bluuebunny/crossref_metadata_2025 huggingface dataset:
The Quick Peek Program
Authors: Harris Jill , Norton Amy
Published: August 2016

Developmental screening of young children is important in all populations, especially underserved communities with known health care disparities. The American Academy of Pediatrics created guidelines and a toolkit for pediatricians to conduct developmental surveillance and screening, yet these guidelines are not uniformly implemented within pediatric health care settings. This results in missed opportunities to identify young children with developmental issues, delaying enrollment in early intervention and affecting child outcome. A community-based developmental screening program was designed to address this need and to reduce barriers to developmental screening. Free, bilingual clinics were provided within underserved communities, targeting children between 1 and 5 years old. These brief screenings consisted of an Ages and Stages Questionnaire–Third Edition conducted interactively with the child, parent/guardian, and screener, as well as the Modified Checklist for Autism in Toddlers–Revised (MCHAT-R) when applicable for child's age. In the first 3 years of the program, 1,150 children were screened and 51% were found to be “at risk.” Twenty-seven percent of at-risk children were lost to follow-up at 1 month. Of those at-risk children reached at 1 month follow-up, 88% had arranged recommended evaluations and services. Implications of this model for improving access to care are discussed.
Multivariate Risk Adjustment of Primary Care Patient Panels in a Public Health Setting
Authors: Hirozawa Anne M. , Montez-Rath Maria E. , Johnson Elizabeth C. , Solnit Stephen A. , Drennan Michael J. , Katz Mitchell H. , Marx Rani
Published: August 2016

We compared prospective risk adjustment models for adjusting patient panels at the San Francisco Department of Public Health. We used 4 statistical models (linear regression, two-part model, zero-inflated Poisson, and zero-inflated negative binomial) and 4 subsets of predictor variables (age/gender categories, chronic diagnoses, homelessness, and a loss to follow-up indicator) to predict primary care visit frequency. Predicted visit frequency was then used to calculate patient weights and adjusted panel sizes. The two-part model using all predictor variables performed best (R2= 0.20). This model, designed specifically for safety net patients, may prove useful for panel adjustment in other public health settings.
Improving Employees' Safety Awareness in Healthcare Organizations Using the DMAIC Quality Improvement Approach
Authors: Momani Amer , Hirzallah Mu'ath , Mumani Ahmad
Published: August 2016

Occupational injuries and illnesses in healthcare can cause great human suffering, incur high cost, and have an adverse impact on the quality of patient care. One of the most effective solutions for addressing health and safety issues and improving decisions at the point of care rests in raising employees' safety awareness to recognize, avoid, or respond to potential problems before they arise. In this article, the DMAIC Six Sigma model (Define, Measure, Analyze, Improve, Control) is used as a systematic program to measure, improve, and sustain employees' safety awareness in healthcare organizations. We report on a case study using the model, which was implemented and validated at a local hospital. First, the occupational health and safety knowledge that each job requires was identified. Next, the degree of competence of jobholders to meet these requirements was assessed. Based on the assessment, different awareness-raising efforts were proposed and implemented. The results showed significant improvement in the overall safety awareness compliance assessed: from 74.2% to 84.4% (p < .001) after the intervention. The proposed model ensures that the organization's awareness-raising efforts serve its actual needs and produce optimized and sustained results that eventually lead to safer healthcare service.
Medication Knowledge Among Older Adults Admitted to Home Care in Ontario During 2012–2013
Authors: Sears Kim , Woo Kevin Y. , Almost Joan , Wilson Rosemary , Frymire Eliot , Whitehead Marlo , VanDenKerkhof Elizabeth
Published: August 2016

Background:

Medication use among Canadian seniors is widespread and increases with the number of comorbidities. Limited evidence exists on medication knowledge among seniors, especially in home care.

Purpose:

The purpose of this retrospective cohort study was to describe medication knowledge and ability to take medication among seniors admitted to home care in Ontario.

Results:

Ten percent had little or no knowledge of what medication to take (n = 1,389/14,004) or an understanding of the purpose of their medications (n = 1,396/14,004). Increasing numbers of medications prescribed was associated with decreased knowledge of medications. The strongest predictor of limited knowledge and ability to take medication was dementia (odds ratio > 5.0).

Discussion:

Among Ontario seniors living at home, knowledge about medications decreases as the number of medications increases. Therefore, this group may be at high risk of medication errors.

Conclusion:

Better systems are required to allow healthcare professionals to review with patients, any medications with patients and caregivers, to assist in addressing the decreased knowledge of medications. Such a system would provide the capacity to target those individuals at high risk for a medication error, as well as the medications and drug–drug interactions that seem most likely to be harmful among older adults.
Reliability and Validity for Neuroscience Nurses
Authors: Buelow Janice M. , Hinkle Janice L. , McNett Molly
Published: August 2016

The concepts of reliability and validity are important for neuroscience nurses to understand, particularly because they evaluate existing literature and integrate common scales or tools into their practice. Nurses must ensure instruments measuring specified concepts are both reliable and valid. This article will review types of reliability and validity—sometimes referred to collectively as a psychometric testing–of an instrument. Relevant examples in neuroscience are included to illustrate the importance of reliability and validity to neuroscience nurses.
External Ventricular Catheters: Is It Appropriate to Use an Open/Monitor Position to Adequately Trend Intracranial Pressure in a Neuroscience Critical Care Environment?
Authors: Sunderland Nicole E. , Villanueva Nancy E. , Pazuchanics Susan J.
Published: August 2016

