bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical and MRI Outcomes After Surgical Treatment of Osteochondral Lesions of the Talus in Skeletally Immature Children
Authors: Jurina Andrija , Dimnjaković Damjan , Mustapić Matej , Smoljanović Tomislav , Bojanić Ivan
Published: March 2016

Background:

The literature on the osteochondral lesion of the talus (OLT) in skeletally immature children is scarce and little is known about the clinical outcomes and the radiologic appearance of these lesions after surgical treatment. The aim of this study was to assess mid-term clinical and magnetic resonance imaging (MRI) outcomes after arthroscopic microfracture (AM) of OLT in skeletally immature children.

Methods:

Thirteen patients with OLT treated by AM before skeletal maturity were included in the study. The Berndt and Harty outcome question, the Single Assessment Numeric Evaluation question, and the Martin questionnaire were used to obtain patients’ subjective satisfaction with their operated ankle. Functional outcomes preoperatively and postoperatively were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) score. MRI scans were performed postoperatively using a magnetic resonance observation of cartilage repair tissue (MOCART) scoring system for 11 ankles.

Results:

The median age was 15 years (range, 13 to 16 y) and the median follow-up period was 5.6 years (range, 3.8 to 13.6 y). According to the Berndt and Harty outcome question, good clinical results were reported in 10 (76.9%) and fair in 3 (23.1%) patients. The postoperative AOFAS score was significantly improved when compared with the preoperative AOFAS score, with a mean increase of 35 points (P<0.001). The overall MOCART score was 65 (range, 10 to 75). MRI variables of the MOCART scoring system showed no association with clinical outcomes.

Conclusions:

AM seems to be an effective surgical method for the treatment of OLT in skeletally immature children.

Level of Evidence:

Level IV—therapeutic studies, case series.
Maternal Origin and Risk of Neonatal and Maternal ICU Admission*
Authors: Medcalf Karyn E. , Park Alison L. , Vermeulen Marian J. , Ray Joel G.
Published: March 2016

Objectives:

To evaluate maternal world region of birth, as well as maternal country of origin, and the associated risk of admission of 1) a mother to a maternal ICU, 2) her infant to a neonatal ICU, or 3) both concurrently to an ICU.

Design:

Retrospective population-based cohort study.

Setting:

Entire province of Ontario, Canada, from 2003 to 2012.

Patients:

All singleton maternal-child pairs who delivered in any Ontario hospital.

Measurements and Main Results:

We explored how maternal world region of birth, and specifically, maternal country of birth for the top 25 countries, was associated with the outcome of 1) neonatal ICU, 2) maternal ICU, and 3) both mother and newborn concurrently admitted to ICU. Relative risks were adjusted for maternal age, parity, income quintile, chronic hypertension, diabetes mellitus, obesity, dyslipidemia, drug dependence or tobacco use, and renal disease. Compared with infants of Canadian-born mothers (110.7/1,000), the rate of neonatal ICU admission was higher in immigrants from South Asia (155.2/1,000), Africa (140.4/1,000), and the Caribbean (167.3/1,000; adjusted relative risk, 1.41; 95% CI, 1.36–1.46). For maternal ICU, the adjusted relative risk was 1.79 (95% CI, 1.43–2.24) for women from Africa and 2.21 (95% CI, 1.78–2.75) for women from the Caribbean. Specifically, mothers from Ghana (adjusted relative risk, 2.71; 95% CI, 1.75–4.21) and Jamaica (adjusted relative risk, 2.74; 95% CI, 2.12–3.53) were at highest risk of maternal ICU admission. The risk of both mother and newborn concurrently admitted to ICU was even more pronounced for Ghana and Jamaica.

Conclusions:

Women from Africa and the Caribbean and, in particular, Ghana and Jamaica, are at higher risk of admission to ICU around the time of delivery, as are their newborns.
Mechanical Ventilation and Diaphragmatic Atrophy in Critically Ill Patients: An Ultrasound Study
Authors: Zambon Massimo , Beccaria Paolo , Matsuno Jun , Gemma Marco , Frati Elena , Colombo Sergio , Cabrini Luca , Landoni Giovanni , Zangrillo Alberto
Published: March 2016

Objective:

Mechanical ventilation contributes to diaphragmatic atrophy and dysfunction, and few techniques exist to assess diaphragmatic function: the purpose of this study was to quantify diaphragm atrophy in a population of critically ill mechanically ventilated patients with ultrasound and to identify risk factors that can worsen diaphragmatic activity.

Design:

Prospective observational study.

Setting:

ICU of a 1,200-bed university hospital.

Patients:

Newly intubated adult critically ill patients.

Interventions:

Diaphragm thickness in the zone of apposition was measured daily with ultrasound, from the first day of mechanical ventilation till discharge to the main ward.

Measurements and Main Results:

Daily atrophy rate (ΔTdi/d) was calculated as the reduction in percentage from the previous measurement. To analyze the difference in atrophy rate (ΔTdi/d), ventilation was categorized into four classes: spontaneous breathing or continuous positive airway pressure; pressure support ventilation 5–12 cm H2O (low pressure support ventilation); pressure support ventilation greater than 12 cm H2O (high pressure support ventilation); and controlled mechanical ventilation. Multivariate analysis with ventilation support and other clinical variables was performed to identify risk factors for atrophy. Forty patients underwent a total of 153 ultrasonographic evaluations. Mean (sd) ΔTdi/d was –7.5% (12.3) during controlled mechanical ventilation, –5.3% (12.9) at high pressure support ventilation, –1.5% (10.9) at low pressure support ventilation, +2.3% (9.5) during spontaneous breathing or continuous positive airway pressure. At multivariate analysis, only the ventilation support was predictive of diaphragm atrophy rate. Pressure support predicted diaphragm thickness with coefficient –0.006 (95% CI, –0.010 to –0.002; p = 0.006).

