bluuebunny/crossref_metadata_2025 huggingface dataset:
Variations in Patient Safety Climate in Chinese Hospitals
Authors: Zhu Junya , Li Liping , Zhou Zehui , Lou Qingqing , Wu Albert W.
Published: September 2016

Objectives

Patient safety climate is associated with patient outcomes in hospitals around the world. A better understanding of how safety climate varies within and across hospitals will help identify improvement opportunities. We examined variations in safety climate by work area and job category in Chinese hospitals.

Methods

We administered the Chinese Hospital Survey on Patient Safety Climate in 2011 to workers in 6 hospitals in China, with completed surveys from 1464 (86% response). We calculated the percent positive response for survey items and dimensions among hospitals and compared this across work areas and job categories using general linear models.

Results

Overall, 68% of responses suggested the presence of a positive safety climate. The percent positive responses were highest for organizational learning (86.1%) and unit management support for safety (84.5%) and lowest for staffing (30.6%) and error reporting (44.5%). Workers in surgical units, intensive care units, operating rooms, and emergency departments were slightly more negative regarding overall safety climate than those in medical and ancillary units. Physicians reported worse perceptions than nurses or other hospital workers on all dimensions except for unit management support for safety and communication and peer support.

Conclusions

The perceived problem with staffing in Chinese hospitals was consistent with other studies. The lack of positive responses for error reporting may indicate a lack of awareness of the importance of learning from and reporting minor events and near misses. Variations within and across hospitals in safety climate suggest that improvement interventions should be tailored to individual units and professional groups.
Improving Incident Reporting Among Physician Trainees
Authors: Krouss Mona , Alshaikh Jumana , Croft Lindsay , Morgan Daniel J.
Published: September 2016

Background

Preventable medical harm is a leading cause of death in the United States. Incident reporting systems have been identified as the primary method to capture medical error and harm. Incidents are rarely reported, particularly among physician trainees.

Methods

We conducted a single-center, quasi-experimental study to examine the effect of education on the importance of and how to file an incident report for physician trainees on reporting rates. Trainees were provided laminated plastic instructions, and reporting was reinforced with weekly patient safety rounds. In addition, trainees completed anonymous surveys preintervention and postintervention to determine barriers to reporting. A χ2 test compared the number of reports preintervention and postintervention.

Results

For 6 months, 73 resident physicians participated in the study. Median incident reports entered by trainees increased from 1 report per month during the preintervention period to 10 reports per month after the intervention (P = 0.005). The most common barriers to reporting incidents before intervention were not knowing how to report (72.6%), what to report (56.2%), and lack of time (42.5%). A total of 13.7% reported fear of retaliation. Most incident reports were due to delay in patient care (40.9%) and medical errors (33.3%).

Conclusions

Real-time education and regular reinforcement increased incident reporting among resident physicians. This educational approach may increase incidence reporting in other institutions.
Using Broken Windows Theory as the Backdrop for a Proactive Approach to Threat Identification in Health Care
Authors: Boquet Albert J. , Cohen Tara N. , Cabrera Jennifer S. , Litzinger Tracy L. , Captain Kevin A. , Fabian Michael A. , Miles Steven G. , Shappell Scott A.
Published: September 2016

Objectives

Historically, health care has relied on error management techniques to measure and reduce the occurrence of adverse events. This study proposes an alternative approach for identifying and analyzing hazardous events. Whereas previous research has concentrated on investigating individual flow disruptions, we maintain the industry should focus on threat windows, or the accumulation of these disruptions. This methodology, driven by the broken windows theory, allows us to identify process inefficiencies before they manifest and open the door for the occurrence of errors and adverse events.

Methods

Medical human factors researchers observed disruptions during 34 trauma cases at a Level II trauma center. Data were collected during resuscitation and imaging and were classified using a human factors taxonomy: Realizing Improved Patient Care Through Human-Centered Operating Room Design for Threat Window Analysis (RIPCHORD-TWA).

