bluuebunny/crossref_metadata_2025 huggingface dataset:
Decolonizing Hispanic-Serving Institutions: A Framework for Organizing
Authors: Garcia Gina Ann
Published: October 2017

Hispanic-serving institutions (HSIs) should realign their organizational approach in order to liberate themselves and their students. As colonized institutions enrolling colonized people, HSIs must recognize their history of colonialism before moving toward an organizational model grounded in decolonization. The Organizational Framework for Decolonizing HSIs has nine elements and is grounded in organizational theory, yet it challenges the white normative ways in which postsecondary institutions have been studied and the models that have been used to organize them.
The Utility of Plain Films for Nonoperative Fifth Metacarpal Fractures: Are Follow-up Radiographs Necessary?
Authors: Heckmann Nathanael , Dusch Marie N. , Pannell William C. , Bauschard Michael , Alluri Ram K. , Sivasundaram Lakshmanan , Ghiassi Alidad
Published: October 2017

Background: Fifth metacarpal fractures are often treated nonoperatively with serial radiographs; however, the utility of these radiographs in altering clinical management has not been investigated. We hypothesize that follow-up plain films will not alter clinical management and are therefore unnecessary for most patients. Methods: Between 2007 and 2014, patients with a fifth metacarpal fracture at our level I trauma center were retrospectively reviewed. Patients with inadequate documentation or imaging, ipsilateral upper extremity injuries, or who underwent initial surgical fixation were excluded. Initial and postreduction radiographs were reviewed by 4 board-certified attending hand surgeons and 2 hand fellows who indicated their preferred management. At a later date, blinded to their initial management, the reviewers assessed follow-up films taken at least 2 weeks later and indicated their preferred management. Results: In total, 60 patients met inclusion criteria, and of those, 30 were randomly selected. There were 9 base, 7 shaft, and 14 neck fractures. Initially, reviewers opted for nonoperative management in 72.2% of base, 71.4% of shaft, and 91.7% of neck fractures. After reviewing follow-up films, reviewers changed from nonoperative to operative management in 0.0% of base, 9.5% of shaft, and 1.2% of neck fractures. Conclusions: Follow-up radiographs may not be indicated for most fifth metacarpal base and neck fractures. Follow-up radiographs may change management in select fifth metacarpal shaft fractures as these fractures may displace. Follow-up radiographs should be performed at the discretion of the treating surgeon on an as-needed basis for fractures at risk for displacement.
A scoping review of community pharmacists and patients at risk of suicide
Authors: Murphy Andrea Lynn , Hillier Katelyn , Ataya Randa , Thabet Pierre , Whelan Anne Marie , O’Reilly Claire , Gardner David
Published: October 2017

Background:

Medications are commonly used in suicide attempts. Pharmacists are inextricably linked to medications and may have roles in helping those at risk of suicide. We conducted a scoping review to characterize the existing literature and make recommendations about future research.

Methods:

We used a 6-step approach based on an existing scoping review methodological framework, including identifying the research question; identifying relevant studies and other literature; study and literature selection; data charting; collating, summarizing and reporting results; and dissemination of results. We searched electronic databases, various grey literature sources and mobile app stores.

Results:

Thirty-five articles were included following screening of 1013 database citations. Of 1085 results from grey literature searches, we included 12. Most publications were opinion pieces ( n = 22), followed by survey studies ( n = 9), primarily assessing pharmacists’ knowledge and attitudes. Themes included education and training to impact knowledge and attitudes, gatekeeping of medication supply, collaboration and integration, and role perception. Public perspectives on pharmacists’ roles were limited.

Conclusions:

Research regarding pharmacists’ roles in the care of people at risk for suicide is limited. The areas that have dominated the literature include legal liability, especially with respect to gatekeeping medications, ethical decision making and education and training. Research is needed to determine what methods, outcomes and measures are required to best serve in building the evidence base for policy and practice decisions in this area.
Activities performed by pharmacists integrated in family health teams: Results from a web-based survey
Authors: Gillespie Ulrika , Dolovich Lisa , Dahrouge Simone
Published: October 2017

Objectives:

Family health teams (FHTs), an interprofessional primary care practice model, were established in Ontario in 2005. As of October 2014, 191 FHT organizations were in operation, and 111 (58%) included one or several pharmacists. The objective of this study was to document the focus of pharmacist activities in FHTs.

Approach:

We invited all 155 known FHT pharmacists to a web-based survey. The survey was constructed using information obtained from previously done semi-structured telephone interviews with pharmacists working in FHTs. The survey consisted of a list of activities, grouped into 5 main categories, and participants were asked to estimate time spent on each category. Free-text response questions allowed participants to identify activities not listed. Survey results were analyzed using descriptive statistics and content analysis for open-ended responses.

Results:

Seventy (45%) pharmacists completed the survey. The mean respondent age was 43 years, and the average length of time working in an FHT was 4 years. All pharmacists reported being engaged in some form of direct patient care, including managing single therapeutic issues (96%), conducting general medication reviews (70%) and medication reconciliation after hospitalization (63%). Most reported providing education and drug information (83%). Pharmacists felt their work would increase patient medication adherence (94%) and physician adherence to recommended guidelines (86%), as well as reduce inappropriate prescribing (93%), polypharmacy (90%), emergency room and hospital utilization (70%-81%).

