bluuebunny/crossref_metadata_2025 huggingface dataset:
Supersloppy Readings: Indexicals as Bound Descriptions
Authors: Charnavel Isabelle
Published: June 2019

This article explores understudied dependent readings in (English) ellipsis and focus constructions and their theoretical consequences. The main focus is on “supersloppy” readings of person indexicals in VP-ellipsis, in which you can be bound by I and vice versa. The empirical properties of these cases, tested in a large-scale systematically controlled questionnaire, show that I and you can be construed as e-type pronouns dependent on each other. This challenges the Kaplanian fixity theory of indexicals in a new way: not only can first- and second-person pronouns be bound, they can also contribute descriptive meanings that affect the interpretation of (elided) sentences. Readings similar to supersloppy readings furthermore extend to time and location indexicals, demonstratives and proper names, which indicates the linguistic relevance of other relations between indexicals and between non-indexicals. All these types of dependent readings shed new light on the theories of indexicals, demonstratives and proper names as well as e-type pronouns.
‘I Find Comfort Here’: Rohingya Women and Taleems in Bangladesh’s Refugee Camps
Authors: Rahman Farhana
Published: June 2019

This article draws on feminist ethnographic research to examine Rohingya refugee women’s place-making activities through the case of the taleem—a women’s prayer space—as a site of identity, home and belonging in the refugee camps outside of Cox’s Bazar, Bangladesh. The findings suggest that, as a space for religious activity and prayer, taleems hold important meanings for Rohingya women in three ways: in the social relations—bonds and friendships—it creates; through religious observance as a coping strategy; and providing a sense of collective identity and belonging in displacement by evoking positive memories of ‘home’.
Statistical properties of polarized CMB foreground maps
Authors: von Hausegger Sebastian , Gammelgaard Ravnebjerg Aske , Liu Hao
Published: June 2019

Foreground removal techniques for CMB analyses make specific assumptions about the properties of foregrounds in temperature and in polarization. By investigating the statistics of foreground components more understanding about the degree to which these assumptions are valid can be obtained. In this work we investigate E- and B-mode maps of the two strongest polarized foregrounds, synchrotron and thermal dust emission, with regards to their similarity with Gaussian processes, their spectral variations, and cross-correlations. We perform tests in patches of ∼3.7° size collectively covering the full sky and find most of them to conform to their Gaussian expectation according to the statistics in use. Correlations exhibit distinct differences in E- and B-mode signals, which point towards necessities in foreground removal methods. We discuss potential consequences and possible further directions.
Separating line emission from star formation, shocks, and AGN ionization in NGC 1068
Authors: D’Agostino Joshua J , Kewley Lisa J , Groves Brent A , Medling Anne M , Di Teodoro Enrico , Dopita Michael A , Thomas Adam D , Sutherland Ralph S , Garcia-Burillo Santiago
Published: June 2019

In the optical spectra of galaxies, the separation of line emission from gas ionized by star formation and an active galactic nucleus (AGN), or by star formation and shocks, are very well-understood problems. However, separating line emission between AGN and shocks has proven difficult. With the aid of a new three-dimensional diagnostic diagram, we show the simultaneous separation of line emission from star formation, shocks, and AGN in NGC 1068, and quantify the ratio of star formation, shocks, and AGN in each spaxel. The AGN, shock, and star formation luminosity distributions across the galaxy accurately align with X-ray, radio, and CO(3–2) observations, respectively. Comparisons with previous separation methods show that the shocked emission heavily mixes with the AGN emission. We also show that if the H α flux is to be used as a star formation rate indicator, separating line emission from as many sources as possible should be attempted to ensure accurate results.
Barriers to accrual and enrollment in brain tumor trials
Authors: Lee Eudocia Q , Chukwueke Ugonma N , Hervey-Jumper Shawn L , de Groot John F , Leone Jose Pablo , Armstrong Terri S , Chang Susan M , Arons David , Oliver Kathy , Verble Kay , Musella Al , Willmarth Nicole , Alexander Brian M , Bates Amanda , Doherty Lisa , Galanis Evanthia , Gaffey Sarah , Halkin Thomas , Friday Bret E , Fouladi Maryam , Lin Nancy U , Macdonald David , Mehta Minesh P , Penas-Prado Marta , Vogelbaum Michael A , Sahebjam Solmaz , Sandak David , van den Bent Martin , Weller Michael , Reardon David A , Wen Patrick Y
Published: June 2019

Many factors contribute to the poor survival of malignant brain tumor patients, some of which are not easily remedied. However, one contributor to the lack of progress that may be modifiable is poor clinical trial accrual. Surveys of brain tumor patients and neuro-oncology providers suggest that clinicians do a poor job of discussing clinical trials with patients and referring patients for clinical trials. Yet, data from the Cancer Action Network of the American Cancer Society suggest that most eligible oncology patients asked to enroll on a clinical trial will agree to do so. To this end, the Society for Neuro-Oncology (SNO) in collaboration with the Response Assessment in Neuro-Oncology (RANO) Working Group, patient advocacy groups, clinical trial cooperative groups, including the Adult Brain Tumor Consortium (ABTC), and other partners are working together with the intent to double clinical trial accrual over the next 5 years. Here we describe the factors contributing to poor clinical trial accrual in neuro-oncology and offer possible solutions.
Stereotactic Radiosurgery for Cavernous Sinus Versus Noncavernous Sinus Dural Arteriovenous Fistulas: Outcomes and Outcome Predictors
Authors: Hung Yi-Chieh , Mohammed Nasser , Kearns Kathryn N , Chen Ching-Jen , Starke Robert M , Kano Hideyuki , Lee John , Mathieu David , Kaufmann Anthony M , Wang Wei Gang , Grills Inga S , Cifarelli Christopher P , Vargo John , Chytka Tomas , Janouskova Ladislava , Feliciano Caleb E , Rodriguez-Mercado Rafael , Lunsford L Dade , Sheehan Jason P
Published: June 2019

BACKGROUND

Dural arteriovenous fistulas (DAVFs) can be categorized based on location.

