bluuebunny/crossref_metadata_2025 huggingface dataset:
Enhanced Recovery Implementation in Major Gynecologic Surgeries
Authors: Modesitt Susan C. , Sarosiek Bethany M. , Trowbridge Elisa R. , Redick Dana L. , Shah Puja M. , Thiele Robert H. , Tiouririne Mohamed , Hedrick Traci L.
Published: August 2016

OBJECTIVE:

To examine implementing an enhanced recovery after surgery (ERAS) protocol for women undergoing major gynecologic surgery at an academic institution and compare surgical outcomes before and after implementation.

METHODS:

Two ERAS protocols were developed: a full pathway using regional anesthesia for open procedures and a light pathway without regional anesthesia for vaginal and minimally invasive procedures. Enhanced recovery after surgery pathways included extensive preoperative counseling, carbohydrate loading and oral fluids before surgery, multimodal analgesia with avoidance of intravenous opioids, intraoperative goal-directed fluid resuscitation, and immediate postoperative feeding and ambulation. A before-and-after study design was used to compare clinical outcomes, costs, and patient satisfaction. Complications and risk-adjusted length of stay were drawn from the American College of Surgeons’ National Surgical Quality Improvement Program database.

RESULTS:

On the ERAS full protocol, 136 patients were compared with 211 historical controls and the median length of stay was reduced (2.0 compared with 3.0 days; P=.007) despite an increase in National Surgical Quality Improvement Program-predicted length of stay (2.5 compared with 2.0 days; P=.009). Reductions were seen in median intraoperative morphine equivalents (0.3 compared with 12.7 mg; P<.001), intraoperative (285 compared with 1,250 mL; P<.001) and total intravenous fluids (−917.5 compared with 1,410 mL; P<.001), immediate postoperative pain scores (3.7 compared with 5.0; P<.001), and total complications (21.3% compared with 40.2%; P=.004). On the ERAS light protocol, 249 patients were compared with 324 historical controls and demonstrated decreased intraoperative and postoperative morphine equivalents (0.0 compared with 13.0 mg; P<.001 and 15.0 compared with 23.6 mg; P<.001) and decreased intraoperative and overall net intravenous fluids (P<.001). Patient satisfaction scores showed a marked and significant improvement on focus questions regarding pain control, nurses keeping patients informed, and staff teamwork; 30-day total hospital costs were significantly decreased in both ERAS groups.

CONCLUSION:

Implementation of ERAS protocols in gynecologic surgery was associated with a substantial decrease in intravenous fluids and morphine administration coupled with reduction in length of stay for open procedures combined with improved patient satisfaction and decreased hospital costs.
Group Prenatal Care Compared With Traditional Prenatal Care
Authors: Carter Ebony B. , Temming Lorene A. , Akin Jennifer , Fowler Susan , Macones George A. , Colditz Graham A. , Tuuli Methodius G.
Published: August 2016

OBJECTIVE:

To estimate the effect of group prenatal care on perinatal outcomes compared with traditional prenatal care.

DATA SOURCES:

We searched MEDLINE through PubMed, EMBASE, Scopus, Cumulative Index of Nursing and Allied Health literature, the Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov.

METHODS OF STUDY SELECTION:

We searched electronic databases for randomized controlled trials and observational studies comparing group care with traditional prenatal care. The primary outcome was preterm birth. Secondary outcomes were low birth weight, neonatal intensive care unit admission, and breastfeeding initiation. Heterogeneity was assessed using the Q test and I
2 statistic. Pooled relative risks (RRs) and weighted mean differences were calculated using random-effects models.

TABULATIONS, INTEGRATION, AND RESULTS:

Four randomized controlled trials and 10 observational studies met inclusion criteria. The rate of preterm birth was not significantly different with group care compared with traditional care (11 studies: pooled rates 7.9% compared with 9.3%, pooled RR 0.87, 95% confidence interval [CI] 0.70–1.09). Group care was associated with a decreased rate of low birth weight overall (nine studies: pooled rate 7.5% group care compared with 9.5% traditional care; pooled RR 0.81, 95% CI 0.69–0.96), but not among randomized controlled trials (four studies: 7.9% group care compared with 8.7% traditional care, pooled RR 0.92, 95% CI 0.73–1.16). There were no significant differences in neonatal intensive care unit admission or breastfeeding initiation.

CONCLUSION:

Available data suggest that women who participate in group care have similar rates of preterm birth, neonatal intensive care unit admission, and breastfeeding.
Outcomes and Postoperative Complications After Hysterectomies Performed for Benign Compared With Malignant Indications
Authors: Wallace Sumer K. , Fazzari Melissa J. , Chen Hui , Cliby William A. , Chalas Eva
Published: August 2016

OBJECTIVE:

To compare complications and outcomes after hysterectomy for benign compared with malignant indications in the United States.

METHODS:

Women who underwent hysterectomy in the United States for either benign or malignant indications from January 2008 to December 2012 were retrospectively identified using the National Surgical Quality Improvement Program database. Patients were excluded if the procedure was not performed for primary gynecologic indications. Appropriate procedures were identified using Current Procedural Terminology and International Classification of Diseases, 9th Revision codes. Univariate and multivariable models for complication risk were estimated using logistic regression.

