bluuebunny/crossref_metadata_2025 huggingface dataset:
Opportunities for intervention: stroke treatments, disability and mortality in urban Tanzania
Authors: Regenhardt Robert W , Biseko Maijo R , Shayo Agness F , Mmbando Theoflo N , Grundy Sara J , Xu Ai , Saadi Altaf , Wibecan Leah , Kharal G Abbas , Parker Robert , Klein Joshua P , Mateen Farrah J , Okeng’o Kigocha
Published: August 2018

Objective

Given the high post-stroke mortality and disability and paucity of data on the quality of stroke care in Sub-Saharan Africa, we sought to characterize the implementation of stroke-focused treatments and 90-day outcomes of neuroimaging-confirmed stroke patients at the largest referral hospital in Tanzania.

Design

Prospective cohort study.

Setting

Muhimbili National Hospital (MNH) in Dar es Salaam, July 2016–March 2017.

Participants

Adults with new-onset stroke (<14 days), confirmed by head CT, admitted to MNH.

Main outcomes measures

Modified Rankin scale (mRS) and vital status.

Results

Of 149 subjects (mean age 57; 48% female; median NIH stroke scale (NIHSS) 19; 46% ischemic stroke; 54% hemorrhagic), implementation of treatments included: dysphagia screening (80%), deep venous thrombosis prophylaxis (0%), aspirin (83%), antihypertensives (89%) and statins (95%). There was limited ability to detect atrial fibrillation and carotid artery disease and no acute thrombolysis or thrombectomy. Of ischemic subjects, 19% died and 56% had severe disability (mRS 4–5) at discharge; 49% died by 90 days. Of hemorrhagic subjects, 33% died and 49% had severe disability at discharge; 50% died by 90 days. In a multivariable model, higher NIHSS score but not dysphagia, unconsciousness, or patient age was predictive of death by 90 days.

Conclusions

The 90-day mortality of stroke presenting at MNH is 50%, much higher than in higher income settings. Although severe stroke presentations are a major factor, efforts to improve the quality of care and prevent complications of stroke are urgently needed. Acute stroke interventions with low number needed to treat represent challenging long-term goals.
Frequent Diagnostic Under-Grading in Isocitrate Dehydrogenase Wild-Type Gliomas due to Small Pathological Tissue Samples
Authors: Gutt-Will Marielena , Murek Michael , Schwarz Christa , Hewer Ekkehard , Vulcu Sonja , Beck Jürgen , Raabe Andreas , Schucht Philippe
Published: August 2018

BACKGROUND

In contrast to isocitrate dehydrogenase (IDH) mutation analysis, which is homogenous within a given tumor, diagnostic errors in histological analysis following the 2016 World Health Organization (WHO) classification could be due to small samples because of histological heterogeneity.

OBJECTIVE

To assess whether the sample size sent to histopathology influences the tumor grading in IDH wild-type gliomas.

METHODS

Histologically diagnosed WHO grade, sample volume, and preoperative tumor volume data of 111 patients aged who received resection of IDHwt gliomas between January 2007 and December 2015 at our hospital were evaluated. The differences between absolute and relative pathological sample sizes stratified by WHO grade were conducted using One-Way-Permutation-Test.

RESULTS

With a mean sample size of 10.9 cc, 83.8% of patients were histologically diagnosed as WHO grade IV, while 16.2% of patients with a mean sample size of 2.62 cc were diagnosed as WHO grade II/III. One-Way-Permutation-Test showed a significant difference between absolute tissue samples stratified by WHO grade (P = .0374). The distribution of preoperative tumor volumes with WHO grade IV vs WHO grade II/III showed no significant difference (P = .8587). Of all tumors with a sample size >10 cc 100% were pathologically diagnosed as WHO grade IV and those with sample size >5 cc 93.5% were diagnosed as WHO grade IV.

CONCLUSION

Small sample sizes are associated with a higher risk of under-estimating malignancy in histological grading in IDHwt gliomas. This study suggests a standard minimum sample size (>5cc) in every resection. Modalities of adjuvant treatment for IDHwt, WHO grade II/III gliomas need to reflect a prognosis that is only marginally better than of a glioblastoma.
Resting-state Functional Magnetic Resonance Imaging Identifies Cerebrovascular Reactivity Impairment in Patients With Arterial Occlusive Diseases: A Pilot Study
Authors: Nishida Sei , Aso Toshihiko , Takaya Shigetoshi , Takahashi Yuki , Kikuchi Takayuki , Funaki Takeshi , Yoshida Kazumichi , Okada Tomohisa , Kunieda Takeharu , Togashi Kaori , Fukuyama Hidenao , Miyamoto Susumu
Published: August 2018

BACKGROUND

The development of noninvasive approaches for identifying hypoperfused brain tissue at risk is of major interest. Recently, the temporal-shift (TS) maps estimated from resting-state blood oxygenation level-dependent (BOLD) signals have been proposed for determining hemodynamic state.

OBJECTIVE

To examine the equivalency of the TS map and the cerebrovascular reactivity (CVR) map derived from acetazolamide-challenged single-photon emission computed tomography (SPECT) in identifying hemodynamic impairment in patients with arterial occlusive diseases.

METHODS

Twenty-three patients with arterial occlusive diseases who underwent SPECT were studied. With a recursive TS analysis of low-frequency fluctuation of the BOLD signal, a TS map relative to the global signal was created for each patient. The voxel-by-voxel correlation coefficient was calculated to examine the image similarity between TS and SPECT-based cerebral blood flow (CBF) or CVR maps in each patient. Furthermore, simple linear regression analyses were performed to examine the quantitative relationship between the TS of BOLD signals and CVR in each cerebrovascular territory.

