bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Nocturnal Intermittent Peritoneal Dialysis on Intraocular Pressure and Anterior Segment Optical Coherence Tomography Parameters
Authors: Chong Ka Lung , Samsudin Amir , Keng Tee Chau , Kamalden Tengku Ain , Ramli Norlina
Published: September 2016

Purpose:

To evaluate the effect of nocturnal intermittent peritoneal dialysis (NIPD) on intraocular pressure (IOP) and anterior segment optical coherence tomography (ASOCT) parameters. Systemic changes associated with NIPD were also analyzed.

Methods:

Observational study. Nonglaucomatous patients on NIPD underwent systemic and ocular assessment including mean arterial pressure (MAP), body weight, serum osmolarity, visual acuity, IOP measurement, and ASOCT within 2 hours both before and after NIPD. The Zhongshan Angle Assessment Program (ZAAP) was used to measure ASOCT parameters including anterior chamber depth, anterior chamber width, anterior chamber area, anterior chamber volume, lens vault, angle opening distance, trabecular-iris space area, and angle recess area. T tests and Pearson correlation tests were performed with P<0.05 considered statistically significant.

Results:

A total of 46 eyes from 46 patients were included in the analysis. There were statistically significant reductions in IOP (−1.8±0.6 mm Hg, P=0.003), MAP (−11.9±3.1 mm Hg, P<0.001), body weight (−0.7±2.8 kg, P<0.001), and serum osmolarity (−3.4±2.0 mOsm/L, P=0.002) after NIPD. All the ASOCT parameters did not have any statistically significant changes after NIPD. There were no statistically significant correlations between the changes in IOP, MAP, body weight, and serum osmolarity (all P>0.05).

Conclusions:

NIPD results in reductions in IOP, MAP, body weight, and serum osmolarity in nonglaucomatous patients.
Increased spatial dimensions of repetitive heat and cold stimuli in older women
Authors: Naugle Kelly M. , Cruz-Almeida Yenisel , Fillingim Roger B. , Staud Roland , Riley Joseph L.
Published: September 2016

Protocols of temporal summation (TS) of pain typically involve the delivery of brief repetitive noxious pulses of a constant intensity while measuring the perceived intensity of pain after each pulse. The size percept of noxious repetitive stimulation has been poorly characterized. Furthermore, no studies have investigated age differences in TS of cold pain. The current study examined TS of pain intensity and the perceived size of the painful area during repetitive noxious heat and cold pulses in healthy younger (n = 104) and older adults (n = 40). Trials of 10 brief repetitive noxious heat or cold pulses were delivered to the upper extremities. Participants rated the perceived size of the painful area or intensity of pain after each pulse. The magnitude of change for the size percept and intensity for pain were calculated for each trial. The results indicated that older adults experienced greater TS of the size percept of cold stimuli compared with younger adults. Additionally, older women experienced greater TS of the size percept of heat stimuli compared with older men and all younger participants. No overall age or sex differences were found in the TS of pain intensity for cold or heat trials. These results suggest dysfunctional modulation of the spatial percept of the painful stimuli by older adults, and in particular older women, during repetitive noxious thermal pulses.
Withdrawal-associated injury site pain (WISP): a descriptive case series of an opioid cessation phenomenon
Authors: Rieb Launette Marie , Norman Wendy V. , Martin Ruth Elwood , Berkowitz Jonathan , Wood Evan , McNeil Ryan , Milloy M.-J.
Published: September 2016

Withdrawal pain can be a barrier to opioid cessation. Yet, little is known about old injury site pain in this context. We conducted an exploratory mixed-methods descriptive case series using a web-based survey and in-person interviews with adults recruited from pain and addiction treatment and research settings. We included individuals who self-reported a past significant injury that was healed and pain-free before the initiation of opioids, which then became temporarily painful upon opioid cessation—a phenomenon we have named withdrawal-associated injury site pain (WISP). Screening identified WISP in 47 people, of whom 34 (72%) completed the descriptive survey, including 21 who completed qualitative interviews. Recalled pain severity scores for WISP were typically high (median: 8/10; interquartile range [IQR]: 2), emotionally and physically aversive, and took approximately 2 weeks to resolve (median: 14; IQR: 24 days). Withdrawal-associated injury site pain intensity was typically slightly less than participants' original injury pain (median: 10/10; IQR: 3), and more painful than other generalized withdrawal symptoms which also lasted approximately 2 weeks (median: 13; IQR: 25 days). Fifteen surveyed participants (44%) reported returning to opioid use because of WISP in the past. Participants developed theories about the etiology of WISP, including that the pain is the brain's way of communicating a desire for opioids. This research represents the first known documentation that previously healed, and pain-free injury sites can temporarily become painful again during opioid withdrawal, an experience which may be a barrier to opioid cessation, and a contributor to opioid reinitiation.
Transient remission of nonalcoholic fatty liver disease decreases the risk of incident type 2 diabetes mellitus in Japanese men
Authors: Fukuda Takuya , Hamaguchi Masahide , Kojima Takao , Mitsuhashi Kazuteru , Hashimoto Yoshitaka , Ohbora Akihiro , Kato Takahiro , Nakamura Naoto , Fukui Michiaki
Published: September 2016

Introduction

It is unclear how the transient remission of nonalcoholic fatty liver disease (NAFLD) affects incident type 2 diabetes mellitus (T2DM). Here, we sought to determine the effect of the transient remission of NAFLD on incident T2DM in Japanese men.

