bluuebunny/crossref_metadata_2025 huggingface dataset:
A Proposed Grading Scale for Predicting Outcomes After Stereotactic Radiosurgery for Dural Arteriovenous Fistulas
Authors: Mohammed Nasser , Hung Yi-Chieh , Chen Ching-Jen , Xu Zhiyuan , Schlesinger David , Kano Hideyuki , Chiang Veronica , Hess Judith , Lee John , Mathieu David , Kaufmann Anthony M , Grills Inga S , Cifarelli Christopher P , Vargo John A , Chytka Tomas , Janouskova Ladislava , Feliciano Caleb E , Mercado Rafael Rodriguez , Lunsford L Dade , Sheehan Jason P
Published: September 2019

BACKGROUND

There are presently no grading scales that specifically address the outcomes of cranial dural arteriovenous fistula (dAVF) after stereotactic radiosurgery (SRS).

OBJECTIVE

To design a practical grading system that would predict outcomes after SRS for cranial dAVFs.

METHODS

From the International Radiosurgery Research Foundation (University of Pittsburgh [41 patients], University of Pennsylvania [6 patients], University of Sherbrooke [2 patients], University of Manitoba [1 patient], West Virginia University [2 patients], University of Puerto Rico [1 patient], Beaumont Health System 1 [patient], Na Homolce Hospital [13 patients], the University of Virginia [48 patients], and Yale University [6 patients]) centers, 120 patients with dAVF treated with SRS were included in the study. The factors predicting favorable outcome (obliteration without post-SRS hemorrhage) after SRS were assessed using logistic regression analysis. These factors were pooled with the factors that were found to be predictive of obliteration from 7 studies with 736 patients after a systematic review of literature. These were entered into stepwise multiple regression and the best-fit model was identified.

RESULTS

Based on the predictive model, 3 factors emerged to develop an SRS scoring system: cortical venous reflux (CVR), prior intracerebral hemorrhage (ICH), and noncavernous sinus location. Class I (score of 0-1 points) predicted the best favorable outcome of 80%. Class II patients (2 points score) had an intermediate favorable outcome of 57%, and class III (score 3 points) had the least favorable outcome at 37%. The ROC analysis showed better predictability to prevailing grading systems (AUC = 0.69; P = .04). Kaplan–Meier analysis showed statistically significant difference between the 3 subclasses of the proposed grading system for post-SRS dAVF obliteration (P = .001).

CONCLUSION

The proposed dAVF grading system incorporates angiographic, anatomic, and clinical parameters and improves the prediction of the outcomes following SRS for dAVF as compared to the existing scoring systems.
Tumor-associated macrophage infiltration in meningioma
Authors: Proctor Dustin T , Huang Jordan , Lama Sanju , Albakr Abdulrahman , Van Marle Guido , Sutherland Garnette R
Published: September 2019

Background

Meningioma, a most common brain tumor, has a high rate of recurrence. Tumor-associated macrophages (TAMs) are the most abundant immune cell type in meningioma. TAMs display functional phenotypic diversity and may establish either an inflammatory and anti-tumoral or an immunosuppressive and pro-tumoral microenvironment. TAM subtypes present in meningioma and potential contribution to growth and recurrence is unknown.

Methods

Immunofluorescence staining was used to quantify M1 and M2 TAM populations in tissues obtained from 30 meningioma patients. Associations between M1 and M2 cells, M1:M2 cell ratio to tumor characteristics, WHO grade, recurrence, size, location, peri-tumoral edema, and patient demographics such as age and sex were examined.

Results

TAM cells accounted for ~18% of all cells in meningioma tissues. More than 80% of infiltrating TAMs were found to be of pro-tumoral M2 phenotype and correlated to tumor size (P = .0409). M1:M2 cell ratio was significantly decreased in WHO grade II, compared to grade I tumors (P = .009). Furthermore, a 2.3-fold difference in M1:M2 ratio between primary (0.14) and recurrent (0.06) tumors was observed (n = 18 and 12 respectively, P = .044).

Conclusion

This study is the first to confirm existence of pro-tumoral M2 TAMs in the meningioma microenvironment, emphasizing its potential role in tumor growth and recurrence.
Harm and Addiction Perceptions of the JUUL E-Cigarette Among Adolescents
Authors: Russell Christopher , Katsampouris Evangelos , Mckeganey Neil
Published: September 2019

Introduction

This study assessed adolescents’ harm and addiction perceptions of the highest-selling brand—JUUL—of the most commonly used tobacco product—electronic cigarettes (e-cigarettes)—among adolescents in the United States.

Methods

A cross-sectional online survey assessed use and perceptions of the harmfulness and addictiveness of the JUUL e-cigarette and conventional tobacco cigarettes in a nationally representative sample of 9865 adolescents aged 13–17 years in the United States. Associations between adolescents’ harm and addiction perceptions and their use of a JUUL e-cigarette were examined through multinomial logistic regression models.

Results

Overall, 6.1% and 9.3% of adolescents believed daily use and occasional use of a JUUL e-cigarette, respectively, would cause them no harm. Around 11.3% believed they would either never experience harm from using a JUUL e-cigarette or they could use a JUUL e-cigarette for at least 20 years before experiencing any harm, and 7.3% believed they would be “very unlikely” to become addicted to using a JUUL e-cigarette. Overall, 39.3% and 29.3% of adolescents perceived the JUUL e-cigarette as “less harmful” and “less addictive” than conventional cigarettes, respectively. Compared to never users of the JUUL e-cigarette, current and former users held significantly lower harm and addiction perceptions of the JUUL e-cigarette on all measures.

