bluuebunny/crossref_metadata_2025 huggingface dataset:
Chapter 8. 50 Years of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN)
Authors: Auricchio Salvatore , Cadranel Samy , Guandalini Stefano , Kelly Deirdre , Koletzko Berthold , Lentze Michael J. , McNeish Alexander S. , Milla Peter J. , Rey Jean , Schmitz Jacques , Shamir Raanan , Strandvik Birgitta , Troncone Riccardo , Visakorpi Jarmo
Published: March 2018

Since the conception of an idea of a few paediatric gastroenterologists in Europe to create a society for Paediatric Gastroenterology in 1967, and its foundation in 1968, half a century has passed. The European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) now celebrates its 50th anniversary and its utmost success in combining clinical and scientific expertise in the fields of paediatric gastroenterology, haepatology, and nutrition. To describe this success story 14 of the still living presidents of ESPGHAN recount their impressions of the steady growth of ESPGHAN with all the historical facets from their own points of view. This historical view of ESPGHAN over the last 5 decades provides personal accounts of the development of all activities and creations of this great European Society. The Society started as a small family of experts in the field into a global working open society involved in a large variety of activities within the subspecialties, becoming a leading organisation in Europe and beyond. This unique view gives also a wonderful insight into the famous clinicians and researchers from all over Europe who have helped in the growth and development of ESPGHAN. By describing all these activities and collaborations it becomes clear that this astonishing pan‐European enterprise was achieved by people who put considerable effort and time into the development of this society. Their statements serve as a historical source and reference for future evaluation of the first 50 years of ESPGHAN. In depicting different time episodes, and by assembling all the historical pieces of a puzzle together, the statements help to illustrate how a highly structured society such as ESPGHAN has evolved over the last 50 years, for what it stands for today and what is to be expected in the future.
Chapter 9. Words From Partner Societies
Authors: Golden Barbara , Stiris Tom , Panés Julián , Namazova‐Baranova Leyla , Van Gossum André , Boeing Heiner , Bhutta Zulfiqar A. , Madrazo Armando , Heubi James E. , Mouane Nezha , Fockens Paul , Koletzko Berthold
Published: March 2018

On the occasion of the 50th anniversary of the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN), its close partner associations submitted comments and felicitations which are presented here. These include words from the Latin American (LASPGHAN), North American (NASPGHAN) and Panarabian Societies (PASPGHAN) and the Commonwealth Association (CAPGHAN) of Paediatric Gastroenterology, Hepatology and Nutrition, the Federation of International Societies of Paediatric Gastroenterology, Hepatology and Nutrition (FISPGHAN), the European Academy of Pediatrics (EAP), the European Pediatric Association/Union of National Pediatric Societies (EPA‐UNEPSA), the International Pediatric Association (IPA), the European Crohn's and Colitis Organisation (ECCO), European Society for Clinical Nutrition and Metabolism (ESPEN) , the Federation of European Nutrition Societies (FENS), and United European Gastroenterology (UEG).
Yield and Examiner Dependence of Digital Rectal Examination in Detecting Impaction in Pediatric Functional Constipation
Authors: Pradhan Shikhar , Jagadisan Barath
Published: March 2018

Objectives:

Guidelines on functional constipation recommend digital rectal examination (DRE) when constipation is doubtful or with a suspicion of organic etiology. The guidelines do not clarify if DRE is mandatory to diagnose impaction. This study aims to determine the frequency of impaction detectable only on DRE among children satisfying Rome III criteria without requiring DRE and also the inter‐observer influences on impaction detection by DRE.

Methods:

Children between 6 months to 13 years of age, presenting with history suggestive of constipation were assessed. After excluding those with suspicion of organic etiology, those who needed DRE for diagnosis of constipation and those who do not satisfy Rome III criteria without DRE, the rest who satisfied Rome III criteria were assessed for impaction by palpable fecoliths or constipation‐associated fecal incontinence. Those without such impaction were randomized to 2 examiners for DRE to diagnose impaction, in the absence of contraindications.

Results:

Two hundred and thirty‐three children were assessed. One hundred and sixty‐nine satisfied Rome III without needing DRE. Forty‐eight (28.4%) had impaction detectable without DRE. Among the rest, 28 (30.1%) had impaction by DRE. There was no difference between the frequency of impaction detected by the 2 examiners. Clinical characteristics were similar (P > 0.05) between those with impaction detectable by DRE and those without.

Conclusions:

DRE does detect cases of impaction not discernible by other means. Such a finding may be comparable between examiners. These children may be identified by other clinical characteristics. The clinical significance of such a finding needs more understanding from the standpoint of therapeutic choices.
Growing the Dietetics Profession via a Mentorship Program Between Dietitians and Dietetics Students
Authors: Hicks-Roof Kristen K.
Published: March 2018

In many undergraduate dietetics programs, there are limited mentoring programs outside of the classrooms for students. We describe the development and evaluation of a project that connected dietetics students to Registered Dietitian Nutritionist mentors in the community. An online survey provided project descriptions available to dietetics students, where they ranked the Registered Dietitian Nutritionists they wanted to be matched with for the experience. Mentor-mentee matches resulted in positive improvements; students reported that they had gained knowledge and improved skills and dietitians cultivated leadership skills. Such project-based mentoring programs can connect students to practicing professionals, providing hands-on field experience.
Basil: A Brief Summary of Potential Health Benefits
Authors: Singletary Keith W.
Published: March 2018