Materials and methods

We used a population-based health check-up program. The primary outcome was set as incident T2DM. We divided the participants who showed NAFLD at the time of enrollment into three groups according to their clinical course of NAFLD: the Regression group, in which the participants showed a regression of NAFLD and no relapse during the follow-up period; the Transient Remission group, in which participants achieved a transient remission of NAFLD, but had a relapse of NAFLD; and the Persistent group, in which participants showed NAFLD throughout the follow-up. The Never group of participants who did not show NAFLD throughout the follow-up served as a reference.

Results

The incidence rates of T2DM in the Never group, the Regression group, the Transient Remission group, and the Persistent group were 4.7% (62/1306), 9.2% (14/153), 18.0% (25/139), and 35.1% (120/342), respectively. In a multivariate Cox regression analysis with covariates, the adjusted hazard ratios for incident T2DM compared with the Never group were as follows: Regression group: 1.08 [95% confidence interval (CI) 0.53–2.04, P=0.81], Transient Remission group: 2.12 (95% CI 1.22–3.57, P<0.01), and Persistent group: 3.44 (95% CI 2.29–5.21, P<0.001). The adjusted hazard ratio of the Transient Remission group was significantly lower than that of the Persistent group (P<0.05).

Conclusion

Transient remission of NAFLD significantly decreased the risk of developing T2DM.
The role of capsule endoscopy in the diagnosis and treatment of obscure gastrointestinal bleeding in older individuals
Authors: Li Lan , Chen Chunxiao , Li Youming , Zhang Bingling
Published: September 2016

Background/aim

Capsule endoscopy (CE) is currently recommended as the first-line diagnostic modality for the investigation of obscure gastrointestinal bleeding (OGIB). This study aimed to evaluate the diagnostic efficacy of CE and to determine the subsequent impacts on the treatment of the OGIB episode in older individuals.

Methods

Eight hundred and fifty-three patients who underwent CE for the indication of OGIB were investigated in a single center between January 2004 and December 2015. Patients were divided into two groups: those 65 years of age and older and those younger than 65 years of age.

Results

There were no significant differences between older patients and younger patients with respect to the CE completion rate. The diagnostic yield was significantly higher in older patients than in younger patients (55.1 vs. 46.6%, P=0.021). Vascular lesions were the main cause of bleeding in the elderly, whereas ulcerated/erosive lesions were found most frequently in younger patients. Furthermore, 56.0% of older patients with positive CE results had relevant changes in their management plans and received specific treatment on the basis of CE findings.

Conclusion

Our study confirmed the important role of CE in the diagnosis of OGIB and its huge impact on decision making in the management plan for older patients.
Pancreaticoduodenectomy for nonampullary duodenal lesions: indications and results
Authors: Shamali Awad , McCrudden Raymond , Bhandari Pradeep , Shek Fanny , Barnett Emily , Bateman Adrian , Abu Hilal Mohammed
Published: September 2016

Background

Pancreaticoduodenectomy (PD) is a complex procedure, associated with a definite risk of mortality and 30–50% risk of complications. For nonampullary duodenal lesions, PD can carry a higher morbidity as they are more commonly associated with a soft pancreas and narrow-calibre main pancreatic ducts. It is therefore paramount that the risks and benefits of surgery are considered carefully in this group of patients. A preoperative histological diagnosis for duodenal lesions is normally achieved by endoscopic biopsy. In this study, we aim to assess the outcome of PD in patients with nonampullary duodenal lesions and correlate the preoperative endoscopic histology work-up with the definitive postoperative pathology.

Materials and methods

We reviewed a prospectively collected PD database from January 2007 to December 2013. Demographic and clinical data were included. Preoperative endoscopic histology was compared with final specimen histology to assess concordance.

Results

Forty patients (55% women, mean age 69.4 years, range 45–83 years) underwent PD for duodenal lesions over a 7-year time period. The most common presenting symptom was epigastric pain (32.5%), followed by anaemia (20%). Overall, the complication rate was 55%, with the most frequent adverse event being pancreatic fistula in 13/40 (32.5%). The perioperative mortality was 2/40 (5%). Duodenal adenocarcinoma (65%) was the most common postoperative histological diagnosis. The mean tumour size was 36 mm (range 5–103 mm) and a median of 13 nodes were harvested. The median length of stay was 15 days (range 7–66 days). Overall, 12/40 patients (30%) had a preoperative diagnosis of high-grade dysplasia. The postoperative specimen in this subgroup of patients was reviewed carefully and only 3/12 (25%) patients had high-grade dysplasia in the resection specimen. In the remaining patients, 3/12 (25%) had adenocarcinoma in the resection specimen and 6/12 patients (50%) had low-grade dysplasia.

