bluuebunny/crossref_metadata_2025 huggingface dataset:
Association of ARID5B gene variants with acute lymphoblastic leukemia in Yemeni children
Authors: Al-absi Boshra , Noor Suzita M , Saif-Ali Riyadh , Salem Sameer D , Ahmed Radwan H , Razif Muhammad FM , Muniandy Sekaran
Published: April 2017

Studies have shown an association between ARID5B gene polymorphisms and childhood acute lymphoblastic leukemia. However, the association between ARID5B variants and acute lymphoblastic leukemia among the Arab population still needs to be studied. The aim of this study was to investigate the association between ARID5B variants with acute lymphoblastic leukemia in Yemeni children. A total of 14 ARID5B gene single nucleotide polymorphisms (SNPs) were genotyped in 289 Yemeni children, of whom 136 had acute lymphoblastic leukemia and 153 were controls, using the nanofluidic Dynamic Array (Fluidigm 192.24 Dynamic Array). Using logistic regression adjusted for age and gender, the risks of acute lymphoblastic leukemia were presented as odds ratios and 95% confidence intervals. We found that nine SNPs were associated with acute lymphoblastic leukemia under additive genetic models: rs7073837, rs10740055, rs7089424, rs10821936, rs4506592, rs10994982, rs7896246, rs10821938, and rs7923074. Furthermore, the recessive models revealed that six SNPs were risk factors for acute lymphoblastic leukemia: rs10740055, rs7089424, rs10994982, rs7896246, rs10821938, and rs7923074. The gender-specific impact of these SNPs under the recessive genetic model revealed that SNPs rs10740055, rs10994982, and rs6479779 in females, and rs10821938 and rs7923074 in males were significantly associated with acute lymphoblastic leukemia risk. Under the dominant model, SNPs rs7073837, rs10821936, rs7896246, and rs6479778 in males only showed striking association with acute lymphoblastic leukemia. The additive model revealed that SNPs with significant association with acute lymphoblastic leukemia were rs10821936 (both males and females); rs7073837, rs10740055, rs10994982, and rs4948487 (females only); and rs7089424, rs7896246, rs10821938, and rs7923074 (males only). In addition, the ARID5B haplotype block (CGAACACAA) showed a higher risk for acute lymphoblastic leukemia. The haplotype (CCCGACTGC) was associated with protection against acute lymphoblastic leukemia. In conclusion, our study has shown that ARID5B variants are associated with acute lymphoblastic leukemia in Yemeni children with several gender biases of ARID5B single nucleotide polymorphisms reported.
Down-regulation of adenosine monophosphate–activated protein kinase activity: A driver of cancer
Authors: He Xiaoling , Li Cong , Ke Rong , Luo Lingyu , Huang Deqiang
Published: April 2017

Adenosine monophosphate–activated protein kinase (AMPK), a serine/threonine protein kinase, is known as “intracellular energy sensor and regulator.” AMPK regulates multiple cellular processes including protein and lipid synthesis, cell proliferation, invasion, migration, and apoptosis. Moreover, AMPK plays a key role in the regulation of “Warburg effect” in cancer cells. AMPK activity is down-regulated in most tumor tissues compared with the corresponding adjacent paracancerous or normal tissues, indicating that the decline in AMPK activity is closely associated with the development and progression of cancer. Therefore, understanding the mechanism of AMPK deactivation during cancer progression is of pivotal importance as it may identify AMPK as a valid therapeutic target for cancer treatment. Here, we review the mechanisms by which AMPK is down-regulated in cancer.
Long and short noncoding RNAs in lung cancer precision medicine: Opportunities and challenges
Authors: Tian Haihua , Zhou Chengwei , Yang Jie , Li Jingqiu , Gong Zhaohui
Published: April 2017

The long and short noncoding RNAs have been involved in the molecular diagnosis, targeted therapy, and predicting prognosis of lung cancer. Utilizing noncoding RNAs as biomarkers and systemic RNA interference as an innovative therapeutic strategy has an immense likelihood to generate novel concepts in precision oncology. Targeting of RNA interference payloads such as small interfering RNAs, microRNA mimetic, or anti-microRNA (antagomirs) into specific cell types has achieved initial success. The clinical trials of noncoding RNA–based therapies are on the way with some positive results. Many attempts are done for developing novel noncoding RNA delivery strategies that could overcome systemic or local barriers. Furthermore, it precipitates concerted efforts to define the molecular subtypes of lung cancer, characterize the genomic landscape of lung cancer subtypes, identify novel therapeutic targets, and reveal mechanisms of sensitivity and resistance to targeted therapies. These efforts contribute a visible effect now in lung cancer precision medicine: patients receive molecular testing to determine whether their tumor harbors an actionable come resistance to the first-generation drugs are in clinical trials, and drugs targeting the immune system are showing activity in patients. This extraordinary promise is tempered by the sobering fact that even the newest treatments for metastatic disease are rarely curative and are effective only in a small fraction of all patients. Thus, ongoing and future efforts to find new vulnerabilities of lung cancers unravel the complexity of drug resistance, increase the efficacy of immunotherapies, and perform biomarker-driven clinical trials are necessary to improve the outcome of lung cancer patients.
The role of sphingosine-1-phosphate in the tumor microenvironment and its clinical implications
Authors: Nakajima Masato , Nagahashi Masayuki , Rashid Omar M , Takabe Kazuaki , Wakai Toshifumi
Published: April 2017

