bluuebunny/crossref_metadata_2025 huggingface dataset:
Liver Stiffness Measured by Shear‐wave Elastography for Evaluating Intrahepatic Portal Hypertension in Children
Authors: Yoon Hee Mang , Kim So Yeon , Kim Kyung Mo , Oh Seak Hee , Ko Gi‐Young , Park Yangsoon , Lee Jin Seong , Jung Ah Young , Cho Young Ah
Published: January 2017

Objectives:

The aim of the study was to correlate liver stiffness (LS) and hepatic venous‐pressure gradient (HVPG) and to evaluate the diagnostic performance of shear‐wave elastography (SWE) for predicting clinically significant portal hypertension in children with suspected liver diseases, in consideration of the reliability criteria.

Methods:

We identified 33 SWEs from 32 children who underwent HVPG measurement within 2 weeks between June 2012 and October 2015. The correlation between LS and HVPG was assessed. The diagnostic performance for predicting clinically significant portal hypertension (HVPG ≥ 10 mmHg) was assessed using the receiver‐operating characteristic curve. Reliable measurement was evaluated based on the coefficient of variation (CV).

Results:

LS was significantly correlated with HVPG (r = 0.742, P < 0.001). The area under the receiver‐operating characteristic curve for predicting clinically significant portal hypertension was 0.914, and the best cutoff value of 18.4 kPa showed sensitivity of 87.5% and specificity of 84.0%. LS measurements having CV ⩽ 0.2 were significantly correlated with HVPG (r = 0.774, P < .001), whereas those having CV > 0.2 did not show a significant correlation with HVPG (r = 0.598, P = 0.089).

Conclusions:

SWE had excellent diagnostic performance for predicting clinically significant portal hypertension in children with suspected liver diseases. LS measurements having CV ⩽ 0.2 may possibly be used as a reliability criterion in SWE measurement.
Enhancements in Confidence, Acceptance, and Friendship at a Summer Camp for Children With Inflammatory Bowel Disease
Authors: McCombie Andrew , Gearry Richard B. , Lopez Robert N. , Lönnfors Sanna , Day Andrew S.
Published: January 2017

Inflammatory bowel disease (IBD) affects many children and adolescents in terms of their confidence, acceptance, and ability to build friendships. New Zealand held its first summer camp for children with IBD in January 2015. We obtained feedback from the campers (ages 10–18 years) in terms of their confidence, acceptance, and quality of life. We also asked what experience was most beneficial to them, whether they made new friends with IBD, and if they would attend the camp again. Thirty‐six campers responded (81.8% response rate; median age 14 years [range 10–18]; 83.3% Crohn disease; 41.7% girls). Most reported that the camp improved their confidence (86.1%), acceptance (83.3%), and overall quality of life (75.0%) relating to IBD. Moreover, most reported that meeting their fellow campers was the most beneficial experience to come from the camp (72.2%). Overall, these results emphasize the importance and relevance of such an undertaking.
The Dyadic Effects of Family Cohesion and Communication on Health-Related Quality of Life: The Moderating Role of Sex
Authors: Lim Jung-won , Shon En-jung
Published: January 2017

Background:

Spouses’ ability to care for survivors can be particularly challenging because patients and spouses are interdependent and mutually influence one another. Family functioning such as family cohesion and communication may play a primary role in improving the health-related quality of life (HRQOL) of couples, given that cancer can influence family dynamics.

Objective:

The aims of this study were to investigate the mediating effect of family communication on the relationship between family cohesion and HRQOL and examine the moderating effect of sex on this relationship among cancer survivor–spouse dyads.

Methods:

A total of 91 cancer survivors with a diagnosis of breast, colorectal, or prostate cancer and their spouses were recruited from the University Hospital Registry in Cleveland, Ohio. The dyadic data were analyzed using structural equation modeling with the actor-partner interdependence mediation model.

Results:

Findings demonstrated that the spouses’ own perceived family communication mediated the associations between their own family cohesion and physical HRQOL and between the survivors’ family cohesion and physical HRQOL. The spouse actor effects between family communication and HRQOL significantly differed by sex.

Conclusions:

Enhancing family cohesion and communication within the family can improve the spouses’ HRQOL. Findings regarding sex differences serve as a rationale for gender-based approaches to improving HRQOL in survivorship care in the family context.

Implications for Practice:

Couple- and/or family-based interventions should be designed to enhance family cohesion and improve family communication skills for effective adjustments within couples and families. Supportive care within the family context can be promoted to address the diverse challenges of survivorship care.
Healthcare Transformation and Changing Roles for Nursing
Authors: Salmond Susan W. , Echevarria Mercedes
Published: January 2017