Conclusion

PD carries a high mortality and morbidity, especially for duodenal lesions. We recommend a careful endoscopic review after the index case with a high-definition optical evaluation of duodenal lesions. This, in addition to an experienced histological assessment of the index biopsy material, forms an essential prerequisite in aiding the multidisciplinary team in the decision-making process with respect to triage of these lesions to conservative management, surveillance, endoscopic resection or finally surgical resection.
Virtual Laboratory and Imaging: an online simulation tool to enhance hospital disaster preparedness training experience
Authors: Carenzo Luca , Ragozzino Francesco , Colombo Davide , Barra Federico Lorenzo , Della Corte Francesco , Ingrassia Pier Luigi
Published: September 2016

Objective

Hospitals play a pivotal role as basic healthcare providers during mass casualty incidents (MCIs). Radiological studies and emergency laboratory test are of high importance for the management of hospital patients. However, it is known that during these events, they can generate significant bottlenecks. Appropriate request of such tests is of utmost importance to not generate delays in the patient flow. The aim of this paper is to describe a software designed to increase the realism of hospital-based MCI training through a realistic reproduction of radiology and laboratory departments.

Methods

In this paper, we present a Virtual Laboratory and Imaging system that we designed with the goal of increasing the realism of full-scale mass casualty simulations. The system is able to dynamically manage the speed and load of virtual departments while collecting data on usage and load, and provide data useful for the after-event debriefing. We tested this system in two pilot simulations involving, respectively, 105 and 89 simulated casualties.

Results

The system, by measuring the number of requests and exams’ turnaround time, enabled an objective measurement of the laboratory and radiology workload during simulated MCIs. It was possible to identify bottlenecks and consequently use these data for after-action debriefing.

Conclusion

The tool not only increased the simulation realism by adding the radiology and laboratory departments but also provided valuable data that could be used for educational and organizational purposes.
Needle Phobia
Authors: Cook Lynda S.
Published: September 2016

Venipuncture is generally associated with some degree of pain, discomfort, and/or apprehension. Yet most patients accept it with tolerance, even nonchalance. A few, not only pediatric patients, exhibit a higher degree of anxiety and face the procedure with tears, tension, and a variety of bargaining techniques (ie, stick on the count of 3; use only this vein). But for 1 group of people, venipuncture is associated with such fear that avoidance of the procedure is practiced. The end results are detrimental to the patient and may have an impact on society as well. These are patients the American Psychiatric Association classifies as needle phobic. What can a nurse with no training in psychiatry do to assist these patients? To form an appropriate professional response, it's beneficial for practitioners to recognize the different pathways that lead to needle phobia and the issues related to the disorder.
Innovative Use of Existing Public and Private Data Sources for Postmarketing Surveillance of Central Line-Associated Bloodstream Infections Associated With Intravenous Needleless Connectors
Authors: Tabak Ying P. , Johannes Richard S. , Sun Xiaowu , Crosby Cynthia T. , Jarvis William R.
Published: September 2016

The Centers for Medicare and Medicaid Services (CMS) Hospital Compare central line-associated bloodstream infection (CLABSI) data and private databases containing new-generation intravenous needleless connector (study NC) use at the hospital level were linked. The relative risk (RR) of CLABSI associated with the study NCs was estimated, adjusting for hospital characteristics. Among 3074 eligible hospitals in the 2013 CMS database, 758 (25%) hospitals used the study NCs. The study NC hospitals had a lower unadjusted CLABSI rate (1.03 vs 1.13 CLABSIs per 1000 central line days, P < .0001) compared with comparator hospitals. The adjusted RR for CLABSI was 0.94 (95% confidence interval: 0.86, 1.02; P = .11).
Acid-Base Homeostasis
Authors: Masco Natalie A.
Published: September 2016

Acid-base homeostasis is essential to normal function of the human body. Even slight alterations can significantly alter physiologic processes at the tissue and cellular levels. To optimally care for patients, nurses must be able to recognize signs and symptoms that indicate deviations from normal. Nurses who provide infusions to patients—whether in acute care, home care, or infusion center settings—have a responsibility to be able to recognize the laboratory value changes that occur with the imbalance and appreciate the treatment options, including intravenous infusions.
Fit Minded College Edition Pilot Study: Can a Magazine-Based Discussion Group Improve Physical Activity in Female College Freshmen?
Authors: Pellitteri Katelyn , Huberty Jennifer , Ehlers Diane , Bruening Meg
Published: September 2016

Objective:

Initial efficacy of a magazine-based discussion group for improving physical activity (PA), self-worth, and eating behaviors in female college freshmen.

Design:

Randomized control trial.

Setting:

A large university in southwestern United States.

Participants:

Thirty-seven female college freshmen were randomized to the intervention (n = 17) and control groups (n = 20) in September 2013.

Intervention:

Participants completed an 8-week magazine-based discussion group program, Fit Minded College Edition, adapted from Fit Minded, a previously tested theory-based intervention. Education on PA, self-worth, and nutrition was provided using excerpts from women's health magazines. Participants also had access to a Web site with supplementary health and wellness material. The control group did not attend meetings or have access to the Web site but received the magazines. Interventions focusing on concepts of self-worth with less focus on weight and appearance may promote long term PA participation and healthy eating behaviors in college women.

Main Outcome Measures:

Self-reported PA, global self-worth, knowledge self-worth, self-efficacy, social support, eating behaviors (ie, fruit/veggie/junk food/sugar-sweetened beverage consumption), satisfaction, and Web site usage.