Elucidating the interaction between cancer and non-cancer cells, such as blood vessels, immune cells, and other stromal cells, in the tumor microenvironment is imperative in understanding the mechanisms underlying cancer progression and metastasis, which is expected to lead to the development of new therapeutics. Sphingosine-1-phosphate is a bioactive lipid mediator that promotes cell survival, proliferation, migration, angiogenesis/lymphangiogenesis, and immune responsiveness, which are all factors involved in cancer progression. Sphingosine-1-phosphate is generated inside cancer cells by sphingosine kinases and then exported into the tumor microenvironment. Although sphingosine-1-phosphate is anticipated to play an important role in the tumor microenvironment and cancer progression, determining sphingosine-1-phosphate levels in the tumor microenvironment has been difficult due to a lack of established methods. We have recently developed a method to measure sphingosine-1-phosphate levels in the interstitial fluid that bathes cancer cells in the tumor microenvironment, and reported that high levels of sphingosine-1-phosphate exist in the tumor interstitial fluid. Importantly, sphingosine-1-phosphate can be secreted from cancer cells and non-cancer components such as immune cells and vascular/lymphatic endothelial cells in the tumor microenvironment. Furthermore, sphingosine-1-phosphate affects both cancer and non-cancer cells in the tumor microenvironment promoting cancer progression. Here, we review the roles of sphingosine-1-phosphate in the interaction between cancer and non-cancer cells in tumor microenvironment, and discuss future possibilities for targeted therapies against sphingosine-1-phosphate signaling for cancer patients.
Postmortem findings in Ontario racehorses, 2003–2015
Authors: DeLay Josepha
Published: April 2017

Postmortem lesions and cause of death were evaluated retrospectively for 963 horses examined as part of the Ontario Racing Commission Death Registry over a 13-y period. The Death Registry was established in 2003 to identify factors leading to death or euthanasia of racehorses in this Canadian province. Postmortem examination was carried out on 56% of horses reported to the Death Registry and included Standardbred, Thoroughbred, and American Quarter Horses. Musculoskeletal injury was the most common reason for death associated with racing or training among all racehorses and involved 68% of horses. A history of sudden death during or immediately following exercise was described for 31% of racing- or training-associated deaths, and in 16% of all horses in the study. Sudden death occurred in horses of all breeds, and our report describes lesions associated with sudden death in a series of Standardbreds. The cause of death in these cases was most frequently attributed to cardiopulmonary lesions. The cause of death was undetermined in 20% of sudden death cases, and it is speculated that cardiac arrhythmia may have contributed to these deaths. Injection-associated death was documented in 4% of the study population. Lesions among horses whose death was not associated with exercise were similar to those in other equine populations, and lesions involving the gastrointestinal system were most common. Standardization of pathology reporting of pulmonary and other lesions in racehorse postmortem cases would allow direct comparison of results among racehorse populations.
Measuring Infusion of Service-Learning on Student Program Development and Implementation Competencies
Authors: Hou Su-I , Pereira Vince
Published: April 2017

This study piloted a service-learning assessment suite to measure students’ perceived self-efficacy on program development and implementation competencies (Service-Learning Self-Efficacy on Program Development and Implementation [SL-SEPDI]), Service-Learning Belief Inventory (SLBI), and an Overall Service-Learning Self-Efficacy on Program Development and Implementation (OVSL-SEPDI) scales. MPH students in a required course participated in the study during 2011-2015 ( N = 87). Baseline survey was used to assess the reliabilities of the 12-item SL-SEPDI and the nine-item SLBI scales, and posttest survey assessed the 10-item OVSL-SEPDI scale. Confirmatory factor analysis showed good model fit index and all items loaded significantly on both the SL-SEPDI (χ2/ df = 1.34; root mean square error of approximation [RMSEA] = .067; Tucker–Lewis index [TLI] = .92; comparative fit index [CFI] = .94; incremental fit index [IFI] = .94; goodness-of-fit index [GFI] = .86) and SLBI (χ2/ df = 1.28; RMSEA = .061; TLI = .97; CFI = .98; IFI = .98; GFI = .91) scales. Data also showed satisfactory reliability scores, with Cronbach’s alphas of .87, .88, and .91 for the SL-SEPDI, SLBI, and OVSL-SEPDI scales. This study provides data supporting the validities and reliabilities of this service-learning measurement suite, and has implications to assess student self-efficacy outcomes.
Revisiting the Structure of the Short Dark Triad
Authors: Persson Björn N. , Kajonius Petri J. , Garcia Danilo
Published: April 2017

In the past decade, extensive interest has been directed toward the Dark Triad (i.e., Machiavellianism, narcissism, and psychopathy), popularly assessed by the Short Dark Triad (SD3). Nevertheless, relatively little research has been conducted on the SD3’s factor structure. We investigated the SD3’s psychometric properties in three studies with three independent samples, using exploratory and confirmatory factor analyses ( N1 = 1,487; N2 = 17,740; N3 = 496). In all three studies, Machiavellianism and psychopathy items displayed large general factor loadings, and narcissism larger specific factor loadings. In subsequent studies, two- and three-factor models fitted the data similarly, with the best fitting model being a bifactor model with items from Machiavellianism and psychopathy modelled as one specific factor, and narcissism as a second specific factor. On this basis, we suggest that the SD3 does not seem to capture the different mental processes theorized to underlie the similar behaviors generated by Machiavellianism and psychopathy. Additionally, we recommend the use of a single SD3 composite score, and not subscale scores, as subscales contain small amounts of reliable variance beyond the general factor.
Remote Preconditioning and Vascular Surgery
Authors: Healy Donagh A. , Walsh Stewart R.
Published: April 2017