Factors driving healthcare transformation include fragmentation, access problems, unsustainable costs, suboptimal outcomes, and disparities. Cost and quality concerns along with changing social and disease-type demographics created the greatest urgency for the need for change. Caring for and paying for medical treatments for patients suffering from chronic health conditions are a significant concern. The Affordable Care Act includes programs now led by the Centers for Medicare & Medicaid Services aiming to improve quality and control cost. Greater coordination of care—across providers and across settings—will improve quality care, improve outcomes, and reduce spending, especially attributed to unnecessary hospitalization, unnecessary emergency department utilization, repeated diagnostic testing, repeated medical histories, multiple prescriptions, and adverse drug interactions. As a nation, we have taken incremental steps toward achieving better quality and lower costs for decades. Nurses are positioned to contribute to and lead the transformative changes that are occurring in healthcare by being a fully contributing member of the interprofessional team as we shift from episodic, provider-based, fee-for-service care to team-based, patient-centered care across the continuum that provides seamless, affordable, and quality care. These shifts require a new or an enhanced set of knowledge, skills, and attitudes around wellness and population care with a renewed focus on patient-centered care, care coordination, data analytics, and quality improvement.
Nursing Care Management
Authors: Lentz Shaynie , Luther Brenda
Published: January 2017

Fragmented and uncoordinated care is the third highest driver of U.S. healthcare costs. Although less than 10% of patients experience uncoordinated care, these patients represent 36% of total healthcare costs; care management interaction makes a significant impact on the utilization of healthcare dollars. A literature search was conducted to construct a model of care coordination for elective surgical procedures by collecting best practices for acute, transitions, and post-acute care periods. A case study was used to demonstrate the model developed. Care management defines care coordination as a model of care to address improving patient and caregiver engagement, communication across settings of care, and ultimately improved patient outcomes of care. Nurse-led care coordination in the presurgical, inpatient, and post-acute care settings requires systems change and administrative support to effectively meet the goals of the Affordable Care Act of reducing redundancy and costs while improving the patient experience. Nursing is the lynchpin of care management processes in all settings of care; thus, this model of care coordination for elective surgical admissions can provide nursing care management leaders a comprehensive view of coordinating care for these patient across settings of care during the predetermined time period of care. As bundled payment structures increasingly affect hospital systems, nursing leaders need to be ready to create or improve their care management processes; care coordination is one such process requiring immediate attention.
Information Sharing
Authors: Cobler Jane , Wang Grace , Stout Chris , Piejak Jeff , Rodts Mary F.
Published: January 2017

Care coordination that improves patient care and patient outcomes is becoming increasingly necessary as bundled payment programs are developed. Rather than looking at each aspect of the patient's care, the entire care continuum from preoperative preparation through completion of the episode will become the norm. The length of the episode of care may be 30 days or as long as 90 days. The transition to different care providers during that episode requires information sharing. This is best accomplished by a technology platform that allows for real-time information sharing. This article describes one organizations experience with managing the full continuum of care.
Overweight Kidney Transplant Recipients Are at Risk of Being Overdosed Following Standard Bodyweight-Based Tacrolimus Starting Dose
Authors: Andrews Louise M. , de Winter Brenda C.M. , Tang Jiang-Tao , Shuker Nauras , Bouamar Rachida , van Schaik Ron H.N. , Koch Birgit C.P. , van Gelder Teun , Hesselink Dennis A.
Published: January 2017

Background

Bodyweight-based dosing of tacrolimus (Tac) is considered standard care, even though the available evidence is thin. An increasing proportion of transplant recipients is overweight, prompting the question if the starting dose should always be based on bodyweight.

Methods

For this analysis, data were used from a randomized-controlled trial in which patients received either a standard Tac starting dose or a dose that was based on CYP3A5 genotype. The hypothesis was that overweight patients would have Tac overexposure following standard bodyweight-based dosing.

Results

Data were available for 203 kidney transplant recipients, with a median body mass index (BMI) of 25.6 (range, 17.2-42.2). More than 50% of the overweight or obese patients had a Tac predose concentration above the target range. The CYP3A5 nonexpressers tended to be above target when they weighed more than 67.5 kg or had a BMI of 24.5 or higher. Dosing guidelines were proposed with a decrease up to 40% in Tac starting doses for different BMI groups. The dosing guideline for patients with an unknown genotype was validated using the fixed-dose versus concentration controlled data set.

Conclusions

This study demonstrates that dosing Tac solely on bodyweight results in overexposure in more than half of overweight or obese patients.
Proteogenomics of adenosine-to-inosine RNA editing in the fruit fly
Authors: Kuznetsova Ksenia G , Kliuchnikova Anna A , Ilina Irina Y , Chernobrovkin Alexey L , Novikova Svetlana E , Farafonova Tatyana E , Karpov Dmitry S , Ivanov Mark V , Goncharov Anton O , Voronko Olga E , Nasaev Shamsudin S , Ilgisonis Ekaterina V , Zgoda Victor G , Zubarev Roman A , Gorshkov Mikhail V , Moshkovskii Sergei A
Published: January 2017