Conclusion:

Pharmacists in FHTs are strongly focused on direct patient care activities, managing specific medication issues and unstructured drug information to physicians. The majority of pharmacists reported that their activities had a substantial impact on patient medication use and health. The findings from this survey can assist pharmacists new to FHT practice, health policy planning and health research to assess associations between pharmacist activities and measures of health and health care system performance.
Adaptive fuzzy dynamic surface tracking control for a class of nonlinear systems with unknown distributed time delays and backlash-like hysteresis
Authors: Yue Hongyun , Wei Zongtian , Chen Qingjiang , Zhang Xiaoyan
Published: October 2017

In this article, an adaptive fuzzy backstepping dynamic surface control approach is developed for a class of nonlinear systems with unknown backlash-like hysteresis and unknown state discrete and distributed time-varying delays. Fuzzy logic systems are used to approximate the unknown nonlinear functions and a fuzzy state observer is designed for estimating the immeasurable states. Then, by combining the backstepping technique and the appropriate Lyapunov–Krasovskii functionals with the dynamic surface control approach, the output-feedback adaptive fuzzy tracking controller is designed. The main advantages of this article are (i) the existence of the state discrete and distributed time-varying delays such that the investigated systems are more general than that of the existing results, (ii) the proposed control scheme can eliminate the problem of “explosion of complexity” inherent in the backstepping design method, and (iii) for the nth nonlinear system, only one fuzzy logic system is used to approximate the unknown continuous time-varying delay functions since all of them are lumped into one unknown nonlinear function, which makes our design scheme easier to be implemented in practical applications. It is proven that the proposed design method is able to guarantee that all the signals in the closed-loop system are bounded and the tracking error can converge to a small neighborhood of origin with an appropriate choice of design parameters. Finally, the simulation results demonstrate the effectiveness of the proposed approach.
Looking westwards: Men in transnational men’s magazine advertising in India
Authors: Mishra Suman
Published: October 2017

This study examines advertising content of four top-selling Indian editions of transnational men’s lifestyle magazines ( Men’s Health India, GQ India, FHM India and Maxim India) to understand how it constructs masculinity for upper-class urban Indian men. Through content analysis of advertisements, the study finds greater presence of international brands and Caucasian models than domestic Indian brands and Indian models. Male models often appear alone and in decorative roles as opposed to professional roles. The study discusses the emergence of class-based glocal masculinity that helps assimilate upper-class Indian men into the global consumer base through shared ideals, goals and values.
Counter-hegemonic contra-flow and the Al Jazeera America fiasco: A social network analysis of Al Jazeera America’s Twitter users
Authors: Samuel-Azran Tal , Hayat Tsahi
Published: October 2017

Al Jazeera America, arguably the most ambitious attempt in history by a non-Western network to broadcast to US audiences, was shut in April 2016. A social network analysis of Al Jazeera America’s following on Twitter reveals that 42 per cent of Al Jazeera America’s followers did not follow any other US news outlet and that most of the remaining 58 per cent followed liberal stations. The findings illustrate mainstream US news consumers’ reluctance to follow Al Jazeera America, which only appealed to specific audiences. The analysis portrays the challenges facing counter-hegemonic contra-flow stations such as Al Jazeera America in their bid to gain legitimacy in the West, and specifically in the United States, and highlights the relevance of selective exposure and hostile media theories in the case of counter-flowing stations.
Developing the foundations of a cognition-based human reliability analysis model via mapping task types and performance-influencing factors: Application to radiotherapy
Authors: Pandya Dhruv , Podofillini Luca , Emert Frank , Lomax Antony J , Dang Vinh N
Published: October 2017

Most human reliability analysis methods have been developed for nuclear power plant applications; this challenges the application of the available techniques to other domains. Indeed, for application to a specific domain, a human reliability analysis method should address the relevant tasks and performance conditions. The aim of this article is to propose a methodology to develop a generic task type–performance-influencing factor structure, specific for application to a domain of interest and directly linked to an underlying cognitive framework of literature. The structure provides the foundation of a human reliability analysis method built on the generic task type concept; it identifies the sector-specific performance-influencing factor effects on the failure probability that the method needs to represent and quantify for each generic task type. The methodology is intended to support a systematic and traceable process to develop the generic task type–performance-influencing factor structure, to ease the review of the process and of its results and, in case, identify and implement changes to the structure. The proposed methodology is applied to the radiotherapy domain allowing the development of sector-specific taxonomies of representative critical tasks, their failure modes, underlying cognitive failure mechanism, and influencing performance-influencing factors. This is part of a broader activity carried out by the Risk and Human Reliability Group at the Paul Scherrer Institute of Switzerland to develop a human reliability analysis method, specific for the radiotherapy domain. The activity is conducted in close cooperation with Paul Scherrer Institute’s Center for Proton Therapy, where a first application of the method is foreseen.
Comparison of objective and subjective factors in the adherence to antimuscarinics when treating overactive bladder in employed persons
Authors: Kosilov Kirill Vladimirovich , Loparev Sergey , Kuzina Irina , Prokofyeva Alexandra
Published: October 2017

Background:

This study examines subjective reasons for the refusal of treatment and the state of objective status markers of various factors influencing the resistance of patients when treating overactive bladder by antimuscarinic drugs (AMs).

Methods:

The socioeconomic and medical parameters were studied in 2465 patients aged 18–60 years (1446 women (58.7%), 1019 men (41.3%); mean age was 52.1) taking AMs during the year. The study control was carried out by studying passport data, employers’ income certificates, patients’ ambulatory medical records, the use of OABq-SF and MOS SF-36 questionnaires, voiding diaries and uroflowmetry.