OBJECTIVE

To compare stereotactic radiosurgery (SRS) outcomes between cavernous sinus (CS) and non-CS DAVFs and to identify respective outcome predictors.

METHODS

This is a retrospective study of DAVFs treated with SRS between 1988 and 2016 at 10 institutions. Patients’ variables, DAVF characters, and SRS parameters were included for analyses. Favorable clinical outcome was defined as angiography-confirmed obliteration without radiological radiation-induced changes (RIC) or post-SRS hemorrhage. Other outcomes were DAVFs obliteration and adverse events (including RIC, symptomatic RIC, and post-SRS hemorrhage).

RESULTS

The overall study cohort comprised 131 patients, including 20 patients with CS DAVFs (15%) and 111 patients with non-CS DAVFs (85%). Rates of favorable clinical outcome were comparable between the 2 groups (45% vs 37%, P = .824). Obliteration rate after SRS was higher in the CS DAVFs group, even adjusted for baseline difference (OR = 4.189, P = .044). Predictors of favorable clinical outcome included higher maximum dose (P = .014) for CS DAVFs. Symptomatic improvement was associated with obliteration in non-CS DAVFs (P = .005), but symptoms improved regardless of whether obliteration was confirmed in CS DAVFs. Non-CS DAVFs patients with adverse events after SRS were more likely to be male (P = .020), multiple arterial feeding fistulas (P = .018), and lower maximum dose (P = .041).

CONCLUSION

After SRS, CS DAVFs are more likely to obliterate than non-CS ones. Because these 2 groups have different total predictors for clinical and radiologic outcomes after SRS, they should be considered as different entities.
Comparative Effectiveness of Exclusive Exposure to Nafcillin or Oxacillin, Cefazolin, Piperacillin/Tazobactam, and Fluoroquinolones Among a National Cohort of Veterans With Methicillin-Susceptible Staphylococcus aureus Bloodstream Infection
Authors: Beganovic Maya , Cusumano Jaclyn A , Lopes Vrishali , LaPlante Kerry L , Caffrey Aisling R
Published: June 2019

Objective

Beta-lactam antibiotics are recommended as first-line for treatment of methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia. The objective of this study was to compare effectiveness of anti-MSSA therapies among bacteremia patients exclusively exposed to 1 antimicrobial.

Method

This was a national retrospective cohort study of patients hospitalized in Veterans Affairs medical centers with MSSA bacteremia from January 1, 2002, to October 1, 2015. Patients were included if they were treated exclusively with nafcillin, oxacillin, cefazolin, piperacillin/tazobactam, or fluoroquinolones (moxifloxacin and levofloxacin). We assessed 30-day mortality, time to discharge, inpatient mortality, 30-day readmission, and 30-day S. aureus reinfection. Hazard ratios (HRs) and 95% confidence intervals (CI) were calculated using propensity-score (PS) matched Cox proportional hazards regression model.

Results

When comparing nafcillin/oxacillin (n = 105) with cefazolin (n = 107), 30-day mortality was similar between groups (PS matched n = 44; HR, 0.67; 95% CI, 0.11–4.00), as were rates of the other outcomes assessed. As clinical outcomes did not vary between nafcillin/oxacillin and cefazolin, they were combined for comparison with piperacillin/tazobactam (n = 113) and fluoroquinolones (n = 103). Mortality in the 30 days after culture was significantly lower in the nafcillin/oxacillin/cefazolin group compared with piperacillin/tazobactam (PS matched n = 48; HR, 0.10; 95% CI, 0.01–0.78), and similar when compared with fluoroquinolones (PS matched n = 32; HR, 1.33; 95% CI, 0.30–5.96).

Conclusions

In hospitalized patients with MSSA bacteremia, no difference in mortality was observed between nafcillin/oxacillin and cefazolin or fluoroquinolones. However, higher mortality was observed with piperacillin/tazobactam as compared with nafcillin/oxacillin/cefazolin, suggesting it may not be as effective as a monotherapy in MSSA bacteremia.
Incidence of Acute, Progressive, and Delayed Proximal Junctional Kyphosis Over an 8-Year Period in Adult Spinal Deformity Patients
Authors: Segreto Frank A , Passias Peter G , Lafage Renaud , Lafage Virginie , Smith Justin S , Line Breton G , Mundis Gregory M , Bortz Cole A , Stekas Nicholas D , Horn Samantha R , Diebo Bassel G , Brown Avery E , Ihejirika Yael , Nunley Pierce D , Daniels Alan H , Gupta Munish C , Gum Jeffrey L , Hamilton D Kojo , Klineberg Eric O , Burton Douglas C , Hart Robert A , Schwab Frank J , Bess Shay , Shaffrey Christopher I , Ames Christopher P ,   on behalf of the International Spine Study Group
Published: June 2019

BACKGROUND

Proximal junctional kyphosis (PJK) is a common radiographic complication of adult spinal deformity (ASD) corrective surgery. Although previous literature has reported a 5 to 61% incidence of PJK, these studies are limited by small sample sizes and short-term follow-up.