Results:

Mean age of participants was 18.11 (SD = 0.32) years. Time × Intervention effects were observed for PA minutes per week (Partial η2 = 0.34), knowledge self-worth (Partial η2 = 0.02), and daily sugar-sweetened beverage consumption (Partial η2 = 0.17) (P < .05), with the intervention group reporting greater increases in PA and knowledge self-worth and greater decreases in sugar-sweetened beverage consumption.

Conclusions:

A magazine-based discussion group may provide a promising platform to improve health behaviors in female college freshmen.
A New Method to Directly Observe Tuberculosis Treatment: Skype Observed Therapy, a Patient-Centered Approach
Authors: Buchman Tavora , Cabello Celina
Published: September 2016

Context:

Tuberculosis (TB) treatment completion is in part determined by patient's adherence to long-term drug regimens. To best ensure compliance, directly observed therapy (DOT) is considered the standard of practice. Nassau County Department of Health TB Control is responsible for providing DOT to patients with TB.

Objective:

Tuberculosis Control sought to use and evaluate Skype Observed Therapy (SOT) as an alternative to DOT for eligible patients.

Design:

The evaluation included analysis of patient's acceptance and adherence to drug regimen using SOT. Tuberculosis Control assessed staff efficiency and cost savings for this program.

Main Outcome Measures:

Percentages of SOT of patients and successful SOT visits, mileage, and travel time savings.

Results:

Twenty percent of the caseload used SOT and 100% of patients who were eligible opted in. Average SOT success was 79%. Total mileage savings and time saved were $9,929.07 and 614 hours.

Conclusions:

Because SOT saves cost and time and is a suitable alternative to DOT for patients, it should be considered as part of new policies and practices in TB control programs.
Exploring the Link Between Completion of Accreditation Prerequisites and Local Health Departments' Decision to Collaborate With Tax-Exempt Hospitals Around the Community Health Assessment
Authors: Singh Simone R. , Carlton Erik L.
Published: September 2016

Context:

Community health assessments (CHAs) are a core function of local health departments (LHDs). Recently, completing a CHA has become a prerequisite for LHDs seeking accreditation by the Public Health Accreditation Board (PHAB). Similarly, under the Affordable Care Act, nonprofit hospitals are required to conduct periodic community health needs assessments (CHNAs). Opportunities thus exist for LHDs and hospitals to jointly complete CHAs/CHNAs.

Objective:

This study examined existing LHD-hospital collaborations around CHAs/CHNAs, focusing specifically on the relationship between LHDs' level of engagement with PHAB accreditation activities and their collaboration with hospitals around CHAs/CHNAs.

Design:

Data came from the 2013 NACCHO (National Association of County & City Health Officials) Profile Study and the Area Health Resource File. Complete data were available for 1332 LHDs that participated in the 2013 NACCHO Profile Study. Logistic regression explored the relationship between LHDs' completion of accreditation prerequisites, in particular completion of a CHA, community health improvement plan, and strategic plan, and their involvement in collaborations with tax-exempt hospitals around CHAs/CHNAs.

Results:

LHDs that collaborated with tax-exempt hospitals on CHAs/CHNAs were larger, more likely to be locally governed, and more likely to have a local board of health. Bivariate analysis showed that CHA/CHNA-related collaboration with hospitals was significantly correlated (P < .01) with an LHD's completion of accreditation prerequisites. In multivariate regression analysis, completion of all 3 PHAB accreditation prerequisites significantly increased the odds of LHDs collaborating with hospitals when controlling for other LHD and community-level characteristics.

Conclusion:

PHAB accreditation prerequisites together with IRS requirements for hospitals foster potential for collaboration around CHAs/CHNAs. Joint completion of CHAs/CHNAs not only allows partners to complete the assessment more efficiently but has also been shown to produce higher-quality assessments, thus building a strong foundation for continued collaboration to improve community health.
Animal Ownership Among Vulnerable Populations in Regional South Australia: Implications for Natural Disaster Preparedness and Resilience
Authors: Thompson Kirrilly , Trigg Joshua , Smith Bradley
Published: September 2016

Context:

Few studies have examined the prevalence of animal ownership among populations likely to be at greater risk from disaster events within a bushfire context.

Objective:

To investigate the proportion of vulnerable community members keeping animals and the types of animals kept, as well as perceived risk of harm to pets, and their inclusion in bushfire survival planning.

Design:

Statewide anonymous online survey in 2014 of adult South Australian animal owners threatened by bushfire in January 2014. Respondents were asked about animal ownership, their bushfire risk perception, and household survival planning. Descriptive statistics are presented for 5 groups considered likely to contribute to increased risk of harm for households: linguistically diverse, older adults, families with young children, physically frail, and self-identifying disabled, as well as individuals with mental health considerations.

Setting:

An opt-in purposively targeted sample of anonymous South Australians living in high fire-risk locations.

Participants:

Adult South Australian animal owners threatened or directly impacted by bushfire events, including individuals matching 1 of the 5 vulnerable groups.

Main Outcome Measures:

Self-reported details of animal ownership, perceived fire risk, survival planning, and vulnerability characteristics.

Results:

Animal ownership was found to be more prevalent in these 5 populations than in the wider South Australian population. Perceived risk to pets was low to moderately low in these individuals. Variation was observed in the role of animals generally and pets specifically as motivators for preparing bushfire survival plans.