RESULTS:

We identified 59,525 eligible patients, with 49,331 (82.9%) hysterectomies performed for benign and 10,194 (17.1%) for malignant indications. All complications, including wound complications (2.5% benign compared with 5.5% malignant, P<.001), venous thromboembolism (0.33% compared with 1.7%, P<.001), urinary tract infection (2.7% compared with 3.2%, P=.009), sepsis (0.53% compared with 1.9%, P<.001), blood transfusion (2.6% compared with 11.5%, P<.001), death (0.02% compared with 0.10%, P<.001), unplanned readmission (1.8% compared with 4.5%, P<.001), and returns to the operating room (0.91% compared with 1.4%, P<.001), were significantly more common for malignant hysterectomies. The overall rate of complications for benign cases was 7.9% compared with a rate of 19.4% for malignant hysterectomy. The median operating time for laparoscopy in benign cases was significantly longer than for open or vaginal hysterectomy procedures (127 minutes compared with 105 or 94 minutes, respectively; P<.001). The median operating time in malignant cases was significantly longer than for benign cases (P<.001).

CONCLUSION:

Hysterectomies performed for gynecologic malignancies are associated with a more than twofold higher complication rate compared with those performed for benign conditions. Minimally invasive surgery is associated with a decreased complication rate compared with open surgery. These data can be used for patient counseling and surgical planning, determining physician and hospital costs of care, and considered when assigning value-based reimbursement.
Accuracy of Onsite Tests to Detect Asymptomatic Bacteriuria in Pregnancy
Authors: Rogozińska Ewelina , Formina Sandra , Zamora Javier , Mignini Luciano , Khan Khalid S.
Published: August 2016

OBJECTIVE:

To estimate the accuracy of onsite tests to detect asymptomatic bacteriuria among pregnant women.

DATA SOURCES:

We searched MEDLINE, EMBASE, Web of Science, Scopus, and Latin-American Literature from inception until June 2015 without language restrictions. The ClinicalTrials.gov register database was screened to identify any recently completed studies.

METHODS OF STUDY SELECTION:

Two independent reviewers selected studies that recruited asymptomatic pregnant women to evaluate the accuracy of onsite tests in detecting the presence of bacteria in the urine using urine culture as a reference standard.

TABULATION, INTEGRATION, AND RESULTS:

Women's characteristics, study design, urine sample collection, and handling were extracted along with the test accuracy data. Where possible, we pooled the data using a bivariate, hierarchical random-effects model. Of 1,360 screened references, 27 articles (13,641 women) with test accuracy data on nine tests met the inclusion criteria. The most commonly evaluated test was urine dipstick. The pooled sensitivity and specificity of nitrites detected by dipstick to detect asymptomatic bacteriuria were 0.55 (95% confidence interval [CI] 0.42–0.67) and 0.99 (95% CI 0.98–0.99), respectively. The Griess test to detect nitrites had a sensitivity of 0.65 (95% CI 0.50–0.78) and specificity of 0.99 (95% CI 0.98–1.00). Dipslide with Gram staining had a pooled sensitivity of 0.86 (95% CI 0.80–0.91) and specificity of 0.97 (95% CI 0.93–0.99).

CONCLUSION:

The specificity of onsite tests is high; however, the sensitivity is not with the result that they will fail to detect a substantial number of cases of asymptomatic bacteriuria.

CLINICAL TRIAL REGISTRATION:

PROSPERO International prospective register of systematic reviews, http://www.crd.york.ac.uk/PROSPERO/, CRD42015027905.
Prolonged Detection of Zika Virus RNA in Pregnant Women
Authors: Meaney-Delman Dana , Oduyebo Titilope , Polen Kara N.D. , White Jennifer L. , Bingham Andrea M. , Slavinski Sally A. , Heberlein-Larson Lea , St. George Kirsten , Rakeman Jennifer L. , Hills Susan , Olson Christine K. , Adamski Alys , Culver Barlow Lauren , Lee Ellen H. , Likos Anna M. , Muñoz Jorge L. , Petersen Emily E. , Dufort Elizabeth M. , Dean Amy B. , Cortese Margaret M. , Santiago Gilberto A. , Bhatnagar Julu , Powers Ann M. , Zaki Sherif , Petersen Lyle R. , Jamieson Denise J. , Honein Margaret A. ,   for the U.S. Zika Pregnancy Registry Prolonged Viremia Working Group
Published: August 2016

OBJECTIVE:

Zika virus infection during pregnancy is a cause of microcephaly and other fetal brain abnormalities. Reports indicate that the duration of detectable viral RNA in serum after symptom onset is brief. In a recent case report involving a severely affected fetus, Zika virus RNA was detected in maternal serum 10 weeks after symptom onset, longer than the duration of RNA detection in serum previously reported. This report summarizes the clinical and laboratory characteristics of pregnant women with prolonged detection of Zika virus RNA in serum that were reported to the U.S. Zika Pregnancy Registry.

METHODS:

Data were obtained from the U.S. Zika Pregnancy Registry, an enhanced surveillance system of pregnant women with laboratory evidence of confirmed or possible Zika virus infection. For this case series, we defined prolonged detection of Zika virus RNA as Zika virus RNA detection in serum by real-time reverse transcription-polymerase chain reaction (RT-PCR) 14 or more days after symptom onset or, for women not reporting signs or symptoms consistent with Zika virus disease (asymptomatic), 21 or more days after last possible exposure to Zika virus.