Conclusions

The majority of adolescents believed using a JUUL e-cigarette would put them at, at least, some risk for experiencing health problems and addiction. A smaller but significant proportion believed they could use a JUUL e-cigarette without ever being harmed by or becoming addicted to the JUUL e-cigarette.

Implications

The study reports adolescents’ perceptions of the harmfulness and addictiveness of the highest-selling brand of the most commonly used tobacco product among youth in the United States. Though the majority of adolescents correctly believed that using a JUUL e-cigarette would put them at, at least, some risk for experiencing health problems and addiction, a small proportion believed that using a JUUL e-cigarette would be risk free. Correcting such risk-free perceptions may reduce adolescents’ interest in trying and continuing to use JUUL e-cigarettes.
Flow
Authors: Ohriner Mitchell
Published: September 2019

Originating in dance parties in the South Bronx in the late 1970s, hip hop and rap music have become a dominant style of popular music in the United States and a force for activism all over the world. So, too, has scholarship on this music grown, yet much of this scholarship, employing methods drawn from sociology and literature, leaves unaddressed the expressive musical choices made by hip-hop artists. This book addresses flow, the rhythm of the rapping voice. Flow presents theoretical and analytical challenges not encountered elsewhere. It is rhythmic as other music is rhythmic. But it is also rhythmic as speech and poetry are rhythmic. Key concepts related to rhythm, such as meter, periodicity, patterning, and accent, are treated independently in scholarship of music, poetry, and speech. This book reconciles those approaches, theorizing flow by integrating the methods of computational music analysis and humanistic close reading. Through the analysis of large collections of verses, it addresses questions in the theories of rhythm, meter, and groove in the unique ecology of rap music. Specifically, the work of Eminem clarifies how flow relates to text, the work of Black Thought clarifies how flow relates to other instrumental streams, and the work of Talib Kweli clarifies how flow relates to rap’s persistent meter. Although the focus throughout is rap music, the methods introduced are appropriate for other genres mix voices and more rigid metric frameworks and further extends the valuable work on hip hop from other perspectives in recent years.
An Analysis of the Power to Issue Ordinance in India
Authors: Bhardwaj Chandrasekaran Mridul
Published: September 2019

Ordinances making power is one of the most controversial powers that has been vested with executive in India. This power is a substitute of legislative power of the legislature and is meant to be used only in situations comprising of exigencies. However, in practicality this power has often been misused by the executive, and is used to circumvent the legislative process. Due the misuse of this power, it is imperative to examine its history and scope. The power to make ordinance have been a reminiscent of the British rule in India. It was conceptualized through the various Government of India acts, and then post-independence it was adopted under the Indian Constitution. Though the present form of ordinance making power is much more curtailed when compared to the British era, still it leaves ample discretion at the hand of executive to use it erroneously for political gains.
Titanium Dioxide Nanoparticles Elicit Lower Direct Inhibitory Effect on Human Gut Microbiota Than Silver Nanoparticles
Authors: Agans Richard T , Gordon Alex , Hussain Saber , Paliy Oleg
Published: September 2019

Due to continued technological development, people increasingly come in contact with engineered nanomaterials (ENMs) that are now used in foods and many industrial applications. Many ENMs have historically been shown to possess antimicrobial properties, which has sparked concern for how dietary nanomaterials impact gastrointestinal health via microbial dysbiosis. We employed an in vitro Human Gut Simulator system to examine interactions of dietary nano titanium dioxide (TiO2) with human gut microbiota. Electron microscopy indicated a close association of TiO2 particles with bacterial cells. Addition of TiO2 to microbial communities led to a modest reduction in community density but had no impact on community diversity and evenness. In contrast, administration of known antimicrobial silver nanoparticles (NPs) in a control experiment resulted in a drastic reduction of population density. In both cases, communities recovered once the addition of nanomaterials was ceased. Constrained ordination analysis of community profiles revealed that simulated colonic region was the primary determinant of microbiota composition. Accordingly, predicted community functional capacity and measured production of short-chain fatty acids were not changed significantly upon microbiota exposure to TiO2. We conclude that tested TiO2 NPs have limited direct effect on human gut microbiota.
Kangaroo Mother Care in Hospitalized Low Birth-Weight Infants on Respiratory Support
Authors: Bisanalli Shridevi , Nesargi Saudamini , Govindu Ram Mohan , Rao Suman PN
Published: September 2019

Background:

Low birth-weight (LBW) infants on respiratory support are often deprived of kangaroo mother care (KMC) due to fear of instability. Data on safety of KMC in these infants are lacking.

Primary Objective:

To determine the feasibility of KMC in LBW infants on continuous positive airway pressure or synchronized intermittent mandatory ventilation.

Secondary Objectives:

To compare vital signs (heart rate [HR], respiration, temperature, and Spo
2) and ventilatory parameters (Fio
2, peak inspiratory pressure [PIP], and positive end-expiratory pressure [PEEP]) before, during, and after KMC, and assess the mother's perception of the KMC intervention.

Methods:

LBW infants stable on respiratory support were given KMC for 1 hour. Vital signs and ventilator parameters were recorded before, every 15 minutes during and after KMC. Feasibility was defined as continuation of KMC for 1 hour without interruption, with stable vital signs (HR > 100/min, Spo
2 > 90%, and temperature 36.5°C-37.5°C) and ventilator parameters (no change in PIP, PEEP, or increase in Fio
2 not more than 0.1) without tube dislodgement.

