bluuebunny/crossref_metadata_2025 huggingface dataset:
Polypill: an affordable strategy for cardiovascular disease prevention in low–medium-income countries
Authors: López-Jaramillo Patricio , González-Gómez Silvia , Zarate-Bernal Diego , Serrano Andrés , Atuesta Leonor , Clausen Christian , Castro-Valencia Claudia , Camacho-Lopez Paul , Otero Johanna
Published: March 2018

The simplification of fixed dose medications by using a single ‘polypill’ is an attractive strategy to improve adherence to medications which has shown benefit to cardiovascular risk factor control and cardiovascular disease prevention or delay in the progression of these diseases. We review the evidence obtained from a series of clinical trials demonstrating an improvement in adherence to the polypill compared to the use of each compound separately, and found similar or better control of the classical cardiovascular risk factors and a similar safety profile. These results suggest that the use of the polypill could have a beneficial impact in cardiovascular morbidity and mortality. Furthermore, the polypill has the potential to improve cost effectiveness and is simple to use. However, before recommending the implementation of the polypill in programs aimed at primary and secondary cardiovascular prevention, we are awaiting the results of several current clinical trials aimed at measuring the impact on the frequency of major cardiovascular outcomes, particularly in low–medium-income countries.
Vascular cognitive impairment and vascular dementia
Authors: Bonnici-Mallia Anne M. , Barbara Christopher , Rao Rahul
Published: March 2018

Vascular dementia is the second-most-common type of dementia. Vascular cognitive impairment is a term encompassing vascular dementia as well as milder forms of pre-dementia cognitive impairment related to vascular damage that do not meet the criteria for a diagnosis of dementia. Early diagnosis of cerebrovascular disease, including silent infarcts and small vessel disease is difficult, but important, as modification of cardiovascular risk factors is the mainstay of management to decrease further insults and deterioration, and maintain the patient’s independence within their family and social unit.
Cycle-by-cycle variations in autonomous and spark assisted homogeneous charge compression ignition combustion of stoichiometric air–fuel mixture
Authors: Hunicz Jacek
Published: March 2018

This study investigates cycle-by-cycle variations in a gasoline fuelled, homogeneous charge compression ignition (HCCI) engine with internal exhaust gas recirculation. In order to study the effects of exhaust-fuel reactions occurring prior to the main combustion event fuel was injected directly into the cylinder at two selected timings during the negative valve overlap period. The engine was operated as both autonomous HCCI and spark assisted HCCI (SA-HCCI). The primary interest in this work was the operating region where the engine is switched between HCCI and spark ignition modes, thus operation with stoichiometric air–fuel mixture, which is typical for this region, was considered. Cycle-by-cycle variations in both combustion timing and indicated mean effective pressure (IMEP) were investigated. It was found that long-period oscillations of the IMEP occur when fuel injection is started at early stages of the negative valve overlap period, and that these can be suppressed by delaying the start of injection. This behaviour remained even when fuel injection was split into early and late-negative valve overlap injections. Spark assisted operation allowed eliminating late combustion cycles, thus improving thermal efficiency. However, characteristic patterns of IMEP variations were found to be the same for both HCCI and SA-HCCI operations, irrespective of the adopted negative valve overlap fuel injection strategy, as evidenced by using symbol-sequence statistics.
Does the Design of Settings Where Acute Care Is Delivered Meet the Needs of Older People? Perspectives of Patients, Family Carers, and Staff
Authors: Haywood Annette , Barnes Sarah , Marsh Hazel , Parker Stuart G.
Published: March 2018

Background:

Older people with an acute illness, many of whom are also frail, form a significant proportion of the acute hospital inpatient population. Attention is focusing on ways of improving the physical environment to optimize health outcomes and staff efficiency.

Purpose:

This article explores the effects of the physical environment in three acute care settings: acute hospital site, in-patient rehabilitation hospital, and intermediate care provision (a nursing home with some beds dedicated to intermediate care) chosen to represent different steps on the acute care pathway for older people and gain the perspectives of patients, family carers, and staff.

Methods:

Semi structured interviews were undertaken with 40 patient/carer dyads (where available) and three staff focus groups were conducted in each care setting with a range of staff.

Results:

Multiple aspects of the physical environment were reported as important by patients, family carers, and staff. For example, visitors stressed the importance of access and parking, patients valued environments where privacy and dignity were protected, storage space was poor across all sites, and security was important to patients but visitors want easy access to wards.

