bluuebunny/crossref_metadata_2025 huggingface dataset:
Incidence of Antiphospholipid Antibodies in Patients With Immune Thrombocytopenia and Correlation With Treatment With Steroids in North Indian Population
Authors: Dayama Aniruddha , Dass Jasmita , Mahapatra Manoranjan , Saxena Renu
Published: April 2016

Introduction:

Antiphospholipid antibodies (APLAs) have been variably reported in 14% to 75% of patients with immune thrombocytopenia (ITP). There is lack of Indian data on incidence of APLA in ITP.

Objective:

We studied the incidence of APLA in patients with pediatric and adult Indian ITP.

Materials and Methods:

We prospectively studied 100 patients including acute (n = 37), persistent (n = 13), and chronic (n = 50) ITP. Male to female ratio was 1.22:1. Median age was 18 years (1.5-56). All patients underwent investigations for lupus anticoagulant (LA), anticardiolipin (aCL) immunoglobulin G (IgG) and IgM antibodies, and anti-β2 glycoprotein 1 (β2GP1) IgG and IgM antibodies. Patients with secondary ITP were excluded. Bleeding manifestations were recorded. Patients with acute and persistent ITP were assessed for steroid response. Response rates were compared between APLA-positive and APLA-negative patients.

Results:

Antiphospholipid antibodies were detected in ∼12% of patients with ITP: 8.1% (3 of 37) in acute, 0% (0 of 13) in persistent, and 18% (9 of 50) in chronic ITP. Anti-β2GP1 antibodies were most frequent (9%). Only 2 patients each were positive for anti-aCL antibodies and LA. Although platelet counts were significantly higher in APLA-positive patients, there was no significant difference in bleeding between the APLA-positive versus APLA-negative patients with ITP. There was also no significant difference in steroid response between APLA-positive and APLA-negative patients with acute/persistent ITP. In the short follow-up (median 8 months), none of the APLA-positive patients developed thrombosis.

Conclusions:

Incidence of APLA in Indian population was lower than reported in the West, which indicates that not all patients of ITP need to be subjected to these manifestations upfront at diagnosis.
Testing of a Statewide Initiative to Enhance Depression Care in Older Home Care Patients
Authors: Delaney Colleen , Barrere Cynthia , Grimes Rita , Apostolidis Beka
Published: April 2016

Late-life depression is becoming increasingly prevalent among older adults in the United States and is predictive of a wide range of negative health-related outcomes. Fourteen home care agencies participated in a quasi-experimental, pre-test, post-test design of a depression screening training program nested within a two-cycle, phased introduction of the intervention. The primary aim of this study was to evaluate the effects of the program at three levels of outcomes: the trainers, the trainees, and the agencies. There was a significant increase in the knowledge and self-efficacy of the trainers and trainees and a trend toward decreased hospitalization.
Modeling memory access behavior for data mapping
Authors: Diener Matthias , Cruz Eduardo HM , Navaux Philippe OA
Published: April 2016

Many modern parallel architectures feature a nonuniform memory access (NUMA) behavior since they contain several memory controllers. In such architectures, deciding where to place memory pages has a high influence on the performance of parallel applications. This placement of pages to NUMA nodes is called data mapping. Two basic types of data mapping policies exist, focusing on improving the locality or the balance of memory accesses. In this article, we introduce a comprehensive set of metrics to characterize the memory access behavior of parallel applications with the aim of describing their suitability for different data mapping policies. We present and evaluate different policies that improve locality, balance, or both. Experiments were performed on three highly different NUMA architectures with two parallel benchmark suites. Results show that the improvements of the policies depend on the characteristics of the architectures and applications, and that our characterization has a high accuracy regarding the behavior. We also find that a mixed policy, which takes both locality and balance into account, can lead to the highest gains overall, while avoiding the performance losses that are caused by applying simple policies that focus only on one metric.
Growth Deficiency in Cystic Fibrosis Is Observable at Birth and Predictive of Early Pulmonary Function
Authors: Darrah Rebecca , Nelson Rebecca , Damato Elizabeth G. , Decker Michael , Matthews Anne , Hodges Craig A.
Published: April 2016

Introduction:

Cystic fibrosis (CF) is a complex disease that includes both pulmonary and gastrointestinal challenges, resulting in decreased weight. Pulmonary symptoms of CF are extremely variable. Greater body mass at an early age is associated with improved pulmonary function, but it is unknown at what age weight becomes predictive of pulmonary disease severity. The purpose of this study was to investigate the relationship between birth weight and pulmonary function in CF.

Methods:

Birth weight and pulmonary data were obtained. Linear regressions were used to examine the relationship between these two variables. A one-tailed t-test was used to compare birth weights between CF patients and the national average.

Results:

Birth weight was significantly lower in babies with CF and correlated with pulmonary disease at ages 6 and 10 years but not with age at which Pseudomonas aeruginosa colonization was observed.