RESULTS

The within-patient, voxel-by-voxel comparison revealed that the TS map was more closely correlated with SPECT-CVR map ([Z(r)] = 0.42 ± 0.18) than SPECT-CBF map ([Z(r)] = 0.058 ± 0.11; P < .001, paired t-test). The regression analysis showed a significant linear association between the TS of BOLD signals and CVR in the anterior circulation where the reduction of CVR was evident in the patient group.

CONCLUSION

BOLD TS analysis has potential as a noninvasive alternative to current methods based on CVR for identification of tissue at risk of ischemic stroke.
Baseline Sensitivity of Penicillium spp. to Difenoconazole
Authors: Jurick Wayne M. , Macarisin Otilia , Gaskins Verneta L. , Janisiewicz Wojciech J. , Peter Kari A. , Cox Kerik D.
Published: August 2018

Penicillium spp. cause blue mold of stored pome fruit. These fungi reduce fruit quality and produce mycotoxins that are regulated for processed fruit products. Control of blue mold is achieved by fungicide application, and in 2015 Academy (active ingredients fludioxonil and difenoconazole) was released for use on pome fruit to manage postharvest blue mold. Baseline sensitivity for fludioxonil but not difenoconazole has been determined for P. expansum. To establish the distribution of sensitivity to difenoconazole before commercial use of Academy, 97 unexposed single-spore isolates from the United States and abroad were tested in vitro. Baseline EC50 values ranged from 0.038 to 0.827 µg/ml of difenoconazole with an average of 0.16 µg/ml. Complete inhibition of mycelial growth for all but three isolates occurred at 5 µg/ml of difenoconazole, whereas 10 µg/ml did not support growth for any of the isolates examined. Hence, 5 µg/ml of difenoconazole is recommended for phenotyping Penicillium spp. isolates with reduced sensitivity. Isolates with resistance to pyrimethanil and to both thiabendazole and pyrimethanil were observed among the isolates from the baseline collection. Academy applied at the labeled rate had both curative and protectant activities and controlled four representative Penicillium spp. from the baseline population. This information can be used to monitor future shifts in sensitivity to this new postharvest fungicide in Penicillium spp. populations.
First Report of Resistance to Boscalid in Podosphaera xanthii, Cucurbit Powdery Mildew, in South Carolina
Authors: Keinath Anthony P. , Rennberger Gabriel , Kousik Chandrasekar S.
Published: August 2018

Resistance to boscalid, one of the older succinate-dehydrogenase inhibitors (SHDI) in Fungicide Resistance Action Committee (FRAC) code 7, was detected in Podosphaera xanthii, the cucurbit powdery mildew fungus, in South Carolina in July 2017. Resistance to the field rate (682 ppm) of boscalid was confirmed in greenhouse experiments and laboratory bioassays conducted on summer squash plants and cotyledons, respectively, that had been treated with a range of boscalid concentrations. This report is the first documentation of resistance to boscalid in P. xanthii in the southern United States.
Two intrauterine programming mechanisms of adult hypercholesterolemia induced by prenatal nicotine exposure in male offspring rats
Authors: Zhou Jin , Zhu Chunyan , Luo Hanwen , Shen Lang , Gong Jun , Wu Yimeng , Magdalou Jacques , Chen Liaobin , Guo Yu , Wang Hui
Published: August 2018

Epidemiologic studies showed that low birth weight is associated with high cholesterol and an increased risk of cardiovascular diseases in adulthood. This study aimed to elucidate the intrauterine programming mechanisms of adult hypercholesterolemia. The results showed that prenatal nicotine exposure (PNE) caused intrauterine growth retardation and hypercholesterolemia in male adult offspring rats. Hepatic cholesterol synthesis and output were deceased in utero but increased in adults; hepatic reverse cholesterol transport (RCT) persistently deceased before and after birth. Meanwhile, PNE elevated serum corticosterone level and decreased hepatic IGF1 pathway activity in male fetuses, whereas converse changes were observed in male adults. The chronic stress model and cortisol‐treated HepG2 cells verified that excessive glucocorticoid (GC)‐induced GC‐IGF1 axis programming enhanced hepatic cholesterol synthesis and output. In addition, PNE decreased the expression of specific protein 1 and P300 enrichment and H3K27 acetylation at the promoter region of genes responsible for RCT both in fetal and adult, male livers and reduced expression of those genes, similar alterations were also confirmed in cortisol‐treated HepG2 cells, suggesting that excessive GC‐related programming induced continuous RCT reduction by epigenetic modification. Taken together, the “2‐programming” approach discussed above may ultimately contribute to the development of hypercholesterolemia in male adult offspring.—Zhou, J., Zhu, C., Luo, H., Shen, L., Gong, J., Wu, Y., Magdalou, J., Chen, L., Guo, Y., Wang, H. Two intrauterine programming mechanisms of adult hypercholesterolemia induced by prenatal nicotine exposure in male offspring rats. FASEB J. 33, 1110–1123 (2019). www.fasebj.org
Stabilization of p27Kip1/CDKN1B by UBCH7/UBE2L3 catalyzed ubiquitinylation: a new paradigm in cell‐cycle control
Authors: Whitcomb Elizabeth A. , Tsai Yien Che , Basappa Johnvesly , Liu Ke , le Feuvre Aurélie K. , Weissman Allan M. , Taylor Allen
Published: August 2018