Conclusions:

In critically ill mechanically ventilated patients, there is a linear relationship between ventilator support and diaphragmatic atrophy rate.
Long-Term Quality of Life Among Survivors of Severe Sepsis: Analyses of Two International Trials*
Authors: Yende Sachin , Austin Shamly , Rhodes Andrew , Finfer Simon , Opal Steven , Thompson Taylor , Bozza Fernando A. , LaRosa Steven P. , Ranieri V. Marco , Angus Derek C.
Published: March 2016

Objectives:

To describe the quality of life among sepsis survivors.

Design:

Secondary analyses of two international, randomized clinical trials (A Controlled Comparison of Eritoran and placebo in patients with Severe Sepsis [derivation cohort] and PROWESS-SHOCK [validation cohort]).

Setting:

ICUs in North and South America, Europe, Africa, Asia, and Australia.

Patients:

Adults with severe sepsis. We analyzed only patients who were functional and living at home without help before sepsis hospitalization (n = 1,143 and 987 from A Controlled Comparison of Eritoran and placebo in patients with Severe Sepsis and PROWESS-SHOCK, respectively).

Interventions:

None.

Measurements and Main Results:

In A Controlled Comparison of Eritoran and placebo in patients with Severe Sepsis and PROWESS-SHOCK, the average age of patients living at home independently was 63 and 61 years; 400 (34.9%) and 298 (30.2%) died by 6 months. In A Controlled Comparison of Eritoran and placebo in patients with Severe Sepsis, 580 patients had a quality of life measured using EQ-5D at 6 months. Of these, 41.6% could not live independently (22.7% were home but required help, 5.1% were in nursing home or rehabilitation facilities, and 5.3% were in acute care hospitals). Poor quality of life at 6 months, as evidenced by problems in mobility, usual activities, and self-care domains were reported in 37.4%, 43.7%, and 20.5%, respectively, and the high incidence of poor quality of life was also seen in patients in PROWESS-SHOCK. Over 45% of patients with mobility and self-care problems at 6 months in A Controlled Comparison of Eritoran and placebo in patients with Severe Sepsis died or reported persistent problems at 1 year.

Conclusions:

Among individuals enrolled in a clinical trial who lived independently prior to severe sepsis, one third had died and of those who survived, a further one third had not returned to independent living by 6 months. Both mortality and quality of life should be considered when designing new interventions and considering endpoints for sepsis trials.
Using Supervised Machine Learning to Classify Real Alerts and Artifact in Online Multisignal Vital Sign Monitoring Data*
Authors: Chen Lujie , Dubrawski Artur , Wang Donghan , Fiterau Madalina , Guillame-Bert Mathieu , Bose Eliezer , Kaynar Ata M. , Wallace David J. , Guttendorf Jane , Clermont Gilles , Pinsky Michael R. , Hravnak Marilyn
Published: March 2016

Objective:

The use of machine-learning algorithms to classify alerts as real or artifacts in online noninvasive vital sign data streams to reduce alarm fatigue and missed true instability.

Design:

Observational cohort study.

Setting:

Twenty-four–bed trauma step-down unit.

Patients:

Two thousand one hundred fifty-three patients.

Intervention:

Noninvasive vital sign monitoring data (heart rate, respiratory rate, peripheral oximetry) recorded on all admissions at 1/20 Hz, and noninvasive blood pressure less frequently, and partitioned data into training/validation (294 admissions; 22,980 monitoring hours) and test sets (2,057 admissions; 156,177 monitoring hours). Alerts were vital sign deviations beyond stability thresholds. A four-member expert committee annotated a subset of alerts (576 in training/validation set, 397 in test set) as real or artifact selected by active learning, upon which we trained machine-learning algorithms. The best model was evaluated on test set alerts to enact online alert classification over time.

Measurements and Main Results:

The Random Forest model discriminated between real and artifact as the alerts evolved online in the test set with area under the curve performance of 0.79 (95% CI, 0.67–0.93) for peripheral oximetry at the instant the vital sign first crossed threshold and increased to 0.87 (95% CI, 0.71–0.95) at 3 minutes into the alerting period. Blood pressure area under the curve started at 0.77 (95% CI, 0.64–0.95) and increased to 0.87 (95% CI, 0.71–0.98), whereas respiratory rate area under the curve started at 0.85 (95% CI, 0.77–0.95) and increased to 0.97 (95% CI, 0.94–1.00). Heart rate alerts were too few for model development.

Conclusions:

Machine-learning models can discern clinically relevant peripheral oximetry, blood pressure, and respiratory rate alerts from artifacts in an online monitoring dataset (area under the curve > 0.87).
Potential Influence of Advance Care Planning and Palliative Care Consultation on ICU Costs for Patients With Chronic and Serious Illness*
Authors: Khandelwal Nita , Benkeser David C. , Coe Norma B. , Curtis J. Randall
Published: March 2016

Objectives:

To estimate the potential ICU-related cost savings if in-hospital advance care planning and ICU-based palliative care consultation became standard of care for patients with chronic and serious illness.

Design and Setting:

Decision analysis using literature estimates and inpatient administrative data from Premier.

Patients:

Patients with chronic, life-limiting illness admitted to a hospital within the Premier network.

Interventions:

None.