Discussion:

These data suggest that CF growth deficiency has prenatal origins. Early nutritional intervention for babies with CF and a low birth weight is warranted to maximize pulmonary potential.
Theorizing alternatives to capital
Authors: Gills Barry K , Goodman James , Hosseini S A Hamed
Published: April 2016

We are living in an era of multiple crises, multiple social resistances, and multiple cosmopolitanisms. The post-Cold War context has generated a plethora of movements, but no single unifying ideology or global political program has yet materialized. The historical confrontation between capital and its alternatives, however, continues to pose new possibilities for social and systemic transformations. Critical analysis of ideological divisions among today’s diverse emancipatory and transformative movements is important in order to understand past and present shortcomings, and many continuing difficulties in imagining crisis-free alternative futures. Inspired by a multiplicity of responses from the Global South and the Global North, and by furthering Delanty’s critical cosmopolitanist approach, this article aims to create a new framework for interpreting ‘transformative visions’ that challenge systems of domination embedded in capitalist social relations. The framework is designed to enable the evaluative analysis of such visions, as well as the exploration of embedded ideological obstacles to dialogue and collaboration among them.
Study of demands resulting from transverse impact of high mass, low velocity debris
Authors: Aghl Payam Piran , Naito Clay J , Riggs H Ronald
Published: April 2016

Debris impact forces generated during floods, tsunamis, and hurricane storm surges can contribute to severe structural damage. Proper estimation of debris impact forces is critical to design the structures to resist typical water-borne debris. In previous work, the force demands from axial debris impact were experimentally and analytically assessed. This study characterizes the impact force demands generated during transverse debris impact on structures and develops simplified models that can estimate impact force and duration accurately. An experimental study was conducted on a full-scale standard shipping container, steel tube, and solid bar subjected to transverse impact. Numerical models of the transverse members are also developed to evaluate the impact demands during relatively high impact velocities. Simplified analytical models are developed and validated with data from impact experiments and simulated results. The simplified models to predict impact demands from debris under both elastic and inelastic responses are shown to be quite accurate. Moreover, the results show that impact forces estimated by current design guidelines are not accurate.
The collision of care and punishment: Ageing prisoners’ view on compassionate release
Authors: Handtke Violet , Bretschneider Wiebke , Elger Bernice , Wangmo Tenzin
Published: April 2016

Most prisoners wish to spend their last days outside prison. Early release of seriously ill and ageing prisoners, commonly termed compassionate release, can be granted based on legal regulations but is rarely successful. The aim of this paper is to present the views of ageing prisoners on compassionate release using qualitative interviews. Participants argued for compassionate release on the grounds of illness and old age, citing respect for human dignity. Their hopes of an early release however often contradicted their actual experiences. Framing these results within Garland’s depiction of the criminology of the self and the criminology of the other, it is evident that in reality, the punitive strategy prevails. This strategy explains the rare use of compassionate release and how it negatively impacts prisoners’ access to end-of-life care. A possible solution is the welfarist criminology, strongly supported by a human rights approach. Awareness of the dominance of the punitive strategy is crucial for medical personnel as they are best placed to ensure access to end-of-life care for prisoners through compassionate release.
Analysis of factors determining Colombia's tourist enterprises organizational innovations
Authors: Zuñiga-Collazos Alexander
Published: April 2016

Colombia is a country that has achieved significant tourism growth in recent years. However, there is limited empirical evidence about its tourism development. Organizational innovation in tourism enterprises is one of the keys to Colombia maintaining positive tourism development. This empirical study analyzes organizational innovation in 364 of Colombiás tourism companies. The findings show that “Directing and Management (The way of directing and managing company)” and “Commercialization and Sales (The way to directing and managing the commercialization and sales of a company)” have a significant relationship with Colombiás tourist enterprises organizational innovations.
Spray evolution, engine performance, emissions and combustion characterization of Karanja biodiesel fuelled common rail turbocharged direct injection transportation engine
Authors: Agarwal Avinash Kumar , Gupta Jai Gopal , Maurya Rakesh Kumar , Kim Woong Il , Lee Sanghoon , Lee Chang Sik , Park Sungwook
Published: April 2016

Internal combustion engine research on alternative fuels has gained momentum because of growing awareness about energy security and environmental issues worldwide. Biodiesel offers an ideal solution to these problems and is an excellent partial replacement to mineral diesel. In this study, Karanja biodiesel blended with mineral diesel has been investigated for macroscopic spray characterization vis-à-vis baseline mineral diesel by varying fuel injection pressures (50, 100 and 150 MPa). Spray developed with relatively narrower spray angle for KB20. Injector needle movement for energizing and real injection durations were also compared for diesel and KB20 at fuel injection pressures of 50, 100 and 150 MPa. Needle movement was slightly higher for KB20 because of its relatively higher viscosity. However, with increasing fuel injection pressure, the difference reduced and showed quite similar results. A 2.2 L common rail direct injection sport utility vehicle EURO-IV diesel engine was used for the experiments. Engine performance, emissions and combustion characteristics of KB20 were compared with baseline mineral diesel at (1) the rated engine speed (2500 r/min) with varying engine loads as well as (2) at the rated load at varying engine speeds (1500–3500 r/min). Brake thermal efficiency of KB20 was lower than mineral diesel. Brake-specific carbon monoxide and carbon dioxide emissions decreased with increasing brake mean effective pressure and showed increasing trend with increasing engine speeds. KB20 showed emission of higher number of particles compared to mineral diesel at all engine operating conditions. Higher oxygen content of biodiesel resulted in shorter ignition delay and slightly higher peak cylinder pressure. KB20 showed relatively longer combustion duration compared to mineral diesel at 2500 r/min engine speed.
Concept mapping to improve team work, team learning and care of the person with dementia and behavioural and psychological symptoms
Authors: Aberdeen Suzanne M , Byrne Graeme
Published: April 2016