Ubiquitinylation drives many cellular processes by targeting proteins for proteasomal degradation. Ubiquitin conjugation enzymes promote ubiquitinylation and, thus, degradation of protein substrates. Ubiquitinylation is a well‐known posttranslational modification controlling cell‐cycle transitions and levels or/and activation levels of ubiquitin‐conjugating enzymes change during development and cell cycle. Progression through the cell cycle is tightly controlled by CDK inhibitors such as p27Kip1. Here we show that, in contrast to promoting its degradation, the ubiquitin‐conjugating enzyme UBCH7/UBE2L3 specifically protects p27Kip1 from degradation. Overexpression of UBCH7/UBE2L3 stabilizes p27Kip1 and delays the G1‐to‐S transition, while depletion of UBCH7/UBE2L3 increases turnover of p27Kip1. Levels of p21Cip1/Waf1, p57Kip2, cyclin A and cyclin E, all of which are also involved in regulating the G1/S transition are not affected by UBCH7/UBE2L3 depletion. The effect of UBCH7/UBE2L3 on p27Kip1 is not due to alteration of the levels of any of the ubiquitin ligases known to ubiquitinylate p27Kip1. Rather, UBCH7/UBE2L3 catalyzes the conjugation of heterotypic ubiquitin chains on p27Kip1 that are proteolytically incompetent. These data reveal new controls and concepts about the ubiquitin proteasome system in which a ubiquitin‐conjugating enzyme selectively inhibits and may even protect, rather than promote degradation of a crucial cell‐cycle regulatory molecule.—Whitcomb, E. A., Tsai, Y. C., Basappa, J., Liu, K., le Feuvre, A. K., Weissman, A.M., Taylor, A. Stabilization of p27Kip1/CDKN1B by UBCH7/UBE2L3 catalyzed ubiquitinylation: a new paradigm in cell‐cycle control. FASEB J. 33, 1235–1247 (2019). www.fasebj.org
Validation of the Dutch-Flemish PROMIS Pain Interference Item Bank in Patients With Musculoskeletal Complaints
Authors: Schuller Wouter , Terwee Caroline B. , Klausch Thomas , Roorda Leo D. , Rohrich Daphne C. , Ostelo Raymond W. , Terluin Berend , de Vet Henrica C.W.
Published: August 2018

Study Design.

A cross-sectional study.

Objective.

The aim of this study was to validate the Dutch-Flemish PROMIS Pain Interference item bank in patients with musculoskeletal complaints.

Summary of Background Data.

PROMIS item banks have been developed and validated in the US. They need to be further validated in various patient populations and in different languages.

Methods.

One thousand six hundred seventy-seven patients answered the full item bank. A Graded Response Model (GRM) was used to study dimensionality with confirmatory factor analyses and by assessing local independency. Monotonicity was evaluated with Mokken scaling. An Item Response Theory (IRT) model was used to study item fit and to estimate slope and threshold parameters. Differential item functioning (DIF) for language, age, and gender was assessed using ordinal logistic regression analyses. DIF for language was evaluated by comparing our data with a similar US sample. Hypotheses concerning construct validity were tested by correlating item bank-scores with scores on several legacy instruments.

Results.

The GRM showed suboptimal evidence of unidimensionality in confirmatory factor analysis [Comparative Fit Index (CFI): 0.903, Tucker-Lewis Index (TLI): 0.897, Root Mean Square Error of Approximation (RMSEA): 0.144], and 99 item pairs with local dependence. A bifactor model showed good fit (CFI: 0.964, TLI: 0.961, RMSEA: 0.089), with a high Omega-H (0.97), a high explained common variance (ECV: 0.81), and no local dependence. Sufficient monotonicity was shown for all items (Mokken H(i): 0.367–0.686). The unidimensional IRT model showed good fit (only two items with S-X2 < 0.001), with slope parameters ranging from 1.00 to 4.27, and threshold parameters ranging from −1.77 to 3.66. None of the items showed DIF for age or gender. One item showed DIF for language. Correlations with legacy instruments were high (Pearson R: 0.53–0.75), supporting construct validity.

Conclusion.

The high omega-H and the high ECV indicate that the item bank could be considered essentially unidimensional. The item bank showed good item fit, good coverage of the pain interference trait, and good construct validity.

Level of Evidence: N/A
Vulnerability to the Cardiovascular Effects of Ambient Heat in Six US Cities
Authors: Gronlund Carina J. , Sheppard Lianne , Adar Sara D. , O’Neill Marie S. , Auchincloss Amy , Madrigano Jaime , Kaufman Joel , Diez Roux Ana V.
Published: August 2018

Background:

With climate change, temperatures are increasing. Heat-associated health events disproportionately affect certain subpopulations. However, prior research has often lacked information on individual-level health and air conditioning and neighborhood stressors/protections.

Objectives:

To assess whether (1) heat (2-day mean temperature above local 75th percentiles) is associated with increased heart rate and decreased blood pressure, controlling for age, time, season, daily ozone, and daily particulate matter (PM2.5) and (2) associations differ by antihypertensive medication use, renal function, fasting glucose, emotional support, air conditioning ownership and use, normalized difference vegetation index, neighborhood safety, and residence- specific oxides of nitrogen and PM2.5.

Methods:

Health and behavioral characteristics were obtained repeatedly on participants of the Multi-Ethnic Study of Atherosclerosis in six US sites (2000–2010). These were linked with airport temperature, air quality, and satellite- and survey-derived neighborhood characteristics. We used a fixed-effects design, regressing health outcomes on linear temperature splines with knots at the 75th percentiles, interaction terms for each characteristic, and adjustment for month of year, age, PM2.5, and ozone.

