baseline disease severity and other comorbidities.
Barriers to implementing clinical trials on nonpharmacological treatments in developing countries: lessons learnt from addressing pain in HIV
Authors: Parker Romy , Madden Victoria J. , Devan Dershnee , Cameron Sarah , Jackson Kirsty , Kamerman Peter , Reardon Cameron , Wadley Antonia
Published: December 2019

Pain affects over half of the people living with HIV/AIDS (LWHA), and pharmacological treatment has limited efficacy. Preliminary evidence supports nonpharmacological interventions. We previously piloted a multimodal intervention in amaXhosa women LWHA and chronic pain in South Africa with improvements seen in all outcomes, in both intervention and control groups. A multicentre, single-blind randomised controlled trial with 160 participants recruited was conducted to determine whether the multimodal peer-led intervention reduced pain in different populations of both male and female South Africans LWHA. Participants were followed up at weeks 4, 8, 12, 24, and 48 to evaluate effects on the primary outcome of pain, and on depression, self-efficacy, and health-related quality of life. We were unable to assess the efficacy of the intervention due to a 58% loss to follow-up (LTFU). Secondary analysis of the LTFU found that sociocultural factors were not predictive of LTFU. Depression, however, did associate with LTFU, with greater severity of depressive symptoms predicting LTFU at week 8 (P = 0.01). We were unable to evaluate the effectiveness of the intervention due to the high LTFU and the risk of retention bias. The different sociocultural context in South Africa may warrant a different approach to interventions for pain in HIV compared with resource-rich countries, including a concurrent strategy to address barriers to health care service delivery. We suggest that assessment of pain and depression need to occur simultaneously in those with pain in HIV. We suggest investigation of the effect of social inclusion on pain and depression.
Long Term Follow-up of Intralesional Laser Photocoagulation for Head and Neck Lymphatic Malformations Using Neodymium-Yttrium-Aluminium-Garnet Laser
Authors: Chang Cheng-Jen , Hsiao Yen-Chang
Published: December 2019

Background

Lymphatic malformations remain a challenge for patients and plastic surgeons. Promising results have been reported using intralesional laser photocoagulation (ILP) for treating vascular anomalies.

Background Data

The objective of our study is to review the long-term results of a large series of lymphatic malformations in patients treated with ILP.

Materials and Methods

A retrospective review of 190 head and neck lymphatic malformations in patients were treated by ILP with an neodymium-yttrium-aluminum-garnet (Nd:YAG) laser (1064 nm) over a period of 20 years (January 1997–January 2016). Patients' ages ranged from 10 months to 12 years and 6 months (mean, 1 year and 11 months). The patient group consisted of 98 female and 92 male patients.

Results

Patients were treated with an Nd:YAG laser (Sharplan Inc, Allendale, New Jersey) delivered through a 600-μm optical fiber. Laser power was set at 7 to 15 W and delivered with a pulse duration of 7 to 15 seconds. All patients demonstrated improvement as judged by clinical assessment of the reduction in lesion size (range, 65%–100%; mean reduction, 85%). One hundred fifty-two (80%) patients had a more than 65% reduction of the volume in lymphatic malformations at 3 months after 1 treatment, and 171 (90%) patients had a more than 85% reduction of the volume after 2 treatments. Excellent results were seen in 19 (10%) patients after 3 treatments. Postoperative complications were related to photocoagulation that was delivered too extensively or superficially, with resultant ulceration, infection, induration, and scarring.

Conclusions

Throughout the course of our long-term study, ILP using an Nd:YAG laser is an effective treatment modality for lymphatic malformations. Complications can be avoided if the potential for harm is kept in mind.
Aspergillus fumigatus Spores Are Not Able to Penetrate Silicone Breast Implant Shells
Authors: Horch Raymund E. , Krappmann Sven , Dümig Michaela , Schmitz Marweh , Kengelbach-Weigand Annika , Schubert Dirk W. , Kremser Thomas , Bogdan Christian , Ludolph Ingo
Published: December 2019

Introduction

Bacterial contamination is hypothesized to be one reason for the development of capsular contracture after alloplastic breast reconstruction using silicone breast implants. The role of fungal colonization or infection in this context as well as the question if microorganisms can penetrate the shell of silicone breast implants remains an unresolved question to date. Therefore, the aim of this study was to assess whether fungal spores are able to penetrate the shell of silicone implants.

Materials and Methods

In an experimental in vitro setup with different arrangements of growth compartments, silicone chambers were placed in culture dishes filled withAspergillusminimal medium or liquid culture medium. Inoculation was performed with conidia ofAspergillus fumigatusand incubated for seven days. On a daily basis, plates were inspected for conidial germination and hyphal growth.