Measurements and Main Results:

Using Premier data (2008–2012), ICU resource utilization and costs were tracked over a 1-year time horizon for 2,097,563 patients with chronic life-limiting illness. Using a Markov microsimulation model, we explored the potential cost savings from the hospital system perspective under a variety of scenarios by varying the interventions’ efficacies and availabilities. Of 2,097,563 patients, 657,825 (31%) used the ICU during the 1-year time horizon; mean ICU spending per patient was 11.3k (sd, 17.6k). In the base-case analysis, if in-hospital advance care planning and ICU-based palliative care consultation were systematically provided, we estimated a mean reduction in ICU costs of 2.8k (sd, 14.5k) per patient and an ICU cost saving of 25%. Among the simulated patients who used the ICU, the receipt of both interventions could have resulted in ICU cost savings of 1.9 billion, representing a 6% reduction in total hospital costs for these patients.

Conclusions:

In-hospital advance care planning and palliative care consultation have the potential to result in significant cost savings. Studies are needed to confirm these findings, but our results provide guidance for hospitals and policymakers.
Nutritional Status Based on Body Mass Index Is Associated With Morbidity and Mortality in Mechanically Ventilated Critically Ill Children in the PICU*
Authors: Bechard Lori J. , Duggan Christopher , Touger-Decker Riva , Parrott J. Scott , Rothpletz-Puglia Pamela , Byham-Gray Laura , Heyland Daren , Mehta Nilesh M.
Published: March 2016

Objective:

To determine the influence of admission anthropometry on clinical outcomes in mechanically ventilated children in the PICU.

Design:

Data from two multicenter cohort studies were compiled to examine the unique contribution of nutritional status, defined by body mass index z score, to 60-day mortality, hospital-acquired infections, length of hospital stay, and ventilator-free days, using multivariate analysis.

Setting:

Ninety PICUs from 16 countries with eight or more beds.

Patients:

Children aged 1 month to 18 years, admitted to each participating PICU and requiring mechanical ventilation for more than 48 hours.

Measurements and Main Results:

Data from 1,622 eligible patients, 54.8% men and mean (sd) age 4.5 years (5.1), were analyzed. Subjects were classified as underweight (17.9%), normal weight (54.2%), overweight (14.5%), and obese (13.4%) based on body mass index z score at admission. After adjusting for severity of illness and site, the odds of 60-day mortality were higher in underweight (odds ratio, 1.53; p < 0.001) children. The odds of hospital-acquired infections were higher in underweight (odds ratio, 1.88; p = 0.008) and obese (odds ratio, 1.64; p < 0.001) children. Hazard ratios for hospital discharge were lower among underweight (hazard ratio, 0.71; p < 0.001) and obese (hazard ratio, 0.82; p = 0.04) children. Underweight was associated with 1.3 (p = 0.001) and 1.6 (p < 0.001) fewer ventilator-free days than normal weight and overweight, respectively.

Conclusions:

Malnutrition is prevalent in mechanically ventilated children on admission to PICUs worldwide. Classification as underweight or obese was associated with higher risk of hospital-acquired infections and lower likelihood of hospital discharge. Underweight children had a higher risk of mortality and fewer ventilator-free days.
Absence of socioeconomic inequalities in access to good-quality breast cancer treatment within a population-wide screening programme in Turin (Italy)
Authors: Zengarini Nicolás , Ponti Antonio , Tomatis Mariano , Casella Denise , Giordano Livia , Mano Maria P. , Segnan Nereo , Whitehead Margaret , Costa Giuseppe , Spadea Teresa
Published: March 2016

Several studies suggest that population-based breast cancer screening programmes might help reduce social inequalities in breast cancer survival both by increasing early diagnosis and by improving access to effective treatments. To start disentangling the two effects, we evaluated social inequalities in quality of treatment of screen-detected breast cancer in the city of Turin (Italy). Combining data from the Audit System on Quality of Breast Cancer Treatment and the Turin Longitudinal Study, we analysed 2700 cases in the screening target age class 50–69 diagnosed in the period 1995–2008. We selected 10 indicators of the pathway of care, relative to timeliness and appropriateness of diagnosis and treatment, and three indicators of socioeconomic position: education, occupational status and housing characteristics. For each indicator of care, relative risks of failure were estimated by robust Poisson regression models, controlling for calendar period of diagnosis, size of tumour and activity volume of the surgery units. The principal predictor of failure of the good care indicators was the calendar period of diagnosis, with a general improvement with time in the quality of diagnosis and treatment, followed by size of the tumour and volume of activity. Socioeconomic indicators show only a marginal independent effect on timeliness indicators. The observed associations of quality indicators with socioeconomic characteristics are lower than expected, suggesting a possible role of the screening programme in reducing disparities in the access to good-quality treatments thanks to its capability to enter screen-detected women into a protected pathway of care.
The mitogen-activated protein kinase pathway plays a critical role in regulating immunological properties of BRAF mutant cutaneous melanoma cells
Authors: Whipple Chery A. , Boni Andrea , Fisher Jan L. , Hampton Thomas H. , Tsongalis Gregory J. , Mellinger Diane L. , Yan Shaofeng , Tafe Laura J. , Brinckerhoff Constance E. , Turk Mary J. , Mullins David W. , Fadul Camilo E. , Ernstoff Marc S.
Published: March 2016

