bluuebunny/crossref_metadata_2025 huggingface dataset:
Attribution of Adverse Events Following Coronary Stent Placement Identified Using Administrative Claims Data
Authors: Dhruva Sanket S. , Parzynski Craig S. , Gamble Ginger M. , Curtis Jeptha P. , Desai Nihar R. , Yeh Robert W. , Masoudi Frederick A. , Kuntz Richard , Shaw Richard E. , Marinac‐Dabic Danica , Sedrakyan Art , Normand Sharon‐Lise T. , Krumholz Harlan M. , Ross Joseph S.
Published: February 2020

Background

More than 600 000 coronary stents are implanted during percutaneous coronary interventions (
PCI
s) annually in the United States. Because no real‐world surveillance system exists to monitor their long‐term safety, claims data are often used for this purpose. The extent to which adverse events identified with claims data can be reasonably attributed to a specific medical device is uncertain.

Methods and Results

We used deterministic matching to link the NCDR (National Cardiovascular Data Registry) Cath
PCI
Registry to Medicare fee‐for‐service claims for patients aged ≥65 years who underwent
PCI
with drug‐eluting stents (
DESs
) between July 1, 2009 and December 31, 2013. We identified subsequent
PCI
s within 1 year of the index procedure in Medicare claims as potential safety events. We linked these subsequent
PCI
s back to the
NCDR
Cath
PCI
Registry to ascertain how often the revascularization could be reasonably attributed to the same coronary artery as the index
PCI
(ie, target vessel revascularization). Of 415 306
DES
placements in 368 194 patients, 33 174 repeat
PCI
s were identified in Medicare claims within 1 year. Of these, 28 632 (86.3%) could be linked back to the
NCDR
Cath
PCI
Registry; 16 942 (51.1% of repeat
PCI
s) were target vessel revascularizations. Of these, 8544 (50.4%) were within a previously placed
DES
: 7652 for in‐stent restenosis and 1341 for stent thrombosis. Of 16 176 patients with a claim for acute myocardial infarction in the follow‐up period, 4446 (27.5%) were attributed to the same coronary artery in which the
DES
was implanted during the index
PCI
(ie, target vessel myocardial infarction). Of 24 288 patients whose death was identified in claims data, 278 (1.1%) were attributed to the same coronary artery in which the
DES
was implanted during the index
PCI
.

Conclusions

Most repeat
PCI
s following
DES
stent implantation identified in longitudinal claims data could be linked to real‐world registry data, but only half could be reasonably attributed to the same coronary artery as the index procedure. Attribution among those with acute myocardial infarction or who died was even less frequent. Safety signals identified using claims data alone will require more in‐depth examination to accurately assess stent safety.
Contemporary Use and Outcomes of Arterial Closure Devices After Percutaneous Coronary Intervention: Insights From the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program
Authors: Prouse Andrew , Gunzburger Elise , Yang Fan , Morrison Justin , Valle Javier A. , Armstrong Ehrin J. , Waldo Stephen W. 
Published: February 2020

Background

Arterial closure devices reduce the length of bedrest after invasive cardiac procedures via the femoral approach, but there are conflicting data on their association with major bleeding and vascular complications. We thus sought to evaluate the contemporary use of femoral arterial closure devices and their association with major bleeding among patients undergoing percutaneous coronary intervention.

Methods and Results

We identified patients undergoing percutaneous intervention via the femoral approach within the Veterans Affairs Healthcare System from December 2004 through September 2018. The association between arterial closure device use and major bleeding was evaluated using both propensity matching and instrumental variable analyses, incorporating contrast‐induced nephropathy as a falsification end point. We identified 132 373 percutaneous coronary interventions performed by 681 operators, with closure device use increasing 1.2% each year (linear trend
P
<0.001). In a propensity‐matched cohort, closure devices were associated with a 1.1% reduction in periprocedural bleeding (95%
CI
, −1.5% to −0.6%). Closure devices were also associated with a numerical decrease in contrast‐inducted nephropathy that did not reach statistical significance (−0.6%; 95%
CI
, −1.3% to 0.1%). In an instrumental variable analysis of closure device use, there was no difference in the bleeding rate between those who received a closure device and those who did not (0.2%; 95%
CI
, −0.9% to 1.2%).

Conclusions

Arterial closure devices are associated with a reduction in major bleeding within a propensity‐matched cohort. This association dissipates in an instrumental variable analysis, highlighting some of the methodologic limitations of comparative effectiveness research in observational analyses.
The osce and the Libyan Crisis
Authors: Morana Walter
Published: February 2020

This article examines the role played by the Organization for Security and Co-operation in Europe (osce) and other external actors in tackling security issues that have emerged in Libya since the outbreak of the Arab Spring. Uncontrolled migration, human trafficking, radicalization and energy security are still at stake within the comprehensive and indivisible security that the osce strives to bring across its area. Although security in the Mediterranean is linked to that of osce participating States, Libya’s fragmentation has highlighted the challenges in adopting joint policies in the country. Therefore, the osce still faces the challenge to effectively engage with Libya in its ongoing debate on common security in the Mediterranean.
Respecting Human Rights While Countering Terrorism
Authors: de Klerk Piet
Published: February 2020