Conclusions:

Emergency services and associated agencies need to consider how the unique needs of vulnerable populations that keep animals, and their potential differences in risk perception, relate to their bushfire survival planning and preparedness requirements.
Using a Theory of Change to Guide Grant Monitoring and Grantmaking
Authors: Glasgow LaShawn , Adams Elizabeth , Joshi Sandhya , Curry Laurel , Schmitt Carol L. , Rogers Todd , Willett Jeffrey , Van Hersh Deanna
Published: September 2016

Charitable foundations play a significant role in advancing public health, funding billions of dollars in health grants each year. Evaluation is an important accountability tool for foundations and helps ensure that philanthropic investments contribute to the broader public health evidence base. While commitment to evaluation has increased among foundations over the past few decades, effective use of evaluation findings remains challenging. To facilitate use of evaluation findings among philanthropic organizations, evaluators can incorporate the foundation's theory of change—an illustration of the presumed causal pathways between a program's activities and its intended outcomes—into user-friendly products that summarize evaluation findings and recommendations. Using examples from the evaluation of the Kansas Health Foundation's Healthy Living Focus Area, we present a mapping technique that can be applied to assess and graphically depict alignment between program theory and program reality, refine the theory of change, and inform grantmaking.
A Practice-Grounded Approach for Evaluating Health in All Policies Initiatives in the United States
Authors: Gase Lauren N. , Schooley Taylor , Lee Meredith , Rotakhina Sierra , Vick John , Caplan Julia
Published: September 2016

Objective:

To address the social determinants of health, an increasing number of public health practitioners are implementing Health in All Policies initiatives aimed at increasing cross-sectoral collaboration and integrating health considerations into decisions made by “nonhealth” sectors. Despite the growth in practice nationally and internationally, evaluation of Health in All Policies is a relatively new field. To help inform evaluation of Health in All Policies initiatives in the United States, this study sought to develop a practice-grounded approach, including a logic model and a set of potential indicators, which could be used to describe and assess Health in All Policies activities, outputs, and outcomes.

Design:

Methods included (a) a review of the literature on current Health in All Policies approaches, practices, and evaluations; and (b) consultation with experts with substantive knowledge in implementing or evaluating Health in All Policies initiatives. Feedback from experts was obtained through individual (n = 11) and group (n = 14) consultation.

Results:

The logic model depicts a range of potential inputs, activities, outputs, and outcomes of Health in All Policies initiatives; example indicators for each component of the logic model are provided. Case studies from California, Washington, and Nashville highlight emerging examples of Health in All Policies evaluation and the ways in which local context and goals inform evaluation efforts.

Conclusion:

The tools presented in this article synthesize concepts present in the emerging literature on Health in All Policies implementation and evaluation. Practitioners and researchers can use the tools to facilitate dialogue among stakeholders, clarify assumptions, identify how they will assess progress, and implement data-driven ways to improve their Health in All Policies work.
Excess Deaths Among the Uninsured Before the Affordable Care Act (ACA), and Potential Post-ACA Reductions
Authors: Powell Dumbiri J. , Xirasagar Sudha
Published: September 2016

Context:

Despite implementation of the Affordable Care Act (ACA), as of 2015, about 25.8 million working-age Americans remained uninsured and vulnerable to premature death because of poor health care access. The ACA-mandated phasing out of disproportionate share hospital payments that supported charity care may aggravate care access for the residual uninsured.

Objectives:

To estimate excess deaths among the uninsured and the potential ACA impact on the basis of a recent cohort's mortality experience. We hypothesized a higher uninsured mortality risk than the available pre-2000 estimate because of worsening of care disparities owing to technology-driven advances in life-saving care.

Design:

We conducted a retrospective cohort study of the 1999 to 2002 National Health and Nutrition Examination Survey respondents observed through 2011. We estimated (a) weighted Cox proportional mortality hazard of uninsured working-age adults adjusted for demographics, comorbidity, and lifestyle behaviors, (b) weighted mortality rates among the uninsured and insured within age and comorbidity strata, and (c) excess deaths because of uninsurance using the Institute of Medicine methodology.

Setting:

Noninstitutionalized US population.

Participants:

Adults aged 20 to 64 years.

Main Outcome Measure:

Mortality.

Results:

Of 7274 study-eligible respondents, 20.6% were uninsured and 478 died during follow-up, for an adjusted uninsured mortality hazard ratio of 1.57 (95% confidence interval, 1.12-2.21) versus privately insured, translating to 48 529 excess deaths among the population aged 25 to 64 years in 2011 (7.8% of total deaths in this age group). The estimated proportion of excess deaths was 52% higher than the pre-2000 cohort study. The mortality disparity increased with age and comorbidity.

Conclusions:

Findings support our hypotheses, and indicate that post-ACA, a residual 4.7% excess mortality among working-age adults will continue, about 30 428 excess deaths annually. Restoration of disproportionate share hospital supports and continued advocacy for universal health care coverage are needed to reduce avoidable deaths.
CDC's “Flexible” Epidemiologist: A Strategy for Enhancing Health Department Infectious Disease Epidemiology Capacity
Authors: Chung Christina , Fischer Leah S. , O'Connor Angelica , Shultz Alvin
Published: September 2016

Context:

CDC's Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) Cooperative Agreement aims to help health departments strengthen core epidemiology capacity needed to respond to a variety of emerging infectious diseases. In fiscal year 2014, $6 million was awarded to 41 health departments for flexible epidemiologists (FEs). FEs were intended to help meet health departments' unique needs and support unanticipated events that could require the diversion of resources to specific emerging or reemerging diseases.