Basil is an aromatic plant that encompasses scores of species of herb and shrub species belonging to the genus Ocimum L. (Lamiaceae). The name basil comes from the Greek basileus or “king.” Common basil (Ocimum basilicum L.) leaves have had culinary importance for centuries. Several Ocimum species, collectively known as Tulsi in India and Nepal, are used in Ayurvedic and other traditional medicine systems. Purported uses for Tulsi and other Ocimum species include relief of stress and treatment of respiratory, gastrointestinal, and kidney ailments, as well as blood disorders and skin and eye diseases, to name a few. The present report is intended to provide a brief summary based on human studies from the scientific literature of the potential health benefits of basil relating to alleviating metabolic disorders, cognitive enhancement, strengthening the immune system, and oral and skin health.
Stress and Burnout in Nutrition and Dietetics
Authors: Eliot Kathrin A. , Kolasa Kathryn M. , Cuff Patricia A.
Published: March 2018

Literature from across multiple health professions points to a budding crisis where current and future health professionals are experiencing stress and burnout at an alarming rate that threatens the vitality of our healthcare system and it appears to be no different for professionals engaged in nutrition education and dietetics. We draw attention to stressors impacting the field of nutrition and dietetics and encourage a conversation for stronger interprofessional collaborations between registered dietitian nutritionists and other members of the healthcare team.
Syphilis Elimination: Lessons Learned Again
Authors: Valentine Jo A. , Bolan Gail A.
Published: March 2018

It is estimated that approximately 20 million new sexually transmitted infections (STIs) occur each year in the United States. The federally funded sexually transmitted disease prevention program implemented by Centers for Disease Control and Prevention is primarily focused on the prevention and control of the three most common bacterial STIs: syphilis, gonorrhea, and chlamydia. A range of factors facilitate the transmission and acquisition of STIs, including syphilis. In 1999, Centers for Disease Control and Prevention launched the National Campaign to Eliminate Syphilis from the United States. The strategies were familiar to public health in general and to sexually transmitted disease control in particular: (1) enhanced surveillance, (2) expanded clinical and laboratory services, ((3) enhanced health promotion, (4) strengthened community involvement and partnerships, and (5) rapid outbreak response. This national commitment to syphilis elimination was not the first effort, and like others before it too did not succeed. However, the lessons learned from this most recent campaign can inform the way forward to a more comprehensive approach to the prevention and control of STIs and improvement in the nation's health.
Centers for Disease Control and Prevention Syphilis Summit—Diagnostics and Laboratory Issues
Authors: Pillay Allan
Published: March 2018

Syphilis, caused by the bacterium Treponema pallidum, is on the rise in the United States particularly among men who have sex with men. The disease is complex with varied clinical manifestations and challenges remain in the laboratory diagnostic setting because T. pallidum is noncultivable and no single test can accurately diagnose all stages of the disease. There are missed opportunities for the use of direct detection tests in primary and secondary syphilis. The increasing use of different reverse sequence algorithms for serology testing without validation in populations with varying risks for syphilis makes the interpretation of test results difficult; this has led to concerns about diagnostic errors or overtreatment. On the other hand, the traditional algorithm may miss some early primary syphilis cases, which is of concern in high-risk populations. The potential utility of rapid syphilis serology tests in different settings or populations remains to be determined. The implementation of better tests and appropriate testing algorithms together with laboratory guidelines for test use in general will lead to better diagnostic options for syphilis.
Chronic Myelomonocytic Leukemia With Fibrosis Is a Distinct Disease Subset With Myeloproliferative Features and Frequent JAK2 p.V617F Mutations
Authors: Gur Hatice D. , Loghavi Sanam , Garcia-Manero Guillermo , Routbort Mark , Kanagal-Shamanna Rashmi , Quesada Andres , Khogeer Haitham , Pierce Sherry , Medeiros L. Jeffrey , Kantarjian Hagop , Khoury Joseph D.
Published: March 2018

A subset of patients with chronic myelomonocytic leukemia (CMML) presents with significance myelofibrosis. In myelodysplastic syndromes, significant myelofibrosis has been associated with adverse outcomes and p53 dysregulation. However, in CMML the clinical and molecular correlates of significant myelofibrosis at presentation remain poorly understood. From a cohort of 651 CMML patients, we identified retrospectively 20 (3.1%) cases with moderate to severe reticulin fibrosis (CMML-F) detected at diagnosis, and we compared them to CMML patients without fibrosis (n=631) seen during the same period. Patients with CMML-F had a median age of 69.8 years (range, 24.8 to 91.2 y) and most (13; 65%) were men. Patients with CMML-F differed significantly from other CMML patients across the following parameters: white blood count, absolute monocyte count, serum lactate dehydrogenase level, splenomegaly, and bone marrow blast percentage. Notably, the frequency of JAK2 p.V617F mutation was higher in CMML-F patients compared with other CMML patients (P<0.001). Most CMML-F patients (12/20; 60%) had myeloproliferative CMML. Dysregulation of p53 was uncommon in CMML-F. CMML-F patients tended to have a shorter median overall survival compared with other CMML patients (P=0.079). Multivariate analysis using the Cox proportional hazards model showed an independent association between CMML-F and overall survival (P=0.047). In summary, unlike typical CMML, CMML-F is commonly associated with JAK2 p.V617F. The high frequency of myeloproliferative features and JAK2 p.V617F mutation, and the low frequency of p53 dysregulation, suggest that fibrosis in the context of CMML has a different pathogenesis from that previously reported in myelodysplastic syndrome.
Acute Terminal Ileitis in Children
Authors: Molina Gutiérrez Miguel Angel , Martínez-Ojinaga Nodal Eva , Piñán Díez Julia , Rubio Aparicio Pedro María , Alcolea Sánchez Alida , Remesal Camba Agustín , Pérez Vigara Ana
Published: March 2018