Results

Of the 576 total disruptions observed, communication issues were the most prevalent (28%), followed by interruptions and coordination issues (24% each). Issues related to layout (16%), usability (5%), and equipment (2%) comprised the remainder of the observations. Disruptions involving communication issues were more prevalent during resuscitation, whereas coordination problems were observed more frequently during imaging.

Conclusions

Rather than solely investigating errors and adverse events, we propose conceptualizing the accumulation of disruptions in terms of threat windows as a means to analyze potential threats to the integrity of the trauma care system. This approach allows for the improved identification of system weaknesses or threats, affording us the ability to address these inefficiencies and intervene before errors and adverse events may occur.
A framework for RNA quality correction in differential expression analysis
Authors: Jaffe Andrew E. , Tao Ran , Norris Alexis L. , Kealhofer Marc , Nellore Abhinav , Jia Yankai , Hyde Thomas M. , Kleinman Joel E. , Straub Richard E. , Leek Jeffrey T. , Weinberger Daniel R.
Published: September 2016

RNA sequencing (RNA-seq) is a powerful approach for measuring gene expression levels in cells and tissues, but it relies on high-quality RNA. We demonstrate here that statistical adjustment employing existing quality measures largely fails to remove the effects of RNA degradation when RNA quality associates with the outcome of interest. Using RNA-seq data from a molecular degradation experiment of human brain tissue, we introduce the quality surrogate variable (qSVA) analysis framework for estimating and removing the confounding effect of RNA quality in differential expression analysis. We show this approach results in greatly improved replication rates (>3x) across two large independent postmortem human brain studies of schizophrenia. Finally, we explored public datasets to demonstrate potential RNA quality confounding when comparing expression levels of different brain regions and diagnostic groups beyond schizophrenia. Our approach can therefore improve the interpretation of differential expression analysis of transcriptomic data from the human brain.
MAPPING OF LONG-RANGE CHROMATIN INTERACTIONS BY PROXIMITY LIGATION ASSISTED CHIP-SEQ
Authors: Fang Rongxin , Yu Miao , Li Guoqiang , Chee Sora , Liu Tristin , Ren Bing
Published: September 2016

We report a highly sensitive and cost-effective method for genome-wide identification of chromatin interactions in eukaryotic cells. Combining proximity ligation with chromatin immunoprecipitation and sequencing, the method outperforms the state of art approach in sensitivity, accuracy and ease of operation. Application of the method to mouse embryonic stem cells improves mapping of enhancer-promoter interactions.
Re-evaluation of SNP heritability in complex human traits
Authors: Speed Doug , Cai Na ,   The UCLEB Consortium, Johnson Michael R. , Nejentsev Sergey , Balding David J
Published: September 2016

SNP heritability, the proportion of phenotypic variance explained by SNPs, has been reported for many hundreds of traits. Its estimation requires strong prior assumptions about the distribution of heritability across the genome, but the assumptions in current use have not been thoroughly tested. By analyzing imputed data for a large number of human traits, we empirically derive a model that more accurately describes how heritability varies with minor allele frequency, linkage disequilibrium and genotype certainty. Across 19 traits, our improved model leads to estimates of common SNP heritability on average 43% (SD 3) higher than those obtained from the widely-used software GCTA, and 25% (SD 2) higher than those from the recently-proposed extension GCTA-LDMS. Previously, DNaseI hypersensitivity sites were reported to explain 79% of SNP heritability; using our improved heritability model their estimated contribution is only 24%.
Fitness effects of thermal stress differ between outcrossing and selfing populations inCaenorhabditis elegans
Authors: Plesnar-Bielak Agata , Labocha Marta K. , Kosztyła Paulina , Woch Katarzyna R. , Banot Woronika M. , Markot Karolina , Skarboń Magdalena , Prus Monika A. , Prokop Zofia M.
Published: September 2016