Results:

Overall, heat was not associated with heart rate. However, for a 2°C increase in heat, systolic blood pressure decreased by 1.1 mmHg (95% CI = −1.6, −0.6) and diastolic blood pressure by 0.3 mmHg (95% CI = −0.6, −0.1). Among nonusers of antihypertensive medications, heat-associated decreases in SBP were 2.1 mmHg greater among individuals with central air conditioning versus those without. Confidence intervals around the remaining modifiers were wide after multiple-comparisons corrections or sensitivity analyses.

Conclusions:

Outdoor heat is associated with decreasing blood pressure, and cardiovascular vulnerability may vary primarily by ownership of central air conditioning.
Estimating Life Expectancy From Chinese Medicine Could Improve End-of-Life Care in Terminally Ill Cancer Patients
Authors: Shih Ya-Lan , Hsu Yu-Ching , Chiu Wei-Hsin , Chao Co-Shi Chantal
Published: August 2018

Preparing for a good death is an important and meaningful concept in Chinese culture because people hope to know residual life to make effort for their unfinished business. However, the family of terminally ill patients with cancer may be annoyed and frustrated about unexpected bereavement if they have unresolved conflicts with the loved one, missing a chance for declaring love, untimely apologizing and saying goodbye. The study aimed to explore this difficult issue. The medical records of 121 deceased terminally ill patients with cancer at National Cheng Kung University Hospital between December 2010 and February 2012 were reviewed. The signs and awareness of dying among these patients were collected using palliative routine instruments in the hospice ward. The top 3 most prevalent dying signs were coolness and cyanosis (prevalence 98.3%, median period from the first documented dying sign to death 2 days, P = .028), mirror-like tongue (prevalence 94.2%, median period 5 days, P = .007), and earlobe crease (prevalence 93.4%, median period 4 days, P = .052). In addition, the prevalence of dying awareness was 71.1% (median period 4 days, P = .001). Furthermore, terminal agitation was identified more frequently in terminally ill patients with hepatoma and colon cancer (adjusted odds ratio = 3.240, P = .043), but turbid sclera with edema was noted more often in terminally ill patients with head and neck cancer (adjusted odds ratio = 5.698, P = .042). The results provide evidence to support clinical practice, offering knowledge and techniques to health care providers, and increasing quality of life for terminally ill patients with cancer.
Survey to Assess Interest in a Mindfulness Intervention at a Midwifery and Women's Health Clinic
Authors: Haslam Alyson , Salm Ward Trina , Wagner Robb Sara
Published: August 2018

We conducted a voluntary survey among ethnically and socioeconomically diverse women. About half of the respondents reported experiencing at least one health issue; over half were interested in attending a mindfulness class to reduce stress. Our study suggests interest in participating in a mindfulness intervention, primarily among those with more health issues.
Exploring Cultural Health Practices at a Midwestern University
Authors: Hritz Sue L. , Wang Ya-Fen , Akkarawongvisit Chutarat
Published: August 2018

This study investigated complementary health practices (CHPs) at a Midwestern state university to examine regional usage rates. Study results demonstrated a high use of CHPs as compared with national studies, supporting significance of incorporating CHPs in the nursing curriculum to ensure culturally competent and safe care for all populations.
SUPRACHOROIDAL INJECTION OF TRIAMCINOLONE ACETONIDE, CLS-TA, FOR MACULAR EDEMA DUE TO NONINFECTIOUS UVEITIS
Authors: Yeh Steven , Kurup Shree K. , Wang Robert C. , Foster C. Stephen , Noronha Glenn , Nguyen Quan Dong , Do Diana V. ,   for the DOGWOOD Study Team
Published: August 2018

Purpose:

Evaluate a single suprachoroidal injection of a proprietary triamcinolone acetonide suspension, CLS-TA, in subjects with macular edema due to noninfectious uveitis.

Methods:

Randomized, controlled, masked Phase 2 study. Safety and efficacy of a single suprachoroidal injection of CLS-TA (4.0 and 0.8 mg in a 4:1 ratio) were assessed at 1 and 2 months after injection. The primary efficacy endpoint was change in central subfield thickness from baseline to Month 2, assessed by spectral domain optical coherence tomography.

Results:

Twenty-two adults were enrolled. The primary endpoint was met in subjects who received suprachoroidal injection of CLS-TA 4.0 mg, mean central subfield thickness significantly decreased from baseline by 135 µm and 164 µm at Month 1 (P = 0.0056) and Month 2 (P = 0.0017), respectively. At Month 2, 69% of subjects who received 4.0 mg experienced ≥20% reduction in central subfield thickness, and 65% had improvement of best-corrected visual acuity of ≥5 Early Treatment Diabetic Retinopathy Study letters, with a mean improvement of 9.2 letters (P = 0.0004). Safety analyses supported acceptable safety/tolerability, with no corticosteroid-related increases in intraocular pressure.

Conclusion:

A single suprachoroidal injection of CLS-TA (4.0 mg; 0.1 mL) in subjects with macular edema due to noninfectious uveitis was well-tolerated, significantly reduced central subfield thickness from baseline at 2 months, and significantly improved visual acuity.
Single-Stage Total Arch Replacement with Open Stent Graft for Kommerell's Diverticulum with Right-Sided Aortic Arch
Authors: Horikawa Kohei , Nishi Hiroyuki , Sekiya Naosumi , Yamada Mitsutomo , Takahashi Toshiki
Published: August 2018

