bluuebunny/crossref_metadata_2025 huggingface dataset:
Levels, Correlates, and Predictors of Stress and Caregiver Burden among Caregivers of Children with Cerebral Palsy in Nigeria
Authors: Adegoke Samuel , Omole Kehinde , Mbada Chidozie , Adedeji Ganiyu , Adeyemi Olanrewaju , Omole John
Published: December 2017

Cerebral palsy (CP) is a major cause of physical disability in childhood. Caregivers are often subjected to both stress and burden due to prolonged care. This article assesses levels, correlates, and predictive factors of stress and caregiver burden among primary caregivers of children with CP. A hospital-based descriptive cross-sectional study was conducted in three tertiary hospitals within the Osun State, Nigeria. Two hundred and nine caregivers were interviewed with both the Parental Stress Scale and Caregiver Difficulty Scale to assess for stress and burden of caregivers, respectively. Data were collected and analyzed using Statistical Program for Social Sciences for Windows version 22 (SPSS Inc., Chicago, Illinois, United States) with alpha set at p < 0.05. Two hundred and nine children with CP aged 12 months to 12 years were seen during the 6-month period. Mothers constituted 87.1% of the total caregivers. The mean (standard deviation [SD]) stress seen in caregivers was 44.8 ± 10.1, while the mean (SD) caregiver burden was 45.2 ± 13.4. Both these scores were above the minimum score of 42, which signifies high psychosocial stress and burden. Multivariate linear regression was used to assess associations between clinical and sociodemographic and each of stress and caregivers' burden. Severity of CP and level of education were the most important predictors of stress, while severity of CP, level of education, and male child were the most important predictors of caregivers' burden. Caregivers' burden and stress are known to result in negative outcomes. Identifying factors that can predict caregivers' burden and stress could help develop an early intervention strategy to minimize these negative effects while promoting caregivers' psychosocial well-being.
Depressionswissen – Deutsche Übersetzung und Testung der Depression Literacy Scale
Authors: Freitag Simone , Stolzenburg Susanne , Schomerus Georg , Schmidt Silke
Published: December 2017

Ziel der Studie Übersetzung und psychometrische Testung einer Skala zum Depressionswissen.

Methodik Übersetzung der Depression Literacy Scale von Griffith et al. (2004) ins Deutsche und Testung der Skala in einer Stichprobe von 229 Menschen mit depressivem Syndrom.

Ergebnisse Im Durchschnitt war die Stichprobe 49,4 Jahre alt und es wurden 51 % der 22 Fragen richtig beantwortet. Die Skala zeigte eine zufriedenstellende interne Konsistenz. Die erstmalige Anwendung der übersetzten Skala D-Lit German konnte signifikante Unterschiede im Depressionswissen in Subgruppenanalysen zu Geschlecht, Alter und Schulbildung aufzeigen. So berichteten Frauen, jüngere Personen und Personen mit höherem Schulabschluss höhere Werte auf der Depressionskompetenzskala.

Schlussfolgerung Die Übersetzung der Skala zur Depressionskompetenz (D-Lit German) resultierte in einem leicht verständlichen und gut beantwortbaren Fragebogen. Vor allem Items, die sich auf therapeutische und medikamentöse Behandlungsansätze bezogen, waren jedoch schwerer zu beantworten. Insgesamt erwies sich die D-Lit-Skala als reliables und ökonomisches Instrument zur Erfassung des Depressionswissens. Zukünftige Studien sollten Depressionswissen als Prädiktor zur Untersuchung von Inanspruchnahme und Hilfesuchverhalten einbeziehen.
Wie beeinflussen psychosoziale Risiken den Erfolg von Patientenschulungen in der Pädiatrie?
Authors: Menrath Ingo , Ernst Gundula , Mönkemöller Kirsten , Lehmann Christine , Eberding Angela , Müller-Godeffroy Esther , Szczepanski Rüdiger , Lange Karin , Staab Doris , Thyen Ute ,   on behalf of the ModuS Study group
Published: December 2017

Hintergrund Modulare Patientenschulungen sind bei chronisch kranken Kindern wirksam. Wenig ist über den Einfluss von sozioökonomischem Status (SoS), Migrationshintergrund (MH) und psychischen Auffälligkeiten der Kinder und ihrer Familien bekannt.

Frage Beeinflussen SoS, MH oder psychische Auffälligkeiten den Erfolg von Patientenschulungen (Krankheitswissen, gesundheitsbezogene Lebensqualität (LQ) und Lebenszufriedenheit des Kindes und die elterliche Krankheitsbelastung)?

Methoden Unterschiedlich chronisch kranke Kinder und ihre Eltern nahmen an Patientenschulungen teil. Vor bzw. 6 Wochen nach der Schulung wurden mit standardisierten Fragebögen SoS, MH, psychische Auffälligkeiten der Kinder, Krankheitswissen der Kinder und Eltern, gesundheitsbezogene LQ bzw. Lebenszufriedenheit der Kinder und elterliche Krankheitsbelastungen erfasst. Mit Varianz- und Regressionsanalysen wurde der Einfluss von SoS, MH und psychischen Auffälligkeiten auf den Schulungseffekt untersucht.

Ergebnisse 398 Kinder (durchschnittlich 10,2 Jahre) und ihre Eltern nahmen an den Schulungen teil. SoS, MH und psychische Auffälligkeiten hatten keinen Einfluss auf die Verbesserungen des Krankheitswissens, der kindlichen gesundheitsbezogenen LQ und Lebenszufriedenheit sowie der elterlichen Belastung. In den Verlaufsuntersuchungen gingen ein niedriger SoS, ein MH und psychische Auffälligkeiten mit niedrigerem Wissen, niedrigerer gesundheitsbezogener LQ bzw. Lebenszufriedenheit des Kindes und erhöhter elterlicher Belastung einher.