This is an article by a practitioner who has worked on two sides of the divide between countering terrorism and protecting human rights, both as Netherlands Human Rights Ambassador and later as the Dutch Special Counterterrorism Envoy. What was most striking in looking at these two periods that were roughly a decade apart, was how different the issues and perspectives at the junction of countering terrorism and respecting human rights were. These can be attributed to three factors: 1) that in the first period the shock of 9/11 was still new and the US was in overdrive; 2) the differences between al-Qaeda and the Islamic State; and 3) revolutionary technological changes that have an impact on human rights and on the way a terrorist organization can function these days.
‘Propaganda by the Deed’ in Theory and Practice
Authors: Chilton Phil
Published: February 2020

Many analysts of the ‘terrorism’ phenomena locate the desire to cause terror as a key definitional concept: terrorists seek to cause terror. Such a conception risks obscuring the motivations for the act of terrorism, it is committed purely to terrorise. The idea that this type of political violence is an act of ‘propaganda by the deed’, however, is one commonly applied by the perpetrators themselves. The anarchist ‘terrorists’ of the late nineteenth and early twentieth century and contemporary ‘jihadists’ both understood their acts, at least in part, as propaganda by the deed. Beyond just the creation of terror propaganda by the deed can be used as an alternative conceptual vantage point to examine and understand the motivations that lie behind acts of terrorism and the material conditions that give rise to these acts.
Terror Management Theory
Authors: Arrowood Robert B. , Cox Cathy R.
Published: February 2020

From the perspective of terror management theory (TMT), the awareness of death is problematic as it has the potential to increase anxiety. It would be hard to function when faced with this fear; thus, people defend themselves from heightened mortality awareness by adhering to their cultural beliefs (e.g., religion, nationalism), having positive self-views (i.e., self-esteem), and/or turning toward their relationships with close others. The purpose of the current volume is to introduce readers to the field of experimental existential psychology (broadly) and TMT (specifically). To do this, Section 1 will provide an introduction to the field, along with discussing methodological considerations when conducting terror management research. Section 2 was written to discuss some of the applied implications of TMT as it is relates to close relationships, religion, politics and law, positivity, and existential growth. Much work from a terror management tradition has been interested in how death concerns affect physical and psychological health. Because of this, Section 3 will introduce two variations of TMT (i.e., Terror Management Health Model [TMHM] & Anxiety-buffer Disruption Theory [ABDT]), with implications for individuals’ well-being. Finally, Section 4 will discuss alternative perspectives and controversies within the field. Throughout this volume, we provide a discussion on potential avenues of future study.
Nostoc oromo sp. nov. (Nostocales, Cyanophyceae) from Ethiopia: a new species based on morphological and molecular evidence

Authors: MESFIN MELAKU , JOHANSEN JEFFREY R. , PIETRASIAK NICOLE , BALDARELLI LAUREN M.
Published: February 2020

In the course of study of the cyanobacterial flora of Ethiopian soil crusts, we isolated a distinctive strain most closely resembling Chroococcidiopsis kashayi, and at first considered it to be a new Chroococcidiopsis species. However, when placed in nitrogen-free medium for an extended time period this strain developed heterocytes, and consequently was placed in the genus Nostoc. It is morphologically distinct from all other Nostoc species due to its consistent formation of microscopic few-celled colonies lacking clear filamentous organization, which release smaller colonies from the mother colony, leaving behind a persistent thin firm sheath that resembles cell wall material in the light microscope. Analysis of 16S rRNA and 16S-23S ITS sequence data confirmed its uniqueness among numerous strains of soil Nostoc. We are describing it as Nostoc oromo, named for the nationality of the people from the region of its origin.
A new arborescent Chamaecrista (Leguminosae) from Amazon, Brazil

Authors: RANDO JULIANA GASTALDELLO , DE LIMA HAROLDO CAVALCANTE
Published: February 2020

Chamaecrista ipanorensis, a new arborescent species of caesalpinioid legume restricted to campinarana vegetation (white sand forest) in upper Rio Negro, northern Amazon basin, is described, illustrated, and compared with the morphologically similar species C. hymenaeifolia and C. polystachya.
Proceedings of the 14th International Symposium on Aquatic Oligochaeta (Cover)

Authors: OHTAKA AKIFUMI , HIRABAYASHI KIMIO , WETZEL MARK J. , SCHENKOVÁ JANA , PINDER ADRIAN
Published: February 2020

(Cover)
An ongoing saga: Endemic branchiobdellidans (Annelida: Clitellata) on translocated commercial North American crayfish

Authors: GELDER STUART R.
Published: February 2020

Over the last 130 years demand for crayfish has exceeded regional supplies around the world, so stocks, primarily from North America, have been imported to satisfy this need. These demands are human based and include gastronomy, sport fishing bait, food for rearing animals, educational aides, ornamentation in waterbodies, and more recently a significant increase in pet crayfish sales. The three most common commercial species from North America are Pacifastacus leniusculus, Procambarus clarkii and Orconectes limosus, although four other species are increasing in importance as they become more widely distributed. All of these crayfish in their endemic range have been reported to carry branchiobdellidan annelids. Therefore, when the crayfish are translocated, their ectosymbionts likely accompany them. Eighty-six potentially transportable branchiobdellidans are recognized in this paper, along with the distribution of six species known to have been translocated. Moreover, branchiobdellidans endemic to the translocation regions have adopted introduced crustacean hosts, which demonstrates that branchiobdellidan host species specificity is not as restrictive as many researchers believe. On the evidence to date, these translocated branchiobdellidans appear to have the same relationship and cause the same amount of damage, if any, as those on their endemic crayfish hosts. The geographical distribution of endemic branchiobdellidan—crayfish species associations are unique to each of four disjunct regions as defined by Bănărescu: Euro-Mediterranean, East Asian, western North American and eastern North American; the latter includes eastward drainages from Canada to Costa Rica.
A catalog and assessment of Prof. Hideji Yamaguchi's slide collection of branchiobdellidans (Annelida: Clitellata) with the identification of syntypes

