bluuebunny/crossref_metadata_2025 huggingface dataset:
A Randomized Controlled Study of an Insulin Dosing Application That Uses Recognition and Meal Bolus Estimations
Authors: Pańkowska Ewa , Ładyżyński Piotr , Foltyński Piotr , Mazurczak Karolina
Published: January 2017

Background:

Throughout the insulin pump therapy, decisions of prandial boluses programming are taken by patients individually a few times every day, and, moreover, this complex process requires numerical skills and knowledge in nutrition components estimation. The aim of the study was to determine the impact of the expert system, supporting the patient’s decision on meal bolus programming, on the time in range of diurnal glucose excursion in patients treated with continuous subcutaneous insulin infusion (CSII).

Methods:

The crossover, randomized study included 12 adults, aged 19 to 53, with type 1 diabetes mellitus, duration ranging from 7 to 30 years. Patients were educated in complex food counting, including carbohydrate units (CU) and fat-protein units (FPU). Subsequently, they were randomly allocated to the experimental group (A), which used the expert software named VoiceDiab, and the control group (B), using a manual method of meal-bolus estimation.

Results:

It was found that 66.7% of patients within the A group statistically reported a relevant increase in the percentage (%) of sensor glucose (SG) in range (TIR 70-180 mg/dl), compared to the B group. TIR (median) reached 53.9% in the experimental group (A) versus 44% within the control group (B), P < .05. The average difference in the number of hypoglycemia episodes was not statistically significant (–0.2%, SD 11.6%, P = .93). The daily insulin requirement in both groups was comparable—the average difference in total daily insulin dose between two groups was 0.26 (SD 7.06 IU, P = .9).

Conclusion:

The expert system in meal insulin dosing allows improvement in glucose control without increasing the rates of hypoglycemia or the insulin requirement.
Monetizing Managerial Responses on TripAdvisor: Performance Implications Across Hotel Classes
Authors: Xie Karen , Kwok Linchi , Wang Wei
Published: January 2017

This study assesses the moderating effect of hotel class on managerial responses’ influence on hotel performance through the lens of data analytics. A panel data model was applied to analyze 7,979 managerial responses and 51,801 online reviews on TripAdvisor, which were matched with the financial performance data (revenue per available room [RevPAR]) for 2,652 hotels in 427 cities in Texas over 26 consecutive quarters from 2005 to 2011. The results suggest that even though all hotels will be able to observe an increase of RevPAR as they post more managerial responses to online reviews, above-average and luxury hotels in particular benefit from managerial responses in longer length and provided by frontline managers, whereas full-service, mid-market economy, and budget traveler hotels benefit from executives’ responses. In addition, the speed of responses is important for full-service and above-average hotels, and conciseness of responses is critical to budget traveler hotels. This study provided important yet specific implications on how hotels can benefit from different types of managerial response strategies according to their product characteristics (hotel class). It also adds to hospitality and online review literature with new theoretical perspectives on the varying effect of managerial responses on business performance specific to the lodging industry context.
School Nurses and RN to BSN Nursing Students
Authors: Dabney Beverly W. , Linton Mary , Koonmen Jamie
Published: January 2017

Many nursing schools and public schools are facing various challenges including a lack of resources. Schools of nursing strive to provide meaningful clinical experiences despite the challenge of a limited supply of quality placements. Similarly, public schools are expected to provide more nursing services at a time when many school nurses already are overloaded. For example, new state legislation placed additional responsibilities (regarding epinephrine auto-injectors and cardiac emergency response plans) on school nurses in Michigan. Establishing a partnership between the University of Michigan–Flint and the Genesee Intermediate School District (GISD) allowed RN to BSN students in the community health nursing course to complete enriching clinical experiences at selected GISD schools. While gaining valuable clinical knowledge, these nursing students helped school nurses comply with the new legislation’s requirements. This partnership benefitted the nursing students, the school nurses, and the schools that served as clinical placement sites. Nursing school administrators and faculty members should consider pursuing similar clinical placement partnerships that could be advantageous for students and local communities.
Town & Gown
Authors: King Beth M. , Gordon Shirley C. , Barry Charlotte D. , Goodman Rhonda , Jannone Laura T. , Foley Marie , Resha Cheryl , Hendershot Candace
Published: January 2017

Innovative approaches for building “town and gown” relationships between practicing school nurses, community partners, and universities/colleges are presented through exemplars relating to research, education, policy, and practice. The exemplars demonstrate the critical factors of successful partnerships as validated by their outcomes.
Extra-pontine myelinolysis secondary to hypernatremia induced by postpartum water restriction
Authors: Chhabra A , Kaushik R , Kaushik RM , Goel D
Published: January 2017

A young adult female with restricted water intake during the postpartum period presented with history of progressive weakness, dizziness and tendency to fall with generalized slowing of movement. On examination, patient was anaemic, febrile and stuporous. Investigations revealed hypernatremia, delta waves in electroencephalogram (EEG) and features suggestive of extra-pontine myelinolysis on magnetic resonance imaging (MRI) of brain. After correcting hypernatremia and instituting anti-cholinergic therapy, there was a gradual but steady improvement in neurological symptoms of the patient over a period of one week and the patient was discharged in a conscious, oriented and ambulant state. As such, neuroimaging findings can be crucial in diagnosing hypernatremic encephalopathy in the postpartum period.
Spontaneous occlusion of cerebral arteriovenous malformation following partial embolization with Onyx
Authors: Nas Omer Fatih , Ozturk Kerem , Gokalp Gokhan , Hakyemez Bahattin
Published: January 2017