Diskussion Benachteiligte Familien und Kinder mit Verhaltensauffälligkeiten profitieren von Patientenschulungen, jedoch benötigen sie angesichts spezifischer Bedarfe einen erhöhten Schulungsumfang.
Sc and Sc–Zr effects on microstructure and mechanical properties of Be–Al alloy
Authors: Yu Liangbo , Wang Jing , Wang Zhenhong , Qu Fengsheng , Zhou Fuyin , Lai Xinchun
Published: December 2017

Herein, we investigated the effects of Sc and Sc–Zr on the microstructure and mechanical properties of Be–Al alloy, showing that Sc alloying resulted in Be grain refinement and reduced the secondary dendritic arm spacing (SDAS) of these grains by 1/3, whereas Sc–Zr alloying further decreased the SDAS to 7.5 µm and afforded equiaxed/cellular-like morphology with further refined Be grains. The above alloying resulted in the formation of intermetallic compounds (Be13Sc, Be13Zr, and Al3(Sc1– xZr x)), increasing the macrohardness of the Be–Al alloy, with the microhardness and elastic modulus of the Be phase increasing to a larger extent than those of Al. Importantly, Sc–Zr alloying resulted in better microstructure modification and mechanical reinforcement than Sc alloying.
3D nano-arrays of silver nanoparticles and graphene quantum dots with excellent surface-enhanced Raman scattering
Authors: Liu Xiaoguang , Li Yan , Xue Wendong , Ge Juan , Wang Jun , Sun Jialin
Published: December 2017

Active surface-enhanced Raman scattering (SERS) substrates, 3D nano-arrays of Ag nanoparticles (NPs) and graphene quantum dots (GQDs), were prepared using a photochemical approach and an electrophoresis deposition technique with the formation mechanism addressed. The GQDs (ca. 6 nm average) fit into the inter-particle gaps between Ag NPs, as verified by their scanning electron microscopy and high-resolution transmission electron microscopy. This deliberately designed 3D assembly of Ag NPs and GQDs could promote the synergistic effects of both components to further enhance the SERS performances according to both electromagnetic mechanism and chemical mechanism. Preliminary experiments show that the 3D substrates exhibited strong SERS signals comparing with bare Si substrates. This work provides a promising way for 3D SERS substrates.
Stacking faulted P phase in a grit-blasted Ni-based single-crystal superalloy after thermal exposure
Authors: Zhuo Longchao , Xiong Jichun , Chen Qiuyu , Liang Shuhua , Wang Feng
Published: December 2017

In the present work, direct and detailed investigation was carried out with respect to the precipitation in the grit-blasted single-crystal superalloy of DD6 after thermal exposure at 1100°C for 8 h. The precipitation was confirmed to be an orthorhombic topologically close-packed phase of P. In the phase, abundant atomic stacking faults were clearly revealed by bright field transmission electron microscope imaging and high-resolution HAADF imaging. Furthermore, statistical analysis for the 42 P phase particles observed by electron backscattered diffraction revealed that they had a mean size of 0.21 µm and volume percentage of 0.172% in the recrystallised region. The orientation distribution was essentially random besides very weak textures of {511}<0-32> and {921}<0-15>.
Ductile Fe-based bulk metallic glasses at room temperature
Authors: Wan Chao , Yang Weiming , Liu Haishun , Zuo Mingqing , Li Qiang , Ma Zhanguo , Zhao Yucheng , Inoue Akihisa
Published: December 2017

In this work, Fe70Ni10P13C7 and Fe60Ni20P13C7 bulk metallic glasses (BMGs) with high ductility are synthesised through the appropriate adjustment of flux conditions. Microstructure analyses indicate that the ductility of these two Fe-based BMGs is primarily determined by Fe–Ni and Ni–Ni metal–metal bonds, which enable the glasses to undergo a strain of more than 50% in the absence of fracture, as well as extensive bending ductility, similar to metals such as Fe and Ni. This study aims to find a solution to the brittleness problem in Fe-based BMGs, and the results have implications for understanding the deformation mechanism in Fe-based BMGs.
NGLview–interactive molecular graphics for Jupyter notebooks
Authors: Nguyen Hai , Case David A , Rose Alexander S
Published: December 2017

NGLview is a Jupyter/IPython widget to interactively view molecular structures as well as trajectories from molecular dynamics simulations. Fast and scalable molecular graphics are provided through the NGL Viewer. The widget supports showing data from the file-system, online data bases and from objects of many popular analysis libraries including mdanalysis, mdtraj, pytraj, rdkit and more.