Adenosine-to-inosine RNA editing is one of the most common types of RNA editing, a posttranscriptional modification made by special enzymes. We present a proteomic study on this phenomenon for Drosophila melanogaster. Three proteome data sets were used in the study: two taken from public repository and the third one obtained here. A customized protein sequence database was generated using results of genome-wide adenosine-to-inosine RNA studies and applied for identifying the edited proteins. The total number of 68 edited peptides belonging to 59 proteins was identified in all data sets. Eight of them being shared between the whole insect, head and brain proteomes. Seven edited sites belonging to synaptic vesicle and membrane trafficking proteins were selected for validation by orthogonal analysis by Multiple Reaction Monitoring. Five editing events in cpx, Syx1A, Cadps, CG4587 and EndoA were validated in fruit fly brain tissue at the proteome level using isotopically labeled standards. Ratios of unedited-to-edited proteoforms varied from 35:1 (Syx1A) to 1:2 (EndoA). Lys-137 to Glu editing of endophilin A may have functional consequences for its interaction to membrane. The work demonstrates the feasibility to identify the RNA editing event at the proteome level using shotgun proteomics and customized edited protein database.
A New Hyperprior Distribution for Bayesian Regression Model with Application in Genomics
Authors: Silva Renato Rodrigues
Published: January 2017

In the regression analysis, there are situations where the model have more predictor variables than observations of dependent variable, resulting in the problem known as “large p small n”. In the last fifteen years, this problem has been received a lot of attention, specially in the genome-wide context. Here we purposed the bayes H model, a bayesian regression model using mixture of two scaled inverse chi square as hyperprior distribution of variance for each regression coefficient. This model is implemented in the R package BayesH.
Cortical elasticity determines the geometry of prospective mesoderm constriction inDrosophila melanogaster
Authors: Doubrovinski Konstantin
Published: January 2017

1

An animal embryo begins its life as a ball of epithelial cells. In the course of development, invariably, this cellular ball will undergo a process of gastrulation to form a multilayered structure with the different germ layers designated to form organs with different shapes and functions. In the fruit flyDrosophia melanogaster, gastrulation begins with the constriction of mesodermal cells that make up a rectangular domain in the ventral part of the embryo. A remarkable aspect of this morphogenetic event is its anisotropy - the mesoderm constricts much more along one axis than along the other. In this paper we propose an explanation of this observed anisotropy. Specifically, we show that tissue contraction must be anisotropic, provided that the tissue is elastic and that the contractile domain is elongated (e.g. rectangular as opposed to square). This conclusion is generic in the sense that it does not depend on the specific values of model parameters. Since our recent study demonstrated that embryonic tissue is elastic on a developmentally relevant time-scale, it appears likely that the anisotropy of mesoderm contraction is an elastic effect. Our model makes a number of specific predictions that appear in close agreement with the available data.
Unjani “clinics in a container”: social franchising in South Africa
Authors: Sutherland Margie , Krige Kerryn
Published: January 2017

Subject area

This case study focuses on social entrepreneurship in emerging markets, looking at what is social entrepreneurship, theories of market failure, opportunity generation through effectuation, social franchising and funding.

Study level/applicability

Students of social entrepreneurship, development studies, sustainable livelihoods and asset-based development. It is useful for customised or short programmes or for students with a background in business (e.g. Diploma in Business Administration/MBA/custom programmes) wanting to understand social enterprise and blended theories of social and economic change.

Case overview

The case tells the story of Unjani container clinics which are providing affordable, quality access to people who struggle to access South Africa’s crumbling public health system. Dr Iain Barton recognised the role that nurses can play to relieve pressure on the system, by providing primary healthcare. He piloted Unjani using shipping containers as clinics with support from his company, Imperial Health Sciences. The story of Unjani is therefore one of startup and sustainable growth, partnership and building independent, self-sustaining social enterprises in a franchising system. The theory explored includes the importance of context, the role of market failure in spotting opportunity, developing opportunity through effectuation, defining social entrepreneurship and funding and growing the organisation.

Expected learning outcomes

The teaching objectives are framed by Mair (2010) who finds that where social entrepreneurs operate affects what they do and how they do it. Objective 1: Explores the influence of context on social entrepreneurship helping students frame a definition of social entrepreneurship. Objective 2: Students are able to connect the theory of market failure to opportunity identification and effectuation for social entrepreneurs. Objective 3: Students apply the definition of social entrepreneurship based on Santos’ (2010) Positive Theory. Objective 4: Students will be able to apply knowledge of social franchising models, as an approach to scaling. Objective 5: Students understand the principles of resource dependency theory and are able to use the funding spectrum as a tool to identify funding types.

Supplementary materials

Links to two videos are provided in the case. Recommendations are also made for materials to be used in the class, e.g. Global Competitiveness Index and Gapminder World, which are excellent tools to demonstrate the social and economic growth divide.