Authors: OHTAKA AKIFUMI , GELDER STUART R. , PETERSON SUSAN M.
Published: February 2020

The branchiobdellidan slide collection of Professor Hideji Yamaguchi was rediscovered in 1995; however, all of the written records associated with it appear to have been lost. The slide collection has been examined, cataloged and deposited in the Invertebrate Collection of the Hokkaido University Museum, Sapporo, Japan (ICHAM). The collection was found to contain whole mounted specimens of all 17 species described by Prof. Yamaguchi, together with specimens of three other Oriental species described after his death. In addition, mounted specimens of some of these species were designated syntypes. Many sectioned and stained specimens were also cataloged, but those were not identified to species at this time.
Citations for the published proceedings of our 14 International Symposia on Aquatic Oligochaetes (1979–2018)

Authors: WETZEL MARK J.
Published: February 2020

These special publications, below, present overviews of and papers presented during our triennial international symposia on aquatic oligochaete biology.  Three similar names for our symposia have been used since we began as a group in 1979: International Symposium on Aquatic Oligochaete Biology (ISAOB), International Symposium on Aquatic Oligochaetes (ISAO), and International Symposium on Aquatic Oligochaeta (ISAO).
Proceedings of the 14th International Symposium on Aquatic Oligochaeta (Table of Contents)
Authors: OHTAKA AKIFUMI , HIRABAYASHI KIMIO , WETZEL MARK J. , SCHENKOVÁ JANA , PINDER ADRIAN
Published: February 2020

(Table of Contents)
New species and new records of Japanese Lumbriculidae (Annelida, Clitellata)

Authors: FEND STEVEN V. , OHTAKA AKIFUMI , TORII TAKAAKI
Published: February 2020

Most Japanese records and descriptions of the family Lumbriculidae are from the work of H. Yamaguchi, who described 6 endemic species and one genus, in addition to reporting the cosmopolitan Lumbriculus variegatus (Müller, 1774). Yamaguchi's work focused largely on the northern island of Hokkaido; since then, only one new Japanese lumbriculid genus and species has been described, also from Hokkaido. Recent collections from Honshu Island include several species not recorded in earlier literature, and here we report 4 new species of Lumbriculidae, plus a range extension of the Korean Lamprortus orientalis Rodriguez, 1994. Of the new species, only Styloscolex (Styloscolex) tazawaensis can be confidently assigned to an accepted genus using current morphological diagnoses. Styloscolex (Neoscolex) tatsukoae n. sp. is provisionally assigned to that Asian genus and subgenus based on the prosoporous male duct, spermathecae in the preatrial segment, and penial sheath—despite differing from congeners in having a single, median atrium in X, and single spermatheca in IX. Two additional species are here attributed to a new genus, Honshudrilus, which is distinguished by a combination of characters: spermathecae 2 or more segments anterior to the male pores, non-functional anterior male ducts (with loss of anterior testes), elongate-petiolate atria, penes formed by extruding the atrial duct lining, and spermathecal ducts with vestibules.
Composition and abundance of oligochaetes in Scandinavian lakes in the 1970s in full compatibility with the ”morpho-edaphic index”. Do these relationships still hold 40 years later?

Authors: MILBRINK GÖRAN
Published: February 2020

In the 1960s it became fairly well-known that biological indices through their supposedly integrative power could be more robust measures of the water quality than separate chemical data. Oligochaetes and chironomid larvae in the bottom fauna hereby played an important role. Precision, however, increased dramatically if the relationship between oligochaetes and the so-called morpho-edaphic index, i.e. the average total phosphorus content in µg/l divided by the mean depth (in meters) of the lake (Ryder et al., 1974), was used in stead (Milbrink, 1978). The percentage composition and total abundance of oligochaetes in a number of lakes or selected basins of large lakes in southern Sweden and Norway were thus tested against this index in the 1970s. In logarithmic scales these relationships turned out to be more or less linear. The immediate conclusions were then that this method of classifying lakes could be of considerable scientific as well as practical value. Today we know a lot more about the ecological preferences of oligochaete species and characteristic species associations. The oligochaete fauna of the large lakes of southern Sweden, Mälaren, Vättern, Vänern and Hjälmaren, have been studied in detail over many years—over 100 years in the first three of these lakes and in the last lake for over 50-years. Effects of generally applied advanced sewage treatment in Sweden since the late 1960s are easily recognizable in the material. We have a situation of oligotrophication. With our new knowledge it comes natural today to study changes in species composition after trophic change and to investigate if the above close relationships in abundance are still largely linear.
A new Corydoras (Ostariophysi: Siluriformes: Callichthyidae) with an unusual sexual dimorphism from the rio Juruena basin, Brazil
Authors: LIMA FLÁVIO C.T. , BRITTO MARCELO R.
Published: February 2020