Results:

Twenty LBW infants with a mean birth weight of 1390 ± 484 g were included. All infants completed 1-hour duration of KMC without interruption. No significant changes in temperature, respiratory rates, or saturations were noted. The HR and Fio
2 were marginally higher during KMC than before or after (HR before 147.3 ± 11.5, during 150.8 ± 11, and after 147.3 ± 11.1, P = .04; Fio
2 before 30.6 ± 8.1, during 31.8 ± 8.1, and after 30.7 ± 8.0, P = .034). No accidental extubation or dislodgement of lines occurred. Most mothers were happy.

Implications for Practice:

The vital signs were stable during KMC. KMC is feasible in infants receiving respiratory support.

Implications for Research:

Effectiveness of early initiation and prolonged duration of KMC.
Giving Voice to Parents in the Development of the Preemie Prep for Parents (P3) Mobile App
Authors: Pizur-Barnekow Kris , Kim Una Olivia , Ahamed Sheikh I. , Hasan Md kamrul K. , Dreier Shannon , Leuthner Steven R. , Rau Nicole , Basir Mir A.
Published: September 2019

Background:

Parents at risk for preterm birth frequently receive prematurity education when the mother is hospitalized for premature labor. Parental ability to learn and consider the information is limited because of the stress of the hospitalization. A promising approach is dissemination of information to at-risk parents before the birth hospitalization.

Purpose:

This article describes formative research used to develop smartphone-based prematurity education app for parents at-risk for preterm birth.

Methods:

Stakeholders were parents with a prior preterm birth. Using stakeholder meeting transcripts, constant comparative analysis was used to reflect upon the parental voice.

Results:

The parents named the app, Preemie Prep for Parents (P3). Parent perspectives revealed desire for information in the following 5 categories. (1) Power in knowledge and control: parents want autonomy when learning information that may influence medical decision-making. (2) Content and framing of information: they desire information from a trusted resource that helps promote prenatal health and provides neonatal intensive care information. (3) Displaying content: parents want personalization, push notifications, photographs displaying fetal development, and easy-to-understand statistics. (4) Providing information without causing harm: they desire non–value-laden information, and they do not support “gamifying” the app to enhance utilization. (5) Decision making: parents want information that would benefit their decision making without assuming that parents have a certain outlook on life or particular values.

Implications for Practice:

These findings support the need for the P3 App to aid in decision making when parents experience preterm birth.

Implications for Research:

The findings highlight the need to study the effects of smartphone-based prematurity education on medical decision-making.
Implant Design and the Anchoring Mechanism Influence the Incidence of Heterotopic Ossification in Cervical Total Disc Replacement at 2-year Follow-up
Authors: Mehren Christoph , Wuertz-Kozak Karin , Sauer Daniel , Hitzl Wolfgang , Pehlivanoglu Tuna , Heider Franziska
Published: September 2019

Study Design.

A nonrandomized, prospective, and single-center clinical trial.

Objective.

The aim of this study was to determine whether the prosthesis design, and especially changes in the primary anchoring mechanism between the keel-based ProDisc C and the spike-based ProDisc Vivo, affects the frequency of heterotopic ossification (HO) formation over time.

Summary of Background Data.

The occurrence of motion-restricting HO as well as underlying risk factors has so far been a widely discussed, but not well understand phenomenon. The anchoring mechanism and the opening of the anterior cortex may be possible causes of this unwanted complication.

Methods.

Forty consecutive patients treated with the ProDisc C and 42 consecutive patients treated with the ProDisc Vivo were compared with respect to radiological and clinical outcome, with 2 years of follow-up. Clinical outcome scores included the Neck Disability Index (NDI), Visual Analogue Scale (VAS), and arm and neck pain self-assessment questionnaires. Radiological outcomes included the segmental lordosis and range of motion (ROM) of the index-segment as well as the occurrence of HO.

Results.

The clinical outcome parameters improved in both groups significantly. [ProDisc C: VAS arm and neck pain from 6.3 and 6.2 preoperatively to 0.7 and 1.3; NDI from 23.0 to 3.7; ProDisc Vivo: VAS arm and neck pain from 6.3 and 4.9 to 1.4 and 1.6, NDI from 34.1 to 8.7; 2-year follow-up (FU)]. The ProDisc Vivo cohort demonstrated a significantly lower incidence of HO than the ProDisc C group at 1-year FU (P = 0.0005) and 2-year FU (P = 0.005). Specifically, high-grade HO occurred in 9% versus 31%.

Conclusion.

These findings demonstrate that prosthesis designs that allow primary anchoring without violation of the cortical surface help to reduce the incidence of severe ossification, possibly affecting the functionality and mobility of the artificial disc device over of time.

Level of Evidence: 3
Effects of Computerized Cognitive Training on Physical Mobility in Community-Dwelling Older Adults With Cardiovascular Disease: A Pilot Study
Authors: Blackwood Jennifer , Gore Shweta
Published: September 2019

Purpose:

Mobility deficits and cognitive decline have been associated with cardiovascular disease (CVD) in older adults. Computerized cognitive training (CCT) interventions have reported the transfer of improvements in cognitive function to gait and mobility. The purpose of this study was to examine the effects of a 6-week CCT program on mobility in older adults with CVD.

Methods:

A quasi-experimental design was used. Noninstitutionalized older adults with CVD who could speak and understand English and were computer users were recruited. Participants were divided into a control group (n = 11) and an intervention group (n = 16) that received a progressively challenging CCT program. Testing was performed at baseline and after intervention. Baseline differences were examined using Mann–Whitney U and chi-square tests. Changes in outcomes after intervention were assessed using the Wilcoxon signed-rank test.

