bluuebunny/crossref_metadata_2025 huggingface dataset:
A systematic review of costing studies for implementing and scaling-up breastfeeding interventions: what do we know and what are the gaps?
Authors: Carroll Grace , Safon Cara , Buccini Gabriela , Vilar-Compte Mireya , Teruel Graciela , Pérez-Escamilla Rafael
Published: January 2020

Despite the well-established evidence that breastfeeding improves maternal and child health outcomes, global rates of exclusive breastfeeding remain low. Cost estimates can inform stakeholders about the financial resources needed to scale up interventions to ultimately improve breastfeeding outcomes in low-, middle- and high-income countries. To inform the development of comprehensive costing frameworks, this systematic review aimed to (1) identify costing studies for implementing or scaling-up breastfeeding interventions, (2) assess the quality of identified costing studies and (3) examine the availability of cost data to identify gaps that need to be addressed through future research. Peer-reviewed and grey literature were systematically searched using a combination of index terms and relevant text words related to cost and the following breastfeeding interventions: breastfeeding counselling, maternity leave, the World Health Organization International Code of Marketing of Breastmilk Substitutes, the Baby-Friendly Hospital Initiative, media promotion, workplace support and pro-breastfeeding social policies. Data were extracted after having established inter-rater reliability among the first two authors. The quality of studies was assessed using an eight-item checklist for key costing study attributes. Forty-five studies met the inclusion criteria, with the majority including costs for breastfeeding counselling and paid maternity leave. Most cost analyses included key costing study attributes; however, major weaknesses among the studies were the lack of clarity on costing perspectives and not accounting for the uncertainty of reported cost estimates. Costing methodologies varied substantially, standardized costing frameworks are needed for reliably estimating the costs of implementing and scaling-up breastfeeding interventions at local-, national- or global-levels.
Disease Characteristics and Severity in Patients With Inflammatory Bowel Disease With Coexistent Diabetes Mellitus
Authors: Din Hassieb , Anderson Alyce J , Ramos Rivers Claudia , Proksell Siobhan , Koutroumpakis Filippos , Salim Tariq , Babichenko Dmitriy , Tang Gong , Koutroubakis Ioannis E , Schwartz Marc , Johnston Elyse , Barrie Arthur , Harrison Janet , Hashash Jana , Dunn Michael A , Hartman Douglas J , Binion David G
Published: January 2020

Background

Given the rising prevalence of diabetes mellitus (DM) and the limited data on its effect on the course of inflammatory bowel disease (IBD), we characterized multiyear patterns of disease severity in a cohort of IBD patients with coexistent DM.

Methods

Data of consented IBD patients followed prospectively in a natural history registry at a tertiary center between 2009 and 2017 were analyzed. Patients with ≥3 years of clinical follow-up were included. Patients identified with a diagnosis of DM were compared with 400 consecutive IBD controls without a diagnosis of DM, no laboratory evidence of hyperglycemia, and no history of antihyperglycemic treatment.

Results

Out of 2810 IBD patients, 141 (5%) had DM (IBD DM; 44% ulcerative colitis, 56% Crohn’s disease, 48.2% female). IBD DM had higher use of 5-aminosalicylic acid (5ASA) agents (P = 0.04), narcotics (P < 0.001), and antibiotics (P = 0.007) but not immunomodulators and/or biologics compared with IBD controls. When analyzing biomarkers of severity, IBD DM demonstrated higher frequencies of elevated C-reactive protein (CRP; P = 0.006), elevated erythrocyte sedimentation rate (ESR; P = 0.001), eosinophilia (P = 0.004), monocytosis (P = 0.02), and hypoalbuminemia (P = 0.001). IBD DM had worse quality of life (mean Short Inflammatory Bowel Disease Questionnaire; P < 0.001). IBD DM had increased health care utilization compared with controls (emergency room usage P = 0.008, hospitalizations P < 0.001, gastroenterology clinic visits P < 0.001, and median annual charges P < 0.001). Among IBD DM patients, the use of immunomodulators and/or biologics was not associated with further complications as measured by antibiotic use or hospitalizations.

Conclusions

This study of a large IBD cohort suggests that DM in IBD may be associated with increased disease severity and that there may be room for increasing use of highly effective immunomodulator and/or biologic agents in this group.
Anthropogenic Change Alters Ecological Relationships via Interactive Changes in Stress Physiology and Behavior within and among Organisms
Authors: Hammond Talisin T , Ortiz-Jimenez Chelsea A , Smith Jennifer E
Published: January 2020

Synopsis

Anthropogenic change has well-documented impacts on stress physiology and behavior across diverse taxonomic groups. Within individual organisms, physiological and behavioral traits often covary at proximate and ultimate timescales. In the context of global change, this means that impacts on physiology can have downstream impacts on behavior, and vice versa. Because all organisms interact with members of their own species and other species within their communities, the effects of humans on one organism can impose indirect effects on one or more other organisms, resulting in cascading effects across interaction networks. Human-induced changes in the stress physiology of one species and the downstream impacts on behavior can therefore interact with the physiological and behavioral responses of other organisms to alter emergent ecological phenomena. Here, we highlight three scenarios in which the stress physiology and behavior of individuals on different sides of an ecological relationship are interactively impacted by anthropogenic change. We discuss host–parasite/pathogen dynamics, predator–prey relationships, and beneficial partnerships (mutualisms and cooperation) in this framework, considering cases in which the effect of stressors on each type of network may be attenuated or enhanced by interactive changes in behavior and physiology. These examples shed light on the ways that stressors imposed at the level of one individual can impact ecological relationships to trigger downstream consequences for behavioral and ecological dynamics. Ultimately, changes in stress physiology on one or both sides of an ecological interaction can mediate higher-level population and community changes due in part to their cascading impacts on behavior. This framework may prove useful for anticipating and potentially mitigating previously underappreciated ecological responses to anthropogenic perturbations in a rapidly changing world.
Del Nido cardioplegia in coronary surgery: a propensity-matched analysis
Authors: Schutz Alexander , Zhang Qianzi , Bertapelle Kimberly , Beecher Nicholas , Long William , Lee Vei-Vei , Pan Wei , Arcaro Michael , Ghanta Ravi , Jimenez Ernesto , Ott David A , Loor Gabriel
Published: January 2020