The advent of drugs targeting the mitogen-activated protein kinase (MAPK) pathway has markedly changed the treatment of advanced-stage melanoma harboring BRAF mutations. However, drug resistance, through mechanisms not well elucidated, often occurs. A better understanding of how melanoma-derived immunologically active molecules change in response to MAPK inhibition of BRAF mutated (BRAFV600E) and BRAF wild type (BRAFWT) melanomas could help identify promising treatment combinations of small molecule inhibitors and immunotherapy. To this aim, we treated 13 BRAFWT and 13 BRAFV600E mutated human melanoma cell lines with either a specific BRAFV600E inhibitor or an MEK1/2 inhibitor and analyzed changes in the secretion of 42 selected cytokines, chemokines, and growth factors. We also measured changes in the expression levels of immunologically relevant melanoma cell surface markers. The BRAFWT melanomas showed minimal changes in response to the inhibitors, whereas the BRAFV600E cell lines showed, on average, a significant decrease in IFNα2, interleukin-7, Fractalkine, GCSF, GRO, TGFα2, interleukin-8, and VEGF, as well as a reduction in pERK and pMEK protein levels, upon MAPK pathway blockade. BRAF inhibition in BRAFV600E cell lines also resulted in significant changes in the expression of several surface markers including upregulation of β2-microglobulin as well as a decrease in MIC A/B and TRAIL-R2. These results indicate that MAPK pathway inhibition leads to changes in the immunological properties of mutant BRAFV600E melanoma cells and lends support for future studies aimed at designing effective treatment strategies that combine BRAF and MEK inhibition with immunotherapy.
Vemurafenib in leptomeningeal carcinomatosis from melanoma: a case report of near-complete response and prolonged survival
Authors: Floudas Charalampos S. , Chandra Abhinav B. , Xu Yiqing
Published: March 2016

Targeted therapies such as the BRAF inhibitors vemurafenib and dabrafenib are highly effective in the treatment of systemic metastatic melanoma and have been shown to be effective in controlling solid brain metastases; however, limited data exist on their activity in leptomeningeal spread. Here, we present a case of a 60-year-old woman who developed leptomeningeal carcinomatosis from melanoma after resection and stereotactic radiotherapy of melanoma brain metastases, with poor performance status, who received vemurafenib as first-line treatment, resulting in significant clinical and imaging response as well as prolonged survival.
Induction Therapy for Locally Advanced, Resectable Esophagogastric Cancer
Authors: Boland Patrick M. , Meyer Joshua E. , Berger Adam C. , Cohen Steven J. , Neuman Tzahi , Cooper Harry S. , Olszanski Anthony J. , Davey Monica , Cheng Jonathan D. , Lebenthal Abraham , Burtness Barbara A. , Scott Walter J. , Astsaturov Igor A.
Published: March 2016

Objectives:

Preoperative chemotherapy and radiation for localized esophageal cancer produces cure rates near 30% when combined with surgical resection. Vandetanib, a small molecule receptor tyrosine kinase inhibitor of VEGFR-2, VEGFR-3, RET, and EGFR, demonstrated synergy with radiation and chemotherapy in preclinical models. We conducted a phase I study to assess the safety and tolerability of vandetanib when combined with preoperative chemoradiation in patients with localized esophageal carcinoma who were surgical candidates.

Methods:

Patients with stage II-III esophageal and gastroesophageal junction carcinoma without prior therapy were enrolled in a 3+3 phase I design. Patients received once-daily vandetanib (planned dosing levels of 100, 200, and 300 mg) with concomitant daily radiotherapy (1.8 Gy/d, 45 Gy total) and chemotherapy, consisting of infusional 5-FU (225 mg/m2/d over 96 h, weekly), paclitaxel (50 mg/m2, days 1, 8, 15, 22, 29) and carboplatin (AUC of 5, days 1, 29).

Results:

A total 9 patients were enrolled with 8 having either distal esophageal or gastroesophageal junction carcinomas. All patients completed the planned preoperative chemoradiation and underwent esophagectomy. Nausea (44%) and anorexia (44%) were the most common acute toxicities of any grade. One grade 4 nonhematologic toxicity was observed (gastrobronchial fistula). One additional patient suffered a late complication, a fatal aortoenteric hemorrhage, not definitively related to the investigational regimen. Five (56%) patients achieved a pathologic complete response. Three (33%) additional patients had only microscopic residual disease. Five (56%) patients remain alive and disease free with a median follow-up of 3.7 years and median overall survival of 3.2 years. The maximum tolerated dose was vandetanib 100 mg/d.

Conclusions:

Vandetanib at 100 mg daily is tolerable in combination with preoperative chemotherapy (5-FU, paclitaxel, carboplatin) and radiation therapy with encouraging efficacy worthy of future study.
Anterior Segment Biometry of the Accommodating Intraocular Lens and its Relationship With the Amplitude of Accommodation
Authors: Leng Lin , Chen Qi , Yuan Yimin , Hu Di , Zhu Dexi , Wang Jianhua , Yu Ayong , Lu Fan , Shen Meixiao
Published: March 2016

Objectives:

To evaluate the anterior segment biometry of the Tetraflex accommodating intraocular lens (AIOL) and the contribution of forward movement to the amplitude of accommodation (AMP).

Methods:

Patients who underwent phacoemulsification with implantation of Tetraflex AIOLs and control nonaccommodating intraocular lenses were imaged by custom-built, long scan depth spectral-domain optical coherence tomography at relaxed and maximal accommodative states. Anterior segment biometry was performed and correlated with the clinical manifestation including AMP.

Results:

Patients in the Tetraflex group showed better distance-corrected near visual acuity (logMAR 0.43±0.10 vs. logMAR 0.51±0.10, P<0.05) and greater AMP (1.99±0.58 diopters [D] vs. 1.59±0.45 D, P<0.05) compared with the control group. The measurement of the postoperative anterior chamber depth (ACD) during accommodation showed a forward movement of the AIOLs in 16 eyes (69.6%). Compared with the control group, a greater proportion of cases in the Tetraflex group experienced forward movement (χ2 test, P<0.001). The AMP in the AIOL group negatively correlated with changes in postoperative ACD during accommodation (r=−0.47, P<0.05), whereas AMP in the control group negatively correlated with postoperative pupil diameter (r=−0.57, P<0.05).