Subject code

CSS 3: Entrepreneurship.
A comprehensive internal quality assurance system at University of Minho
Authors: Santos Isabel M. , Dias Graciete
Published: January 2017

Purpose

The European Standards and Guidelines (ESG) for quality assurance (QA) adopted at the Bergen Ministerial Meeting in 2005 in the scope of the Bologna process call upon higher education institutions to take up a systematic approach to internal QA. Standard 1.1 of the ESG establishes that institutions should have a policy and associated procedures for the assurance of the quality and standards of their programmes and awards. University of Minho (UMinho) has a longstanding experience on innovative methods for the coordination and management of the teaching and learning processes, including, since 1991, systematic mechanisms for the evaluation of teaching. However, to fulfil the new demands raised by the ESG UMinho felt the need to define a formal institutional quality policy, building upon the existing procedures and mechanisms in order to set up a comprehensive internal QA system (SIGAQ-UM) fully compatible with the ESG. The purpose of this paper is to present the distinctive features of SIGAQ-UM, the procedures involved in its certification by Agency for Assessment and Accreditation of Higher Education (A3ES), as well as on the perceived impact on the university’s activities, including some comments on the difficulties to develop and consolidate a quality culture embedded in all the academic community.

Design/methodology/approach

Case study approach.

Findings

SIGAQ-UM is a fully operational comprehensive internal QA system certified by the Portuguese Agency A3ES in January 2013, with considerable impact on the university’s operation.

Originality/value

Disclosure of best practices on QA in higher education.
Supply chain management practices and firms’ operational performance
Authors: Truong Huy Quang , Sameiro Maria , Fernandes Ana Cristina , Sampaio Paulo , Duong Binh An Thi , Duong Hiep Hoang , Vilhenac Estela
Published: January 2017

Purpose

The purpose of this paper is to provide an empirical evidence about the relationship between practices of supply chain management (SCM) and operational performance (OP).

Design/methodology/approach

Based on a comprehensive literature review, a set of SCM practices has been identified and selected to develop a conceptual model as well as to establish their relationship to companies’ OP. The measurement scales of the practices were developed in four steps: identification and development of initial instrument; personal interviews and Q-sort; large-scale data collection; and large-scale analysis in order to ensure unidimensionality, reliability and validity. Structural equation modeling was used to validate the model with the data were collected in Vietnamese garment enterprises.

Findings

The study consolidated relationships between the SCM practices and OP. According to the research results, these practices have a “resonant” influence on OP that can explain 52.6 percent variance of this output concept. In particular, customer focus and supplier management both direct and indirect impact on OP while top management support and process control/improvement only have indirect and direct influences on OP, respectively.

Research limitations/implications

There are some limitations that can guide academics to new lines of future research: to extend the scope of the survey to include different countries and new situations, so results can be generalized; to consider the impacts of the SCM practices on the entire supply chain performance; and to explore additional factors that can further explain OP, such as operational environment, capital, technology, human resource, etc.

Practical implications

The authors suggest that the SCM practices should be implemented as an integrated system rather than independent practices, in which they interact with each other and improve OP.

Originality/value

The empirical results of this study provide an evidence to consider the SCM practices as reliable predictors for OP. According to the research, these practices interact with each other and have both direct and indirect effects on OP. In other words, through the mutual interaction among the SCM practices, they have the “resonant” influence on improving OP. Moreover, the proposed research model analyzing the relationship among SCM practices and OP and its validation using the Vietnam garment industry provided valuable insights both from theoretical and practical perspectives.
A standard proposal for biological resources centres
Authors: Martins Anabela , Lima Nelson , Sampaio Paulo
Published: January 2017

Purpose

The purpose of this paper is to contribute to develop a standard providing requirements for managing the quality and competence of the biological resource centres (BRC).

Design/methodology/approach

The methodology for the standard setting was based on the principles of credibility, transparency, alignment and consistency. A justification study was performed to establish its objectives and scope, avoid overlap and prevent the risks in implementation. International documents providing rules for standard development were taken into consideration. Requirements were assembled from several standards and participation of interested parties was promoted.

Findings

No relevant international document exists covering fundamental issues for BRC operation. It is possible to develop a consistent and aligned standard, under a credible and transparent process that fits BRC purposes.

Practical implications

This standard will strengthen the BRC technical competence increasing its capability to provide authenticated high-quality biological materials – a crucial factor for biotechnological developments in the fields of health, agriculture and environment. It will serve as a basis for the BRC compliance assessment and the launch pad for establishing the global BRC network.

Originality/value

Original paper.
Z and W charts for controlling service processes
Authors: Requeijo José Gomes , Puga-Leal Rogério , Matos Ana Sofia
Published: January 2017

Purpose

The purpose of this paper is to discuss the causes for the discrepancy between the utilization of statistical process control (SPC) in services and manufacturing. Furthermore, an approach for integrating customer demands and technical aspects of a service is presented. Services are very often characterized by a large number of characteristics, with relatively few observations. This research addresses a methodology based on Z and W charts, proposing it for the control of service features. An example associated with service provision is presented to illustrate the computation of Z and W as well as its interpretation.

Design/methodology/approach

The shortcomings of traditional control charts are stated and compared with the control charts for Z and W. An example illustrates how to utilize these charts, their ability to monitor several characteristics simultaneously, along with a continuous monitoring of process capability.

Findings

The proposed approach allowed the representation of several process characteristics in the same charts, even when those characteristics are not collected with the same periodicity. The Z and W charts are dimensionless and can be applied whenever it is possible to estimate process parameters, being an interesting approach to be utilized in Phase 2 of SPC. The difficulty for identifying the existence of non-random patterns emerges as the major shortcoming for these charts.

