bluuebunny/crossref_metadata_2025 huggingface dataset:
FOREST Unbiased Galactic plane Imaging survey with the Nobeyama 45 m telescope (FUGIN): Molecular clouds toward W 33; possible evidence for a cloud–cloud collision triggering O star formation
Authors: Kohno Mikito , Torii Kazufumi , Tachihara Kengo , Umemoto Tomofumi , Minamidani Tetsuhiro , Nishimura Atsushi , Fujita Shinji , Matsuo Mitsuhiro , Yamagishi Mitsuyoshi , Tsuda Yuya , Kuriki Mika , Kuno Nario , Ohama Akio , Hattori Yusuke , Sano Hidetoshi , Yamamoto Hiroaki , Fukui Yasuo
Published: October 2017

We observed molecular clouds in the W 33 high-mass star-forming region associated with compact and extended H ii regions using the NANTEN2 telescope as well as the Nobeyama 45 m telescope in the J = 1–0 transitions of 12CO, 13CO, and C18O as part of the FOREST Unbiased Galactic plane Imaging survey with the Nobeyama 45 m telescope (FUGIN) legacy survey. We detected three velocity components at 35 km s−1, 45 km s−1, and 58 km s−1. The 35 km s−1 and 58 km s−1 clouds are likely to be physically associated with W 33 because of the enhanced 12CO J = 3–2 to J = 1–0 intensity ratio as $R_{\rm 3\mbox{-}2/1\mbox{-}0} > 1.0$ due to the ultraviolet irradiation by OB stars, and morphological correspondence between the distributions of molecular gas and the infrared and radio continuum emissions excited by high-mass stars. The two clouds show complementary distributions around W 33. The velocity separation is too large to be gravitationally bound, and yet not explained by expanding motion by stellar feedback. Therefore, we discuss whether a cloud–cloud collision scenario likely explains the high-mass star formation in W 33.
Factors Influencing the Regional Dynamics of Butternut Canker
Authors: Sambaraju Kishan R. , DesRochers Pierre , Rioux Danny
Published: October 2017

Butternut (Juglans cinerea) is an important component of native biodiversity in eastern North America. Of urgent concern is the survival of butternut, whose populations are declining rapidly, in large part due to an exotic pathogen, Ophiognomonia clavigignenti-juglandacearum, that causes butternut canker. The disease presently occurs throughout the range of butternut in North America, causing branch and stem cankers, dieback, and tree mortality. Despite the existential threat posed by O. clavigignenti-juglandacearum to butternut, a detailed understanding of the factors that drive cross-scale disease patterns is lacking. Therefore, we investigated the association of a range of factors, including tree attributes, topography, and weather, with butternut canker spatial dynamics at different scales using data collected in the province of Quebec, Canada. Trunk canker damage and dieback showed distinct geographic patterns. Bark phenotype was not significantly associated with trunk canker damage. Results suggest that open or dominant trees may show less dieback than intermediate or suppressed trees. Probability of the presence of trunk canker and percent dieback were proportional to the tree diameter at breast height. Temperature was positively associated with disease severity at a 1-km2 scale. Our results provide strong evidence that multiple factors, notably weather, influence butternut canker epidemiology.
Restorative Justice as the Rx for Mistreatment in Academic Medicine: Applications to Consider for Learners, Faculty, and Staff
Authors: Acosta David , Karp David R.
Published: October 2017

The mistreatment of learners is an ongoing issue at U.S. medical schools. According to responses to the 2017 Association of American Medical Colleges Graduation Questionnaire, 39.3% of medical students nationally reported being mistreated. Many articles have been published on the topic of mistreatment at medical schools over the last 20 years. These articles have focused primarily on the definition of mistreatment, the impact of mistreatment, and initiatives put into place to help mitigate the problem. To date, very little attention has been paid to repairing the harm caused by mistreatment and rebuilding community trust. Academic medicine is in need of new forums of interaction to achieve more positive learning and workplace environments.

The authors discuss restorative justice practices and the potential applications that they may have in academic medicine learning and workplace environments to serve vulnerable students, faculty, and staff who are targets of mistreatment. Restorative justice practices are used to convene groups of people to engage in substantive dialogue about consequential issues that impede community functioning. This process can help a group identify and gain mutual understanding of the personal and collective harm that has occurred, create the conditions that incentivize offenders to admit responsibility rather than deny or minimize the harm, and explore and define a set of problem-solving steps to address the harm and rebuild community trust.
Glenohumeral joint morphometry with reference to anatomic shoulder arthroplasty
Authors: Kadavkolan Aditya Sai , Jawhar Ahmed
Published: October 2017

Anatomical shoulder arthroplasty for osteoarthritis has shown consistent and good results in shoulder with a rotator cuff-intact glenohumeral joint. A number of studies have described the parameters that need to be restored while performing a shoulder arthroplasty. Results depend on proper implant selection, positioning, and correct restoration of the glenohumeral parameters. Errors in treating the glenoid pathology, restoring the normal glenohumeral anatomy, and failure in achieving adequate soft-tissue balance are detrimental to the outcome. The present study reviews the normal glenohumeral parameters that need to be restored in an anatomical total shoulder arthroplasty and hemiarthroplasty. Furthermore, avoidable surgical errors while performing an anatomical shoulder arthroplasty are discussed.
Renal Replacement Therapy Modality in the ICU and Renal Recovery at Hospital Discharge*
Authors: Bonnassieux Martin , Duclos Antoine , Schneider Antoine G. , Schmidt Aurélie , Bénard Stève , Cancalon Charlotte , Joannes-Boyau Olivier , Ichai Carole , Constantin Jean-Michel , Lefrant Jean-Yves , Kellum John A. , Rimmelé Thomas
Published: October 2017

Objectives:

Acute kidney injury requiring renal replacement therapy is a major concern in ICUs. Initial renal replacement therapy modality, continuous renal replacement therapy or intermittent hemodialysis, may impact renal recovery. The aim of this study was to assess the influence of initial renal replacement therapy modality on renal recovery at hospital discharge.