Conclusions:

The Tetraflex AIOLs seemed to have a tendency for forward movement; however, the slight forward axial shifts of the Tetraflex AIOL during natural accommodation may not produce a clinically relevant change in optical power.
Chinese Version of Psychometric Evaluation of Self-Reflection and Insight Scale on Taiwanese Nursing Students
Authors: Chen Shu-Yueh , Lai Chen-Chun , Chang Hui-Mei , Hsu Hui-Chen , Pai Hsiang-Chu
Published: March 2016

Background:

Self-reflection (also known as reflection) is an internal process that is difficult to perceive or assess. An instrument that is able to measure self-reflection may serve as a resource for educators to assess the learning process of students and to tailor education approaches to student needs.

Purpose:

The aim of this study was to translate the Self-Reflection and Insight Scale (SRIS) into Chinese and evaluate its psychometric properties for use with Taiwanese nursing students.

Methods:

For this cross-sectional study, nursing students were recruited from two nursing schools in southern Taiwan in two phases: Phase 1, which included 361 fourth-year students, and Phase 2, which included 703 fifth-year students. Data were collected in December 2012 and May 2013 using the Chinese version of the SRIS (SRIS-C), Taiwan Critical Thinking Disposition Inventory, and the Perceived Identity as a Nurse Questionnaire, which was developed by the author. In Phase 1, exploratory factor analysis was used to explore the factor structure of the SRIS-C in the fourth-year student participants. In Phase 2, confirmatory factor analysis was used to determine the fitness of the model for the fifth-year student participants.

Results:

Eight items were deleted from the original SRIS to create the SRIS-C. Thus, the Chinese-version measure had 12 items and two factors (self-reflection and insight) that fit the data well. The Cronbach’s alpha coefficients for the total scale and its two subscales were .79, .87, and .83, respectively. The 3-week test–retest reliability was .74. SRIS-C scores correlated significantly with scores on the Taiwan Critical Thinking Disposition Inventory and the Perceived Identity as a Nurse Questionnaire, indicating good convergent validity for the SRIS-C.

Conclusions:

The current study showed that the SRIS-C has sound psychometric properties. This instrument provides nurse educators with information that may be used to evaluate the self-reflection and insight of students and to develop interventions to effectively improve these skills in Chinese-language-based nursing education.
Impaired Kidney Function and Associated Factors Among Rural Adults With Disabilities in Taiwan
Authors: Chen Chu-Yeh , Chiu Wen-Nan , Lin Yu-Chen , Jane Sui-Hwi , Chiang Hsin-Hung , Chen Mei-Yen
Published: March 2016

Background:

The results of numerous studies indicate that people with disabilities seek more healthcare than those who are not disabled, particularly for conditions such as chronic kidney disease, cardiovascular disease, and obesity. However, little is known about the incidence of impaired kidney function and its associated factors among adults with disabilities in Taiwan.

Purpose:

The aim of this study was to explore the prevalence and factors associated with impaired kidney function among adults with disabilities.

Methods:

This descriptive study was nurse led and was conducted as part of a health promotion program for disadvantaged rural adults with disabilities in Chiayi County, Taiwan. Health screening and a health needs survey were conducted between July and December 2013. Kidney function, physiological biomarkers, health-related behaviors, and demographic characteristics were examined.

Results:

Eight hundred ten rural adults with disabilities were enrolled. The most common disabilities included physical-related disability (33.1%), intellectual-related disability (26.7%), and hearing and vision impairment (18.6%). The prevalence of impaired kidney function in this population was 85%. According to classification for chronic kidney disease, 68.6% were in Stages 1–2, and 16.8% were in Stages 3–4. Univariate analysis showed that impaired kidney function was significantly associated with lower educational level (p < .001), hearing or vision impairment (p < .001), being overweight or obese (p < .05), high systolic blood pressure (p < .01), fasting blood glucose (p < .001), total cholesterol (p < .001), total triglyceride (p < .05), older age (p < .001), smoking (p < .05), chewing betel nuts (p = .001), and low levels of participation in social activities (p < .05). The final logistic regression model showed that residents with disabilities who were older or had less education, high fasting blood glucose, and high total cholesterol tended to have impaired kidney function after adjustment for other potential confounding variables.

Conclusions/Implications for Practice:

Most participants showed impaired kidney function. The factors that were found to relate significantly to this impairment include being overweight, having hyperlipidemia, having hypertension, having high fasting blood glucose, and having an unhealthy lifestyle. Because of the lack of symptoms during the early stages of chronic kidney disease, a community-based health promotion program for these factors is an important element in health advocacy for this vulnerable population.
Income Inequities and Medicaid Expansion are Related to Racial and Ethnic Disparities in Delayed or Forgone Care Due to Cost
Authors: Clark Cheryl R. , Ommerborn Mark J. , A. Coull Brent , Pham Do Quyen , Haas Jennifer S.
Published: March 2016

Background:

Monitoring political and social determinants of delayed or forgone care due to cost is necessary to evaluate efforts to reduce racial and ethnic disparities in access to care. Our objective was to examine the extent to which state Medicaid expansion decisions and personal household income may be associated with individual-level racial and ethnic disparities in delayed or forgone care due to cost, at baseline, before the implementation of the Affordable Care Act.

Methods:

We used 2012 Behavioral Risk Factor Surveillance System survey data to examine racial and ethnic differences in delayed or forgone care due to cost in states that do and do not plan Medicaid expansion. We examined personal household income as a social factor that could contribute to racial and ethnic disparities in delayed or forgone care.

Results:

We found that personal income differences were strongly related to disparities in delayed or forgone care in places with and without plans to expand Medicaid. In addition, while delayed or forgone care disparities between non-Hispanic whites and non-Hispanic blacks were lowest in places with plans to expand Medicaid access, disparities between non-Hispanic whites and Hispanics did not differ by state Medicaid expansion plans.