Conclusions:

The physical environment is a significant component of acute care for older people, many of whom are also frail, but often comes second to organization of care, or relationships between actors in an episode of care.
The reliability of identifying the Omega sign using axial T2-weighted magnetic resonance imaging
Authors: Zakaria Hesham Mostafa , Massa Peter Joseph , Smith Richard L , Moharram Tarek Hazem , Corrigan John , Lee Ian , Schultz Lonni , Hu Jianhui , Patel Suresh , Griffith Brent
Published: March 2018

Preoperative identification of the eloquent brain is important for neurosurgical planning. One common method of finding the motor cortex is by localizing “the Omega sign.” No studies have tested the reliability of imaging to identify the Omega sign. We identified 40 recent and consecutive patients who had undergone preoperative functional magnetic resonance imaging for identification of the hand motor area prior to tumor resection. We recruited 11 neurosurgical residents of various levels of training and one board-certified neurosurgeon to identify the hand motor cortex Omega. Testees were given axial images of T2-weighted MRI and placed marks where they expected to find the Omega. Two board-certified radiologists graded and quantified the localization attempts. Inter-rater reliability was assessed using the kappa statistic, and Rao–Scott chi-square tests were used to examine the relationship between clinical factors and testees’ experience with correct identification of the Omega sign. The overall correct identification rate was 69.9% (95% CI = 63.4–75.7), ranging from 36.6% to 92.7% among all raters for the tumor side and from 46.2% to 97.4% for the non-tumor side. Anatomic distortion greatly affected correct identification ( p < 0.005). Senior residents had a significantly higher rate of identification of the Omega than junior residents ( p < 0.001). Overall, inter-rater reliability for the Omega sign is poor, with a Fleiss kappa of 0.23. We concluded that correct identification of the Omega sign is affected by tumor distortion and experience but overall is not reliable. This underscores the limitations of anatomic landmarks and the importance of utilizing multiple scanning planes and preoperative fMRI for appropriate localization.
Mortality predictors in an acute care geriatric unit in Singapore
Authors: Goh Kiat Sern , Low Serena Kiat Mun , Zhang Di , Png Gek Kheng , Lin Huimin , Ang Wendy Swee Tee , Lim Jim Kim Hwa
Published: March 2018

Aim:

Admission to an acute care geriatric unit may lead to adverse outcomes. It is therefore important to identify high-risk patients early so that appropriate management can be instituted to prevent or delay onset of adverse events. The aim of this study is to evaluate one-year mortality and its associated risk factors among hospitalized patients.

Methods:

This is a retrospective cohort study on consecutive patients admitted to an acute geriatric ward in a Singapore hospital from March to April 2013.Demographic and clinical information was collected from patient medical records. Linkage with death records from a national registry was performed.

Results:

Of the 196 patients assessed, 4.6%, 20.9% and 35.7% died during admission, within six months post-admission and within one year post-admission respectively. Pneumonia and cardiovascular diseases accounted for most of the death cases. In the multivariable logistic regression adjusted by age and gender, abbreviated mental test (AMT) score, admission for falls and depression were found to be significantly associated with death within one year post-admission. In the analysis stratified by gender, AMT score and depression were found to be significantly associated with death in males whereas AMT score and admission for falls were significantly associated with death in females.

Conclusions:

This study offers significant insight into mortality trends and risk factors for clinicians, hence guiding them in individualizing their management plan for acutely ill geriatric patients. Predicting long-term prognosis will enhance rehabilitation goal-setting and advance care-planning.
Surveillance for colorectal cancer survivors in an integrated safety-net health system in the United States
Authors: Balasubramanian Bijal A , Jetelina Katelyn K , Bowen Michael , Santini Noel O , Craddock Lee Simon
Published: March 2018

Introduction

Guideline-recommended surveillance reduces the likelihood of colorectal cancer recurrence, yet surveillance rates are low in the United States. Little is known about colorectal cancer surveillance rates among patients without health insurance and their primary care clinicians/oncologists’ attitudes toward surveillance care.

Methods

A retrospective study of 205 patients diagnosed with Stage I–III colorectal cancer from 2008 to 2010 was conducted in an integrated system with a network of clinics and health care providers, delivering care to patients lacking health insurance coverage. Surveillance patterns were characterized from medical records, and logistic regression models examined correlates of guideline-concordant surveillance. Forty-four Parkland primary care physicians (PCPs) and 24 oncologists completed surveys to assess their attitudes and practices regarding colorectal cancer surveillance.

Results

Thirty-eight percent of colorectal cancer patients received guideline-concordant surveillance; those with early stage cancers were less likely to receive surveillance (odds ratio = 0.35; 95 confidence interval: 0.14, 0.87). PCPs and oncologists differed markedly on who is responsible for cancer surveillance care. Seventy-seven percent of oncologists responded that PCPs evaluated patients for cancer recurrence, while 76% of PCPs responded that these services were either ordered by oncologists or shared with PCPs. Sixty-seven percent of oncologists said that they rarely provide a treatment and surveillance care plan to survivors, and over half said that they infrequently communicate with patients’ other physicians about who will follow patients for their cancer and other medical issues.