Design:

Retrospective cohort study of all ICU stays from January 1, 2010, to December 31, 2013, with a “renal replacement therapy for acute kidney injury” code using the French hospital discharge database.

Setting:

Two hundred ninety-one ICUs in France.

Patients:

A total of 1,031,120 stays: 58,635 with renal replacement therapy for acute kidney injury and 25,750 included in the main analysis.

Interventions:

None.

Measurements Main Results:

PPatients alive at hospital discharge were grouped according to initial modality (continuous renal replacement therapy or intermittent hemodialysis) and included in the main analysis to identify predictors of renal recovery. Renal recovery was defined as greater than 3 days without renal replacement therapy before hospital discharge. The main analysis was a hierarchical logistic regression analysis including patient demographics, comorbidities, and severity variables, as well as center characteristics. Three sensitivity analyses were performed. Overall mortality was 56.1%, and overall renal recovery was 86.2%. Intermittent hemodialysis was associated with a lower likelihood of recovery at hospital discharge; odds ratio, 0.910 (95% CI, 0.834–0.992) p value equals to 0.0327. Results were consistent across all sensitivity analyses with odds/hazards ratios ranging from 0.883 to 0.958.

Conclusions:

In this large retrospective study, intermittent hemodialysis as an initial modality was associated with lower renal recovery at hospital discharge among patients with acute kidney injury, although the difference seems somewhat clinically limited.
NLRP3 Inflammasome Activation Contributes to Mechanical Stretch–Induced Endothelial-Mesenchymal Transition and Pulmonary Fibrosis
Authors: Lv Zhou , Wang Yan , Liu Yu-Jian , Mao Yan-Fei , Dong Wen-Wen , Ding Zhong-Nuo , Meng Guang-Xun , Jiang Lai , Zhu Xiao-Yan
Published: October 2017

Objectives:

Mechanical ventilation can induce lung fibrosis. This study aimed to investigate whether ventilator-induced lung fibrosis was associated with endothelial-mesenchymal transition and to uncover the underlying mechanisms.

Design:

Randomized, controlled animal study and cell culture study.

Setting:

University research laboratory.

Subjects:

Adult male Institute of Cancer Research, NACHT, LRR, and PYD domains-containing protein 3 (NLRP3) knockout and wild-type mice. Primary cultured mouse lung vascular endothelial cells.

Interventions:

Institute of Cancer Research, NLRP3 knockout and wild-type mice were subjected to mechanical ventilation (20 mL/kg) for 2 hours. Mouse lung vascular endothelial cells were subjected to cyclic stretch for 24 hours.

Measurements and Main Results:

Mice subjected to mechanical ventilation exhibited increases in collagen deposition, hydroxyproline and type I collagen contents, and transforming growth factor-β1 in lung tissues. Ventilation-induced lung fibrosis was associated with increased expression of mesenchymal markers (α smooth muscle actin and vimentin), as well as decreased expression of endothelial markers (vascular endothelial–cadherin and CD31). Double immunofluorescence staining showed the colocalization of CD31/α smooth muscle actin, CD31/vimentin, and CD31/fibroblast-specific protein-1 in lung tissues, indicating endothelial-mesenchymal transition formation. Mechanical ventilation also induced NLRP3 inflammasome activation in lung tissues. In vitro direct mechanical stretch of primary mouse lung vascular endothelial cells resulted in similar NLRP3 activation and endothelial-mesenchymal transition formation, which were prevented by NLRP3 knockdown. Furthermore, mechanical stretch–induced endothelial-mesenchymal transition and pulmonary fibrosis were ameliorated in NLRP3-deficient mice as compared to wild-type littermates.

Conclusions:

Mechanical stretch may promote endothelial-mesenchymal transition and pulmonary fibrosis through a NLRP3-dependent pathway. The inhibition of endothelial-mesenchymal transition by NLRP3 inactivation may be a viable therapeutic strategy against pulmonary fibrosis associated with mechanical ventilation.
COMPARISON OF SHORT-TERM EFFICACY BETWEEN ORAL SPIRONOLACTONE TREATMENT AND PHOTODYNAMIC THERAPY FOR THE TREATMENT OF NONRESOLVING CENTRAL SEROUS CHORIORETINOPATHY
Authors: Lee Ji Hwan , Lee Sung Chul , Kim Hyesun , Lee Christopher Seungkyu
Published: October 2017

Purpose:

To compare the short-term therapeutic efficacy of oral spironolactone treatment with that of half-dose photodynamic therapy (PDT) in patients with nonresolving central serous chorioretinopathy.

Methods:

This retrospective, interventional, comparative study included 41 patients with nonresolving central serous chorioretinopathy who exhibited subretinal fluid accumulation for more than 3 months. Of the 41 patients, 18 (18 eyes) received oral spironolactone treatment and 23 (23 eyes) received half-dose PDT. Treatment outcomes, including the central macular thickness, subretinal fluid height, subfoveal choroidal thickness, and best-corrected visual acuity, were measured at baseline and 1 and 3 months after treatment.

Results:

There were no differences in baseline characteristics between the two groups. The central macular thickness and the subretinal fluid height significantly decreased at 1 and 3 months after treatment. The central macular thickness at 1 month was lesser in the PDT group than in the spironolactone group. The subfoveal choroidal thickness decreased at 1 and 3 months only in the PDT group, whereas best-corrected visual acuity showed a significant improvement at 3 months in both groups.