Conclusions:

As access to insurance improves for diverse groups, health systems must develop innovative strategies to overcome social determinants of health, including income inequities, as barriers to accessing care for Hispanic and non-Hispanic blacks. Additional efforts may be needed to ensure Hispanic groups achieve the benefits of investments in health care access.
Development and Validation of a Simplified Falls Assessment Tool in an Acute Care Setting
Authors: Yip Wai Kin , Mordiffi Siti Zubaidah , Wong Hung Chew , Ang Emily Neo Kim
Published: March 2016

An easy-to-use assessment tool, which contains reversible risk factors, might influence the success of a falls prevention program. A 2-phase study was undertaken to develop and validate a simplified falls assessment tool. Risk factors of confusion, dizziness, altered elimination, and difficulty with mobility were found to be significantly associated with fall status. The simplified falls assessment tool that contains these 4 risk factors yielded a comparable predictive value to Hendrich II Falls Risk Model.
A Measure of Lean Quality Improvement for Hospital Staff Nurses
Authors: Roszell Sheila Serr , Lynn Mary R.
Published: March 2016

In this study, a measure of Lean management was developed and tested. Items were identified using the Delphi technique with literature review and expert responses. Twenty-five nurses pilot-tested the instrument and then 212 nurses in 5 hospitals completed the instrument, and their responses were subjected to exploratory factor analysis. The 75-item instrument includes 12 factors describing Lean management conceptualization. Reliability and validity are acceptable for a new instrument.
Interpersonal Subtypes of Anxiety Disorder Patients
Authors: Pitman Seth R. , Hilsenroth Mark J.
Published: March 2016

We attempted to replicate earlier findings of interpersonal subtypes in patients with anxiety disorder (Psychotherapy. 2011;48:304–310) and examine whether these subtypes are characterized by different types of pathology and respond differently to treatment. Interpersonal problems were measured by the Inventory of Interpersonal Problems (Inventory of Interpersonal Problems Manual. San Antonio, TX: Psychological Cooperation; 2000) in a sample of 31 patients with anxiety disorder. Results demonstrated the existence of 4 interpersonal subtypes. The subtypes did not differ in severity of anxiety and global levels of symptoms at pretreatment or in Reliable Change Index of anxiety symptoms over the course of treatment. However, they were significantly different in terms of overall interpersonal problems (p = 0.004). Regarding treatment variables, half of the patients in the nonassertive cluster discontinued treatment prematurely. The number of psychotherapy sessions attended was significantly different across the 4 clusters (p = 0.04), with socially avoidant patients attending significantly greater number of sessions.
Cytokeratin 17 Expression is Associated With Poor Prognosis in Gallbladder Adenocarcinoma
Authors: Kim Kyungeun , Lee Hyoun Wook , Chae Seoung Wan , Kim Dong-Hoon , Do In Gu , Lee Hyun Joo , Do Sung-Im , Min Kyueng-Whan , Pyo Jung-Soo , Shin Jun-Ho , Sohn Jin Hee
Published: March 2016

Cytokeratin 17 (CK17), a basal/myoepithelial cell keratin, is a poor prognostic marker for cancers of organs such as the stomach, ovary, and breast as well as a useful diagnostic marker for pancreatobiliary adenocarcinoma. However, its expression pattern and prognostic significance have not been studied in gallbladder adenocarcinoma. We constructed a tissue microarray from samples from 82 consecutive patients with gallbladder adenocarcinoma treated by cholecystectomy at the Kangbuk Samsung Hospital from 2000 to 2011. CK17 expression was examined by immunohistochemistry and correlated with clinicopathologic prognostic factors. CK17 stained the cytoplasm of tumor cells and immunohistochemical interpretation was possible in 77 cases. Among these, 41 (53.2%) were considered positive using a 5% cutoff determined by a receiver operating characteristic curve (area under the curve=0.656, P=0.021). CK17 expression was associated with poor tumor differentiation (P<0.001), high pT stage (P<0.001), presence of distant metastasis (P=0.036), and low disease-specific survival rate (P<0.001). These results indicate that CK17 can be used as a marker for poor prognosis for gallbladder adenocarcinoma.
Human Cytomegalovirus is Present in Alveolar Soft Part Sarcoma
Authors: Price Richard L. , Harkins Lualhati , Chiocca Ennio A. , Zhang Paul J. , Kurt Habibe , Iwenofu Obiajulu H.
Published: March 2016

Alveolar soft part sarcoma (ASPS) is an exquisitely rare sarcoma of unknown histogenesis, with a predilection for adolescents and young adults, characterized by slow progressive clinical course and high frequency of metastases. They are traditionally chemoresistant with very limited treatment options in the metastatic setting. Human cytomegalovirus (HCMV) is a DNA β-herpes virus and it is characterized by persistent lifelong and latent infection. There is growing evidence to indicate the presence of HCMV proteins and nucleic acids in glioblastoma, medulloblastoma, rhabdomyosarcoma, and a variety of solid organ malignancies of the breast, prostate, lung, and colon at very high prevalence. Immunotherapy-based clinical trials targeting specific cytomegalovirus proteins are currently in progress in the treatment of glioblastoma. Herein, we evaluated for the presence of HCMV proteins (IE1 and pp65), genes (US28 and UL96), and RNA in a cohort of ASPS. Six confirmed cases of ASPS were retrieved and full thickness sections of formalin-fixed paraffin-embedded material were stained for anti-HMCV-IE1 and anti-HCMV-pp65. Any nuclear and/or cytoplasmic staining was considered positive. DNA was purified from 50 µm of formalin-fixed paraffin-embedded material. One hundred nanogram of DNA was amplified using polymerase chain reaction for primers specific to HCMV-US28 (forward: AGCGTGCCGTGTACGTTAC and reverse: ATAAAGACAAGCACGACC) and HCMV-UL96 (forward: ACAGCTCTTAAAGGACGTGATGCG and reverse: ACCGTGTCCTTCAGCTCGGTTAAA) using Promega Taq polymerase. HCMV in situ hybridization was performed. All 6 cases of ASPS were positive for both HCMV-IE1 and HCMV-pp65. Usable DNA was available in 4 of the 6 cases. HCMV-US28 gene was found in 75% (3/4) of cases and HCMV-UL96 gene was detected in 50% (2/4) of cases. Importantly, all cases tested positive for at least 1 gene. HCMV-encoded RNA was identified in 80% (4/5) of cases. The presence of HCMV DNA, RNA along with HCMV protein indicates that HCMV is present in ASPS and may contribute to its pathogenesis.
Strong NFκB Expression is Associated With High-grade Dysplasia in Barrett’s Esophagus
Authors: El Jamal Siraj M. , Yaseen Alae A. , Alatassi Houda , Slone Stephen , Bishop Barbara J. , Fraig Mostafa
Published: March 2016