OBJECTIVES

Del Nido cardioplegia (DNC) has been shown to be safe in adults with normal coronary arteries who are undergoing valve surgery. This study compared the effects of DNC versus traditional blood-based cardioplegia on postoperative complications in patients who underwent coronary artery bypass grafting (CABG).

METHODS

A retrospective analysis was performed on 863 patients who underwent CABG with DNC (n = 420) or control cardioplegia (CC) (n = 443) between 2014 and 2017. The full cohort of DNC and CC recipients, as well as propensity score-matched pairs, was compared regarding preoperative risk variables and outcomes.

RESULTS

The DNC and CC groups showed no significant differences in mean cardiopulmonary bypass time (53.09 vs 52.10 min, P = 0.206) or aortic cross-clamp time (32.82 vs 33.28 min, P = 0.967). The groups also showed no difference in operative mortality (2.1% vs 2.5%, P = 0.734); however, DNC use resulted in lower rates of overall infections (1.7% vs 4.3%, P = 0.024), total sternal infections (0.9% vs 3.2%, P = 0.023), postoperative atrial fibrillation (23.8% vs 30.7%, P = 0.023) and postoperative ventricular tachycardia (0.5% vs 3.4%, P = 0.002). A propensity-matching analysis (n = 335 pairs) showed similar statistically significant decreases with DNC.

CONCLUSIONS

In this large cohort of CABG patients, DNC was shown as a safe alternative to CC and was associated with lower postoperative dysrhythmia and infection rates. These findings show that DNC is safe and effective in patients whose operative interventions may require only single-dosing cardioplegia; its use in longer cases should be further explored given its low complication rate.
Human Immunodeficiency Virus and Hepatitis C Virus Infection Testing Among Commercially Insured Persons Who Inject Drugs, United States, 2010–2017
Authors: Bull-Otterson Lara , Huang Ya-Lin A , Zhu Weiming , King Hope , Edlin Brian R , Hoover Karen W
Published: January 2020

Background

We assessed prevalence of testing for human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infection among persons who inject drugs (PWID).

Methods

Using a nationwide health insurance database for claims paid during 2010–2017, we identified PWID by using codes from the International Classification of Diseases, Current Procedural Terminology, and National Drug Codes directory. We then estimated the percentage of PWIDs tested for HIV or HCV within 1 year of an index encounter, and we used multivariate logistic regression models to assess demographic and clinical factors associated with testing.

Results

Of 844 242 PWIDs, 71 938 (8.5%) were tested for HIV and 65 188 (7.7%) were tested for HCV infections. Missed opportunities were independently associated with being male (odds ratios [ORs]: HIV, 0.50 [95% confidence interval {CI}, 0.49–0.50], P < .001; HCV, 0.66 [95% CI, 0.65–0.72], P < .001), rural residence (ORs: HIV, 0.67 [95% CI, 0.65–0.69], P < .001; HCV, 0.75 [95% CI, 0.73–0.77], P < .001), and receiving services for skin infections or endocarditis (adjusted ORs: HIV, 0.91 [95% CI, 0.87–0.95], P < .001; HCV, 0.90 [95% CI, 0.86–0.95], P < .001).

Conclusions

Approximately 90% of presumed PWIDs missed opportunities for HIV or HCV testing, especially male rural residents with claims for skin infections or endocarditis, commonly associated with injection drug use.
Humoral and Mucosal Immune Responses to Human Norovirus in the Elderly
Authors: Costantini Veronica P , Cooper Emilie M , Hardaker Hope L , Lee Lore E , DeBess Emilio E , Cieslak Paul R , Hall Aron J , Vinjé Jan
Published: January 2020

Background

Most information on mucosal and systemic immune response to norovirus infection is derived from human challenge studies, birth cohort studies, or vaccine trials in healthy adults. However, few data are available on immune responses to norovirus in the elderly.

Methods

To study the mucosal and systemic immune response against norovirus, 43 long-term care facilities were enrolled prospectively in 2010–2014. Baseline saliva samples from 17 facilities, cases and controls up to day 84 from 10 outbreaks, as well as acute and convalescent sera were collected.

Results

Norovirus-specific immunoglobulin A (IgA) levels in baseline saliva samples were low and increased in both symptomatic patients and asymptomatic shedders at day 5 after onset during outbreaks. Receiver operating characteristics analysis correctly assigned prior norovirus infection in 23 (92%) of 25 participants. Cases and asymptomatic shedders showed seroconversion for IgG (80%), IgA (78%), and blockade antibodies (87%). Salivary IgA levels strongly correlated with increased convalescent serum IgA titers and blockade antibodies.