Research limitations/implications

The proposed approach is a contribute to overcoming the discrepancy that persists between the utilization of SPC in services and manufacturing. Nevertheless, service production and consumption are frequently simultaneous, which constitutes an issue hard to deal with that is not fully addressed in this piece of research. Furthermore, the Z charts also present some disadvantages, notably an increased difficulty for analyzing the existence of non-random patterns, which worsens as increases the number of products/quality characteristics to be checked.

Practical implications

The proposed charts are very flexible and provide a rational utilization of resources. In fact, the representation of several processes is possible, along with the traditional analysis of patterns, thus providing an effective approach for controlling services processes.

Social implications

Several quantitative approaches that have been utilized in manufacturing for a long time are still scarce in services. However, services play a major role in modern economies, being clear that improvements in service provision might have a direct impact on society.

Originality/value

The approach was based on the utilization of Z/W with samples, but it can be extended to individual observations or even to the control of discrete variables. Additionally, a methodology for process capability analysis in real-time is also proposed.
Six Sigma DMAIC project to improve the performance of an aluminum die casting operation in Portugal
Authors: Marques Pedro Alexandre de Albuquerque , Matthé Robert
Published: January 2017

Purpose

The purpose of this paper is to illustrate an application of the Six Sigma define, measure, analyze, improve, control (DMAIC) problem-solving methodology in a Portuguese industrial enterprise, aimed at reducing the rejection rate of a specific manufactured product due to defects generated in an aluminum gravity die casting operation.

Design/methodology/approach

Along the five-stage roadmap, a set of analytical and conceptual tools was systematically employed to better characterize the problem, define the product’s critical to quality characteristics, estimate the process baseline, determine the relevant cause-and-effect relationships, identify the root causes leading to the high rejection rate, implement an improvement plan, determine the effectiveness of the improvement actions, and put in place a control plan.

Findings

The project team discovered that the high rejection rate was caused by factors inherent to the gravity die casting operation itself and by the mixing of rejected parts made of different types of alloys from other locations within the plant. Another key finding was that the successful execution of the project was only possible due to the belief and support of top management and to the active involvement of the team members.

Practical implications

This case study illustrates a successful practical application of a Six Sigma project in a small-medium enterprise in Portugal, as well as the operational and financial benefits that derived from it; thus providing a good example for others to follow.

Originality/value

Few cases of continual improvement initiatives, including Six Sigma projects, developed at a Portuguese company are available in the literature; this paper fills such void by describing a very successful application that demonstrates the advantages that other companies can learn in terms of adopting structured methodologies to improve the quality of their products and the efficiency of their processes. Moreover, the analysis and conclusions herein presented can be of great importance for companies using gravity die casting technology.
Supply chain of the Indian public distribution system: a new paradigm
Authors: Bohtan Ajay , Vrat Prem , Vij Anil K.
Published: January 2017

Purpose

The purpose of this paper is to identify the various strengths, weaknesses, opportunities and threats (SWOT) in the supply chain of the existing Indian public distribution system (PDS) and to analyse the same with a view to arriving at the vital recommended strategies for making the supply chain more effective and efficient.

Design/methodology/approach

This paper examines a new hybrid method for improving the usability of SWOT analysis. The analytic hierarchy process (AHP) has been integrated with SWOT analysis. Use of the AHP method on the SWOT factors has yielded analytically determined priorities for the factors included in SWOT analysis and made them commensurable. The main aim in applying the hybrid method was to improve the quantitative information basis of strategy planning processes. The paper was started by listing the various factors of the four different groups of SWOT with reference to the PDS. After further shortlisting, pairwise comparisons were carried out using a software (Super Decisions) to arrive at prioritised factors for each group. The strategy options were then formulated and prioritised on the basis of the existing weightages of each factor.

Findings

The results indicated that use of available ICT solutions as part of the “Digital India” is vital in achieving the most important potential strategy alternatives in improving the supply chain for the PDS.

Practical implications

The analysis helps in identifying strategies to improve the existing supply chain of the Indian PDS and make it more efficient and cost effective.

Originality/value

This paper provides some useful insight into the SWOT analysis of the Indian PDS with specific reference to the supply chain management issues of the PDS.
Use of Cardiac Injury Markers in the Postmortem Diagnosis of Sudden Cardiac Death
Authors: Carvajal‐Zarrabal Octavio , Hayward‐Jones Patricia M. , Nolasco‐Hipolito Cirilo , Barradas‐Dermitz Dulce Ma. , Calderón‐Garcidueñas Ana Laura , López‐Amador Noé
Published: January 2017