Discussion

Care coordination between PCP and oncologist is needed to improve colorectal cancer surveillance. New models of shared care clearly delineating roles for oncologists and PCPs are needed to improve colorectal cancer survivorship care.
Information, Opinion, or Rumor? The Role of Twitter During the Post-Electoral Crisis in Côte d’Ivoire
Authors: Schreiner Tanja
Published: March 2018

On the African continent, the use of Internet and social media has been growing at an incredible speed in the past decade. Social media have thus been used in an array of instances such as election periods, natural disasters, and political crises. However, previous research on social media has barely taken a look at the use of social media during war. By investigating on the use of Twitter during the post electoral crisis in Côte d’Ivoire in 2010/2011, this study wants to emphasize the potential of social media for the development of democracy in the context of crisis, war, and limited media freedom. Through a content analysis of Twitter and qualitative expert interviews with Ivoirian bloggers, this study found that Twitter was mainly used for political debate and crowdsourcing information. The crisis turning over to a civil war, the network was used in particular by a small group of active citizens and bloggers, operating as technically versed opinion leaders, to provide humanitarian help for the population caught in the crisis. Results further showed that mobile devices played a crucial role for the use of Twitter within the country and indicated that the post electoral crisis considerably contributed to the discovery of Twitter in Côte d’Ivoire. A central finding is that Twitter, on the one hand, was used for diffusing false information and expressing verbal violence and, on the other hand, it served to verify information and throwback rumors.
Novel, 3D Display of Heart Models in the Postoperative Care Setting Improves CICU Caregiver Confidence
Authors: Olivieri Laura J. , Zurakowski David , Ramakrishnan Karthik , Su Lillian , Alfares Fahad A. , Irwin Matthew R. , Heichel Jenna , Krieger Axel , Nath Dilip S.
Published: March 2018

Background:

Postoperative care delivered in the pediatric cardiac intensive care unit (CICU) relies on providers’ understanding of patients’ congenital heart defects (CHDs) and procedure performed. Novel, bedside use of virtual, three-dimensional (3D) heart models creates access to patients’ CHD to improve understanding. This study evaluates the impact of patient-specific virtual 3D heart models on CICU provider attitudes and care delivery.

Methods:

Virtual 3D heart models were created from standard preoperative cardiac imaging of ten patients with CHD undergoing repair and displayed on a bedside tablet in the CICU. Providers completed a Likert questionnaire evaluating the models’ value in understanding anatomy and improving care delivery. Responses were compared using two-tailed t test and Mann-Whitney U test and were also compared to previously collected CICU provider responses regarding use of printed 3D heart models.

Results:

Fifty-three clinicians (19 physicians, 34 nurses/trainees) participated; 49 (92%) of 53 and 44 (83%) of 53 reported at least moderate to high satisfaction with the virtual 3D heart’s ability to enhance understanding of anatomy and surgical repair, respectively. Seventy-one percent of participants felt strongly that virtual 3D models improved their ability to manage postoperative problems. The majority of both groups (63% physicians, 53% nurses) felt that virtual 3D heart models improved CICU handoffs. Virtual 3D heart models were as effective as printed models in improving understanding and care delivery, with a noted provider preference for printed 3D heart models.

Conclusions:

Virtual 3D heart models depicting patient-specific CHDs are perceived to improve understanding and postoperative care delivery in the CICU.
Optimization of the Assisted Bidirectional Glenn Procedure for First Stage Single Ventricle Repair
Authors: Verma Aekaansh , Esmaily Mahdi , Shang Jessica , Figliola Richard , Feinstein Jeffrey A. , Hsia Tain-Yen , Marsden Alison L.
Published: March 2018

Background:

First-stage single-ventricle palliation is challenging to manage, and significant interstage morbidity and mortality remain. Prior computational and in vitro studies of the assisted bidirectional Glenn (ABG), a novel first-stage procedure that has shown potential for early conversion to a more stable augmented Glenn physiology, demonstrated increased pulmonary flow and oxygen delivery while decreasing cardiac work, as compared to conventional stage-1 alternatives. This study aims to identify optimal shunt designs for the ABG to improve pulmonary flow while maintaining or decreasing superior vena caval (SVC) pressure.

Methods:

A representative three-dimensional model of a neonatal bidirectional Glenn (BDG) was created, with a shunt connecting the innominate artery to the SVC. The shunt design was studied as a six-parameter constrained shape optimization problem. We simulated hemodynamics for each candidate designs using a multiscale finite element flow solver and compared performance against designs with taper-less shunts, the standalone BDG, and a simplified control volume model. Three values of pulmonary vascular resistance (PVR) of 2.3, 4.3, and 7.1 WUm2 were studied.

Results:

Increases in pulmonary flow were generally accompanied by increases in SVC pressure, except at low PVR (2.3 WUm2), where the optimal shunt geometry achieved a 13% increase in pulmonary flow without incurring any increase in SVC pressure. Shunt outlet area was the most influential design parameter, while others had minimal effect.

Conclusion:

Assisted bidirectional Glenn performance is sensitive to PVR and shunt outlet diameter. An increase in pulmonary flow without a corresponding increase in SVC pressure is possible only when PVR is low.
Verification of Data Accuracy in Japan Congenital Cardiovascular Surgery Database Including Its Postprocedural Complication Reports
Authors: Takahashi Arata , Kumamaru Hiraku , Tomotaki Ai , Matsumura Goki , Fukuchi Eriko , Hirata Yasutaka , Murakami Arata , Hashimoto Hideki , Ono Minoru , Miyata Hiroaki
Published: March 2018

Background:

Japan Congenital Cardiovascluar Surgical Database (JCCVSD) is a nationwide registry whose data are used for health quality assessment and clinical research in Japan. We evaluated the completeness of case registration and the accuracy of recorded data components including postprocedural mortality and complications in the database via on-site data adjudication.