Intracranial pressure (ICP) monitoring can be an important assessment tool in critically and acutely ill patients. An external ventricular drain offers a comprehensive way to monitor ICP and drain cerebrospinal fluid. The Monro-Kellie hypothesis, Pascal’s principle, and fluid dynamics were used to formulate an assumption that an open/monitor position on the stopcock is an adequate trending measure for ICP monitoring while concurrently draining cerebrospinal fluid. Data were collected from 50 patients and totaled 1053 separate number sets. The open/monitor position was compared with the clamped position every hour. An order for “open to drain” was needed for appropriate measurement and nursing care. Results showed the absolute average differences between open/monitor and clamped positions at 1.6268 mm Hg. This finding suggests that it is appropriate to use an open/monitor position via an external ventricular drain for adequate trending of patients’ ICP.
Barriers and Facilitators to Physical Activity Participation for Men with Transtibial Osteomyoplastic Amputation: A Thematic Analysis
Authors: Crawford Derek A. , Hamilton Toby B. , Dionne Carol P. , Day Jonathan D.
Published: August 2016

Background

Lower-limb amputation (LLA) results in participation restrictions in major life activities in personal, work, and leisure environments. By participating in significantly less physical activity (PA) than those who are otherwise healthy, people with LLA are at risk for developing secondary chronic health conditions. Barriers and facilitators to PA participation for those with conventional LLA are well documented. However, these factors are not well understood for those with transtibial osteomyoplastic amputation (TOA).

Purpose

The aim of this study was to qualitatively investigate the barriers and facilitators to PA participation in the TOA population.

Design

This study is an observational, qualitative research using thematic analysis.

Methods

Semistructured interviews were utilized to collect information-rich data from nine men with TOA.

Results

The participants reported minimal body structure impairments but still experience impairment to body functions. Participants reported that they were limited during running and resistance exercises during before and after the actual amputation surgery. The majority of participants value PA benefits as they relate to prevention of chronic disease but fail to recognize potential benefits on function. An individual's motivation to participate can serve as both a facilitator and barrier to PA. Having the opportunity to socialize during PA is important to these participants. The quality of postoperative care program has a direct influence on the long-term PA participation for these participants.

Conclusions

People with TOA continue to experience body function impairment, activity limitations, and participation restrictions. The health care team can play a significant role in the adoption of a physically active lifestyle for people with TOA.
Efficacy and Safety of Lamivudine Versus Entecavir for Treating Chronic Hepatitis B Virus–related Acute Exacerbation and Acute-on-Chronic Liver Failure
Authors: Huang Kuang-Wei , Tam Ka-Wai , Luo Jiing-Chyuan , Kuan Yi-Chun
Published: August 2016

Background:

Oral nucleos(t)ide analogs are recommended for patients with chronic hepatitis B virus (HBV)-related acute exacerbation (AE) and acute-on-chronic liver failure (ACLF). The efficacy and safety of administering entecavir (ETV) and lamivudine (LAM) to such patients remain unclear.

Methods:

A comprehensive literature search was performed to select studies published before December 2015 on therapy involving ETV or LAM for chronic HBV-related AE with or without ACLF. The main outcomes were short-term (within 4 mo) and long-term (beyond 4 mo) mortality. The secondary outcomes were virological and biochemical responses, ACLF recurrence, and safety.

Results:

Three prospective and 8 retrospective cohort studies involving 1491 patients were selected. An overall analysis revealed comparable short-term and long-term mortality rates among all patients who received ETV or LAM [short term: risk ratio (RR)=0.99; 95% confidence interval (CI), 0.78-1.27; long term: RR=0.82; 95% CI, 0.45-1.52]. However, in patients with ACLF, ETV yielded a more favorable long-term outcome than did LAM (RR=0.60; 95% CI, 0.45-0.80). Furthermore, ETV resulted in more efficient virological and biochemical responses than did LAM regarding the HBV DNA undetectable rate (RR=1.34; 95% CI, 1.09-1.63), HBV DNA reduction rate (weighted mean difference=−0.41; 95% CI, −0.69 to −0.13), and serum alanine aminotransferase normalization rate (RR=1.13; 95% CI, 1.05-1.21).

Conclusions:

ETV and LAM treatments exerted similar effects on the mortality rate of patients with chronic HBV-related AE with or without ACLF. However, ETV yielded a more favorable long-term outcome than did LAM in patients with ACLF; ETV was associated with greater clinical improvements. Additional larger, long-term randomized controlled trials are required to confirm these conclusions.
Early detection of pancreatic cancer: impact of high-resolution imaging methods and biomarkers
Authors: Frič Přemysl , Škrha Jan , Šedo Aleksi , Zima Tomaš , Bušek Petr , Kmochová Klára , Laclav Martin , Bunganič Bohuš , Solař Svatopluk , Hrabal Petr , Bělina František , Záruba Pavel , Škrha Pavel , Zavoral Miroslav
Published: August 2016