Results:

The average time to reach the 30-day break in the AM administration was 177 days. During the 12-month follow up, 74.7% of patients discontinued their participation. In total, 35.9% of patients stated medical reasons for the refusal of AM treatment; in 31.9% of individuals in the group the deviation of objective health status markers from average sample values was established. Economic reasons for the refusal were given by 20.4% of patients; in 18.5% of individuals economic status markers were different from average sample values. In 24.1% of cases of refusal of treatment, patients indicated social and psychological reasons; objective social and psychological status markers were altered in 35.9%.

Conclusions:

The percentage of patients indicating economic and medical reasons for the refusal of AM treatment is statistically uniform with respect to the percentage of patients with objective disturbances of health and economic statuses. The percentage of patients indicating social and psychological factors as a reason for the refusal of treatment was significantly lower than the percentage of patients with altered social and psychological status markers. These results can be used in practical healthcare when predicting adherence to AM use.
Repositioning health information management practice in Nigeria: Suggestions for Africa
Authors: Ojo Adebowale Ifeoluwa
Published: October 2017

The significance of health information management practice to the effectiveness of a healthcare delivery system cannot be overemphasised. A well-structured and coordinated health information management system has been known to generate the information needed for decision-making at all levels of healthcare delivery. However, the state of health information management in Nigeria, as is the case in most African countries, is a cause for concern. Observation and past studies have highlighted challenges facing the practice of health information management in Africa to be centred around the quality of professional training, inadequately qualified practitioners, disgruntled practitioners, government’s indifference towards the practice, lack of policies and inadequate technological infrastructure among others. This article examines some of the challenges facing health information management practice in Nigeria and makes recommendations that may uplift the profession.
Comparison of Near-Infrared Spectroscopy with Needle Indentation and Histology for the Determination of Cartilage Thickness in the Large Animal Model Sheep
Authors: Horbert Victoria , Lange Matthias , Reuter Thomas , Hoffmann Martin , Bischoff Sabine , Borowski Juliane , Schubert Harald , Driesch Dominik , Mika Joerg , Hurschler Christof , Kinne Raimund W.
Published: October 2017

The suitability of near-infrared spectroscopy (NIRS) for non-destructive measurement of cartilage thickness was compared with the gold standard needle indentation. A combination of NIRS and biomechanical indentation (NIRS-B) was used to address the influence of varying loads routinely applied for hand-guided NIRS during real-life surgery on the accuracy of NIRS-based thickness prediction. NIRS-B was performed under three different loading conditions in 40 osteochondral cylinders from the load-bearing area of the medial and lateral femur condyle of 20 cadaver joints (left stifle joints; female Merino sheep; 6.1 ± 0.6 years, mean ± standard error of the mean). The cartilage thickness measured by needle indentation within the region analyzed by NIRS-B was then compared with cartilage thickness prediction based on NIRS spectral data using partial least squares regression. NIRS-B repeat measurements yielded highly reproducible values concerning force and absorbance. Separate or combined models for the three loading conditions (the latter simulating load-independent measurements) resulted in models with optimized quality parameters (e.g., coefficients of determination R2 between 92.3 and 94.7) and a prediction accuracy of < 0.1 mm. NIRS appears well suited to determine cartilage thickness (possibly in a hand-guided, load-independent fashion), as shown by high reproducibility in repeat measurements and excellent reliability compared with tissue-destructive needle indentation. This may provide the basis for non-destructive, intra-operative assessment of cartilage status quo and fine-tuning of repair procedures.
Eptifibatide is associated with significant cost savings and similar clinical outcomes to abciximab when used during primary percutaneous coronary intervention for ST-elevation myocardial infarction: An observational cohort study of 3863 patients
Authors: Rathod KS , Antoniou S , Avari P , Ding N , Wright P , Knight C , Jain AK , Mathur A , Smith EJ , Weerackody R , Wragg A , Jones DA
Published: October 2017

Introduction

Glycoprotein IIb/IIIa inhibitors are recommended by guidelines in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. There are few studies directly comparing these agents. The aim of this study was to assess whether eptifibatide is a safe and cost-effective alternative to abciximab in the treatment of primary percutaneous coronary intervention for ST-segment elevation myocardial infarction.

Methods

This was an observational cohort study of 3863 patients who received a GPIIb/IIIa inhibitor whilst undergoing primary percutaneous coronary intervention from 2007 to 2014. Patients who did not receive a GPIIb/IIIa inhibitor were excluded. Time to first major adverse cardiac event defined as death, non-fatal myocardial infarction, stroke or target vessel revascularization, and total hospital costs were compared between the groups.

Results

In all, 1741 patients received abciximab with 2122 receiving eptifibatide. Patients who received eptifibatide had higher rates of previous MI/percutaneous coronary intervention and were more likely to undergo a procedure from the radial route. Unadjusted Kaplan–Meier analysis revealed no significant difference in the 1-year event rates between patients given eptifibatide versus abciximab (p = 0.201). Age-adjusted Cox analysis demonstrated no difference in 1-year outcome between abciximab and eptifibatide (hazard ratio: 0.83; 95% confidence interval: 0.73–1.39), which persisted after multivariate adjustment (hazard ratio: 0.92; 95% confidence interval: 0.79–1.56) including the incorporation of a propensity score (hazard ratio: 0.88; 95% confidence interval: 0.71–1.44). Eptifbatide was associated with significant cost savings being 87% cheaper overall compared to abciximab (on average £650 cheaper per patient and saving approximately £950,000).