Objectives

This study aims to describe the clinical presentation and outcome of patients diagnosed with acute ileitis in our pediatric emergency department.

Methods

We performed a retrospective study of all patients diagnosed with terminal ileitis by abdominal ultrasonography findings in our pediatric emergency department, over the years 2013 and 2014. Patients with previous diagnosis of inflammatory bowel disease (IBD) were excluded. Data collected were clinical, radiological, and laboratory data at diagnosis; outcome including hospitalization care; and outpatient follow-up in pediatric gastroenterology and/or primary care.

Results

A total of 20 cases were retrieved and studied. All of them presented with abdominal pain, 65% located in the right lower quadrant. Leukocyte count, C-reactive protein, and fibrinogen levels (means, 12,889; 4/μL; 50.1 mg/L; and 575 mg/dL, respectively) were above normal range. Hemoglobin and platelet count were normal. A microbial cause of ileitis was found in 3 cases (Yersinia enterocolitica, Campylobacter jejuni, and Adenovirus). Nine patients were referred to a pediatric gastroenterology unit. No cases of IBD were found.

Conclusions

Acute ileitis is a rare and benign cause of abdominal pain in the pediatric emergency department. The main intervention on initial assessment is to rule out potentially severe causes of abdominal pain that could benefit of an emergency surgical procedure. In contrast with adults and adolescents, acute ileitis in children does not have a clear association with development of IBD.
Pediatric Sigmoid Volvulus
Authors: Lee Bennett , Wu Andrea
Published: March 2018

Sigmoid volvulus is an extremely rare cause of abdominal pain in children. More commonly seen in older adults, an SV occurs when a redundant loop of sigmoid wraps around its elongated, narrow mesentery causing obstruction and ischemia to the affected bowel segment. Children usually present with abdominal pain, nausea, and abdominal distension. Presentations may be acute or chronic with a history of episodic constipation or abdominal distension. The treatment plan includes an initial reduction of the volvulus via sigmoidoscopy with rectal biopsy to rule out Hirschsprung disease; however, operative management to remove the dilated sigmoid colon may be required in the setting of recurrence or confirmed Hirschsprung disease. Although rare, SV should be considered in a child presenting with abdominal pain as a missed diagnosis can have high potential morbidity and mortality.
A Case of Wernicke Encephalopathy Developing After Ileal Bypass Surgery
Authors: Kamaşak Tülay , Kul Sibel , Tuşat Mustafa , Ozgun Nezir , Cansu Ali
Published: March 2018

Wernicke encephalopathy is an acute neurological problem resulting from thiamine deficiency and manifesting with mental confusion, oculomotor dysfunction, and ataxia. It is associated with alcohol dependence in adults. Preparatory factors include hyperemesis gravidarum, prolonged diarrhea, prolonged parental nutrition without vitamin support, absorption disorders, anorexia, cancer, and chemotherapy. Failure to consider the clinical findings and preparatory factors of this disease, which is rare in children, can delay diagnosis. This report describes a case of Wernicke encephalopathy developing in a patient with brid ileus and receiving total parenteral nutrition after partial ileal bypass surgery. The patient's clinical and cranial magnetic resonance findings were compatible with Wernicke encephalopathy. Although these are not widespread, typical ocular findings for Wernicke encephalopathy were present. Dramatic improvements were observed in clinical, ocular, and cranial magnetic resonance findings after treatment.
Implementing Liquid Biopsies in Clinical Trials
Authors: Lustberg Maryam B. , Stover Daniel G. , Chalmers Jeffrey J.
Published: March 2018

A primary goal of personalized medicine is to develop tumor-specific biomarkers to aid in treatment selection and to better evaluate response to targeted therapies. The assessment of circulating blood markers as surrogate real-time biopsies of disease status, termed liquid biopsies, has been under investigation. There are many different types of liquid biopsies each with different functionalities and limitations. These include tumor markers, circulating tumor cells, cell-free DNA, and extracellular vesicles including exosomes. Multiple clinical trials have evaluated liquid biopsies as prognostic biomarkers with positive results. Additional studies are underway to evaluate liquid biopsies as predictive biomarkers, pharmacodynamic biomarkers, and surrogate efficacy endpoints for treatment response evaluation. There are several challenges in and barriers to implementation of liquid biopsies into clinical trials and subsequently into routine clinical practice, which are addressed in this review.
Circulating Tumor Cells
Authors: Agarwal Ashutosh , Balic Marija , El-Ashry Dorraya , Cote Richard J.
Published: March 2018