RESULTS:

Prolonged Zika virus RNA detection in serum was identified in four symptomatic pregnant women up to 46 days after symptom onset and in one asymptomatic pregnant woman 53 days postexposure. Among the five pregnancies, one pregnancy had evidence of fetal Zika virus infection confirmed by histopathologic examination of fetal tissue, three pregnancies resulted in live births of apparently healthy neonates with no reported abnormalities, and one pregnancy is ongoing.

CONCLUSION:

Zika virus RNA was detected in the serum of five pregnant women beyond the previously estimated timeframe. Additional real-time RT-PCR testing of pregnant women might provide more data about prolonged detection of Zika virus RNA and the possible diagnostic, epidemiologic, and clinical implications for pregnant women.
Pediatric Cancer Patients' Treatment-Related Distress and Longer-Term Anxiety: An Individual Differences Perspective
Authors: Trentacosta Christopher J. , Harper Felicity W. K. , Albrecht Terrance L. , Taub Jeffrey W. , Phipps Sean , Penner Louis A.
Published: August 2016

Objective:

Although distress during treatment procedures and longer-term treatment-related anxiety are among the most common cancer-related stressors for children and their families, they are not invariant. This study examined whether individual differences in temperament and personality play a role in how children respond to treatment procedures. Attention control, a facet of the effortful control dimension of temperament, and the personality attribute ego-resilience were hypothesized to predict lower levels of distress during procedures. Moreover, ego-resilience and distress during procedures were hypothesized to account for indirect associations between attention control and longer-term treatment-related anxiety. Child gender was examined as a potential moderator of these relationships.

Method:

Participants were 147 children undergoing treatment for pediatric cancer and their parents. At baseline, parents reported on children's effortful control and ego-resilience. Multiple raters assessed children's distress during multiple cancer-related procedures. Treatment-related anxiety was measured 3 and 9 months after the last assessed treatment procedure.

Results:

Attention control was linked to ego-resilience and lower levels of distress, and these variables, in turn, accounted for indirect associations between attention control and treatment-related anxiety. Associations involving ego-resilience were stronger for boys than girls.

Conclusion:

Attention control plays an important role in children's immediate and longer-term responses to cancer-related medical procedures. Medical staff should consider individual differences in child temperament and personality when considering the nature and extent of support to provide to pediatric cancer patients and their families.
Posaconazole Therapeutic Drug Monitoring in a Regional Hospital Setting
Authors: Lindsay Patrick J. , Bond Stuart E. , Norris Ross , Marriott Deborah J. E. , Miyakis Spiros
Published: August 2016

Background:

Posaconazole therapeutic drug monitoring (TDM) is recommended to promote effective antifungal prophylaxis, but its utility has yet to be optimized. Breakthrough invasive fungal infections have been reported with serum concentrations <700 mcg/L, but there is little evidence to determine the optimal serum concentration for efficacy or concentrations associated with toxicity. Challenges for effective monitoring are greater in settings without posaconazole TDM facilities because of the long turnaround time before receipt of results.

Methods:

Thirty-eight TDM episodes were performed on 18 patients in a regional center in Australia during a 30-month period. Australian guidelines recommend a trough serum concentration of ≥700 mcg/L. The response to concentrations below the recommendation threshold (700 mcg/L), the final serum plasma concentration for each patient, and the appropriateness of TDM were evaluated.

Results:

A total of 19 (50%) concentrations were recorded to be < 700 mcg/L. Of these 19 concentrations, the drug dose was increased on only 4 occasions. Eleven of 18 patients (61%) had initial concentrations <700 mcg/L, with only 3 (27%) among those achieving final concentration ≥ 700 mcg/L; 5 patients with initial concentrations <700 mcg/L did not have any further TDM testing. Nine of the 18 (50%) patients had a final concentration <700 mcg/L. Five of 7 (71%) patients with initial concentrations ≥700 mcg/L had further TDM with no reasoning documented.

Conclusions:

The results demonstrate a lack of confidence and consistency in ordering, interpreting, and following up posaconazole concentrations. Therefore, the use of TDM should be carefully considered, especially in regional centers. Such settings should consider the practicalities of posaconazole TDM and try to improve the process to ensure consistency and optimization of patient care.
SEVERE BILATERAL RETINAL VASCULAR OCCLUSION AS FIRST PRESENTATION OF SYSTEMIC LUPUS ERYTHEMATOSUS AND ANTIPHOSPHOLIPID SYNDROME
Authors: Storey Philip , Ter-Zakarian Anna , Rao Narsing , Rodger Damien
Published: August 2016

Purpose:

To describe a patient with undiagnosed systemic lupus erythematosus and secondary antiphospholipid syndrome presenting with bilateral severe retinal vaso-occlusion on first presentation.

Methods:

Retrospective case report. A 42-year-old Hispanic female with no medical history presented with 2 weeks of bilateral decreased vision.

Results:

At initial presentation, the patient's best-corrected visual acuity was 2 ft/200 and 20/400 in the right and left eyes, respectively. Dilated fundus examination revealed diffuse, confluent cotton-wool spots, and severe vascular occlusions in both eyes. Fluorescein angiography confirmed that the patient had both arterial and venous vascular occlusions and retinal vasculitis. A thorough work-up revealed that the patient had systemic lupus erythematosus and APS with positive antibodies to anticardiolipin, beta-2-glycoprotein, and lupus anticoagulant. The patient was treated with steroids, immunosuppression agents, anticoagulation, and extensive panretinal photocoagulation. One month later, best-corrected visual acuity had improved to 20/200 and 20/40, the vasculitis had substantially improved, and no neovascularization was present.