High-resolution imaging methods (HRIMs) and biomarkers present the second step of pancreatic cancer (PC) diagnostics in at-risk individuals. These include patients with positive risk factors, early symptoms, nonresponders to the initial antidiabetic therapy, patients older than 50 years of age with new-onset unstable diabetes requiring insulin as well as patients with long-term insulin-non-dependent diabetes and recent (up to 6 months) failure of antidiabetic therapy. The procedures should be started without delay and the co-operation between the primary and tertiary medical centers is highly desirable. An early indication of HRIMs and biomarkers is a prerequisite for the diagnosis of a resectable PC. This publication reviews the recent contribution of HRIMs and biomarkers toward an early diagnosis of PC.
Hospital Use of Observation Stays
Authors: Venkatesh Arjun K. , Wang Changqin , Ross Joseph S. , Altaf Faseeha K. , Suter Lisa G. , Vellanky Smitha , Grady Jacqueline N. , Bernheim Susannah M.
Published: August 2016

Background:

The Centers for Medicare and Medicaid Services publicly reports hospital risk-standardized readmission rates (RSRRs) as a measure of quality and performance; mischaracterizations may occur because observation stays are not captured by current measures.

Objectives:

To describe variation in hospital use of observation stays, the relationship between hospitals observation stay use and RSRRs.

Materials and Methods:

Cross-sectional analysis of Medicare fee-for-service beneficiaries discharged after acute myocardial infarction (AMI), heart failure, or pneumonia between July 2011 and June 2012. We calculated 3 hospital-specific 30-day outcomes: (1) observation rate, the proportion of all discharges followed by an observation stay without a readmission; (2) observation proportion, the proportion of observation stays among all patients with an observation stay or readmission; and (3) RSRR.

Results:

For all 3 conditions, hospitals’ observation rates were <2.5% and observation proportions were <12%, although there was variation across hospitals, including 28% of hospital with no observation stay use for AMI, 31% for heart failure, and 43% for pneumonia. There were statistically significant, but minimal, correlations between hospital observation rates and RSRRs: AMI (r=−0.02), heart failure (r=−0.11), and pneumonia (r=−0.02) (P<0.001). There were modest inverse correlations between hospital observation proportion and RSRR: AMI (r=−0.34), heart failure (r=−0.26), and pneumonia (r=−0.21) (P<0.001). If observation stays were included in readmission measures, <4% of top performing hospitals would be recategorized as having average performance.

Conclusions:

Hospitals’ observation stay use in the postdischarge period is low, but varies widely. Despite modest correlation between the observation proportion and RSRR, counting observation stays in readmission measures would minimally impact public reporting of performance.
Regional Variation of Cost of Care in the Last 12 Months of Life in Switzerland
Authors: Panczak Radoslaw , Luta Xhyljeta , Maessen Maud , Stuck Andreas E. , Berlin Claudia , Schmidlin Kurt , Reich Oliver , von Wyl Viktor , Goodman David C. , Egger Matthias , Zwahlen Marcel , Clough-Gorr Kerri M.
Published: August 2016

Background:

Health care spending increases sharply at the end of life. Little is known about variation of cost of end of life care between regions and the drivers of such variation. We studied small-area patterns of cost of care in the last year of life in Switzerland.

Methods:

We used mandatory health insurance claims data of individuals who died between 2008 and 2010 to derive cost of care. We used multilevel regression models to estimate differences in costs across 564 regions of place of residence, nested within 71 hospital service areas. We examined to what extent variation was explained by characteristics of individuals and regions, including measures of health care supply.

Results:

The study population consisted of 113,277 individuals. The mean cost of care during last year of life was 32.5k (thousand) Swiss Francs per person (SD=33.2k). Cost differed substantially between regions after adjustment for patient age, sex, and cause of death. Variance was reduced by 52%–95% when we added individual and regional characteristics, with a strong effect of language region. Measures of supply of care did not show associations with costs. Remaining between and within hospital service area variations were most pronounced for older females and least for younger individuals.

Conclusions:

In Switzerland, small-area analysis revealed variation of cost of care during the last year of life according to linguistic regions and unexplained regional differences for older women. Cultural factors contribute to the delivery and utilization of health care during the last months of life and should be considered by policy makers.
Cannabis and Pediatric Inflammatory Bowel Disease
Authors: Hoffenberg Edward J. , Newman Heike , Collins Colm , Tarbell Sally , Leinwand Kristina
Published: August 2016

The trend toward decriminalization of cannabis (marijuana) continues sweeping across the United States. Colorado has been a leader of legalization of medical and recreational cannabis use. The growing public interest in the medicinal properties of cannabis and its use by patients with a variety of illnesses including inflammatory bowel disease (IBD) makes it important for pediatric gastroenterologists to understand this movement and its potential effect on patients. This article describes the path to legalization and “medicalization” of cannabis in Colorado and the public perception of safety despite the known adverse health effects of use. We delineate the mammalian endocannabinoid system and our experience of caring for children and adolescents with IBD in an environment of increasing awareness and acceptance of its use. We then summarize the rationale for considering that cannabis may have beneficial and harmful effects for patients with IBD. Finally, we highlight the challenges federal laws impose on conducting research on cannabis in IBD. The intent of this article is to inform health care providers about the issues around cannabis use and research in adolescents and young adults with IBD.
Perceptions of Nursing and Physical Therapy Students Toward Peer-Led Interprofessional Education in Manual Handling
Authors: McCrorie Pamela , Roberts Pamela A. , Sainsbury David , Boldy Duncan , Gower Shelley
Published: August 2016