Circulating tumor cells (CTCs) play a central role in tumor dissemination and metastases, which are ultimately responsible for most cancer deaths. Technologies that allow for identification and enumeration of rare CTC from cancer patients’ blood have already established CTC as an important clinical biomarker for cancer diagnosis and prognosis. Indeed, current efforts to robustly characterize CTC as well as the associated cells of the tumor microenvironment such as circulating cancer associated fibroblasts (cCAF), are poised to unmask key insights into the metastatic process. Ultimately, the clinical utility of CTC will be fully realized once CTC can be reliably cultured and proliferated as a biospecimen for precision management of cancer patients, and for discovery of novel therapeutics. In this review, we highlight the latest CTC capture and analyses technologies, and discuss in vitro strategies for culturing and propagating CTC.
Recovery of Elbow Flexion after Nerve Reconstruction versus Free Functional Muscle Transfer for Late, Traumatic Brachial Plexus Palsy: A Systematic Review
Authors: Hoang Don , Chen Vivi W. , Seruya Mitchel
Published: March 2018

Background:

In late presentation of brachial plexus trauma, it is unclear whether donor nerves should be devoted to nerve reconstruction or reserved for free functional muscle transfer. The authors systematically reviewed recovery of elbow flexion after nerve reconstruction versus free functional muscle transfer for late, traumatic brachial plexus palsy.

Methods:

A systematic review was performed using the PubMed, Embase, and Cochrane databases to identify all cases of traumatic brachial plexus palsy in patients aged 18 years or older. Patients who underwent late (≥12 months) nerve reconstruction or free functional muscle transfer for elbow flexion were included. Age, time to operation, and level of brachial plexus injury were recorded. British Medical Research Council grade for strength and range of motion were evaluated for elbow flexion.

Results:

Thirty-three studies met criteria, for a total of 103 patients (nerve reconstruction, n = 53; free functional muscle transfer, n = 50). There were no differences across groups regarding surgical age (time from injury) and preoperative elbow flexion. For upper trunk injuries, 53 percent of reconstruction patients versus 100 percent of muscle transfer patients achieved grade M3 or greater strength, and 43 percent of reconstruction patients versus 70 percent of muscle transfer patients achieved grade M4 or greater strength. Of the total brachial plexus injuries, 37 percent of reconstruction patients versus 78 percent of muscle transfer patients achieved grade M3 or greater strength, and 16 percent of reconstruction patients versus 46 percent of muscle transfer patients achieved grades M4 or greater strength.

Conclusion:

In late presentation of traumatic brachial plexus injuries, donor nerves should be reserved for free functional muscle transfer to restore elbow flexion.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Augmentation of the Median Tubercle with Dermis-Fat Graft in Children with Repaired Cleft Lip
Authors: Resnick Cory M. , Partridge Justin , Dang Rushil R. , Burashed Hamad M. , Padwa Bonnie L. , Mulliken John B.
Published: March 2018

Background:

Deficiency of the median tubercle is a common residual deformity after repair of cleft lip. The purpose of this study was to analyze the change in labial contour after insertion of a dermis-fat graft.

Methods:

Patients with repaired cleft lip who underwent secondary dermis-fat grafting of the median tubercle between 2012 and 2015, along with preoperative and greater than or equal to 3-month postoperative three-dimensional photographs, were included. The photographs were registered to one another and measurements made before and after grafting using anthropometric landmarks. Outcome variables included the following: labial surface area, midline labial height (ls-sto), and lateral labial height (cphi-sto′).

Results:

Twenty-five patients were included: 14 with unilateral and 11 with bilateral repaired cleft lip. Mean age at graft placement was 10.9 ± 3.2 years. Preoperative and postoperative three-dimensional images were taken at 13.6 ± 21.6 weeks before and 34.8 ± 25.1 weeks after the procedure, respectively. There were significant increases in labial surface area (11.5 percent; p = 0.019) and labial height (14.1 to 18.5 percent; p = 0.002) after grafting. Augmentation was greater in bilateral clefts (25.5 percent at midline and 16.8 percent laterally) compared with unilateral clefts (11.6 percent at midline and 12.5 percent on the grafted noncleft side). Intrarater and interrater reliability was excellent for all measurements.

Conclusion:

Dermis-fat grafting significantly increases contour of the median tubercle in patients with repaired cleft lip.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Ten-year Core Study Data for Sientra’s Food and Drug Administration–Approved Round and Shaped Breast Implants with Cohesive Silicone Gel
Authors: Stevens W. Grant , Calobrace M. Bradley , Alizadeh Kaveh , Zeidler Kamakshi R. , Harrington Jennifer L. , d’Incelli Rosalyn C.
Published: March 2018

Background:

In March 2012, the United States Food and Drug Administration approved Sientra’s application for premarket approval of its portfolio of round and shaped silicone gel breast implants based on data from the largest silicone gel breast implant study to date. This article presents the results of Sientra’s Core Study at the conclusion of 10 years.

Methods:

The Sientra Core Study was a 10-year, open-label, prospective, multicenter clinical study designed to assess the safety and effectiveness of Sientra’s breast implants in augmentation and reconstruction. A total of 1,788 patients (3,506 implants) were enrolled, including 1,116 primary augmentation, 363 revision-augmentation, 225 primary reconstruction, and 84 revision-reconstruction.