Results:

Statistically significant improvements in gait speed (0.23 min/s) were found in the intervention group after intervention. No significant differences were noted in other mobility/cognitive measures.

Conclusions:

A transference of the effects of CCT on mobility was found in older adults with CVD with clinically meaningful improvement in gait speed after 18 CCT sessions. These results indicate the positive impact of CCT in facilitating improvements in mobility.
The ACIRA Registry: A Regional Tool to Improve the Healthcare Pathway for Patients Undergoing Percutaneous Coronary Interventions and Coronary Angiographies in the French Aquitaine Region: Study Design and First Results
Authors: Lesaine Emilie , Saillour-Glenisson Florence , Leymarie Jean-Louis , Jamet Isabelle , Fernandez Laura , Perez Corinne , Legrand Jean-Pierre , Salmi Louis-Rachid , Coste Pierre
Published: September 2019

Background:

In France, there is a lack of information about practices and pathways of coronary angiographies and percutaneous coronary interventions (PCI). We present the design and the first results of the ACIRA registry, the goal of which is to answer questions about quality, security, appropriateness, efficiency of, and access to interventional cardiology (IC) healthcare pathway in the French Aquitaine region.

Methods:

The ACIRA registry is an on-going, multicenter, prospective, exhaustive, scalable, and nominative cohort study of patients who undergo coronary angiographies or percutaneous coronary intervention in any of the catheterization laboratories. The data related to hospitalizations and procedures are directly extracted from hospital information systems. In-hospital mortality, readmissions, and cardiovascular morbidity are collected from the French hospital medical information system database. An identity management system has been implemented to create the patient health care pathway.

Results:

From January 1, 2012, to June 30, 2018, 147,136 procedures performed on 106,005 patients have been included in the ACIRA registry.

Conclusions:

ACIRA has shown its ability to study the patient IC healthcare pathway, up to 1 year after the procedure. Nominative data enable the linkage between clinical and medico-administrative databases and possible supplementary data collection. The use of existing databases allowed us to limit patients lost to follow-up, prevent the double entry of data, improve data quality, and reduce the operating costs. The prospect of linkage with the French National Health Data System may offer promising opportunities for future medical research projects and for developing collaboration and benchmarking with other IC registries abroad.
High Altitude Alternobaric Facial Palsy: Case Series and Systematic Review of the Literature
Authors: Cumming Benjamin , Matchett Ian , Meller Catherine , Saxby Alexander
Published: September 2019

Background:

Alternobaric facial palsy (AFP) is a rare phenomenon which occurs in patients with Eustachian tube dysfunction, a dehiscent facial canal, and subsequent compression induced ischemic neuropraxia of the facial nerve upon exposure to atmospheric pressure changes. There are few documented cases of AFP and most relate to underwater diving. There is limited understanding in the literature of AFP in the setting of high altitude, leading to a potential for misdiagnosis and inappropriate management.

Objective:

We present two cases of transient, recurrent, unilateral facial palsy at high altitude and perform a systematic review of the available literature.

Data Sources:

Full-text articles indexed to Medline, EMBase, and PubMed, and associated reference lists.

Data Extraction:

Data was extracted into standardized data extraction forms.

Data Synthesis:

Binomial proportions and Fischer's exact test were used to analyze sex distribution and relationship between sex and side of palsy, and number of episodes experienced.

Methods:

Systematic review using PRISMA guidelines with meta-analysis.

Results:

We identified 19 cases in the literature relating to AFP in patients at high altitude and present two new cases.

Conclusion:

AFP is an uncommon but important diagnosis. We present two cases and systematically review the literature to discuss the diagnosis and management of AFP.
Clinical Review of EUS-guided Gastroenterostomy (EUS-GE)
Authors: Carbajo Ana Y. , Kahaleh Michel , Tyberg Amy
Published: September 2019

Gastric outlet obstruction (GOO) refers to mechanical obstruction of the distal stomach or proximal duodenum and it is associated with a significant decrease in quality of life. Surgical gastrojejunostomy and self-expandable metal stents were the traditional treatment for GOO. Recently, endoscopic ultrasound guided gastroenterostomy (EUS-GE) has emerged as a third therapeutic option for patients with GOO. Most EUS-GE techniques utilize the placement of a lumen-apposing metal stent under echoendoscopy but differ in the method of localizing the jejunal loop prior to EUS puncture. Data supporting EUS-GE have been promising. Case series including 10 or more cases showed the technical success rate to be approximately 90%. Clinical success is achieved in approximately 85–90% and a less than 18% risk of adverse events is reported. EUS-GE was associated with a lower recurrence of GOO and need for re-intervention when compared to enteral stenting. In addition, EUS-GE shows significantly fewer adverse events compared with surgical gastrojejunostomy. In conclusion, EUS-GE provides symptom relief without the risks of surgical intervention and the limited patency of enteral SEMS placement. EUS-GE is an exciting new option in the management of GOO. Despite the excellent results, randomized studies comparing these different modalities of treatment for GOO are needed before EUS-GE can be accepted as standard of care.
Drivers of Hospital Length of Stay in Medicaid and Commercially Insured Mother-Infant Pairs With a Diagnosis of Neonatal Abstinence Syndrome
Authors: Parlett Lauren , Agiro Abiy , Brown Susan , Wilt Mary , Portzline Amy , Verburg Jacqueline , Shea Karen , DeVries Andrea
Published: September 2019

Background:

The occurrence of neonatal abstinence syndrome (NAS) mirrors the growing opioid epidemic in the United States. As Medicaid covers a majority of cases, the commercially insured population has largely been ignored for NAS risk.