A new Corydoras is described from the rio Juruena system, upper rio Tapajós drainage, Amazon basin, Brazil. The new Corydoras is distinguished from all congeners by presenting a combination of a conspicuous broad vertical dark bar on head, at the level of the eye (mask), an overall light background color without large blotches or stripes on body or fins, the presence of two to four small dark blotches along the midline, and pectoral spine with antrorse serrations on its posterior margin. Males of the new species possess numerous, well-developed odontodes over the lateral portions of head, pectoral girdle, and pectoral spines, an uncommon feature for the genus. The new species is hypothesized to belong, within the genus Corydoras, either to Lineage 6 or Lineage 9.
New country records for three species of frog from Myanmar including two genera (Nasutixalus and Oreolalax)
Authors: RAHMAN MD MIZANUR , CHEN JIN-MIN , WU YUN-HE , CHEN HONG-MAN , LWIN YE-HTET , MURPHY ROBERT W. , LI GUO-GANG , CHE JING
Published: February 2020

Myanmar, a biodiversity hotspot, harbors a striking diversity and endemism of species. Despite this, its herpetofauna remains one of the least explored in continental Asia due to restrictions of crossing political boundaries and infrastructure in remote regions. Many species in adjacent China and India are hypothesized to occur in Myanmar but records are wanting. Recent fieldwork found the frogs Polypedates braueri, Nasutixalus jerdonii and Oreolalax jingdongensis there, and the latter two species represent new generic records for Myanmar. All major morphological characters of these populations match the original descriptions. In addition, our matrilineal genealogy based on DNA barcoding confirms their identities. Overall, these findings confirm that the amphibian diversity is underestimated and this has important implications for conservation. Analyses indicate that northern Myanmar is a biogeographic corridor for the Himalayas, southern China, and northeastern India.
Impact of Soil Moisture on Winter 2-m Temperature Forecasts in Northern China
Authors: Zhong Ji-Qin , Lu Bing , Wang Wei , Huang Cheng-Cheng , Yang Yang
Published: February 2020

In this study, the causes of the underestimated diurnal 2-m temperature range and the overestimated 2-m specific humidity in the winter of northern China in the Rapid-Refresh Multiscale Analysis and Prediction System–Short Term (RMAPS-ST) are investigated. Three simulations based on RMAPS-ST are conducted from 1 November 2016 to 28 February 2017. Further analyses show that the partitioning of surface upward sensible heat fluxes and downward ground heat fluxes might be the main contributing factor to the 2-m temperature forecast bias. In this study, two simulations are conducted to examine the effect of soil moisture initialization and soil hydraulic property on the 2-m temperature and 2-m specific humidity forecasts. First, the High-Resolution Land Data Assimilation System (HRLDAS) is used to provide an alternative soil moisture initialization. The results show that the drier soil moisture could lead to noticeable change in energy partitioning at the land surface, which in turn results in improved prediction of the diurnal 2-m temperature range, although it also enlarges the 2-m specific humidity bias in some parts of the domain. Second, a soil texture dataset developed by Beijing Normal University and the revised hydraulic parameters are applied to provide a more detailed description of soil properties, which could further improve the 2-m specific humidity bias. In summary, the combination of using optimized soil moisture initialization, an updated soil map, and revised soil hydraulic parameters can help improve the 2-m temperature and 2-m specific humidity prediction in RMAPS-ST.
Mobile Radar Observations of the Evolving Debris Field Compared with a Damage Survey of the Shawnee, Oklahoma, Tornado of 19 May 2013
Authors: Wakimoto Roger M. , Wienhoff Zachary , Bluestein Howard B. , Bodine David J. , Kurdzo James M.
Published: February 2020

A detailed damage survey is combined with high-resolution mobile, rapid-scanning X-band polarimetric radar data collected on the Shawnee, Oklahoma, tornado of 19 May 2013. The focus of this study is the radar data collected during a period when the tornado was producing damage rated EF3. Vertical profiles of mobile radar data, centered on the tornado, revealed that the radar reflectivity was approximately uniform with height and increased in magnitude as more debris was lofted. There was a large decrease in both the cross-correlation coefficient (ρhv) and differential radar reflectivity (ZDR) immediately after the tornado exited the damaged area rated EF3. Low ρhv and ZDR occurred near the surface where debris loading was the greatest. The 10th percentile of ρhv decreased markedly after large amounts of debris were lofted after the tornado leveled a number of structures. Subsequently, ρhv quickly recovered to higher values. This recovery suggests that the largest debris had been centrifuged or fallen out whereas light debris remained or continued to be lofted. Range–height profiles of the dual-Doppler analyses that were azimuthally averaged around the tornado revealed a zone of maximum radial convergence at a smaller radius relative to the leading edge of lofted debris. Low-level inflow into the tornado encountering a positive bias in the tornado-relative radial velocities could explain the existence of the zone. The vertical structure of the convergence zone was shown for the first time.
Sensitivity Analysis of the Spatial Structure of Forecasts in Mesoscale Models: Noncontinuous Model Parameters
Authors: Marzban Caren , Tardif Robert , Sandgathe Scott
Published: February 2020