Results:

Across all cohorts, the rate of rupture by patient was 8.6%, the rate of Baker grade III/IV capsular contracture was 13.5%, and the rate of reoperation was 31.5%. The rate of capsular contracture was statistically significantly lower for textured devices [9.0%; 95% confidence interval (CI), 7.0–11.5%] compared with smooth devices (17.5%; 95% CI, 14.9–20.4%). There were no cases of breast implant–associated anaplastic large cell lymphoma. Primary reasons for reoperations included capsular contracture (18.8%), and style/size change (19.3%), with over 50% of the reoperations due to cosmetic reasons.

Conclusion:

The 10-year results of Sientra’s Core Study support a comprehensive safety and effectiveness profile of Sientra’s portfolio of round and shaped breast implants.
Risk Factor Analysis for Capsular Contracture: A 10-Year Sientra Study Using Round, Smooth, and Textured Implants for Breast Augmentation
Authors: Calobrace M. Bradley , Stevens W. Grant , Capizzi Peter J. , Cohen Robert , Godinez Tess , Beckstrand Maggi
Published: March 2018

Background:

Despite the increased understanding of surgical best practices, capsular contracture remains the most commonly reported complication and reason for reoperation following breast implant surgery. This study provides a long-term update to a previous investigation of potential contributing risk factors for capsular contracture in primary augmentation patients.

Methods:

The data used for this analysis include 5,122 implants in 2,565 primary augmentation patients implanted by 34 surgeons based on long-term results from Sientra’s clinical study. Potential risk factors, including patient and implant attributes, surgery characteristics, pocket irrigation, and postsurgery characteristics, were analyzed using frequency and multivariate models.

Results:

A total of 333 capsular contracture events in 224 patients were reported. The overall Kaplan–Meier rate for capsular contracture was 10.8% by device through 10 years. Results from the multivariate analysis found 8 factors to be independently associated with capsular contracture (implant placement, implant surface, incision site, hematoma or seroma development, device size, surgical bra, steroid, and antibiotic pocket irrigation; all P values < 0.05). Results from correlation analysis found 2 of the 8 factors to be more strongly associated with early onset capsular contracture events, compared with those occurring after 2 and 5 years of implantation (implant surface and steroid pocket irrigation).

Conclusion:

The results of this large-scale, multivariate analysis identified several significant risk factors for capsular contracture, including device features (smooth surface, smaller size), surgical factors (periareolar incision, subglandular placement, antibiotic irrigation), the development of hematoma/seroma, and the use of a surgical bra.
High-Risk Prescription Opioid Use Among People Living With HIV
Authors: Canan Chelsea E. , Chander Geetanjali , Monroe Anne K. , Gebo Kelly A. , Moore Richard D. , Agwu Allison L. , Alexander G. Caleb , Lau Bryan ,   for the HIV Research Network
Published: March 2018

Background:

Prescription opioid use is greater among people living with HIV (PLWH), yet little is known about the prevalence of specific types of high-risk use among these individuals.

Setting:

We analyzed clinical and demographic data from the HIV Research Network and prescribing data from Medicaid for noncancer patients seeking HIV treatment at 4 urban clinics between 2006 and 2010.

Methods:

HIV Research Network patients were included in the analytic sample if they received at least one incident opioid prescription. We examined 4 measures of high-risk opioid use: (1) high daily dosage; (2) early refills; (3) overlapping prescriptions; and (4) multiple prescribers.

Results:

Of 4605 eligible PLWH, 1814 (39.4%) received at least one incident opioid prescription during follow-up. The sample was 61% men and 62% African American with a median age of 44.5 years. High-risk opioid use occurred among 30% of incident opioid users (high daily dosage: 7.9%; early refills: 15.9%; overlapping prescriptions: 16.4%; and multiple prescribers: 19.7%). About half of the cumulative incidence of high-risk use occurred within 1 year of receiving an opioid prescription. After adjusting for study site, high-risk opioid use was greater among patients with injection drug use as an HIV risk factor [adjusted hazard ratio (aHR) = 1.39, 95% confidence interval: 1.11 to 1.74], non-Hispanic whites [aHR = 1.61, (1.21 to 2.14)], patients age 35–45 [aHR = 1.94, (1.33 to 2.80)] and 45–55 [aHR = 1.84, (1.27 to 2.67)], and patients with a diagnosis of chronic pain [aHR = 1.32, (1.03 to 1.70)].

Conclusions:

A large proportion of PLWH received opioid prescriptions, and among these opioid recipients, high-risk opioid use was common. High-risk use patterns often occurred within the first year, suggesting this is a critical time for intervention.
VA Quality Scholars Quality Improvement Coach Model to Facilitate Learning and Success
Authors: Olds Danielle M. , Dolansky Mary A. , Gali Kari , Callaway-Lane Carol
Published: March 2018

Despite the increase in quality improvement (QI) education both in practice and in health professions' education, gaps exist in the usefulness and success of QI projects. Barriers to successful QI are a result of delays in implementation, teamwork issues, and lack of QI knowledge. These barriers can be addressed using a QI Coach. A QI Coach is an expert in QI principles who has excellent communication and collaboration skills, and is experienced with organizational policies. The purpose of this article is to (a) describe the VA Quality Scholars (VAQS) QI Coach Model that includes the role of a coach and effective coaching strategies and (b) discuss lessons learned from the application of the VAQS QI Coach Model. The QI Coach facilitates success by providing novice QI teams with practical skills, encouragement, and support.
Constrictive Bronchiolitis in Patients With Primary Sjögren Syndrome
Authors: Wight Elizabeth C. , Baqir Misbah , Ryu Jay H.
Published: March 2018

Objective

Constrictive bronchiolitis (CB) is a poorly understood pulmonary manifestation of primary Sjögren syndrome (pSS). We aimed to clarify the presenting clinicoradiologic features and clinical course of pSS-associated CB through a retrospective cohort study.