OBJECTIVE

To assess the incidence of PJK utilizing a high-powered ASD database.

METHODS

Retrospective review of a prospective multicenter ASD database. Operative ASD patients > 18 yr old from 2009 to 2017 were included. PJK was defined as ≥ 10° for the sagittal Cobb angle between the inferior upper instrumented vertebra (UIV) endplate and the superior endplate of the UIV + 2. Chi-square analysis and post hoc testing assessed annual and overall incidence of acute (6-wk follow-up [f/u]), progressive (increase in degree of PJK from 6 wk to 1 yr), and delayed (1-yr, 2-yr, and 3-yr f/u) PJK development.

RESULTS

A total of 1005 patients were included (age: 59.3; 73.5% F; body mass index: 27.99). Overall PJK incidence was 69.4%. Overall incidence of acute PJK was 48.0%. Annual incidence of acute PJK has decreased from 53.7% in 2012 to 31.6% in 2017 (P = .038). Overall incidence of progressive PJK was 35.0%, with stable rates observed from 2009 to 2016 (P = .297). Overall incidence of 1-yr-delayed PJK was 9.3%. Annual incidence of 1-yr-delayed PJK has decreased from 9.2% in 2009 to 3.2% in 2016 (P < .001). Overall incidence of 2-yr-delayed PJK development was 4.3%. Annual incidence of 2-yr-delayed PJK has decreased from 7.3% in 2009 to 0.9% in 2015 (P < .05). Overall incidence of 3-yr-delayed PJK was 1.8%, with stable rates observed from 2009 to 2014 (P = .594).

CONCLUSION

Although progressive PJK has remained a challenge for physicians over time, significantly lower incidences of acute and delayed PJK in recent years may indicate improving operative decision-making and management strategies.
High-Definition 3-Dimensional Exoscope for 5-ALA Glioma Surgery: 3-Dimensional Operative Video
Authors: Doglietto Francesco , Belotti Francesco , Panciani Pierpaolo , Poliani Pietro Luigi , Fontanella Marco Maria
Published: June 2019

A 54-yr-old man presented with the radiological recurrence of a glioblastoma at the level of the left anterior cingulate gyrus, 46 mo after first surgery, which had been complicated by bone flap infection. Due to the relatively small recurrence, the long survival, and the good neurological status, surgery was warranted. A new, high-definition (4 K) and 3-dimensional exoscope (ORBEYE; Sony Olympus Medical Solutions Inc, Tokyo, Japan) was used during the surgical approach and throughout tumor removal, which was aided by five-aminolevulinic acid (5-ALA) derived fluorescence. The postoperative course was characterized by supplementary motor area syndrome, which quickly improved, leading to a discharge home 1 wk after surgery. Histological examination confirmed a wild-type (WT) IDH1/2, MGMT (DNA repair enzyme O6-methylguanine-DNA methyltransferase) methylated glioblastoma with a proliferative index focally as high as 20%. He is now being considered for a second-line treatment.

As recently reported for spinal surgery,
1
we believe this technology has significant potential for its small dimension (which can provide optimal positioning even in ergonomically challenging positions), ease of movement, and image quality, including 5-ALA fluorescence.

The patient's consent was obtained for publication.
Functional shifts in leaves of woody invaders of deciduous forests between their home and away ranges
Authors: Martinez Kelsey A , Fridley Jason D , Oguchi Riichi , Aiba Masahiro , Hikosaka Kouki
Published: June 2019

Temperate forests are widely invaded by shade-tolerant shrubs and trees, including those of Eastern North America (ENA). However, it remains unknown whether these invaders are ‘preadapted’ for success in their new ranges due to unique aspects of their evolutionary history or whether selection due to enemy release or other postintroduction processes have driven rapid evolution in the invaded range. We sampled leaf traits of populations of woody understory invaders across light gradients in their native range in Japan and in their invaded ENA range to examine potential phenotypic shifts related to carbon gain and nitrogen use between ranges. We also measured leaf traits in three co-occurring ENA native shrub species. In their invaded range, invaders invested significantly less in leaf chlorophyll content (both per unit leaf mass and area) compared with native range populations of the same species, yet maintained similar rates of photosynthesis in low light. In addition, compared with ENA natives, ENA invaders displayed greater trait variation in response to increasing light availability (forest edges, gaps), giving them a potential advantage over ENA natives in a variety of light conditions. We conclude that, for this group of species, newly evolved phenotypes in the invaded range are more important than preadaptation for their success as shade-tolerant forest invaders.
Cross-talk between Human Spinal Cord μ-opioid Receptor 1Y Isoform and Gastrin-releasing Peptide Receptor Mediates Opioid-induced Scratching Behavior
Authors: Liu Xian-Yu , Ginosar Yehuda , Yazdi Joseph , Hincker Alexander , Chen Zhou-Feng
Published: June 2019

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New

Background

Although spinal opioids are safe and effective, pruritus is common and distressing. The authors previously demonstrated in mouse spinal cord that interactions between μ-opioid receptor isoform 1D and gastrin releasing peptide receptor mediate morphine-induced scratch. The C-terminal of 1D inhibits morphine-induced scratch without affecting analgesia. The authors hypothesize that human spinal cord also contains itch-specific μ-opioid receptor isoforms which interact with gastrin releasing peptide receptor.