The incidence of behavioural and psychological symptoms of dementia in residential aged care facilities is high. Effective team work and knowledgeable staff are cited as important facilitators of appropriate care responses to clients with these symptoms, but to achieve this within a resource-poor workplace can be challenging. In the study reported in this paper, concept mapping was trialled to enhance multifocal person-centred assessment and care planning as well as team learning. The outcomes of team concept mapping were evaluated using a quasi-experimental design with pre- and post-testing in 11 selected Australian residential aged care facilities , including two control residential aged care facilities , over a nine-month period. It was demonstrated that use of concept mapping improved team function, measured as effectiveness of care planning, as well as enhancing learning, with increased knowledge of dementia care even amongst staff who were not directly involved with the process. It is suggested that these results may be generalizable to other countries and care settings.
A Similar Place
Authors: Warburton Theresa
Published: April 2016

In 2014, Nishnaabeg scholar Leanne Simpson connected #BlackLivesMatter and #MMIWG2S by highlighting their existence in “a similar place.” Here, I interpret this as a space of shared emotion and geography, emphasizing the land on which anti-Black and colonial violences occur. I argue that this provides a methodology for the study of multiethnic literature in a way that reckons with the interrelatedness of settler colonialism and anti-Black racism without conflating them under the auspices of “multiculturalism.” I read memoirs by Deborah Miranda and Jesmyn Ward to explore how they articulate the relationship between personal and spatial history.
“The More I Do, the Better I’ll Be”: The Treatment Preferences of Type 2 Diabetes Among African American Men
Authors: Sherman Ledric D. , Fawole Taliat
Published: April 2016

To gain better insight to the preferred methods of managing and treating type 2 diabetes among African American men (AA men). Participants ( n = 19) were AA men aged 35 to 69 years, who were diagnosed with type 2 diabetes. Participants were recruited via community outreach efforts, including barbershops and churches located in predominantly African American communities in Southeast United States. On consent, individual interviews were conducted, audio recorded, and subsequently transcribed. Transcripts were analyzed using a phenomenological approach, and focused on identifying common themes among the descriptions of AA men’s experiences specific to type 2 diabetes. Participants’ statements indicated three main commonalities regarding treatment preferences which were medication, dietary changes, and increase in exercise. Some participants from the study stated that they preferred taking oral medication primarily out of convenience, lack of pain, and how well the medicine makes them feel. Others stated educating themselves and having a consistent relationship with the diabetes physician has assisted them the most. Other participants shared preferences of being dedicated to proper diet and exercise without any medication (pill or injection), as well as maintaining the mental motivation needed to sustain management. Some participants preferred to not take an oral pill, while some did not mind taking pills at all. For some of the participants, it appears that it is easier for them to manage their diabetes by prescription medication than by lifestyle changes such as diet and exercise. Future studies are needed to investigate how social support system also assists these men in managing their diabetes.
Thrombus remnant despite intra-arterial thrombolysis for thrombus formation during endovascular treatment of ruptured cerebral aneurysms: Does it harm?
Authors: Jun Hyo Sub , Ahn Jun Hyong , Kim Ji Hee , Oh Jae Keun , Song Joon Ho , Chang In Bok
Published: April 2016

Background

The fate and safety of thrombus remnant despite intra-arterial thrombolysis for unexpected thrombus formation has rarely been reported.

Methods

From January 2010 to May 2015, 131 consecutive patients with ruptured intracranial aneurysms were treated by endovascular methods at our institution. Among the 21 patients (16%) treated by intra-arterial thrombolysis for the thrombus formation during the procedure, nine patients (nine aneurysms) suffered from thrombus remnant. We reviewed the clinical and radiologic outcomes of patients with thrombus remnant as well as intraoperative and postoperative management of thrombus formation.

Results

Thrombus formation occurred near the coiled aneurysm in eight patients, and distal embolic occlusion was observed in one patient. All nine patients were initially managed by intra-arterial thrombolysis with tirofiban. One patient with persistent distal embolic occlusion and two patients with distal migration of the thrombus after intra-arterial thrombolysis were additionally treated with stent retriever. One patient with occlusion of the parent artery near the coiled aneurysm despite intra-arterial thrombolysis was partially recanalized by permanent deployment of a stent retriever. Delayed cerebral angiography showed no increase in size of thrombus remnant in any patients. After the procedure, thrombus remnant was managed by intravenous tirofiban. Follow-up CT angiography on the first postoperative day showed patent arterial flow, and ischemic complication related with thromboembolism did not occur in any patients. One patient suffered from hemorrhagic complication.

Conclusion

If the patency of parent artery is maintained and the size of the thrombus remnant does not increase on delayed angiography after intra-arterial thrombolysis, postoperative thromboembolic events rarely occur.
Less can be more: Targeted embolization of aneurysms associated with arteriovenous malformations unsuitable for surgical resection
Authors: Alexander Matthew D , Cooke Daniel L , Hallam Danial K , Kim Helen , Hetts Steven W , Ghodke Basavaraj V
Published: April 2016

Introduction

To mitigate risks of hemorrhage, high-risk features of brain arteriovenous malformations (BAVMs) can be targeted to reduce the risk of rupture. Previous investigation has examined embolization of a pedicle supplying a high-risk feature; this study examines embolization targeted specifically at aneurysms associated with BAVMs.