Conclusions

Salivary IgA levels strongly correlated with serum IgA titers and blockade antibodies and remained elevated 3 months after a norovirus outbreak. A single salivary sample collected on day 14 could be used to identify recent infection in a suspected outbreak or to monitor population salivary IgA.
Systematic Review: Patient Perceptions of Monitoring Tools in Inflammatory Bowel Disease
Authors: Goodsall Thomas M , Noy Richard , Nguyen Tran M , Costello Samuel P , Jairath Vipul , Bryant Robert V
Published: January 2020

Background and Aims

Inflammatory bowel disease (IBD) is a lifelong disease requiring frequent assessment to guide treatment and prevent flares or progression. Multiple tools are available for clinicians to monitor disease activity; however, there are a paucity of data to inform which monitoring tools are most acceptable to patients. The review aims to describe the available evidence for patient preference, satisfaction, tolerance and/or acceptability of the available monitoring tools in adults with IBD.

Methods

Embase, Medline, Cochrane Central and Clinical Trials.gov were searched from January 1980 to April 2019 for all study types reporting on the perspectives of adults with confirmed IBD on monitoring tools, where two or more tools were compared. Outcome measures with summary and descriptive data were presented.

Results

In 10 studies evaluating 1846 participants, monitoring tools included venipuncture, stool collection, gastrointestinal ultrasound, computed tomography, magnetic resonance imaging, wireless capsule endoscopy, barium follow-through and endoscopy. Outcome domains were patient satisfaction, acceptability of monitoring tool and patient preference. Noninvasive investigations were preferable to endoscopy in nine studies. When assessed, gastrointestinal ultrasound was consistently associated with greater acceptability and satisfaction compared with endoscopy or other imaging modalities.

Conclusions

Adults with IBD preferred noninvasive investigations, in particular gastrointestinal ultrasound, as compared to endoscopy for monitoring disease activity. When assessing disease activity, patient perceptions should be considered in the selection of monitoring tools. Further research should address whether adpoting monitoring approaches considered more acceptable to patients results in greater satisfaction, adherence and ultimately more beneficial clinical outcomes.
Burial and Compaction of Sandy Soils to Prevent Emergence of Adult Stable Fly (Diptera: Muscidae) at the Soil Surface
Authors: Cook David Francis , Deyl Robert A , Lindsey Jeremy B , D’Antuono Mario F , Telfer Donald V , McPharlin Ian R
Published: January 2020

Stable fly (Stomoxys calcitrans L.) remain a significant pest affecting livestock and rural communities on the Swan Coastal Plain around Perth, Western Australia. Vegetable crop residues remaining after harvest enable stable fly development. Left untreated they can produce from several hundred to >1,000 stable fly/m2 of post-harvest residues. We studied the effect of burial and compaction of sandy soils on adult emergence of stable fly and house fly (Musca domestica L.) (Diptera: Muscidae). Adults of both fly species can move up through 50 cm of loose, dry sand, however at depths greater than 60 cm, emergence rapidly declines with <5% of adults surviving under 100 cm of soil. Burial of stable fly larvae and pupae under 15 cm of soil followed by compaction using a static weight dramatically reduced adult emergence. Moist soil compacted at ≥3 t/m2 completely prevented stable fly emergence whereas house fly emergence was not affected. One t/m2 of compaction resulted in <5% emergence of stable fly buried as pupae. Soil that was easily compactible (i.e., high silt, fine sand and clay content) reduced stable fly emergence more than soil with more coarse sand and low clay content. This study demonstrates the potential for a novel and chemical-free option for controlling stable fly development from vegetable crop post-harvest residue. Field trials are needed to confirm that burial and compaction of vegetable post-harvest residues using agricultural machinery can dramatically reduce the subsequent emergence of adult stable fly on a large scale.
Calcium channel CNGC19 mediates basal defense signaling to regulate colonization by Piriformospora indica in Arabidopsis roots
Authors: Jogawat Abhimanyu , Meena Mukesh Kumar , Kundu Anish , Varma Mahendra , Vadassery Jyothilakshmi
Published: January 2020

The activation of calcium signaling is a crucial event for perceiving environmental stress. Colonization by Piriformospora indica, a growth-promoting root endosymbiont, activates cytosolic Ca2+ in Arabidopsis roots. In this study, we examined the role and functional relevance of calcium channels responsible for Ca2+ fluxes. Expression profiling revealed that CYCLIC NUCLEOTIDE GATED CHANNEL 19 (CNGC19) is an early-activated gene, induced by unidentified components in P. indica cell-wall extract. Functional analysis showed that loss-of-function of CNGC19 resulted in growth inhibition by P.indica, due to increased colonization and loss of controlled fungal growth. The cngc19 mutant showed reduced elevation of cytosolic Ca2+ in response to P. indica cell-wall extract in comparison to the wild-type. Microbe-associated molecular pattern-triggered immunity was compromised in the cngc19 lines, as evidenced by unaltered callose deposition, reduced cis-(+)-12-oxo-phytodienoic acid, jasmonate, and jasmonoyl isoleucine levels, and down-regulation of jasmonate and other defense-related genes, which contributed to a shift towards a pathogenic response. Loss-of-function of CNGC19 resulted in an inability to modulate indole glucosinolate content during P. indica colonization. CNGC19-mediated basal immunity was dependent on the AtPep receptor, PEPR. CNGC19 was also crucial for P. indica-mediated suppression of AtPep-induced immunity. Our results thus demonstrate that Arabidopsis CNGC19 is an important Ca2+ channel that maintains a robust innate immunity and is crucial for growth-promotion signaling upon colonization by P. indica.
Three Overlooked Principles in Evaluation of Global Health Engagements
Authors: Waller Stephen G
Published: January 2020