Methods

Reverse transcription polymerase chain reaction was performed on human spinal cord complimentary DNA from two human cadavers. Calcium responses to morphine (1 μM) were examined using calcium imaging microscopy on human cells (HEK293) coexpressing gastrin releasing peptide receptor and different human μ-opioid receptor isoforms. The authors assessed morphine-induced scratching behavior and thermal analgesia in mice following intrathecal injection of morphine (0.3 nmol) and a transactivator of transcription peptide designed from C-terminal sequences of 1Y isoform (0, 0.1, and 0.4 nmol).

Results

The authors demonstrated 1Y expression in the spinal cord dorsal horn. Morphine administration evoked a calcium response (mean ± SD) (57 ± 13 nM) in cells coexpressing both gastrin releasing peptide receptor and the 1Y isomer. This was blocked by 10 μM naltrexone (0.7 ± 0.4 nM; P < 0.0001), 1 μM gastrin-releasing peptide receptor antagonist (3 ± 2 nM; P < 0.0001), or 200 μM 1Y-peptide (2 + 2 nM; P < 0.0001). In mice, 0.4 nmol 1Y-peptide significantly attenuated morphine-induced scratching behaviors (scratching bouts, vehicle vs. 1Y-peptide) (92 ± 31 vs. 38 ± 29; P = 0.011; n = 6 to 7 mice per group), without affecting morphine antinociception in warm water tail immersion test (% of maximum possible effect) (70 ± 21 vs. 67 ± 22; P = 0.80; n = 6 mice per group).

Conclusions

Human μ-opioid receptor 1Y isomer is a C-terminal splicing variant of Oprm1 gene identified in human spinal cord. Cross-talk between 1Y and gastrin releasing peptide receptor is required for mediating opioid-induced pruritus. Disrupting the cross talk may have implications for therapeutic uncoupling of desired analgesic effects from side effects of opioids.
Recruitment and Retention of Asian Americans in Web-Based Physical Activity Promotion Programs
Authors: Chee Wonshik , Ji Xiaopeng , Kim Sangmi , Park Sooyoung , Zhang Jingwen , Chee Eunice , Tsai Hsiu-Min , Im Eun-Ok
Published: June 2019

Web-based interventions that promote physical activity have been tested in various populations and proven effective. However, information on recruiting and retaining ethnic minorities in these interventions is limited. This study discusses practical issues in recruitment and retention of Asian Americans using three strategies: (1) only Web-based intervention (Group 1), (2) one with Fitbit Charge HR (Group 2), and (3) one with Fitbit Charge HR and office visits (Group 3). Recruitment and retention rates, minutes of weekly research team meetings, and the researchers' memos were collected. Retention rates were analyzed using descriptive statistics, and the minutes and memos were content analyzed following Weber's methods. Retention rates varied by the end of the first (12% in Group 3, 36.9% in Group 2) and third month (0% in Group 3, 36.9% in Group 2). The practical issues were (1) difficulties in recruitment across strategies, (2) the necessity of using community consultants/leaders across strategies, (3) subethnic differences across strategies, (4) timing issues across strategies, (5) Fitbit as a facilitator with several hindrances, and (6) office visits as an inhibitor. Fitbits with user guidelines and community consultants'/leaders' involvement are proposed for future Web-based interventions to promote physical activity in Asian Americans.
Identification of a Promiscuous Epitope Peptide Derived From HSP70
Authors: Matsui Hiroto , Hazama Shoichi , Tamada Koji , Udaka Keiko , Irie Atsushi , Nishimura Yasuharu , Miyakawa Tomoya , Doi Shun , Nakajima Masao , Kanekiyo Shinsuke , Tokumitsu Yukio , Shindo Yoshitaro , Tomochika Shinobu , Yoshida Shin , Iida Michihisa , Suzuki Nobuaki , Takeda Shigeru , Yamamoto Shigeru , Yoshino Shigefumi , Ueno Tomio , Nagano Hiroaki
Published: June 2019

We previously found that heat-shock protein 70 (HSP70) is expressed on hepatocellular carcinoma cells and developed an HSP70 mRNA-transfected dendritic cell therapy for treating unresectable or recurrent hepatocellular carcinoma. The phase I trial was completed successfully. The purpose of this study is to identify a promiscuous epitope peptide derived from HSP70 for the purpose of developing a novel cancer peptide vaccine. Using a computational algorithm to analyze the specificity of previously reported major histocompatibility complex class I–binding peptides, we selected candidates that bound to >2 of the 3 HLA types. Twenty-nine HSP70-derived peptides (9-mers) that bound to HLA-class I was selected. The peptides were prioritized based on the results of peptide binding experiments. Using dendritic cells stimulated with the candidate peptide described previously as stimulators and CD8+ T cells as effectors, an ELISPOT assay was performed. Cytotoxicity of CD8 lymphocytes stimulated with the candidate peptides toward HSP70-expressing cancer cells was analyzed using an xCELLigence System. Peptides were administered to HLA-A 24 transgenic mice as vaccines, and peptide-specific T-cell induction was measured in vivo. We identified a multi-HLA-class I–binding epitope peptide that bound to HLA-A*02:01, *02:06, and *24:02 in vitro using an interferon-γ ELISPOT immune response induction assay. Cytotoxicity was confirmed in vitro, and safety and immune response induction were confirmed in vivo using HLA-A 24 transgenic mice. Our study demonstrated that the promiscuous HSP70-derived peptide is applicable to cancer immunotherapy in patients with HLA-A*24:02-positive, *02:01-positive, and *02:06-positive HSP70-expressing cancers.
“Let's Boogie”
Authors: Wshah Adnan , Butler Stacey , Patterson Kara , Goldstein Roger , Brooks Dina
Published: June 2019

Purpose:

Exercise is an effective treatment for individuals with chronic obstructive pulmonary disease (COPD); however, lack of adherence to exercise programs is a common barrier. Innovative approaches to exercise are needed to increase patient engagement and adherence. Dance has been shown to benefit populations with neurological conditions. The aim of our study was to investigate the feasibility of a dance intervention in individuals with COPD.