Materials and methods

Patients with BAVMs treated at two high-volume neurointerventional services were retrospectively reviewed. Patients treated with intention to occlude only the associated aneurysm itself were analyzed. Demographic and lesion characteristics were identified, as were technical and clinical outcomes. Adverse events were defined as hemorrhage, new seizure, and death.

Results

Thirty-two patients met inclusion criteria out of 1103 patients treated during the study period. Twenty-seven (84.4%) BAVMs were acutely ruptured, all with the aneurysm identified as the hemorrhage source. Twenty-four (75.0%) lesions involved eloquent territory. There were equal numbers of feeding artery and nidus aneurysms. Follow-up data were available for a total of 101.3 patient-years for a mean follow-up time of 2.9 years. One patient died; the remaining 31 patients had improved functional status at last contact. Annualized rate of hemorrhage after treatment was 1.0%; rate of adverse events after treatment was 3.0%. Excluding time after confirmed occlusion following radiosurgery, annualized rates were 1.4% and 4.8%, respectively.

Conclusion

In inoperable BAVMs, targeted embolization of associated aneurysms can be performed safely and effectively. This should be considered in high-risk lesions prior to radiosurgery or in cases when no other treatment options are available. Such intervention warrants further investigation.
An experimental study on the effect of parameters on the depth of crater machined by electrostatic field–induced electrolyte jet micro electrical discharge machining
Authors: Zhang Yaou , Han Ning , Kang Xiaoming , Zhao Wansheng
Published: April 2016

Electrostatic field–induced electrolyte jet micro electrical discharge machining depends on heat generated by the periodic pulsed discharge between the workpiece and the electrolyte fine jet from the tip of Taylor cone, induced by the intense electric field, to erode the material from the workpiece. To further investigate the characteristics of this discharge process, with the NaCl solution as the electrostatic field–induced electrolyte jet electrolyte and the silicon wafer as the workpiece, the governing factors of machining polarity, nozzle-to-workpiece distance, voltage applied between positive and negative polarities, and the effect of concentration of the electrolyte on the depth of crater after a single electrostatic field–induced electrolyte jet discharge have been studied. The experimental results show that the average depth of crater increases with the increase in the voltage applied between the nozzle and the workpiece, and increases with the increase in the concentration of the electrolyte, but decreases with the increase in the distance between the nozzle and the workpiece. The results have also demonstrated that the polarity has no clear influence on the average depth of crater after a single discharge.
Improving the legibility of prescription medication labels for older adults and adults with visual impairment
Authors: Leat Susan J. , Krishnamoorthy Abinaya , Carbonara Antonio , Gold Deborah , Rojas-Fernandez Carlos
Published: April 2016

Objectives:

Most current prescription labels fail to meet print guidelines, especially in print size. We therefore compared the legibility of current prescription medication labels against the legibility of prototype labels, based on current guidelines for legibility.

Method:

Sample medication labels were obtained from pharmacies, and prototype medication labels were developed according to legibility guidelines from nongovernmental organizations and pharmacy organizations. Three groups of participants, consisting of older adults with normal vision, older adults with visual impairment and younger adults with visual impairment (total N = 71) took part. Participants were asked to read and rank the labels. Reading speed and accuracy were determined.

Results:

Accuracies were high (75%–100%), and there were no significant differences between samples or prototypes or between groups. Prototypes, however, were read faster than samples ( p < 0.001). Subjectively, participants preferred the largest print option ( p < 0.001) and instructions with the numbers written in highlighted uppercase words ( p < 0.001).

Discussion:

The results indicate that improvements to the label would include larger print size, a consistent layout with left justification and using upper case with highlighting for emphasis of the numbers in the instructions.
Multimorbidity, mortality, and physical activity
Authors: Loprinzi Paul D , Addoh Ovuokerie , Joyner Chelsea
Published: April 2016

Objectives

Multimorbidity and physical inactivity are individually associated with increased mortality risk, but the possibility for physical activity to moderate the multimorbidity–mortality relationship has yet to be investigated.

Methods

Data from the 1999–2006 NHANES were employed, with 16,091 participants constituting the analytic sample. Participants were followed through 2011, including a median follow-up of 99 months. Physical activity was assessed via self-report with multimorbidity assessed from physician diagnosis.

Results

After adjustment, for every 1 morbidity increase, participants had a 23% increased risk of all-cause mortality (HR = 1.23; 95% CI: 1.19–1.28; p < 0.001). Multimorbidity mostly remained associated with all-cause mortality across all levels of physical activity, with the exception of those achieving four times the dose of the government guidelines.