Remote ischemic preconditioning (RIPC) is a theoretically attractive strategy for organ protection; and phase 2 studies in a variety of settings have yielded promising results. In this article, we review the existing clinical studies on RIPC in vascular surgery. We examine aspects of design that may potentially be optimized in future vascular surgery studies and we highlight some challenges that have emerged since the publication of the Remote Ischaemic Preconditioning for Heart Surgery (RIPHeart) trial and the Effect of Remote Ischaemic Preconditioning on Clinical Outcomes in Patients Undergoing Coronary Artery Bypass Surgery (ERICCA) trial.
Audiovisual Distraction Increases Prefrontal Cortical Neuronal Activity and Impairs Attentional Performance in the Rat
Authors: Ririe Douglas G , Boada MD , Schmidt Benjamin S , Martin Salem J , Kim Susy A , Martin Thomas J
Published: April 2017

Involvement of attentional processes is generally evidenced by disruption of behavior in the presence of distracting stimuli. The medial prefrontal cortex (mPFC) seems to play a role in fine-tuning activity during attentional tasks. A novel titration variant of the 5-choice serial reaction time task (5-choice serial reaction time titration variant [5CTV]) that adjusts task difficulty based on subject performance was used to evaluate the effects of audiovisual distraction (DSTR) on performance and mPFC single spike activity and local field potential (LFP). Attention was impaired in the 5CTV from DSTR, and mPFC spike activity was increased, whereas LFP was reduced. The increased spike activity in the mPFC in conjunction with DSTR suggests that conflicting attentional demands may contribute to the reduced task performance. As both hypo- and hyperactivation of the mPFC may contribute to attentional disruption, further studies using the 5CTV are needed to understand mPFC activity changes in real time during disruption of performance by other types of behavioral or neurobiological manipulations.
Intralesional Vitamin D3 Injection in the Treatment of Recalcitrant Warts: A Novel Proposition
Authors: Raghukumar Sonia , Ravikumar B. C. , Vinay K. N. , Suresh M. R. , Aggarwal Archit , Yashovardhana D. P.
Published: April 2017

Background:

Verruca vulgaris (viral warts) is a fairly common condition with a plethora of treatment options having variable success rates. Recalcitrant warts are refractory to treatment with often disappointing response and high recurrence rates. Lately, treatment with intralesional injections has gained momentum due to its effectiveness in clearing warts by stimulating the cell-mediated immunity. Vitamin D, when applied topically, regulates epidermal cell proliferation and is involved in the formation of antimicrobial peptides. We have attempted to use vitamin D3 to exploit its reported action as an immunotherapeutic molecule in addition to its topical effects. To our knowledge, there are no reports of intralesional vitamin D3 injections used in the treatment of extragenital recalcitrant warts.

Methods:

Sixty-four patients with recalcitrant warts of varying sizes and duration were included in the study. About 0.2- to 0.5-mL vitamin D3 solution (600,000 IU, 15 mg/mL) was injected to the base of the wart. A maximum of 5 warts were injected per session at 3-week intervals until resolution or for a maximum of 4 treatments. Patients were followed up for 6 months after the last injection to detect any recurrence.

Results:

Sixty patients completed the study. Complete response was seen in 54 of 60 (90%), partial response in 4 of 60 (6.66%), and no response in 2 of 60 (3.33%). The average number of injections required to achieve a complete resolution was 3.66. Complete resolution of distant warts was noticed in all patients.

Conclusions:

Intralesional vitamin D3 is a safe, effective, and an inexpensive treatment option for recalcitrant warts.
Data retention, journalist freedoms and whistleblowers
Authors: Humphreys Sal , de Zwart Melissa
Published: April 2017

As members of the ‘fourth estate’, journalists have enjoyed certain limited protections for themselves and their sources under the laws of various countries. These protections are now uniquely challenged in the context of metadata retention and enhanced surveillance and national security protections. This article examines the recent changes to laws in Australia and the position of journalists as investigative watchdogs. It considers the nature of the new laws, the responses of journalists, the broader context of commercial journalism and the rise of the infotainment business model, and the role of the ‘networked fourth estate’ and non-institutional actors in creating accountable government in Australia.
Long-term disability trajectories in primary progressive MS patients: A latent class growth analysis
Authors: Signori Alessio , Izquierdo Guillermo , Lugaresi Alessandra , Hupperts Raymond , Grand’Maison Francois , Sola Patrizia , Horakova Dana , Havrdova Eva , Prat Alexandre , Girard Marc , Duquette Pierre , Boz Cavit , Grammond Pierre , Terzi Murat , Singhal Bhim , Alroughani Raed , Petersen Thor , Ramo Cristina , Oreja-Guevara Celia , Spitaleri Daniele , Shaygannejad Vahid , Butzkueven Helmut , Kalincik Tomas , Jokubaitis Vilija , Slee Mark , Fernandez Bolaños Ricardo , Sanchez-Menoyo Jose Luis , Pucci Eugenio , Granella Franco , Lechner-Scott Jeannette , Iuliano Gerardo , Hughes Stella , Bergamaschi Roberto , Taylor Bruce , Verheul Freek , Edite Rio Maria , Amato Maria Pia , Sajedi Seyed Aidin , Majdinasab Nastaran , Van Pesch Vincent , Sormani Maria Pia , Trojano Maria
Published: April 2017

Background:

Several natural history studies on primary progressive multiple sclerosis (PPMS) patients detected a consistent heterogeneity in the rate of disability accumulation.