Perceptions of first-semester BSN students (N = 220) who received education on patient moving and handling skills from either fourth-year physical therapy/physiotherapy student peer teachers (n = 8) or regular nurse educators were obtained via validated scales and focus groups. There was a significant increase in the mean scores of items concerning communication skills in both groups, with increased scores for all items in the peer-led group. The teaching skills of physical therapy/physiotherapy student peers were evaluated highly by the nursing students.
Analysis of Student Reflections of Experiential Learning in Nursing Health Policy Courses
Authors: McGuire Maureen , Goldstein Carol , Claywell Lora , Patton Ryan
Published: August 2016

This is a content analysis of the reflections of 187 nursing students after experiential learning opportunities in both master’s and doctoral level health policy courses. Results show that experiential activities in a health policy class for nursing students increased their knowledge of the legislative process and motivated them to identify newfound intent to become more involved in the political process.
Development and Validation of the Human Papillomavirus Attitudes and Beliefs Scale in a National Canadian Sample
Authors: Perez Samara , Shapiro Gilla K. , Tatar Ovidiu , Joyal-Desmarais Keven , Rosberger Zeev
Published: August 2016

Background

Parents' human papillomavirus (HPV) vaccination decision-making is strongly influenced by their attitudes and beliefs toward vaccination. To date, psychometrically evaluated HPV vaccination attitudes scales have been narrow in their range of measured beliefs and often limited to attitudes surrounding female HPV vaccination. The study aimed to develop a comprehensive, validated and reliable HPV vaccination attitudes and beliefs scale among parents of boys.

Methods

Data were collected from Canadian parents of 9- to 16-year-old boys using an online questionnaire completed in 2 waves with a 7-month interval. Based on existing vaccination attitudes scales, a set of 61 attitude and belief items were developed. Exploratory and confirmatory factor analyses were conducted. Internal consistency was evaluated with Cronbach's α and stability over time with intraclass correlations.

Results

The HPV Attitudes and Beliefs Scale (HABS) was informed by 3117 responses at time 1 and 1427 at time 2. The HABS contains 46 items organized in 9 factors: Benefits (10 items), Threat (3 items), Influence (8 items), Harms (6 items), Risk (3 items), Affordability (3 items), Communication (5 items), Accessibility (4 items), and General Vaccination Attitudes (4 items). Model fit at time 2 were: χ2/df = 3.13, standardized root mean square residual = 0.056, root mean square error approximation (confidence interval) = 0.039 (0.037–0.04), comparative fit index = 0.962 and Tucker-Lewis index = 0.957. Cronbach’s αs were greater than 0.8 and intraclass correlations of factors were greater than 0.6.

Conclusions

The HABS is the first psychometrically-tested scale of HPV attitude and beliefs among parents of boys available for use in English and French. Further testing among parents of girls and young adults and assessing predictive validity are warranted.
Estimating Utility Weights for the Vision Related Quality of Life Index
Authors: Chen Gang , Finger Robert P. , Holloway Edith Eva , Iezzi Angelo , Richardson Jeff
Published: August 2016

Purpose

The VisQoL instrument was constructed as a vision-specific addition to the AQoL-6D multi-attribute utility instrument. The composite instrument, the AQoL-7D, was assigned utility scores that are the basis for now estimating VisQoL utilities when it is used as a stand-alone instrument. This study aimed to construct mapping functions that allow utility scores to be assigned to the Vision Related Quality of Life (VisQoL) instrument, a stand-alone vision-specific quality-of-life measure.

Methods

A sample of 164 patients completed the AQoL-7D, which includes the VisQoL. Mapping algorithms between VisQoL and AQoL-7D were then derived using two econometric methods, ordinary least squares estimator and generalized linear model (GLM). Two model specifications were considered with either six VisQoL raw item values or VisQoL overall dimension value as the key independent variables. The predictive performance of each method on each model specification was assessed using the mean absolute error (MAE) and intraclass correlation coefficient (ICC). Both internal and external validation tests (using a second, independent sample of 164 patients) were performed.

Results

The mapping algorithms derived from the GLM had superior properties to the ordinary least squares–based algorithms in both internal and external validation tests. The ICC values ranged from 0.851 to 0.913, and the MAE ranged from 0.043 to 0.052 for two model specifications, based on two econometric methods. However, predicted utilities tend to over-predict/under-predict the lowest/highest observed utility.

Conclusions

Mapping algorithms predicting AQoL-7D utility based on six VisQoL items or VisQoL dimension value have been developed. The algorithm can be used to estimate quality adjusted life years. This allows the VisQoL to be used in cost utility analyses.
Hospital Volume and Mortality in Mechanically Ventilated Children: Analysis of a National Inpatient Database in Japan*
Authors: Sasaki Ryuji , Yasunaga Hideo , Matsui Hiroki , Michihata Nobuaki , Fushimi Kiyohide
Published: August 2016

Objectives:

To evaluate the relationship between annual hospital volume of mechanical ventilation in children and mortality.