Conclusion:

Severe retinal vaso-occlusion may be the first presenting signs for patients with systemic lupus erythematosus and APS.
Sedation and Afternoon Placement of the 48-Hour Wireless Ambulatory pH Capsule Results in More Reflux on the First Day
Authors: Patel Rupal , Chae Soojong , Kumar Ambuj , Richter Joel E.
Published: August 2016

Background:

A 48-hour wireless capsule results often vary from the first to second day. Previous investigations comparing discrepant acid reflux readings have yielded variable results. In this study we investigated differences in data obtained on day 1 versus day 2, and the effect of time of capsule placement on discrepancies.

Methods:

We performed a retrospective cohort study. Patients undergoing a 48-hour wireless capsule study between January 2012 through November 2013 were eligible for inclusion. We collected reflux data for each patient and calculated the proportion of patients in four groups based on abnormal DeMeester score groups (+/+, −/+, +/−, −/−). We placed patients into morning placement or afternoon placement categories and calculated the proportions of patients with various DeMeester score discrepancies.

Key Results:

This study evaluated 229 patients. The mean day 1 DeMeester score was 28.38 and the mean day 2 DeMeester score was 23.24 (P<0.0001). The mean day 1 DeMeester score in the morning group was 24.9 and 31.7 in the afternoon group (P<0.05). The mean total DeMeester score in the morning placement group was 23.1 and 30.6 in the afternoon group (P<0.05). Twenty-five percent of afternoon patients had a +day 1/−day 2 DeMeester discordance, whereas only 12% of morning placement patients had this discordance (P=0.26).

Conclusions:

Afternoon capsule placement is associated with a significantly increased amount of acid reflux on day 1. Approximately 10% of 48-hour esophageal wireless monitoring studies may falsely overestimate reflux when the capsule is placed in the afternoon. Capsule placement should ideally be performed in the morning.
Disease-specific Pay-for-Performance Programs
Authors: Huang Yu-Chin , Lee Miaw-Chwen , Chou Yiing-Jenq , Huang Nicole
Published: August 2016

Background:

Several studies have investigated the effects of pay-for-performance (P4P) initiatives. However, little is known about whether patients with multiple chronic conditions (MCC) would benefit from P4P initiatives similarly to patients without MCC.

Objectives:

The objective of this study was to compare the effects of the diabetes mellitus pay-for-performance (DM-P4P) program on the quality of diabetic care between type 2 diabetic patients with and without MCC.

Methods:

This study used data from Taiwan’s Longitudinal Health Insurance Database 2005. Of this cohort, 52,276 diabetic patients were identified. To address potential selection bias between the intervention and comparison groups, the propensity score matching method was used. Generalized estimating equations were applied to analyze the difference-in-difference model to examine the effect of the intervention, the DM-P4P program.

Results:

The disease-specific DM-P4P program had positive impacts on process and outcome indicators of health care quality regardless of patients’ MCC status. Diabetic patients with MCC experienced a significantly larger decrease in the admission rate of diabetes-related ambulatory care sensitive conditions after the P4P enrollment over time compared with patients without MCC.

Conclusions:

The positive impacts on use of diabetes-related services were comparable between diabetic patients with and without MCC. Most importantly, for MCC patients, the disease-specific DM-P4P program had a stronger positive impact on health outcomes. Hence, the commonly observed phenomenon of “cherry picking” in implementing P4P strategies may lead to disparities in the quality of diabetic care between diabetic patients with and without MCC.
Benchmarks for Reducing Emergency Department Visits and Hospitalizations Through Community Health Workers Integrated Into Primary Care
Authors: Basu Sanjay , Jack Helen E. , Arabadjis Sophia D. , Phillips Russell S.
Published: August 2016

Background:

Uncertainty about the financial costs and benefits of community health worker (CHW) programs remains a barrier to their adoption.

Objectives:

To determine how much CHWs would need to reduce emergency department (ED) visits and associated hospitalizations among their assigned patients to be cost-neutral from a payer’s perspective.

Research Design:

Using a microsimulation of patient health care utilization, costs, and revenues, we estimated what portion of ED visits and hospitalizations for different conditions would need to be prevented by a CHW program to fully pay for the program’s expenses. The model simulated CHW programs enrolling patients with a history of at least 1 ED visit for a chronic condition in the prior year, utilizing data on utilization and cost from national sources.

Results:

CHWs assigned to patients with uncontrolled hypertension and congestive heart failure, as compared with other common conditions, achieve cost-neutrality with the lowest number of averted visits to the ED. To achieve cost-neutrality, 4–5 visits to the ED would need to be averted per year by a CHW assigned a panel of 70 patients with uncontrolled hypertension or congestive heart failure—approximately 3%–4% of typical ED visits among such patients, respectively. Most other chronic conditions would require between 7% and 12% of ED visits to be averted to achieve cost-savings.

Conclusion:

Offsetting costs of a CHW program is theoretically feasible for many common conditions. Yet the benchmark for reducing ED visits and associated hospitalizations varies substantially by a patient’s primary diagnosis.
Alcohol Use and Associations With Biological Markers and Self-Reported Indicators of Unprotected Sex in Human Immunodeficiency Virus-Positive Female Sex Workers in Mombasa, Kenya
Authors: White Darcy , Wilson Kate S. , Masese Linnet N. , Wanje George , Jaoko Walter , Mandaliya Kishorchandra , Richardson Barbra A. , Kinuthia John , Simoni Jane M. , McClelland R. Scott
Published: August 2016

Background

Studies of alcohol use and sexual behavior in African populations have primarily been cross-sectional, used nonvalidated measures of alcohol use, or relied on self-reported sexual risk endpoints. Few have focused on human immunodeficiency virus (HIV)-positive women.