Conclusion:

Our results suggest that the short-term efficacy of oral spironolactone treatment for the management of nonresolving central serous chorioretinopathy is comparable with that of half-dose PDT, with an excellent safety profile.
Excisional Bleb Revision for Management of Failed Ahmed Glaucoma Valve
Authors: Eslami Yadollah , Fakhraie Ghasem , Moghimi Sasan , Zarei Reza , Mohammadi Masoud , Nabavi Amin , Yaseri Mehdi , Izadi Ali
Published: October 2017

Purpose:

To evaluate the outcome of excisonal bleb revision in patients with failed Ahmed glaucoma valve (AGV).

Patients and Methods:

In total, 29 patients with uncontrolled intraocular pressure (IOP) despite of maximal tolerated medical therapy at least 6 months after AGV implantation were enrolled in this prospective interventional case series. Excision of fibrotic tissue around the reservoir with application of mitomycin C 0.02% was performed. IOP, number of glaucoma medications were evaluated at baseline and 1 week and 1, 3, 6, and 12 months postoperatively. Complete and qualified success was defined as IOP≤21 mm Hg with or without glaucoma medications, respectively. Intraoperative and postopervative complications were also recorded.

Results:

Mean IOP was reduced from 30±4.2 mm Hg at baseline to 19.2±3.1 mm Hg at 12-month follow-up visit (P<0.001). Average number of glaucoma medications was decrease from 3.2±0.5 at baseline to 1.9±0.7 at 12-month follow-up (P<0.001). Qualified and complete success rates at 12-month follow-up were 65.5% and 6.9%, respectively. Younger age and higher number of previous glaucoma surgeries were significantly associated with the failure of excisonal bleb revision.

Conclusion:

Excisional bleb revision could be considered as a relatively effective alternative option for management of inadequate IOP control after AGV implantation.
Efficacy of 2 Trabecular Micro-Bypass Stents During Phacoemulsification for Mild to Advanced Primary Open-angle Glaucoma Controlled With Topical Hypotensive Medications
Authors: Buffet Jenna , Brasnu Emmanuelle , Baudouin Christophe , Labbé Antoine
Published: October 2017

Purpose:

The purpose of the current study was to evaluate the efficacy and adverse event profile of 2 trabecular micro-bypass stents implanted during standard phacoemulsification cataract surgery in patients with mild to advanced open-angle glaucoma whose intraocular pressure (IOP) was well controlled by topical medications.

Patients and Methods:

This study was a retrospective analysis of patients with mild to advanced chronic open-angle glaucoma who underwent phacoemulsification and implantation of 2 stents. For all patients, preoperative and postoperative characteristics were evaluated, including number of medications and IOP. Postoperative visits were scheduled at 7 days and at months 1, 6, 12, and 24 after surgery. At each visit, IOP and the number of medications were noted.

Results:

In total, 63 eyes of 41 patients were included in the study. The vast majority of eyes (85.7%) were diagnosed with primary open-angle glaucoma. Preoperative mean IOP at baseline was 16.8±3.0 mm Hg (range, 10 to 24 mm Hg) with a mean of 2.3±0.9 medications. The mean IOP reduction represented a 13% decrease at 1 month (P<0.001), 13% at 6 months (P<0.001), 12% at 1 year (P<0.001), and 10% at 2 years (P<0.001), concomitant with a 23% reduction in the mean number of medications (P<0.001), 35% (P<0.001), 40% (P<0.001), and 40% (P<0.001), respectively, at each scheduled follow-up visit. At 24 months postoperatively, 19 of 23 (83%) patients experienced an IOP decrease compared with the preoperative visit. No severe device-related adverse events were observed.

Conclusions:

Patients with mild to advanced glaucoma can benefit from micro-bypass implantation even if their IOP is well controlled with topical hypotensive medications. Expectations for these reductions should be moderate.
Revision of a Leaking Bleb With XEN Gel Stent Replacement
Authors: Salinas Lauriane , Chaudhary Ankita , Guidotti Jacopo , Mermoud André , Mansouri Kaweh
Published: October 2017

Minimally invasive glaucoma surgery includes different devices which provide a less invasive and safer means of reducing intraocular pressure. The XEN Gel Stent (Allergan Inc., CA) is an ab interno procedure which creates a subconjunctival drainage pathway. It is a new surgical device and there is a paucity of data on complications and their management. We report a clinical case of a leaking bleb after XEN surgery managed by bleb revision, conjunctival suturing, and XEN replacement.
Microphthalmia, Dermal Aplasia, and Sclerocornea Syndrome: Endoscopic Cyclophotocoagulation in the Management of Congenital Glaucoma
Authors: Thompson Atalie C. , Thompson Matthew O. , Lim Maria E. , Freedman Sharon F. , Enyedi Laura B.
Published: October 2017

Purpose:

To report on the use of endoscopic cyclophotocoagulation (ECP) to treat congenital glaucoma in a triple X female with microphthalmia, dermal aplasia, and sclerocornea (MIDAS) syndrome.

Observations:

The patient demonstrated linear streaks on the face and neck consistent with dermal aplasia. The corneas were scleralized with ectatic areas of corneal thinning, and the eyes were microphthalmic. Ultrasound biomicroscopy demonstrated congenital aphakia and iris stumps. The patient had elevated intraocular pressure (IOP) that responded to topical glaucoma therapy in the right but not the left eye. Intraoperative endoscopy of the posterior segment revealed multiple hypopigmented chorioretinal lacunae surrounding a pale, cupped optic nerve. ECP of the ciliary processes in the left eye led to marked improvement in IOP.