Three important but neglected principles of evaluation of global health engagement missions are stakeholder engagement, impact, and relative value. Implementing better M&E programs could be carried out in this fiscal year, without new appropriations or manpower. The result would be cost savings and improved security cooperation.
Simulation of the loss-cone instability in spherical systems – II. Dominating Keplerian potential
Authors: Polyachenko E V , Berczik P , Just A , Shukhman I G
Published: January 2020

According to our previous theoretical findings, physical processes in centres of galaxies, star clusters, and the Oort comet cloud can be significantly altered by a new so-called ‘gravitational loss-cone instability’. Using N-body simulations of a spherical stellar model in the dominating Keplerian potential, we confirm the possibility of the instability and go beyond the linear theory. Unlike most other instabilities, the new one shows no notable change in spherical geometry of the cluster, but it significantly accelerates the speed of diffusion of particles in phase space leading to a repopulation of the loss cone and early instability saturation.
Ethics in Music Therapy Education: Four Points to Consider
Authors: DiMaio Lauren , Engen Becky
Published: January 2020

Ethical thinking in music therapy is a vital aspect of the profession. However, little is published on the subject of ethics in the music therapy academic setting. Therefore, this article explores the complex issues of ethics and ethical thinking in music therapy education from the perspective of two music therapists who have held various positions within academics in music therapy. The purpose of this article is to encourage integrity within music therapy education and to draw attention to the complex ethical issues within music therapy academics. Four points are described for music therapy educators: (1) Assess positions of power, (2) Explore your adaptability, (3) Assess possible infringement of rights, and (4) Consider cultural bias in your responses. These points are offered as recommendations inserted into the Dileo Model of Ethical Thinking for Music Therapists for people in academia when faced with ethical dilemmas.
An overview of frailty in kidney transplantation: measurement, management and future considerations
Authors: Harhay Meera N , Rao Maya K , Woodside Kenneth J , Johansen Kirsten L , Lentine Krista L , Tullius Stefan G , Parsons Ronald F , Alhamad Tarek , Berger Joseph , Cheng XingXing S , Lappin Jaqueline , Lynch Raymond , Parajuli Sandesh , Tan Jane C , Segev Dorry L , Kaplan Bruce , Kobashigawa Jon , Dadhania Darshana M , McAdams-DeMarco Mara A
Published: January 2020

The construct of frailty was first developed in gerontology to help identify older adults with increased vulnerability when confronted with a health stressor. This article is a review of studies in which frailty has been applied to pre- and post-kidney transplantation (KT) populations. Although KT is the optimal treatment for end-stage kidney disease (ESKD), KT candidates often must overcome numerous health challenges associated with ESKD before receiving KT. After KT, the impacts of surgery and immunosuppression represent additional health stressors that disproportionately impact individuals with frailty. Frailty metrics could improve the ability to identify KT candidates and recipients at risk for adverse health outcomes and those who could potentially benefit from interventions to improve their frail status. The Physical Frailty Phenotype (PFP) is the most commonly used frailty metric in ESKD research, and KT recipients who are frail at KT (~20% of recipients) are twice as likely to die as nonfrail recipients. In addition to the PFP, many other metrics are currently used to assess pre- and post-KT vulnerability in research and clinical practice, underscoring the need for a disease-specific frailty metric that can be used to monitor KT candidates and recipients. Although frailty is an independent risk factor for post-transplant adverse outcomes, it is not factored into the current transplant program risk-adjustment equations. Future studies are needed to explore pre- and post-KT interventions to improve or prevent frailty.
Extreme Lateral Transodontoid Approach for Resection of Clival Chordoma: 2-Dimensional Operative Video
Authors: Joyce Evan J , Cohen Michael A , Ho Winson , Brockmeyer Douglas L , Couldwell William T
Published: January 2020

This 15-yr-old girl presented with nasal obstruction and dysphagia of duration 3 mo and 8 to 10 pounds of weight loss. On examination, she had a hoarse voice and left tongue deviation without weakness or myelopathy. Computed tomography (CT) demonstrated an erosive lesion arising from the clivus and left occipital condyle. Magnetic resonance imaging (MRI) demonstrated a T1-isointense, T2-hyperintense, enhancing mass centered at the occipital condyle and extending into the craniovertebral junction (CVJ), causing severe brainstem compression and extending inferiorly to C2 and anteriorly into the retropharyngeal space. The patient underwent transoral biopsy to confirm the diagnosis of chordoma and complete tumor resection via a left extreme lateral transodontoid (ELTO) approach. This approach was chosen because it provides bilateral exposure to the ventral CVJ and retropharyngeal space and allows for complete tumor removal using a single approach, although it requires an experienced surgeon. The ELTO incision should provide adequate exposure for occipitocervical fusion (OCF) after the destabilization of the CVJ. Transposition of the vertebral artery and odontoidectomy are key maneuvers that provide exposure to the ventral CVJ bilaterally. Dural closure is performed primarily and augmented with fat, fibrin glue, and temporary cerebrospinal fluid diversion. Postoperative MRI showed a gross-total resection and decompression of the brainstem at the CVJ. The patient remained in a cervical collar until OCF. Postoperatively, she had left vocal cord paralysis and moderate weakness with left arm abduction at the deltoid. At 2-mo follow-up, she had improved lower cranial neuropathies, tolerated oral intake, and was scheduled to begin proton beam therapy. The patient provided consent for publication.
Constructing Allyship and the Persistence of Inequality
Authors: Sumerau J E , Forbes TehQuin D , Denise Eric Joy , Mathers Lain A B
Published: January 2020