Conclusion

This observational data suggest that eptifibatide is associated with similar outcomes and significant cost savings compared to abciximab when used in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.
Hospital Workplace Violence Prevention in California: New Regulations
Authors: Gooch Patricia (Pidge)
Published: October 2017

In response to startling statistics in the increasing number of workplace violence (WPV) incidents against health care workers, California employers across the continuum of care are preparing their organizations to comply with California Occupational Safety and Health Administration (CAL/OSHA) regulation SB 1299. This groundbreaking legislation requires hospitals and other health care settings to implement written strategic prevention plans and broaden the identification and reporting of incidents related to WPV. Also included in the law is a minimum staff education requirement and formal risk identification and mitigation plans. The occupational health nurse will play a critical role in preparing health care organizations and staff in this endeavor.
Previous Rotator Cuff Repair Is Associated With Inferior Clinical Outcomes After Reverse Total Shoulder Arthroplasty
Authors: Shields Edward J.W. , Koueiter Denise M. , Maerz Tristan , Schwark Adam , Wiater J. Michael
Published: October 2017

Background:

Although recent evidence suggests that any prior shoulder surgery may cause inferior shoulder arthroplasty outcomes, there is no consensus on whether previous rotator cuff repair (RCR) is associated with inferior outcomes after reverse total shoulder arthroplasty (RTSA).

Purpose:

To retrospectively compare outcomes in patients who underwent RTSA with and without previous RCR.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Patients with prior RCR and those without previous shoulder surgery (control) who underwent RTSA for cuff tear arthropathy or irreparable cuff tear were retrospectively identified from a prospective database. Exclusion criteria included revision arthroplasty, fractures, rheumatoid arthritis, dislocations, infection, prior non-RCR procedures, less than 12 months of follow-up, and latissimus dorsi tendon transfer. The American Shoulder and Elbow Surgeons (ASES) score, ASES Activities of Daily Living (ADL) score, visual analog scale (VAS) score for pain, Subjective Shoulder Value (SSV), and range of motion (ROM) were compared between groups.

Results:

Patients with previous RCR (n = 83 shoulders) were younger (mean ± SD, 67 ± 10 vs 72 ± 8 years; P < .001) and more likely to be male (46% vs 32%, P = .033) than controls (n = 189 shoulders). No differences were found in follow-up duration (25 ± 13 vs 26 ± 13 months, P = .734), body mass index, or any preoperative outcome variable or ROM measure. At final follow-up, patients with previous RCR had significantly lower ASES (76.5 [95% CI, 71.2-81.7] vs 85.0 [82.6-87.5], P = .015), lower SSV (76 [72-81] vs 86 [83-88], P < .001), worse pain (2.0 [1.4-2.6] vs 0.9 [0.6-1.1], P < .001), and less improvement in the ASES, ASES ADL, VAS, SSV, and forward elevation measures than controls. Multivariable linear regression analysis demonstrated that previous RCR was significantly associated with lower postoperative ASES score ( B = –9.5, P < .001), lower ASES improvement ( B = –7.9, P = .012), worse postoperative pain ( B = 0.9, P = .001), worse improvement in pain ( B = –1.0, P = .011), lower postoperative SSV ( B = –9.2, P < .001), lower SSV improvement ( B = –11.1, P = .003), and lower forward elevation ROM improvement ( B = –12.7, P = .008).

Conclusion:

Patients with previous RCR attempts may experience fewer short-term gains in functional and subjective outcome scores after RTSA compared with patients with no history of shoulder surgery who undergo RTSA. However, the differences between groups were small and below the minimal clinically important differences for the outcome measures analyzed.
Health and Health Behavior Concordance between Spouses in Same-Sex and Different-Sex Marriages
Authors: Holway Giuseppina Valle , Umberson Debra , Donnelly Rachel
Published: October 2017

Research shows that heterosexual spouses are concordant on a variety of health and health behavior outcomes. Yet, little is known about patterns of concordance between spouses in same-sex marriages, or whether concordance patterns differ for spouses in same- and different-sex marriages. Using descriptive techniques, we analyze survey data from both spouses in 121 gay, 168 lesbian, and 122 heterosexual married couples to examine health and health behavior concordance. We find that gay and lesbian couples are more concordant than heterosexual couples on several health and health behavior outcomes. Differences in concordance between gay and lesbian couples are also found. Findings suggest that the pathways through which concordance occurs may differ in important ways for same-sex and different-sex unions.
Marginal zone B cells are critical to factor VIII inhibitor formation in mice with hemophilia A
Authors: Zerra Patricia E. , Cox Courtney , Baldwin W. Hunter , Patel Seema R. , Arthur Connie M. , Lollar Pete , Meeks Shannon L. , Stowell Sean R.
Published: October 2017

Key Points

FVIII colocalizes with MZ B cells following infusion into hemophilia A mice. Depletion of MZ B cells prevents FVIII inhibitor development in hemophilia A mice.
Distinct TP73–DAPK2–ATG5 pathway involvement in ATO-mediated cell death versus ATRA-mediated autophagy responses in APL
Authors: Humbert Magali , Federzoni Elena A , Tschan Mario P
Published: October 2017