Conclusions and Importance:

Patients with MIDAS syndrome can develop congenital glaucoma secondary to angle dysgenesis. This is the first case report to demonstrate the safe and effective use of ECP to treat elevated IOP in a patient with MIDAS.
Postoperative Spinal Implant Infections in Children
Authors: Lamberet Aurore , Violas Philippe , Buffet-Bataillon Sylvie , Hamel Antoine , Launay Elise , Lamberet Romain , Arvieux Cédric , Tattevin Pierre
Published: October 2017

Background:

Postoperative infection is a major complication of spinal surgery with implants. We aimed to identify risk factors for, and characteristics of, postoperative spinal infections in children.

Methods:

We performed a retrospective observational study of all children who underwent posterior spinal fusion with instrumentation in 2 referral hospitals in 2008–2013. Spinal infections were defined as local and/or general signs of infection that required surgical treatment in the early postoperative phase (ie, within 30 days). Data were collected on a standardized questionnaire from medical charts.

Results:

Of the 450 children who underwent spinal surgery, 26 (5.8%) were diagnosed with early postoperative spinal implant infection, with a median age of 14 years (interquartile range, 13–17) and a median delay of 13 days postsurgery (interquartile range, 7–18). Postoperative infection was more common in children with neurologic scoliosis as compared with idiopathic scoliosis (12.2% [15/123] versus 2.4% [5/211]; P < 0.01). Neurologic scoliosis was an independent predictor of spinal implant infections (hazard ratio, 3.87 [1.72–8.69]; P < 0.001). Main pathogens were Staphylococcus aureus (n = 14) and Enterobacteriaceae (n = 8). All children underwent early surgery (wound exploration, debridement and lavage) and antibiotics for a median duration of 19 weeks [interquartile range, 12–26]. Two children (7.7%) required a second surgery. Spinal implants could be retained in all, and no relapse occurred with a follow-up of ≥24 months after antibiotic discontinuation.

Conclusions:

Postoperative spinal implant infection is not rare in pediatric patients, especially with neurologic scoliosis. Most children may be cured with implant retention if managed with early surgery followed by a 3-month course of appropriate antibacterial agents.
Pertussis Outbreak in a Primary School in China
Authors: Liu Xiaoguai , Wang Zengguo , Zhang Juansheng , Li Fang , Luan Yang , Li Hao , Li Yarong , He Qiushui
Published: October 2017

Background:

A pertussis outbreak was studied in a primary school in Xi’an, China, in March 2016. The school consisted of 536 pupils 6–12 years of age who were divided into 12 classes of 6 grades (2 classes for each grade). The identified index case was an 11-year-old girl at class 2 of grade 5.

Methods:

Interview was conducted and nasopharyngeal swabs were taken from all pupils (N = 94) in the 2 classes of grade 5. Nasopharyngeal swabs were tested by both culture and polymerase chain reaction (PCR).

Results:

Four culture- and 17 PCR-positive cases were identified in 94 pupils. Infection rate was significantly higher in class 2 compared with that in class 1 [37.0% (17/46) vs. 14.6% (7/48), χ2 = 4.26, P < 0.05]. All Bordetella pertussis isolates were macrolide-resistant, harbored prn1/ptxP1/fim3-1 as previously reported and belonged to multilocus variable tandem repeat analysis type MLVA 195. Of the 17 DNAs positive for diagnostic PCR, 12 were also positive for 23S ribosomal RNA PCR. All the 12 DNAs had the A2047G mutation of 23S rRNA gene of B. pertussis.

Conclusions:

This study described a pertussis outbreak caused by macrolide-resistant B. pertussis in a primary school and indicated that close contact of index case causes the bacterial transmission.
A Phase II/III Trial of Lopinavir/Ritonavir Dosed According to the WHO Pediatric Weight Band Dosing Guidelines
Authors: Pinto Jorge A. , Capparelli Edmund V. , Warshaw Meredith , Zimmer Bonnie , Cressey Tim R. , Spector Stephen A. , Qin Min , Smith Betsy , Siberry George K. , Mirochnick Mark
Published: October 2017

Background:

The World Health Organization (WHO) recommends weight band dosing of antiretrovirals for children. Data are limited describing drug exposure/safety of lopinavir/ritonavir using WHO weight band dosing.

Methods:

International Maternal Pediatric Adolescent AIDS Clinical Trials (IMPAACT) P1083 was a phase II/III trial assessing the pharmacokinetics (PK) and short-term safety, tolerance and efficacy of lopinavir/ritonavir in human immunodeficiency virus–infected children 3–25 kg dosed according to WHO weight bands, with liquid solution or meltrex extrusion tablets. The main PK target was an area under the curve (AUC0–24) of 80–320 μg·h/mL.

Results:

Of 97 enrolled participants, median age 2.5 years, 89 (91.8%) completed the protocol. Median LPV dose was 303 mg/m2. The geometric mean (90% confidence limits) LPV PK AUC0–24 was 196 (177–217) μg·h/mL and C
min was 2.47 (1.52–4.02) μg/mL. AUC0–24 was within the target range for 79% of participants. The median (Q1, Q3) difference between individual observed PK parameters and those expected if Food and Drug Administration dosing guidelines were followed was 30.7 (7.9, 54.3) for AUC0–24 and 0.56 (0, 1.27) for C
min. Ten (10%) participants had grade 3 or 4 events deemed related to study treatment, mostly asymptomatic laboratory abnormalities. Three participants died of unrelated study treatment causes. At week 24, 57 of 79 (72%) participants reached viral suppression and the median increase in CD4% (n = 83) was 6.0 (P < 0.0001).