The maintenance of males and outcrossing is widespread, despite considerable costs of males. By enabling recombination between distinct genotypes, outcrossing may be advantageous during adaptation to a novel environments and if so, it should be selected for under environmental challenge. However, a given environmental change may influence fitness of male, female, and hermaphrodite or asexual individuals differently, and hence the relationship between reproductive system and dynamics of adaptation to novel conditions may not be driven solely by the level of outcrossing and recombination. This has important implications for studies investigating the evolution of reproductive modes in the context of environmental changes, and for the extent to which their findings can be generalized. Here, we useCaenorhabditis elegans– a free-living nematode species in which hermaphrodites (capable of selfing but not cross-fertilizing each other) coexist with males (capable of fertilizing hermaphrodites) – to investigate the response of wild type as well as obligatorily outcrossing and obligatorily selfing lines to stressfully increased ambient temperature. We found that thermal stress affects fitness of outcrossers much more drastically than that of selfers. This shows that apart from the potential for recombination, the selective pressures imposed by the same environmental change can differ between populations expressing different reproductive systems and affect their adaptive potential.
A single intracellular protein governs the critical transition from an individual to a coordinated population response during quorum sensing: Origins of primordial language
Authors: Vila-Sanjurjo Celina , Engwer Christoph , Qin Xiaofei , Hembach Lea , Verdía-Cotelo Tania , Remuñán-López Carmen , Vila-Sanjurjo Antón , Goycoolea Francisco M.
Published: September 2016

Quorum sensing (QS) explains a type of bacterial cell-cell communication mediated by exocellular compounds that act as autoinducers (AIs). As such, QS can be considered the most primordial form of language. QS has profound implications for the control of many important traits (e.g.biofilm formation, secretion of virulence factors, etc.). Conceptually, the QS response can be split into its “listening” and “speaking” components,i.e.the power to sense AI levelsvs.the ability to synthesize and release these molecules. By explaining the cell-density dependence of QS behavior as the consequence of the system’s arrival to a threshold AI concentration, models of QS have traditionally assumed a salient role for the “QS speaking” module during bacterial cell-to-cell communication. In this paper, we have provided evidence that challenges this AI-centered view of QS and establishes LuxR-like activators at the center of QS. Our observation that highly coordinated, cell-density dependent responses can occur in the absence of AI production, implies that the ability to launch such responses is engrained within the “QS listening” module. Our data indicates that once a critical threshold of intracellular activator monomers in complex with AI is reached, a highly orchestrated QS response ensues. While displaying a clear cell-density dependence, such response does not strictly require the sensing of population levels by individual cells. We additionally show, bothin vivoandin silico, that despite their synchronous nature, QS responses do not require that all the cells in the population participate in the response. Central to our analysis was the discovery that percolation theory (PT) can be used to mathematically describe QS responses. While groundbreaking, our results are in agreement with and integrate the latest conclusions reached in the field. We explain for the first time, the cell-density-dependent synchronicity of QS responses as the function of a single protein, the LuxR-like activator, capable of coordinating the temporal response of a population of cells in the absence of cell-to-cell communication. Being QS the most primordial form of speech, our results have important implications for the evolution of language in its ancient chemical form.

Abbreviations

3D

three dimensional

ac

wthreshold intracellular concentration of activator molecules

AHL

acyl-homoserine lactone

AHLfisch

N-(3-oxohexanoyl)-L-homoserine lactone

AHLviol

N-hexanoyl-DL-homoserine-lactone

AI

autoinducer

a.u

arbitrary units

BMB

bromophenol blue

CA

trans-cinnamaldehyde

Fl

fluorescence intensity

FI/OD600

density-normalized fluorescence intensity

GFP

green fluorescent protein

Mw

molecular weight

PT

percolation theory

QS

quorum sensing

tc

percolation critical time

wt

wild type
Stochastic dynamics of genetic broadcasting networks
Authors: Potoyan Davit A. , Wolynes Peter G.
Published: September 2016