Design:

A retrospective analysis.

Setting:

Japanese hospitals (n = 641) in the Japanese Diagnosis Procedure Combination database from July 2010 to March 2013.

Patients:

Patients 15 years old or younger receiving mechanical ventilation during hospitalization.

Interventions:

None.

Measurements and Main Results:

A total of 26,981 mechanically ventilated pediatric patients were identified. They were categorized into four subgroups based on the quartiles of mean annual hospital volume of mechanical ventilation in children. Multivariable logistic regression analyses were performed to examine the effects of hospital volume on 30-day mortality, with adjustment for patient and hospital characteristics. Compared with the low volume group (≤ 34 per year), the odds ratios (95% CI) for 30-day mortality of low-medium (35–80), medium-high (81–165), and high (≥ 166) volume groups were 0.63 (0.50–0.79), 0.56 (0.42–0.74), and 0.57 (0.50–0.79), respectively. Subgroup analyses of surgical and nonsurgical patients showed similar trends.

Conclusions:

In mechanically ventilated pediatric patients divided by hospital volume quartiles, all three higher volume groups had lower mortality than the lowest volume group.
Childhood Bullying Victimization and Overweight in Young Adulthood: A Cohort Study
Authors: Baldwin Jessie R. , Arseneault Louise , Odgers Candice , Belsky Daniel W. , Matthews Timothy , Ambler Antony , Caspi Avshalom , Moffitt Terrie E. , Danese Andrea
Published: August 2016

Objective

To test whether bullied children have an elevated risk of being overweight in young adulthood and whether this association is: (1) consistent with a dose-response relationship, namely, its strength increases with the chronicity of victimization; (2) consistent across different measures of overweight; (3) specific to bullying and not explained by co-occurring maltreatment; (4) independent of key potential confounders; and (5) consistent with the temporal sequence of bullying preceding overweight.

Method

A representative birth cohort of 2,232 children was followed to age 18 years as part of the Environmental Risk Longitudinal Twin Study. Childhood bullying victimization was reported by mothers and children during primary school and early secondary school. At the age-18 follow-up, we assessed a categorical measure of overweight, body mass index, and waist-hip ratio. Indicators of overweight were also collected at ages 10 and 12. Co-twin body mass and birth weight were used to index genetic and fetal liability to overweight, respectively.

Results

Bullied children were more likely to be overweight than non-bullied children at age 18, and this association was (1) strongest in chronically bullied children (odds ratio = 1.69; 95% confidence interval [CI] = 1.21–2.35); (2) consistent across measures of overweight (body mass index: b = 1.12; 95% CI = 0.37–1.87; waist-hip ratio: b = 1.76; 95% CI = 0.84–2.69); (3) specific to bullying and not explained by co-occurring maltreatment; (4) independent of child socioeconomic status, food insecurity, mental health, and cognition, and pubertal development; and (5) not present at the time of bullying victimization, and independent of childhood weight and genetic and fetal liability.

Conclusion

Childhood bullying victimization predicts overweight in young adulthood.
Ectopic Hepatocellular Carcinoma Occurring in the Bile Duct and Extending to the Gallbladder
Authors: Cheng Mei Qing , Zeng Dan , Huang Hui , Tang Xiao Feng , Xu Zuo Feng
Published: August 2016

Ectopic hepatocellular carcinoma (HCC) is rare and there has been no report on ectopic HCC arising from both the bile duct and the gallbladder. It is difficult to establish a correct diagnosis for this kind of HCC based on preoperative imaging. All of the preoperative imaging examinations misdiagnosed the HCC as cholangiocarcinoma in our case. However, via retrospective analysis of this case, we found that the patient was positive for hepatitis virus markers and that a tumor marker (α-fetoprotein) was significantly elevated. Therefore, diagnosis of HCC with significantly elevated α-fetoprotein (>200 μg/L) is highly likely, particularly with chronic hepatitis and excluding pregnancy and tumor of genital system.
The Value of Active Ultrasound Surveillance for Patients With Small Testicular Lesions
Authors: Li Qian , Vij Abhinav , Hahn Peter F. , Xiang Feixiang , Samir Anthony E.
Published: August 2016

This study aimed to determine whether active ultrasound surveillance may obviate the need for surgical resection in selected patients with small testicular lesions (STLs). A retrospective 11-year review was conducted of adults who were diagnosed with an STL on scrotal ultrasonography and who either had orchiectomy or sonographic follow-up during a period of at least 3 months. A total of 101 subjects were enrolled. Ultrasound findings, clinical features, histopathology/follow-up imaging were recorded. Logistic regression analysis was performed to select independent risk factors for the diagnosis of malignancy. Seventeen (16.8%) subjects underwent immediate surgery, 8 (7.9%) of 101 underwent surgery after ultrasound follow-up, and 76 (75.3%) of 101 were followed with ultrasound only. The follow-up period ranged from 1 to 7 months in the 8 patients who ultimately underwent surgery after ultrasound follow-up and from 6 to 84 months in the 76 patients followed up with ultrasound only. All 15 malignant cases underwent immediate surgery without follow-up sonography. The frequency of lesions, either benign at surgery or stable on ultrasound, was 85.1% (86 of 101; 95% confidence interval, 77%–91%). Logistic regression analysis showed that lesion size was the only independent risk factor for malignancy in hypoechoic STLs (P < 0.05). Most of the STLs were stable on serial sonograms and likely benign. Active ultrasound surveillance may be an appropriate management strategy in patients with STLs.
Sonographic Pulmonary Abnormalities in Fetuses With Hypoplastic Left Heart Syndrome and Intact Atrial Septum Undergoing Attempted Atrial Septostomy In Utero
Authors: Mackesy Meaghan M. , Kalish Brian T. , Tworetzky Wayne , Sanders Stephen , Al-Ibraheemi Alyaa , Wilkins-Haug Louise , Lock James , Marshall Audrey , Benson Carol B.
Published: August 2016