Management options for brain arteriovenous malformations (AVMs) are surgery, radiosurgery, and endovascular embolization. The aim of partial embolization in endovascular treatment is to make total resection possible. However, increased risk of bleeding in partial embolization creates some controversies about treatment options. Spontaneous total occlusion of cerebral AVMs following partial obliteration with embolization agents is a rarely seen condition. We present a case with an AVM vanishing from right posterior cerebral artery which spontaneously occluded following partial embolization with Onyx liquid agent.
Giant multi-compartmental suprasellar Rathke’s cleft cyst with restriction on diffusion weighted images
Authors: Sivaraju Laxminadh , Anantha Sai Kiran Narayanam , Rao Arun S , Ghosal Nandita , Hegde Alangar S
Published: January 2017

Rathke’s cleft cysts are congenital lesions seen in sellar–suprasellar regions. We report a case of giant Rathke cyst in a 43-year-old patient with multi-compartmental involvement who presented with seizures with almost normal visual acuity. We discuss radiological and pathological features of various differential diagnoses for the giant suprasellar Rathke’s cyst.
Persistent trigeminal artery communicating with a fetal posterior communicating artery: A case report
Authors: Chiang Florence L , Zafar Abdul M , Bazan Carlos
Published: January 2017

A persistent trigeminal artery (PTA) is the most common carotid-vertebrobasilar anastomosis. PTA variants terminating on cerebellar arteries instead of the basilar artery have been reported previously. We present the first case of a PTA communicating with a fetal posterior communicating artery identified on a magnetic resonance angiogram. An understanding of these anatomical variants is important to clarify pathological processes that can help guide neurosurgical and endovascular procedures.
Extra-axial ependymoma of the cerebral convexity: A very rare intracranial adult tumor
Authors: Berhili Soufiane , Aissa Abdellah , Kadiri Selma , Cherradi Nadia , El Majjaoui Sanae , El Kacemi Hanan , Kebdani Tayeb , Benjaafar Noureddine
Published: January 2017

Background

Ependymomas are rare adult tumors that originate from the ventricular system or the ependymal surface of the central canal. Extra-axial supratentorial ependymomas are extremely rare, and only five cases have been reported to date in the English literature.

Case presentation

A 46-year-old previously healthy male presented with a gradual painless loss of vision in the right eye. Cerebral MRI showed a right parietal-occipital lesion resembling an atypical meningioma. Surgical resection was performed, and immunohistochemical staining results concluded that it was a very uncommon location of a grade 3 ependymoma. Favorable outcome was observed one year after completion of postoperative radiotherapy.

Conclusion

Clinical and imaging aspects are misleading in rare brain tumors, and immunohistochemistry is essential to re-address diagnosis.
Echocardiography is useful to predict postoperative atrial fibrillation in patients undergoing isolated coronary bypass surgery: A prospective study
Authors: Magne Julien , Salerno Baptiste , Mohty Dania , Serena Claire , Rolle Florence , Piccardo Alessandro , Echahidi Najmeddine , Le Guyader Alexandre , Aboyans Victor
Published: January 2017

Objective:

Postoperative atrial fibrillation is a major complication following coronary artery bypass graft. We hypothesized that, beyond clinical and electrocardiogram (ECG) data, transthoracic echocardiography could improve the prediction of postoperative atrial fibrillation.

Methods:

We prospectively studied 169 patients in sinus rhythm who underwent isolated coronary artery bypass graft in our institution. Clinical, biological, ECG and transthoracic echocardiography data were collected within 24 h before surgery. The patients were continuously monitored during the first five days, and then had daily 12-lead ECG afterwards until discharge. Postoperative atrial fibrillation was defined by any episode >10 min.

Results:

Postoperative atrial fibrillation was found in 65 patients (38%). Compared with those without, patients with postoperative atrial fibrillation were significantly older ( p=0.008), had more frequently a history of hypertension ( p=0.009), history of atrial fibrillation ( p<0.001) and New York Heart Association class ⩾III ( p=0.004). They also had longer PR interval ( p=0.005), higher preoperative NT-pro brain natriuretic peptide level ( p=0.006), left ventricle end-diastolic volume ( p=0.002), indexed left ventricle mass ( p<0.0001), indexed maximal left atrial volume ( p<0.0001), maximal right atrial area ( p<0.001) and lower left ventricle ejection fraction ( p=0.04). In multivariate analysis, history of atrial fibrillation (odds ratio =6.1, 95% confidence interval: 1.4–26.0, p=0.02) and indexed maximal left atrial volume (odds ratio =1.13, 95% confidence interval: 1.1–1.2, p=0.001) were the only two independent predictive factors of postoperative atrial fibrillation. The addition of echocardiographic parameters improved the predictive value (χ2) of the model, from 34 to 57.