We treated a 70-year-old patient with Kommerell's diverticulum associated with an aberrant left subclavian artery and right aortic arch using single-stage total arch replacement with a commercially available open stent graft through only a median sternotomy. A four-branched prosthetic graft was implanted after insertion of the open stent graft through the anastomotic site under moderate hypothermia and cardiopulmonary bypass with selective cerebral perfusion. The aberrant subclavian artery was occluded by coil embolization from the distal site and anatomically reconstructed from the prosthetic graft. This approach is safe and effective and allows avoidance of a right thoracotomy and second stage intervention.
Tolerance of Oral Opioid Medication After Surgery for Ruptured Appendicitis in Pediatric Patients
Authors: Wilson-Kocovsky Kathleen , Sudar Kimberly
Published: August 2018

Introduction:

Each year, numerous children undergo surgery and require oral opioids during their postoperative recovery. Little is known about when children who have been on a nothing-by-mouth diet after surgery can tolerate oral opioids. Although oral opioids offer advantages over the intravenous route, healthcare professionals have differing opinions regarding how much oral intake (liquids or solids) a patient needs to tolerate before starting oral opioids. This could lead to inconsistencies in practice, which could impact patients' comfort, length of stay, and, ultimately, healthcare costs. The primary purpose of this study was to identify current practice regarding initiation of oral opioids in pediatric patients recovering from an appendectomy for ruptured appendicitis. On the basis of this data, our team aimed to provide a best practice recommendation for this population.

Methods:

A retrospective chart review was conducted from a sample of 43 children recovering from an appendectomy secondary to ruptured appendicitis. Data included time from surgery to ingestion of clear liquids, administration of oral opioids, and occurrence of emesis in relation to either of these administrations.

Results:

Children received from 30 ml to an average of 354 ml of clear liquids before taking oral opioids, and no patients had emesis documented regardless of the volume of clear liquids they ingested before administration of oral opioids.

Discussion:

Results suggest that pediatric patients may be able to tolerate oral opioids regardless of the amount of clear liquids they tolerate beforehand. Although more studies are needed to support these results, such results could mean earlier transition from intravenous to oral opioids, which could decrease healthcare costs and potentially decrease length of stay.
Incidence of Combat Sport-Related Mild Traumatic Brain Injuries Presenting to the Emergency Department From 2012 to 2016
Authors: Lemme Nicholas J. , Johnston Benjamin , DeFroda Steven F. , Owens Brett D. , Kriz Peter K.
Published: August 2018

Objectives:

We sought to investigate the incidence and characteristics of traumatic brain injuries [mild traumatic brain injury (MTBI)] presenting to the emergency department as a result of boxing, wrestling, and martial arts (MA).

Design:

Retrospective cross-sectional study of MTBI in combat sport athletes who were evaluated in emergency departments in the United States.

Setting:

Patient data were taken from the National Electronic Injury Surveillance System.

Participants:

All patients with MTBI from 2012 to 2016, which occurred during participation in boxing, MA, or wrestling.

Interventions:

None.

Main Outcome Measures:

The incidence of combat sport-related MTBI presenting to emergency departments in the United States.

Results:

The mean annual incidence of MTBI due to wrestling was significantly larger (269.3 per 100 000 person-years) than boxing (85.6 per 100 000 person-years) and MA (61.0 per 100 000 person-years) (P< 0.01). The average age at injury was significantly lower for wrestling compared with boxing and MA (15.0 years [SD ± 3.9] vs 21.7 years [SD ± 8.2] vs 19.9 years [SD ± 10.5];P< 0.01). A significantly larger proportion of MTBIs (95.3%;P< 0.01) in patients younger than 20 years were related to wrestling, compared with boxing (55.8%) and MA (54.1%). Most patients with combat sport-related MTBIs were treated and discharged (96.3%), with only 1.7% of patients being admitted and 0.6% of patients being held for observation.

Conclusion:

Combat sports athletes are at high risk of sustaining an MTBI. Such athletes presenting to the emergency department for combat sport-related MTBI were more likely to be male and younger than 20 years. Of these athletes, wrestlers experience the highest incidence of MTBI-related emergency department visits.
Evaluation of Muscle Injuries in Professional Football Players: Does Coach Replacement Affect the Injury Rate?
Authors: Dönmez Gürhan , Kudaş Savaş , Yörübulut Mehmet , Yıldırım Murat , Babayeva Naila , Torgutalp Şerife Şeyma
Published: August 2018

Objectives:

To assess the incidence and characteristics of muscle injuries in professional football players and to assess if coach dismissal may be related with muscle injuries within 1-month period from the dismissal.

Design:

Prospective cohort study during 3 consecutive seasons.

Setting:

Turkish Super League football teams.

Participants:

One hundred eighteen male football players.

Main Outcome Measures:

Data on time-loss muscle injuries confirmed using magnetic resonance imaging were recorded, including type, body part, duration, and lay-off time, and training session and match exposure times. The muscle injury rate was evaluated at 2 weeks and 30 days after coach dismissal.

Results:

In total, 124 muscle injuries were recorded, with injury incidences of 2.3 muscle injuries per 1000 hours of exposure overall, 1.2 in training sessions, and 13.6 in matches. Injury time loss ranged from 3 to 67 days (median, 13 days). Eighteen percent of the injuries (n = 23) were recurrent; no association was found between recurrence rate and the player's age or position (P = 0.15, P = 0.27, respectively). Recurrent injuries caused more severe injuries (26.1%, P = 0.02) and longer median lay-off time (P = 0.01). During the study, teams A and B replaced 7 and 3 coaches, respectively. The injury incidence increased to 5.3 per 1000 hours of exposure in the 2 weeks after the coach dismissal, and decreased to 4.5 within 1 month of coach dismissal.