We examine how people construct what it means to be an ally to marginalized groups. Based on 70 in-depth interviews with college students who identify as allies to one or more marginalized groups, we analyze how they construct allyship in ways that ultimately reproduce patterns of social inequality by (1) assigning responsibility for inequalities to minorities, and (2) suggesting individualized, rather than structural, remedies for combatting unequal systems. We find that the combination of these strategies allows them to claim identities as allies without having to engage in concrete efforts that could challenge systems of oppression. We argue that systematically examining processes through which people construct and perform what it means to be an ally may provide insights into mechanisms whereby inequality is maintained and justified. Such systematic examination may also point to potential avenues for combating social inequalities.
Training Mentor–Mentee Pairs to Build a Robust Culture for Mentorship and a Pipeline of Clinical and Translational Researchers: The Colorado Mentoring Training Program
Authors: Nearing Kathryn A. , Nuechterlein Bridget M. , Tan Shuyuan , Zerzan Judy T. , Libby Anne M. , Austin Gregory L.
Published: January 2020

The Colorado Mentoring Training program (CO-Mentor) was developed at the University of Colorado Anschutz Medical Campus in 2010, supported by the Colorado Clinical and Translational Sciences Institute. CO-Mentor represents a different paradigm in mentorship training by focusing equally on the development of mentees, who are valued as essential to institutional capacity for effective mentorship. The training model is unique among Clinical and Translational Science Award sites in that it engages mentors and mentees in an established relationship. Dyads participate in 4 day-long sessions scheduled throughout the academic year. Each session features workshops that combine didactic and experiential components. The latter provide structured opportunities to develop mentorship-related skills, including self-knowledge and goal setting, communication skills (including negotiation), “managing up,” and the purposeful development of a mentorship support network. Mentors and mentees in 3 recent cohorts reported significant growth in confidence with respect to all mentorship-related skills assessed using a pre–post evaluation survey (P = .001). Mentors reported the most growth in relation to networking to engage social and professional support to realize goals as well as sharing insights regarding paths to success. Mentees reported the most growth with respect to connecting with potential/future mentors, knowing characteristics to look for in current/future mentors, and managing the work environment (e.g., prioritizing work most fruitful to advancing research/career objectives). CO-Mentor represents a novel approach to enhancing mentorship capacity by investing equally in the development of salient skills among mentees and mentors and in the mentorship relationship as an essential resource for professional development, persistence, and scholarly achievement.
The Definition of Faculty Must Evolve: A Call to Action
Authors: Bellini Lisa M. , Kaplan Brian , Fischel Janet E. , Meltzer Carolyn , Peterson Pamela , Sonnino Roberta E.
Published: January 2020

As academic medical centers and academic health centers continue to adapt to the changing landscape of medicine in the United States, the definition of what it means to be faculty must evolve as well. Both institutional economic priorities and the need to recalibrate educational programs to address current and future societal and patient needs have brought new complexity to faculty identity, faculty value, and the educational mission.

The Council of Faculty and Academic Societies, 1 of 3 membership councils of the Association of American Medical Colleges (AAMC), established working groups in 2014 to provide a strong voice for academic faculty within the AAMC governance and leadership structures. The Faculty Identity and Value Working Group was charged with identifying the attributes and qualities of future academic medicine faculty in light of the transformational changes occurring at many medical schools and teaching hospitals. The working group developed a framework that could be applied throughout the United States by AAMC member schools to define and value teaching activities. This report adds to the work of others by offering a contemporary construct that is flexible and easily adaptable to enable fair and transparent implementation of an education value system; it is especially relevant for systems in which mergers and acquisitions lead to a large number of clinicians. An example of such an implementation at a large and growing academic medical center is provided.

The ability to identify and quantify educational effort by faculty could be transformative by highlighting the fundamental importance of faculty to the development of the future medical workforce.
Pregnancy Status is Associated With Screening for Alcohol and Other Substance Use in the Emergency Department
Authors: Greenmyer Jacob R. , Stacy John M. , Klug Marilyn G. , Foster Katrina , Tiongson Christopher , Burd Larry
Published: January 2020

Objectives:

Determine the rates of screening for substance use in pregnant women versus non-pregnant women attending the emergency department (ED).

Methods:

We captured all ED visits by women of childbearing age (12–50 years in our study) over a 5-year period (2012–2017) (n = 72,752) from a local community hospital. The 2742 pregnant women were then matched by ethnicity, marital status, and arrival method to 9888 non-pregnant women. We then compared rates of screening for substance use by pregnancy status stratifying by age and diagnosis.

Results:

The proportion of non-pregnant women who were screened for substance use was 3.66% compared to 1.90% of pregnant women, yielding an odds ratio (OR) of 1.96 (95% CI = 1.44 to 2.67). We then stratified the results by presenting complaint and age. Non-pregnant women 14 to 19 and 30 to 34 had the highest likelihood for screening (OR > 3.0). The presenting complaint showed little effect on screening.