Methods:

Twenty individuals with COPD participated in a 1-hr dance class delivered twice a week for 8 wk. The primary outcome measure of the study was the feasibility determined by enrollment rate, attendance rate, adverse events, and participant satisfaction. Secondary outcomes included functional capacity, balance, anxiety and depression, steps count, and health-related quality of life.

Results:

Of the 47 individuals approached, 37 (79%) were interested in the program and 23 (49%) consented to participate and 20 completed the program with no adverse events and a mean attendance rate of 78%. The mean age ± SD of the participants was 73.4 ± 7.6 yr and 70% were females. Participant satisfaction with the program was high and significant improvements were achieved in the 6-min walk test (P = .03), Balance Evaluation Systems Test (BESTest) (P < .01), Chronic Respiratory Disease Questionnaire (P = .001), and the Activities-specific Balance Confidence scale (P = .007).

Conclusion:

Dance is an enjoyable, safe, and feasible way to exercise for those with COPD. This pilot study will inform the design of a larger randomized controlled trial to determine effectiveness of dance on exercise capacity, balance, and quality of life for people with COPD.
Activation of Collimators Irradiated With Clinical Proton Beams and Development of a Semiempirical Model for Activity Calculation
Authors: Carnicer Adela , Candela-Juan Cristian , Nirrengarten Manon , Blideanu Valentin , Mazal Alejandro , Hérault Joël , Delacroix Sabine
Published: June 2019

Patient-specific collimators used in proton therapy are activated after use. The aim of this work is to assess the residual activity in brass collimators considering clinical beams, so far studied only for monoenergetic beams, and to develop a model to calculate the activity. Eight brass collimators irradiated with different clinical and monoenergetic beams were included in the study. The collimators were analyzed with gamma spectrometry in the framework of three independent studies carried out at the two French proton therapy sites. Using FLUKA (a fully integrated particle physics Monte Carlo simulation package), simulations were performed to determine radionuclides and activities for all the collimators. The semiempirical model was built using data calculated with FLUKA for a range of clinical beams (different maximum proton energies, modulations, and doses). It was found that there was global coherence in experimental results from different studies. The relevant radionuclides at 1 mo postirradiation were 57Co, 58Co, and 65Zn, and additionally, 54Mn, 56Co, and 60Co for high-energy beams. For nondegraded monoenergetic beams, differences between FLUKA and spectrometry were within those reported in reference benchmark studies (±30%). Due to the use of perfect monochromatic sources in the FLUKA model, FLUKA results systematically underestimated experimental activities for clinical beams, especially for 65Zn, depending on the beam energy spread (modulation, degradation, beam line characteristics). To account for the energy spread, correction factors were derived for the semiempirical model. The model is applicable to the most relevant radionuclides and total amounts. Secondary neutrons have a negligible contribution to the activity during treatment with respect to proton activation.
Development of an External Radiation Dose Estimation Model for Children Returning to Their Homes in Areas Affected by the Fukushima Nuclear Accident
Authors: Mori Airi , Takahara Shogo , Yoshida Hiroko , Sanada Yukihisa , Munakata Masahiro
Published: June 2019

On 1 April 2017, around 6 y after the Fukushima Daiichi nuclear power station accident, evacuation orders for large affected areas were lifted, and areas to which people could return were expanded. In the current study, a dose estimation model based on a probabilistic approach has been developed to estimate the external radiation doses children would receive after returning to these areas. The target groups are children from infants to high school students, and the target areas are nine municipalities including evacuation areas as of 5 September 2015. The estimation period is for 4 y starting 1 April 2017. Validation of the model in an area for which individual personal dosimetry measurements were available showed that it is valid for infants, kindergarteners, 3rd and 4th grade elementary school students, 5th and 6th grade elementary school students, and junior high school students. Considering the statement of the International Commission on Radiological Protection, the estimated radiation doses for these five age groups were taken to be the 95th percentiles of the predicted distributions as an index of conservative judgement. As a result of our estimations, the 95th percentile doses to all age groups were less than 20 mSv y−1 in all periods and in all areas. The 95th percentile doses in some areas were less than 1 mSv y−1, which is the long-term dosimetric target set by the Japanese government. It should be noted that our results are preliminary, being based on several assumptions and limitations regarding environmental contamination conditions and the behavioral patterns of children. To estimate the children’s doses precisely, further considerations for these assumptions and limitations will be needed.
Acoustic radiation forced impulse-based splenic prediction model using data mining for the noninvasive prediction of esophageal varices in hepatitis C virus advanced fibrosis
Authors: Darweesh Samar K. , Yosry Ayman , Salah Mohammed , Zayed Naglaa , Khairy Ahmad , Awad Abubakr , Mabrouk Mahasen , Albuhairi Ahmed
Published: June 2019

Background

Esophageal varices (EV) are serious complications of hepatitis C virus (HCV) cirrhosis. Endoscopic screening is expensive, invasive, and uncomfortable. Accordingly, noninvasive methods are mandatory to avoid unnecessary endoscopy. Acoustic radiation forced impulse (ARFI) imaging using point shear wave elastography as demonstrated with virtual touch quantification is a possible noninvasive EV predictor. We aimed to validate the reliability of liver stiffness (LS) and spleen stiffness (SS) by an ARFI-based study together with other noninvasive parameters for EV prediction in HCV patients. Also, we aimed to evaluate the diagnostic performance of a new simple prediction model (incorporating SS) using data mining analysis.