Objective:

Explore multiple perspectives to characterize how FEs are utilized and to understand the perceived value of this strategy from the health department perspective.

Design, Setting, and Participants:

We conducted 14 in-depth interviews using a semistructured questionnaire with a heterogeneous sample of 8 state health departments; 2 different instruments were administered to ELC principal investigators (PIs) or supervisors, and FEs. The team produced a codebook consisting of both structural and data-driven codes to prepare for a thematic analysis of the data.

Results:

Three major patterns emerged to describe how FEs are being used in health departments; most commonly, FEs were used to support priorities and gaps across a range of infectious diseases, with an emphasis on enteric diseases. Almost all of the health departments utilized FEs to assist in investigating and responding to outbreaks, maintaining and upgrading surveillance systems, and coordinating and collaborating with partners. Both PIs and supervisors highly valued the flexibility it offered to their programs because FEs were cross-trained and could be used to help with situations where additional staff members were needed.

Conclusion:

ELC enhances epidemiology capacity in health departments by providing flexible personnel that help sustain areas with losses in capacity, addressing programmatic gaps, and supporting unanticipated events. Our findings support the notion that flexible personnel could be an effective model for strengthening epidemiology capacity among health departments.

Implications for Policy & Practice:

Our findings have practical implications for addressing the overall decline in the public health workforce, as well as the current context and environment of public health funding at both state and federal levels.
Barriers and Facilitators to Scientific Writing Among Applied Epidemiologists
Authors: Pittman Jessica , Stahre Mandy , Tomedi Laura , Wurster Jessica
Published: September 2016

Context:

Communication in the form of written and oral reports and presentations is a core competency for epidemiologists at governmental public health agencies. Many applied epidemiologists do not publish peer-reviewed articles, limiting the scientific literature of best practices in evidence-based public health.

Objectives:

To describe the writing and publishing experiences of applied epidemiologists and identify barriers and facilitators to publishing.

Design:

Telephone focus groups and an 18-question multiple-choice and short-answer Web-based assessment were fielded in 2014.

Setting and Participants:

Six focus groups composed of 26 applied epidemiologists and an online assessment answered by 396 applied epidemiologists. Sample selection was stratified by years of experience.

Main Outcome Measures:

Past publishing experience, current job duties as related to publishing, barriers and facilitators to writing and publishing, and desired training in writing and publishing were assessed through focus groups and the online assessment.

Results:

Focus groups identified 4 themes: job expectations, barriers to publishing, organizational culture, and the understanding of public health practice among reviewers as issues related to writing and publishing. Most respondents (80%) expressed a desire to publish; however, only 59% had published in a peer-reviewed journal. An academic appointment (among doctoral educated respondents) was identified as a facilitator to publishing as was access to peer-reviewed literature. Time (68%) was identified as the greatest barrier to writing and publishing. Other major barriers included lack of encouragement or support (33%) within the public health agency and agency clearance processes (32%). Assistance with journal selection (62%), technical writing skills (60%), and manuscript formatting (57%) were listed as the most needed trainings.

Conclusion:

Public health agencies can be facilitators for epidemiologists to contribute to the scientific literature through increasing access to the peer-reviewed literature, creating a supportive environment for writing and publishing, and investing in desired and needed training. The results have implications for modifying workplace policies surrounding writing and publishing.
Harnessing the Power of the Electronic Medical Record to Facilitate an Opt-Out HIV Screening Program in an Urban Academic Emergency Department
Authors: Lin Janet , Mauntel-Medici Cammeo , Heinert Sara , Baghikar Sara
Published: September 2016

Emergency Departments (EDs) are important settings for routine HIV screening because they are safety nets for populations with limited access to primary care and high risk for HIV infection. However, EDs rarely perform routine HIV screening due to logistical barriers. An electronic medical record (EMR)-driven routine opt-out HIV screening program was implemented in an urban academic ED and led to rapid scale-up of screening volume and detection of unknown HIV infection. The streamlined tool, requiring 4 mouse clicks, automates screening for eligibility, facilitates documentation of consent and orders the HIV test. HIV screening increased to a monthly average of 550 tests compared to an average of 7 tests prior to program implementation. Similar EMR innovations can be leveraged in a variety of other clinical settings and for testing of other diseases to improve clinical flow and outcomes.
Pathways to Program Success: A Qualitative Comparative Analysis (QCA) of Communities Putting Prevention to Work Case Study Programs
Authors: Kane Heather , Hinnant Laurie , Day Kristine , Council Mary , Tzeng Janice , Soler Robin , Chambard Megan , Roussel Amy , Heirendt Wendy
Published: September 2016

Objective:

To examine the elements of capacity, a measure of organizational resources supporting program implementation that result in successful completion of public health program objectives in a public health initiative serving 50 communities.