Conclusion:

Pregnant women were screened only 51% as often as non-pregnant women for substance use in the ED. These results are of particular concern as we continue to see a rise in substance use during pregnancy which results in an increased burden on the healthcare system and society. This study replicates a previous study showing that the rates of screening are lower for pregnant women than non-pregnant women presenting to the ED. Earlier recognition of substance use offers increased opportunities for intervention and prevention of adverse outcomes from substance use during both the current pregnancy and future pregnancies.
Framework to Support the Process of Decision-Making on Life-Sustaining Treatments in the ICU: Results of a Delphi Study
Authors: Kerckhoffs Monika C. , Senekal Jannien , van Dijk Diederik , Artigas Antonio , Butler Jenie , Michalsen Andrej , van Mol Margo M. C. , Moreno Rui , Pais da Silva Filipa , Picetti Edoardo , Póvoa Pedro , Robertsen Annette , van Delden Johannes J. M.
Published: January 2020

Objectives:

To develop a consensus framework that can guide the process of decision-making on continuing or limiting life-sustaining treatments in ICU patients, using evidence-based items, supported by caregivers, patients, and surrogate decision makers from multiple countries.

Design:

A three-round web-based international Delphi consensus study with a priori consensus definition was conducted with experts from 13 countries. Participants reviewed items of the decision-making process on a seven-point Likert scale or with open-ended questions. Questions concerned terminology, content, and timing of decision-making steps. The summarized results (including mean scores) and expert suggestions were presented in the subsequent round for review.

Setting:

Web-based surveys of international participants representing ICU physicians, nurses, former ICU patients, and surrogate decision makers.

Patients:

Not applicable.

Interventions:

Not applicable.

Measurements and Main Results:

In three rounds, respectively, 28, 28, and 27 (of 33 invited) physicians together with 12, 10, and seven (of 19 invited) nurses participated. Patients and surrogates were involved in round one and 12 of 27 responded. Caregivers were mostly working in university affiliated hospitals in Northern Europe. During the Delphi process, most items were modified in order to reach consensus. Seven items lacked consensus after three rounds. The final consensus framework comprises the content and timing of four elements; three elements focused on caregiver-surrogate communication (admission meeting, follow-up meeting, goals-of-care meeting); and one element (weekly time-out meeting) focused on assessing preferences, prognosis, and proportionality of ICU treatment among professionals.

Conclusions:

Physicians, nurses, patients, and surrogates generated a consensus-based framework to guide the process of decision-making on continuing or limiting life-sustaining treatments in the ICU. Early, frequent, and scheduled family meetings combined with a repeated multidisciplinary time-out meeting may support decisions in relation to patient preferences, prognosis, and proportionality.
Complications of cosmetic iris implants: French series of 87 eyes
Authors: El Chehab Hussam , Gatinel Damien , Baudouin Christophe , Muraine Marc , Hoffart Louis , Rozot Pascal , Mehanna Chadi , Bonnet Clémence , Nordmann Jean-Philippe , Santiago Pierre-Yves , Burillon Carole , Baillif Stéphanie , Pisella Pierre Jean , Weber Michel , Robinet-Perrin Antoine , Deidier Danielle , Hay Aurélien , Villain Max , Baïkoff Georges , Gauthier Anne Sophie , Mathis Thibaud , Dot Corinne
Published: January 2020

Purpose:

Iris intraocular implants were developed to manage congenital or traumatic iris defects. However, they are also used to change the color of patient eyes. The aim of this retrospective series was to report complications in patients managed in France after cosmetic implantation.

Setting:

Ophthalmological institutions and private ophthalmologists in France.

Design:

Multicenter retrospective observational study.

Methods:

Questionnaires were sent to all ophthalmology departments in university hospitals and to private ophthalmologists. This questionnaire listed demographic and clinical data for each implanted eye with a focus on safety, the description of ocular complications (corneal edema, endothelial cell loss, increased intraocular pressure, and intraocular inflammation), and the therapeutic management implemented.

Results:

Forty-four questionnaires (87 eyes) were collected, and ultimately, 33 questionnaires (65 eyes) were considered complete and analyzed. Two types of implants were identified. Of the 65 eyes analyzed, only 5 eyes (7.7%) did not experience any complication and 60 eyes (92.3%) had at least 1 complication. The most commonly reported complication was corneal decompensation (78.5%). The diagnosis of glaucoma was made in over half (52.3%) of the cases. Explantation was needed in 81.5% of cases. The mean final visual acuity was 0.45 ± 0.08 logarithm of the minimum angle of resolution (logMAR) (0 to 2 logMAR).

Conclusions:

Several ocular complications with a decreased mean visual acuity were described in a young healthy population. In addition, patient information on the safety of this procedure appeared insufficient.
Assessment of the image quality of extended depth-of-focus intraocular lens models in polychromatic light
Authors: Lee Yumi , Łabuz Grzegorz , Son Hyeck-Soo , Yildirim Timur M. , Khoramnia Ramin , Auffarth Gerd U.
Published: January 2020

Purpose:

The use of monochromatic light in the assessment of intraocular lenses (IOLs) has been criticized for not representing the real-world situation. This study aimed to measure and compare the image quality of 3 extended depth-of-focus (EDOF) IOL models in monochromatic and polychromatic light.

Setting:

David J Apple Laboratory, Heidelberg, Germany.

Design:

In vitro study.

Methods:

An optical metrology instrument was used to study image quality metrics of diffractive IOLs with chromatic aberration correction (Symfony and AT Lara) and a refractive lens (Mini Well). The modulation transfer function (MTF) was measured in green and polychromatic light at a 2.0 mm, 3.0 mm, and 4.0 mm aperture. The EDOF IOL's tolerance to defocus was tested against a monofocal lens.