Objectives:

To identify subgroups of PPMS patients with similar longitudinal trajectories of Expanded Disability Status Scale (EDSS) over time.

Methods:

All PPMS patients collected within the MSBase registry, who had their first EDSS assessment within 5 years from onset, were included in the analysis. Longitudinal EDSS scores were modeled by a latent class mixed model (LCMM), using a nonlinear function of time from onset. LCMM is an advanced statistical approach that models heterogeneity between patients by classifying them into unobserved groups showing similar characteristics.

Results:

A total of 853 PPMS (51.7% females) from 24 countries with a mean age at onset of 42.4 years (standard deviation (SD): 10.8 years), a median baseline EDSS of 4 (interquartile range (IQR): 2.5–5.5), and 2.4 years of disease duration (SD: 1.5 years) were included. LCMM detected three different subgroups of patients with a mild ( n = 143; 16.8%), moderate ( n = 378; 44.3%), or severe ( n = 332; 38.9%) disability trajectory. The probability of reaching EDSS 6 at 10 years was 0%, 46.4%, and 81.9% respectively.

Conclusion:

Applying an LCMM modeling approach to long-term EDSS data, it is possible to identify groups of PPMS patients with different prognosis.
Gender discrimination in land ownership and the alleviation of women’s poverty in Nigeria
Authors: Ajala Taiwo
Published: April 2017

In Nigeria, gender roles are manifested in social rights and entitlements in a form which denies women equal economic and political empowerment and, in particular, women right to own land. The consequence of gender discrimination in land ownership is women’s lack of access to land which constitutes a major source and means of wealth creation and economic empowerment, hence women’s vulnerability to poverty. This article considers a land redistribution reform which can address the discrimination against women in land ownership and give women access to land for economic empowerment, thereby alleviating poverty among women in Nigeria. The article proposes that an ideal land reform in Nigeria has to fulfil three key objectives of equity, equality and productivity which the article refers to as ‘new equities’. It argues that only a redistributive land reform which integrates these ‘equities’ can adequately address gender discrimination in land ownership, ensure women’s access to land for economic empowerment and alleviate women’s poverty in Nigeria.
Impact of Mergers and Acquisitions on Firms’ Export Competitiveness
Authors: Mishra Pulak , Jaiswal Neha
Published: April 2017

This article attempts to examine the impact of mergers and acquisitions (M&A) on export competitiveness of firms in Indian pharmaceutical industry. It finds that the wave of M&A has positive influence on both incidence and extent of export competitiveness. In addition, incidence of exports is positively influenced by market share and efforts towards creating marketing and distribution related complementary assets as well. On the other hand, the extent of export intensity is also higher for firms with larger market share, greater marketing and distribution-related efforts, innovation and foreign technology purchase. However, advertising and financial performance do not cause any significant impact on export competitiveness. It is, therefore, suggested that policies and regulations relating to M&A, innovation and sourcing foreign technology need a fresh look with greater industry-specific flexibilities. There is also a need for integration of different policies and regulations in areas like FDI, intellectual property, and so on.
Openness and Innovation
Authors: Shepherd Ben
Published: April 2017

This article uses firm-level data for India to examine the determinants of innovation activity, focusing on variables related to economic openness. Firms that export and those that import are found to be significantly more likely to engage in innovation, defined sequentially as the introduction of new products, new processes, new systems, or devotion of financial resources or time to research and development. Concretely, exporters are 22 per cent more likely to introduce a new product than non-exporters, while the corresponding figure is 66 per cent for importers. Openness to trade is, therefore, a key determinant of firm-level innovation, which is a key component of economic growth.
Psychometric properties of the five-item version of the Mindful Awareness Attention Scale (MAAS) in Norwegian adolescents
Authors: Smith Otto R.F. , Melkevik Ole , Samdal Oddrun , Larsen Torill M. , Haug Ellen
Published: April 2017

Objectives: The aim of the present study was to examine the factor structure, model-based reliability, measurement invariance and concurrent validity of the five-item version of the Mindfulness Attention Awareness Scale (MAAS) in Norwegian adolescents. Methods: An initial pilot study was carried out using a sample of 77 fifteen year olds. For the main analyses, a sample of 2140 Norwegian adolescents was used who participated in the cross-sectional Health Behaviour in School-Aged Children (HBSC) study. All participants were asked to complete a questionnaire. Results: Confirmatory factor analyses found support for the one-factor structure of the five-item version of the MAAS. Acceptable model fit was found in both the pilot sample (χ2=6.48, df=5, p=0.26; root mean square error of approximation [RMSEA]=0.06; comparative fit index [CFI]=0.99; standardised root mean square residual [SRMR]=0.03) and the HBSC sample (χ2=27.1, df=4, p<0.001; RMSEA=0.05; CFI=0.99; SRMR=0.01). The model-based reliability of the scale was good (ω=0.84 and ω=0.81, respectively). Scalar measurement invariance was established for sex, age and material affluence. Finally, the five-item MAAS displayed concurrent validity through moderate negative associations with health complaints ( r=−0.44; p<0.001) and school stress ( b=−0.44, p<0.001), and a positive moderate correlation with life satisfaction ( r=0.26; p<0.001). Conclusions: The five-item version of the MAAS is an adequate measure of mindfulness in Norwegian adolescents. Due to the brief nature of the scale, it can easily be included in epidemiological and clinical studies with an interest for trait mindfulness. The five-item MAAS may therefore have great potential to facilitate more knowledge about the role of mindfulness in adolescent health.
The Event of Terrorism: Ambiguous Categories and Public Spectacle
Authors: Price Stuart
Published: April 2017