Availability and implementation

The source code is freely available under the MIT license at https://github.com/arose/nglview. Python packages are available from PyPI and bioconda. NGLview uses Python on the server-side and JavaScript on the client. The integration with Jupyter is done through the ipywidgets package. The NGL Viewer is embedded client-side to provide WebGL accelerated molecular graphics.
Decay of HIV DNA in the Reservoir and the Impact of Short Treatment Interruption in Kenyan Infants
Authors: Pankau Mark D , Wamalwa Dalton , Benki-Nugent Sarah , Tapia Kenneth , Ngugi Evelyn , Langat Agnes , Otieno Vincent , Moraa Helen , Maleche-Obimbo Elizabeth , Overbaugh Julie , John-Stewart Grace C , Lehman Dara A
Published: December 2017

We compared change in HIV reservoir DNA following continued antiretroviral therapy (ART) vs short treatment interruption (TI) in early ART-treated Kenyan infants. While HIV DNA in the reservoir decayed with continued ART, HIV DNA levels were similar to pre-TI HIV DNA reservoir levels in most children after short TI.
Optimizing safety for the visually impaired patient
Authors: Brennan Jean , Fischer Nanci , Mauk Tina , McKinney Stephanie , Ruiz Daniel
Published: December 2017

Information and support are crucial for successful adaptation after a visual impairment diagnosis.
An Innovative Model for Naloxone Use Within an OTP Setting: A Prospective Cohort Study
Authors: Katzman Joanna G. , Takeda Mikiko Y. , Bhatt Snehal R. , Moya Balasch Monica , Greenberg Nina , Yonas Howard
Published: December 2017

Objectives:

Unintentional opioid overdose deaths are a public health crisis, and naloxone is the most effective harm reduction tool to curb many of these deaths. There is growing evidence that take-home naloxone can prevent opioid overdose in targeted populations. The goal of this study is to measure the opioid overdose reversal rate with take-home naloxone among participants with a diagnosis of opioid use disorder (OUD) in an opioid treatment program (OTP) setting.

Methods:

Patients enrolled in an outpatient OTP program were eligible for this prospective cohort study between April 4, 2016 and July 4, 2016. Two hundred forty-four study participants received overdose education, instruction on how to use naloxone, and were provided with 2 doses of a take-home naloxone auto-injector kit. They were subsequently followed for 3 months.

Results:

Thirty-one study participants reported overdose reversals using naloxone auto-injector kits on 38 community members. All overdose reversals were heroin-related. Eighty-seven per cent of the community members reversed with naloxone were friends or relatives of the study participants.

Conclusions:

This study validates that naloxone is not commonly used on the index study participant, but is often used on a secondary target among people who inject drugs. The large number of overdose reversals reported in this prospective study suggests that this novel model for naloxone use may be replicated at other OTP settings to reduce opioid overdose deaths.
Epidemiology of axial spondyloarthritis: an update
Authors: Wang Runsheng , Ward Michael M.
Published: December 2017

Purpose of review

To provide an update of the prevalence and incidence of axial spondyloarthritis in the general population and in patients with spondyloarthritis-related conditions, environmental risk factors for ankylosing spondylitis, progression from nonradiographic axial spondyloarthritis to ankylosing spondylitis, mortality, and risks for cardiovascular events in patients with ankylosing spondylitis.

Recent findings

Increasingly, administrative healthcare data have been used to study disease frequency and outcomes. The prevalence of ankylosing spondylitis ranged from 9 to 30 per 10 000 persons, which are lower than previous estimates. Data on whether childhood infections influence the risk of ankylosing spondylitis were equivocal, while having been breast-fed may be protective. Progression of patients with nonradiographic axial spondyloarthritis to ankylosing spondylitis is slow, with estimates of 5.1% in 5 years and 19% in 10 years. Risk of mortality is slightly increased in ankylosing spondylitis. Risks for cardiovascular events in ankylosing spondylitis were either not different from, or only slightly higher than in controls. No studies have examined these outcomes in the broader group of patients with axial spondyloarthritis.

Expanded use of administrative and registry data has facilitated studies of the epidemiology of ankylosing spondylitis, but lack of specific diagnostic codes limits use of these resources for studying axial spondyloarthritis in general.
Incidence of Meniscal Entrapment and Associated Knee Injuries in Tibial Spine Avulsions
Authors: Rhodes Jason T. , Cannamela Peter C. , Cruz Aristides I. , Mayo Meredith , Styhl Alexandra C. , Richmond Connor G. , Ganley Theodore J. , Shea Kevin G.
Published: December 2017

Background:

Tibial spine avulsions (TSA) have historically been treated as isolated injuries. Data on associated injuries are limited with existing literature reporting wide ranging incidences. The purpose of this multicenter study was to (1) describe the incidence of meniscal entrapment and associated knee injuries in TSA and to (2) compare surgical and magnetic resonance image (MRI) findings for these injuries. Our hypothesis is that tibial spine injuries are not usually isolated injuries, and other meniscal, ligament, and cartilage injuries may be present.

Methods:

MRI and surgical reports for patients with a diagnosis of a tibial spine fracture were retrospectively reviewed. Type of fracture was recorded as noted in the reports along with concomitant meniscal entrapment and osteochondral, ligamentous, and meniscal injury. Images and reports were reviewed by an orthopaedic surgeon at each respective institution.

Results:

A total of 163 patients were included in this study. MRI was done for 77 patients and surgery was performed in 144 cases. Meniscal entrapment was found in 39.9% of all patients. MRI diagnosed meniscus, osteochondral, and non-anterior cruciate ligament ligamentous injury was found in 31.2%, 68.8%, and 32.4% of cases, respectively. Surgically diagnosed meniscus, chondral, and non-anterior cruciate ligament ligamentous injury was found in 34.7%, 33.3%, and 5.6% of patients, respectively.

Conclusions:

TSA fractures are associated with significant risk for concomitant knee injuries including meniscal tear, bone contusion, and chondral injury. Incidence of meniscal entrapment found during surgery was high, in spite of low incidence of positive findings by MRI.