Conclusion:

Given the link between coach dismissal and increased rates of muscle strain injuries, increased attentiveness to preventing muscle injuries during coaching transitions and to the impact of new training regimens is required by trainers and medical teams.
The impact of interprofessional education on family nurse practitioner students' and family medicine residents' knowledge and confidence in screening for breast and cervical cancer
Authors: Weston Cindy , Akinlotan Marvellous , Lichorad Anna , McClellan David , Helduser Janet , Ojinnaka Chinedum , Holland Benny , Bolin Jane N.
Published: August 2018

Background and Purpose:

This study determined the impact of an interprofessional education (IPE) simulation on family nurse practitioner (FNP) students' and family medicine residents' (FMRs) self-reported confidence in counseling women reluctant to engage in cancer screening or evaluation and assessed knowledge of breast and cervical cancer risk factors.

Method:

A multi-item knowledge survey on breast and cervical cancer risk factors was administered to 76 FNP students and FMRs followed by an IPE simulation with a pre-/postsurvey of self-reported confidence in counseling a woman reluctant to have breast and cervical cancer screening and evaluation.

Discussion:

Data demonstrated knowledge deficits in breast and cervical cancer risk factors in both disciplines with the average risk factor knowledge score of 8.5/12 for breast cancer and 7.8/12 for cervical cancer. Following IPE simulation, confidence in counseling women reluctant to have breast or cervical cancer screening improved across both disciplines (p < .05) and debrief feedback findings suggest improved attitudes toward collegiality, communication, and understanding of other interprofessional roles among both disciplines.

Conclusion:

Knowledge gaps exist among both FNP students and FMRs in breast and cervical cancer risk factors. This study suggests IPE simulation is effective in building individual provider confidence and team collegiality.
Nurse practitioners' time on nonbillable activities
Authors: Kippenbrock Thomas , Lo Wen-Juo , Emory Jan , Buron Bill , Odell Ellen , Reimers Jennifer
Published: August 2018

Background and purpose:

During the provision of patient care delivery, all providers, including nurse practitioners (NPs), spend some time in activities that are not reimbursable. Understanding these nonbillable activities is crucial to the economic viability and success of existing and projected practice models. This study explored and compared seven nonbillable activities occurring in the practices of NPs in various settings.

Methods:

Using a nonexperimental, descriptive design, 509 NPs were surveyed about nonbillable activities encountered in daily practice. Binomial regression analyses and incidence rate ratios were used to interpret relationships between each variable and nonbillable time.

Conclusions:

Although not every variable had significance, there were significant differences found in the amount of time spent in certain nonbillable activities depending on workplace setting, number of support staff, and primary care provider role.

Implications for practice:

The uncertainty of health care reform, including reimbursement, provider shortage, and the expanding roles of NPs, requires a closer look at both billable and nonbillable care activities. Understanding how nonbillable time affects work efficiency, costs, and the value of NPs will allow NPs to influence future health care reimbursement policies and delivery care models.
Acute Otitis Media and Associated Complications in United States Emergency Departments
Authors: Ren Yin , Sethi Rosh K. V. , Stankovic Konstantina M.
Published: August 2018

Objective:

Complications due to acute otitis media (AOM), while rare, are associated with significant morbidity and are not well characterized from an epidemiological perspective. We analyze the pattern of presentation and emergency department (ED) utilization in patients with AOM and associated complications.

Study Design:

Retrospective analysis of the Nationwide Emergency Department Sample (NEDS) from 2009 to 2011.

Setting:

Emergency Department.

Patients:

Patients who presented with a primary diagnosis of AOM or acute mastoiditis.

Intervention:

Diagnostic.

Main Outcome Measures:

NEDS was queried for patient encounters with a diagnosis of AOM or acute mastoiditis based on ICD-9 codes. Complications of severe infection, including petrositis, Gradenigo's syndrome, facial paresis, labyrinthitis, meningitis, intracranial abscess, venous sinus thrombosis, and cerebrospinal fluid leak, were assessed. Weighted estimates for demographics, types of complications, socioeconomic status, and trends over time were extracted.

Results:

A weighted total of 5,811,127 ED visits were identified. The majority of patients were less than 18 years old (79.9%) with an average age of 10.1 years. Most were discharged (99.4%). There were 15,243 (0.26%) patients who presented with a complication. The most common complications were acute mastoiditis (0.16%), labyrinthitis (0.06%), and facial paresis (0.03%). Compared with patients with uncomplicated AOM, patients with complicated AOM were older (37 vs. 10-yr old), insured by Medicare (18% vs. 2.1%), and more likely to be admitted (43.6% vs. 0.4%) (p < 0.0001, for all comparisons).

Conclusions:

ED visits related to AOM or mastoiditis are common and complications are rare. An in-depth analysis on a national level is useful for assessing healthcare utilization trends.
Analysis of survival and prognostic factors in treatment of hepatocellular carcinoma in Spanish patients with drug-eluting bead transarterial chemoembolization
Authors: Sánchez-Delgado Jordi , Vergara Mercedes , Machlab Salvador , Lira Alba , Gómez Zaragoza Carlos , Criado Eva , Rosinach Mercè , Batista Lissette , Arau Beatriz , Roget Mercè , Ortiz Jordi , Garcia Caridad , Sort Pau , Casas Meritxell , Dalmau Blai , Forné Montserrat , Falcó Joan , Miquel Mireia
Published: August 2018

Background and aim

Drug-eluting bead transarterial chemoembolization (DEB-TACE) improves the survival of patients with hepatocellular carcinoma (HCC), intermediate stage [i.e. Barcelona Clinic Liver Cancer-B (BCLC-B)]. The aim of our study was to analyse the overall survival (OS) and prognostic factors of patients with HCC treated with DEB-TACE.