Design:

We used crisp set Qualitative Comparative Analysis (QCA) to analyze case study and quantitative data collected during the evaluation of the Communities Putting Prevention to Work (CPPW) program.

Setting:

CPPW awardee program staff and partners implemented evidence-based public health improvements in counties, cities, and organizations (eg, worksites, schools).

Participants:

Data came from case studies of 22 CPPW awardee programs that implemented evidence-based, community- and organizational-level public health improvements.

Intervention:

Program staff implemented a range of evidence-based public health improvements related to tobacco control and obesity prevention.

Main Outcome Measure:

The outcome measure was completion of approximately 60% of work plan objectives.

Results:

Analysis of the capacity conditions revealed 2 combinations for completing most work plan objectives: (1) having experience implementing public health improvements in combination with having a history of collaboration with partners; and (2) not having experience implementing public health improvements in combination with having leadership support.

Conclusion:

Awardees have varying levels of capacity. The combinations identified in this analysis provide important insights into how awardees with different combinations of elements of capacity achieved most of their work plan objectives. Even when awardees lack some elements of capacity, they can build it through strategies such as hiring staff and engaging new partners with expertise. In some instances, lacking 1 or more elements of capacity did not prevent an awardee from successfully completing objectives. These findings can help funders and practitioners recognize and assemble different aspects of capacity to achieve more successful programs; awardees can draw on extant organizational strengths to compensate when other aspects of capacity are absent.
Implementation and Operational Research: An Integrated and Comprehensive Service Delivery Model to Improve Pediatric and Maternal HIV Care in Rural Africa
Authors: Gamell Anna , Glass Tracy R. , Luwanda Lameck B. , Mapesi Herry , Samson Leila , Mtoi Tom , Nyamtema Angelo , Muri Lukas , Ntamatungiro Alex , Tanner Marcel , Hatz Christoph , Battegay Manuel , Letang Emilio ,   on behalf of the KIULARCO Study Group
Published: September 2016

Background:

Strategies to improve HIV diagnosis and linkage into care, antiretroviral treatment coverage, and treatment outcomes of mothers and children are urgently needed in sub-Saharan Africa.

Methods:

From December 2012, we implemented an intervention package to improve prevention of mother-to-child transmission (PMTCT) and pediatric HIV care in our rural Tanzanian clinic, consisting of: (1) creation of a PMTCT and pediatric unit integrated within the reproductive and child health clinic; (2) implementation of electronic medical records; (3) provider-initiated HIV testing and counseling in the hospital wards; and (4) early infant diagnosis test performed locally. To assess the impact of this strategy, clinical characteristics and outcomes were compared between the period before (2008–2012) and during/after the implementation (2013–2014).

Results:

After the intervention, the number of mothers and children enrolled into care almost doubled. Compared with the pre-intervention period (2008–2012), in 2013–2014, children presented lower CD4% (16 vs. 16.8, P = 0.08) and more advanced disease (World Health Organization stage 3/4 72% vs. 35%, P < 0.001). The antiretroviral treatment coverage rose from 80% to 98% (P < 0.001), the lost-to-follow-up rate decreased from 20% to 11% (P = 0.002), and mortality ascertainment improved. During 2013–2014, 261 HIV-exposed infants were enrolled, and the early mother-to-child transmission rate among mother–infant pairs accessing PMTCT was 2%.

Conclusions:

This strategy resulted in an increased number of mothers and children diagnosed and linked into care, a higher detection of children with AIDS, universal treatment coverage, lower loss to follow-up, and an early mother-to-child transmission rate below the threshold of elimination. This study documents a feasible and scalable model for family-centered HIV care in sub-Saharan Africa.
Adult-Onset Idiopathic Hypertrophic Pyloric Stenosis Associated With Osteoglophonic Dysplasia and HIV
Authors: Holder Justin , Zinn Daniel , Samin Amiram
Published: September 2016

Adult-onset hypertrophic pyloric stenosis (HPS) is a rare anomaly that can be idiopathic or related to underlying gastric pathology. We describe a case of a 25-year-old man with history of human immunodeficiency virus and osteoglophonic dysplasia who presented with pain and swelling at a gastrostomy site. Computed tomography and upper gastrointestinal barium swallow demonstrated gastric distention and stricture at the distal portion of the gastric antrum. An ultrasound detected HPS. The patient eventually required pyloromyotomy for treatment. Human immunodeficiency virus infection has numerous gastrointestinal ramifications, but HPS has not been identified as one. Osteoglophonic dysplasia has not been an established risk factor for HPS. Idiopathic HPS is extremely rare in adults, but should be considered in this population when patients present with gastric outlet obstruction.
Real-Time Ultrasound Elastographic Features of Primary Open Angle Glaucoma
Authors: Unal Ozlem , Cay Nurdan , Yulek Fatma , Taslipinar Ayse Guzin , Bozkurt Selen , Gumus Mehmet
Published: September 2016

Objective

To investigate the significance of ultrasound elastography for evaluating the optic nerve in patients with primary open angle glaucoma (POAG).

Methods

This prospective, comparative case series included 40 eyes of 40 patients. Twenty eyes with POAG comprised the POAG group, and 20 eyes of 20 patients without glaucoma who admitted to general eye clinic for near vision glasses comprised the control group. All real-time sonographicelastographic examinations were performed by the same physician. The ratio of orbital fat to optic nerve head (ROFON) and lateral rectus to optic nerve head (RLRON) were determined. Statistical analyses were performed using Student t test, Kolmogorov-Smirnov test, and χ2 test.