Discussion

With the exception of those who engaged in high levels of self-reported physical activity, physical activity had a minimal effect on the multimorbidity–mortality relationship.
Critical evaluation of the expression of gastrin-releasing peptide in dorsal root ganglia and spinal cord
Authors: Barry Devin M , Li Hui , Liu Xian-Yu , Shen Kai-Feng , Liu Xue-Ting , Wu Zhen-Yu , Munanairi Admire , Chen Xiao-Jun , Yin Jun , Sun Yan-Gang , Li Yun-Qing , Chen Zhou-Feng
Published: April 2016

There are substantial disagreements about the expression of gastrin-releasing peptide (GRP) in sensory neurons and whether GRP antibody cross-reacts with substance P (SP). These concerns necessitate a critical revaluation of GRP expression using additional approaches. Here, we show that a widely used GRP antibody specifically recognizes GRP but not SP. In the spinal cord of mice lacking SP ( Tac1 KO), the expression of not only GRP but also other peptides, notably neuropeptide Y (NPY), is significantly diminished. We detected Grp mRNA in dorsal root ganglias using reverse transcription polymerase chain reaction, in situ hybridization and RNA-seq. We demonstrated that Grp mRNA and protein are upregulated in dorsal root ganglias, but not in the spinal cord, of mice with chronic itch. Few GRP+ immunostaining signals were detected in spinal sections following dorsal rhizotomy and GRP+ cell bodies were not detected in dissociated dorsal horn neurons. Ultrastructural analysis further shows that substantially more GRPergic fibers form synaptic contacts with gastrin releasing peptide receptor-positive (GRPR+) neurons than SPergic fibers. Our comprehensive study demonstrates that a majority of GRPergic fibers are of primary afferent origin. A number of factors such as low copy number of Grp transcripts, small percentage of cells expressing Grp, and the use of an eGFP GENSAT transgenic as a surrogate for GRP protein have contributed to the controversy. Optimization of experimental procedures facilitates the specific detection of GRP expression in dorsal root ganglia neurons.
Contrast-enhanced ultrasonography for detecting histological carotid plaque rupture: Quantitative analysis of ulcer
Authors: Hamada Omi , Sakata Noriyuki , Ogata Toshiyasu , Shimada Hirofumi , Inoue Tooru
Published: April 2016

Background

Few studies have evaluated the distinct ability of contrast-enhanced ultrasonography for detecting carotid plaque rupture versus histological observations.

Aims

The aim of this study was to quantitatively assess the ability of contrast-enhanced ultrasonography to detect plaque rupture compared to ultrasonographic and histological images in terms of geometric accordance.

Methods

Carotid plaque morphology was classified as “smooth,” “irregular,” or “ulcerated” on 45 conventional ultrasonography and contrast-enhanced ultrasonography images from consecutive patients undergoing endarterectomy, and 55 regions of interests were captured on contrast-enhanced ultrasonography. A comparative study with a receiver operating characteristic analysis was performed using histological findings for reference.

Results

Contrast-enhanced ultrasonography exhibited a higher percentage of “ulcerated” findings in patients with plaque rupture compared to conventional ultrasonography (P = 0.002) as well as an association with thrombus formation (P = 0.048) and fibrous cap disruption (P < 0.0001). On contrast-enhanced ultrasonography, “ulcerated” were significantly more likely than “smooth” findings when the fibrous cap was disrupted (odds ratio (OR), 41.5). The receiver operating characteristic areas under the curve for the orifice, depth, and width of the concavities on contrast-enhanced ultrasonography were significantly greater than 0.5, while their optimal cut-off values were 1.40 mm, 1.30 mm, and 1.88 mm, respectively. When one of these variables was greater than the optimal cut-off value, the sensitivity, negative hit rate, and odds ratio for detecting fibrous cap disruption were 91.3%, 91.6%, and 23.1, respectively.

Conclusions

In our study, contrast-enhanced ultrasonography has high sensitivity for identifying histological plaque rupture, and the measurement of concavity on contrast-enhanced ultrasonography may enable the accurate detection of fibrous cap disruption.
Biomechanical predictors of ball velocity during punt kicking in elite rugby league kickers
Authors: Sinclair J , Taylor P J , Atkins S , Hobbs S J
Published: April 2016

Punt kicking is integral to the attacking and defensive elements of rugby league and the ability to kick the ball with high velocity is desirable. This study aimed to identify important technical aspects of kicking linked to the generation of ball velocity. Maximal punt kicks were obtained from six elite rugby league kickers using a 10-camera motion capture system. Three-dimensional kinematics of the lower extremities was obtained. Regression analysis with ball velocity as criterion was used to identify the kinematic parameters associated with the development of ball velocity. The regression model yielded an adj R2 = 0.76, p ≤ 0.01. Two parameters were identified: knee extension angular velocity of the kicking limb at impact ( R2 = 0.50) and peak flexion angular velocity of the kicking hip ( R2 = 0.26, p ≤ 0.01). It is conceivable that players may benefit from exposure to coaching and strength techniques geared toward the modification of kicking mechanics specific to this study.
Reappraising Stress Arousal Improves Performance and Reduces Evaluation Anxiety in Classroom Exam Situations
Authors: Jamieson Jeremy P. , Peters Brett J. , Greenwood Emily J. , Altose Aaron J.
Published: April 2016