Objective:

The objective of this study was to examine Medicaid and commercially insured mother-infant pairs to determine demographic and clinical characteristics associated with NAS length of stay (LOS).

Research Design:

This observational, descriptive case-series study utilized administrative claims from HealthCore Integrated Research Database to measure maternal characteristics for 6 months before delivery, and neonatal characteristics and health care service utilization for 3 months after NAS diagnosis. Bootstrapped regressions were used to model LOS.

Results:

The sample included 1807 mother-infant pairs. Most infants (79%) had Medicaid coverage (Medicaid: N=1419; Commercial: N=388). Although all infants had NAS, Medicaid-insured mothers had more prevalent drug abuse (70.8% vs. 41.0%; P<0.0001), but fewer used prescription opioids (45.3% vs. 60.8%; P<0.0001) compared with commercially insured mothers. Commercially insured infants were sicker, with a higher prevalence of complex chronic conditions, and yet Medicaid-insured infants were admitted to neonatal intensive care unit at a much higher rate (91.1% vs. 78.9%; P<0.0001). After adjustment, neonatal intensive care unit admission (+6.7 d, 95% confidence interval: 4.5–9.3) and chronic complex conditions (+5.2 d, 95% confidence interval: 3.8–6.6) contributed most to LOS.

Conclusion:

A re-evaluation of obstetrical management towards a focus on the history of possible opioid and substance use regardless of insurance type and demographic background might inform efforts to reduce LOS.
Relative Effects of the Hospital Readmissions Reduction Program on Hospitals That Serve Poorer Patients
Authors: Wasfy Jason H. , Bhambhani Vijeta , Healy Emma W. , Choirat Christine , Dominici Francesca , Wadhera Rishi K. , Shen Changyu , Wang Yun , Yeh Robert W.
Published: September 2019

Importance:

Hospitals that serve poorer populations have higher readmission rates. It is unknown whether these hospitals effectively lowered readmission rates in response to the Hospital Readmissions Reduction Program (HRRP).

Objective:

To compare pre-post differences in readmission rates among hospitals with different proportion of dual-eligible patients both generally and among the most highly penalized (ie, low performing) hospitals.

Design:

Retrospective cohort study using piecewise linear model with estimated hospital-level risk-standardized readmission rates (RSRRs) as the dependent variable and a change point at HRRP passage (2010). Economic burden was assessed by proportion of dual-eligibles served.

Setting:

Acute care hospitals within the United States.

Participants:

Medicare fee-for-service beneficiaries aged 65 years or older discharged alive from January 1, 2003 to November 30, 2014 with a principal discharge diagnosis of acute myocardial infarction (AMI), congestive heart failure (CHF), and pneumonia.

Main Outcome and Measure:

Decrease in hospital-level RSRRs in the post-law period, after controlling for the pre-law trend.

Results:

For AMI, the pre-post difference between hospitals that service high and low proportion of dual-eligibles was not significant (−65 vs. −64 risk-standardized readmissions per 10000 discharges per year, P=0.0678). For CHF, RSRRs declined more at high than low dual-eligible hospitals (−79 vs. −75 risk-standardized readmissions per 10000 discharges per year, P=0.0006). For pneumonia, RSRRs declined less at high than low dual-eligible hospitals (−44 vs. −47 risk-standardized readmissions per 10000 discharges per year, P=0.0003). Among the 742 highest penalized hospitals and all conditions, the pre-post decline in rate of change of RSRRs was less for high dual-eligible hospitals than low dual-eligible hospitals (−68 vs. −74 risk-standardized readmissions per 10000 discharges per year for AMI, −88 vs. −97 for CHF, and −47 vs. −56 for pneumonia, P<0.0001 for all).

Conclusions and Relevance:

For all hospitals, differences in pre-post trends in RSRRs varied with disease conditions. However, for the highest-penalized hospitals, the pre-post decline in RSRRs was greater for low than high dual-eligible hospitals for all penalized conditions. These results suggest that high penalty, high dual-eligible hospitals may be less able to improve performance on readmission metrics.
Review of Nonsurgical Treatment Guidelines for Lower Extremity Osteoarthritis
Authors: Gourdine Jessica
Published: September 2019

Osteoarthritis (OA) is a chronic debilitating disease affecting over 30 million Americans. Many health providers fall prey to believing it is a normal part of aging, leading to inadequate management. Recommendations from the American Academy of Orthopaedic Surgeons (AAOS), American College of Rheumatology (ACR) and Osteoarthritis Research Society International (OARSI) guidelines provide the nurse practitioner options for treating those with OA who are not undergoing surgical management. These interventions include weight loss, exercise, and the use of nonsteroidal anti-inflammatory drugs. Although supported by evidence, these interventions are oftentimes not practiced in primary care. This article presents evidence-based interventions for the nonsurgical treatment of hip and knee OA from the AAOS, ACR, and OARSI guidelines.
p57 in Hydatidiform Moles: Evaluation of Antibodies and Expression in Various Cell Types
Authors: Lund Helle , Nielsen Søren , Grove Anni , Vyberg Mogens , Sunde Lone
Published: September 2019