Methods:

We validated the records from JCCVSD 2010 to 2012 containing congenital cardiovascular surgery data performed in 111 facilities throughout Japan. We randomly chose nine facilities for site visit by the auditor team and conducted on-site data adjudication. We assessed whether the records in JCCVSD matched the data in the source materials.

Results:

We identified 1,928 cases of eligible surgeries performed at the facilities, of which 1,910 were registered (99.1% completeness), with 6 cases of duplication and 1 inappropriate case registration. Data components including gender, age, and surgery time (hours) were highly accurate with 98% to 100% concordance. Mortality at discharge and at 30 and 90 postoperative days was 100% accurate. Among the five complications studied, reoperation was the most frequently observed, with 16 and 21 cases recorded in the database and source materials, respectively, having a sensitivity of 0.67 and a specificity of 0.99.

Conclusions:

Validation of JCCVSD database showed high registration completeness and high accuracy especially in the categorical data components. Adjudicated mortality was 100% accurate. While limited in numbers, the recorded cases of postoperative complications all had high specificities but had lower sensitivity (0.67-1.00). Continued activities for data quality improvement and assessment are necessary for optimizing the utility of these registries.
Pediatric Cardiac Trauma in the United States: A Systematic Review
Authors: Mylonas Konstantinos S. , Tsilimigras Diamantis I. , Texakalidis Pavlos , Hemmati Pouya , Schizas Dimitrios , Economopoulos Konstantinos P.
Published: March 2018

Literature discussing cardiac injuries in children is limited. Systematic search of PubMed identified 21 studies enrolling 1,062 pediatric patients who experienced cardiac trauma in the United States during the period 1961 to 2012. The predominant type of injury was blunt cardiac contusion affecting 59.7% (n = 634/1,062) of the study population. Motor vehicle crashes (53.5%, n = 391/731) were the leading cause of blunt cardiac trauma, while gunshot wounds (50%, n = 150/300) accounted for most penetrating injuries. Overall mortality rate was 35.2% (n = 374/1,062).
Complete Resection of a Right-Sided Interventricular Septal Fibroma
Authors: Picarelli Dante , Leone Ruben , Surraco José L. , Fernandez Nicolas , Antelo Martin , Grela Carolina , Speyer Jorge , Bianchi Domingo , Rios Mateo , Chiesa Pedro
Published: March 2018

A 15-month-old infant with a systolic cardiac murmur developed an episode of nonsustained ventricular tachycardia during transthoracic echocardiography. A large intracardiac mass, which widened the interventricular septum causing right ventricular outflow tract obstruction, was seen and confirmed by magnetic resonance imaging. A cardiac fibroma was suspected, and because of the risk of life-threatening arrhythmias, surgery was rapidly considered. Despite the challenging location, the tumor was completely and successfully resected. Microscopic examination confirms the diagnosis of ventricular fibroma.
Association of Habitual Activity and Body Mass Index in Survivors of Congenital Heart Surgery: A Study of Children and Adolescents With Tetralogy of Fallot, Transposition of the Great Arteries, and Fontan Palliation
Authors: O’Byrne Michael L. , McBride Michael G. , Paridon Stephen , Goldmuntz Elizabeth
Published: March 2018

Background:

Obesity is associated with increased lifelong morbidity and reduced life span and is increasingly prevalent in the congenital heart disease population. Habitual exercise is an important aspect of a healthy lifestyle and primary prevention of obesity in the general population. The association between habitual activity and body mass index (BMI) has not been studied in children with congenital heart disease.

Methods:

A cross-sectional analysis of two previously collected cohorts was performed, including participants 8 to 18 years old with tetralogy of Fallot, transposition of the great arteries, and single ventricle heart disease after a Fontan operation. The association between BMI and duration of habitual exercise (measured by questionnaire) was studied. Secondary analyses assessing the effect of other possible factors for BMI were performed.

Results:

In total, 172 participants were studied (45% Tetralogy of Fallot, 12% transposition of the great arteries, and 43% Fontan). Median BMI was 18.2, and 29% of the participants were obese or overweight. Median habitual exercise was 5.9 h/wk. Thirty-eight percent of participants reported having their activity restricted by their cardiologist. Increasing exercise duration was associated with lower BMI ( P = .01) in univariate analysis. In secondary analyses, restriction to mild exertion and participation in low-intensity exercise were both associated with increased BMI.

Conclusion:

Increased habitual activity was associated with lower BMI, emphasizing the potential role of recreational sport in the health of children with congenital heart disease.
Predictors of Pericardial Effusion in Patients Undergoing Pulmonary Artery Banding
Authors: Noma Mio , Matsubara Muneaki , Tokunaga Chiho , Nakajima Tomomi , Mathis Bryan James , Sakamoto Hiroaki , Hiramatsu Yuji
Published: March 2018

Background:

Although pulmonary artery banding (PAB) is a common palliative procedure for pediatric heart malformation, there are concerns of pressure overload and concomitant immune reactions in the right ventricle causing postsurgical complications such as pericardial effusion. At this time, no clear guidelines as to potential risk factors or procedural contraindications have been widely disseminated. Therefore, a study was undertaken to examine wide-ranging factors to find potential biomarkers for postsurgical pericardial effusion formation risk.