In the daily practice of forensic pathology, sudden cardiac death (SCD) is a diagnostic challenge. Our aim was to determine the usefulness of blood biomarkers [creatine kinase CK‐MB, myoglobin, troponins I and T (cTn‐I and T), and lactate dehydrogenase] measured by immunoassay technique, in the postmortem diagnosis of SCD. Two groups were compared, 20 corpses with SCD and 8 controls. Statistical significance was determined by variance analysis procedures, with a post hoc Tukey multiple range test for comparison of means (p < 0.05). SCD cases showed significantly higher levels (p < 0.05) of cTn‐T and cTn‐I compared to the control group. Although only cases within the first 8 h of postmortem interval were included, and the control group consisted mainly of violent death cases, our results suggest that blood troponin levels may be useful to support a diagnosis of SCD.
Individual Physician Penalties Resulting From Violation of Emergency Medical Treatment and Labor Act: A Review of Office of the Inspector General Patient Dumping Settlements, 2002–2015
Authors: Terp Sophie , Wang Brandon , Raffetto Brian , Seabury Seth A. , Menchine Michael
Published: January 2017

Objective

The objective was to describe characteristics of civil monetary penalty settlements levied by the Office of the Inspector General (OIG) against individual physicians related to violation of the Emergency Medical Treatment and Labor Act (EMTALA).

Methods

Descriptions of all civil monetary penalty settlements between 2002 and 2015 were obtained from the OIG. Characteristics of settlements against individual physicians related to EMTALA violations were described including settlement date, location, amount, whether there was an associated hospital settlement, the medical specialty of the physician involved, and the nature of the allegation.

Results

Of 196 OIG civil monetary penalty settlements related to EMTALA, eight (4%) were levied against individual physicians, and 188 (96%) against facilities. Seven of the eight penalties against individual physicians were imposed upon on‐call specialists, including six who failed to respond to evaluate and treat a patient in the emergency department (ED), and one who failed to accept appropriate transfer of a patient requiring higher level of care. The only penalty imposed on an emergency physician involved a case where a provider repeatedly failed to provide a medical screening examination to a pregnant teen based on the erroneous belief that a minor could not be evaluated or treated absent parental consent. Four of eight penalties against individual physicians were levied within the first 3 years of the 14‐year study period. Half of all physician settlements were associated with a separate hospital civil monetary penalty settlement.

Conclusions

For emergency physicians, a civil monetary penalty is a feared consequence of EMTALA enforcement, as a physician can be held individually liable for fine of up to $50,000 not covered by malpractice insurance. Although EMTALA is an actively enforced law, and violation of the EMTALA statute often results in hospital citations and fines, and occasionally facility closure, we found that individual physicians are rarely penalized by the OIG following EMTALA violation. Individual physician penalties are far less common than hospital citations or fines related to EMTALA or malpractice claims or payments. The majority of penalties against individual physicians were levied upon on‐call specialists who refused to evaluate and treat ED patients. Only one emergency physician was fined during the study period for a clear violation of the EMTALA statute. Physicians should be diligent to ensure appropriate patient care and that facilities are compliant with the EMTALA statute, but should be aware that settlements against individual physicians are a rare consequence of EMTALA enforcement.
‘The early bird catches the nest’: possible competition between scops owls and ring‐necked parakeets
Authors: Mori E. , Ancillotto L. , Menchetti M. , Strubbe D.
Published: January 2017

Competition for critical resources is one of the key mechanisms through which invasive species impact on native communities. Among birds, the widely introduced ring‐necked parakeet Psittacula krameri locally affects cavity‐nesting communities through competition for suitable tree cavities, although it remains unclear to what extent such competition translates into population declines of native species. Here, we studied the potential for nest site competition between ring‐necked parakeets and the native scops owl Otus scops, a small nocturnal migratory raptor, by comparing the spatial distribution of the nest site locations of the raptor before (2002) and after (2015) the parakeet invasion. Pre‐invasion nesting sites of scops owls (2002) strongly coincided with those selected by ring‐necked parakeets, but although both parakeet and scops owl populations increased during the study period, this was no longer true for 2015. Ring‐necked parakeets took over several cavities formerly occupied by scops owls, and land‐use data suggest that because of the higher overall breeding densities in 2015, scops owls were forced to occupy suboptimal breeding habitats to minimize nest site competition with invasive parakeets. Ring‐necked parakeets start breeding early in the season, a behaviour enabling them to secure the best nest sites first, before the owls return from their wintering grounds. Our study highlights that locally observed competition not necessarily impacts on population dynamics of competing species and thus warns against uncritical extrapolation of smaller scale studies for assessing invasive species risks at larger spatial scales. Nonetheless, given the increasing number of studies demonstrating its competitive capacities, monitoring of ring‐necked parakeet populations is prudent and mitigation measures (such as mounting of man‐made nest‐boxes, which are used by scops owls, but not by parakeets) may be justified when the parakeets are likely to invade areas harbouring cavity‐nesters of conservation concern.
Autophagy in renal tubular injury and repair
Authors: Lin F.
Published: January 2017