Conclusions:

WHO weight band dosing guidelines in children achieved adequate LPV plasma exposure but was higher than that expected with Food and Drug Administration dosing guidelines. Despite the higher LPV exposure, the treatment was well tolerated and the 24-week efficacy data were favorable.
Correlation of MRI to Arthroscopy in the Elbow: Thrower’s Elbow and Ulnar Collateral Ligament Injury
Authors: Ciccotti Michael C. , Stull Justin D. , Buckley Patrick S. , Cohen Steven B.
Published: October 2017

One cannot overstate the importance of a thorough history and physical examination, supplemented with directed imaging, to help pinpoint the exact cause of the athlete’s elbow pain. Although plain radiographs should not be overlooked, advanced imaging plays a critical role in diagnosis and management of pathology in the thrower’s elbow, including computed tomography, magnetic resonance imaging, and stress ultrasound. By judiciously combining these elements, the clinician can appropriately manage these injuries in order to successfully return the athlete to their preinjury level of play.
Magnetic Resonance Imaging (MRI) and Hip Arthroscopy Correlations
Authors: Carstensen Samuel E. , McCrum Erin C. , Pierce Jennifer L. , Gwathmey Frank W.
Published: October 2017

The hip is a complex joint which commonly generates referrals to orthoaedic surgeons. Hip arthroscopy continues to expand its indications for addressing hip pathology. Before operative intervention, the appropriate information must be obtained with magnetic resonance imaging playing a significant role in the workup given its outstanding characterization of soft tissue anatomy. We attempt to highlight multiple hip findings to correlate intraoperative arthroscopic findings with specific magnetic resonance imaging images and sequences.
Emergency Department Burden of Nausea and Vomiting Associated With Cannabis Use Disorder
Authors: Bollom Andrea , Austrie Jasmine , Hirsch William , Nee Judy , Friedlander Daniel , Iturrino Johanna , Ballou Sarah , Lembo Anthony
Published: October 2017

Background and Aims:

Chronic cannabis use is associated with nausea and vomiting that may lead to emergency department (ED) visits, multiple diagnostic tests, and procedures. The aim of this study was to analyze recent trends in ED visits for vomiting associated with cannabis use disorder between 2006 and 2013.

Methods:

Data were obtained from the National Emergency Department Sample records in which vomiting (ICD-9-CM codes 787.01, 787.03, and 536.2) was a primary diagnosis in combination with cannabis abuse or dependence (304.3, 304.30, 304.31, 304.32, 304.33, 305.2, 305.20, 305.21, 305.22, and 305.23) and were seen in the ED between 2006 and 2013. The National Emergency Department Sample collects data from more than 25 million visits in over 950 EDs and is weighted to provide national estimates.

Results:

The rate of ED visits for vomiting with cannabis use disorder from 2006 compared with 2013 increased from 2.3 to 13.3 per 100,000 ED visits, while the mean inflation-adjusted costs increased 68.5% from $2758.43 to $4647.62, respectively. Men between the ages of 20 and 29 were the most common group to present to the ED for vomiting with cannabis use disorder. The Midwest and West had the higher rates of ED visits for vomiting with cannabis use disorder compared with the Northeast and South.

Conclusions:

ED visits for vomiting associated with cannabis use disorder is common and is associated with significant medical costs. Further research on the role of cannabis use in nausea and vomiting is warranted.
EUS-guided Choledochoduodenostomy Versus Hepaticogastrostomy
Authors: Uemura Ricardo S. , Khan Muhammad Ali , Otoch José P. , Kahaleh Michel , Montero Edna F. , Artifon Everson L.A.
Published: October 2017

Background and Aims:

Endoscopic ultrasound-guided biliary drainage (EUS-BD) has emerged as an alternative in cases of endoscopic retrograde cholangiopancreatography (ERCP) failure. Two types of EUS-BD methods for achieving biliary drainage when ERCP fails are choledochoduodenostomy (CDS) or hepaticogastrostomy (HGS). However, there is no consensus if one approach is better than the other. Therefore, we conducted a systematic review and meta-analysis to evaluate these 2 main EUS-BD methods.

Methods:

We searched MEDLINE, Embase, Scopus, Cochrane database, LILACS from inception through April 8, 2017, using the following search terms in various combinations: biliary drainage, biliary stent, transluminal biliary drainage, choledochoduodenostomy, hepaticogastrostomy, endoscopic ultrasound-guided biliary drainage. We selected studies comparing CDS and HGS in patients with malignant biliary obstruction with ERCP failure. Pooled odds ratio (OR) were calculated for technical success, clinical success, and adverse events and difference of means calculated for duration of procedure and survival after procedure.

Results:

A total of 10 studies with 434 patients were included in the meta-analysis: 208 underwent biliary drainage via HGS and the remaining 226 via CDS. The technical success for CDS and HGS was 94.1% and 93.7%, respectively, pooled OR=0.96 [95% confidence interval (CI)=0.39-2.33, I
2=0%]. Clinical success was 88.5% in CDS and 84.5% in HGS, pooled OR=0.76 (95% CI=0.42-1.35, I
2=17%). There was no difference for adverse events OR=0.97 (95% CI=0.60-1.56), I
2=37%. CDS was about 2 minutes faster with a pooled difference in means of was −2.69 (95% CI=−4.44 to −0.95).

Conclusion:

EUS-CDS and EUS-HGS have equal efficacy and safety, and are both associated with a very high technical and clinical success. The choice of approach may be selected based on patient anatomy.
Adaptation and Validation of the Combined Comorbidity Score for ICD-10-CM
Authors: Sun Jenny W. , Rogers James R. , Her Qoua , Welch Emily C. , Panozzo Catherine A. , Toh Sengwee , Gagne Joshua J.
Published: October 2017

Background:

The combined comorbidity score, which merges the Charlson and Elixhauser comorbidity indices, uses the ninth revision of the International Classification of Diseases, Clinical Modification (ICD-9-CM). In October 2015, the United States adopted the 10th revision (ICD-10-CM).