Patients and methods

This cross-sectional study included 200 HCV patients with advanced fibrosis. Labs, endoscopic, ultrasonographic, LS, and SS data were collected. Their accuracy in diagnosing EV was assessed and a data mining analysis was carried out.

Results

Ninety patients (22/46% of F3/F4 patients) had EV (39/30/18/3 patients had grade I/II/III/IV, respectively). LS and SS by ARFI showed high significance in differentiating not only patients with/without EV (P = 0.000 for both) but also correlated with the grading of varices (R = 0.31 and 0.45, respectively; P = 0.000 for both). Spleen longitudinal diameter (SD), splenic vein diameter (SVD), platelets to spleen diameter ratio, LOK index, and FIB-4 score were the best ultrasonographic and biochemical predictors for the prediction of EV [area under receiver operating characteristic (AUROC) 0.79, 0.76, 0.76, 0.74, and 0.71, respectively]. SS (using ARFI) had better diagnostic performance than LS for the prediction of EV (AUROC = 0.76 and 0.70, respectively). The diagnostic performance increased using data mining to construct a simple prediction model: high probability for EV if [(SD cm) × 0.17 + (SVD mm) × 0.06 + (SS) × 0.97] more than 6.35 with AUROC 0.85.

Conclusion

SS by ARFI represents a reliable noninvasive tool for the prediction of EV in HCV patients, especially when incorporated into a new data mining-based prediction model.
Training and Interpreting Machine Learning Algorithms to Evaluate Fall Risk After Emergency Department Visits
Authors: Patterson Brian W. , Engstrom Collin J. , Sah Varun , Smith Maureen A. , Mendonça Eneida A. , Pulia Michael S. , Repplinger Michael D. , Hamedani Azita G. , Page David , Shah Manish N.
Published: June 2019

Background:

Machine learning is increasingly used for risk stratification in health care. Achieving accurate predictive models do not improve outcomes if they cannot be translated into efficacious intervention. Here we examine the potential utility of automated risk stratification and referral intervention to screen older adults for fall risk after emergency department (ED) visits.

Objective:

This study evaluated several machine learning methodologies for the creation of a risk stratification algorithm using electronic health record data and estimated the effects of a resultant intervention based on algorithm performance in test data.

Methods:

Data available at the time of ED discharge were retrospectively collected and separated into training and test datasets. Algorithms were developed to predict the outcome of a return visit for fall within 6 months of an ED index visit. Models included random forests, AdaBoost, and regression-based methods. We evaluated models both by the area under the receiver operating characteristic (ROC) curve, also referred to as area under the curve (AUC), and by projected clinical impact, estimating number needed to treat (NNT) and referrals per week for a fall risk intervention.

Results:

The random forest model achieved an AUC of 0.78, with slightly lower performance in regression-based models. Algorithms with similar performance, when evaluated by AUC, differed when placed into a clinical context with the defined task of estimated NNT in a real-world scenario.

Conclusion:

The ability to translate the results of our analysis to the potential tradeoff between referral numbers and NNT offers decisionmakers the ability to envision the effects of a proposed intervention before implementation.
“There Is No Before Cancer… There Is Only Cancer.” Perceived Late Effects of Pediatric Cancer on Survivors
Authors: Molinaro Monica L. , Fletcher Paula C.
Published: June 2019

Background

Although “late effects” connotes experiencing effects later in life, they can emerge immediately after active treatment. The effects that survivors experience have been reported but rarely from the point of view of the survivors regarding their life after treatment.

Objective

To examine the perceived late effects of pediatric cancer on survivors and their self-identified primary support persons in order to understand the multifaceted nature of living after a pediatric cancer diagnosis.

Methods

Using a pragmatic interpretive phenomenology approach, 10 survivors of pediatric cancer (aged 21–28 years) and 9 of their support persons (aged 23–73 years) participated, completing background questionnaires and semistructured, one-on-one interviews. Interview transcripts were analyzed thematically.

Results

Both survivors and support persons acknowledged that survivors experienced negative physical and cognitive health outcomes that require follow-up care. Survivors acknowledged that their cancer experience and residual effects have changed the trajectory of their lives.

Conclusions

Research on young adult survivors of pediatric cancer and the residual/late effects and emotional outcomes they experience is warranted. Longitudinal research can aid in understanding how effects develop or worsen over time.

Implications for Practice

The findings of this study support The Children’s Oncology Group Long-term Follow-up Guidelines for practitioners. As the frontline caring for these individuals and families, nurses’ involvement in transitional care out of treatment is necessary. Continued involvement and understanding of long-term pediatric cancer survivorship for nurses are also imperative for continuity for survivors and families.
Clinical Nurse Specialist–Facilitated Collaborative Skin Assessments for Respiratory Care Devices
Authors: Mahramus Hunt Tara L. , Penoyer Daleen A.
Published: June 2019

Purpose/Aim:

To evaluate a collaborative skin assessment intervention between respiratory therapists and registered nurses.

Design:

A quality improvement design was used to determine feasibility of a collaborative skin assessment.

Methods:

The collaborative skin assessment intervention included skin assessments, documentation of findings, and use of a treatment guideline for patients using a respiratory care device. Perceptions of the collaborative intervention and pressure injury numbers were measured after a 2-month intervention period.