Methods:

A retrospective study was conducted on all cardiac surgeries performed over an eight-year period, and the main inclusion criterion was pericardial effusion development after PAB that required surgical drainage. Nine cases were then analyzed against a control group of 45 cases with respect to body measurements, concomitant surgeries, genetic screens, laboratory tests results, and cardiac function parameters.

Results:

Trisomy 21 was strongly associated with the development of severe pericardial effusion after PAB, and postoperative serum albumin levels in patients with trisomy 21 were associated with pericardial effusion development. Other parameters showed no significant correlation with pericardial effusion development.

Conclusions:

Our data indicate a strong association between trisomy 21 and pericardial effusion requiring drainage after PAB, which is in line with translational research findings. Pressure overload from PAB may play a role in the formation of severe pericardial effusion that is exacerbated by cardiac structural defects commonly associated with trisomy 21. Surgical teams should therefore use caution and plan to implement drainage in PAB cases, and postoperative serum albumin may serve as a useful biomarker for pericardial effusion formation.
Diverse Pathways to Purpose for College Students With Disabilities
Authors: Newman Barbara M. , Kimball Ezekiel W. , Vaccaro Annemarie , Moore Adam , Troiano Peter F.
Published: March 2018

The sense of purpose, which directs and motivates goal attainment, is associated with health and happiness as students make transitions from high school to college and work. Despite its importance for student well-being, little empirical work has addressed the development of purpose among students with disabilities. This article expands on a model of the relationship between purpose development, career aspirations, and disability identity in a sample of 59 college students with a variety of visible and invisible disabilities. Using a constructivist grounded theory approach to the analysis of extensive interviews, results present five pathways to purpose and the processes through which students’ disabilities contribute to their sense of purpose. Implications for practice and future research emerge from this rich source of student voices.
Does the Lever Sign Test Have Added Value for Diagnosing Anterior Cruciate Ligament Ruptures?
Authors: Lichtenberg Miranda C. , Koster Christiaan H. , Teunissen Lennart P.J. , Oosterveld Frits G.J. , Harmsen Annelieke M.K. , Haverkamp Daniel , Hoornenborg Daniel , Berg Robert P. , Bloemers Frank W. , Faber Irene R.
Published: March 2018

Background:

Diagnosing an anterior cruciate ligament (ACL) rupture based on a physical examination remains a challenge for both surgeons and physical therapists. The lever sign test was developed to overcome the practical limitations of other tests and to optimize diagnosis. An evaluation of the measurement properties of the lever sign test is needed to make adequate interpretations in practice.

Purpose:

To evaluate the reliability and diagnostic value of the lever sign test.

Study Design:

Cohort study (diagnosis); Level of evidence, 2.

Methods:

A total of 94 patients were recruited between November 2014 and July 2016. Patients were included if they were at least 16 years old, suffered from knee trauma, and had indications for knee arthroscopic surgery. Lever sign, anterior drawer, Lachman, and pivot-shift test outcomes were examined by an orthopaedic/trauma surgeon and a physical therapist. A test-retest design was used to investigate interrater reliability. Moreover, the lever sign test outcomes, alone and in combination with the other diagnostic tests, were compared with arthroscopic results, which served as the gold standard for the test’s diagnostic value.

Results:

The lever sign test and pivot-shift test had kappa values exceeding 0.80 for interrater reliability. The kappa values for the anterior drawer test and Lachman test were 0.80 and 0.77, respectively. The lever sign test showed the highest specificity (100%) and the lowest sensitivity (39%) when compared with the other 3 tests. Moreover, its positive and negative predictive values were 100% and 65%, respectively, while an accuracy of 71% was calculated. Clustering the lever sign test parallel with the other 3 tests resulted in the highest accuracy of 91%.

Conclusion:

The lever sign test appears to have high interrater reliability and is the most specific test, showing a maximal positive predictive value. A positive lever sign test result indicates an ACL rupture. These results support the added value of the lever sign test for diagnosing ACL ruptures.
The Family Framework in a Drug Treatment Court
Authors: Gordon Daanika
Published: March 2018

Drug courts reflect an expanding effort to transform the state’s response to drug crimes. Such programs merge punitive and therapeutic strategies in efforts to rehabilitate clients. The author takes the case of one drug court to elaborate on a set of institutional practices characterizing this mode of intervention. On the basis of ethnographic observation of the court’s weekly review hearings, interviews with program professionals, and analysis of documents and media accounts, the author describes the centrality of the “family framework”—the idea that clients are childlike and “grow up” in the context of the program—to the priorities, norms, and practices of drug court professionals. The family framework relied on raced and classed constructs of dependence and deservingness. These constructs shaped program selection and completion, enabling the court to focus on a predominately white and often middle-class client base. The author suggests that this case clarifies how state projects can both intensively regulate and circumscribe their scope to a population deemed worthy.
Head and Neck Squamous Cell Carcinoma in Western Uganda: Disease of Uncertainty and Poor Prognosis
Authors: Nabukenya Jamilah , Hadlock Tessa A. , Arubaku Wilfred
Published: March 2018

Objectives

Patients with head and neck squamous cell carcinoma (HNSCC) have symptoms that masquerade as benign conditions, resulting in late presentations. The objective is to describe characteristics and stages of patients with HNSCC and document their prognosis from clinical experience in western Uganda.