This article examines the ways in which executive authority and media organizations categorize the spectacle of public violence and disaster, with particular reference to an event (the Germanwings crash in 2015) where large-scale fatalities were purposely caused. On occasions when a perpetrator commits multiple killings (acting impersonally but with “malice aforethought,” and usually against civilian victims), the immediate question appears to be whether or not the incident should be classified as a terrorist attack. This is especially the case during periods when mass or individual assaults are prominent in the public domain. The article examines the problems inherent in the uses of unstable or contested linguistic definitions, which typify the family of terms that include both the act of terrorizing individuals, groups, and wider polities, and the supposedly political practice known as terrorism.
How are pharmacists in Ontario adapting to practice change? Results of a qualitative analysis using Kotter’s change management model
Authors: Teixeira Beatriz , Gregory Paul A. M. , Austin Zubin
Published: April 2017

Background:

The pace of practice change in community pharmacy over the past decade has been significant, yet there is little evidence documenting implementation of change in the profession.

Methods:

Kotter’s change management model was selected as a theoretical framework for this exploratory qualitative study. Community pharmacists were interviewed using a semistructured protocol based on Kotter’s model. Data were analyzed and coded using a constant-comparative iterative method aligned with the stages of change management outlined by Kotter.

Results:

Twelve community pharmacists were interviewed. Three key themes emerged: 1) the profession has successfully established the urgency to, and created a climate conducive for, change; 2) the profession has been less successful in engaging and enabling the profession to actually implement change; and 3) legislative changes (for example, expansion of pharmacists’ scope of practice) may have occurred prematurely, prior to other earlier stages of the change process being consolidated.

Interpretation:

As noted by most participants, allowing change is not implementing change: pharmacists reported feeling underprepared and lacking confidence to actually make change in their practices and believe that more emphasis on practical, specific implementation tactics is needed.

Conclusions:

Change management is complex and time and resource intensive. There is a need to provide personalized, detailed, context-specific implementation strategies to pharmacists to allow them to take full advantage of expanded scope of practice.
Confronting methodological challenges in studying school leader time use through technological advancements
Authors: Hochbein Craig , Dever Bridget V , White George , Mayger Linda , Gallagher Emily
Published: April 2017

Among the multitude of studies that have examined an array of variables related to school leadership, only a small percentage have rigorously examined how school leaders spend their time. The complex role of school leaders poses challenges to common methods of collecting data about school leader time use, which subsequently threaten the validity of researchers’ claims. In this study we identified three prevalent challenges to studying school leader time use, and applied technological advancements in an event sampling methodology framework to mitigate the challenges associated with studying school leader time use. We used new technology and event sampling methodology to collect data, between the hours of 8 a.m. and 8 p.m. during 28 consecutive days, on the time use of 11 school leaders. Our system of notification and response achieved an overall response rate of 85% and enabled the collection of school leaders’ perceptions of their time use as they worked in multiple locations over an extended period of time. Finally, we have proposed a research agenda to study rigorously the time use of school leaders.
Development of the ICD-10 simplified version and field test
Authors: Paoin Wansa , Yuenyongsuwan Maliwan , Yokobori Yukiko , Endo Hiroyoshi , Kim Sukil
Published: April 2017

Background:

The International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) has been used in various Asia-Pacific countries for more than 20 years. Although ICD-10 is a powerful tool, clinical coding processes are complex; therefore, many developing countries have not been able to implement ICD-10-based health statistics (WHO-FIC APN, 2007).

Objective:

This study aimed to simplify ICD-10 clinical coding processes, to modify index terms to facilitate computer searching and to provide a simplified version of ICD-10 for use in developing countries.

Method:

The World Health Organization Family of International Classifications Asia-Pacific Network (APN) developed a simplified version of the ICD-10 and conducted field testing in Cambodia during February and March 2016. Ten hospitals were selected to participate. Each hospital sent a team to join a training workshop before using the ICD-10 simplified version to code 100 cases. All hospitals subsequently sent their coded records to the researchers.

Results:

Overall, there were 1038 coded records with a total of 1099 ICD clinical codes assigned. The average accuracy rate was calculated as 80.71% (66.67–93.41%). Three types of clinical coding errors were found. These related to errors relating to the coder (14.56%), those resulting from the physician documentation (1.27%) and those considered system errors (3.46%).

Discussion:

The field trial results demonstrated that the APN ICD-10 simplified version is feasible for implementation as an effective tool to implement ICD-10 clinical coding for hospitals.