The complex genetic programs of eukaryotic cells are often regulated by key transcription factors occupying or clearing out of a large number of genomic locations. Orchestrating the residence times of these factors is therefore important for the well organized functioning of a large network. The classic models of genetic switches sidestep this timing issue by assuming the binding of transcription factors to be governed entirely by thermodynamic protein-DNA affinities. Here we show that relying on passive thermodynamics and random release times can lead to a “time-scale crisis” of master genes that broadcast their signals to large number of binding sites. We demonstrate that this “time-scale crisis” can be resolved by actively regulating residence times through molecular stripping. We illustrate these ideas by studying the stochastic dynamics of the genetic network of the central eukaryotic master regulatorNFκBwhich broadcasts its signals to many downstream genes that regulate immune response, apoptosis etc.
The impact of rare variation on gene expression across tissues
Authors: Li Xin , Kim Yungil , Tsang Emily K. , Davis Joe R. , Damani Farhan N. , Chiang Colby , Zappala Zachary , Strober Benjamin J. , Scott Alexandra J. , Ganna Andrea , Merker Jason ,   GTEx Consortium, Hall Ira M. , Battle Alexis , Montgomery Stephen B.
Published: September 2016

Rare genetic variants are abundant in humans yet their functional effects are often unknown and challenging to predict. The Genotype-Tissue Expression (GTEx) project provides a unique opportunity to identify the functional impact of rare variants through combined analyses of whole genomes and multi-tissue RNA-sequencing data. Here, we identify gene expression outliers, or individuals with extreme expression levels, across 44 human tissues, and characterize the contribution of rare variation to these large changes in expression. We find 58% of underexpression and 28% of overexpression outliers have underlying rare variants compared with 9% of non-outliers. Large expression effects are enriched for proximal loss-of-function, splicing, and structural variants, particularly variants near the TSS and at evolutionarily conserved sites. Known disease genes have expression outliers, underscoring that rare variants can contribute to genetic disease risk. To prioritize functional rare regulatory variants, we develop RIVER, a Bayesian approach that integrates RNA and whole genome sequencing data from the same individual. RIVER predicts functional variants significantly better than models using genomic annotations alone, and is an extensible tool for personal genome interpretation. Overall, we demonstrate that rare variants contribute to large gene expression changes across tissues with potential health consequences, and provide an integrative method for interpreting rare variants in individual genomes.
Local genetic effects on gene expression across 44 human tissues
Authors: Aguet François , Brown Andrew A. , Castel Stephane E. , Davis Joe R. , Mohammadi Pejman , Segrè Ayellet V. , Zappala Zachary , Abell Nathan S. , Frésard Laure , Gamazon Eric R. , Gelfand Ellen , Gloudemans Michael J. , He Yuan , Hormozdiari Farhad , Li Xiao , Li Xin , Liu Boxiang , Garrido-Martín Diego , Ongen Halit , Palowitch John J. , Park YoSon , Peterson Christine B. , Quon Gerald , Ripke Stephan , Shabalin Andrey A. , Shimko Tyler C. , Strober Benjamin J. , Sullivan Timothy J. , Teran Nicole A. , Tsang Emily K. , Zhang Hailei , Zhou Yi-Hui , Battle Alexis , Bustamonte Carlos D. , Cox Nancy J. , Engelhardt Barbara E. , Eskin Eleazar , Getz Gad , Kellis Manolis , Li Gen , MacArthur Daniel G. , Nobel Andrew B. , Sabbati Chiara , Wen Xiaoquan , Wright Fred A. ,   GTEx Consortium, Lappalainen Tuuli , Ardlie Kristin G. , Dermitzakis Emmanouil T. , Brown Christopher D. , Montgomery Stephen B.
Published: September 2016