The protein p57 is encoded by CDKN1C. This gene is known to be paternally imprinted and maternally expressed in cytotrophoblasts and villous stromal cells. We present a method for evaluating p57 antibodies (Abs) in hydatidiform mole (HM) and demonstrate the results for 4 p57 Abs in various cell types. Five cases of complete HM, diploid with 2 paternal genome sets (CHM;PP), 5 cases of partial HM, triploid with 2 paternal and 1 maternal genome sets (PHM;PPM), and 5 cases of non-HM, with diploid biparental genomes (non-HM;PM) were stained with p57 Abs: 57P06, EP183, KP10, and KP39. Assessment of the fraction of nuclei stained, and the intensity of staining of the nuclei and cytoplasm was performed. For evaluation of the Abs, the observations in cytotrophoblasts, villous stromal cells, maternal decidual cells, and intermediate trophoblasts were scored. The fraction of stained nuclei in cytotrophoblasts and villous stromal cells and the staining of cytoplasm showed to be important parameters in the evaluation of the Abs. 57P06 was evaluated as optimal. KP10 showed moderate cytoplasmatic staining in maternal decidual cells and intermediate trophoblasts, and was evaluated as good. EP183 was evaluated as poor, primarily due to nuclear staining in ≥10% of the villous stromal cells in CHM;PP. KP39 was evaluated as poor, primarily due to strong cytoplasmatic staining in some cytotrophoblasts and villous stromal cells. A structured testing of p57 for diagnosing HM is recommended. No nuclear staining was observed in syncytiotrophoblasts of CHM;PP, indicating that in syncytiotrophoblasts also, CDKN1C is paternally imprinted.
Platelet Transfusion Practice and Related Outcomes in Pediatric Extracorporeal Membrane Oxygenation*
Authors: Cashen Katherine , Dalton Heidi , Reeder Ron W. , Saini Arun , Zuppa Athena F. , Shanley Thomas P. , Newth Christopher J. L. , Pollack Murray M. , Wessel David , Carcillo Joseph , Harrison Rick , Dean J. Michael , Meert Kathleen L.
Published: September 2019

Objective:

To describe factors associated with platelet transfusion during pediatric extracorporeal membrane oxygenation and the relationships among platelet transfusion, complications, and mortality.

Design:

Secondary analysis of data collected prospectively by the Collaborative Pediatric Critical Care Research Network between December 2012 and September 2014.

Setting:

Eight Collaborative Pediatric Critical Care Research Network–affiliated hospitals.

Patients:

Age less than 19 years old and treated with extracorporeal membrane oxygenation.

Interventions:

None.

Measurements and Main Results:

Of 511 children, 496 (97.1%) received at least one platelet transfusion during extracorporeal membrane oxygenation. Neonatal age, venoarterial extracorporeal membrane oxygenation, and various acute and chronic diagnoses were associated with increased average daily platelet transfusion volume (milliliters per kilogram body weight). On multivariable analysis, average daily platelet transfusion volume was independently associated with mortality (per 1 mL/kg; odds ratio, 1.05; CI, 1.03–1.08; p < 0.001), whereas average daily platelet count was not (per 1 × 109/L up to 115 × 109/L; odds ratio, 1.00; CI, 0.98–1.01; p = 0.49). Variables independently associated with increased daily bleeding risk included increased platelet transfusion volume on the previous extracorporeal membrane oxygenation day, a primary cardiac indication for extracorporeal membrane oxygenation, adolescent age, and an acute diagnosis of congenital cardiovascular disease. Variables independently associated with increased daily thrombotic risk included increased platelet transfusion volume on the previous extracorporeal membrane oxygenation day and venoarterial extracorporeal membrane oxygenation. Variables independently associated with decreased daily thrombotic risk included full-term neonatal age and an acute diagnosis of airway abnormality.

Conclusions:

Platelet transfusion was common in this multisite pediatric extracorporeal membrane oxygenation cohort. Platelet transfusion volume was associated with increased risk of mortality, bleeding, and thrombosis.
A Multicenter Network Assessment of Three Inflammation Phenotypes in Pediatric Sepsis-Induced Multiple Organ Failure
Authors: Carcillo Joseph A. , Berg Robert A. , Wessel David , Pollack Murray , Meert Kathleen , Hall Mark , Newth Christopher , Lin John C. , Doctor Allan , Shanley Tom , Cornell Tim , Harrison Rick E. , Zuppa Athena F. , Reeder Ron W. , Banks Russell , Kellum John A. , Holubkov Richard , Notterman Daniel A. , Dean J. Michael
Published: September 2019

Objectives:

Ongoing adult sepsis clinical trials are assessing therapies that target three inflammation phenotypes including 1) immunoparalysis associated, 2) thrombotic microangiopathy driven thrombocytopenia associated, and 3) sequential liver failure associated multiple organ failure. These three phenotypes have not been assessed in the pediatric multicenter setting. We tested the hypothesis that these phenotypes are associated with increased macrophage activation syndrome and mortality in pediatric sepsis.

Design:

Prospective severe sepsis cohort study comparing children with multiple organ failure and any of these phenotypes to children with multiple organ failure without these phenotypes and children with single organ failure.

Setting:

Nine PICUs in the Eunice Kennedy Shriver National Institutes of Child Health and Human Development Collaborative Pediatric Critical Care Research Network.

Patients:

Children with severe sepsis and indwelling arterial or central venous catheters.

Interventions:

Clinical data collection and twice weekly blood sampling until PICU day 28 or discharge.