Fetuses with hypoplastic left heart syndrome (HLHS) and intact atrial septum are a particular subset of HLHS neonates with high perinatal mortality. The reported mortality in these patients is 50% to 70%, even with prenatal diagnosis. Prenatal left atrial and pulmonary venous hypertension results in abnormal pulmonary vascular and parenchymal development. The goal of this study was to compare the sonographic appearance of the lungs in fetuses with HLHS/intact atrial septum to neonatal outcome and/or pathology in cases where in utero intervention was performed to open the atrial septum. We found that lung inhomogeneity on ultrasound corresponded to peripheral lymphatic dilatation at autopsy and was associated with a dismal prognosis even when in utero intervention was successful.
Modified Hand-Sewn Closure With Retroperitoneal Tissue-covering Method Prevents Pancreatic Fistula in Laparoscopic Distal Pancreatectomy
Authors: Ji Wenbin , Wang Youlong , Wang Lie , Tan Huamin , Tan Jingwang
Published: August 2016

Background:

In laparoscopic distal pancreatectomy, the stapler transection of the pancreas remains the preferred method; however, pancreatic fistula continues to be a critical unsolved problem. The aim of this study was to compare complications associated with distal pancreatectomy, especially regarding the formation of pancreatic fistula, with particular attention to the stapler and hand-sewn closure technique.

Patients and Methods:

Between January 2004 and June 2012, 47 patients underwent laparoscopic distal pancreatectomy. These patient’s pancreatic bodies were similar, and they were subjected to closure of the pancreatic stump either by stapler (Staple group, n=21) or by a modified hand-sewn technique (Sewn group, n=26), and were subsequently retrospectively reviewed.

Results:

The incidence of PF was significantly higher in the “Staple group” compared with the “Sewn group.” Likewise, the amylase levels in the drainage fluid, were significantly higher in the “Staple group” compared with the “Sewn group.” Patients in the Sewn group had shorter median hospital stay compared with those in the Sewn group (5 vs. 8 d, P<0.001).

Conclusions:

The 2-layer hand-sewn technique is a simple method, and it significantly decreased the incidence of PF and hospital stay compared with the use of staples in laparoscopy.
The “Left Ureteral Triangle” as an Anatomic Landmark for the Identification of the Left Ureter in Laparoscopic Distal Colectomies
Authors: Tebala Giovanni D.
Published: August 2016

Ureteral injury is one of the possible complications of distal colectomies. It may be caused by misidentification of the anatomic landmarks during the left lateral dissection, due to factor pertaining to the patient, the disease, and the surgeon. The only way to reduce the risk of this avoidable complication is the perfect knowledge and identification of the anatomy of the left ureter. In this article, we describe an anatomic triangle that can be a valid help in the identification of the ureter in the area where higher is the risk of iatrogenic injury. The left ureteric triangle can be prepared after the dissection of the left Toldt plane, as soon as the dissection reaches the superior mesorectum. Sides of this triangle are (a) superiorly, the dissected mesosigmoid, (b) right side, upper mesorectum and sacral promontorium, and (c) inferiorly, the margin of the incised posterior parietal peritoneum. The left ureter runs within this triangle.
Efficacy of Head Repositioning in Restoration of Electrophysiological Signals During Cervical Spine Procedures
Authors: Appel Shmuel , Korn Akiva , Biron Tali , Goldstein Kobi , Rand Nahshon , Millgram Michael , Floman Yizhar , Ashkenazi Ely
Published: August 2016

Purpose:

To evaluate the frequency of loss of neurophysiological potentials during head positioning, the usefulness of head repositioning to restore the potentials, and the effect on neurological outcome.

Methods:

We retrospectively reviewed consecutive cervical spine surgeries performed at the Israel Spine Center, Assuta Medical Center, during 2006 to 2013. Surgeries performed with neuromonitoring (transcranial-electric motor evoked potentials, somatosensory evoked potentials, electromyographic recordings) were included. Demographic data, medical history, findings at neurological examination and imaging, electrophysiological data recorded during surgery, and neurological outcomes were collected and analyzed.

Results:

Three hundred eighty-one patients met inclusion criteria. Loss of potentials detected in nine patients during patient positioning and repositioning was undertaken with the aim of restoring electrophysiological signals. In 5/9 patients, repositioning resulted in immediate reappearance of potentials; in 1/5, potentials were affected again during decompression. In 4/9, repositioning did not immediately restore electrophysiological signals; in ¼, potentials reappeared later during the decompression and in ¾, potentials had not recovered till the conclusion of surgery. There were new neurological deficits in 2/9, including one patient with loss of potential that was not restored with repositioning and the one in whom potential was restored but lost again during decompression.