Results:

The mean MTF of the EDOF IOL at far distance was decreased in polychromatic compared with monochromatic light. The largest effect was found in the refractive lens; however, at intermediate distance, only small differences occurred. In their tolerance to defocus, the EDOF IOLs were superior to the monofocal IOL. The diffractive IOL had higher MTFs than that of the refractive IOL at 2 primary foci, the refractive IOL's optical quality varied less with defocus at 3.0 mm. The refractive lens was the most susceptible to changes in aperture size.

Conclusion:

The diffractive EDOF IOL was more resistant to chromatic effects than the refractive IOL. The EDOF IOLs provided an extended through-focus performance compared with the monofocal IOL, but differences in optical design, particularly pupil dependency, should be considered when refining IOL selection for patients.
Diagnostic utility of neuroretinal rim thickness, measured in clock-hour sectors with HD optical coherence tomography, in preperimetric glaucoma
Authors: Tai Tzu-Yang , Ko Yu-Chieh , Chang Yu-Fan , Liu Catherine Jui-Ling , Chen Mei-Ju
Published: January 2020

Background:

We evaluated the usefulness of neuroretinal rim (NRR) thicknesses, measured in clock-hour sectors with Cirrus HD optical coherence tomography, for diagnosing preperimetric glaucoma (PPG).

Methods:

This prospective study included 39 eyes of 39 patients with PPG and 39 eyes of 39 controls that were matched to patients for age and refractive error. We measured the circumpapillary retinal nerve fiber layer (cpRNFL) thickness, macular ganglion cell–inner plexiform layer (GCIPL) thickness, and optic nerve head (ONH) parameters with optical coherence tomography. The clock-hour NRR thicknesses were derived from a 360° circumferential rim thickness curve. We analyzed the area under the receiver operating characteristics curve (AUROC), cutoff values, and sensitivities at specificities of 90% and 95%.

Results:

The largest area under the receiver operating characteristics curves were observed for the NRR thickness at 6 o’clock (0.823), the inferior RNFL thickness (0.821), the average RNFL thickness (0.819), and the NRR thickness at 7 o’clock (0.818). The performance of the NRR thickness at 6 o’clock was comparable to the best performances of the cpRNFL, GCIPL, and ONH parameters (all p > 0.05).

Conclusion:

The ability of the clock-hour NRR thickness assessment to diagnose PPG was comparable to the diagnostic abilities of cpRNFL, GCIPL, and ONH parameters. The best indicator of PPG was the NRR thickness parameter that was at 6 o’clock. This finding could play a role in detecting early structural changes in PPG.
Added Potential of the Pap Smear
Authors: Yorozuya Lauren I. , Moore Diana , Jacob Sharon E.
Published: January 2020

The field of dermatology and syphilology has relied on diagnostic laboratory and pathology tools to aid in the clinician in care of the patient for the better part of two centuries. The purpose of the diagnostics in dermatology column is to highlight commonly encountered diagnostic tools in dermatology and review the indications for use and result interpretation. This article discusses the anal Pap smear, a useful and cost-effective tool to screen for anal intraepithelial neoplasia in at-risk groups.
Reducing Unnecessary Phlebotomy Testing Using a Clinical Decision Support System
Authors: Strockbine Valerie L. , Gehrie Eric A. , Zhou Qiuping (Pearl) , Guzzetta Cathie E.
Published: January 2020

Introduction:

Reducing unnecessary tests reduces costs without compromising quality. We report here the effectiveness of a clinical decision support system (CDSS) on reducing unnecessary type and screen tests and describe, estimated costs, and unnecessary provider ordering.

Methods:

We used a pretest posttest design to examine unnecessary type and screen tests 3 months before and after CDSS implementation in a large academic medical center. The clinical decision support system appears when the test order is initiated and indicates when the last test was ordered and expires. Cost savings was estimated using time-driven activity-based costing. Provider ordering before and after the CDSS was described.

Results:

There were 26,206 preintervention and 25,053 postintervention specimens. Significantly fewer unnecessary type and screen tests were ordered after the intervention (12.3%, n = 3,073) than before (14.1%, n = 3,691; p < .001) representing a 12.8% overall reduction and producing an estimated yearly savings of $142,612. Physicians had the largest weighted percentage of unnecessary orders (31.5%) followed by physician assistants (28.5%) and advanced practice nurses (11.9%).

Conclusions:

The CDSS reduced unnecessary type and screen tests and annual costs. Additional interventions directed at providers are recommended. The clinical decision support system can be used to guide all providers to make judicious decisions at the time of care.
Association of 17q24 rs1859962 gene polymorphism with prostate cancer risk
Authors: Ren Feiqiang , Zhang Peihai , Ma Ziyang , Zhang Ling , Li Guangsen , Huang Xiaopeng , Chang Degui , Yu Xujun
Published: January 2020

Background:

Recently, several genome-wide association studies have demonstrated a cumulative association of 17q24 rs1859962 gene variants with prostate cancer (PCa) risk, but conflicting results on this issue have been reported. Hence, we performed a systematic literature review and meta-analysis to assess the association between 17q24 rs1859962 gene and PCa risk.

Methods:

Systematic literature searches were conducted with PubMed, EMBASE, Science Direct/Elsevier, CNKI, and the Cochrane Library up to January 2019 for studies focusing on the association of 17q24 rs1859962 gene polymorphism with PCa risk. Meta-analysis was performed with Review Manager and stata software. Combined OR were identified with 95% confidence intervals (95% CI) in a random or fixed effects model.