Patients and methods

Patients’ clinical course was recorded from January 2005 to July 2014. The median OS was obtained by the Kaplan–Meier method and compared using the log-rank test. The prognosis factors associated with OS were determined by a multivariate Cox regression analysis and the accuracy of the OS prediction was determined by calculation of the assessment for retreatment with TACE score (ART score).

Results

A cohort of 147 consecutive patients treated with DEB-TACE was included. Median age of the patients was 73.4 years. Overall, 68.7% were men, and all had cirrhosis, with 68.8% being hepatisis C virus positive. Moreover, 35.2% were staged as BCLC-A and 60.2% as BCLC-B. After a median follow-up of 19.2 months, 29.3% were alive, 4.3% needed treatment with sorafenib and 56.1% underwent DEB-TACE retreatment. Median OS was 22.8 [95% confidence interval (CI)=19.6–25.9]. After censoring for ascites and more than one nodule, OS was 23.87 (95% CI =20.72–27.01) and 26.89 (95% CI =21.00–32.78), respectively. The risk of death decreased by 22.3% with the number of DEB-TACE sessions (hazard ratio=0.777) and increased by 25.9% with higher Child–Pugh score (hazard ratio=1.259). Overall, 61.2% of the cohort had an ART score between 0 and 1.5. There were no statistical differences in OS between cohort groups with ART of 0–1.5 and at least 2.5.

Conclusion

The results validate the efficacy and safety of DEB-TACE in patients with HCC and the importance of some prognostic factors for patient survival.
Acute Pancreatitis in Chronic Dialysis Patients
Authors: Barbara Mary , Tsen Adrianne , Rosenkranz Laura
Published: August 2018

The annual incidence of acute pancreatitis (AP) ranges from 4.9 to 73.4 cases per 100,000 worldwide. Patients with end-stage renal disease on dialysis have an increased risk for developing AP compared with patients without renal disease. In addition to the general population risk factors, there are factors related to renal insufficiency and dialysis process that might predispose to AP in this population. Clinical features and diagnosis are the same as those in patients without renal failure; however, amylase and lipase levels should be interpreted cautiously as they might be falsely elevated in renal failure. In this article, we will describe the risk factors that are exclusive to this population. In addition, we will also focus on the laboratory indices and clinical features that are unique to this population with patients with end-stage renal disease.
Germline Variants and Risk for Pancreatic Cancer
Authors: Zhan Wei , Shelton Celeste A. , Greer Phil J. , Brand Randall E. , Whitcomb David C.
Published: August 2018

Pancreatic cancer requires many genetic mutations. Combinations of underlying germline variants and environmental factors may increase the risk of cancer and accelerate the oncogenic process. We systematically reviewed, annotated, and classified previously reported pancreatic cancer–associated germline variants in established risk genes. Variants were scored using multiple criteria and binned by evidence for pathogenicity, then annotated with published functional studies and associated biological systems/pathways. Twenty-two previously identified pancreatic cancer risk genes and 337 germline variants were identified from 97 informative studies that met our inclusion criteria. Fifteen of these genes contained 66 variants predicted to be pathogenic (APC,ATM,BRCA1,BRCA2,CDKN2A,CFTR,CHEK2,MLH1,MSH2,NBN,PALB2,PALLD,PRSS1,SPINK1,TP53). Pancreatic cancer risk genes were organized into key biological mechanisms that promote pancreatic oncogenesis within an oncogenic model. Development of precision medicine approaches requires updated variant information within the framework of an oncogenic progression model. Complex risk modeling may improve interpretation of early biomarkers and guide pathway-specific treatment for pancreatic cancer in the future. Precision medicine is within reach.
Use of Breast Milk and Other Feeding Practices Following Gastrointestinal Surgery in Infants
Authors: Varma Sanskriti , Bartlett Edward L. , Nam Lucy , Shores Darla R.
Published: August 2018

Objectives:

The aim of the study was to characterize the enteral feeding practices in infants after gastrointestinal surgery.

Methods:

We performed a retrospective analysis of infants who underwent intestinal surgery at age <6 months who survived to be fed enterally between January 2012 and June 2017. Demographics, surgical characteristics, feeding practices, and growth‐related outcomes during hospitalization, discharge, and follow‐up (3, 6, and 12 months) were obtained from the electronic medical records. Descriptive statistics compared infants by their initial diagnosis.

Results:

We reviewed 111 infants: necrotizing enterocolitis (NEC) = 21, gastroschisis = 28, atresia = 27, spontaneous intestinal perforation (SIP) = 18, and other diagnoses = 17. Most infants (77%) received mother's milk (MM) as the first postoperative feed, but this differed by diagnosis (P = 0.004). Donor milk was used in 11%, most commonly in infants with NEC and SIP. Infants with NEC were least likely to continue MM in the hospital (7%, P = 0.0014) and were more likely to receive elemental formula. Only 44% of infants received MM at discharge. After 1 year, 25% were fed MM. The majority of infants were discharged with feeding tubes (nasogastric: 35%, gastric: 23%). Although all groups had acceptable weights at discharge, infants with NEC (z score: −1.8) and SIP (z score: −1.1) showed growth failure at 3 months (z scores: −3.3, −3.2, respectively, P < 0.0001), but had appropriate gain by 1 year (z scores: −1.1, −1.7, respectively).