Autophagy is a fundamental cellular process that maintains normal function and structure of the cell. It can be induced during stress and serves as an adaptive response for cell survival. Normal kidneys have high metabolic demands yet are relatively hypoxic, especially in the medulla and papilla. Injury or ageing aggravates metabolic perturbation and activates autophagy in many types of renal cells. In the kidney, tubular epithelial cells consume the most energy due to active transport mechanisms and therefore are the most susceptible to injuries from hypoxic or low‐energy states. This brief review will summarize current understandings of the biological function and molecular regulation of epithelial autophagy during tubular injury and repair.
Defining endoscopic response and remission in ulcerative colitis clinical trials: an international consensus
Authors: Vuitton L. , Peyrin‐Biroulet L. , Colombel J. F. , Pariente B. , Pineton de Chambrun G. , Walsh A. J. , Panes J. , Travis S. P. L. , Mary J. Y. , Marteau P.
Published: January 2017

Background

Recently, endpoints for clinical trials have been changing from measuring clinical response to mucosal healing in ulcerative colitis. Endoscopic evaluation is the current gold standard to assess mucosal lesions and has become a major measure of therapeutic efficacy in addition to patients reported outcomes.

Aim

To achieve consensus on endoscopic definitions of remission and response for clinical trials in patients with ulcerative colitis.

Methods

In reaching the current international recommendations on an International Organization For the Study of Inflammatory Bowel Disease (IOIBD) initiative, we first performed a systematic review of technical aspects of endoscopic scoring systems. Then, to achieve consensus on endoscopic definitions of remission and response for clinical trials, we conducted a two‐round vote using a Delphi‐style process among fifteen specialists in the field of inflammatory bowel diseases.

Results

The literature review showed that many endoscopic indices have been proposed to evaluate disease activity in ulcerative colitis; most are unvalidated and arbitrary definitions have been used in clinical trials for defining endoscopic response or remission. At the end of the voting process, the investigators ranked initially the Ulcerative Colitis Endoscopic Index of Severity (UCEIS) 0 for the definition of endoscopic remission, and a decrease in Mayo endoscopic score ≥1 grade or a decrease in UCEIS ≥2 points for the definition of endoscopic response in ulcerative colitis.

Conclusions

These international recommendations represent the first consensus on measurement indices for endoscopic outcomes in ulcerative colitis. They should be subject to prospective testing in clinical trials of ulcerative colitis.
Elemental diet decreases inflammation and improves symptoms in adult eosinophilic oesophagitis patients
Authors: Warners M. J. , Vlieg‐Boerstra B. J. , Verheij J. , van Rhijn B. D. , Van Ampting M. T. J. , Harthoorn L. F. , de Jonge W. J. , Smout A. J. P. M. , Bredenoord A. J.
Published: January 2017

Background

Eosinophilic oesophagitis (EoE) is a chronic disease, driven by food allergens. Elemental diets are effective for the management of children with EoE, but studies on the effect of elemental diets in adults are scarce and poor palatability challenges dietary adherence.

Aim

To assess the effects of an elemental diet (Neocate, Nutricia, Utrecht, the Netherlands) on the inflammation, symptoms and endoscopic signs in adult EoE patients.

Methods

In this prospective study, 21 patients with active EoE, confirmed by biopsies showing ≥15 eosinophils per microscopic high power field (HPF) and symptoms of oesophageal dysfunction were included. Patients underwent endoscopy before and 4 weeks after diet. Histological disease activity (peak eosinophil count/HPF), and endoscopic signs were scored by physicians. Symptoms and adherence to the diet were evaluated by questionnaires. Serum total IgE levels and total eosinophil counts were determined and the expression of inflammatory cytokines was analysed by qPCR.

Results

In total, 17 (81%) of the patients completed the diet, of whom 12 (71%) showed complete histological response (≤15 eosinophils/HPF) and 4 (24%) showed partial histological response (≥50% reduction of baseline eosinophil count). Peak eosinophil counts decreased significantly after the diet from 40 to 9 per HPF (P ≤ 0.001). A marked improvement in endoscopic signs was observed. Symptoms decreased significantly in all subjects, and 15 patients (88%) became completely asymptomatic (P ≤ 0.001). In 14 patients (82%), blood eosinophil count and serum IgE decreased (P ≤ 0.05).

Conclusion

Elemental diet reduces eosinophilic inflammation and induces clinical remission in adult patients with eosinophilic oesophagitis.
Efficacy of olanzapine for the prophylaxis of chemotherapy‐induced nausea and vomiting: a meta‐analysis
Authors: Yang Ting , Liu Qianxin , Lu Min , Ma Lingyue , Zhou Ying , Cui Yimin
Published: January 2017

Aim

The aim of the present study was to evaluate the efficacy of olanzapine for the prevention of chemotherapy‐induced nausea and vomiting (CINV).

Methods

The literature was searched for randomized controlled trials (RCTs) evaluating the efficacy of olanzapine for the prophylaxis of CINV using PubMed, Embase, Central, as well as clinicaltrials.gov for unpublished studies. The endpoints of the study were the number of patients who achieved a complete response (CR; no emesis and no rescue) and no nausea in the acute, delayed and overall phases. Two authors independently selected studies, assessed the risk of bias and extracted data. The included RCTs were analysed using RevMan 5.3 provided by the Cochrane Collaboration.