In a recent work, a sensitivity analysis methodology was described that allows for a visual display of forecast sensitivity, with respect to model parameters, across a gridded forecast field. In that approach, sensitivity was assessed with respect to model parameters that are continuous in nature. Here, the analogous methodology is developed for situations involving noncontinuous (discrete or categorical) model parameters. The method is variance based, and the variances are estimated via a random-effects model based on 2k−p fractional factorial designs and Graeco-Latin square designs. The development is guided by its application to model parameters in the stochastic kinetic energy backscatter scheme (SKEBS), which control perturbations at unresolved, subgrid scales. In addition to the SKEBS parameters, the effect of daily variability and replication (both, discrete factors) are also examined. The forecasts examined are for precipitation, temperature, and wind speed. In this particular application, it is found that the model parameters have a much weaker effect on the forecasts as compared to the effect of daily variability and replication, and that sensitivities, weak or strong, often have a distinctive spatial structure that reflects underlying topography and/or weather patterns. These findings caution against fine-tuning methods that disregard 1) sources of variability other than those due to model parameters, and 2) spatial structure in the forecasts.
Exploring the Dynamic Team Cohesion–Performance and Coordination–Performance Relationships of Newly Formed Teams
Authors: Braun Michael T. , Kozlowski Steve W. J. , Brown Tara A. (Rench) , DeShon Richard P.
Published: February 2020

Emergent states, like cohesion, and behavioral processes, like coordination, are considered critical for team performance, yet little is known regarding their relative importance over time. Testing several hypotheses and exploring multiple research questions, this study used a laboratory design to better understand the evolution of cohesion–performance and coordination–performance relationships of newly formed teams. Forty-two teams of three completed 10 task episodes of an interdependent team task over the course of two and a half hours. Results reveal that cohesion and performance have a reciprocal relationship such that cohesion predicts subsequent performance, which then predicts subsequent cohesion. Moreover, coordination predicts subsequent performance, but performance does not predict subsequent coordination. Both the cohesion–performance and coordination–performance relationships weaken as the team works together, indicating that other states and processes predict performance at later stages of team development. Meanwhile, the relative importance of cohesion compared with coordination strengthens with increased team interactions.
Anti-thyroid peroxidase antibody and thyroid cysts among the general Japanese population: a cross-sectional study
Authors: Shimizu Yuji , Nabeshima-Kimura Yuko , Kawashiri Shin-Ya , Noguchi Yuko , Nagata Yasuhiro , Maeda Takahiro , Hayashida Naomi
Published: February 2020

Background

Anti-thyroid peroxidase antibody (TPO-Ab) has been shown to cause autoimmune thyroiditis by inducing a deleterious influence on thyroid hormone synthesis. Further, thyroglobulin, which has an important role in thyroid hormone synthesis, is reported to be high in the fluid from thyroid cysts. Therefore, TPO-Ab could be associated with the presence of thyroid cyst, partly by affecting the activity of thyroid hormone synthesis.

Methods

To investigate the association between TPO-Ab and thyroid cysts, we conducted a cross-sectional study of 1432 Japanese with normal thyroid function [i.e., normal range of free triiodothyronine (free T3) and free thyroxine (free T4)] between the ages of 40 and 74 years, who participated in an annual health check-up.

Results

In men, the statistical power did not reach a statistical significance value. Additionally, subjects with TPO-Ab showed lower odds ratios (ORs) of thyroid cysts than those without TPO-Ab. In women, subjects with TPO-Ab showed significantly lower ORs of thyroid cysts than those without TPO-Ab. The fully adjusted ORs were 0.68 (0.40, 1.18) for men and 0.40 (0.27, 0.60) for women. When evaluating the association between logarithmic values of TPO-Ab titer and thyroid cysts in both men and women, a notable inverse correlation was observed. The fully adjusted ORs were 0.68 (0.50, 0.92) for men and 0.68 (0.57, 0.81) for women.

Conclusion

TPO-Ab titer revealed to be inversely associated with thyroid cysts among Japanese with normal thyroid function. The presence of a thyroid cyst could indicate a lower risk of having TPO-Ab among the general population with normal thyroid function.
Whole genome sequencing of Mycobacterium tuberculosis isolates and clinical outcomes of patients treated for multidrug-resistant tuberculosis in Tanzania
Authors: Katale Bugwesa Z. , Mbelele Peter M. , Lema Nsiande A. , Campino Susana , Mshana Stephen E. , Rweyemamu Mark M. , Phelan Jody E. , Keyyu Julius D. , Majigo Mtebe , Mbugi Erasto V. , Dockrell Hazel M. , Clark Taane G. , Matee Mecky I. , Mpagama Stellah
Published: February 2020

Background

Tuberculosis (TB), particularly multi- and or extensive drug resistant TB, is still a global medical emergency. Whole genome sequencing (WGS) is a current alternative to the WHO-approved probe-based methods for TB diagnosis and detection of drug resistance, genetic diversity and transmission dynamics ofMycobacterium tuberculosiscomplex (MTBC). This study compared WGS and clinical data in participants with TB.