Conclusion:

Developing countries may consider adopting the APN ICD-10 simplified version for ICD-10 code assignment in hospitals and health care centres. The simplified version can be viewed as an introductory tool which leads to the implementation of the full ICD-10 and may support subsequent ICD-11 adoption.
Heart rate variability is differentially altered in multiple sclerosis: implications for acute, worsening and progressive disability
Authors: Studer Valeria , Rocchi Camilla , Motta Caterina , Lauretti Benedetta , Perugini Jacopo , Brambilla Laura , Pareja-Gutierrez Lorena , Camera Giorgia , Barbieri Francesca Romana , Marfia Girolama A , Centonze Diego , Rossi Silvia
Published: April 2017

Background

Sympathovagal imbalance has been associated with poor prognosis in chronic diseases, but there is conflicting evidence in multiple sclerosis.

Objectives

The objective of this study was to investigate the autonomic nervous system dysfunction correlation with inflammation and progression in multiple sclerosis.

Methods

Heart rate variability was analysed in 120 multiple sclerosis patients and 60 healthy controls during supine rest and head-up tilt test; the normalised units of low frequency and high frequency power were considered to assess sympathetic and vagal components, respectively. Correlation analyses with clinical and radiological markers of disease activity and progression were performed.

Results

Sympathetic dysfunction was closely related to the progression of disability in multiple sclerosis: progressive patients showed altered heart rate variability with respect to healthy controls and relapsing–remitting patients, with higher rest low frequency power and lacking the expected low frequency power increase during the head-up tilt test. In relapsing–remitting patients, disease activity, even subclinical, was associated with lower rest low frequency power, whereas stable relapsing–remitting patients did not differ from healthy controls. Less sympathetic reactivity and higher low frequency power at rest were associated with incomplete recovery from relapse.

Conclusions

Autonomic balance appears to be intimately linked with both the inflammatory activity of multiple sclerosis, which is featured by an overall hypoactivity of the sympathetic nervous system, and its compensatory plastic processes, which appear inefficient in case of worsening and progressive multiple sclerosis.
Lymphocyte subtypes in relapsing–remitting multiple sclerosis patients treated with dimethyl fumarate
Authors: Chaves C , Ganguly R , Ceresia C , Camac A
Published: April 2017

Background

Recent data suggest that lymphopenia is more prevalent than reported in relapsing–remitting multiple sclerosis (RRMS) patients taking dimethyl fumarate (DMF).

Objective

The objective of this study was to investigate the effect of DMF on lymphocyte subtypes in RRMS patients with and without lymphopenia.

Method

A retrospective study compared lymphocyte subtypes in DMF-treated RRMS patients with low (G1, n = 35) and normal lymphocyte counts (G2, n = 24).

Results

Fifty-nine patients were identified, with mean age 49, 71.2% females, and average DMF duration 20 months. Age, sex, baseline white blood count, disease and treatment durations were similar between groups. Prior interferon therapy and baseline lower normal lymphocyte counts were more frequent in G1. Mean lymphocyte counts were 0.8 ± 0.2 × 109/L in G1 and 1.6 ± 0.3 × 109/L in G2. CD3+, CD4+, and CD8+ T cell mean counts were lower ( p < 0.0001), while CD4/CD8 ratio higher ( p = 0.03) in G1 than G2. Mean CD19 + B cell counts were normal; however, values were lower in G1 ( p = 0.04). After adjusting for confounders, significantly positive correlations were noted between lymphocyte counts and CD3 + , CD4+, CD8+ T, and B cell counts. Negative correlation was observed between lymphocyte counts and CD4/CD8 ratio driven by low CD8+ T cell counts.

Conclusion

DMF treatment predominantly impacts T cells, in particular CD8+ subtype. This finding may have implications in this population’s immunocompetence.
Autologous fat grafting in keloids and hypertrophic scars: a review
Authors: Lee Geoffrey , Hunter-Smith David J. , Rozen Warren Matthew
Published: April 2017

Keloid and hypertrophic scars are unique human dermal fibroproliferative disorders of the injured skin and are associated with pain, itch and can cause functional limitations. A number of genetic, systemic and local factors have been identified in the formation of keloids and hypertrophic scars. Studies have shown that adipose-derived stem cells have angiogenic and antiapoptotic properties which has effects on wound healing, soft-tissue restoration and scar remodelling, and thus may have a role in managing keloid scaring. However, this role is not well described in the literature. A systemic review of available literature was thus undertaken, regarding the use of fat grafting in treatment of keloids and hypertrophic scarring. In total, 858 articles were identified, with ten studies ultimately fulfilling inclusion criteria. There were no studies specifically isolating the keloids and hypertrophic group of patients, and thus quantitative data were completely lacking from the literature. There were, however, individual cases described, and qualitatively encouraging clinical results were reported for the use of fat grafting on keloids and hypertrophic scars. Combined with the current theoretical and immunohistochemical understanding through other laboratory and animal studies, fat grafting may play a role in the treatment of keloids and hypertrophic scaring; however, specific evidence is currently lacking. The role for further research is clear.
Improving Chronic Disease Outcomes Through Medication Therapy Management in Federally Qualified Health Centers
Authors: Rodis Jennifer L. , Sevin Alexa , Awad Magdi H. , Porter Brianne , Glasgow Kyle , Hornbeck Fox Carrie , Pryor Barbara
Published: April 2017