Level of Evidence:

Level IV—retrospective case series.
Collateral Ligament Knee Injuries in Pediatric and Adolescent Athletes
Authors: Kramer Dennis E. , Miller Patricia E. , Berrahou Iman K. , Yen Yi-Meng , Heyworth Benton E.
Published: December 2017

Background:

The majority of research on medial (MCL) and lateral (LCL) collateral ligament injuries has focused on adults and combined collateral/cruciate injuries. The purpose of this study was to determine characteristics associated with isolated collateral ligament injuries in adolescents, and assess timing for return to sports.

Methods:

Electronic medical records were queried to identify patients aged below 17 years who sustained a magnetic resonance imaging–confirmed isolated MCL or LCL injury over an 8-year period. Retrospective review then documented patient and injury characteristics and clinical course. General linear modeling was used to analyze risk factors for prolonged return to sports, continued pain or reinjury.

Results:

Fifty-one knees (33 in males, 65%), mean age 13.8 years (range, 5 to 17), were identified, of which 40 (78%) had MCL injuries. Over half (29, 57%) of knees had an open distal femoral physis including all 5 bony avulsion injuries. Eleven (22%) had LCL injuries of which 3 (6%) had concurrent posterolateral corner injuries. Forty-two (82%) knees had injuries that occurred during sports. Eleven knees (28%) with MCL tears had a simultaneous patellar instability episode. Knee injuries that occurred during sports had 37% shorter recovery time (P=0.02). Eight knees (16%) experienced a reinjury and 12 (24%) were followed over an extended period of time for various knee issues. Football injuries were more likely to be grade 3 (P=0.03), and football and soccer accounted for all grade III injuries. The mean return to sports was 2.2 months, with grade III cases returning at 2.4 months, and 95% of cases within 4 months.

Conclusions:

Isolated collateral ligament injuries are rare in adolescent athletes. MCL injuries, one-quarter of which occurred in conjunction with patellar instability events, were 4 times more common than LCL injuries, one quarter of which have other posterolateral corner structures involved. Grade III injuries represent 20% to 25% of collateral ligament injuries and occurred most commonly in football and soccer.

Level of Evidence:

Level IV—retrospective case series.
Trends in Physician Reimbursement for Spinal Procedures Since 2010
Authors: Meyers Joshua E. , Wang Jiefei , Khan Asham , Davies Jason M. , Pollina John
Published: December 2017

Study Design.

Retrospective cohort study.

Objective.

To identify trends in spinal procedure reimbursement in our practice since 2010.

Summary of Background Data.

In an uncertain healthcare climate with continuous reform, trends in physician reimbursement are unclear. Market forces of supply and demand, legislation imposing penalties for quality measures, local competition, and geographic location have the potential to affect reimbursement. An emphasis on quality-of-care and cost reduction is placed on providers and insurers. In a high-cost area such as spine surgery, it is unknown what the reimbursement trends have been over the last 7 years of major healthcare reforms.

Methods.

We collected payments received data for the 20 most commonly billed Current Procedural Terminology (CPT) codes for spinal surgery from January 2010 to December 2016. Payments were adjusted for inflation using the Consumer Price Index for Medical Care in the Northeastern United States. Insurers were separated into four groups: Medicare, Medicaid, Private Insurance, and Workers Compensation and No Fault (WC/NF). Using a weighted average to adjust for variation in procedures performed, average payments were trended over time. Average payments were trended by insurance group averaged by CPT code.

Results.

After adjusting for inflation, average overall payments for spinal claims from 2010 to 2016 increased 13.6%. Average reimbursement declined 1.9% from 2010 to 2013 and rose 16.8% from 2014 to 2016. Average Medicaid payments increased 150.1% since 2010 whereas average Medicare payments rose 4.9%. Average reimbursement from private insurers and WC/NF claims decreased 16.2% and 8.5%, respectively, from 2010 to 2013; increasing 14.2% and 12.5%, respectively, from 2014 to 2016. From 2010 to 2016, reimbursement for private insurance decreased 9.3% and increased 8.2% for WC/NF claims.

Conclusion.

Since 2010, inflation-adjusted reimbursement for spinal procedures increased in our practice. There was a decline from 2010 to 2013. Increases occurred from 2014 to 2016 across all insurers. Medicaid payments more than doubled since 2010.

Level of Evidence: 3
Analysis of Successful Versus Failed Radiographic Outcomes After Cervical Deformity Surgery
Authors: Protopsaltis Themistocles S. , Ramchandran Subaraman , Hamilton D. Kojo , Sciubba Daniel , Passias Peter G. , Lafage Virginie , Lafage Renaud , Smith Justin S. , Hart Robert A. , Gupta Munish , Burton Douglas , Bess Shay , Shaffrey Christopher , Ames Christopher P.
Published: December 2017

Study Design.

Prospective multicenter cohort study with consecutive enrollment.

Objective.

To evaluate preoperative alignment and surgical factors associated with suboptimal early postoperative radiographic outcomes after surgery for cervical deformity.

Summary of Background Data.

Recent studies have demonstrated correlation between cervical sagittal alignment and patient-reported outcomes. Few studies have explored cervical deformity correction prospectively, and the factors that result in successful versus failed cervical alignment corrections remain unclear.

Methods.

Patients with adult cervical deformity (ACD) included with either cervical kyphosis more than 10°, C2-C7 sagittal vertical axis (cSVA) of more than 4 cm, or chin-brow vertical angle of more than 25°. Patients were categorized into failed outcomes group if cSVA of more than 4 cm or T1 slope and cervical lordosis (TS-CL) of more than 20° at 6 months postoperatively.

Results.