Objective:

The objective of this study is to examine different coding algorithms for the ICD-10-CM combined comorbidity score and compare their performance to the original ICD-9-CM score.

Methods:

Four ICD-10-CM coding algorithms were defined: 2 using General Equivalence Mappings (GEMs), one based on ICD-10-CA (Canadian modification) codes for Charlson and Elixhauser measures, and one including codes from all 3 algorithms. We used claims data from the Clinfomatics Data Mart to identify 2 cohorts. The ICD-10-CM cohort comprised patients who had a hospitalization between January 1, 2016 and March 1, 2016. The ICD-9-CM cohort comprised patients who had a hospitalization between January 1, 2015 and March 1, 2015. We used logistic regression models to predict 30-day hospital readmission for the original score in the ICD-9-CM cohort and for each ICD-10-CM algorithm in the ICD-10-CM cohort.

Results:

Distributions of each version of the score were similar. The algorithm based on ICD-10-CA codes [c-statistic, 0.646; 95% confidence interval (CI), 0.640–0.653] had the most similar discrimination for readmission to the ICD-9-CM version (c, 0.646; 95% CI, 0.639–0.653), but combining all identified ICD-10-CM codes had the highest c-statistic (c, 0.651; 95% CI, 0.644–0.657).

Conclusions:

We propose an ICD-10-CM version of the combined comorbidity score that includes codes identified by ICD-10-CA and GEMs. Compared with the original score, it has similar performance in predicting readmission in a population of United States commercially insured individuals.
Influence of Nonindex Hospital Readmission on Length of Stay and Mortality
Authors: Burke Robert E. , Jones Christine D. , Hosokawa Patrick , Glorioso Thomas J. , Coleman Eric A. , Ginde Adit A.
Published: October 2017

Importance:

Hospitals and health care systems face increasing accountability for postdischarge outcomes of patients, but it is unclear how frequently hospital readmissions in particular occur at a different hospital than the index hospitalization and whether this is associated with worse outcomes.

Objective:

Describe the prevalence of nonindex 30-day readmissions in a nationally representative sample of all payers and associations with outcomes.

Design:

Secondary retrospective analysis of the 2013 Nationwide Readmissions Database.

Setting:

Nonfederal hospitals from 21 states representing half of hospitalizations in the United States annually.

Participants:

Our overall sample included all adults discharged alive from an inpatient stay with 30 days of follow-up; we also created 3 additional cohorts: patients with Medicare as the payer (Medicare cohort), patients discharged to home health or skilled nursing facilities after discharge (postacute care cohort), and Medicare patients with any of the current Hospital Readmission Reduction Program’s penalized conditions (readmission penalty cohort).

Exposure:

Readmission within 30 days to “index” hospital (where index stay occurred) or “nonindex” hospital.

Main Outcome(s) and Measure(s):

In-hospital mortality and length of stay during the readmission.

Results:

The weighted overall sample included 22,884,505 hospital discharges from 2004 unique hospitals. The overall 30-day readmission rate was 11.9%, of these, 22.5% occurred at a nonindex hospital. Readmissions to nonindex facilities were associated with increased odds of in-hospital mortality (odds ratio, 1.21; 95% confidence interval, 1.17–1.25) and longer hospital length of stay (hazard ratio for hospital discharge, 0.87; 95% confidence interval, 0.86–0.88) in the overall sample and in the 3 cohorts.

Conclusions and Relevance:

Nonindex readmissions are common and associated with worse outcomes; the common findings across cohorts highlight the importance for hospitals and care systems participating in value-based payment models. Hospitals and care systems should invest in improved methods for real-time identification and intervention for these patients.
Intensive Outpatient Program Effects on High-need Patients’ Access, Continuity, Coordination, and Engagement
Authors: Wu Frances M. , Slightam Cindie A. , Wong Ava C. , Asch Steven M. , Zulman Donna M.
Published: October 2017

Objective:

The intensive and varied services required by high-need patients have inspired a number of new care delivery models; however, evidence of their effectiveness is mixed. This study evaluated whether augmenting a patient-centered medical home (PCMH) with intensive outpatient management enhances high-need patients’ care processes.

Research Design:

Retrospective analysis using differences-in-differences and χ2 tests.

Subjects:

Of 545 high-need patients receiving PCMH care, 140 were previously randomly selected for the intensive outpatient management program; the remaining received usual care.

Measures:

We evaluated program effects on care continuity (proportion of primary care visits with assigned primary care physician); access (proportion of telephone visits out of all primary care encounters, missed appointment rate); care coordination (rate of follow-up after hospital discharge, new telehealth enrollment); and patient engagement (rates of online personal health record registration, advance directive completion).

Results:

Compared with patients receiving usual care, patients enrolled in intensive management experienced a 5.9% increase in proportion of primary care visits with an assigned primary care physician (P<0.001) and a 17.9% increase in proportion of telephone-based visits (P<0.001). Patients in the program had 7.5% higher rates of telehealth referral (P=0.01), 17.2% higher rates of advance directive completion (P<0.01), and 9.3% higher rates of personal health record registration (P=0.02). There was no effect on missed appointments or posthospital discharge visit rates.