Conclusions:

Intraoperative neuro monitoring is an efficient tool to alert the surgical team to potential neurological damage. Head reposition often restores the electrophysiological signals with possible prevention of impending sequelae.
Staphylococcus caprae native mitral valve infective endocarditis
Authors: Kwok T'ng Choong , Poyner Jennifer , Olson Ewan , Henriksen Peter , Koch Oliver
Published: August 2016

Introduction:

Staphylococcus caprae is a rare cause of infective endocarditis. Here, we report a case involving the native mitral valve in the absence of an implantable cardiac electronic device.

Case presentation:

A 76-year-old man presented with a 2 week history of confusion and pyrexia. His past medical history included an open reduction and internal fixation of a humeral fracture 17 years previously, which remained non-united despite further revision 4 years later. There was no history of immunocompromise or farm-animal contact. Two sets of blood culture bottles, more than 12 h apart, were positive for S. caprae. Trans-thoracic echocardiography revealed a 1×1.2 cm vegetation on the mitral valve, with moderate mitral regurgitation. Due to ongoing confusion, he had a magnetic resonance imaging brain scan, which showed a subacute small vessel infarct consistent with a thromboembolic source. A humeral SPECT-CT (single-photon emission computerized tomography-computerized tomography) scan showed no clear evidence of acute osteomyelitis. Surgical vegetectomy and mitral-valve repair were considered to reduce the risk of further systemic embolism and progressive valve infection. However, the potential risks of surgery to this patient led to a decision to pursue a cure with antibiotic therapy alone. He remained well 3 months after discharge, with repeat echocardiography demonstrating a reduction in the size of the vegetation (0.9 cm).

Conclusion:

Management of this infection was challenging due to its rarity and its unclear progression, complicated by the dilemma surrounding surgical intervention in a patient with a complex medical background.
Entropy in Primary Sensory Areas Lower than in Associative Ones: The Brain Lies in Higher Dimensions than the Environment
Authors: Peters James F. , Tozzi Arturo , İnan Ebubekir , Ramanna Sheela
Published: August 2016

The brain, rather than integrate sensory inputs and concentrate them into concepts as currently believed, appears to increase the complexity from the perceived object to the idea of it. Topological models predict indeed an increase in dimensions and symmetries from the environment to the higher activities of the brain. Models predict that informational entropy in the primary sensory areas must be lower than in the higher associative ones. In order to demonstrate the novel hypothesis, we introduce a method for the measurement of information in fMRI neuroimages,i.e., nucleus clustering’s Rényi entropy derived from strong proximities in feature-based Voronoï tessellations,e.g.,maximal nucleus clustering. The technique facilitates the objective detection of entropy/information in zones of fMRI images generally not taken into account. We found that the Rényi entropy is higher in associative cortices than in the visual primary ones. It suggests that the brain lies in higher dimensions than the environment and that it does not concentrate, but rather dilutes the message coming from external inputs.
The Dichotomous Effects of Caffeine on Homologous Recombination in Mammalian Cells
Authors: Magwood Alissa C. , Mundia Maureen M. , Mosser Dick D. , Baker Mark D.
Published: August 2016

This study was initiated to examine the effects of caffeine on the DNA damage response (DDR) and homologous recombination (HR). An initial 2 h exposure to 5 mM caffeine slowed a fraction of the cells in G1, but thereafter, continued caffeine exposure permitted this cell fraction to progress through the cycle until they eventually stalled at G2/M and underwent apoptosis. This prolonged caffeine exposure also induced a strong DDR along with subsequent activation of wild-type p53 protein. An unexpected observation was the caffeine-induced depletion of Rad51 (and Brca2) proteins. Consequently, caffeine-treated cells were expected to be inefficient in HR. However, a dichotomy in the HR response of cells to caffeine treatment was revealed. Caffeine treatment rendered cells significantly better at performing the nascent DNA synthesis that accompanies the early strand invasion steps of HR. Conversely, the increase in nascent DNA synthesis did not translate into a higher level of gene targeting events. Levels of Rad51 appear to be irrelevant. Thus, prolonged caffeine exposure stalls the cell cycle, induces a p53-mediated apoptotic response and a down-regulation of critical HR proteins, and stimulates early steps of HR, but not the formation of complete repair products.
panX: pan-genome analysis and exploration
Authors: Ding Wei , Baumdicker Franz , Neher Richard A.
Published: August 2016

Horizontal transfer, gene loss, and duplication result in dynamic bacterial genomes shaped by a complex mixture of different modes of evolution. Closely related strains can differ in the presence or absence of many genes, and the total number of distinct genes found in a set of related isolates – the pan-genome – is often many times larger than the genome of individual isolates. We have developed a pipeline that efficiently identifies orthologous gene clusters in the pan-genome. This pipeline is coupled to a powerful yet easy-to-use web-based visualization software for interactive exploration of the pan-genome. The visualization consists of connected components that allow rapid filtering and searching of genes and inspection of their evolutionary history. For each gene cluster, panX displays an alignment, a phylogenetic tree, maps mutations within that cluster to the branches of the tree and infers gain and loss of genes on the core-genome phylogeny. PanX is available atpangenome.de. Custom pan-genomes can be visualized either using a webserver or by serving panX locally as a browser-based application.
Degradation of non-methylated DNA by MsPJI impairs its usefulness as epigenetic tool
Authors: Jerez María Belén , Juri Ayub Maximiliano
Published: August 2016