A total of 71 patients with ACD (mean age 62 yr, 56% women, 41% revisions) were included. Fourty-five had primary cervical deformities and 26 at the cervico-thoracic junction. Thirty-three (46.4%) had failed radiographic outcomes by cSVA and 46 (64.7%) by TS-CL. Failure to restore cSVA was associated with worse preoperative C2 pelvic tilt angle (CPT: 64.4° vs. 47.8°, P = 0.01), worse postoperative C2 slope (35.0° vs. 23.8°, P = 0.004), TS-CL (35.2° vs. 24.9°, P = 0.01), CPT (47.9° vs. 28.2°, P < 0.001), “+” Schwab modifiers (P = 0.007), revision surgery (P = 0.05), and failure to address the secondary, thoracolumbar driver of the deformity (P = 0.02). Failure to correct TS-CL was associated with worse preoperative cervical kyphosis (10.4° vs. –2.1°, P = 0.03), CPT (52.6° vs. 39.1°, P = 0.04), worse postoperative C2 slope (30.2° vs. 13.3°, P < 0.001), cervical lordosis (–3.6° vs. –15.1°, P = 0.01), and CPT (37.7° vs. 24.0°, P < 0.001). Multivariate analysis revealed postoperative distal junctional kyphosis associated with suboptimal outcomes by cSVA (odds ratio 0.06, confidence interval 0.01–0.4, P = 0.004) and TS-CL (odds ratio 0.15, confidence interval 0.02–0.97, P = 0.05).

Conclusion.

Factors associated with failure to correct the cSVA included revision surgery, worse preoperative CPT, and concurrent thoracolumbar deformity. Failure to correct the TS-CL mismatch was associated with worse preoperative cervical kyphosis and CPT. Occurrence of early postoperative distal junctional kyphosis significantly affects postoperative radiographic outcomes.

Level of Evidence: 3
The Present State of Neurointensivist Training in the United States: A Comparison to Other Critical Care Training Programs
Authors: Marcolini Evie G. , Seder David B. , Bonomo Jordan B. , Bleck Thomas P. , Hemphill J. Claude , Shutter Lori , Rincon Fred , Timmons Shelly D. , Nyquist Paul
Published: December 2017

Objective:

This manuscript describes the state of neurocritical care fellowship training, compares its written standards to those of other critical care fellowship programs, and discusses how programmatic oversight by the United Council for Neurological Subspecialties should evolve to meet American College of Graduate Medical Education standards. This review is a work product of the Society of Critical Care Medicine Neuroscience section and was reviewed and approved by the Council of the Society of Critical Care Medicine.

Data Sources:

We evaluated the published training criteria and requirements of American College of Graduate Medical Education Critical Care subspecialty fellowships programs of Internal Medicine, Surgery, and Anesthesia and compared them with the training criteria and required competencies for neurocritical care.

Study Selection:

We have reviewed the published training standards from American College of Graduate Medical Education as well as the United Council for Neurologic Subspecialties subspecialty training documents and clarified the definition and responsibilities of an intensivist with reference to the Leapfrog Group, the National Quality Forum, and the Joint Commission.

Data Extraction:

No data at present exist to test the concept of similarity across specialty fellowship critical care training programs.

Data Synthesis:

Neurocritical care training differs in its exposure to clinical entities that are directly associated to other critical care subspecialties. However, the core critical care knowledge, procedural skills, and competencies standards for neurocritical care appears to be similar with some important differences compared with American College of Graduate Medical Education critical care training programs.

Conclusions:

The United Council for Neurologic Subspecialties has developed a directed program development strategy to emulate American College of Graduate Medical Education standards with the goal to have standards that are similar or identical to American College of Graduate Medical Education standards.
Medical bioinformatics in melanoma
Authors: Cheng Phil F.
Published: December 2017

Purpose of review

Bioinformatic insights from next-generation sequencing has been integral in understanding melanoma biology, resistance to treatment and provided new avenues for melanoma treatment. Whole-genome sequencing, whole-exome sequencing and RNA sequencing has redefined the molecular classification of melanoma, revealed distinct genetic aberrations that define clinical subtypes of melanoma and uncovered the diverse heterogeneity that resides in an individual tumor.

Recent findings

In this review, we will summarize the recent whole-genome study that catalogs the genomic landscape across many melanoma subtypes, the single-cell RNA sequencing studies that interrogates tumor heterogeneity and the personalized vaccine approaches to melanoma treatment.

Whole-genome sequencing of diverse subtypes of melanoma revealed acral and mucosal subtypes to have a different genomic landscape compared with cutaneous melanoma. Acral and mucosal melanomas are characterized by low mutation burden and high structural variants. Single-cell RNA sequencing revealed high intratumoral heterogeneity and the existence of rare intrinsic drug-resistant populations. Lastly, vaccination against tumor neoantigens could be a potential personalized medicine therapy for melanoma patients. In summary, bioinformatics research is deeply ingrained in all aspects of melanoma research and will continue to blossom together for many years to come.
Continuing Education Meets the Learning Organization: The Challenge of a Systems Approach to Patient Safety
Authors: Eisenberg John M.
Published: December 2017

Since the release of the report of the Institute of Medicine on medical errors and patient safety in November 1999, health policy makers and health care leaders in several nations have sought solutions that will improve the safety of health care. This attention to patient safety has highlighted the importance of a learning approach and a systems approach to quality measurement and improvement. Balanced with the need for public disclosure of performance, confidential reporting with feedback is one of the prime ways that nations such as the United States, Canada, the United Kingdom, and Australia have approached this challenge. In the United States, the Quality Interagency Coordination Task Force has convened federal agencies that are involved in health care quality improvement for a coordinated initiative. Based on an investment in a strong research foundation in health care quality measurement and improvement, there are eight key lessons for continuing education if it is to parlay the interest in patient safety into enhanced continuing education and quality improvement in learning health care systems. The themes for these lessons are (1) informatics for information, (2) guidelines as learning tools, (3) learning from opinion leaders, (4) learning from the patient, (5) decision support systems, (6) the team learning together, (7) learning organizations, and (8) just-in-time and point-of care delivery.
Faculty Development for Continuing Interprofessional Education and Collaborative Practice
Authors: Silver Ivan l. , Leslie Karen
Published: December 2017