Conclusions:

Augmenting a PCMH with intensive outpatient management may have positive effects on primary care processes related to continuity, access, coordination, and patient engagement.
Women Firefighters and Workplace Harassment
Authors: Hom Melanie A. , Stanley Ian H. , Spencer-Thomas Sally , Joiner Thomas E.
Published: October 2017

This cross-sectional study investigated the association between harassment, career suicidality, and psychiatric symptoms among women firefighters. Women firefighters (n = 290) completed self-report measures of experiences with harassment on the job, career suicidality, and various psychiatric symptoms. Logistic regression analyses and one-way analyses of variance were used to address study aims. Of the sample, 21.7% reported having experienced sexual harassment and 20.3% reported having been threatened or harassed in another way on their firefighting job. Sexual harassment and other threats/harassment on the job were both significantly associated with a greater likelihood of reporting career suicidal ideation, as well as reporting more severe psychiatric symptoms. Harassment and threats experienced on the job may be associated with increased suicide risk and more severe psychiatric symptoms among women firefighters. Efforts are needed to reduce the occurrence of harassment and threats within the fire service and provide support for women firefighters who have been harassed or threatened.
The Impact of the Endovascular Treatment of Cerebral Aneurysms on Headaches
Authors: Assadi Mitra , Binning Mandy , Liebman Kenneth , Veznedaroglu Erol
Published: October 2017

Objective:

The co-occurrence of headaches and cerebral aneurysms is common in clinical practice, although a clear causal relationship has not been ascertained. We aimed to investigate the impact of endovascular obliteration of aneurysms on headaches using a cross-sectional, prospective, open-label protocol. We also sought to characterize the preexisting headaches in patients harboring cerebral aneurysms using the International Classification of Headache Disorders criteria.

Methods:

A total of 33 patients were recruited into the study and underwent endovascular treatment for obliteration of their aneurysms. A standardized survey was administered before and 3 to 6 months after the procedure, documenting the HIT-6 scores as well as the headache frequency.

Results:

The study cohort included 25 women and 8 men. In 61% of cases, the aneurysms were located in the posterior circulation. We achieved grade 0 or 1 obliteration of aneurysms in 100% of cases and there were no complications. The mean for HIT-6 scores were 52.3 at baseline and 49.6 postprocedure (student t test, P<0.047). The headache frequency measured as total headache days per month did not demonstrate statistical significance. Our data indicated that more than half of our cohort had preexisting headaches which fulfilled the criteria for a primary headache disorder. These individuals showed a more robust response to the intervention compared with the remainder of the group, although the P-value per se was not considered statistically significant due to the small sample size.

Conclusions:

Endovascular treatment of the aneurysms mitigates the headache-related disability.
Sustaining Teamwork Behaviors Through Reinforcement of TeamSTEPPS Principles
Authors: Lee Soo-Hoon , Khanuja Harpal S. , Blanding Renee J. , Sedgwick Jeanne , Pressimone Kathleen , Ficke James R. , Jones Lynne C.
Published: October 2017

Background

Teamwork training improves short-term teamwork behaviors. However, improvements are often not sustained.

Question/Purpose

The purpose of this study was to explore the extent to which teamwork reinforcement activities for orthopedic surgery teams lead to sustained teamwork behaviors.

Methods

Seven months after 104 staff from an orthopedic surgical unit were trained in Team Strategies and Tools to Enhance Performance and Patient Safety principles, 4 reinforcement activities were implemented regarding leadership and communication: lectures with videos on leadership skills for nursing staff; an online self-paced learning program on communication skills for nursing staff; a 1-page summary on leadership skills e-mailed to surgical staff; and a 1-hour perioperative grand rounds on Team Strategies and Tools to Enhance Performance and Patient Safety principles for anesthesia staff and new staff. Twenty-four orthopedic surgical teams were evaluated on teamwork behaviors during surgery by 2 observers before and after the reinforcement period using the Observational Teamwork Assessment for Surgery tool.

Results

After reinforcement, leadership (P = 0.022) and communication (P = 0.044) behaviors improved compared with prereinforcement levels. Specifically, nursing staff improved in leadership (P = 0.016) and communication (P = 0.028) behaviors, surgical staff improved in leadership behaviors (P = 0.009), but anesthesia staff did not improve in any teamwork behaviors.

Conclusions

Sustained improvement in teamwork behaviors requires reinforcement.

Level of Evidence

Level III, prospective pre-post cohort study.
Learning From Morbidity and Mortality Conferences: Focus and Sustainability of Lessons for Patient Care
Authors: de Vos Marit S. , Hamming Jaap F. , Marang-van de Mheen Perla J.
Published: October 2017

Objective

It remains unclear to what extent the morbidity and mortality conference (M&M) meets the objective of improving quality and safety of patient care. It has been suggested that M&M may be too focused on individual performance, hampering system-level improvement. The aim of this study was to assess focus and sustainability of lessons for patient care that were derived from M&M.

Methods

This is an observational study of routinely collected data on evaluated complications and identified lessons at surgical M&M for 8 years, assessing type and recurrence of lessons and cases from which these were drawn. Semistructured interviews with clinicians were qualitatively analyzed to explore factors contributing to lesson focus and recurrence.

Results

Three hundred eighteen lessons were drawn from 10,883 evaluated complications, primarily for those that were more severe, related to surgical or other treatment, and occurring in nonemergent, lower risk cases (all P < 0.001). Most lessons targeted intraoperative (43%) rather than preoperative or postoperative care as well as specifically technical (87%) and individual-level issues (74%). There were 43 recurring lessons (14%), mostly about postoperative care (47%) and medication management (50%). Interviewed clinicians attributed the intraoperative, technical focus primarily to greater appeal and control but identified an array of factors contributing to lesson recurrence, such as typical staff turnover in teaching hospitals.