Methods

Longitudinal data were collected from a cohort of HIV-positive Kenyan female sex workers. At enrollment and annual visits, participants were asked about past-year alcohol use using the Alcohol Use Disorders Identification Test (AUDIT). The primary endpoint was detection of prostate-specific antigen (PSA) in vaginal secretions at quarterly examinations. Associations between hazardous/harmful alcohol use (AUDIT score ≥7), PSA detection, and secondary measures of sexual risk were evaluated using generalized estimating equations with a log binomial regression model.

Results

A total of 405 women contributed 2750 vaginal samples over 606 person-years of follow-up. Hazardous/harmful alcohol use was reported at 16.6% of AUDIT assessments and was associated with higher risk of PSA detection (relative risk 1.50; 95% confidence interval, 1.11–2.01) relative to no alcohol use. This association was attenuated and no longer statistically significant, after adjusting for age, work venue, intimate partner violence, depression, and partnership status (adjusted relative risk, 1.13; 95% confidence interval, 0.82–1.56). In exploratory analyses, alcohol use was associated with self-report of unprotected sex and with sexually transmitted infection acquisition.

Conclusions

Although hazardous/harmful alcohol use was not associated with detection of PSA in adjusted analysis, associations with secondary outcomes suggest that alcohol use is at least a marker of sexual risk behavior.
Differentiation of Osteophytes and Disc Herniations in Spinal Radiculopathy Using Susceptibility-Weighted Magnetic Resonance Imaging
Authors: Bender Yvonne Yi-Na , Diederichs Gerd , Walter Thula Cannon , Wagner Moritz , Liebig Thomas , Rickert Marcus , Hermann Kay-Geert , Hamm Bernd , Makowski Marcus Richard
Published: August 2016

Objective

The aim of this study was to evaluate the diagnostic performance of susceptibility-weighted magnetic resonance imaging (SW-MRI) for the differentiation of osteophytes and disc herniations of the spine compared with that of conventional spine MR sequences and radiography.

Materials and Methods

This study was approved by the local ethics review board; written consent was obtained from all subjects. Eighty-one patients with suspected radiculopathy of the spine were included prospectively. Radiography, T1/T2, and SW-MRI of the cervical/lumbar spine were performed. As reference standard, 93 osteophytes (n = 48 patients) were identified on radiographs in combination with conventional T1/T2 images. One hundred fourteen posterior disc herniations (n = 60 patients) were identified on T1/T2 in combination with radiography excluding osteophytes. For this study, 2 observers independently assessed the presence of osteophytes and disc herniations on T1/T2 and SW-MRI, with radiographs excluded from the analysis. In a subgroup of patients (n = 19), additional computed tomography images were evaluated. Sensitivity, specificity, and interobserver agreement were calculated.

Results

Most osteophytes (n = 92 of 93) and disc herniations (n = 113 of 114) could be identified and differentiated on SW-MRI magnitude/phase images, if radiographs were excluded from analysis. Susceptibility-weighted magnetic resonance imaging achieved a sensitivity of 98.9% and specificity of 99.1% for the identification of osteophytes. Conventional T1/T2 spine MR sequences achieved a sensitivity and specificity of 68.6% and 86.5%, respectively, if radiographs were excluded from analysis. Regarding the size of osteophytes, SW-MRI showed a strong correlation with computed tomography (R
2 = 0.96) and radiography (R
2 = 0.95). In addition, SW-MRI achieved a higher interobserver agreement compared with conventional MR.

Conclusions

Susceptibility-weighted magnetic resonance imaging enables the reliable differentiation of osteophytes and disc herniations in patients with spinal radiculopathy with a higher sensitivity and specificity compared with conventional T1/T2 MR sequences.
Virtual Global Transplant Laboratory Standard Operating Procedures for Blood Collection, PBMC Isolation, and Storage
Authors: Higdon Lauren E. , Lee Karim , Tang Qizhi , Maltzman Jonathan S.
Published: August 2016

Research on human immune responses frequently involves the use of peripheral blood mononuclear cells (PBMC) immediately, or at significantly delayed timepoints, after collection. This requires PBMC isolation from whole blood and cryopreservation for some applications. It is important to standardize protocols for blood collection, PBMC isolation, cryopreservation, and thawing that maximize survival and functionality of PBMC at the time of analysis. This resource includes detailed protocols describing blood collection tubes, isolation of PBMC using a density gradient, cryopreservation of PBMC, and thawing of cells as well as preparation for functional assays. For each protocol, we include important considerations, such as timing, storage temperatures, and freezing rate. In addition, we provide alternatives so that researchers can make informed decisions in determining the optimal protocol for their application.
Measuring cellular traction forces on non-planar substrates
Authors: Soiné Jérôme R. D. , Hersch Nils , Dreissen Georg , Hampe Nico , Hoffmann Bernd , Merkel Rudolf , Schwarz Ulrich S.
Published: August 2016