Introduction: Appropriate management of chronic diseases, including proper use of medications, can lead to better disease control, decrease disease-related complications, and improve overall health. Pharmacists have been shown to positively affect chronic disease outcomes through medication therapy management (MTM). The primary objectives of this project are to increase the number of patients with (1) A1c in control and (2) blood pressure in control; secondary objectives are to (3) describe number and type of medication-related problems identified and resolved by pharmacists providing MTM in Federally Qualified Health Centers (FQHCs), (4) identify potential (pADEs) and actual adverse drug events (ADEs), and refer patients to diabetes self-management education classes, as needed. Methods: This multisite, prospective, descriptive pilot study engaged three FQHC sites with distinct models of established pharmacist MTM services to care for patients with uncontrolled diabetes and/or hypertension. Data were reported in aggregate regarding primary and secondary outcomes. Results: As of December 2015, 706 patients were enrolled in the project. Of the 422 with uncontrolled diabetes, 52.84% (n = 223) had an A1c <9%; 72 patients (17.06%) achieved an A1c between 8% and 9%, 19.19% (n = 81) of patients achieved an A1c <8% and ≥7%, and 16.59% (n = 70) of patients achieved an A1c <7%. The percentage of patients with blood pressure <140/90 mm Hg improved to 65.21%. Conclusion: Pharmacist-provided MTM can improve chronic disease intermediate outcomes for medically underserved patients in FQHCs.
Caspase-3 controls AML1-ETO–driven leukemogenesis via autophagy modulation in a ULK1-dependent manner
Authors: Man Na , Tan Yurong , Sun Xiao-Jian , Liu Fan , Cheng Guoyan , Greenblatt Sarah M. , Martinez Camilo , Karl Daniel L. , Ando Koji , Sun Ming , Hou Dan , Chen Bingyi , Xu Mingjiang , Yang Feng-Chun , Chen Zhu , Chen Saijuan , Nimer Stephen D. , Wang Lan
Published: April 2017

Key Points

Loss of Caspase-3 delays leukemogenesis in a mouse model for t(8;21) AML. Loss of Caspase-3 triggers upregulation of ULK1 and induction of autophagy in leukemia-initiating cells.
CD138 mediates selection of mature plasma cells by regulating their survival
Authors: McCarron Mark J. , Park Pyong Woo , Fooksman David R.
Published: April 2017

Key Points

CD138 is required for survival of ASCs and long-term humoral immunity.
Doxycycline improves clinical outcomes during cystic fibrosis exacerbations
Authors: Xu Xin , Abdalla Tarek , Bratcher Preston E. , Jackson Patricia L. , Sabbatini Gina , Wells J. Michael , Lou Xiang-Yang , Quinn Rebecca , Blalock J. Edwin , Clancy J. P. , Gaggar Amit
Published: April 2017

Matrix metalloprotease-9 (MMP-9) plays a role in progression of cystic fibrosis, and doxycycline can reduce MMP-9in vitro. Here, we explore the effect of doxycycline during cystic fibrosis exacerbation treatment on MMP-9 related readouts and clinical end-points.

This randomised, double-blind, placebo-controlled study enrolled hospitalised patients with cystic fibrosis undergoing exacerbation. In total, 20 participants were given doxycycline and 19 participants were given placebo over an 8-day period during hospitalisation. Biospecimens were collected at the beginning and the end of the study period. Primary end-points were total MMP-9 levels in the sputum and safety/tolerability. Secondary end-points included change in lung function, time to next exacerbation, and markers of MMP-9-related protease activity (active MMP-9 and TIMP-1). Nonparametric testing was used for within-group and between-group analyses.

Doxycycline was well tolerated, with no treatment discontinuations or serious adverse events. Doxycycline reduced total sputum MMP-9 levels by 63.2% (p<0.05), and was also associated with a 56.5% reduction in active MMP-9 levels (p<0.05), a 1.6-fold increase in sputum TIMP-1 (p<0.05), improvement in forced expiratory volume in 1 s (p<0.05), and an increase in time to next exacerbation (p<0.01).

Adjunctive use of doxycycline improved dysregulated MMP-9 levels in sputum, along with biomarkers consistent with a reduced proteolytic pulmonary environment. Improvement in clinical outcome measures suggests an important therapeutic benefit of doxycycline for individuals with cystic fibrosis.
The effect of fluid overload on sleep apnoea severity in haemodialysis patients
Authors: Lyons Owen D. , Inami Toru , Perger Elisa , Yadollahi Azadeh , Chan Christopher T. , Bradley T. Douglas
Published: April 2017

As in heart failure, obstructive and central sleep apnoea (OSA and CSA, respectively) are common in end-stage renal disease. Fluid overload characterises end-stage renal disease and heart failure, and in heart failure plays a role in the pathogenesis of OSA and CSA. We postulated that in end-stage renal disease patients, those with sleep apnoea would have greater fluid volume overload than those without.

End-stage renal disease patients on thrice-weekly haemodialysis underwent overnight polysomnography on a nondialysis day to determine their apnoea–hypopnoea index (AHI). Extracellular fluid volume of the total body, neck, thorax and right leg were measured using bioelectrical impedance.