DNA treatment with sensitive and/or dependent restriction enzymes, followed by PCR amplification is a widely used approach for testing CpG methylation. Recently, MspJI has been characterized as a promisory tool for epigenetic analyses. In the present report, we describe that MspJI shows significant activity against non-methylated DNA, suggesting that additional caution and improvements would be required before applying this enzyme as a routine epigenetic tool.
Revealing unobserved factors underlying cortical activity using a rectified latent variable model applied to neural population recordings
Authors: Whiteway Matthew R. , Butts Daniel A.
Published: August 2016

The activity of sensory cortical neurons is not only driven by external stimuli, but is also shaped by other sources of input to the cortex. Unlike external stimuli these other sources of input are challenging to experimentally control or even observe, and as a result contribute to variability of neuronal responses to sensory stimuli. However, such sources of input are likely not “noise”, and likely play an integral role in sensory cortex function. Here, we introduce the rectified latent variable model (RLVM) in order to identify these sources of input using simultaneously recorded cortical neuron populations. The RLVM is novel in that it employs non-negative (rectified) latent variables, and is able to be much less restrictive in the mathematical constraints on solutions due to the use an autoencoder neural network to initialize model parameters. We show the RLVM outperforms principal component analysis, factor analysis and independent component analysis across a variety of measures using simulated data. We then apply this model to the 2-photon imaging of hundreds of simultaneously recorded neurons in mouse primary somatosensory cortex during a tactile discrimination task. Across many experiments, the RLVM identifies latent variables related to both the tactile stimulation as well as non-stimulus aspects of the behavioral task, with a majority of activity explained by the latter. These results suggest that properly identifying such latent variables is necessary for a full understanding of sensory cortical function, and demonstrates novel methods for leveraging large population recordings to this end.
Disaster vulnerability of Emirati energy sector and barriers to enhance resilience
Authors: Pathirage Chaminda , Al-Khaili Khalifa
Published: August 2016

Purpose

United Arab Emirates (UAE) has experienced various natural and man-made hazards. The energy sector dominates in the UAE and protection of this critical infrastructure against any impending hazards is important. The purpose of this paper is to examine the vulnerability of Emirati energy sector, explored barriers to enhance resilience and ways to overcome identified barriers.

Design/methodology/approach

Study followed case study research strategy and multiple case studies; three electricity generating power plant facilities – one in Abu Dhabi, one in Dubai and one in Sharjah were selected. Data collection involved a combination of a questionnaire survey and semi-structured face-to-face interviews. In total 42 questionnaire responses and nine interviews among Emirati energy sector employees were analyzed.

Findings

Results indicated terrorism, atmospheric and tectonic hazards as the three main risks of vulnerability within Emirati energy sector; whereas “lack of or absence of national government legislation” and “awareness and education” are revealed as the main barriers. Improving human resource management within Emirati energy sector through better awareness, training and practices is considered as a priority.

Research limitations/implications

It is argued that the vulnerabilities and barriers identified in this study can be applicable to Emirati energy sector in general, not just the case studies represented in the study.

Originality/value

The feedback from the members of the Emirati energy sector is indicative of the latent failures and urgent issues that need to be addressed; predominately those of training, education and awareness. Findings of this study may help UAE energy sector to be prepared and build resilience for future hazards.
Observing the NHS’s A&E performance objectives: is lean the cure?
Authors: Bancroft John , Saha Krish
Published: August 2016

Purpose

The purpose of this paper is to investigate England’s Accident and Emergency (A&E) portion of the National Health Service (NHS). This paper is based upon weekly published data from A&E trusts across England, spanning from November 2010 to December 2014.

Design/methodology/approach

Emphasis is placed on a number of variables; month (time of year), performance (patients seen in less than four hours), patient volume and exploring the relationship between these variables. A deductive approach has been selected as the most appropriate for this paper and the format of a correlational study. Lean will be discussed as a philosophy throughout this paper, as a means to improve the NHS.

Findings

The NHS’s success in reaching its 95 per cent performance objective has in a gradual downwards trend since the data started being published and the volume of patients seen in A&E is trending upwards. However, there is only a weak relationship between these variables, suggesting that peak in demand are effectively foretasted by the NHS and appropriate resources deployed to combat this. Additionally, there is a clear relationship between the time of year (month) and volume.

Research limitations/implications

The data used are not broken down and are aggregated from A&E departments across the NHS in England. Therefore, outliers could be present that impact the data and results. Should outliers exist, these should be targeted for improvement or to be learnt from, depending on their ranking.

Practical implications

Should the NHS continue with their Lean transformation, it is believed that efficiency will improvement throughout the organisation.

Social implications

Through the identification of volume trends better care and efficiency can be provided to patients visiting the A&E departments of the NHS.

Originality/value

This paper analyses data over the past four years which can be used to spot past trends and predict future trends, therefore smoothing the reliability and quality of the care offered to patients. This can be achieved through a Lean transformation and a flexible resourcing approach.