Conclusion:

A history of atrial fibrillation and indexed left atrial maximal volume are the best predictors of the occurrence of postoperative atrial fibrillation following coronary artery bypass graft. The identification of high risk population of postoperative atrial fibrillation using these two factors could lead to the development of targeted strategies to limit this frequent complication in these patients.
Multicomponent meningococcal B vaccination (4CMenB) of adolescents and college students in the United States
Authors: Banzhoff Angelika
Published: January 2017

Meningococcal disease is rare, easily misdiagnosed, and potentially deadly. Diagnosis in the early stages is difficult and the disease often progresses extremely rapidly. In North America, the incidence of invasive meningococcal disease (IMD) is highest in infants and young children, with a secondary peak in adolescents, a population predominantly responsible for the carriage of disease. Neisseria meningitidis serogroup B (MenB) accounts for a large proportion of meningococcal disease in North America, with documented outbreaks in three universities in the United States (US) during 2008–2013. Vaccination is the most effective way to protect against this aggressive disease that has a narrow timeframe for diagnosis and treatment. 4CMenB is a multi-component vaccine against MenB which contains four antigenic components. We describe in detail the immunogenicity and safety profile of 4CMenB based on results from four clinical trials; the use of 4CMenB to control MenB outbreaks involving vaccination at two US colleges during outbreaks in 2013–2014; and the use of 4CMenB in a Canadian mass vaccination campaign to control the spread of MenB disease. We discuss the reasons why adolescents should be vaccinated against MenB, by examining both the peak in disease incidence and carriage. We consider whether herd protection may be attained for MenB, by discussing published models and comparing with meningitis C (MenC) vaccines. In conclusion, MenB vaccines are now available in the US for people aged 10–25 years, representing an important opportunity to reduce the incidence of IMD in the country across the whole population, and more locally to combat MenB outbreaks.
Identifying standards for care coordination in adult social care: a multinational perspective
Authors: Abendstern Michele , Hughes Jane , Jasper Rowan , Sutcliffe Caroline , Challis David
Published: January 2017

Introduction

Standards for care coordination in adult social care can support the delivery of high-quality services.

Methods

A content analysis of 20 guidance documents produced over the last 30 years was undertaken to consider their utility for current practice. a mix of convenience and purposive sampling was used. Data were extracted on document design and substance and were analysed in relation to a conceptual framework that articulated standards as principles of practice situated within elements of care coordination such as assessment.

Results

A total of 24 standards were repeatedly found across the documents. the most frequently cited were user participation, a network approach and person-centred practice. Most documents contained ‘standards’ as identified by the framework above. Variation was found regarding how standards were operationalised in relation to elements of care coordination. Principles were most frequently linked to assessment and care/support planning and least often to referrals and case closures. User participation was the most cited principle, operationalised in relation to all elements of practice in seven documents. a total of 16 standards related to individual practice and eight to agency level responsibilities.

Discussion

The findings indicate a set of core standards that have demonstrated utility over a 30-year period and to gaps in relation to both the operationalisation of certain principles and particular elements of care coordination. the application of the definition of a standard developed by this study could support the delivery of comprehensive high-quality services across the care coordination pathway. Further research is needed to validate its use in different settings.
Patent foramen ovale presenting as visual loss
Authors: Liu Xiaoxuan , Calvert Patrick A , Arif Sayqa , Keane Pearse A , Denniston Alastair K
Published: January 2017

Retinal artery occlusion in an otherwise healthy, young patient is rare. In this context it is important to consider patent foramen ovale as a differential. Early referral to a cardiology specialist for diagnosis and treatment is important for preventing further ocular and non-ocular events.
Tricuspid Valve Replacement in Infants and Children With Exclusively Autologous Tissue
Authors: Mohamed Khaled Samir
Published: January 2017

Tricuspid valve replacement has always been a challenge in the pediatric population, with high rates of mortality and morbidity. This article describes a new technique that we have used to replace the tricuspid valve with exclusively autologous tissues. The pulmonary autograft is used for tricuspid valve replacement. Pulmonary artery wall and autologous pericardium are utilized for right ventricular out flow tract reconstruction with the creation of a monocusp.
Sustained Improvement in Right Ventricular Chamber Dimensions 10 Years Following Xenograft Pulmonary Valve Replacement
Authors: Schubmehl Heidi B. , Swartz Michael F. , Atallah-Yunes Nader , Wittlieb-Weber Carol , Pratt Rebecca E. , Alfieris George M.
Published: January 2017

Background:

The goals following pulmonary valve replacement (PVR) are to optimize right ventricular hemodynamics and minimize the need for subsequent reoperations on the right ventricular outflow tract. We hypothesized PVR using a xenograft valved conduit would result in superior freedom from reoperation with sustained improvement in right ventricular chamber dimensions.

Methods:

Xenograft valved conduits placed in patients aged >16 years were reviewed from 2000 to 2010 to allow for a 5-year minimum follow-up. Preoperative, one-year, and the most recent echocardiograms quantified right ventricular chamber dimensions, corresponding Z scores, and prosthetic valve function. Magnetic resonance imaging (MRI) studies compared preoperative and follow-up right ventricular volumes.