Results

In none of the different experimental settings nutrients or hyphae ofAspergillus fumigatuswere able to penetrate the silicone material.

Conclusions

Fungal spores and hyphae do not permeate through an intact silicone shell used in breast implants; thus, the silicone material serves as an impenetrable barrier.
Opioid Use Disorder is Associated With Complications and Increased Length of Stay After Major Abdominal Surgery
Authors: Song Yun , Tang Rebecca , Roses Robert E. , Fraker Douglas L. , DeMatteo Ronald P. , Kelz Rachel R. , Karakousis Giorgos C.
Published: December 2019

Objective:

The objective of this study was to determine the impact of opioid use disorder (OUD) on perioperative outcomes after major upper abdominal surgeries.

Summary of Background Data:

OUD, defined as dependence/abuse, is a national health epidemic. Its impact on outcomes after major abdominal surgery has not been well characterized.

Methods:

Patients who underwent elective esophagectomy, total/partial gastrectomy, major hepatectomy, and pancreatectomy were identified using the National Inpatient Sample (2003–2015). Propensity score matching by baseline characteristics was performed for patients with and without OUD. Outcomes measured were in-hospital complications, mortality, length of stay (LOS), and discharge disposition.

Results:

Of 376,467 patients, 1096 (0.3%) had OUD. Patients with OUD were younger (mean 53 vs 61 years, P < 0.001) and more often male (55.1% vs 53.2%, P < 0.001), black (15.0% vs 7.6%, P < 0.001), Medicaid beneficiaries (22.0% vs 6.4%, P < 0.001), and in the lowest income quartile (32.6% vs 21.3%, P < 0.001). They also had a higher rate of alcohol (17.2% vs 2.8%, P < 0.001) and nonopioid drug (2.2% vs 0.2%, P = 0.023) dependence/abuse. After matching (N = 1077 OUD, N = 2164 no OUD), OUD was associated with a higher complication rate (52.9% vs 37.3%, P < 0.001), including increased pain [odds ratio (OR) 3.5, P < 0.001], delirium (OR 3.0, P = 0.004), and pulmonary complications (OR 2.0, P = 0.006). Additionally, OUD was associated with increased LOS (mean 12.4 vs 10.6 days, P = 0.015) and nonroutine discharge (OR 1.6, P < 0.001). In-hospital mortality did not differ (OR 2.4, P = 0.10).

Conclusion:

Patients with OUD more frequently experienced complications and increased LOS. Close postoperative monitoring may mitigate adverse outcomes.
Incidence and Symptomatology of Vascular Crossed Aphasia in Bengali
Authors: Lahiri Durjoy , Dubey Souvik , Sawale Vishal M. , Das Gautam , Ray Biman K. , Chatterjee Suparna , Ardila Alfredo
Published: December 2019

Background:

Crossed aphasia (CA) refers to aphasia following a right-hemispheric lesion in right-handed individuals. It has been suggested that the prevalence of CA differs with language, although its worldwide incidence, as reported by most studies, is less than 3%.

Objective:

To find the incidence of CA in the Bengali language.

Methods:

From 2016 to 2018, in a hospital located in a Bengali-speaking area of eastern India, 515 cases of first-ever stroke were documented, out of which 208 patients presented with aphasia (40.38%) according to their scores on the Bengali version of the Western Aphasia Battery.

Results:

Among the patients with aphasia, 14 (6.73%; 8 men and 6 women) presented with CA. Of these, 10 were diagnosed with Broca aphasia and four with transcortical motor aphasia. No patient presented with Wernicke aphasia.

Conclusions:

The relatively high incidence of CA in our study suggests that bi-hemispheric language representation may be more prevalent in Bengali speakers than in speakers of other languages. The absence of crossed Wernicke aphasia in our study participants may represent a left-hemispheric advantage for receptive language abilities in Bengali speakers. Further studies are required to clarify whether idiosyncrasies in the Bengali language may be responsible for the differential brain representation of language seen in our study participants.
Continuous EEG Findings in Autoimmune Encephalitis
Authors: Moise Anna-Marieta , Karakis Ioannis , Herlopian Aline , Dhakar Monica , Hirsch Lawrence J. , Cotsonis George , LaRoche Suzette , Cabrera Kang Christian M. , Westover Brandon , Rodriguez Andres
Published: December 2019

Purpose:

Autoimmune encephalitis (AE) is a cause of new-onset seizures, including new-onset refractory status epilepticus, yet there have been few studies assessing the EEG signature of AE.