Measurements and Main Results:

Of 401 severe sepsis cases enrolled, 112 (28%) developed single organ failure (0% macrophage activation syndrome 0/112; < 1% mortality 1/112), whereas 289 (72%) developed multiple organ failure (9% macrophage activation syndrome 24/289; 15% mortality 43/289). Overall mortality was higher in children with multiple organ and the phenotypes (24/101 vs 20/300; relative risk, 3.56; 95% CI, 2.06–6.17). Compared to the 188 multiple organ failure patients without these inflammation phenotypes, the 101 multiple organ failure patients with these phenotypes had both increased macrophage activation syndrome (19% vs 3%; relative risk, 7.07; 95% CI, 2.72–18.38) and mortality (24% vs 10%; relative risk, 2.35; 95% CI, 1.35–4.08).

Conclusions:

These three inflammation phenotypes were associated with increased macrophage activation syndrome and mortality in pediatric sepsis-induced multiple organ failure. This study provides an impetus and essential baseline data for planning multicenter clinical trials targeting these inflammation phenotypes in children.
Parental Conflict, Regret, and Short-term Impact on Quality of Life in Tracheostomy Decision-Making
Authors: October Tessie W. , Jones Amy H. , Greenlick Michals Hannah , Hebert Lauren M. , Jiang Jiji , Wang Jichuan
Published: September 2019

Objectives:

The prevalence of tracheostomy-dependence in critically ill children is increasing in the United States. We do not know the impact of this decision on parental outcomes. We aimed to determine the prevalence of decisional conflict and regret and explore the impact on quality of life among parents considering tracheostomy placement for their child.

Subjects:

Parents facing tracheostomy decision for their child.

Design:

Prospective, mixed-methods longitudinal study.

Setting:

PICU, cardiac ICU, and neonatal ICU of a single quaternary medical center.

Interventions:

None.

Measurements and Main Results:

Parents completed a decisional conflict survey at the time of tracheostomy decision and decisional regret and quality of life surveys at 2 weeks and 3 months after the decision regarding tracheostomy placement was made. We enrolled 39 parents, of which 25 completed surveys at all three time points. Thirty-five of 39 (89.7%) reported at least some decisional conflict, most commonly from feeling uninformed and pressured to make a decision. At 2 weeks, 13 of 25 parents (52%) reported regret, which increased to 18 of 25 participants (72%) at 3 months. Regret stemmed from feeling uninformed, ill-chosen timing of placement, and perceptions of inadequate medical care. At 2 weeks, the quality of life score was in the mid-range, 78.8 (sd 13.8) and decreased to 75.5 (sd 14.2) at 3 months. Quality of life was impacted by the overwhelming medical care and complexity of caring for a child with a tracheostomy, financial burden, and effect on parent’s psychosocial health.

Conclusions:

The decision to pursue tracheostomy among parents of critically ill children is fraught with conflict with worsening regret and quality of life over time. Strategies to reduce contributing factors may improve parental outcomes after this life-changing decision.
Apneic Oxygenation As a Quality Improvement Intervention in an Academic PICU*
Authors: Napolitano Natalie , Laverriere Elizabeth K. , Craig Nancy , Snyder Megan , Thompson Allison , Davis Daniela , Nett Sholeen , Branca Aline , Harwayne-Gidansky Ilana , Sanders Ron , Shults Justine , Nadkarni Vinay , Nishisaki Akira
Published: September 2019

Objectives:

To evaluate if the use of apneic oxygenation during tracheal intubation in children is feasible and would decrease the occurrence of oxygen desaturation.

Design:

Prospective pre/post observational study.

Setting:

A large single-center noncardiac PICU in North America.

Patients:

All patients less than 18 years old who underwent primary tracheal intubation from August 1, 2014, to September 30, 2018.

Interventions:

Implementation of apneic oxygenation for all primary tracheal intubation as quality improvement.

Measurements and Main Results:

Total of 1,373 tracheal intubations (661 preimplementation and 712 postimplementation) took place during study period. Within 2 months, apneic oxygenation use reached to predefined adherence threshold (> 80% of primary tracheal intubations) after implementation and sustained at greater than 70% level throughout the postimplementation. Between the preimplementation and postimplementation, no significant differences were observed in patient demographics, difficult airway features, or providers. Respiratory and procedural indications were more common during preintervention. Video laryngoscopy devices were used more often during the postimplementation (pre 5% vs post 75%; p < 0.001). Moderate oxygen desaturation less than 80% were observed in fewer tracheal intubations after apneic oxygenation implementation (pre 15.4% vs post 11.8%; p = 0.049); severe oxygen desaturation less than 70% was also observed in fewer tracheal intubations after implementation (pre 10.4% vs post 7.2%; p = 0.032). Hemodynamic tracheal intubation associated events (i.e., cardiac arrests, hypotension, dysrhythmia) were unchanged (pre 3.2% vs post 2.0%; p = 0.155). Multivariable analyses showed apneic oxygenation implementation was significantly associated with a decrease in moderate desaturation less than 80% (adjusted odds ratio, 0.55; 95% CI, 0.34–0.88) and with severe desaturation less than 70% (adjusted odds ratio, 0.54; 95% CI, 0.31–0.96) while adjusting for tracheal intubation indications and device.