Nuclear factor kappa B (NFκB) is a transcription factor that regulates the activation of genes involved in proinflammatory response and growth. In this study, we utilized immunohistochemical stains for 2 of the NFκB molecules (RELA and NFκB-1) to evaluate the expression of NFκB in Barrett’s esophagus (BE). Forty-three cases of BE [17 cases with no dysplasia, 16 cases with low-grade dysplasia (LGD), and 10 cases with high-grade dysplasia (HGD)], 10 normal esophageal biopsies, and 9 cases of esophageal adenocarcinoma were evaluated. Expression of NFκB-1 and RELA did not occur in normal esophageal squamous mucosa. BE without dysplasia showed weak expression of RELA and NFκB-1 in 35% and 65% of cases, respectively. BE with LGD showed weak expression of RELA and NFκB-1 in 50% and 75% of cases, respectively. Strong expression of RELA and NFκB-1 did not occur in BE without dysplasia or with LGD. BE with HGD showed strong expression of RELA and NFκB-1 in 80% and 90% of cases, respectively. All cases of adenocarcinoma showed strong expression of both RELA and NFκB-1. There was a progressive increase in staining intensity of RELA and NFκB-1 along the metaplasia-dysplasia-adenocarcinoma pathway. Strong expression of NFκB is associated with HGD and adenocarcinoma (P<0.0001). We showed that strong expression of NFκB-1 and RELA correlates highly with BE with HGD and adenocarcinoma.
Clinicopathologic Spectrum of Gastrointestinal T-cell Lymphoma
Authors: Tanaka Tsutomu , Yamamoto Hideko , Elsayed Ahmed Ali , Satou Akira , Asano Naoko , Kohno Kei , Kinoshita Tomohiro , Niwa Yasumasa , Goto Hidemi , Nakamura Shigeo , Kato Seiichi
Published: March 2016

The differential diagnosis of primary gastrointestinal EBV−T-cell lymphoma (GITCL) includes enteropathy-associated T-cell lymphoma (EATL), peripheral T-cell lymphoma, not otherwise specified, adult T-cell leukemia/lymphoma, and anaplastic large cell lymphoma. Type II EATL is considered to be a tumor of intraepithelial lymphocytes. However, the evaluation of intraepithelial lymphocytosis by biopsy specimens is challenging, which poses a diagnostic problem between the EATL and peripheral T-cell lymphoma, not otherwise specified. This situation requested us to establish a pragmatic diagnostic approach for the classification of GITCL. We identified 42 cases of GITCL and analyzed clinicopathologic features, especially addressing their T-cell receptor (TCR) phenotype. Nine (21%) of 42 GITCL cases were positive for TCRγ protein expression. Among these TCRγ+cases, TCRβ expression or not was detected in 5 and 4, respectively, but resulted in no further clinicopathologic differences. TCRβ positivity without TCRγ expression (β+γ−) was seen in 9 GITCL patients (21%). Twenty-four patients (57%) were negative for TCRβ and γ expression (β−γ−). Compared with TCRβ+γ−or β−γ−type, TCRγ+cases were characterized by exclusive involvement of intestinal sites (100% vs. 11%,P<0.001; 100% vs. 58%,P=0.032, respectively), but not of stomach (0% vs. 78%,P=0.002; 0% vs. 38%,P=0.039, respectively). Notably, TCRγ positivity was an independent unfavorable prognostic factor among our GITCL patients (P<0.001). Considering our results, TCRγ+GITCL, that is, intestinal γδ T-cell lymphoma, appears to constitute a distinct disease entity.
TFE3-Fusion Variant Analysis Defines Specific Clinicopathologic Associations Among Xp11 Translocation Cancers
Authors: Argani Pedram , Zhong Minghao , Reuter Victor E. , Fallon John T. , Epstein Jonathan I. , Netto George J. , Antonescu Cristina R.
Published: March 2016