Methods:

Multicenter retrospective review of patients diagnosed with AE who underwent continuous EEG monitoring.

Results:

We identified 64 patients (male, 39%; white, 49%; median age, 44 years); of whom, 43 (67%) were antibody-proven AE patients. Of the patients with confirmed antibody AE, the following were identified: N-methyl-D-aspartate receptor (n = 17, 27%), voltage-gated potassium channel (n = 16, 25%), glutamic acid decarboxylase (n = 6, 9%), and other (n = 4, 6%). The remaining patients were classified as probable antibody-negative AE (n = 11, 17%), definite limbic encephalitis (antibody-negative) (n = 2, 3%), and Hashimoto encephalopathy (n = 8, 13%). Fifty-three percent exhibited electrographic seizures. New-onset refractory status epilepticus was identified in 19% of patients. Sixty-three percent had periodic or rhythmic patterns; of which, 38% had plus modifiers. Generalized rhythmic delta activity was identified in 33% of patients. Generalized rhythmic delta activity and generalized rhythmic delta activity plus fast activity were more common in anti-N-methyl-D-aspartate AE (P = 0.0001 and 0.0003, respectively). No other periodic or rhythmic patterns exhibited AE subtype association. Forty-two percent had good outcome on discharge. Periodic or rhythmic patterns, seizures, and new-onset refractory status epilepticus conferred an increased risk of poor outcome (OR, 6.4; P = 0.0012; OR, 3; P = 0.0372; OR, 12.3; P = 0.02, respectively).

Conclusion:

Our study confirms a signature EEG pattern in anti-N-methyl-D-aspartate AE, termed extreme delta brush, identified as generalized rhythmic delta activity plus fast activity in our study. We found no other pattern association with other AE subtypes. We also found a high incidence of seizures among patients with AE. Finally, periodic or rhythmic patterns, seizures, and new-onset refractory status epilepticus conferred an increased risk of poor outcome regardless of AE subtype.
Spontaneous abortion as a response to reproductive conflict in the banded mongoose
Authors: Inzani E. , Marshall H. H. , Thompson F. J. , Kalema-Zikusoka G. , Cant M. A. , Vitikainen E. I. K.
Published: December 2019

When breeding females compete for limited resources, the intensity of this reproductive conflict can determine whether the fitness benefits of current reproductive effort exceed the potential costs to survival and future fertility. In group-living species, reproductive competition can occur through post-natal competition among the offspring of co-breeding females. Spontaneous abortion could be a response to such competition, allowing females to curtail reproductive expenditure on offspring that are unlikely to survive and to conserve resources for future breeding opportunities. We tested this hypothesis using long-term data on banded mongooses,
Mungos mungo
, in which multiple females within a group give birth synchronously to a communal litter that is cared for by other group members. As predicted, abortions were more likely during dry periods when food is scarce, and in breeding attempts with more intense reproductive competition. Within breeding events, younger, lighter females carrying smaller fetuses were more likely to abort, particularly those that were also of lower rank. Our results suggest that abortion may be a means by which disadvantaged females conserve resources for future breeding attempts in more benign conditions, and highlight that female reproductive competition may be resolved long before the production of offspring.
Metastasis is altered through multiple processes regulated by the E2F1 transcription factor
Authors: Swiatnicki Matthew , Andrechek Eran R.
Published: December 2019

The E2F family of transcription factors is important for many cellular processes, from their canonical role in cell cycle regulation to other roles in angiogenesis and metastasis. Alteration of the Rb/E2F pathway occurs in various forms of cancer, including breast cancer. E2F1 ablation has been shown to decrease metastasis in MMTV-Neu and MMTV-PyMT transgenic mouse models of breast cancer. Here we take a bioinformatic approach to determine the E2F1 regulated genomic alterations involved in the metastatic cascade, in both Neu and PyMT models. Through gene expression analysis, we reveal few transcriptome changes in non-metastatic E2F1−/− tumors relative to transgenic tumor controls. However investigation of these models through whole genome sequencing found numerous differences between the models, including differences in the proposed tumor etiology between E2F1−/− and E2F1+/+ tumors induced by Neu or PyMT. Investigating mutated genes through gene set analysis also found a significant number of genes mutated in the cell adhesion pathway in E2F1−/− tumors, indicating this may be a route for disruption of metastasis in E2F1−/− tumors. Overall, these findings illustrate the complicated nature of uncovering drivers of the metastatic process.