Methods

We retrospectively identified 11 patients with pSS and CB (defined by mosaic pattern with air trapping on computed tomography) encountered at our institution over 9 years from 2007 to 2015. Presenting clinical features, laboratory results, radiologic findings, and clinical course were analyzed.

Results

Our patients were mostly women (91%), with a median age 53 years (range, 31–76 years) at the time of pulmonary symptom (dyspnea or cough) onset. Most (64%) were nonsmokers. Average interval between diagnosis of pSS and the onset of pulmonary symptoms was 4.4 years; in 4 patients (36%), CB was the presenting manifestation of pSS. Chest radiographs were normal (67%) or demonstrated hyperinflation (33%). Pulmonary function testing demonstrated airflow obstruction in 7 patients (63%), and 2 patients (18%) had an isolated reduction in diffusing capacity, whereas the remaining 2 patients manifested mixed physiology or normal results. Surgical lung biopsy was performed in 2 patients and confirmed the diagnosis of CB in both. Treatment was variable among our patients included glucocorticoids, hydroxychloroquine, mycophenolate mofetil, and cyclophosphamide. Among 6 patients with follow-up computed tomography and pulmonary function, the results remained stable or worsened.

Conclusions

Constrictive bronchiolitis is a rare extraglandular manifestation and can sometimes be the presenting manifestation of pSS. This pulmonary manifestation is associated with an indolent clinical course and does not respond well to immunosuppressive therapy.
Low-Dose Characterization of Kidney Stones Using Spectral Detector Computed Tomography
Authors: Große Hokamp Nils , Salem Johannes , Hesse Albrecht , Holz Jasmin Alexandra , Ritter Manuel , Heidenreich Axel , Maintz David , Haneder Stefan
Published: March 2018

Objectives

The aim of this study was to investigate the feasibility of kidney stone composition analysis using spectral detector computed tomography scanner (SDCT) with normal- and low-dose imaging protocols.

Methods

A total of 154 stones harvested from nephrolithotripsy or nephrolithotomy with a known monocrystalline composition as determined by infrared spectroscopy were examined in a nonanthropomorphic phantom on an SDCT (IQon, Philips, Best, the Netherlands). Imaging was performed with 120 kVp and (a) 40 mAs and (b) 200 mAs, resulting in a computed tomography dose index (CTDIvol) of 2 and 10 mGy, respectively. Besides conventional CT images (CIs), SDCT enables reconstruction of virtual monoenergetic images (40–200 keV). Spectral coefficient images were calculated by performing a voxel-by-voxel combination of 40 and 200 keV images (Matlab R2017b, Mathworks Inc). All stones were semiautomatically 3D-segmented on CI using a threshold-based algorithm implemented in an offline DICOM viewer. Statistical assessment was performed using Steel-Dwass method to adjust for multiple comparisons.

Results

Ca-phosphate (n = 22), Ca-oxalate (n = 82), cysteine (n = 20), struvite (n = 3), uric acid (n = 18), and xanthine stones (n = 9) were included in the analysis. Stone diameter ranged from 3.0 to 13.5 mm. On CI, attenuation differed significantly between calcific and noncalcific stones only (P ≤ 0.05), the spectral coefficient differed significantly between (//): Ca-oxalate//Ca-phosphate//cystine//struvite//uric acid//xanthine in 10 mGy protocol (all P ≤ 0.05). The same results were found for the 2 mGy-protocol, except that differentiation of Ca-oxalate and Ca-phosphate as well as uric acid and xanthine was not possible (P ≥ 0.05).

Conclusions

Spectral detector CT allows for differentiation of kidney stones using semi-automatic segmentation and advanced image post-processing, even in low-dose imaging protocols.
Effect of Early Postoperative Feeding on the Recovery of Children Post Appendectomy
Authors: Rızalar Selda , Özbaş Ayfer
Published: March 2018

The aim of this study was to determine the effect of early postoperative feeding on recovery after appendectomy in children. It was undertaken as a multicenter study. Patients were randomly assigned to 2 groups, each containing 46 children. Postoperatively, liquid and solid food intake and evacuation of first flatus and stool were recorded for the intervention and routine care groups. Postoperative thirst, hunger, nausea, and pain levels were evaluated at regular intervals using the Visual Analogue Scale. Data were obtained as number, mean, and percentage, and statistically analyzed using the chi-square test and the 2-sample t test. A statistically significant difference was found for both the first evacuation of flatus and stool and the length of hospital stay. Patients in the intervention group had evacuated flatus and stool earlier and had a shorter hospital stay than the control group. In addition, a significant difference was found in hunger (48th hour), thirst (36th and 48th hours), and pain (48th hour) levels between the intervention and control groups. Early postoperative feeding in children who have had an appendectomy affects the occurrence of the first evacuation of flatus and stool, the length of hospital stay, and the level of hunger, thirst, and pain.
Factors Influencing the Life Experiences of Individuals With Inflammatory Bowel Disease
Authors: Lopez-Cortes Rafael , Hueso-Montoro Cesar , Garcia-Caro Maria Paz , Montoya-Juarez Rafael , Schmidt-Riovalle Jacqueline , Marti-Garcia Celia , Marin-Fernandez Blanca
Published: March 2018