Animal cells use traction forces to sense the mechanics and geometry of their environment. Measuring these traction forces requires a workflow combining cell experiments, image processing and force reconstruction based on elasticity theory. Such procedures have already been established mainly for planar substrates, in which case one can use the Green's function formalism. Here we introduce a workflow to measure traction forces of cardiac myofibroblasts on non-planar elastic substrates. Soft elastic substrates with a wave-like topology were micromoulded from polydimethylsiloxane and fluorescent marker beads were distributed homogeneously in the substrate. Using feature vector-based tracking of these marker beads, we first constructed a hexahedral mesh for the substrate. We then solved the direct elastic boundary volume problem on this mesh using the finite-element method. Using data simulations, we show that the traction forces can be reconstructed from the substrate deformations by solving the corresponding inverse problem with an L1-norm for the residue and an L2-norm for a zeroth-order Tikhonov regularization. Applying this procedure to the experimental data, we find that cardiac myofibroblast cells tend to align both their shapes and their forces with the long axis of the deformable wavy substrate.
StarBEAST2 brings faster species tree inference and accurate estimates of substitution rates
Authors: Ogilvie Huw A. , Bouckaert Remco R. , Drummond Alexei J.
Published: August 2016

Fully Bayesian multispecies coalescent (MSC) methods like *BEAST estimate species trees from multiple sequence alignments. Today thousands of genes can be sequenced for a given study, but using that many genes with *BEAST is intractably slow. An alternative is to use heuristic methods which compromise accuracy or completeness in return for speed. A common heuristic is concatenation, which assumes that the evolutionary history of each gene tree is identical to the species tree. This is an inconsistent estimator of species tree topology, a worse estimator of divergence times, and induces spurious substitution rate variation when incomplete lineage sorting is present. Another class of heuristics directly motivated by the MSC avoids many of the pitfalls of concatenation but cannot be used to estimate divergence times. To enable fuller use of available data and more accurate inference of species tree topologies, divergence times, and substitution rates, we have developed a new version of *BEAST called StarBEAST2. To improve convergence rates we add analytical integration of population sizes, novel MCMC operators and other optimisations. Computational performance improved by 13.5× to 13.8× when analysing empirical data sets, and an average of 33.1 × across 30 simulated data sets. To enable accurate estimates of per-species substitution rates we introduce species tree relaxed clocks, and show that StarBEAST2 is a more powerful and robust estimator of rate variation than concatenation. StarBEAST2 is available through the BEAUTi package manager in BEAST 2.4 and above.
A gene for genetic background inZea mays: fine-mappingenhancer of teosinte branched1.2(etb1.2) to a YABBY class transcription factor
Authors: Yang Chin Jian , Kursel Lisa E. , Studer Anthony J. , Bartlett Madelaine E. , Whipple Clinton J. , Doebley John F.
Published: August 2016

The effects of an allelic substitution at a gene often depend critically on genetic background, the genotype at other genes in the genome. During the domestication of maize from its wild ancestor (teosinte), an allelic substitution atteosinte branched(tb1) caused changes in both plant and ear architecture. The effects oftb1on phenotype were shown to depend on multiple background loci including one called enhancer oftb1.2 (etb1.2).We mappedetb1.2to a YABBY class transcription factor (ZmYAB2.1) and showed that the maize alleles ofZmYAB2.1are either expressed at a lower level than teosinte alleles or disrupted by insertions in the sequences.tb1andetb1.2interact epistatically to control the length of internodes within the maize ear which affects how densely the kernels are packed on the ear. The interaction effect is also observed at the level of gene expression withtb1acting as a repressor ofZmYAB2.1expression. Curiously,ZmYAB2.1was previously identified as a candidate gene for another domestication trait in maize, non-shattering ears. Consistent with this proposed role,ZmYAB2.1is expressed in a narrow band of cells in immature ears that appears to represent a vestigial abscission (shattering) zone. Expression in this band of cells may also underlie the effect on internode elongation. The identification ofZmYAB2.1as a background factor interacting withtb1is a first step toward a gene-level understanding of howtb1and the background within which it works evolved in concert during maize domestication.
USP14 regulates autophagy by suppressing K63 ubiquitination of Beclin 1
Authors: Xu Daichao , Shan Bing , Sun Huawang , Xiao Juan , Zhu Kezhou , Xie Xingxing , Li Xingyan , Liang Wei , Lu Xiaojuan , Qian Lihui , Yuan Junying
Published: August 2016

The ubiquitin–proteasome system (UPS) and autophagy are two major intracellular degradative mechanisms that mediate the turnover of complementary repertoires of intracellular proteomes. Simultaneously activating both UPS and autophagy might provide a powerful strategy for the clearance of misfolded proteins. However, it is not clear whether UPS and autophagy can be controlled by a common regulatory mechanism. K48 deubiquitination by USP14 is known to inhibit UPS. Here we show that USP14 regulates autophagy by negatively controlling K63 ubiquitination of Beclin 1. Furthermore, we show that activation of USP14 by Akt-mediated phosphorylation provides a mechanism for Akt to negatively regulate autophagy by promoting K63 deubiquitination. Our study suggests that Akt-regulated USP14 activity modulates both proteasomal degradation and autophagy through controlling K48 and K63 ubiquitination, respectively. Therefore, regulation of USP14 provides a mechanism for Akt to control both proteasomal and autophagic degradation. We propose that inhibition of USP14 may provide a strategy to promote both UPS and autophagy for developing novel therapeutics targeting neurodegenerative diseases.
Crystal structures of ethyl {2-[4-(4-isopropylphenyl)thiazol-2-yl]phenyl}carbamate and ethyl {2-[4-(3-nitrophenyl)thiazol-2-yl]phenyl}carbamate
Authors: Sukhonosova Elena V. , Sokov Sergey A. , Ostapenko Gennady I. , Bunev Alexander S. , Dorovatovskii Pavel V. , Zubavichus Yan V. , Khrustalev Victor N.
Published: August 2016