Results:

A total of 100 patients underwent PVR at 24 (19-34) years. Freedom from reintervention was 100% at 10 years. At most recent follow-up, only one patient had greater than mild pulmonary insufficiency. The one-year (17.3 ± 7.2 mm Hg; P < .01) and most recent follow-up (18.6 ± 9.8 mm Hg; P < .01) Doppler-derived right ventricular outflow tract gradients remained significantly lower than preoperative measurements (36.7 ± 27.0 mm Hg). Similarly, right ventricular basal diameter, basal longitudinal diameter, and the corresponding Z scores remained lower at one year and follow-up from preoperative measurements. From 34 MRI studies, the right ventricular end-diastolic indexed volume (161.7 ± 58.5 vs 102.9 ± 38.3; P < .01) and pulmonary regurgitant fraction (38.0% ± 15.9% vs 0.8% ± 3.3%; P < .01) were significantly lower at 7.1 ± 3.4 years compared to the preoperative levels.

Conclusion:

Use of a xenograft valved conduit for PVR results in excellent freedom from reoperation with sustained improvement in right ventricular dimensions at an intermediate-term follow-up.
The Accuracy of Noninvasive Peripheral Pulse Oximetry After Palliative Cardiac Surgery in Patients With Cyanotic Congenital Heart Disease
Authors: Scrimgeour Gemma E. , Griksaitis Michael J. , Pappachan John V. , Baldock Andrew J.
Published: January 2017

Background:

Children with cyanotic congenital heart disease (CCHD) live with oxyhemoglobin saturations that are typically expressed as percentages in the range of 70s and 80s. Peripheral pulse oximetry (measurement of SpO2) performs poorly in this range and yet is widely used to inform clinical decisions in these patients. The reference standard is co-oximetry of arterial samples (SaO2).

Methods:

In this study, 515 paired measurements of SpO2 and SaO2 were taken from 19 children who had undergone palliative cardiac surgery.

Results:

SpO2 (Masimo SET LNCS Neo pulse oximeter) overestimated oxyhemoglobin saturation in 82% of measurements (mean 4.6% ± 6.6%). There was a strong negative correlation between mean bias and SaO2 ( r = −.96, P = .002, 95% confidence interval: −0.99 to −0.68).

Conclusion:

The results raise a concern that critical hypoxemia may go undetected and untreated if pulse oximetry is relied upon as the primary means of assessing oxyhemoglobin saturation in children with CCHD. Strong preference must be given to co-oximetry of arterial samples.
Common Arterial Trunk Repair by Means of a Handmade Bovine Pericardial-Valved Woven Dacron Conduit
Authors: Ramírez-Marroquín Samuel , Curi-Curi Pedro José , Calderón-Colmenero Juan , García-Montes José Antonio , Cervantes-Salazar Jorge Luis
Published: January 2017

Background:

Surgical repair of common arterial trunk (CAT) by means of a homograft conduit has become a standard practice. We report our experience in the correction of this heart disease with a handmade bovine pericardial-valved woven Dacron conduit as an alternative procedure to homografts, with a focus on early, mid-term, and long-term results.

Methods:

We designed a retrospective study that included 15 patients with a mean age of 1.5 years (range: three months to eight years), who underwent primary repair of simple CAT. Right ventricular outflow tract was reconstructed in all the cases with this handmade graft that was explanted at the time of its biological stenotic degeneration. A peeling procedure was performed at this time, in order to reconstruct the right ventricle-to-pulmonary artery continuity.

Results:

Overall mortality was 13.3% (one death at the early postoperative primary repair and the other at the mid-term postoperative peeling reoperation). Actuarial survival rate was 93.3%, 86.7%, and 86.7% at 5, 10, and 15 years, respectively. All of the 14 survivors developed stenosis of the handmade conduit at the mid-term period (8 ± 3 years), but after the peeling procedure, 13 survivors remain asymptomatic to date.

Conclusions:

Primary repair of common arterial trunk using a handmade conduit can be performed with very low perioperative mortality and satisfactory mid-term and long-term results, which can be favorably compared with those reported with the use of homografts. When graft obstruction develops, peeling procedure is a good option because it does not affect the overall survival, although long-term outcomes warrant further follow-up.
Clinical Databases and Registries in Congenital and Pediatric Cardiac Surgery, Cardiology, Critical Care, and Anesthesiology Worldwide
Authors: Vener David F. , Gaies Michael , Jacobs Jeffrey P. , Pasquali Sara K.
Published: January 2017

The growth in large-scale data management capabilities and the successful care of patients with congenital heart defects have coincidentally paralleled each other for the last three decades, and participation in multicenter congenital heart disease databases and registries is now a fundamental component of cardiac care. This manuscript attempts for the first time to consolidate in one location all of the relevant databases worldwide, including target populations, specialties, Web sites, and participation information. Since at least 1,992 cardiac surgeons and cardiologists began leveraging this burgeoning technology to create multi-institutional data collections addressing a variety of specialties within this field. Pediatric heart diseases are particularly well suited to this methodology because each individual care location has access to only a relatively limited number of diagnoses and procedures in any given calendar year. Combining multiple institutions data therefore allows for a far more accurate contemporaneous assessment of treatment modalities and adverse outcomes. Additionally, the data can be used to develop outcome benchmarks by which individual institutions can measure their progress against the field as a whole and focus quality improvement efforts in a more directed fashion, and there is increasing utilization combining clinical research efforts within existing data structures. Efforts are ongoing to support better collaboration and integration across data sets, to improve efficiency, further the utility of the data collection infrastructure and information collected, and to enhance return on investment for participating institutions.
Prevalence and Determinants of Bullying Among Health Care Workers in Portugal
Authors: Norton Pedro , Costa Viviana , Teixeira Joel , Azevedo Ana , Roma-Torres António , Amaro Joana , Cunha Liliana
Published: January 2017