Conclusions:

Implementation of apneic oxygenation in PICU was feasible, and was associated with significant reduction in moderate and severe oxygen desaturation. Use of apneic oxygenation should be considered when intubating critically ill children.
Laparoscopic Versus Open Left Lateral Segmentectomy for Large Hepatocellular Carcinoma: A Propensity Score–Matched Analysis
Authors: Fu Xiu-Tao , Tang Zheng , Shi Ying-Hong , Zhou Jian , Liu Wei-Ren , Gao Qiang , Ding Guang-Yu , Chen Jia-Feng , Song Kang , Wang Xiao-Ying , Fan Jia , Ding Zhen-Bin
Published: September 2019

Background:

With the advancement of endoscopic technology, laparoscopic liver resection has become the standard procedure for left lateral segmentectomy. The aim of this study was to compare perioperative and oncological outcomes between laparoscopic and open left lateral segmentectomy for hepatocellular carcinoma (HCC) >5 cm.

Patients and Methods:

A total of 66 patients underwent left lateral segmentectomy for HCC (>5 cm) during the period spanning between 2013 and 2015. To overcome selection bias, 1:3 match using propensity score–matched analysis was performed between laparoscopic and open liver resection.

Results:

Relatively smaller tumor size (6.0 vs. 7.0 cm; P=0.030) and more frequent incidence of complete tumor capsule (93.3% vs. 58.8%; P=0.013) were observed in the laparoscopic group compared with the open group before matching. Although the longer operation time (195 vs. 150 min; P=0.022) was consumed in the laparoscopic procedure after matching, the laparoscopic group had shorter postoperative hospital stay (6 vs. 7 d; P=0.002) and less blood loss volume (50 vs. 100 mL; P=0.022). The Pringle maneuver for hepatic inflow occlusion was more likely to be applied in patients who underwent open surgery. The incidence of postoperative complication seemed to be lower in the laparoscopic group (6.7%) compared with that in the open group (11.8%) before matching. On the basis of propensity score–matched analysis, the complication rates were comparable between the 2 groups (7.1% vs. 6.7%, P=0.953). No difference in the 1-year and 3-year overall and recurrence-free survival rates was found between the laparoscopic and open groups.

Conclusion:

Laparoscopic left lateral segmentectomy for large HCC patients showed better perioperative outcomes and equivalent oncologic outcomes as the open procedure, providing evidence for considering as a standard laparoscopic practice through careful selection.
Association Between Colonic Diverticulosis and Colorectal Polyps, Advanced Neoplastic Lesions, and Colorectal Carcinomas: A Cross-Sectional, Retrospective Study
Authors: Tomaoglu Kamer
Published: September 2019

Purpose:

The aim of the present study was to evaluate the association of diverticulosis with colorectal polyps, advanced neoplastic lesions (ANLs), and colorectal cancers (CRCs).

Methods:

The first-time colonoscopy records of 3496 patients were evaluated in this retrospective, cross-sectional cohort study. Data on clinical indications, presence of diverticulosis and diverticulitis, location of diverticula and polps, the size and number of polyps, and results of histopathologic examinations of polypectomies were noted. Categorical data were analyzed with χ2 test or the Fisher exact probability. P-values <0.05 (2 sided) were considered statistically significant. Statistical analyses were conducted with SPSS, version 18.

Results:

Of the 3496 patients, 1691 were male individuals (48.4%) and 1805 (51.6%) were female individuals. Diverticulosis was present in 12.6% of patients. A total of 870 polyps were detected in 716 patients. A total of 170 polyps (19.5%) were classified as ANLs. CRC was diagnosed in 112 (3.2%) patients. A significant relationship between diverticulosis and colorectal polyps (odds ratio: 1.99; 95% confidence interval: 1.59-0.2.48, P<0.001) was found. Similarly, adenomas and ANLs were more frequent in diverticulosis (P<0.05). There was no significant relationship between diverticulosis and CRCs (P=0.243).

Conclusions:

Adenomatous polyps and ANLs were more frequently observed in patients with diverticulosis, but no significant relationship was found between CRC and diverticulosis. The results of this retrospective cross-sectional study need to be confirmed by longitudinal prospective cohort studies.
Catechol-O-methyltransferase gene expression in stress-induced and non-stress induced schizophrenia
Authors: Aghamaleki-Sarvestani Ziba , Vousooghi Nasim , Tabrizi Mina , Alipour Mohammad Esmaeil , Alaghband-Rad Javad , Mostafavi-Abdolmaleky Hamid , Zarindast Mohammad Reza
Published: September 2019

Introduction

As schizophrenia is a complex mental disorder and the outcome of gene-gene-environmental interactions, there are different possible pathophysiological mechanisms in different schizophrenia subtypes corresponding to various risk factors. This study was aimed at examining the impact of one of the most likely interactions, that is, ‘dopamine and stress’, in schizophrenia pathogenesis.

Methods

Here, we investigated the interaction between ‘war-related psychological trauma’ without brain trauma and catechol-O-methyltransferase gene. Using real-time PCR analysis we measured catechol-O-methyltransferase gene expression level in the blood cells of 66 male subjects in four groups, namely veteran schizophrenia patients as ‘stress-exposed schizophrenia’ (S-schizophrenia), their healthy brothers as ‘their genetically closest relatives’ (S-siblings), schizophrenia patients without any history of significant stress as ‘non-stress-exposed schizophrenia’ (NoS-schizophrenia), and the control group. The results were analyzed by Relative Expression Software Tool 2009 software.

Results

The catechol-O-methyltransferase gene expression was not significantly different between the S-schizophrenia and NoS-schizophrenia groups. However, compared to the control group, the catechol-O-methyltransferase expression was significantly decreased in three groups of S-schizophrenia, their healthy siblings, and NoS-schizophrenia patients.

Conclusion

This data supports that reduced blood catechol-O-methyltransferase expression, which may be associated with higher dopamine level, is involved both in stress-induced and non-stress–induced schizophrenia.