Inflammatory bowel disease has a negative impact on individuals perception of their health status and is associated with disabling processes that have physical, social, and work repercussions. The objectives of this study were to describe the life experiences of individuals with Crohn disease and ulcerative colitis and to develop a theoretical framework to describe the relationships of these diseases with personal and clinical factors. A qualitative study on the basis of grounded theory was conducted, involving individual and semistructured interviews on the life experiences of 14 adults of different ages with inflammatory bowel disease in relapse or inactive phase. The individuals in relapse phase and those with a short time since diagnosis had the most negative perceptions of their health, and experienced impaired ability for daily activities. The life experiences of individuals with inflammatory bowel disease were influenced by the time since diagnosis and the disease phase, with no gender difference in either factor. The predominant strategy of participants for coping with the disease was to pursue normality. According to these findings, nursing interventions should focus on the initial adaptation phase and on coping strategies during active phases of the disease.
Diverticular Disease
Authors: Lamanna Lenore , Moran Patricia E.
Published: March 2018

Diverticular disease includes diverticulosis, which are sac protrusions of the intestinal mucosa, and diverticulitis, inflammation of the diverticula. Diverticular disease is listed as one of the top 10 leading physician diagnoses for gastrointestinal disorders in outpatient clinic visits in the United States. There are several classifications of diverticular disease ranging from asymptomatic diverticulosis to diverticulitis with complications. Several theories are linked to the development of diverticula which includes the physiology of the colon itself, collagen cross-linking, and recently challenged, low-fiber intake. The differential diagnoses of lower abdominal pain in addition to diverticular disease have overlapping signs and symptoms, which can make a diagnosis challenging. Identification of the distinct signs and symptoms of each classification will assist the practitioner in making the correct diagnosis and lead to appropriate management. The findings from recent studies have changed the paradigm of diverticular disease. The purpose of this article is to discuss traditional dogma and evolving concepts in the pathophysiology, prevention, and management of diverticular disease. Practitioners must be knowledgeable about diverticular disease for improved outcomes.
Screening Indication Associated With Lower Likelihood of Minor Adverse Events in Patients Undergoing Outpatient Colonoscopy
Authors: Sewitch Maida J. , Azalgara Vladimir Marquez , Sing Mélanie Fon
Published: March 2018

We sought to determine, among outpatients at one university hospital endoscopy center, rates of self-reported minor adverse events (MAEs) at 2, 14, and 30 days postcolonoscopy and to identify predictors of MAEs at Day 2 postcolonoscopy. A single-center longitudinal cohort study with follow-ups at Days 2, 14, and 30 postcolonoscopy was conducted in Montreal, Canada. Baseline self-report data included patient age, gender, gastrointestinal discomforts and other discomforts in the preceding month, and comorbidity. Intracolonoscopy procedures and the method of insufflation were obtained from endoscopy reports. Minor adverse event data were obtained by either phone or Internet survey. Multivariate logistic regression was used to identify predictors of MAEs at Day 2. Of 705 individuals approached, 420 (mean age = 58.7 years; SD = 8.4, 45.7% female) were eligible and consented to study participation, and 378 (90%) participated in at least one follow-up. At Days 2, 14, and 30, 86 (25.1%), 46 (13.7%), and 13 (3.1%) patients, respectively, experienced at least one MAE. At the Day 30 follow-up, 2 (0.53%) patients reported having experienced a serious adverse event. The multivariable analysis results showed that screening compared with nonscreening colonoscopy was protective for MAEs at 2 days (OR = 0.5, 95% CI [0.3, 0.9]). We found that 25% of patients experienced at least one MAE at 2 days postcolonoscopy, and screening compared with nonscreening colonoscopy patients were half as likely to experience these early MAEs. Nurses may use these findings to educate and reassure patients about colonoscopy risks. Large, longitudinal multicenter studies are needed to corroborate our findings.
Increasing Hepatitis C Virus Knowledge Through an Evidence-Based Educational Intervention
Authors: Koman Danielle
Published: March 2018

Hepatitis C virus infection is the most common chronic blood-borne infection in the United States (U.S.). Increasing rates of hepatitis C virus infection among drug users present a significant public health problem in the U.S. and globally. This article describes the effect an educational intervention on hepatitis C virus knowledge. A project was conducted using the Brief Hepatitis C Knowledge Scale to assess pre- and post-test intervention knowledge. An educational intervention consisting of a video (Hepatitis C: Get the Facts) and a written handout, as well as a question-and-answer session, was administered to participants at a local health department. Analysis of the data through use of descriptive statistics to compare percentage change of the mean from the pretest to post-test to 3-week post-test intervention was performed. Results demonstrated the use of an educational intervention to be effective in increasing hepatitis C virus knowledge. An increase in knowledge regarding hepatitis C virus transmission may lead to a decrease in overall hepatitis C virus infection rates as well as risky behaviors.
A Retrospective Study Comparing Polyethylene Glycol-Electrolyte Solution With Magnesium Citrate for Treatment of Fecal Disimpaction
Authors: Philichi Lisa , Yuwono Melawati
Published: March 2018