Bullying is defined as systematic exposure to humiliation as well as hostile and violent behaviors against one or more individuals. These behaviors are a serious, growing problem, which affects a significant proportion of health care professionals. To support the hospital’s risk management policy, a cross-sectional study was undertaken to determine the prevalence of bullying in this institution and identify the determinants of bullying. Bullying was measured using the Negative Acts Questionnaire–Revised, Portuguese version (NAQ-R), a self-administered tool. The questionnaire was made available in digital format on the hospital’s internal network (Intranet) and in hard copy; questionnaires were returned via nonidentified internal mail addressed to the occupational health unit or deposited in suggestion boxes located throughout the hospital. Multiple questionnaire delivery methods guaranteed data anonymity and confidentiality. The prevalence of bullying in this hospital was 8% (95% confidence interval [CI] = [6.2, 10.2]). Reported bullying was predominantly vertical and more frequently occurring among nurses, clerical staff, and health care assistants (12.5%, 7.6%, 6.4%, respectively; p = .005). After adjusting for gender, age, occupation, type of contract, and work schedule, only type of contract was significantly associated with bullying in the workplace; the risk of bullying was twice as high among government employees compared to workers with indefinite duration employment contracts ( p = .038). This study identified a high prevalence of bullying among health professionals; hence a program to prevent and control this phenomenon was implemented in this institution.
Cooperation Between Occupational Health Services and Small-Scale Enterprises in Norway and Sweden: A Provider Perspective
Authors: Vinberg Stig , Torsdatter Markussen Lisa , Landstad Bodil J.
Published: January 2017

Although small-scale enterprises (SSEs) dominate the private enterprise sector, knowledge about support for these organizations from occupational health services (OHSs) is insufficient. The aim of this research was to study OHS services provided and staff cooperation with SSEs in Norway and Sweden. In total, 87 Norwegian and 51 Swedish OHS providers answered a survey on their experiences providing requested services from and cooperation with SSEs. Based on survey questions and constructed indices, providers in the two countries were compared using independent sample t tests and non-parametric tests. Open-ended questions were analyzed using qualitative content analysis. The results showed that SSEs, particularly in industrial, construction, and trade sectors, commonly contract for Norwegian and Swedish OHSs, and these contracts have increased in the last 12 months. Norwegian providers state that SSEs request broader organizationally- based services; their Swedish counterparts request more individual-based health-related services. Improvements concerning specific strategies for OHS collaboration with SSEs may be needed.
The Physical Aspects of Industrial Rehabilitation
Authors: Heath Sherburne W.
Published: January 2017

The physical aspects of rehabilitation should be considered on the basis of the organization and service of a rehabilitation center, even though the principles rather than actual rehabilitation center facilities would be used. It is recognized that every patient presenting himself to the doctor's office and every industrial disability requires rehabilitation to some degree.

A rehabilitation center basically is a simultaneous Integration of physical, emotional, social and vocational evaluation and treatment. The physical is further subdivided into the indicated medical and surgical specialties and related paramedical therapies, the total personnel comprising a rehabilitation team.

It should be emphasized that physical rehabilitation is not the province of one medical specialty, but is a philosophy imparting a logical dynamic aspect to medicine and surgery. Added to these, but not replacing them is physical medicine which, in addition to diagnostic aspects offers:

A. Conservative measures to control muscle spasm and pain, which often begin a vicious cycle of contracture and debility.

B. Progressive resistive exercise techniques to strengthen muscles and muscle groups.

C. Exercises to maintain normal joint ranges or to restore restricted joints.

D. Retraining for physical coordination and dexterity, including gait training.

E. Activities to integrate the patient's abilities with the demands of self care and employment.
Interpreting the Disparity in Educational Attainment among Various Socio-religious Groups in India
Authors: Chaudhury Anjan Ray
Published: January 2017

This study is an attempt to identify the origin of disparity in educational participation and educational achievement among various socio-religious groups in India. To accomplish this objective, we run the logistic model of regression to estimate the differential influences of the monetary returns to education and some personal, household and community-related factors affecting educational decisions of the school-age children across the groups. Then we use the method of inequality decomposition applicable for logit/probit model and decompose the existing inequality in the proportion of educational participation between some pairs of the socio-religious groups into ‘response effect’ and ‘attribute effect’.