Results:

Respiratory therapists and registered nurses reported satisfaction with the collaborative intervention; stating it was best practice and could prevent respiratory care device–related pressure injuries. However, timing the skin assessment together was difficult. One device-related pressure injury occurred during the intervention period.

Conclusions:

Respiratory therapists and nurses should partner to perform skin assessments under respiratory devices each shift and develop a plan of care to prevent skin injury. Protocol orders to prevent and treat skin alterations found under respiratory care devices and a dedicated area in the medical record to document skin assessments may be helpful to support efforts to prevent injuries. Additionally, as a result of these efforts, pressure injuries specific to endotracheal tubes declined greater than 50% in 2 critical care units in the year following this quality improvement project.
Synchronous Well-differentiated Endometrioid Adenocarcinoma and Leiomyosarcoma of the Uterus With Pulmonary Metastasis in a 50-Yr-Old Woman: A Case Report and Review of Literature
Authors: Abbas Alizeh , Ud Din Nasir , Kayani Naila
Published: June 2019

The most common synchronous gynecologic malignancies are endometrial and ovarian cancers. However, synchronous endometrial adenocarcinoma and uterine leiomyosarcoma are extremely rare. We report the case of a 50-yr-old woman who was diagnosed with concomitant endometrial adenocarcinoma and uterine leiomyosarcoma. The sarcomatous neoplasm was positive for anti-smooth muscle actin and CD10, and focally positive for Cytokeratin AE1/AE3 and Cytokeratin Cam 5.2. She underwent total abdominal hysterectomy with bilateral salpingoopherectomy followed by radiation, brachytherapy, and chemotherapy. Three years later, she presented with cough and dyspnea and was found to have pulmonary metastasis. These tumor cells were positive for anti-smooth muscle actin, Cytokeratin AE1/AE3, Cytokeratin Cam 5.2, and epithelial membrane antigen, and therefore a diagnosis of lung metastasis from myometrial leiomyosarcoma was made. She received chemotherapy postoperatively. Currently, the patient has multiple lung metastases, is on Megestrol Acetate and is clinically well. This is the first reported case of concomitant uterine malignancies with pulmonary metastases and a long follow-up of 9 yr. It is important to rule out carcinosarcoma as a differential diagnosis in such patients.
Combination of MCM2 With Ki67 and p16 Immunohistochemistry Can Distinguish Uterine Leiomyosarcomas
Authors: Keyhanian Kianoosh , Lage Janice M. , Chernetsova Elizaveta , Sekhon Harman , Eslami Zohreh , Islam Shahidul
Published: June 2019

Our objective was to evaluate the diagnostic utility of 2 new proliferation markers, cyclin D1 and minichromosome maintenance complex component 2 (MCM2), in comparison with p16, p53, and Ki67 in differentiating the spectrum of smooth muscle tumors. An institutional database search from 2009 to 2017 identified 10 cases of uterine leiomyoma with bizarre nuclei (LBN), 12 smooth muscle tumors of uncertain malignant potential, and 13 leiomyosarcomas (LMS). Ten resected leiomyomas (LM) were included as controls. Immunohistochemistry was performed on the befitting representative block from each case. Ki67 was <10% in all LMs and LBNs, whereas >10% in all LMSs. Although wild-type in majority of cases, p53 was overexpressed in 38% of LMSs. Cyclin D1 nuclear positivity in LMs, LBNs, and smooth muscle tumors of uncertain malignant potentials ranged from 0% to 65% of neoplastic cells with mostly weak to moderate staining intensity. Instead, cyclin D1 expression was <5% in all LMSs. The ratio of MCM2 positivity exhibited a similar wide range (<1%–80%) in LMs, LBNs, and smooth muscle tumors of uncertain malignant potentials but interestingly, 92% (12/13) of LMSs were diffusely and strongly positive for MCM2 (>80% cell positivity). Overall, for diagnosis of LMS, the sensitivity for diffuse intense MCM2 staining was higher (92%) compared with diffuse staining for p16 (77%); however, specificity of MCM2 and p16 was comparable (94% and 97%, respectively). Herein, we describe the immunohistochemical profile of 2 new proliferation markers, cyclin D1 and MCM2 in uterine smooth muscle tumors. A combination of diffuse strong MCM2 and p16 reactivity with increased Ki67 index can reliably distinguish LMSs from benign histologic mimics.
Incorporating Injury Prevention Into Energy Weatherization Programs
Authors: Tohn Ellen , Wilson Jonathan , Van Oss Tracy , Gurecka Michael
Published: June 2019

Clients receiving weatherization/energy services with an added injury prevention home assessment with modifications/repairs experienced a decline in falls and thus fall-related costs. Interventions in 35 homes were associated with significant reductions in falls from baseline to 6 months postintervention (from 94% to 9%; P < .001) and falls with calls for assistance (from 23% to 3%; P < .02). The decline in falls with calls for assistance in the intervention group was significant when adjusted for a comparison group effect (P = .07). At a median cost of $2058 per home, the addition of an injury prevention component led by an occupational therapist offers the potential to avoid expensive fall-related medical costs (lift assistance, hospital transport and admission, long-term care). Integration of injury prevention into weatherization work, which targets lower-income seniors with high energy use, offers potential to reduce costly hospitalizations and poor health outcomes.
Understanding Emerging Environmental Health Concerns and Environmental Public Health–Tracking Priorities Among State and Local Professionals in Colorado
Authors: Murphy Jacquelyn A. , Peel Jennifer L. , Butts Tom , McKenzie Lisa M. , Litt Jill S.
Published: June 2019

Context:

Colorado is experiencing dramatic changes related to population growth, climate change, and expanded industrial activity. Local and state public health professionals are trying to address a growing array of unique public health issues with stagnant or limited resources.