We have previously demonstrated that the death-associated protein kinase 2 (DAPK2) expression is significantly reduced in acute myeloid leukemia (AML), particularly in acute promyelocytic leukemia (APL) blast cells. In this study, we aimed at further understanding DAPK2 function and regulation during arsenic trioxide (ATO) cytotoxic or all-trans retinoic acid (ATRA) differentiation therapy in APL cells. We found that the p53 family member transactivation domain-p73 isoform (TAp73) binds to and activates the DAPK2 promoter, whereas the dominant-negative ΔNp73 isoform inhibits DAPK2 transcription. Furthermore, the knocking down of tumor protein p73 (TP73) in NB4 cells resulted in reduced DAPK2 expression associated with decreased cell death and autophagy upon ATO and ATRA treatment, respectively. Moreover, the silencing of DAPK2 revealed that DAPK2 is an important downstream effector of p73 in ATO-induced apoptosis but not autophagy responses of APL cells. In contrast, the p73–DAPK2 pathway is essential for ATRA-induced autophagy that is mediated by an interaction of DAPK2 with the key autophagy-related protein (ATG)5. Lastly, we show that DAPK2 binds and stabilizes the p73 protein; thus, we propose a novel mechanism by which ATO- or ATRA-induced therapy responses initiate a positive p73–DAPK2 feedback loop.
Petroleum system modeling and assessment of the remaining hydrocarbon potential in the eastern part of Drava Depression
Authors: Cvetković Marko , Emanović Ivona , Stopar Andrej , Slavinić Petra
Published: October 2017

The eastern part of the Drava Depression presents a relatively small part within the Croatian part of the Pannonian Basin. A confined part within the eastern part of the Drava Depression with a working petroleum system but few hydrocarbon accumulations was selected for the evaluation of the remaining hydrocarbon potential. Four subsurface models were built with different levels of detail on which determination of source rock maturity, assessment of potential, and finally, volumes of the potentially accumulated hydrocarbons were estimated. In addition, several case scenarios, regarding source rock properties and boundary conditions were addressed to present the risk points in the model. Results proved that the amounts of hydrocarbons generated ([Formula: see text] of oil and [Formula: see text] of gas) and accumulated ([Formula: see text] of oil and [Formula: see text] of gas) in the subsurface strongly support further exploration efforts even for the conservative modeling parameters (low heat flow [HF] and moderate total organic carbon values). A set of scenarios was also modeled including different HF, total organic content, and kinetic values each with significant impact for the final model result.
Where Are the Opportunities for Reducing Health Care Spending Within Alternative Payment Models?
Authors: Rocque Gabrielle B. , Williams Courtney P. , Kenzik Kelly M. , Jackson Bradford E. , Halilova Karina I. , Sullivan Margaret M. , Rocconi Rod P. , Azuero Andres , Kvale Elizabeth A. , Huh Warner K. , Partridge Edward E. , Pisu Maria
Published: October 2017

Purpose:

The Oncology Care Model (OCM) is a highly controversial specialty care model developed by the Centers for Medicare & Medicaid aimed to provide higher-quality care at lower cost. Because oncologists will be increasingly held accountable for spending as well as quality within new value-based health care models like the OCM, they need to understand the drivers of total spending for their patients.

Methods:

This retrospective cohort study included patients ≥ 65 years of age with primary fee-for-service Medicare insurance who received antineoplastic therapy at 12 cancer centers in the Southeast from 2012 to 2014. Medicare administrative claims data were used to identify health care spending during the prechemotherapy period (from cancer diagnosis to antineoplastic therapy initiation) and during the OCM episodes of care triggered by antineoplastic treatment. Total health care spending per episode includes all types of services received by a patient, including nononcology services. Spending was further characterized by type of service.

Results:

Average total health care spending in the three OCM episodes of care was $33,838 (n = 3,427), $23,811 (n = 1,207), and $19,241 (n = 678). Antineoplastic drugs accounted for 27%, 32%, and 36% of total health care spending in the first, second, and third episodes. Ten drugs, used by 31% of patients, contributed 61% to drug spending ($18.8 million) in the first episode. Inpatient spending also substantially contributed to total costs, representing 17% to 20% ($30.5 million) of total health care spending.

Conclusion:

Health care spending was heavily driven by both antineoplastic drugs and hospital use. Oncologists’ ability to affect these types of spending will determine their success under alternative payment models.
Germ Cell Neoplasia in Situ and Preserved Fertility Despite Suppressed Gonadotropins in a Patient With Testotoxicosis
Authors: Juel Mortensen Li , Blomberg Jensen Martin , Christiansen Peter , Rønholt Ann-Margrethe , Jørgensen Anne , Frederiksen Hanne , Nielsen John E , Loya Anand C , Grønkær Toft Birgitte , Skakkebæk Niels E , Rajpert-De Meyts Ewa , Juul Anders
Published: October 2017

Context

Testotoxicosis is an autosomal-dominant, male-limited disorder. Activating mutations in the luteinizing hormone receptor gene (LHCGR) cause high autonomous testosterone secretion, resulting in early-onset peripheral precocious puberty. Little is known about long-term consequences of testotoxicosis.