It is observed that there exists sharp disparity in educational participation among the various groups. A rise in estimated returns enhances the educational decisions of the members of the disadvantaged groups irrespective of their age and levels of education, but it can enhance the educational decisions of the members of the advantaged groups only at the upper end of their school-age. The percentage contribution of the ‘response effect’ of disparity in the rate of educational participation between Hindu-others and Muslims is greater compared to that of the ‘attribute effect’, but the former declines with the rise in the level of education. However, a significant proportion of the disparities in the educational participation between Hindu-others and Hindu-SC, and Hindu-others and Hindu-ST, is attributed to the characteristic differences at all levels of education except the middle.
Using Theory and Measurement to Sharpen Conceptualizations of Mathematics Teaching in the Common Core Era
Authors: Stein Mary Kay , Correnti Richard , Moore Debra , Russell Jennifer Lin , Kelly Katelynn
Published: January 2017

We argue that large-scale, standards-based improvements in the teaching and learning of mathematics necessitate advances in our theories regarding how teaching affects student learning and progress in how we measure instruction. Our theory—an embodiment of the interaction of high and low levels of two constructs that past research has shown to influence students’ development of conceptual understanding (explicit attention to concepts and students’ opportunity to struggle)—guided the development of survey-, video-, and artifact-based measures of teaching. Here, we develop a validity argument for the inferences that can be drawn about teaching from these measures by identifying claims and empirical evidence about the extent to which those claims are born out in practice. Results suggest our theory is capturing four patterns of teaching and that it can successfully predict different types of student learning: skills efficiency measured on the state standardized test and conceptual understanding as measured through open-ended task sets.
Natural Window of Opportunity? Low-Income Parents’ Responses to Their Children’s Impending Kindergarten Entry
Authors: Weiland Christina , McCoy Dana Charles , Grace Elizabeth , Park Soojin Oh
Published: January 2017

Parental investments in the activities and materials that drive learning are central to young children’s school readiness and life success. Little is known, however, about how parents adjust these investments in response to outside pressures, including their children’s impending entry into kindergarten. In the present study, we employ two analytical strategies (multilevel residualized change and regression discontinuity) within national data from the Head Start Impact Study to examine whether parents of children facing an impending entry to kindergarten invest more time and materials in their children’s language and literacy skill development compared with parents of otherwise similar children who are not yet facing formal school entry. Results suggest that low-income parents react to the impending kindergarten transition by increasing their provision of parent–child language and literacy activities (d = .15) but not related materials. We discuss the implications of our findings for the timing of parenting interventions.
Optimizing Implementation of Hepatitis C Birth-Cohort Screening and Treatment Strategies
Authors: Li Yuankun , Huang Hao , Zabinsky Zelda B. , Liu Shan
Published: January 2017

Background: Chronic hepatitis C (HCV) is a significant public health problem affecting more than three million Americans. The US health care systems are ramping up costly HCV screening and treatment efforts with limited budget. We determine the optimal implementation of HCV birth-cohort screening and treatment strategies under budget constraints and health care payer’s perspective. Methods: Markov model and scenario-based simulation optimization. The target population is birth cohort born between 1945 and 1975. The interventions are allocating annual budget to screen a proportion of the target population and treat a proportion of the identified chronic HCV-positive patients over 10 years. Outcomes measure is to maximize lifetime discounted quality-adjusted life-years. Results: Allocate a percentage of the annual budget to screening, then treat patients with the remaining budget and prioritize the sickest patients. When the budget is $1 billion/year, the best strategy is to allocate the entire budget to treatment. When the budget is $5 billion/year, it is optimal to allocate 60% of the budget to screening in the first 2 years and 0% thereafter for age cohort 40 to 49; and allocate 20% of the budget to screening starting in year 3 for age cohorts 50 to 59 and 60 to 69. Health benefits are sensitive to budget in the first 2 years. Results are not sensitive to distribution of fibrosis stages by awareness of HCV. Conclusion: When budget is limited, all efforts should be focused on early treatment. With higher budget, better population health outcomes are achieved by reserving some budget for HCV screening while implementing a priority-based treatment strategy. This work has broad applicability to diverse health care systems and helps determine how much effort should be devoted to screening versus treatment under resource limitations.
Prospective study of nonmyeloablative, HLA-mismatched unrelated BMT with high-dose posttransplantation cyclophosphamide
Authors: Kasamon Yvette L. , Ambinder Richard F. , Fuchs Ephraim J. , Zahurak Marianna , Rosner Gary L. , Bolaños-Meade Javier , Levis Mark J. , Gladstone Douglas E. , Huff Carol Ann , Swinnen Lode J. , Matsui William H. , Borrello Ivan , Brodsky Robert A. , Jones Richard J. , Luznik Leo
Published: January 2017

Key Points

Nonmyeloablative, HLA-mismatched unrelated BMT with high-dose posttransplantation cyclophosphamide carries an acceptable safety profile. This platform may expand the donor pool for patients who lack an HLA-matched or -haploidentical donor.
Improvement of quality of life through glycemic control by liraglutide, a GLP-1 analog, in insulin-naive patients with type 2 diabetes mellitus: the PAGE1 study
Authors: Ishii Hitoshi , Niiya Tetsuji , Ono Yasuhiro , Inaba Naoyuki , Jinnouchi Hideaki , Watada Hirotaka
Published: January 2017

Background

In addition to achieving good glycemic control, diabetes care management aims to improve the quality of life (QOL) in patients. Treatment-associated difficulties and side effects frequently cause deterioration in QOL. Liraglutide, a GLP-1 receptor agonist, is a novel injection drug that promotes insulin secretion. It is a user-friendly, once-daily injection with fewer hypoglycemic events. In this study, we aimed to examine the effect of liraglutide therapy on QOL in patients.