Results

The mean ages of the patients in the study and the control groups were 65.10 ± 7.88 years (range, 48–80 years), and 69.15 ± 7.92 years (range, 55–89 years), respectively (P = 0.113). Mean ROFONs were 1.85 and 6.42 (P < 0.05), and mean RLRONs were 0.65 and 1.07 (P < 0.05) in the control and POAG groups, respectively.

Conclusions

Real-time elastography showed increased ROFON and RLRON in POAG patients. This can help to understand optic nerve head biomechanics and clarify glaucoma damage in early glaucoma cases.
Testicular Microlithiasis in the Setting of Primary Extragonadal Germ Cell Tumor
Authors: Thompson Joel P. , Jean-Gilles Jerome , Dogra Vikram
Published: September 2016

The clinical significance of testicular microlithiasis (TM) in patients with primary extragonadal germ cell tumor (EGCT) is not well understood. When EGCT is suspected, sonographic and physical examination of the testicles should be performed to evaluate for testicular lesion or atrophy; negative testicular ultrasound with current technology virtually excludes the possibility of occult primary lesion. Although EGCTs are known to be associated with elevated level of serum tumor markers, the utility of tumor markers in the presence of TM is not well understood. Current guidelines for TM follow-up and management do not include any potential correlation between TM and primary EGCT, an association that should be addressed on future updates.
Reliability of Central Adiposity Assessments Using B-Mode Ultrasound
Authors: Stoner Lee , Geoffron Morgane , Cornwall Jon , Chinn Victoria , Gram Martin , Credeur Daniel , Fryer Simon
Published: September 2016

Recently, it was reported that intra-abdominal thickness (IAT) assessments using ultrasound are most reliable if measured from the linea alba to the anterior vertebral column. These 2 anatomical sites can be simultaneously visualized using a linear array transducer. Linear array transducers have different operational characteristics when compared with conventional curved array transducers and are more reliable for some ultrasound-derived measures such as abdominal subcutaneous fat thickness. However, it is unknown whether linear array transducers facilitate more reliable IAT measurements than curved array transducers. The purpose of the current study was to (1) compare the reliability of linear and curved array transducer assessments of IAT and maximal abdominal ratio (MAR) and (2) use the findings to update central adiposity measurement guidelines. Fifteen healthy adults (mean [SD], 27 [10] years; 60% female) with a range of somatotypes (body mass index: mean [SD], 24 [4]; range, 19–33 kg/m2; waist circumference: mean [SD], 75 [11]; range, 61–96 cm) were tested on 3 mornings under standardized conditions. Intra-abdominal thickness was assessed 2 cm above the umbilicus (transverse plane), measuring from linea alba to the anterior vertebral column. Maximal abdominal ratio was defined as the ratio of IAT to abdominal subcutaneous fat thickness. The IAT range was 25 to 87 mm, and the MAR range was 0.15 to 0.77. Between-day intraclass correlation coefficient values for IAT measurements made were comparable (0.96–0.97) for both transducers, as were MAR values (0.95). In conclusion, while both transducers provided equally reliable measurement of IAT, the use of a single linear array transducer simplifies the assessment of central adiposity.
Reductive Analytics on Big MS Data leads to tremendous reduction in time for peptide deduction
Authors: Awan Muaaz Gul , Saeed Fahad
Published: September 2016

In this paper we present a feasibility of using a data-reductive strategy for analyzing big MS data. The proposed method utilizes our reduction algorithm MS-REDUCE and peptide deduction is accomplished using Tide with hiXcorr. Using this approach we were able to process 1 million spectra in under 3 hours. Our results showed that running peptide deduction with smaller amount of selected peaks made the computations much faster and scalable with increasing resolution of MS data. Quality assessment experiments performed on experimentally generated datasets showed good quality peptide matches can be made using the reduced datasets. We anticipate that the proteomics and systems biology community will widely adopt our reductive strategy due to its efficacy and reduced time for analysis.
Ankyrin G membrane partners drive the establishment and maintenance of the axon initial segment
Authors: Leterrier Christophe , Clerc Nadine , Rueda-Boroni Fanny , Montersino Audrey , Dargent Bénédicte , Castets Francis
Published: September 2016

The axon initial segment (AIS) is a specialized neuronal compartment that plays a key role in neuronal development and excitability. It concentrates multiple ion channels and cell adhesion molecules. The anchoring of these AIS membrane components is known to be highly dependent of the scaffold protein ankyrin G (ankG) but whether ankG membrane partners play a reciprocal role in ankG targeting and stabilization has not been studied yet. In cultured hippocampal neurons and cortical organotypic slices, we found that shRNA-mediated knockdown of ankG membrane partners led to a decrease of ankG concentration and perturbed the AIS formation and maintenance. These perturbations were rescued by expressing an AIS-targeted sodium channel, or a minimal construct containing the ankyrin-binding domain of Nav1.2 and a membrane anchor. We thus demonstrate that a tight and precocious association of ankG to its membrane partners is crucial for the establishment and maintenance of the AIS.