Results

This cohort study performed WGS on 87 from MTBC DNA isolates, 57 (66%) and 30 (34%) patients with drug resistant and susceptible TB, respectively. Drug resistance was determined by Xpert® MTB/RIF assay and phenotypic culture-based drug-susceptibility-testing (DST). WGS and bioinformatics data that predict phenotypic resistance to anti-TB drugs were compared with participant’s clinical outcomes. They were 47 female participants (54%) and the median age was 35 years (IQR): 29–44). Twenty (23%) and 26 (30%) of participants had TB/HIV co-infection BMI < 18 kg/m2respectively. MDR-TB participants had MTBC with multiple mutant genes, compared to those with mono or polyresistant TB, and the majority belonged to lineage 3 Central Asian Strain (CAS). Also, MDR-TB was associated with delayed culture-conversion (median: IQR (83: 60–180 vs. 51:30–66) days). WGS had high concordance with both culture-based DST and Xpert® MTB/RIF assay in detecting drug resistance (kappa = 1.00).

Conclusion

This study offers comparison of mutations detected by Xpert and WGS with phenotypic DST ofM. tuberculosisisolates in Tanzania. The high concordance between the different methods and further insights provided by WGS such as PZA-DST, which is not routinely performed in most resource-limited-settings, provides an avenue for inclusion of WGS into diagnostic matrix of TB including drug-resistant TB.
Predictors of 1-year mortality in patients on prolonged mechanical ventilation after surgery in intensive care unit: a multicenter, retrospective cohort study
Authors: Sun Yueming , Li Shuangling , Wang Shupeng , Li Chen , Li Gang , Xu Jiaxuan , Wang Hongzhi , Liu Fei , Yao Gaiqi , Chang Zhigang , Liu Yalin , Shang Meixia , Wang Dongxin
Published: February 2020

Objectives

The requirement of prolonged mechanical ventilation (PMV) is associated with increased medical care demand and expenses, high early and long-term mortality, and worse life quality. However, no study has assessed the prognostic factors associated with 1-year mortality among PMV patients, not less than 21 days after surgery. This study analyzed the predictors of 1-year mortality in patients requiring PMV in intensive care units (ICUs) after surgery.

Methods

In this multicenter, respective cohort study, 124 patients who required PMV after surgery in the ICUs of five tertiary hospitals in Beijing between January 2007 and June 2016 were enrolled. The primary outcome was the duration of survival within 1 year. Predictors of 1-year mortality were identified with a multivariable Cox proportional hazard model. The predictive effect of the ProVent score was also validated.

Results

Of the 124 patients enrolled, the cumulative 1-year mortality was 74.2% (92/124). From the multivariable Cox proportional hazard analysis, cancer diagnosis (hazard ratio [HR] 2.14, 95% confidence interval [CI] 1.37–3.35; P < 0.01), no tracheostomy (HR 2.01, 95% CI 1.22–3.30; P < 0.01), enteral nutrition intolerance (HR 1.88, 95% CI 1.19–2.97; P = 0.01), blood platelet count ≤150 × 109/L (HR 1.77, 95% CI 1.14–2.75; P = 0.01), requirement of vasopressors (HR 1.78, 95% CI 1.13–2.80; P = 0.02), and renal replacement therapy (HR 1.71, 95% CI 1.01–2.91; P = 0.047) on the 21st day of mechanical ventilation (MV) were associated with shortened 1-year survival.

Conclusions

For patients who required PMV after surgery, cancer diagnosis, no tracheostomy, enteral nutrition intolerance, blood platelet count ≤150 × 109/L, vasopressor requirement, and renal replacement therapy on the 21st day of MV were associated with shortened 1-year survival. The prognosis in PMV patients in ICUs can facilitate the decision-making process of physicians and patients’ family members on treatment schedule.
Reccurent thrombus in the gigantic left atrium during effective anticoagulant therapy: case report
Authors: Masarova Lucia , Novak Jan , Pesl Martin , Ondrasek Jiri , Semenka Jiri , Simarova Eva , Panovsky Roman
Published: February 2020

Background

Gigantic left atrium is defined in the current literature as an excessive dilatation of the left atrium above 65mm. Chronic mitral valve disease is associated with the development of thrombus in the left atrium in up to 19% of all cases of mitral insufficiency and appropriate treatment must be initiated to prevent thromboembolic events. In order to diagnose thrombi in the left atrium or left atrial appendage, various imaging methods may be used, including cardiac magnetic resonance.

Case presentation

The case report describes a 73-year-old male who developed recurrent sessile thrombus on the posterior wall of the gigantic left atrium. A large thrombus was first detected following mitral valve surgery despite effective vitamin K antagonist anticoagulation therapy. Echocardiography and cardiac magnetic resonance were used within the diagnostic procedure and to monitor the treatment outcomes. Cardiac magnetic resonance was shown to be beneficial as it provided a more precise description of the intra-atrial masses located on the posterior left atrial wall, and in such situations, is of greater benefit than standard echocardiography. This led to the surgical removal of the intra-atrial mass; nevertheless, it was quickly followed by the recurrence of the thrombus. The anticoagulant therapy was adjusted and fortified by the introduction of acetylsalicylic acid and sequentially clopidogrel, but this also did not resolve the thrombus formation. Finally, employing a combination of rivaroxaban and clopidogrel resulted in partial thrombus regression. Therefore, various pathophysiological aspects of thrombus formation and used anticoagulation strategies are discussed.