Case Description

We present a rare case of a patient followed for 25 years with two remarkable outcomes: preserved fertility and germ cell neoplasia in situ (GCNIS). He presented with precocious puberty at 10 months of age and was diagnosed with testotoxicosis due to a de novo heterozygous Asp578Tyr mutation in LHCGR. Testicular biopsy in childhood showed Leydig cell hyperplasia with altered cell maturation. From infancy throughout adulthood, elevated testosterone and estradiol, low inhibin B and anti-Müllerian hormone, and completely suppressed follicle-stimulating hormone and luteinizing hormone were noted. Height acceleration and advanced bone age resulted in a reduced final height. Semen analysis revealed ongoing spermatogenesis, and the patient fathered a child by natural conception. Ketoconazole treatment decreased circulating testosterone in childhood, supported by experimental suppression of testosterone production in his adult testis tissue cultured ex vivo. At 25 years of age, ultrasound revealed a testicular tumor, identified as a Leydig cell adenoma, but unexpectedly with GCNIS present in adjacent seminiferous tubules.

Conclusion

The case illustrates that absence of gonadotropins but high intratesticular testosterone concentration is sufficient for spermatogenesis and to allow fatherhood. Our study is also the first description, to our knowledge, of GCNIS in a patient with testotoxicosis. We recommend regular clinical examination and ultrasonic evaluation of the testes in these patients due to potential increased risk of malignancy.
Thermal A-δ Nociceptors, Identified by Transcriptomics, Express Higher Levels of Anesthesia-Sensitive Receptors Than Thermal C-Fibers and Are More Suppressible by Low-Dose Isoflurane
Authors: Raithel Stephen J. , Sapio Matthew R. , Iadarola Michael J. , Mannes Andrew J.
Published: October 2017

We investigated the effect of isoflurane on 2 main types of thermal nociceptors: A-δ and C-fibers. Surprisingly, 1% inhaled isoflurane led to a hyperalgesic response to C-fiber thermal stimulation, whereas responses to A-δ thermal stimulation were blunted. We explored the hypothesis that differences in withdrawal behavior are mediated by differential expression of isoflurane-sensitive proteins between these types of thermal nociceptors. Multiple transcriptomic databases of peripheral neurons were integrated to reveal that isoflurane-susceptible proteins Htr3a, Kcna2, and Scn8a were enriched in thermosensitive A-δ neurons. This exploratory analysis highlights the differing role that volatile anesthetics might have on nociceptors in the peripheral nervous system.
Higher Operating Table for Optimal Needle-Entry Angle and Less Discomfort During Spinal Anesthesia
Authors: Sohn Hye-Min , Kim Hyerim , Hong Jung-Pyo , Lee Kyoung Min , Kim Jinhee
Published: October 2017

The aim of this study was to find the optimal table height to facilitate insertion of the spinal needle at a 90° angle and to reduce the anesthesiologist’s discomfort. Sixty patients were randomly allocated according to landmarks on the anesthesiologist’s body: umbilicus (group U), lowest rib margin (R), xiphoid process (X), and nipple (N). The coronal insertion angle between the patient’s skin and the spinal needle was obtuse in groups U and R, and 90° in group X. We demonstrated that high operating tables at the xiphoid and nipple level facilitate more optimal needle entry angles while reducing the discomfort and joint flexion of anesthesiologists during spinal anesthesia.
Six Month Follow-Up of a Patient With a Retained Fascia Iliaca Catheter: A Case Report
Authors: Borg Lindsay K. , Kumar Gunjan , Funck Natasha , Tamm-Daniels Inge , Giori Nicholas J. , Mariano Edward R.
Published: October 2017

Retained catheters are a rare but known complication of continuous peripheral nerve block. To date there have been several case reports of retained catheters but none that include longer-term follow-up of the patient experience and outcomes. Here, we present the case of a retained fascia iliaca catheter used for analgesia after total hip arthroplasty that fractured during removal and was ultimately never retrieved. The patient initially experienced paresthesias emanating from the site of continuous peripheral nerve block catheter placement, but these issues resolved completely over several weeks. No infectious or serious sequelae were encountered during 6 months of follow-up.
Atuação da fisioterapia em pacientes transplantados de medula óssea: revisão sistemática de literatura
Authors: Silva Italo Caldas , Campos Nataly Gurgel , Chagas Vinhote Juliana Freire , Lins Florêncio Ana Carolina , Marizeiro Débora Fortes , Braga Darling Késcia , Dias Mariana Teles
Published: October 2017

Introdução: O Transplante de medula óssea (TMO) é um procedimento terapêutico que consiste na infusão de sangue da medula óssea, em receptor adequadamente compatível. Devido ao longo período de isolamento protetor e à toxicidade dos agentes quimioterápicos utilizados no regime de condicionamento pré-transplante, ocorre uma restrição das atividades físicas do paciente e potencializa os efeitos deletérios para o sistema cardiopulmonar. Objetivo: Realizar uma revisão sistemática sobre a atuação da fisioterapia no cuidado a pacientes submetidos ao transplante de medula óssea. Materiais e Métodos: Estudo seccional e documental realizado por meio de revisão sistemática da literatura disponível nas bibliotecas virtuais de saúde: BIREME, PEDro, PubMed e Scielo. Resultados: Sete artigos foram selecionados e discutidos com outros trabalhos. Os estudos mostraram que a Fisioterapia pode auxiliar no tratamento dos pacientes submetidos ao TMO, melhorando a função motora global ou auxiliando no tratamento dos sintomas apresentados, além de se mostrar eficiente nas repercussões pulmonares, melhorando a força dos músculos respiratórios e a ventilação pulmonar, além de poder atuar na avaliação da qualidade de vida desses pacientes utilizando questionário específico. Conclusão: A Fisioterapia tem papel importante no tratamento desses indivíduos, visando à melhoria da funcionalidade e da qualidade de vida, por meio de exercícios físicos e respiratórios, alongamentos e recursos respiratórios fisioterapêuticos. Porém, a atuação da Fisioterapia nesse contexto ainda não está bem descrita na literatura, pois os artigos não detalham os protocolos de reabilitação utilizados na intervenção dos pacientes pós-tratamentos de medula óssea, apenas citam a Fisioterapia em sua realização e sua importância para uma melhor recuperação desses pacientes. É necessário o incentivo à pesquisa nesta área.
Análise da efetividade das ações de controle da dengue no município de Uberlândia, MG a partir da matriz FPEEEA
Authors: Arantes Karen Magalhães , Pereira Boscolli Barbosa
Published: October 2017