The title compounds, C21H22N2O2S (I) and C18H15N3O4S (II), are structural analogs of the alkaloid Thiosporine B. Both molecules adopt a near-planar V-shaped conformation, which is consolidated by intramolecular N—H...N and C—H...O hydrogen bonds. The crystal structure of (I) consists of mlecular stacks along the a axis, in which the molecules are linked to each other by π(S)...π(C) interactions. In the crystal of (II), molecules are linked into chains by C—H...O hydrogen bonds and the chains are cross-linked into (100) sheets by π–π stacking interactions.
Societal culture and the changing role of school principals in the post-Soviet era
Authors: Yakavets Natallia
Published: August 2016

Purpose

The purpose of this paper is to explore the impact of societal and cultural factors on the practices and perceptions of school principals in Kazakhstan.

Design/methodology/approach

The paper draws on empirical data collected in Kazakhstan over two years in the course of an international, collaborative, multi-stranded project.

Findings

The findings support the claim that educational policies and practice are deeply embedded in the national culture, which is an evolving mixture of traditional Kazakh, Russian and diverse ethnic, Soviet and paternalistic cultures. These various societal characteristics exemplify various aspects of the tensions between traditional forms of social organisation, the Soviet legacy, and the sort of educational development promoted by Western educational and international organisations, which now plays an important role in Kazakhstan.

Research limitations/implications

The analysis, though limited in scope, has nevertheless yielded insights into important differences and similarities amongst rural and urban schools and explored the effects of societal cultural factors that shape the practices of school leaders on the periphery of the system.

Originality/value

The paper provides an empirically grounded illustration of the way in which societal culture and cultural norms shape the role of school principals, and how schools cope with a top-down policy in Kazakhstan. By contrasting the norms that shape both existing practice and the reform agenda, the paper offers some explanations for how cultural norms represent both strengths and weaknesses when applied to the process of change in a post-Soviet context.
Factors influencing students’ learning approaches in auditing
Authors: Barac Karin , Kirstein Marina , Kunz Rolien , Beukes Bernice
Published: August 2016

Purpose

This paper aims to report on an investigation to understand factors influencing students learning approaches in the discipline of auditing.

Design/methodology/approach

By using the Approaches and Study Skills Inventory for Students research instrument the learning approaches of students in auditing at a South African residential university were measured on both undergraduate and postgraduate levels. This was followed by focus group discussions to obtain a deeper understanding of the factors that influenced the ways their audit studies were approached.

Findings

The results revealed a contrasting view with that presented in the literature, in that senior students were more inclined to adopt a surface approach. This could be attributed to learning environment dimensions such as the teaching and assessment practices as well as students’ perceptions of the workload. Further statistical analysis revealed that gender and race influenced students’ learning approaches at specific levels.

Research limitations/implications

The data are drawn from audit students at a residential university in South Africa; the findings of the study may thus not be generalisable beyond that context.

Originality/value

The study extends the existing student learning literature by adding perspectives from the discipline auditing. It could stimulate educators’ scholarly interest in pedagogic research which could contribute to curriculum and teaching method changes that equip audit educators to promote deep learning.
The use of extrafloral nectar in pest management: overcoming context dependence
Authors: Jones Ian Matthew , Koptur Suzanne , von Wettberg Eric J.
Published: August 2016

Extrafloral nectar (EFN) provides plants with indirect defence against herbivores by attracting predatory insects, predominantly ants. Decades of research have supported the role of EFN as an effective plant defence, dating back to Thomas Belt's description of ants on acacia in 1874.

Despite this extensive body of literature, knowledge of the ecological role of EFN has rarely been applied in the field of pest management. We review the existing literature on the use of EFN in agriculture and consider the obstacles that have hindered this transition.

Chief among these obstacles is the influence of ecological context on the outcome of EFN‐mediated interactions. As such, we consider the options for various agricultural systems in the light of the growth habit of EFN‐producing species, focusing first on orchard species and then on herbaceous crops. In each case, we highlight the benefits and difficulties of utilizing EFN as a pest management tool and of measuring its efficacy.

Synthesis and applications. We argue that it is time for a shift in extrafloral nectar (EFN) research towards applied settings and seek to address the question: How can a context‐dependent and often inducible plant trait be utilized as a reliable tool in agricultural pest management? Breeding crops for increased EFN production, and intercropping with EFN‐producing plants, can enhance assemblages of beneficial insects in many agricultural settings. Orchard systems, in particular, provide an ecological context in which the attraction of ants can contribute to cost‐effective and sustainable pest management programmes over a broad geographic range.
Bacterial Cross‐contamination Potential Associated with Contaminated Currency
Authors: Kesavan Jana , Stephens Amelia , Kesavan Meera
Published: August 2016