Conclusions

We describe a unique case of a recurrent thrombus located on the posterior wall of the gigantic left atrium. Cardiac magnetic resonance was shown to be beneficial in providing a more precise description of the intra-atrial masses located on the posterior left atrial wall as compared to standard echocardiographic examination. Development of a thrombus after mitral valve surgery despite effective anticoagulant therapy and its final resolution by introducing a combination of rivaroxaban and clopidogrel highlights the complex etiopathogenesis of thrombus formation. This supports the potential use of this combination in tailoring an individual personalized therapy for patients with recurrent atrial thrombi.
A matched case-control study of risk factors associated with multiple sclerosis in Kuwait
Authors: El-Muzaini Hadeel , Akhtar Saeed , Alroughani Raed
Published: February 2020

Background

Genetic and environmental factors seem to have etiologic roles in multiple sclerosis (MS). Kuwait is regarded as medium to high risk country for MS. However, there is a paucity of published data on the risk factors for MS in Kuwait. Therefore, this matched case-control study examined the association between various factors including family history, stressful life events, exposure to tobacco smoke, vaccination history, comorbidities and MS risk in Kuwait.

Methods

Confirmed 110 MS cases and age (± 5 years), gender and nationality matched controls (1:1) were enrolled. A pre-tested structured questionnaire was used to collect the data through face-to-face interviews both from cases and controls. Conditional logistic regression was used to analyze the data.

Results

Among both cases and controls, majority were Kuwaiti (82.7%), and female (76.4%). Multivariable model showed that cases compared to controls were significantly more likely to have had a family history of MS (adjusted matched odds ratio (mORadj) = 5.1; 95% CI: 2.1–12.4; p < 0.001) or less likely to have been vaccinated against influenza A and B viruses before MS onset (mORadj = 0.4; 95% CI: 0.2–0.8; p = 0.010). None of the other variables considered were significantly related to MS status in this study.

Conclusions

Family history of MS had significantly direct, whereas, vaccination against influenza A and B viruses had inverse associations with MS status. Future studies may contemplate to verify the observed results.
Progressive chorioretinal involvement in a patient with light-chain (AL) amyloidosis: a case report
Authors: Augstburger Edouard , Sahel José-Alain , Audo Isabelle
Published: February 2020

Background

To report an unusual case of light-chain (AL) amyloidosis with progressive bilateral chorioretinal abnormalities documented with short-wavelength autofluorescence, SD-OCT, fluorescein and indocyanine green angiography.

Case presentation

Case report of a forty-three-year-old male patient with kappa AL amyloidosis. The patient presented with rapidly progressing pigmented and hyperautofluorescent drusenoid deposits in both eyes, associated with central serous retinal detachments, a pachychoroid and choriocapillaris enlargement. The general assessment revealed a renal failure symptomatic of a nephrotic syndrome, associated with proteinuria composed mainly of free kappa light chains. A kidney biopsy confirmed the diagnosis of kappa AL amyloidosis. Chemotherapy was quickly started. During remission, the extension of drusenoid deposits on the fundus was stopped and a disappearance of the subretinal fluid on SD-OCT was observed.

Conclusions

AL amyloidosis is an insidious and potentially fatal condition. This case is one of the first to document the rapid progression of fundus alterations and their stabilization after disease remission. Identifying these specific fundus abnormalities is essential to avoid diagnosis wandering and therapeutic delay.
Efficacy of web-assisted self-help for parents of children with ADHD (WASH) – a three-arm randomized trial under field/routine care conditions in Germany
Authors: Döpfner Manfred , Wähnke Laura , Klemp Marie-Theres , Mühlenmeister Judith , Schürmann Stephanie , Hellmich Martin , Plück Julia
Published: February 2020

Background

Current clinical guidelines recommend parent management training (PMT) in the treatment of attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD). However, (a) a lack of supply and (b) structural barriers to attending and continuing face-to-face PMT restrict the access to this training. The main purpose of this study is to investigate the efficacy of online PMT in decreasing ADHD symptoms and oppositional behavior problems and to evaluate the effects of additional telephone-based support of the parents.

Methods

The target sample size isn = 495 children with suspected or even clinical diagnosis of ADHD and current symptoms of ADHD or ODD. The study is based on a randomized three-arm parallel group design, in which the effects of treatment as usual (TAU) are compared to TAU plus web-assisted self-help (TAU+WASH) and to TAU plus web-assisted self-help and telephone-based support (TAU+WASH+SUPPORT).

Discussion

The results will provide important insights into the efficacy of web-assisted self-help for parents of children with ADHD and the additional effects of telephone-based support.

Trial registration

German Clinical Trials Register (DRKS)DRKS00013456. January 3rd 2018.

World Health Organization Trial Registration Data Set: Universal Trial number (UTN)U1111–1205-6181. November 23rd 2017.
First-year implementation of mailed FIT colorectal cancer screening programs in two Medicaid/Medicare health insurance plans: qualitative learnings from health plan quality improvement staff and leaders
Authors: Baldwin Laura-Mae , Schneider Jennifer L. , Schwartz Malaika , Rivelli Jennifer S. , Green Beverly B. , Petrik Amanda F. , Coronado Gloria D.
Published: February 2020

Background

Colorectal cancer screening rates remain low, especially among certain racial and ethnic groups and the uninsured and Medicaid insured. Clinics and health care systems have adopted population-based mailed fecal immunochemical testing (FIT) programs to increase screening, and now health insurance plans are beginning to implement mailed FIT programs. We report on challenges to and successes of mailed FIT programs during their first year of implementation in two health plans serving Medicaid and dual eligible Medicaid/Medicare enrollees.