Xp11 translocation cancers include Xp11 translocation renal cell carcinoma (RCC), Xp11 translocation perivascular epithelioid cell tumor (PEComa), and melanotic Xp11 translocation renal cancer. In Xp11 translocation cancers, oncogenic activation of TFE3 is driven by the fusion of TFE3 with a number of different gene partners; however, the impact of individual fusion variant on specific clinicopathologic features of Xp11 translocation cancers has not been well defined. In this study, we analyze 60 Xp11 translocation cancers by fluorescence in situ hybridization using custom bacterial artificial chromosome probes to establish their TFE3 fusion gene partner. In 5 cases RNA sequencing was also used to further characterize the fusion transcripts. The 60 Xp11 translocation cancers included 47 Xp11 translocation RCC, 8 Xp11 translocation PEComas, and 5 melanotic Xp11 translocation renal cancers. A fusion partner was identified in 53/60 (88%) cases, including 18 SFPQ (PSF), 16 PRCC, 12 ASPSCR1 (ASPL), 6 NONO, and 1 DVL2. We provide the first morphologic description of the NONO-TFE3 RCC, which frequently demonstrates subnuclear vacuoles leading to distinctive suprabasal nuclear palisading. Similar subnuclear vacuolization was also characteristic of SFPQ-TFE3 RCC, creating overlapping features with clear cell papillary RCC. We also describe the first RCC with a DVL2-TFE3 gene fusion, in addition to an extrarenal pigmented PEComa with a NONO-TFE3 gene fusion. Furthermore, among neoplasms with the SFPQ-TFE3, NONO-TFE3, DVL2-TFE3, and ASPL-TFE3 gene fusions, the RCCs are almost always PAX8 positive, cathepsin K negative by immunohistochemistry, whereas the mesenchymal counterparts (Xp11 translocation PEComas, melanotic Xp11 translocation renal cancers, and alveolar soft part sarcoma) are PAX8 negative, cathepsin K positive. These findings support the concept that despite an identical gene fusion, the RCCs are distinct from the corresponding mesenchymal neoplasms, perhaps due to the cellular context in which the translocation occurs. We corroborate prior data showing that the PRCC-TFE3 RCCs are the only known Xp11 translocation RCC molecular subtype that are consistently cathepsin K positive. In summary, our data expand further the clinicopathologic features of cancers with specific TFE3 gene fusions and should allow for more meaningful clinicopathologic associations to be drawn.
Primary Glial and Neuronal Tumors of the Ovary or Peritoneum
Authors: Liang Li , Olar Adriana , Niu Na , Jiang Yi , Cheng Wenjun , Bian Xiu-Wu , Yang Wentao , Zhang Jing , Yemelyanova Anna , Malpica Anais , Zhang Zhihong , Fuller Gregory N. , Liu Jinsong
Published: March 2016

Primary glial and neuronal tumors of the ovary or peritoneum are rare neuroectodermal-type tumors similar to their counterparts in the central nervous system. We retrospectively reviewed 11 cases. These cases included 4 ependymomas, 6 astrocytic tumors, and 1 neurocytoma. Patients’ age ranged from 9 to 50 years (mean, 26 y; median, 24 y). All ependymal tumors with detailed clinical history (n=3) were not associated with any other ovarian neoplasm. In contrast, all astrocytic tumors were associated with immature teratoma (n=4), mature cystic teratoma (n=1), or mixed germ cell tumor (n=1). The neurocytoma arose in association with mature teratomatous components in a patient with a history of treated mixed germ cell tumor. Immunohistochemical staining showed that 7 of 7 ependymal and astrocytic tumors (100%) were positive for glial fibrillary acidic protein, and 2 of 2 ependymomas (100%) were positive for both estrogen and progesterone receptors. The neurocytoma was positive for synaptophysin and negative for S100 protein, glial fibrillary acidic protein, and SALL4. No IDH1-R132H mutation was detected in 2 of 2 (0%) astrocytomas by immunohistochemistry. Next-generation sequencing was performed on additional 2 ependymomas and 2 astrocytomas but detected no mutations in a panel of 50 genes that included IDH1, IDH2, TP53, PIK3CA, EGFR, BRAF, and PTEN. Follow-up information was available for 8 patients, with the follow-up period ranging from 4 to 59 months (mean, 15 mo; median, 8.5 mo), of which 3 had no evidence of disease and 5 were alive with disease. In conclusion, primary glial and neuronal tumors of the ovary can arise independently or in association with other ovarian germ cell tumor components. Pathologists should be aware of these rare tumors and differentiate them from other ovarian neoplasms. Even though an IDH1 or IDH2 mutation is found in the majority of WHO grade II and III astrocytomas, and in secondary glioblastomas arising from them, such mutations were not identified in our series, suggesting that these tumors are molecularly different from their central nervous system counterparts despite their morphologic and immunophenotypic similarities.
Reaching Adolescents for Prevention
Authors: Bernstein Judith , Dorfman David , Lunstead Julie , Topp Deric , Mamata Hosana , Jaffer Sara , Bernstein Edward
Published: March 2016

Objectives

Almost 200,000 adolescents visit US emergency departments (EDs) yearly for conditions involving underage drinking but receive no follow-up referral. Other health risk behaviors resulting in sexually transmitted infections, car crashes, and assault-related injury are common among adolescents. A pediatric ED (PED) visit presents an opportunity to discuss and promote prevention. We report here on implementation of a new PED navigator/extender role, the Health Promotion Advocate (HPA).

Methods

Health Promotion Advocates surveyed patients to identify health risks, stresses, and needs. A positive screen triggered a brief conversation containing the following elements: permission to discuss risks/needs; exploration of context (a typical day in your life); brief feedback (information and norms); exploration of benefits and consequences of risk behaviors; assessment of readiness to change; calling up assets, instilling hope; discussing challenges of change; negotiating a menu of options and prescription for change; referrals to primary care, community resources; and treatment services as indicated.

Results

During 2009-2013, HPAs screened 2149 PED patients aged 14 to 21 years and referred 834 for an array of services (eg, primary care, mental health, insurance, personal safety, human immunodeficiency virus testing, general education diploma (GED), employment, housing, and food pantries) to address reported health risks; 785 screened positive for at-risk substance use (53% female, 36% without primary care). Among them, 636 received a brief intervention; 546 were referred to specialized substance abuse treatment. Two case studies are presented to illustrate the engagement and referral process.

Conclusions

Health Promotion Advocates working as PED team members can extend PED services beyond the scope of the presenting complaint.