Introdução: O Brasil ocupa o primeiro lugar no ranking mundial da dengue. O controle da doença é complexo e está relacionado a condições sociais, culturais, ambientais, econômicas e políticas. Objetivo: A partir de um estudo anterior, no qual foram habilitados indicadores para vigilância da dengue em Uberlândia-MG por meio da utilização do modelo FPEEEA (Forças Motrizes, Pressão, Estado, Exposição, Efeito), objetivou-se, nesta pesquisa, avaliar a efetividade das ações realizadas para o controle da dengue neste município. Métodos: Trata-se de um estudo descritivo-exploratório, de abordagem quali-quantitativa, centrado na aplicação do Modelo FPEEEA para análise das correlações entre indicadores relacionados às condições sociais, econômicas e ambientais que podem estar associados à ocorrência da dengue. Resultados: De acordo com os dados apresentados, perceberam-se correlações importantes entre os indicadores que compõem os diferentes eixos da matriz FPEEEA, bem como ausência de correlação entre indicadores que são considerados pela literatura científica como importantes fatores para ocorrência de dengue. Assim, observou-se que são muitas as causas que colaboram para o aumento da incidência da dengue em Uberlândia e que são diversas as ações que podem ser efetivas para o controle da doença. Conclusão: Conclui-se que as ações propostas consistem em um abundante grupo de tarefas que podem afetar de forma progressiva os diferentes eixos da matriz FPEEEA, incluindo políticas sociais, de planejamento urbano, investimentos nos serviços de infraestrutura urbana, estímulo ao consumo consciente e à reciclagem, pesquisas para aprimoramento dos recursos para controle vetorial, além de ações de educação em saúde para controle do vetor.
The lectin isolated from Lonchocarpus araripensis seed elicits endothelium-dependent vasorelaxation
Authors: Pires Alana de Freitas , Almeida Lívia Mendes de , Silva Débora Helen Marques da , Marques Gabriela Fernandes Oliveira , Cajazeiras João Batista , Neto Cornevile Correia , Nascimento Kyria Santiago , Cavada Benildo Sousa , Assreuy Ana Maria Sampaio
Published: October 2017

Background: The vasorelaxant effect of lectins from leguminous plants (Diocleinae subtribe) is well described. However, this effect has been little explored for lectins isolated from Dalbergieae tribe, except for that of Vatairea guianensis, that induces vasorelaxation involving nitric oxide and the lectin domain. Objective: To evaluate the vasorelaxant effect of a lectin isolated from Lonchocarpus araripensis (LAL), Dalbergieae tribe, and the involvement of the lectin domain and endothelium derived relaxing factors. Methods: Aortic rings of Wistar rats (250 - 300 g) were mounted in organ bath and mantained in physiological conditions (CEUA No. 10130208-8/40). LAL (0.1–100 µg/ml) was added to phenylephrine (0.1 µM)-contracted tissues with either endothelium intact or denuded. In order to investigate the mechanisms of LAL relaxation, inhibitors of NOS (L-NAME: 100 µM), cyclooxygenase (indomethacin: 10 µM), or potassium channels (TEA: 5 mM) were added to endothelized tissues 30 min before contraction. The involvement of lectin domain was assessed by previous incubation of LAL (30 µg/ml) with GlcNAc (0.1 M). Results: LAL (0.1-100 µg/ml) induced relaxation only in endothelized aorta, being maximal at 100 µg/ml (62.57 ± 7.8%). The relaxant effect induced by LAL at 30 µg/ml (52.49 ± 10.32%) was abolished by previous incubation with GlcNAc. LAL relaxant effect (IC50 9.75 ± 7.1) was partially reversed by indomethacin (IC50 LAL + indomethacin: 30.47 ± 10.93) and was abolished by L-NAME or TEA. Conclusion: LAL exhibits vasorelaxant activity in contracted endothelized aorta of rats, involving the lectin domain, muscarinic receptor of acetylcholine and endothelial derived relaxing factors.
Desafios Diagnósticos na Síndrome da Taquicardia Postural Ortostática (POTS) em uma Adolescente
Authors: Lucena Jalles Dantas , Queiroz Thamiris Silva , Brito Beatriz Soares , Lima Francisco Pitombeira , Café Anna Flávia da Cruz , Gondim Francisco de Assis Aquino
Published: October 2017