For students to thrive in the U.S. educational system, they must successfully cope with omnipresent demands of exams. Nearly all students experience testing situations as stressful, and signs of stress (e.g., racing heart) are typically perceived negatively. This research tested the efficacy of a psychosituational intervention targeting cognitive appraisals of stress to improve classroom exam performance. Ninety-three students (across five semesters) enrolled in a community college developmental mathematics course were randomly assigned to stress reappraisal or placebo control conditions. Reappraisal instructions educated students about the adaptive benefits of stress arousal, whereas placebo materials instructed students to ignore stress. Reappraisal students reported less math evaluation anxiety and exhibited improved math exam performance relative to controls. Mediation analysis indicated reappraisal improved performance by increasing students’ perceptions of their ability to cope with the stressful testing situation (resource appraisals). Implications for theory development and policy are discussed.
The effects of distress and the dimensions of coping strategies on physicians’ satisfaction with competence
Authors: Lepnurm Rein , Nesdole Robert , Dobson Roy Thomas , Peña-Sánchez Juan-Nicolás
Published: April 2016

Objectives:

The purposes of this study were to (1) articulate the dimensions of Coping strategies used by physicians, and (2) determine whether Coping strategies alleviated Distress and enhanced Satisfaction with Competence.

Methods:

Comprehensive questionnaires on factors associated with Satisfaction with Competence were sent to a stratified sample of 5300 physicians across Canada. The response rate was 57% with negligible bias. Factor analysis was used to articulate the dimensions of Coping strategies. The classic Baron and Kenny regression series was used to establish whether Coping mediates the effects of Distress on Satisfaction with Competence. Years in Practice, Self-Reported Health, and Duties of Physicians were control factors.

Results:

A reliable 15-item measure of Coping was confirmed (α = .76) with four reasonably reliable dimensions: Collegiality (α = .80), Attitude (α = .63), Managing Work (α = .60), and Self-Care (α = .62). Physicians reported a mean Satisfaction with Competence of ( M = 4.26 out of 6.0, standard deviation ( SD) = 0.64) with General practitioners reporting slightly lower levels of Satisfaction with Competence than average. Conversely, chronic disease, clinical, and procedural specialists reported higher levels of Satisfaction with Competence. The mean Distress level for all physicians was ( M = 3.66 out of 7.0, SD = 0.93). The highest levels of distress were reported by emergency physicians, general practitioners, and surgeons. Clinical specialists, anesthesiologists, and psychiatrists reported the lowest levels of distress. Physicians reported ( M = 4.48 out of 7.0, SD = 0.78) as the mean level of Coping ability with clinical specialists and general practitioners reporting lower than average abilities to cope. Laboratory and chronic care specialists reported greater than average coping abilities. Regression analyses established Coping as a mediator of Distress which predicted physicians’ Satisfaction with Competence.

Conclusion:

Four groups of coping strategies were significant in relieving the pressures of work: (1) Collegiality, (2) Self-Care, (3) Managing Work, and (4) Positive Attitude.
The expansion of endoscopic submucosal dissection in France: A prospective nationwide survey
Authors: Barret Maximilien , Lepilliez Vincent , Coumaros Dimitri , Chaussade Stanislas , Leblanc Sarah , Ponchon Thierry , Fumex Fabien , Chabrun Edouard , Bauret Paul , Cellier Christophe , Coron Emmanuel , Bichard Philippe , Bulois Philippe , Charachon Antoine , Rahmi Gabriel , Bellon Serge , Lerhun Marc , Arpurt Jean‐Pierre , Koch Stéphane , Napoleon Bertrand , Vaillant Eric , Esch Anouk , Farhat Said , Robin Francoise , Kaddour Nadira , Prat Frédéric ,   for the Société Française d’Endoscopie Digestive (SFED)
Published: April 2016

Introduction

Early reports of endoscopic submucosal dissection (ESD) in Europe suggested high complication rates and disappointing outcomes compared to publications from Japan. Since 2008, we have been conducting a nationwide survey to monitor the outcomes and complications of ESD over time.

Material and methods

All consecutive ESD cases from 14 centers in France were prospectively included in the database. Demographic, procedural, outcome and follow‐up data were recorded. The results obtained over three years were compared to previously published data covering the 2008–2010 period.

Results

Between November 2010 and June 2013, 319 ESD cases performed in 314 patients (62% male, mean (±SD) age 65.4 ± 12) were analyzed and compared to 188 ESD cases in 188 patients (61% male, mean (±SD) age 64.6 ± 13) performed between January 2008 and October 2010. The mean (±SD) lesion size was 39 ± 12 mm in 2010–2013 vs 32.1 ± 21 for 2008–2010 (p  = 0.004). En bloc resection improved from 77.1% to 91.7% (p  < 0.0001) while R0 en bloc resection remained stable from 72.9% to 71.9% (p  = 0.8) over time. Complication rate dropped from 29.2% between 2008 and 2010 to 14.1% between 2010 and 2013 (p  < 0.0001), with bleeding decreasing from 11.2% to 4.7% (p  = 0.01) and perforations from 18.1% to 8.1% (p  = 0.002) over time. No procedure‐related mortality was recorded.