Methods

In total, 304 insulin- and liraglutide-naïve patients with type 2 diabetes were enrolled in this observational study; they received liraglutide therapy for 12 weeks. The main outcome measure was change in QOL from baseline, which was assessed using diabetes therapy-related QOL (DTR-QOL).

Results

At week 12, liraglutide significantly decreased HbA1c levels (8.7 ± 1.5 vs. 7.5 ± 1.3, p < 0.001) and BMI (27.9 ± 5.3 vs. 27.3 ± 5.2, p < 0.001). According to the QOL scores, although the treatment modality had changed from non-injection to injection therapy, liraglutide improved patient satisfaction with treatment. Significant correlations were found between change in HbA1c level and satisfaction with treatment, as well as between change in body weight and burden on social and daily activities, anxiety and dissatisfaction with treatment, and hypoglycemia.

Conclusions

Liraglutide significantly improved glycemic control and reduced the body weight without deteriorating QOL in obese patients with type 2 diabetes.

Trial registration UMIN-CTR: UMIN000007159
Updates in understanding the role of cyclophilin A in leukocyte chemotaxis
Authors: Dawar Farman Ullah , Wu Junjie , Zhao Lijuan , Khattak Muhammad Nasir Khan , Mei Jie , Lin Li
Published: January 2017

Cyclophilin A (CypA), a well-recognized receptor for anti-inflammatory drug cyclosporine A (CsA) is a ubiquitous and multifunctional protein. Beside the diverse intracellular functions, CypA is secreted against inflammatory stimuli, where it activates and attracts leukocytes via CD147 to the stimulus site. Interestingly, it synergizes with other factors to induce leukocyte migration in different animals. However, the silencing and inhibition of CypA or CD147 inhibits leukocytes chemotaxis and inflammation. This review focuses on the advances made in understanding the mechanism of CypA-dependent leukocytes chemotaxis and hence, recognition of this factor as a possible therapeutic target in inflammatory diseases.
Anesthesia for Ambulatory Pediatric Surgery in Sub-Saharan Africa: A Pilot Study in Burkina Faso
Authors: Kabré Yvette B. , Traoré Idriss S.S. , Kaboré Flavien A.R. , Ki Bertille , Traoré Alain I. , Ouédraogo Isso , Bandré Emile , Wandaogo Albert , Ouédraogo Nazinigouba
Published: January 2017

BACKGROUND:

Long surgical wait times and limited hospital capacity are common obstacles to surgical care in many countries in Sub-Saharan Africa (SSA). Introducing ambulatory surgery might contribute to a solution to these problems. The purpose of this study was to evaluate the safety and feasibility of introducing ambulatory surgery into a pediatric hospital in SSA.

METHODS:

This is a cross-sectional descriptive study that took place over 6 months. It includes all patients assigned to undergo ambulatory surgery in the Pediatric University Hospital in Ouagadougou, Burkina Faso. Eligibility criteria for the ambulatory surgery program included >1 year of age, American Society of Anesthesiologists (ASA) 1 status, surgery with a low risk of bleeding, lasting <90 minutes, and with an expectation of mild to moderate postoperative pain. The family had to live within 1 hour of the hospital and be available by telephone.

RESULTS:

During the study period, a total of 1250 patients underwent surgery, of whom 515 were elective cases; 115 of these met the criteria for ambulatory surgery; 103 patients, with an average age of 59.74 ± 41.57 months, actually underwent surgery. The principal indications for surgery were inguinal (62) and umbilical (47) hernias. All patients had general anesthesia with halothane. Sixty-five percent also received regional or local anesthesia consisting of caudal block in 79.23% or nerve block in 20.77%. The average duration of surgery was 33 ± 17.47 minutes. No intraoperative complications were noted. All the patients received acetaminophen and a nonsteroidal anti-inflammatory drug in the recovery room. Twelve (11.7%) patients had complications in recovery, principally nausea and vomiting. Eight (7.8%) patients were admitted to the hospital.

CONCLUSIONS:

No serious complications were associated with ambulatory surgery. Its introduction could possibly be a solution to improving pediatric surgical access in low-income countries.
Intravenous Ketamine Infusions for Neuropathic Pain Management: A Promising Therapy in Need of Optimization
Authors: Maher Dermot P , Chen Lucy , Mao Jianren
Published: January 2017

Intravenous ketamine infusions have been used extensively to treat often-intractable neuropathic pain conditions. Because there are many widely divergent ketamine infusion protocols described in the literature, the variation in these protocols presents a challenge for direct comparison of one protocol with another and in discerning an optimal protocol. Careful examination of the published literature suggests that ketamine infusions can be useful to treat neuropathic pain and that certain characteristics of ketamine infusions may be associated with better clinical outcomes. Increased duration of relief from neuropathic pain is associated with (1) higher total infused doses of ketamine; (2) prolonged infusion durations, although the rate of infusion does not appear to be a factor; and (3) coadministration of adjunct medications such as midazolam and/or clonidine that mitigate some of the unpleasant psychomimetic side effects. However, there are few studies designed to optimize ketamine infusion protocols by defining what an effective infusion protocol entails with regard to a respective neuropathic pain condition. Therefore, despite common clinical practice, the current state of the literature leaves the use of ketamine infusions without meaningful guidance from high-quality comparative evidence. The objectives of this topical review are to (1) analyze the available clinical evidence related to ketamine infusion protocols and (2) call for clinical studies to identify optimal ketamine infusion protocols tailored for individual neuropathic pain conditions. The Oxford Center for Evidence-Based Medicine classification for levels of evidence was used to stratify the grades of clinical recommendation for each infusion variable studied.
Dural Puncture Epidural Technique Improves Labor Analgesia Quality With Fewer Side Effects Compared With Epidural and Combined Spinal Epidural Techniques: A Randomized Clinical Trial
Authors: Chau Anthony , Bibbo Carolina , Huang Chuan-Chin , Elterman Kelly G. , Cappiello Eric C. , Robinson Julian N. , Tsen Lawrence C.
Published: January 2017