Previous studies have shown a significant amount of contaminants on paper currencies. It is important to study the transfer of microorganisms between paper currencies to determine whether it meets the level of a human health threat. This cross‐contamination potential was analyzed by seeding new US 1‐dollar bills with Bacillus thuringiensis, and pressing or rubbing them against clean currency to determine the amount of bacteria transfer to the unseeded currency. The transferred amount of bacteria was recovered, plated, incubated, and the colony‐forming units were quantified. Among the recovery methods tested, the most efficient method, vortexing for 10 min with a recovery efficiency of 40 ± 8.1%, was used in this analysis. The resulting transfer rates were 4.8%, 8.6%, and 14.3% when pressed for 24 h, 72 h, and rubbed together, respectively. These transferred amounts of bacteria are significant and have the potential to spread infectious diseases.
IgG4‐related tubulointerstitial nephritis: A prospective analysis
Authors: Nada Ritambhra , Ramachandran Raja , Kumar Ashwani , Rathi Manish , Rawat Amit , Joshi Kusum , Kohli Harbir Singh , Gupta Krishan Lal
Published: August 2016

Aims

Immunoglobulin‐G4 (IgG4)‐related tubulo‐interstitial nephritis (IgG4TIN) could be the first presentation of IgG4‐related systemic disease. Most of the data is from the West or Japan and retrospective, with good patient outcome.

Methods

This study was carried out from April 2011 to July 2013. We report a prospective follow‐up of 11 patients who presented with renal dysfunction and had histological diagnosis of IgG4TIN followed for a minimum period of 1 year or until end‐stage renal disease.

Results

IgG4TIN constituted 0.28% of total renal biopsies and 6.5% of all tubulointerstitial nephritis. Patient ages ranged between 21 and 71 years with a male predominance. All the patients had renal dysfunction at presentation with a mean serum creatinine of 5.12 mg/dL. Proteinuria was subnephrotic except when there was coexisting membranous glomerulonephritis (36.4%). The mean 24‐h urine protien excretion was 1.8 g. Serum IgG4 levels were elevated in 10 (90.9%) patients. Ten (90.9%) patients had renomegaly and one (9.1%) had focal renal mass. Extra‐renal manifestations were present in seven (63.6%). Renal histology showed pattern A in five (45.5%), pattern B in four (36.3%) and pattern C in two (18.1%) patients. All but one patient (90.9%) received immunosuppressive therapy. Four (36.3%) achieved complete remission and three (27.2%) progressed to end stage renal disease. Two patients died due to infections while on steroid therapy. One patient with a mass had end stage renal disease for 12 months and did not improve with steroid therapy, and one (pattern C) had progressive chronic kidney disease on follow‐up.

Conclusion

IgG4TIN in an Indian cohort most often presents with rapidly progressive renal failure and less often has extra‐renal organ involvement. On follow‐up, patients can experience a more aggressive course with progression to end stage renal disease.
Pulse oximetry could significantly enhance the early detection of critical congenital heart disease in neonatal intensive care units
Authors: Hu Xiao‐jing , Zhao Qu‐ming , Ma Xiao‐jing , Yan Wei‐li , Ge Xiao‐ling , Jia Bing , Liu Fang , Wu Lin , Ye Ming , Huang Guo‐ying
Published: August 2016

Aim

Limited data have been available regarding critical congenital heart disease (CHD) screening in neonatal intensive care unit (NICUs). This study evaluated the feasibility of screening for CHD by adding pulse oximetry (POX) to clinical evaluation in a NICU in Shanghai, China.

Methods

We screened 4128 eligible consecutive NICU admissions using POX plus clinical evaluation. Infants with positive screening results were then evaluated with echocardiography. Those with negative screening results were put under observation, and they also underwent echocardiography if their oxygen saturation fell below 95% on room air during hospitalisation.

Results

This enhanced procedure detected 19 critical CHD cases, and seven of these diagnoses would have been delayed if POX had not been incorporated into the screening strategy. This means that the addition of POX increased the detection rate of critical CHD from 63.2 to 100%. The false‐positive rate of critical CHD screening using POX plus clinical evaluation was higher in NICU patients with high morbidity rates.

Conclusion

When pulse oximetry screening was added to clinical evaluation, it increased the number of critical CHD cases that were detected in our NICU. This method could provide a useful screening protocol for critical CHD cases.
Histopathological changes in skeletal muscle associated with chronic ischaemia
Authors: Roos Sara , Fyhr Ing‐Marie , Sunnerhagen Katharina S. , Moslemi Ali‐Reza , Oldfors Anders , Ullman Michael
Published: August 2016

Muscle biopsy is an essential part in the diagnostic workup in patients with suspected neuromuscular disorders. It is therefore important to be aware of morphological alterations that can be caused by systemic factors or natural ageing. Chronic limb ischaemia is frequent in elderly individuals. This study was performed to examine histopathological and mitochondrial changes in muscle in patients with chronic critical limb ischaemia. Muscle biopsy of skeletal muscle of the lower limb of patients with chronic ischaemia leading to amputation was performed and compared with muscle biopsies of healthy, age‐matched controls. The histopathological abnormalities included fibrosis, necrosis, atrophy, glycogen depletion, internal nuclei, rimmed vacuoles, fibre type grouping, cytochrome c oxidase deficient fibres, MHC‐I upregulation, and signs of microangiopathy. The only alteration found in age‐matched controls was a few cytochrome c oxidase deficient fibres. There were also increased levels of multiple mitochondrial DNA deletions in ischaemic muscles compared with controls. Critical limb ischaemia is associated with significant histopathological changes in muscle tissue and also increased levels of mitochondrial DNA deletions. Since the alterations mimic different primary myopathic changes, chronic ischaemia is important to consider as a differential diagnosis in elderly individuals, investigated with muscle biopsy for muscle disease.