Conclusions

This study provided empirical evidence that learning at M&M has a tendency to focus on intraoperative, technical performance, with challenges to sustain lessons for more system-level issues. Morbidity and mortality conference formats need to anticipate these tendencies to ensure a wide focus for learning with lasting and wide impact.
The Effects of Oxygen and Treatments in Hypoxic Conditions in SH-SY5Y Cells
Authors: Cho Young-Duck , Choi Sung-Hyuk , Yoon Young-Hoon , Kim Jung-Youn , Park Sung-Jun , Lim Chae-Seung
Published: October 2017

Many patients are admitted to the emergency department due to trauma. Patients with massive hemorrhage and respiratory failure can fall into hypovolemic shock. Thereafter, oxygen is an essential part of the treatment of trauma patients, but the mechanisms of its effects in the management of trauma patients remain unknown. Therefore, we conducted an experiment to apply hypoxia, hyperoxia, and other treatment with the goal of decreasing hypoxic neuronal cells damage, as reflected by cell survival, apoptosis, hydrogen peroxide (H2O2) production, and hypoxia-inducible factor 1α (HIF) expression in SH-SY5Y cells. Under hypoxic insults, cell survival percentages decreased and apoptosis was seen with increased necrotic cell death. High-pressure oxygen (80% O2) had no effect compared with normal-pressure oxygen (20% O2). After exposure to hypoxia, H2O2production and levels of HIF significantly increased compared with normoxia. However, when pentoxifylline (PTX), steroid, and hypertonic saline (HTS) were added after exposure to hypoxic conditions, the production of H2O2and HIF levels significantly decreased in the groups treated with PTX and HTS. That is, the neuroprotective effect of PTX and HTS alleviated the impacts of hypoxic insulted on neuronal cells.
Many-body localization: stability and instability
Authors: De Roeck Wojciech , Imbrie John Z.
Published: October 2017

Rare regions with weak disorder (Griffiths regions) have the potential to spoil localization. We describe a non-perturbative construction of local integrals of motion (LIOMs) for a weakly interacting spin chain in one dimension, under a physically reasonable assumption on the statistics of eigenvalues. We discuss ideas about the situation in higher dimensions, where one can no longer ensure that interactions involving the Griffiths regions are much smaller than the typical energy-level spacing for such regions. We argue that ergodicity is restored in dimension
d
>1, although equilibration should be extremely slow, similar to the dynamics of glasses.

This article is part of the themed issue ‘Breakdown of ergodicity in quantum systems: from solids to synthetic matter’.
Tuwongella immobilis gen. nov., sp. nov., a novel non-motile bacterium within the phylum Planctomycetes
Authors: Seeger Christian , Butler Margaret K. , Yee Benjamin , Mahajan Mayank , Fuerst John A. , Andersson Siv G. E.
Published: October 2017

A gram-negative, budding, catalase negative, oxidase positive and non-motile bacterium (MBLW1T) with a complex endomembrane system has been isolated from a freshwater lake in southeast Queensland, Australia. Phylogeny based on 16S rRNA gene sequence analysis places the strain within the family

Planctomycetaceae

, related to

Zavarzinella formosa

(93.3 %),

Telmatocola sphagniphila

(93.3 %) and

Gemmata obscuriglobus

(91.9 %). Phenotypic and chemotaxonomic analysis demonstrates considerable differences to the type strains of the related genera. MBLW1T displays modest salt tolerance and grows optimally at pH values of 7.5–8.0 and at temperatures of 32–36 °C. Transmission electron microscopy analysis demonstrates the presence of a complex endomembrane system, however, without the typically condensed nucleoid structure found in related genera. The major fatty acids are 16 : 1 ω5c, 16 : 0 and 18 : 0. Based on discriminatory results from 16S rRNA gene sequence analysis, phenotypic, biochemical and chemotaxonomic analysis, MBLW1T should be considered as a new genus and species, for which the name Tuwongella immobilis gen. nov., sp. nov. is proposed. The type strain is MBLW1T (=CCUG 69661T=DSM 105045T).
Whole Genomes Define Concordance of Matched Primary, Xenograft, and Organoid Models of Pancreas Cancer
Authors: Gendoo Deena M.A. , Denroche Robert E. , Zhang Amy , Radulovich Nikolina , Jang Gun Ho , Lemire Mathieu , Fischer Sandra , Chadwick Dianne , Lungu Ilinca M. , Ibrahimov Emin , Cao Ping-Jiang , Stein Lincoln D. , Wilson Julie M. , Bartlett John M.S. , Tsao Ming-Sound , Dhani Neesha , Hedley David , Gallinger Steven , Haibe-Kains Benjamin
Published: October 2017

Pancreatic ductal adenocarcinoma (PDAC) has the worst prognosis among solid malignancies and improved therapeutic strategies are needed to improve outcomes. Patient-derived xenografts (PDX) and patient-derived organoids (PDO) serve as promising tools to identify new drugs with therapeutic potential in PDAC. For these preclinical disease models to be effective, they should both recapitulate the molecular heterogeneity of PDAC and validate patient-specific therapeutic sensitivities. To date however, deep characterization of PDAC PDX and PDO models and comparison with matched human tumour remains largely unaddressed at the whole genome level. We conducted a comprehensive assessment of the genetic landscape of 16 whole-genome pairs of tumours and matched PDX, from primary PDAC and liver metastasis, including a unique cohort of 5 ‘trios’ of matched primary tumour, PDX, and PDO. We developed a new pipeline to score concordance between PDAC models and their paired human tumours for genomic events, including mutations, structural variations, and copy number variations. Comparison of genomic events in the tumours and matched disease models displayed single-gene concordance across major PDAC driver genes, and genome-wide similarities of copy number changes. Genome-wide and chromosome-centric analysis of structural variation (SV) events revealed high variability across tumours and disease models, but also highlighted previously unrecognized concordance across chromosomes that demonstrate clustered SV events. Our approach and results demonstrate that PDX and PDO recapitulate PDAC tumourigenesis with respect to simple somatic mutations and copy number changes, and capture major SV events that are found in both resected and metastatic tumours.