Results:

Eight studies were identified, including 7863 cases of PCa patients and 17122 normal controls. Our results revealed significant associations between the 17q24 rs1859962 gene polymorphism and PCa in all genetic models (P < 0.05). The combined odds ratios and 95% confidence intervals were as follows: Additive model (odds ratios [ORs] 1.44, 95%, confidence interval [CI] [1.32, 1.57]); Codominant model (ORs 1.22, 95% CI [1.08, 1.39]); Dominant model (ORs 1.25, 95%, CI [1.17, 1.34]); recessive model (ORs 1.27, 95% CI [1.18, 1.36]); allele model (ORs 1.32, 95% CI [1.12, 1.55]).

Conclusion:

The present study supports the proposed association between the 17q24 gene rs1859962 and PCa progression. Specifically, this polymorphism is suggested to be a risk factor of PCa. However, studies with larger sample sizes are needed to better illuminate the correlation between 17q24 rs1859962 gene polymorphism and PCa.
Assessment of spinal cord stimulation and radiofrequency
Authors: Corallo Francesco , De Salvo Simona , Floridia Daniela , Bonanno Lilla , Muscarà Nunzio , Cerra Francesco , Cannistraci Cecilia , Di Cara Marcella , Lo Buono Viviana , Bramanti Placido , Marino Silvia
Published: January 2020

Pain has a major impact on anxiety and depression levels. The aim of this study is to demonstrate how these symptoms (depression and anxiety) could positively influence the perception of pain after neurostimulation system implantation.

We enrolled 100 patients and divided in 2 different groups, by using tests screening such as Beck Depression Inventory (BDI), Hamilton Anxiety Rating Scale (HAM-A), Nursing Rating Scale (NRS): the group with spinal cord stimulation (SCS) and the group with pulsed spinal cord radiofrequency (RFP).

We highlighted a significant decrease of scores (BDI, HAM-A, NRS) in each group between T0 (baseline) and T1. Moreover, the intra-group analysis showed a positive significant correlation between NRS and depressive and anxiety symptoms.

We assert that the use of alternative methods (SCS and RFP) to the traditional pharmaceutical-surgical treatments, provide the reduction of the algic and anxiety-depressant symptoms, restoring also the perception of psychological well-being.
PTX3 Gene 3’UTR polymorphism and its interaction with environmental factors are correlated with the risk of preeclampsia in a Chinese Han population
Authors: Xu Ning , Zhang Wei
Published: January 2020

To investigate the interaction between the single nucleotide polymorphism of the 3’ untranslated region (3’UTR) of the pentraxin 3 (PTX3) gene, as well as environmental factors and the preeclampsia risk in a Chinese Han population.

Sanger sequencing was used to analyze rs5853783 and rs73158510 loci of the PTX3 gene 3’UTR from 235 patients with preeclampsia and 235 control subjects. The plasma PTX3 protein level was measured by enzyme-linked immunosorbent assay (ELISA).

The risk of preeclampsia in the PTX3 gene rs5853783 locus D allele carriers was 0.72 times higher than that of the I allele carriers (95% CI: 0.60–0.84, P < .001). The risk of preeclampsia in the PTX3 gene rs73158510 locus A allele carriers was 1.36 times higher than in the G allele carriers (95% CI: 1.16–1.55, P < .001). The area under the ROC curve (AUC) for the diagnosis of preeclampsia by plasma PTX3 protein levels was 0.906 (P < .001). The PTX3 gene rs5853783 and rs73158510 single nucleotide polymorphisms (SNPs) were associated with plasma PTX3 protein levels. The AUC of plasma PTX3 protein level diagnosis of preeclampsia in PTX3 gene rs5853783 locus II genotype subjects was up to 0.9371, followed by the ID genotype (AUC = 0.8586); the DD genotype was the lowest (AUC = 0.8154). The AUC of plasma PTX3 protein level diagnosis of preeclampsia in rs73158510 locus GG genotype subjects was 0.9102, GA genotype was 0.8766, and AA genotype was 0.8750.

The rs5853783 and rs73158510 SNPs in the 3’UTR region of the PTX3 gene are associated with the risk of preeclampsia in a Chinese Han population.
Interpretation bias of high trait anxiety Chinese military servicemen in ambiguous military scenarios
Authors: Zhang Fan , Zhang Xiaomin , Mao Xiaofei , Chen Aibin , Yin Qianlan , Deng Guanghui
Published: January 2020

Converging evidence reveals the negative interpretation bias in anxiety. Given that anxiety is a severe psychological problem among Chinese military personnel, the present study examined whether high trait anxiety military personnel showed negative interpretation bias in real-world situations and whether their interpretations were influenced by self-relevance.

The sample included 24 high trait anxiety (H-TA) and 22 low trait anxiety (L-TA) Chinese military servicemen. Participants completed 20 open-ended ambiguous scenarios by deciding how much they believed in the positive and negative ending of each sentence. The 20 scenarios were designed according to real life in military and half of them were self-relevant and the others were non-self-relevant.

A 2(group) ×2(self-relevance) ANOVA of positive and negative endings revealed that compared to L-TA, H-TA believed more in negative continuations and less in positive continuations. Moderate correlations were found between samples’ believes in positive and negative endings and their trait anxiety scores. Military personnel showed more positive interpretation biases in non-self-relevant scenarios than in self-relevant scenarios.

These findings are the first to show interpretation bias in military situations, and interventional strategies to modify servicemen's interpretation bias could be designed according to military situations.