Objectives:

To understand, through perspectives from local and state public health professionals, the alignment of contemporary environmental and community health issues with state and local capacity and state environmental public health–tracking priorities.

Design:

During 2014-2015, we conducted semistructured interviews which informed the development of a statewide survey of Colorado's professionals from public health, emergency management, forestry, and transportation.

Setting:

This work took place in Colorado.

Participants:

Fifteen professionals from public (n = 9), academic (n = 4), and private (n = 2) sectors were interviewed. Forty-seven professionals, representing 34 counties and 40 public agencies, completed the 25-minute online survey.

Main Outcome Measures:

Environmental and community health concerns; contributing factors to environmental concerns; strengths and limitations of capacity to respond to issues; and frequency of community engagement activities.

Results:

Top environmental health concerns were indoor air pollution (eg, radon), outdoor air pollution, and waste management. Transportation, extreme weather (eg, wildfires), and oil and gas development were most frequently reported as major contributing factors to concerns. Obesity, physical inactivity, and mental illness were the top community health concerns. To remain prepared for emerging challenges, professionals cited a need for more spatiotemporal-refined data related to their top concerns in the environmental public health–tracking database, and support from local, state, and federal agencies, in addition to personnel and funding. To address concerns, participants reported frequently working with government officials, advisory committees, and media outlets.

Conclusions:

This project illuminates opportunities to strengthen connections between the state's environmental public health–tracking priorities and local-level capacity related to professionals' top concerns. It also suggests reinforcing and broadening partnerships to improve data infrastructure and inform environmental public health priorities.
Recruitment, Retention, and Engagement Strategies for Exercise Interventions With Rural Antenatal Adolescents: Qualitative Interviews With WIC Providers
Authors: Gamble Abigail , Saulters Mary Margaret , Cranston Katherine L. , Jones Daniel W. , Herring Sharon J. , Beech Bettina M.
Published: June 2019

Public health stakeholder engagement is integral to developing effective public health interventions. The perspectives of women enrolled in the Special Supplemental Nutritional Program for Women, Infants, and Children (WIC) have often been sought when designing WIC-based interventions; however, the perspectives of WIC providers are underrepresented. The goal of this investigation was to explore the experiences of WIC providers who counsel adolescent clients and to identify strategies for recruitment, retention, and engagement of adolescents in an antenatal exercise intervention. Qualitative interviews were conducted with WIC providers (N = 9) in the Mississippi Delta, a rural, predominantly African American region in northwest Mississippi. From our data emerged 4 themes and 4 hypothesized strategies for recruitment, retention, and engagement of adolescent WIC clients and their parents in a future antenatal exercise intervention that will be implemented through WIC. Engaging the perspectives of WIC providers was a critical first step in understanding the context for this intervention.
Mitigating Ethical Risks in Public-Private Partnerships in Public Health
Authors: Yassanye Diana M. , Anason Andrea P. , Barrett Drue H.
Published: June 2019

Context:

Partnerships between the public and private sectors are necessary in public health and health care. Each partner provides skills, resources, and capabilities. When the public sector, including government, enters into a partnership with a nongovernmental or corporate entity, it is important to determine in advance whether there are real or perceived ethical, financial, or programmatic risks to the organization that might need mitigation.

Program:

This article describes how the Centers for Disease Control and Prevention has approached assessing ethical considerations of public-private partnerships, especially those involving monetary or in-kind gifts.

Implementation:

There are practices that can be applied no matter the size or structure of the organization that can lead to transparency and accountability for a potential partnership.

Discussion:

Examples in this article include a list of practical considerations to review before entering into a new partnership, as well as illustrative anecdotes.
The influence of thermal extremes on coral reef fish behaviour in the Persian Gulf
Authors: D’Agostino Daniele , Burt John A. , Tom Reader , Vaughan Grace O. , Chapman Ben B. , Veronica Santinelli , Cavalcante Geórgenes H. , Feary David A.
Published: June 2019

Despite increasing environmental variability within marine ecosystems, little is known about how coral reef fish species will cope with future climate scenarios. The Arabian/Persian Gulf is an extreme environment, providing an opportunity to study fish behaviour on reefs with seasonal temperature ranges which include both values above the mortality threshold of Indo-Pacific reef fish, and values below the optimum temperature for growth. Summer temperatures in the Gulf are comparable to those predicted for the tropical ocean by 2090-2099. Using field observations in winter, spring and summer, and laboratory experiments, we examined the foraging activity, distance from refugia and resting time ofPomacentrus trichrourus(pale-tail damselfish). Observations of fish behaviour in natural conditions showed that individuals substantially reduced distance from refugia and feeding rate and increased resting time at sub-optimal environmental temperatures in winter (average SST = 21°C) and summer (average SST = 34°C), while showing high movement and feeding activity in spring (average SST= 27°C). Diet was dominated by plankton in winter and spring, while fish used both plankton and benthic trophic resources in summer. These findings were corroborated under laboratory conditions: in a replicated aquarium experiment, time away from refugia and activity were significantly higher at 28°C (i.e., spring temperature conditions) compared to 21 °C (i.e., winter temperature conditions). Our findings suggest thatP. trichrourusmay have adapted to the Arabian/Persian Gulf environment by downregulating costly activity during winter and summer and upregulating activity and increasing energy stores in spring. Such adaptive behavioural plasticity may be an important factor in the persistence of populations within increasing environmentally variable coral reef ecosystems.