This article proposes a framework for faculty development in continuing interprofessional education (CIPE) and collaborative practice. The framework is built on best practices in faculty development and CIPE. It was informed by local experience in the development, delivery, and evaluation of a faculty development program to promote capacity for dissemination of concepts relating to interprofessional education (IPE) and interprofessional collaboration (IPC) in health care environments. Interprofessional education has been demonstrated in clinical contexts to enhance interprofessional collaboration, patient care, and health outcomes. With curriculum design, teaching methods, and educational strategies in faculty development, it is possible to enhance the impact of IPE in clinical contexts. Faculty development activities themselves can model effective interprofessional education methods and practice. An IPE curriculum and teaching and education strategies are outlined. Strategic planning, including the application of a systems approach, attention to the principles of effective learning, and an outcomes-based curriculum design are recommended for the development of continuing IPE faculty development programs that enhance interprofessional collaboration.
Quantitative assessment of neuropilin-2 as a simple and sensitive diagnostic assay for spitzoid melanocytic lesions
Authors: Eisenstein Anna , Panova Izabela P. , Chung Hye J. , Goldberg Lynne J. , Zhang Qing , Lazova Rossitza , Bhawan Jag , Busam Klaus J. , Symanowski James T. , Alani Rhoda M. , Ryu Byungwoo
Published: December 2017

There is a significant need for the development of diagnostic tools that can precisely distinguish Spitz nevi and spitzoid melanomas. Here, we report the development of a PCR-based quantitative diagnostic assay for spitzoid melanocytic lesions utilizing the expression ratio of neuropilin-2 and melan-A genes in primary tumor specimens. We find that the expression ratio of neuropilin-2/melan-A is significantly increased in spitzoid melanomas compared with Spitz nevi. The diagnostic potential of this quantitative assay was validated in two independent sets of patient samples as demonstrated in a receiver operating characteristic curve analysis showing an area under the curve value of 91.8%. Furthermore, the assay was found to quantitatively distinguish the clinical nature of atypical spitzoid melanocytic lesions that were diagnostically undetermined using histopathologic criteria alone. Our data indicate that this quantitative assay may be used as a tool in determining the diagnostic classification of histologically challenging spitzoid tumors.
The Role of the Faith Community Nurse in Weight Management
Authors: Kelley Sabrina
Published: December 2017

Over two thirds of U.S. adults are overweight or obese; many view long-term behavior change as unachievable. Faith community nurses are ideally positioned to help people learn strategies for successful weight management. This article discusses the role of faith in lifestyle modification, and the use of the 5 A's Model for weight management.
Update
Authors: Washburn Joy
Published: December 2017

Nurses are key people who interact with victims of human trafficking in healthcare and other settings. This article provides a current overview of human trafficking, explains legal definitions, elements for protocols in healthcare settings when trafficking is suspected, nursing roles and responses, interview tools, resources, public health recommendations, and nursing education approaches to address human trafficking.
Associations Between Early Family Meal Environment Quality and Later Well-Being in School-Age Children
Authors: Harbec Marie-Josée , Pagani Linda S.
Published: December 2017

Objective:

Past research suggests a positive link between family meals and child and adolescent health. Although researchers have often relied on how often families eat together, this may not capture the complexity of the experience. Using a birth cohort, this study examines the prospective associations between the environmental quality of the family meal experience at age 6 years and child well-being at age 10.

Methods:

Participants are 1492 children of the Quebec Longitudinal Study of Child Development. When children were age 6, parents reported on their typical family meal environment quality. At age 10, parents, teachers, and children themselves provided information on lifestyle habits, academic achievement, and social adjustment, respectively. The relationship between early family meal environment quality and later child outcomes was analyzed using a series of multivariate linear regression.

Results:

Family meal environment quality at age 6 predicted higher levels of general fitness and lower levels of soft drink consumption, physical aggression, oppositional behavior, nonaggressive delinquency, and reactive aggression at age 10. These relationships were adjusted for child characteristics (sex, temperament problems and cognitive abilities, and baseline body mass index [BMI]) and family characteristics (family configuration and functioning, maternal education, depression, and BMI).

Conclusion:

From a population-health perspective, our findings suggest that family meals have long-term influences on children's biopsychosocial well-being. At a time when family meal frequency is on a natural decline in the population, this environmental characteristic can become a target of home-based interventions and could be featured in information campaigns that aim to optimize child development.
Best-Worst Scaling to Prioritize Outcomes Meaningful to Caregivers of Youth with Mental Health Multimorbidities: A Pilot Study
Authors: Camelo Castillo Wendy , Ross Melissa , Tariq Saad , dosReis Susan
Published: December 2017

Objective:

Health care decision-making for youth with mental health multimorbidity is guided by outcomes that are considered most meaningful and important. The study objective was to pilot test a best-worst scaling (BWS) instrument designed to assess trade-offs among caregiver-defined, meaningful health care outcomes.