Conclusions:

Despite most infants receiving MM in the early postoperative period, <50% at discharge and only 33% at 1‐year still received MM. Weight gain after discharge in infants with NEC and SIP warrants close monitoring.
Evaluation of Content on Commonly Used Web sites About Induction of Labor and Pain Management During Labor
Authors: English Cara L. , Alden Kathryn R. , Zomorodi Meg , Travers Debbie , Ross Malcolm S.
Published: August 2018

Purpose:

The Internet is a common source of information for women during pregnancy. A multitude of data about birth can be found on the Internet, yet there are few guidelines to direct women to credible Web sites. Providers are often unaware of the health sites their patients access. The purpose of this study was to evaluate the quality of the written content on Web sites about induction of labor and pain management during labor.

Study Design and Methods:

Descriptive study of 11 Web sites on induction of labor and pain management during labor. Searches on Google, Yahoo, and Bing were used to identify Web sites women use to seek information about labor and birth. The Web sites were evaluated using the Health Information Technology Institute (HITI) criteria, readability, and content criteria from UpToDate, an evidence-based, healthcare professional-authored clinical resource.

Results:

No Web sites met all the HITI criteria for both topics. One Web site was written at or below a seventh-grade reading level and six were written at or above a ninth-grade level. Although there was no perfect Web site, we noted government Web sites provided the highest quality information.

Clinical Implications:

Evaluation and discussion of Web sites used by pregnant women is needed. Nurses and other healthcare providers should be aware of what information exists and what Web sites women are using so they can guide women to credible, evidence-based data. Directing women to government-sponsored Web sites on childbirth topics may help them access accurate information.
Symptoms of Depression and Preterm Birth Among Black Women
Authors: Nutor Jerry John , Slaughter-Acey Jaime C. , Giurgescu Carmen , Misra Dawn P.
Published: August 2018

Objective:

To investigate the relationship between depressive symptoms and preterm birth (PTB) while adjusting for social support, both general and from the father of the baby.

Design:

Retrospective study design.

Setting:

Participants of the Life-course Influences of Fetal Environments (LIFE) study were recruited from a suburban hospital in Metropolitan Detroit, Michigan.

Participants:

The LIFE data consisted of 1,410 self-identified Black women age 18 to 45 years; 1,207 women were included in this analysis.

Methods:

Women were interviewed using a structured questionnaire administered 24 to 48 hours after birth during their postpartum hospitalization. Data on the newborns and their mothers' health were collected through medical record abstraction. The Center for Epidemiologic Studies Depression Scale (CES-D) was used to measure symptoms of depression. The CES-D scores ≥23 were considered severe symptoms of depression. Modified Poisson regression models were built using a stepwise approach to assess association between symptoms of depression and PTB.

Results:

Approximately, 17% of women had a PTB and 20% of women in the sample had a CES-D scores ≥23. Women who had CES-D score ≥23 were about 70% more likely to have a PTB compared with women with CES-D scores <23 (PR = 1.68, 95% CI: 1.24-2.16) after adjustment for both general social support and father of the baby support.

Conclusion:

Women with CES-D scores ≥23 were almost twice more likely to have PTB compared with women with CES-D scores <23. Referrals for mental healthcare providers might benefit women with symptoms of depression and improve birth outcomes. Nurses should encourage women to seek support beyond the father of the baby.
Hepatobiliary Dysfunction and Disseminated Intravascular Coagulation Increase Risk of Mortality in Pediatric Hemophagocytic Lymphohistiocytosis*
Authors: Goldman Jordana , Desai Moreshwar S. , McClain Kenneth L. , Tcharmtchi M. Hossein , Kennedy Curtis E. , Thompson Kathleen , Lam Fong , Bashir Dalia A. , Chinn Ivan K. , Goldberg Baruch R. , Allen Carl E. , Nguyen Trung C.
Published: August 2018

Objectives:

Hemophagocytic lymphohistiocytosis poses significant challenges due to limited tools to guide clinical decisions in a population at high risk of death. We sought to assess whether disseminated intravascular coagulation and hepatobiliary dysfunction, significant comorbidities seen in critical care settings, would identify hemophagocytic lymphohistiocytosis patients with increased risk of mortality.

Design:

Retrospective chart review.

Setting:

Single-center PICU.

Patients:

All patients admitted to a tertiary care children’s hospital diagnosed with hemophagocytic lymphohistiocytosis from 2005 to 2012.

Interventions:

None.

Measurements and Main Results:

Forty-three patients were diagnosed with hemophagocytic lymphohistiocytosis with median age of 61 months. The 5-year overall survival was 51% (22/43). Univariate analyses revealed ferritin levels greater than 10,000 (ng/mL), international normalized ratio greater than 1.5, or platelet counts less than 100,000/µL at initiation of dexamethasone were individually associated with mortality. Development of disseminated intravascular coagulation, hepatobiliary dysfunction, or both increased the likelihood of death in hemophagocytic lymphohistiocytosis patients (relative risk; 95% CI) (6; 1.4–34; p < 0.05), (4.1; 1.8–10; p < 0.05), and (7.5; 1.8–42; p < 0.05). Of 12 autopsies performed, 75% had at least one active infection, 66% had chronic lymphopenia, 50% had lymphocyte depletion in the spleen, thymus, or bone marrow, 42% had evidence of microvascular thrombosis, and 92% had evidence of hepatocellular injury.

Conclusions:

Hemophagocytic lymphohistiocytosis continues to have high mortality with hemophagocytic lymphohistiocytosis-1994/2004 (dexamethasone/etoposide), the current standard of care for all children with hemophagocytic lymphohistiocytosis. Hemophagocytic lymphohistiocytosis patients who developed disseminated intravascular coagulation, hepatobiliary dysfunction, or both had higher risk of death with mortalities of 60%, 77%, and 77%, respectively. Phenotypic classifications are urgently needed to guide individualized treatment strategies to improve outcomes for children with hemophagocytic lymphohistiocytosis.