Dificuldades no diagnóstico de Síndrome da Taquicardia Postural Ortostática (POTS) numa adolescente de 16 anos, com hipotireoidismo a 10 anos, apresenta sudorese, palidez, calor, taquicardia, fadiga e tontura. Após seis meses, houve recidiva pós-prandial, revertida com manobra de Trendelenburg. Tilt Test demonstrou em decúbito dorsal pressão arterial (PA) 106/71mmHg e frequência cardíaca (FC) 72bpm. Após terceiro minuto, PA 101/70mmHg e FC 99bpm. Além hipotireoidismo, não detectou-se outros fatores de risco para disautonomia. Propranolol (10mg, 12/12h) controlou sintomas. Diagnóstico de POTS é difícil em adolescentes, confundindo com Epilepsia e Síncope Neurocardiogênica. Nesse caso, hipotireoidismo parece ser fator causal da POTS.
Optimisation of ex vivo memory B cell expansion/differentiation for interrogation of rare peripheral memory B cell subset responses
Authors: Muir Luke , McKay Paul F. , Petrova Velislava N. , Klymenko Oleksiy V. , Kratochvil Sven , Pinder Christopher L. , Kellam Paul , Shattock Robin J.
Published: October 2017

Background:Human memory B cells play a vital role in the long-term protection of the host from pathogenic re-challenge. In recent years the importance of a number of different memory B cell subsets that can be formed in response to vaccination or infection has started to become clear. To study memory B cell responses, cells can be culturedex vivo,allowing for an increase in cell number and activation of these quiescent cells, providing sufficient quantities of each memory subset to enable full investigation of functionality. However, despite numerous papers being published demonstrating bulk memory B cell culture, we could find no literature on optimised conditions for the study of memory B cell subsets, such as IgM+memory B cells.

Methods:Following a literature review, we carried out a large screen of memory B cell expansion conditions to identify the combination that induced the highest levels of memory B cell expansion. We subsequently used a novel Design of Experiments approach to finely tune the optimal memory B cell expansion and differentiation conditions for human memory B cell subsets. Finally, we characterised the resultant memory B cell subpopulations by IgH sequencing and flow cytometry.

Results:The application of specific optimised conditions induce multiple rounds of memory B cell proliferation equally across Ig isotypes, differentiation of memory B cells to antibody secreting cells, and importantly do not alter the Ig genotype of the stimulated cells. 

Conclusions:Overall, our data identify a memory B cell culture system that offers a robust platform for investigating the functionality of rare memory B cell subsets to infection and/or vaccination.
ПОЛИТИКА РОССИИ В АРКТИКЕ В СФЕРЕ ПРОДОВОЛЬСТВЕННОЙ БЕЗОПАСНОСТИ
Authors: Trofimova Svetlana Alekseevna , Trofimova Inna Borisovna , Trofimov Boris Nikolaevich , Dmitriev Maksim Dmitrievich
Published: October 2017

В статье анализируются актуальные в современных условиях вопросы обеспечения продовольственной безопасности арктических регионов России, которые рассматривались на Международном Арктическом форуме 29–30 марта 2017 г. «АРКТИКА – территория диалога» и на Международной научно-практической конференции «Технологии развития социальных, экономических и логистических процессов Арктической зоны России: история и современность» в Красноярске 30–31 марта 2017 года, проходившей в Красноярском государственном аграрном университете.Особое внимание обращается на реальное обеспечение отдельных районов основными продуктами сельского хозяйства. Предлагаются меры по активному вовлечению населения арктических территорий и коренных малочисленных народов Крайнего Севера в самообеспечение продовольствием с использованием продукции традиционного природопользования коренных малочисленных народов.Обосновывается комплексный подход к обеспечению населения северных территорий сибирской Арктики сбалансированным продовольствием в соответствии с направлениями продовольственной безопасности в мире, разработанными ООН в Декларации Тысячелетия.
ДЕМОГРАФИЧЕСКИЙ ПОТЕНЦИАЛ ТЕРРИТОРИИ КАК ФАКТОР СДЕРЖИВАНИЯ ЭКОНОМИЧЕСКОГО РАЗВИТИЯ
Authors: Lucenko Ekaterina Leonidovna , Govaco Antonida Vitalievna , Golik Anna Sergeevna
Published: October 2017

Статья посвящена рассмотрению динамики демографических процессов, факторов их определяющих, особенностям воспроизводства населения в России и её регионах.В статье представлен обзор теоретических подходов к пониманию и оценке демографического потенциала региона. Авторы подробно остановились на рассмотрении внутрирегиональных диспропорций и прежде всего с позиций потенциальных возможностей территорий. Так большой природный потенциал наталкивается на узость инфраструктурной базы, а планы по развитию территории могут сдерживаться не только отсутствием инвестиций, но и отсутствием достаточного трудового потенциала.Проведённый в работе сравнительный анализ демографической ситуации в российских регионах, анализ динамики количественных и качественных показателей демографического потенциала Еврейской автономной области (ЕАО) с учётом миграционных потоков, позволил выявить факторы сдерживания регионального развития.Переломить создавшуюся ситуацию авторы предлагают за счёт реализации разработанной Стратегии социально-экономического развития ЕАО до 2030 года, а также поиска новых инструментов миграционной политики в отношении Дальнего Востока России.Цель – оценка демографического потенциала территории и выявление региональных диспропорций для поиска новых инструментов региональной политики.Метод или методология проведения работы: в статье использовались статистические методы анализа, а также общенаучные методы (дедукции, аналогии).Результаты: выявлены факторы сдерживания регионального развития (на примере отсталого региона – Еврейская автономная область).Область применения результатов: результаты проведённого анализа целесообразно применять в проведении региональной экономической политики.