28 patients had an AHI ≥15 (sleep apnoea group; OSA:CSA 21:7) and 12 had an AHI <15 (no sleep apnoea group). Total body extracellular fluid volume was 2.6 L greater in the sleep apnoea group than in the no sleep apnoea group (p=0.006). Neck, thorax, and leg fluid volumes were also greater in the sleep apnoea than the no sleep apnoea group (p<0.05), despite no difference in body mass index (p=0.165).

These findings support a role for fluid overload in the pathogenesis of both OSA and CSA in end-stage renal disease.
Low-cost time-lapse seismic with distributed compressive sensing — Part 1: Exploiting common information among the vintages
Authors: Oghenekohwo Felix , Wason Haneet , Esser Ernie , Herrmann Felix J.
Published: April 2017

Time-lapse seismic is a powerful technology for monitoring a variety of subsurface changes due to reservoir fluid flow. However, the practice can be technically challenging when one seeks to acquire colocated time-lapse surveys with high degrees of replicability among the shot locations. We have determined that under “ideal” circumstances, in which we ignore errors related to taking measurements off the grid, high-quality prestack data can be obtained from randomized subsampled measurements that are observed from surveys in which we choose not to revisit the same randomly subsampled on-the-grid shot locations. Our acquisition is low cost because our measurements are subsampled. We have found that the recovered finely sampled prestack baseline and monitor data actually improve significantly when the same on-the-grid shot locations are not revisited. We achieve this result by using the fact that different time-lapse data share information and that nonreplicated (on-the-grid) acquisitions can add information when prestack data are recovered jointly. Whenever the time-lapse data exhibit joint structure — i.e., they are compressible in some transform domain and share information — sparsity-promoting recovery of the “common component” and “innovations,” with respect to this common component, outperforms independent recovery of the prestack baseline and monitor data. The recovered time-lapse data are of high enough quality to serve as the input to extract poststack attributes used to compute time-lapse differences. Without joint recovery, artifacts — due to the randomized subsampling — lead to deterioration of the degree of repeatability of the time-lapse data. We tested this method by carrying out experiments with reliable statistics from thousands of repeated experiments. We also confirmed that high degrees of repeatability are achievable for an ocean-bottom cable survey acquired with time-jittered continuous recording.
Disruptive mood dysregulation disorder in offspring of parents with depression and bipolar disorder
Authors: Propper Lukas , Cumby Jill , Patterson Victoria C. , Drobinin Vladislav , Glover Jacqueline M. , MacKenzie Lynn E. , Morash-Conway Jessica , Abidi Sabina , Bagnell Alexa , Lovas David , Hajek Tomas , Gardner William , Pajer Kathleen , Alda Martin , Uher Rudolf
Published: April 2017

Background

It has been suggested that offspring of parents with bipolar disorder are at increased risk for disruptive mood dysregulation disorder (DMDD), but the specificity of this association has not been established.

Aims

We examined the specificity of DMDD to family history by comparing offspring of parents with (a) bipolar disorder, (b) major depressive disorder and (c) a control group with no mood disorders.

Method

We established lifetime diagnosis of DMDD using the Schedule for Affective Disorders and Schizophrenia for School Aged Children for DSM-5 in 180 youth aged 6–18 years, including 58 offspring of parents with bipolar disorder, 82 offspring of parents with major depressive disorder and 40 control offspring.

Results

Diagnostic criteria for DMDD were met in none of the offspring of parents with bipolar disorder, 6 of the offspring of parents with major depressive disorder and none of the control offspring. DMDD diagnosis was significantly associated with family history of major depressive disorder.

Conclusions

Our results suggest that DMDD is not specifically associated with a family history of bipolar disorder and may be associated with parental depression.
Cost-Effectiveness of Pediatric Cancer Treatment in Tanzania: An Economic Analysis
Authors: Saxton Anthony T. , Bhattacharya Manisha , Masalu Nestory , Rice Henry E. , Schroeder Kristin
Published: April 2017

Abstract 52

Background:

Despite the high burden of pediatric cancer in low- and middle-income countries, the number of facilities at which children can obtain treatment remains distressingly low. Understanding the costs and economic value of pediatric cancer treatment may assist policy makers to maximize the value of investments in health with informed resource allocation decisions. We examined the direct and indirect costs, cost-effectiveness, and societal economic benefit of diagnosing and treating children with cancer in Tanzania at the Bugando Medical Center, one of only two hospitals in the country with a pediatric oncology unit.

Methods:

A retrospective chart review of hospital admissions and clinic visits from January 2010 to August 2014 was performed. Costs were recorded for all items that were billed to the patient for laboratory studies, medications, imaging, pathology, surgeries, and hospital stay. Travel costs were estimated for each patient on the basis of a self-reported home address. All costs were converted from Tanzanian shillings to 2016 US dollars. Health outcomes were measured as disability-adjusted life-year (DALY) averted. We calculated the cost-effectiveness ratio of treatment versus performing no intervention as well as the societal economic benefit using a human capital approach and considering the per capita gross national product in Tanzania.

Results:

We identified costs for a subset of 127 patients, 64% of which were male (n = 81). Mean age at first clinical presentation was 6.9 years. Mean cost for treatment was $218 ± $145, with an average of 10.4 ± 8.9 DALYs averted per patient. Total cost-effectiveness ratio was $21/DALY, and the mean societal economic benefit was $27,118 ± $23,412.

Conclusion:

Our findings show that pediatric cancer treatment in Tanzania is cost-effective and offers substantial economic value.

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

No COIs from the authors.