Conclusions

In this multicenter study, ESD achieved high rates of en bloc resection with a significant trend toward better outcomes over time. Improvements in lesion delineation and characterization are still needed to increase R0 resection rates.
The BCL2 selective inhibitor venetoclax induces rapid onset apoptosis of CLL cells in patients via a TP53-independent mechanism
Authors: Anderson Mary Ann , Deng Jing , Seymour John F. , Tam Constantine , Kim Su Young , Fein Joshua , Yu Lijian , Brown Jennifer R. , Westerman David , Si Eric G. , Majewski Ian J. , Segal David , Heitner Enschede Sari L. , Huang David C. S. , Davids Matthew S. , Letai Anthony , Roberts Andrew W.
Published: April 2016

Key Points

Venetoclax potently induces rapid onset apoptosis of CLL cells in vitro and in vivo, independently of TP53 function. Objective responses in patients with del(17p) and/or TP53-mutated CLL are as deep as patients with no perturbation of TP53.
The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia
Authors: Arber Daniel A. , Orazi Attilio , Hasserjian Robert , Thiele Jürgen , Borowitz Michael J. , Le Beau Michelle M. , Bloomfield Clara D. , Cazzola Mario , Vardiman James W.
Published: April 2016

The World Health Organization (WHO) classification of tumors of the hematopoietic and lymphoid tissues was last updated in 2008. Since then, there have been numerous advances in the identification of unique biomarkers associated with some myeloid neoplasms and acute leukemias, largely derived from gene expression analysis and next-generation sequencing that can significantly improve the diagnostic criteria as well as the prognostic relevance of entities currently included in the WHO classification and that also suggest new entities that should be added. Therefore, there is a clear need for a revision to the current classification. The revisions to the categories of myeloid neoplasms and acute leukemia will be published in a monograph in 2016 and reflect a consensus of opinion of hematopathologists, hematologists, oncologists, and geneticists. The 2016 edition represents a revision of the prior classification rather than an entirely new classification and attempts to incorporate new clinical, prognostic, morphologic, immunophenotypic, and genetic data that have emerged since the last edition. The major changes in the classification and their rationale are presented here.
Patient-Reported Outcomes Labeling for Products Approved by the Office of Hematology and Oncology Products of the US Food and Drug Administration (2010-2014)
Authors: Gnanasakthy Ari , DeMuro Carla , Clark Marci , Haydysch Emily , Ma Esprit , Bonthapally Vijayveer
Published: April 2016

Purpose

To review the use of patient-reported outcome (PRO) data in medical product labeling granted by the US Food and Drug Administration (FDA) for new molecular entities and biologic license applications by the FDA Office of Hematology and Oncology Products (OHOP) between January 2010 and December 2014, to elucidate challenges faced by OHOP for approving PRO labeling, and to understand challenges faced by drug manufacturers to include PRO end points in oncology clinical trials.

Methods

FDA Drug Approval Reports by Month were reviewed to obtain the number of new molecular entities and biologic license applications approved from 2010 to 2014. Drugs approved by the FDA OHOP during this period were selected for further review, focusing on brand and generic name; approval date; applicant; indication; PRO labeling describing treatment benefit, measures, end point status, and significant results; FDA reviewer feedback on PRO end points; and study design of registration trials. First in class, priority review, fast track, orphan drug, or accelerated approval status was retrieved for selected oncology drugs from 2011 to 2014. Descriptive analyses were performed by using Microsoft Excel 2010.

Results

Of 160 drugs approved by the FDA (2010-2014), 40 were approved by OHOP. Three (7.5%) of the 40 received PRO-related labeling (abiraterone acetate, ruxolitinib phosphate, and crizotinib). Compared with nononcology drugs (2011-2014), oncology drugs were more likely to be orphan and first in class. The majority of oncology drug reviews by FDA were fast track, priority, or accelerated.

Conclusion

Although symptoms and functional decrements are common among patients with cancer, PRO labeling is rare in the United States, likely because of logistical hurdles and oncology study design. Recent developments within the FDA OHOP to capture PROs in oncology studies for the purpose of product labeling are encouraging.
Are Small Reimbursement Changes Enough to Change Cancer Care? Reimbursement Variation in Prostate Cancer Treatment
Authors: Ellis Shellie D. , Chen Ronald C. , Dusetzina Stacie B. , Wheeler Stephanie B. , Jackson George L. , Nielsen Matthew E. , Carpenter William R. , Weinberger Morris
Published: April 2016

Purpose:

The Centers for Medicare and Medicaid Services recently initiated small reimbursement adjustments to improve the value of care delivered under fee-for-service. To estimate the degree to which reimbursement influences physician decision making, we examined utilization of gonadotropin-releasing hormone (GnRH) agonists among urologists as Part B drug reimbursement varied in a fee-for-service environment.

Methods:

We analyzed treatment patterns of urologists treating 15,128 men included in SEER-linked Medicare claims who were diagnosed with localized prostate cancer between January 1, 2000, and December 31, 2003. We calculated a reimbursement generosity index to measure differences in GnRH agonist reimbursement among regional Medicare carriers and over time. We used multilevel analysis to control for patient and provider characteristics.

Results:

Among urologists treating early-stage and lower grade prostate cancer, variation in reimbursement was not associated with overuse of GnRH agonists from 2000 to 2003, a period of guideline stability (odds ratio, 1.00; 95% CI, 0.99 to 1.00).