Study Design

Cross‐sectional study with clinical follow‐up.

Setting

Mbarara Regional Referral Hospital.

Subjects and Methods

Fifty‐one participants were recruited from February to July 2016. A questionnaire was used for patient characteristics, and staging, serologic studies, biopsy for histopathology, and immunohistochemistry were investigated. Staging was subclassified as early (stage I and II) and late (stage III and IV). Analysis was done with Fisher’s exact test.

Results

Of 51 participants, 44 (86.5%) were male; the group had a mean age of 57.7 years, and 41 (80.1%) presented with late stage. Of 10 participants who presented with early stage, 6 (60%) had laryngeal HNSCC. The pharynx was ranked as the highest subsite (n = 19, 37.3%), followed by the oral cavity (n = 9, 17.6%), the larynx (n = 9, 17.6%), an unknown primary (n = 8, 15.7%), and sinonasal area (n = 6, 11.8%). Tobacco smoking, alcohol consumption, and prior use of traditional remedy were common characteristics among participants. Moderate differentiation was the most common grade (n = 23, 45.1%). Helicobacter pylori, Epstein‐Barr virus, human immunodeficiency virus, and human papilloma virus type 16 were identified among 51 participants. However, none could afford referral for radiotherapy; hence, 1‐year survival was 4%.

Conclusion

The majority of our patients with HNSCC present at late stage, and the prognosis is poor. There is great need for preventative community‐based education and early screening services to save our population.
Phase 1 clinical trial evaluating abatacept in patients with steroid-refractory chronic graft-versus-host disease
Authors: Nahas Myrna R. , Soiffer Robert J. , Kim Haesook T. , Alyea Edwin P. , Arnason Jon , Joyce Robin , Antin Joseph H. , Ho Vincent T. , Stroopinsky Dina , Li Shuli , Levine James D. , McMasters Malgorzata , Jain Salvia , Hamdan Ayad , Tzachanis Dimitrios , Bryant Mary Paty , Logan Emma K. , Bazemore Josie , Stewart Jeremy , Joyce Amy , Stephenson Susan , Washington Abigail , Cole Leandra , Pyzer Athalia , Leaf Rebecca Karp , Avigan David E. , Rosenblatt Jacalyn
Published: March 2018

Key Points

Costimulatory blockade using abatacept represents a novel therapeutic approach for the treatment of cGVHD. Abatacept resulted in a clinical response in 44% of patients with both decreased prednisone use and T-cell PD-1 expression in responders.
Clinical and functional impact of recurrent S1PR1 mutations in mantle cell lymphoma
Authors: Wasik Agata M. , Wu Chenglin , Mansouri Larry , Rosenquist Richard , Pan-Hammarström Qiang , Sander Birgitta
Published: March 2018

Key Points

S1PR1 mutations are present in 7.8% of patients with MCL and are significantly more frequent at relapse. S1PR1 mutations reduce expression of the S1PR1 receptor, which mediates migration towards the tissue-to-blood egress factor S1P in MCL.
Street Archives and City Life
Authors: Callaci Emily
Published: March 2018

In Street Archives and City Life Emily Callaci maps a new terrain of political and cultural production in mid- to late twentieth-century Tanzanian urban landscapes. While the postcolonial Tanzanian ruling party (TANU) adopted a policy of rural socialism known as Ujamaa between 1967 and 1985, an influx of youth migrants to the city of Dar es Salaam generated innovative forms of urbanism through the production and circulation of what Callaci calls street archives. These urban intellectuals neither supported nor contested the ruling party's anti-city philosophy; rather, they navigated the complexities of inhabiting unplanned African cities during economic crisis and social transformation through various forms of popular texts that included women's Christian advice literature, newspaper columns, self-published pulp fiction novellas, and song lyrics. Through these textual networks, Callaci shows how youth migrants and urban intellectuals in Dar es Salaam fashioned a collective ethos of postcolonial African citizenship. This spirit ushered in a revolution rooted in the city and its networks—an urban revolution that arose in spite of the nation-state's pro-rural ideology.
Metastasis in context: modeling the tumor microenvironment with cancer-on-a-chip approaches
Authors: Sleeboom Jelle J. F. , Eslami Amirabadi Hossein , Nair Poornima , Sahlgren Cecilia M. , den Toonder Jaap M. J.
Published: March 2018

Most cancer deaths are not caused by the primary tumor, but by secondary tumors formed through metastasis, a complex and poorly understood process. Cues from the tumor microenvironment, such as the biochemical composition, cellular population, extracellular matrix, and tissue (fluid) mechanics, have been indicated to play a pivotal role in the onset of metastasis. Dissecting the role of these cues from the tumor microenvironment in a controlled manner is challenging, but essential to understanding metastasis. Recently, cancer-on-a-chip models have emerged as a tool to study the tumor microenvironment and its role in metastasis. These models are based on microfluidic chips and contain small chambers for cell culture, enabling control over local gradients, fluid flow, tissue mechanics, and composition of the local environment. Here, we review the recent contributions of cancer-on-a-chip models to our understanding of the role of the tumor microenvironment in the onset of metastasis, and provide an outlook for future applications of this emerging technology.
Electronic collimation of radiographic images: does it comprise an overexposure risk?
Authors: Tsalafoutas Ioannis A
Published: March 2018

Objective:

To investigate whether electronic collimation software, which is available in all digital X-ray systems, may comprise an overexposure risk.