Fecal disimpaction in the hospital setting may be necessary for a constipated child's condition to improve. This study evaluated the efficiency of 2 disimpaction therapies: nasogastric GoLYTELY (polyethylene glycol-electrolyte solution) compared with oral magnesium citrate. Retrospective chart review of 103 children was conducted to determine the time from the start of the clinic cleanout until abdominal radiograph verification of successful stool evacuation. The children were in an age range of 1–18 years, with average age of 8 years. Forty-five were female and 59 were male. Forty-six (45%) children received nasogastric polyethylene glycol-electrolyte and 57 (55%) drank magnesium citrate. The children receiving nasogastric polyethylene glycol-electrolyte on average required 2.5 enemas, and the children receiving magnesium citrate required 3.0 enemas. The average time for a nasogastric polyethylene glycol-electrolyte cleanout was 5 hours 15 minutes (range: 3 hours 30 minutes to 7 hours) and 5 hours 30 minutes for magnesium citrate cleanout (range: 2 to 8 hours). Seven (15%) children who received nasogastric polyethylene glycol-electrolyte and 6 (10%) of those who drank magnesium citrate did not achieve clearance of stool on the second radiograph. Vomiting was an adverse effect of both medications, and 7 (12%) children were unable to drink the entire magnesium citrate dose. Both methods of disimpaction take the same amount of time. Magnesium citrate can be difficult to drink; however, it is less invasive and less costly than nasogastric polyethylene glycol-electrolyte.
Jagged1/Notch2 Controls Kidney Fibrosis via Tfam-mediated Metabolic Reprogramming
Authors: Huang Shizheng , Park Jihwan , Qiu Chengxiang , Sirin Yasemin , Han Seung Hyeok , Li Szu-yuan , Taylor Verdon , Zimber-Strobl Ursula , Susztak Katalin
Published: March 2018

While Notch signaling has been proposed to play a key role in fibrosis, the direct molecular pathways targeted by Notch signaling and the precise ligand and receptor pair that are responsible for kidney disease remain poorly defined.

In this study, we found that JAG1 and NOTCH2 showed the strongest correlation with the degree of interstitial fibrosis in a genome wide expression analysis of a large cohort of human kidney samples. RNA sequencing analysis of kidneys of mice with folic acid nephropathy, unilateral ureteral obstruction, or APOL1-associated kidney disease indicated that Jag1 and Notch2 levels were higher in all analyzed kidney fibrosis models. Mice with tubule-specific deletion of Jag1 or Notch2 (Kspcre/Jag1flox/flox, and Kspcre/Notch2flox/flox) had no kidney-specific alterations at baseline, but showed protection from folic acid induced kidney fibrosis. Tubule-specific genetic deletion of Notch1 and global knock-out of Notch3 had no effect on fibrosis. In vitro chromatin immunoprecipitation experiments and genome-wide expression studies identified the mitochondrial transcription factor A (Tfam) as a direct Notch target. Re-expression of Tfam in tubule cells prevented Notch-induced metabolic and profibrotic reprogramming. Kidney tubule specific deletion of Tfam resulted in perinatal lethality.

In summary, Jag1/Notch2 plays a key role in kidney fibrosis development by regulating Tfam expression and metabolic reprogramming.
The Kendrick Modelling Platform: Language Abstractions and Tools for Epidemiology
Authors: Bui Mai Anh T. , Papoulias Nick , Stinckwich Serge , Ziane Mikal , Roche Benjamin
Published: March 2018

Background

Mathematical and computational models are widely used for examining transmission, pathogenicity and propagation of infectious diseases. Software implementation of such models and their accompanied modelling tools do not adhere to well established software engineering principles. These principles include bothmodularityandclear separation of concernsthat can promotereproducibilityandreusabilityby other researchers. On the contrary the software written for epidemiology is monolithic, highly coupled and severely heterogeneous. This reality ultimately makes these computational models hard to study and to reuse, both because of the programming competence required and because of the incompatibility of the different approaches involved. Our goal withKendrickis to simplify the creation of epidemiological models through a unified Domain-Specific Language for epidemiology that can support a variety of modelling and simulation approaches classically used in the field. This goal can be achieved by promotingreproducibilityandreusewith modular modelling abstractions.

Results

We show through several examples how our modular abstractions and tools can reproduce uniformly complex mathematical and computational models of epidemics, despite being simulated by different methods. This is achieved without requiring sophisticated programming skills from the part of the user. We then successfully validate each kind of simulation through statistical analysis between the time series generated and the known theoretical expectations.

Conclusions

Kendrickis one of the few DSLs for epidemiology that does not burden its users with implementation details or expecting sophisticated programming skills. It is also currently the only language for epidemiology that supports modularity through clear separation of concerns that promote reproducibility and reuse.Kendrick’s wider adoption and further development from the epidemiological community could boost research productivity in epidemiology by allowing researchers to easily reproduce and reuse each other’s software models and simulations. The tool can also be used by people who are not necessarily epidemiology modelers.