Conclusion:

Small differences in androgen-deprivation therapy reimbursement generosity were not associated with differential use. Fee-for-service reimbursement changes currently being implemented to improve quality in fee-for-service Medicare may not affect patterns of cancer care.
Clinical Trial Accrual Targeting Genomic Alterations After Next-Generation Sequencing at a Non-National Cancer Institute–Designated Cancer Program
Authors: Mantripragada Kalyan C. , Olszewski Adam J. , Schumacher Andrew , Perez Kimberly , Birnbaum Ariel , Reagan John L. , Mega Anthony , Khurshid Humera , Bartley Carolyn , Lombardo Alise , Rossiter Rachael , Papa Alessandro , Bakalarski Pamela , Safran Howard
Published: April 2016

Purpose:

Successful clinical trial accrual targeting uncommon genomic alterations will require broad national participation from both National Cancer Institute (NCI)–designated comprehensive cancer centers and community cancer programs. This report describes the initial experience with clinical trial accrual after next-generation sequencing (NGS) from three affiliated non–NCI-designated cancer programs.

Materials and Methods:

Clinical trial participation was reviewed after enrollment of the first 200 patients undergoing comprehensive genomic profiling by NGS as part of an institutional intuitional review board–approved protocol at three affiliated hospitals in Rhode Island and was compared with published experience from NCI-designated cancer centers.

Results:

Patient characteristics included a median age of 64 years, a median of two lines of prior therapy, and a predominance of GI carcinomas (58%). One hundred sixty-four of 200 patients (82%) had adequate tumor for NGS, 95% had genomic alterations identified, and 100% had variants of unknown significance. Fifteen of 164 patients (9.2%) enrolled in genotype-directed clinical trials, and three patients (1.8%) received commercially available targeted agents off clinical trials. The reasons for nonreceipt of NGS-directed therapy were no locally available matching trial (48.6%), ineligibility (33.6%) because of comorbidities or interim clinical deterioration, physician's choice of a different therapy (6.8%), or stable disease (11%).

Conclusion:

This experience demonstrates that a program enrolling patients in specific targeted agent clinical trials after NGS can be implemented successfully outside of the NCI-designated cancer program network, with comparable accrual rates. This is important because targetable genes have rare mutation rates and clinical trial accrual after NGS is low.
Chemotherapy Errors: A Call for a Standardized Approach to Measurement and Reporting
Authors: Lennes Inga T. , Bohlen Nie , Park Elyse R. , Mort Elizabeth , Burke Debra , Ryan David P.
Published: April 2016

The Massachusetts General Hospital (MGH) Cancer Center is a multidisciplinary cancer center that delivers chemotherapy to 150 to 200 patients daily and adheres to the Oncology Nursing Society and ASCO guidelines for safe chemotherapy administration. An error that occurred at MGH in the summer of 2012 prompted a review of all safety events, the process of classification, and the monitoring of safety events. This article reviews safety monitoring in the oncology setting, details the oncology safety-event reporting program at MGH, summarizes all chemotherapy-related safety events that have occurred over the past 5 years, and concludes with summary recommendations and potential steps to standardize safety reporting and analysis in chemotherapy administration.
A Possible Link Between Parathyroid Hormone Secretion and Local Regulation of GABA in Human Parathyroid Adenomas
Authors: Hong A Ram , Kim Young A , Bae Jae Hyun , Min Hye Sook , Kim Jung Hee , Shin Chan Soo , Kim Seong Yeon , Kim Sang Wan
Published: April 2016

Context:

γ-Aminobutyric acid-B receptor 1 (GABABR1) forms a heterodimeric complex with calcium-sensing receptor (CaSR) in human brain tissue. However, the expression and implication of GABABR1 in human parathyroid adenoma has not yet been examined.

Objective:

The objective of the study was to examine a possible link between GABABR1 and PTH secretion in human parathyroid adenoma

Design and Methods:

Sixty-five patients who underwent parathyroidectomy for primary hyperparathyroidism (PHPT) and 29 control patients with normal parathyroid glands were retrospectively included. All patients diagnosed with PHPT had parathyroid adenomas. We evaluated the protein expression of GABABR1, glutamic acid decarboxylase 65/67 (GAD65/67), and various factors proposed as regulators of PTH secretion including CaSR, vitamin D receptor (VDR), CYP24A1, CYP27B1, fibroblast growth factor, and α-klotho in parathyroid tissues from patients with parathyroid adenomas using immunohistochemistry.

Results:

Expressions of CaSR, GABABR1, and VDR were significantly lower in PHPT patients than in control subjects (P < .001 for CaSR and GABABR1; P = .006 for VDR). Protein expression of GAD65/67, which indicates local production and regulation of GABAergic pathway, was significantly increased in PHPT (P < .001). There were no significant differences in CYP24A1, CYP27B1, fibroblast growth factor, and α-klotho expression between the two groups. Expression of GAD65/67 was significantly correlated with VDR, CYP24A1, CYP27B1, and α-klotho in PHPT (all P < .01) but not in the control groups. CaSR expression was positively associated with serum phosphorus level (r = 0.274, P = .029) and GAD65/67 was negatively correlated with serum PTH level (r = −0.342, P = .005).

Conclusions:

Local production and action of GABA may be regulated in human parathyroid adenomas. This suggests a possible link between PTH secretion and local regulation of GABA in parathyroid adenomas.