Methods:

In the context of surveys on Diagnostic Reference Levels carried out in two radiographic facilities, along with data on exposure factors, the radiographic field sizes were also recorded. In one facility (Unit A), a wireless flat panel detector is used with a conventional X-ray unit, while in the other, a fully digital system is installed (Unit B). The electronically collimated image sizes were compared with the original radiation field sizes. The differences between these two systems concerning the field sizes and the mode of electronic collimation utilization were investigated.

Results:

In Unit A, manual electronic collimation was extensively used and cases where the radiation field size was up to three times larger than that electronically collimated, were identified. On the contrary, in Unit B radiation fields were smaller and electronic collimation was automatic.

Conclusion:

When electronic collimation is used in manual mode instead of proper pre-exposure collimation, then it does comprise an overexposure risk. The risk is larger in radiographic units where the field size is not automatically selected according to the examination protocol and no interlocks against oversized collimation settings exist.

Advances in knowledge:

When radiologists review masked images to make the diagnosis, possible suboptimal X-ray field collimation practices may go unnoticed for long. Therefore, radiologists and medical physicists should periodically survey the original images to determine the actual radiation field sizes used for each radiographic examination type.
The tumour microenvironment links complement system dysregulation and hypoxic signalling﻿
Authors: Olcina Monica M , Kim Ryan K , Melemenidis Stavros , Graves Edward E , Giaccia Amato J
Published: March 2018

The complement system is an innate immune pathway typically thought of as part of the first line of defence against “non-self” species. In the context of cancer, complement has been described to have an active role in facilitating cancer-associated processes such as increased proliferation, angiogenesis and migration. Several cellular members of the tumour microenvironment express and/or produce complement proteins locally, including tumour cells. Dysregulation of the complement system has been reported in numerous tumours and increased expression of complement activation fragments in cancer patient specimens correlates with poor patient prognosis. Importantly, genetic or pharmacological targeting of complement has been shown to reduce tumour growth in several cancer preclinical models, suggesting that complement could be an attractive therapeutic target. Hypoxia (low oxygen) is frequently found in solid tumours and has a profound biological impact on cellular and non-cellular components of the tumour microenvironment. In this review, we focus on hypoxia since this is a prevailing feature of the tumour microenvironment that, like increased complement, is typically associated with poor prognosis. Furthermore, interesting links between hypoxia and complement have been recently proposed but never collectively reviewed. Here, we explore how hypoxia alters regulation of complement proteins in different cellular components of the tumour microenvironment, as well as the downstream biological consequences of this regulation.
A blind spot? Confronting the stigma of hepatitis B virus (HBV) infection - A systematic review
Authors: Mokaya Jolynne , McNaughton Anna L , Burbridge Lela , Maponga Tongai , O'Hara Geraldine , Andersson Monique , Seeley Janet , Matthews Philippa C
Published: March 2018

Background: The Global Hepatitis Health Sector Strategy is aiming for the elimination of viral hepatitis as a public health threat by 2030. Successful diagnostic, treatment and preventive strategies can reduce incidence and morbidity; it is important to ensure that these interventions and services are not only available, but also accessible. Stigma, poverty, and lack of knowledge may present a substantial barrier, especially in resource limited settings. We therefore set out to assimilate evidence for the nature and impact of stigma on the lives of people with HBV infection and on the community, and to suggest ways to tackle stigma and discrimination.

Methods: We carried out a literature search in PubMed using the search terms ‘hepatitis B’, ‘stigma’ to identify relevant papers published between 2007 and 2017 (inclusive), with a particular focus on Africa.

Results: We identified a total of 34 articles, of which only one study was conducted in Africa. Lack of knowledge on HBV was consistently identified: there were misconceptions about HBV transmission among the public, healthcare workers (HCWs) provided inaccurate information to individuals diagnosed with HBV, and poor understanding resulted in lack of preventive precautions. Stigma negatively impacted on health behaviour such as help-seeking, screening, disclosure, prevention of transmission, and adherence to treatment.