BACKGROUND:

The dural puncture epidural (DPE) technique is a modification of the combined spinal epidural (CSE) technique, where a dural perforation is created from a spinal needle but intrathecal medication administration is withheld. The DPE technique has been shown to improve caudal spread of analgesia compared with epidural (EPL) technique without the side effects observed with the CSE technique. We hypothesized that the onset of labor analgesia would follow this order: CSE > DPE > EPL techniques.

METHODS:

A total of 120 parturients in early labor were randomly assigned to EPL, DPE, or CSE groups. Initial dosing for EPL and DPE consisted of epidural 20 mL of 0.125% bupivacaine plus fentanyl 2 μg/mL over 5 minutes, and for CSE, intrathecal 0.25% bupivacaine 1.7 mg and fentanyl 17 μg. Upon block completion, a blinded coinvestigator assessed the outcomes. Two blinded obstetricians retrospectively interpreted uterine contractions and fetal heart rate tracings 1 hour before and after the neuraxial technique. The primary outcome was time to numeric pain rating scale (NPRS) ≤ 1 analyzed by using Kaplan-Meier curves and Cox proportional hazard model. Secondary outcomes included block quality, maternal adverse effects, uterine contraction patterns, and fetal outcomes analyzed by using the χ2 test with Yates continuity correction.

RESULTS:

There was no significant difference in the time to NPRS ≤ 1 between DPE and EPL (hazard ratio 1.4; 95% confidence interval [CI] 0.83–2.4, P = .21). DPE achieved NPRS ≤ 1 significantly slower than CSE (hazard ratio 0.36; 95% CI 0.22–0.59, P = .0001). The median times (interquartile range) to NPRS ≤ 1 were 2 (0.5–6) minutes for CSE, 11 (4–120) minutes for DPE, and 18 (10–120) minutes for EPL. Compared with EPL, DPE had significantly greater incidence of bilateral S2 blockade at 10 minutes (risk ratio [RR] 2.13; 95% CI 1.39–3.28; P < .001), 20 minutes (RR 1.60; 95% CI 1.26–2.03; P < .001), and 30 minutes (RR 1.18; 95% CI 1.01–1.30; P < .034), a lower incidence of asymmetric block after 30 minutes (RR 0.19; 95% CI 0.07–0.51; P < .001) and physician top-up intervention (RR 0.45; 95% CI 0.23–0.86; P = .011). Compared with CSE, DPE had a significantly lower incidence of pruritus (RR 0.15; 95% CI 0.06–0.38; P < .001), hypotension (RR 0.38; 95% CI 0.15–0.98; P = .032), combined uterine tachysystole and hypertonus (RR 0.22; 95% CI 0.08–0.60; P < .001), and physician top-up intervention (RR 0.45; 95% CI 0.23–0.86; p = .011).

CONCLUSIONS:

Analgesia onset was most rapid with CSE with no difference between DPE and EPL techniques. The DPE technique has improved block quality over the EPL technique with fewer maternal and fetal side effects than the CSE technique for parturients requesting early labor analgesia.
The spectraplakin Short stop is an essential microtubule regulator involved in epithelial closure in Drosophila
Authors: Takács Zsanett , Jankovics Ferenc , Vilmos Péter , Lénárt Péter , Röper Katja , Erdélyi Miklós
Published: January 2017

Dorsal closure of the Drosophila embryonic epithelium provides an excellent model system for the in vivo analysis of molecular mechanisms regulating cytoskeletal rearrangements. In this study, we investigated the function of the Drosophila spectraplakin Short stop (Shot), a conserved cytoskeletal structural protein, during closure of the dorsal embryonic epithelium. We show that Shot is essential for the efficient final zippering of the opposing epithelial margins. By using isoform-specific mutant alleles and genetic rescue experiments with truncated Shot variants, we demonstrate that Shot functions as an actin–microtubule cross-linker in mediating zippering. At the leading edge of epithelial cells, Shot regulates protrusion dynamics by promoting filopodia formation. Fluorescence recovery after photobleaching (FRAP) analysis and in vivo imaging of microtubule growth revealed that Shot stabilizes dynamic microtubules. The actin- and microtubule-binding activities of Shot are simultaneously required in the same molecule, indicating that Shot is engaged as a physical crosslinker in this process. We propose that Shot-mediated interactions between microtubules and actin filaments facilitate filopodia formation, which promotes zippering by initiating contact between opposing epithelial cells.