Methods:

A BWS was designed with continuous stakeholder involvement to elicit caregiver-defined outcomes in 4 domains: school, behavioral, social, and independence. Four attributes were identified for each outcome domain, for a total of 16 attributes. Using a balanced incomplete block design, a BWS instrument was developed with 16 choice task questions displaying 6 attributes at a time. A convenience sample was selected from Maryland caregivers of children who were 21 years old or younger and had a developmental delay and a comorbid mental health condition. Participants completed a survey that included demographics and the BWS instrument. Conditional logit was used to estimate utility scores and 95% confidence intervals (CI) for each attribute, which were ranked in order of importance. Attribute statements were refined after a respondent debriefing session.

Results:

A total of 38 caregivers participated in the pilot study. Child safety to self was the most important outcome (1.01, CI, 0.78–1.24). This was followed by securing support for an Individualized educational plan in school (0.77, CI, 0.54–1.01) and the child being able to stay in school all day (0.53, CI, 0.29–0.77).

Conclusion:

BWS scenarios that resemble real-life decision-making can be a useful tool to identify preferences for health care outcomes.
Evaluating the Therapeutic Success of Keloids Treated With Cryotherapy and Intralesional Corticosteroids Using Noninvasive Objective Measures
Authors: Schwaiger Hannah , Reinholz Markus , Poetschke Julian , Ruzicka Thomas , Gauglitz Gerd
Published: December 2017

BACKGROUND

Intralesional corticosteroid injections combined with cryotherapy are considered a first-line therapy for keloids. However, objective evaluation on its efficacy is widely missing.

OBJECTIVE

In this study, the authors evaluated the therapeutic benefits of cryotherapy directly followed by intralesional crystalline triamcinolone acetonide injections using ultrasound and a 3D topographic imaging device.

MATERIALS AND METHODS

Fifteen patients with keloids were treated with cryotherapy and intralesional injections of triamcinolone acetonide for a total of 4 times at intervals of 4 weeks. Objective assessment was performed at each visit.

RESULTS

After the last treatment, a significant average reduction of scar volume of 34.3% and an average decrease in scar height of 41.3% as determined by 3D imaging was observed compared with baseline. Ultrasound revealed an average reduction of scar height of 31.7% and an average decrease in tissue penetration depth of 37.8% when compared with baseline measurements.

CONCLUSION

Objective measurements of relevant keloid characteristics as height, volume, and penetration depth help in quantifying the therapeutic effect. The observed results confirm that intralesional injections of crystalline triamcinolone acetonide combined with cryotherapy represent a powerful approach to reduce scar height and volume significantly.
Melanoma of the Face and Mohs Micrographic Surgery: Nationwide Mortality Data Analysis
Authors: Trofymenko Oleksandr , Bordeaux Jeremy S. , Zeitouni Nathalie C.
Published: December 2017

BACKGROUND

Although Mohs micrographic surgery (MMS), narrow margin excision (NME), and wide margin excision (WME) are commonly used to treat melanoma of the face, there is a paucity of data comparing mortality outcomes for each method.

OBJECTIVE

To determine the association between surgical method used to treat cutaneous melanoma of the face and patient survival.

MATERIALS AND METHODS

A retrospective review of Surveillance, Epidemiology, and End Results registries for patients diagnosed with melanoma of the face between 2003 and 2012 was conducted.

RESULTS

The authors query resulted in 43,443 records. Patients with melanoma were more likely to undergo NME (57.79%) than WME (27.86%) or MMS (14.36%). Overall 5-year risk of death was higher with WME (hazard ratio [HR], 1.11; 95% confidence interval [CI], 1.00–1.23; p = .043) and NME (HR, 1.10; 95% CI, 1.00–1.20; p = .046) relative to MMS after adjusting for patient demographics, residence socioeconomic factors, and tumor characteristics. No statistically significant difference in melanoma-specific mortality was found between different surgical methods on multivariate analysis.

CONCLUSION

Patients with melanoma of the face treated with MMS had similar melanoma-specific mortality or overall survival outcome as patients treated by other surgical modalities.
The target invites a foe: antibody–drug conjugates in gynecologic oncology
Authors: Campos Maira P. , Konecny Gottfried E.
Published: December 2017

Purpose of review

Antibody–drug conjugates (ADCs) represent a promising new class of cancer therapeutics. Currently more than 60 ADCs are in clinical development, however, only very few trials focus on gynecologic malignancies. In this review, we summarize the most recent advances in ADC drug development with an emphasis on how this progress relates to patients diagnosed with gynecologic malignancies and breast cancer.

Recent findings

The cytotoxic payloads of the majority of the ADCs that are currently in clinical trials for gynecologic malignancies or breast cancer are auristatins (MMAE, MMAF), maytansinoids (DM1, DM4), calicheamicin, pyrrolobenzodiazepines and SN-38. Both cleavable and noncleavable linkers are currently being investigated in clinical trials. A number of novel target antigens are currently being validated in ongoing clinical trials including folate receptor alpha, mesothelin, CA-125, NaPi2b, NOTCH3, protein tyrosine kinase-like 7, ephrin-A4, TROP2, CEACAM5, and LAMP1. For most ADCs currently in clinical development, dose-limiting toxicities appear to be unrelated to the targeted antigen but more tightly associated with the payload. Rational drug design involving optimization of the antibody, the linker and the conjugation chemistry is aimed at improving the therapeutic index of new ADCs.