Conclusion: Stigma is a potentially major barrier to the successful implementation of preventive, diagnostic and treatment strategies for HBV infection, and yet there is very limited recognition of the magnitude of this challenge, especially in Africa. There is a need for more research in this area, to identify and evaluate interventions that can be used effectively to tackle stigma in HBV, and to inform collaborative efforts between policy makers, HCWs, traditional healers, religious leaders, charity organisations and support groups, to improve awareness and tackle stigma in HBV in Africa.
COMPUTER GAMES AS A THREAT NATIONAL SECURITY
Authors: Гдалевич Ирина , Gdalevich Irina , Минаева Кристина , Minaeva Christina
Published: March 2018

The Passion for computer games based on cruelty and violence in the modern Russian society is a threat to national security. The danger of such games lies in the development of adolescents unjustified asocial behavior, leading to tragic consequences
Association Between Postdischarge Emergency Department Visitation and Readmission Rates
Authors: Venkatesh Arjun K. , Wang Changqin , Wang Yongfei , Altaf Faseeha , Bernheim Susannah M. , Horwitz Leora
Published: March 2018

BACKGROUND

Hospital readmission rates are publicly reported by the Centers for Medicare & Medicaid Services (CMS); however, the implications of emergency department (ED) visits following hospital discharge on readmissions are uncertain. We describe the frequency, diagnoses, and hospital‐level variation in ED visitation following hospital discharge, including the relationship between risk‐standardized ED visitation and readmission rates.

METHODS

This is a cross‐sectional analysis of Medicare beneficiaries hospitalized for acute myocardial infarction (AMI), heart failure, and pneumonia between July 2011 and June 2012. We used Medicare Standard Analytic Files to identify admissions, readmissions, and ED visits consistent with CMS measures. Postdischarge ED visits were defined as treat‐and‐discharge ED services within 30 days of hospitalization without readmission. We utilized hierarchical generalized linear models to calculate hospital risk–standardized postdischarge ED visit rates and readmission rates.

RESULTS

We included 157,035 patients hospitalized at 1,656 hospitals for AMI, 391,209 at 3,044 hospitals for heart failure, and 342,376 at 3,484 hospitals for pneumonia. After hospitalization for AMI, heart failure, and pneumonia, there were 14,714 (9%), 31,621 (8%), and 26,681 (8%) ED visits, respectively. Hospital‐level variation in postdischarge ED visit rates was substantial: AMI (median: 8.3%; 5th and 95th percentile: 2.8%‐14.3%), heart failure (median: 7.3%; 5th and 95th percentile: 3.0%‐13.3%), and pneumonia (median: 7.1%; 5th and 95th percentile: 2.4%‐13.2%). There was statistically significant inverse correlation between postdischarge ED visit rates and readmission rates: AMI (–0.23), heart failure (‐0.29), and pneumonia (–0.18).

CONCLUSIONS

Following hospital discharge, ED treat‐ and‐discharge visits are half as common as readmissions for Medicare beneficiaries. There is wide hospital‐level variation in postdischarge ED visitation, and hospitals with higher ED visitation rates demonstrated lower readmission rates.
Characterization of the Optimal Risk-Sensitive Average Cost in Denumerable Markov Decision Chains
Authors: Cavazos-Cadena Rolando
Published: March 2018

This work is concerned with Markov decision chains on a denumerable state space. The controller has a positive risk-sensitivity coefficient, and the performance of a control policy is measured by a risk-sensitive average cost criterion. Besides standard continuity-compactness conditions, it is assumed that the state process is communicating under any stationary policy, and that the simultaneous Doeblin condition holds. In this context, it is shown that if the cost function is bounded from below, and the superior limit average index is finite at some point, then (i) the optimal superior and inferior limit average value functions coincide and are constant, (ii) the optimal average cost is characterized via an extended version of the Collatz-Wielandt formula in the theory of positive matrices, and (iii) an optimality inequality is established, from which a stationary optimal policy is obtained. Moreover, an explicit example is given to show that, even if the cost function is bounded, the strict inequality may occur in the optimality relation.
Technical Note—Analysis of Scrip Systems: On an Open Question in Johnson et al. (2014)
Authors: Bo Yang , Dawande Milind , Janakiraman Ganesh
Published: March 2018

In a recent paper, Johnson et al. (2014) [Johnson K, Simchi-Levi D, Sun P (2014) Analyzing scrip systems. Oper. Res. 62(3):524–534.]use an infinitely repeated game with discounting, among a set of homogeneous players, to model a scrip system. In each period, a randomly chosen player requests service; all the other players have a choice of whether or not to volunteer to provide service. Among the players who volunteer, the service provider is chosen using the minimum-scrip rule: a player with the minimum number of scrips is chosen as the service provider. The authors study the always-trade strategy for a player, that is, the strategy of a player always willing to provide service, regardless of the distribution of scrips among the players. A key result of their work is that, under the minimum-scrip rule, for any number of players and for every discount factor close enough to one, there exists a Nash equilibrium in which each player plays the always-trade strategy. This result, however, is established under an assumption of severe punishment: If a player selected to provide service refuses to do so even once, then that player will be forever banned from participating in the system, thus losing all potential future benefit. Johnson et al. (2014) explain that this assumption is unsatisfactory, particularly for large scrip systems, because of difficulties in detecting players who refuse to provide service and verifying the reason(s) for their refusal, and the consequent possibility of players being unfairly banned. Motivated by this concern, the authors suggest an important direction of future research: investigate whether or not the always-trade strategy is an equilibrium without the punishment assumption.

In this note, we address the question posed in Johnson et al. (2014) for a generalization of their model. Our generalization allows for the possibility that players might genuinely not be available to provide service, say because of sickness. Without using the assumption of punishment, we show that when the number of players is large enough and the discount factor is close enough to one, there exists an ε-Nash equilibrium in which each player plays the always-trade strategy.