Methods

This qualitative descriptive study gathered data through in-depth interviews with staff and leaders at each health plan (n = 10). The Consolidated Framework for Implementation Research, field notes from program planning meetings between the research team and the health plans, and internal research team debriefs informed interview guide development. Qualitative research staff used Atlas.ti to code the health plan interviews and develop summary themes through an iterative content analysis approach.

Results

We identified first-year implementation challenges in five thematic areas: 1) program design, 2) vendor experience, 3) engagement/communication, 4) reaction/satisfaction of stakeholders, and 5) processing/returning of mailed kits. Commonly experienced challenges by both health plans related to the time-consuming nature of the programs to set up, and complexities and delays in working with vendors. We found implementation successes in the same five thematic areas as well as four additional areas of: 1) leadership support, 2) compatibility with the health plan, 3) broader impacts, and 4) collaboration with researchers. Commonly experienced successes included the ability to adapt the mailed FIT program to the individual health plan culture and needs, and the synchronicity between the programs and their organizational missions and goals.

Conclusions

Both health plans successfully adapted mailed FIT programs to their own culture and resources and used their strong quality management resources to maximize success in overcoming the time demands of setting up the program and working with their vendors. Mailed FIT programs administered by health plans, especially those serving Medicaid- and dual eligible Medicaid/Medicare-insured populations, may be an important resource to support closing gaps in colorectal cancer screening among traditionally underserved populations.
“From taboo to routine”: a qualitative evaluation of a hospital-based advocacy intervention for domestic violence and abuse
Authors: Dheensa Sandi , Halliwell Gemma , Daw Jennifer , Jones Sue K. , Feder Gene
Published: February 2020

Background

Health services are often the first point of professional contact for people who have experienced domestic violence and abuse. We report on the evaluation of a multi-site, hospital-based advocacy intervention for survivors of domestic violence and abuse. Independent Domestic Violence Advisors (IDVAs), who provide survivors with support around safety, criminal justice, and health and wellbeing, were located in five hospitals in England between 2012 and 2015 in emergency departments and maternity services. We present views about IDVAs’ approaches to tackling domestic violence and abuse, how the IDVA service worked in practice, and factors that hindered and facilitated engagement with survivors.

Methods

We adopted a convenience sampling approach and invited participation from all who offered to take part within the study timeframe. Sixty-four healthcare professionals, IDVAs, IDVA service managers, and commissioners at all sites were interviewed. Interviews were analysed using a thematic approach: familiarising ourselves with the data through repeated readings and noting initial ideas; generating initial codes through double coding notable features of the data across the dataset; collating codes into potential themes; and reviewing themes to ensure they captured the essence of the data.

Results

Two key themes emerged. The first was Hospital-based IDVAs fulfil several crucial roles. This theme highlighted that healthcare professionals thought the hospital-based IDVA service was valuable because it enhanced their skills, knowledge, and confidence in asking about domestic violence and abuse. It enabled them to immediately refer and provide support to patients who might have otherwise been lost along a referral pathway. It also reached survivors who might otherwise have remained hidden. The second theme was Success hinges on a range of structural factors. This theme illustrated the importance of ongoing domestic violence and abuse training for staff, the IDVA having private and dedicated space, and the service being embedded in hospital infrastructure (e.g. featuring it in hospital-wide policies and enabling IDVAs access to medical records).

Conclusion

Hospital-based IDVAs offer a unique and valued way to respond to domestic violence and abuse in a healthcare setting. Further work must now be done to explore how to implement the service sustainably.
Challenges in turning a great idea into great health policy: the case of integrated care
Authors: Raus Kasper , Mortier Eric , Eeckloo Kristof
Published: February 2020

Background

In the organization of health care and health care systems, there is an increasing trend towards integrated care. Policy-makers from different countries are creating policies intended to promote cooperation and collaboration between health care providers, while facilitating the integration of different health care services. Hopes are high, as such collaboration and integration of care are believed to save resources and improve quality. However, policy-makers are likely to encounter various challenges and limitations when attempting to turn these great ideas into effective policies. In this paper, we look into these challenges.

Main body

We argue that the organization of health care and integrated care is of public concern, and should thus be of crucial interest to policy-makers. We highlight three challenges or limitations likely to be encountered by policy-makers in integrated care. These are: (1) conceptual challenges; (2) empirical/methodological challenges; and (3) resource challenges. We will argue that it is still unclear what integrated care means and how we should measure it. ‘Integrated care’ is a single label that can refer to a great number of different processes. It can describe the integration of care for individual patients, the integration of services aimed at particular patient groups or particular conditions, or it can refer to institution-wide collaborations between different health care providers. We subsequently argue that health reform inevitably possesses a political context that should be taken into account. We also show how evidence supporting integrated care may not guarantee success in every context. Finally, we will discuss how promoting collaboration and integration might actually demand more resources. In the final section, we look at three different paradigmatic examples of integrated care policy: Norway, the UK’s NHS, and Belgium.

Conclusions

There seems widespread agreement that collaboration and integration are the way forward for health care and health care systems. Nevertheless, we argue that policy-makers should remain careful; they should carefully consider what they hope to achieve, the amount of resources they are willing to invest, and how they will evaluate the success of their policy.