Antibody–drug conjugates can increase the efficacy and decrease the toxicity of their payloads in comparison with traditional cyctotoxic agents. A better and quicker translation of recent scientific advances in the field of ADCs into rational clinical trials for patients diagnosed with ovarian, endometrial or cervical cancer could create real improvements in tumor response, survival and quality of life for our patients.
TAMOXIFEN RETINOPATHY DURING TREATMENT OF AN INOPERABLE DESMOID TUMOR
Authors: Furst Meredith , Somogyi Marie B. , Wong Robert W. , Araujo Dejka , Harper Clio A.
Published: December 2017

Purpose:

To evaluate the clinical significance and rarity of tamoxifen retinopathy after a long-term tamoxifen treatment for an inoperable desmoid tumor.

Methods:

Case report.

Results:

Tamoxifen retinopathy is a condition rarely observed in clinical practice. Although tamoxifen is typically a treatment for breast cancer patients, we present a 68-year-old woman taking tamoxifen for an inoperable desmoid tumor, an equally rare condition. She presented with bilaterally deteriorating vision over the course of a year. Fundoscopic examination revealed parafoveal deposits bilaterally. Spectral domain optical coherence tomography exhibited hyperreflective deposits in all layers of the retina. She had a cumulative treatment dose of 292 g of tamoxifen, and the medication was subsequently stopped. Her vision remained stable 3 months after the cessation of tamoxifen.

Conclusion:

The development of tamoxifen retinopathy in the treatment of a desmoid tumor makes this case a rare entity, and this is the first reported case of these two concomitant conditions to our knowledge. With the use of long-term tamoxifen as a primary treatment, we recommend screening at regular intervals by an ophthalmologist as an integral part of treatment.
Neuropathic-Like Ocular Pain and Nonocular Comorbidities Correlate With Dry Eye Symptoms
Authors: Chang Victoria S. , Rose Terri P. , Karp Carol L. , Levitt Roy C. , Sarantopoulos Constantine , Galor Anat
Published: December 2017

Objective:

To evaluate the association between dry eye (DE) symptoms and neuropathic-like ocular pain (NOP) features, chronic pain conditions, depression, and anxiety in patients presenting for routine ophthalmic examinations.

Methods:

Two hundred thirty-three consecutive patients ≥18 years of age presenting to a comprehensive eye clinic between January and August 2016 were included in this study. Information on demographics, chronic pain conditions, medication use, DE symptoms (dry eye questionnaire, DEQ5), NOP complaints (burning; wind, light, and temperature sensitivity), depression, and anxiety indices (patient health questionnaire 9, PHQ-9 and symptom checklist 90-revised, SCL-90-R) were collected for each individual. Pearson correlation was used to evaluate strengths of association. Logistic regression analysis examined risk factors for any (DEQ5≥6) and severe (DEQ5≥12) DE symptoms.

Results:

The mean age of the population was 46.3 years (±13.0); 67.8% (n=158) were female. Per the DEQ5, 40.3% (n=94) had mild or greater DE symptoms and 12% (n=24) had severe symptoms. Severity of DE symptoms correlated with NOP complaints: burning (Pearson r=0.37, P<0.001); sensitivity to wind (r=0.37, P<0.001), sensitivity to light (r=0.34, P<0.001), and sensitivity to temperature (r=0.30, P<0.001). Sex, race, and ethnicity were not significant risk factors for DE symptoms. Risk factors for mild or greater DE symptoms included a greater number of chronic nonocular pain conditions (odds ratio [OR]=1.38, P<0.001), arthritic pain (OR=6.34, P<0.001), back pain (OR=2.47, P=0.004), headaches (OR=2.14, P=0.02), depression (OR=1.17, P<0.001), and anxiety (OR=1.13, P=0.02).

Conclusion:

Dry eye severity positively associated with NOP complaints, comorbid chronic pain conditions, and symptoms of depression and anxiety.
Utility of Novel Autoantibodies in the Diagnosis of Sjögren's Syndrome Among Patients With Dry Eye
Authors: Karakus Sezen , Baer Alan N. , Agrawal Devika , Gurakar Merve , Massof Robert W. , Akpek Esen K.
Published: December 2017

Purpose:

To investigate the value of 3 novel autoantibodies [salivary protein 1 (SP1), carbonic anhydrase 6 (CA6), and parotid secretory protein (PSP)] in differentiating Sjögren's syndrome (SS)-related dry eye from non-SS dry eye.

Methods:

Forty-six dry eye patients with SS (SS dry eye), 14 dry eye patients without SS (non-SS dry eye), and 25 controls were included. The 2012 American College of Rheumatology classification criteria were used for the diagnosis of SS. After a detailed review of systems, the Ocular Surface Disease Index questionnaire, Schirmer test without anesthesia, tear film breakup time, and ocular surface staining were performed to assess dry eye. All participants underwent serological testing using a commercially available finger prick kit.

Results:

Thirty-seven patients with SS (80.4%) had a positive traditional autoantibody and 28 (60.9%) had a positive novel autoantibody. Traditional autoantibodies were absent in all non-SS dry eye patients and controls. Novel autoantibodies were present in 7/14 (50%) non-SS dry eye patients and 4/25 (16%) controls. Among 3 novel autoantibodies, anti-CA6 was significantly more prevalent in the SS and non-SS dry eye groups than in controls (52.2% vs. 42.9% vs. 8.0%, P = 0.001). Dry eye patients with positive anti-CA6 alone were significantly younger than patients with only traditional autoantibodies. Anti-CA6 was associated with worse dry eye signs and symptoms.

Conclusions:

Anti-CA6 was the most prevalent novel autoantibody in patients with dry eye, and was associated with younger age and more severe disease. Longitudinal studies are needed to determine whether anti-CA6 is a marker for early SS or perhaps another form of an autoimmune dry eye disease.