Results

Ten RCTs were identified for the meta‐analysis. Compared with other antiemetic agents, olanzapine significantly improved the CR in the delayed and overall phases, but did not enhance the CR in the acute phase. For the control of CINV, olanzapine was better than and comparable with aprepitant in the acute phase and delayed phase, respectively. Compared with placebo, treatment with 5 mg and 10 mg olanzapine exhibited similar efficacy in terms of the CR in the delayed and overall phases.

Conclusions

Olanzapine is an excellent alternative for the prophylaxis of CINV. Olanzapine 5 mg per day should be recommended as the initial dose because of equivalent efficacy to a 10 mg dose but a lower potential risk of side effects. Further studies are needed to explore the optimal combination of medicines.
Advancing Telecommunication Technology and its Impact on Psychotherapy in Private Practice
Authors: Vincent Christopher , Barnett Mary , Killpack Louisa , Sehgal Amita , Swinden Penni
Published: January 2017

This paper is a report on an informal study by a small group of psychotherapists interested in exploring the impact of recent technological innovations on their work as independent clinicians in private practice. The range of technologies studied included websites, email, mobile phones, and internet‐based banking services for payment and receipt of fees. Some of the group had experience of using internet‐based video software (or Voice Over Internet Protocol/VOIP software) for providing therapy and/or establishing supervisory and training links. The study found that these technologies have had both positive and negative impacts on professional practice and, in particular, records how practitioners have managed these changes within their clinical practice. The study notes the lack of professional training about these matters and highlights some of the issues that need to be addressed in redressing this situation.
A novel mitochondria‐targeting fluorescent probe for hydrogen sulfide in living cells
Authors: Shi Wei , Pan Miaobo , Qiang Hao , Qiu Qianqian , Huang Wenlong , Lin Haiyan , Qian Hai , Ge Liang
Published: January 2017

A novel mitochondria‐targeting fluorescent probe compound S‐N3 for hydrogen sulfide (H2S) in living cells has been designed and synthesized in this study. This article contained the chemosynthesis and some studies on bioactivity of the target compound in living cells. Compound S‐N3 is easy to synthesize and can remain stable under the effect of pH, system and photostability. In addition, it shows low cytotoxicity in cell imaging. And it can react with H2S highly selective in PBS or FBS solution, which would cause the obvious increase in fluorescence intensity. Therefore, the low‐cost detection method for H2S is allowed for monitoring the quantity of H2S existed in the mitochondria.
Identification of promising DNA GyrB inhibitors for Tuberculosis using pharmacophore‐based virtual screening, molecular docking and molecular dynamics studies
Authors: Islam Md Ataul , Pillay Tahir S.
Published: January 2017

In this study, we searched for potential DNA GyrB inhibitors using pharmacophore‐based virtual screening followed by molecular docking and molecular dynamics simulation approaches. For this purpose, a set of 248 DNA GyrB inhibitors was collected from the literature and a well‐validated pharmacophore model was generated. The best pharmacophore model explained that two each of hydrogen bond acceptors and hydrophobicity regions were critical for inhibition of DNA GyrB. Good statistical results of the pharmacophore model indicated that the model was robust in nature. Virtual screening of molecular databases revealed three molecules as potential antimycobacterial agents. The final screened promising compounds were evaluated in molecular docking and molecular dynamics simulation studies. In the molecular dynamics studies, RMSD and RMSF values undoubtedly explained that the screened compounds formed stable complexes with DNA GyrB. Therefore, it can be concluded that the compounds identified may have potential for the treatment of TB.
Importance of functional groups in predicting the activity of small molecule inhibitors for Bcl‐2 and Bcl‐xL
Authors: Kanakaveti Vishnupriya , Sakthivel Ramasamy , Rayala S. K. , Gromiha M. Michael
Published: January 2017

Evasion of apoptosis owing to aberrant expression of Bcl‐2 (B‐cell lymphoma‐2) anti‐apoptotic proteins is a promising hallmark of cancer. These proteins are associated with resistance to chemotherapy and radiation. Currently available QSAR models are limited to a set of inhibitors corresponding to a particular chemical scaffold, and unified models are required to identify the differential specificity of diverse compounds toward inhibiting these targets. In this study, we predicted the factors driving differential activity and specificity implementing multiplexed QSAR analysis for a dataset of 1,649 reported inhibitors of Bcl‐2 (B‐cell lymphoma‐2) and Bcl‐xL (B‐cell lymphoma‐extra large). We developed QSAR models for seven diverse scaffolds and critically analyzed the chemical space with coupling factors. The correlation values of QSAR models for Bcl‐2 and Bcl‐xL range from 0.95 to 0.985. The MAE and sMAPE of the models were in the range of 0.052–5.4 nm and 0.41%–10%, respectively, signifying model robustness. The crucial descriptors and moieties accounting for the activity were benchmarked against experimentally determined binding patterns. The comprehensive analysis made in the study explores latent features of the chemical space in a broad perspective. Further, we have developed a user‐friendly Web server for predicting a specific/dual inhibitor of Bcl‐2 and Bcl‐xL [http://www.iitm.ac.in/bioinfo/APPLE/].