Expression quantitative trait locus (eQTL) mapping provides a powerful means to identify functional variants influencing gene expression and disease pathogenesis. We report the identification of cis-eQTLs from 7,051 post-mortem samples representing 44 tissues and 449 individuals as part of the Genotype-Tissue Expression (GTEx) project. We find a cis-eQTL for 88% of all annotated protein-coding genes, with one-third having multiple independent effects. We identify numerous tissue-specific cis-eQTLs, highlighting the unique functional impact of regulatory variation in diverse tissues. By integrating large-scale functional genomics data and state-of-the-art fine-mapping algorithms, we identify multiple features predictive of tissue-specific and shared regulatory effects. We improve estimates of cis-eQTL sharing and effect sizes using allele specific expression across tissues. Finally, we demonstrate the utility of this large compendium of cis-eQTLs for understanding the tissue-specific etiology of complex traits, including coronary artery disease. The GTEx project provides an exceptional resource that has improved our understanding of gene regulation across tissues and the role of regulatory variation in human genetic diseases.
Shared roles of dorsal and subgenual anterior cingulate cortices in economic decisions
Authors: Azab Habiba , Hayden Benjamin Y.
Published: September 2016

Theories of dorsal anterior cingulate cortex (dACC) function generally emphasize its cognitive and regulatory functions while theories of subgenual ACC (sgACC) emphasize its emotional, limbic, and arousal-related roles. But how different are these areas when compared in the same task? We recorded neuronal responses in both regions in macaques in a task with cognitive and limbic aspects, a token gambling task. Using tokens allowed us to compare responses to wins and losses. Both regions phasically encoded several important economic variables in similar ways; these included offered values, remembered values, attended values, and obtained values, and number of current tokens. Signal-to-noise ratio in sgACC was substantially lower than in dACC, and sgACC neurons responded more strongly to losses and in anticipation of large rewards. These results highlight the common economic functions of the anterior cingulum and suggest different functional emphases between regions, rather than a strict cognitive vs. emotional division.
DNA methylation profiles of diverse Brachypodium distachyon align with underlying genetic diversity
Authors: Eichten Steven R. , Stuart Tim , Srivastava Akanksha , Lister Ryan , Borevitz Justin O.
Published: September 2016

DNA methylation, a common modification of genomic DNA, is known to influence the expression of transposable elements as well as some genes. Although commonly viewed as an epigenetic mark, evidence has shown that underlying genetic variation, such as transposable element polymorphisms, often associate with differential DNA methylation states. To investigate the role of DNA methylation variation, transposable element polymorphism, and genomic diversity, whole-genome bisulfite sequencing was performed on genetically diverse lines of the model cereal Brachypodium distachyon. Although DNA methylation profiles are broadly similar, thousands of differentially methylated regions are observed between lines. An analysis of novel transposable element indel variation highlighted hundreds of new polymorphisms not seen in the reference sequence. DNA methylation and transposable element variation is correlated with the genome-wide amount of genetic variation present between samples. However, there was minimal evidence that novel transposon insertions or deletions are associated with nearby differential methylation. This study highlights unique relationships between genetic variation and DNA methylation variation within Brachypodium and provides a valuable map of DNA methylation across diverse resequenced accessions of this model cereal species.
Fire‐induced negative nutritional outcomes for cattle when sharing habitat with native ungulates in an African savanna
Authors: Odadi Wilfred O. , Kimuyu Duncan M. , Sensenig Ryan L. , Veblen Kari E. , Riginos Corinna , Young Truman P.
Published: September 2016

Prescribed burning is used in tropical savannas to improve habitat conditions for domestic and wild herbivores, but its effects on the ecological interactions between these herbivore guilds have never been assessed experimentally. Understanding such effects will contribute towards more informed management of both guilds in landscapes where they share habitats.

We investigated the effects of burning on the nutritional outcomes for cattle sharing habitat with wildlife in a Kenyan savanna ecosystem. We compared forage availability and cattle forage and nutrient intake rates across burned and unburned areas cattle accessed exclusively, and those they shared with medium‐sized wild ungulates, both with and without megaherbivores (elephants and giraffes). We performed these measurements in May 2013 (wet period, 2 months post‐burning) and February 2014 (dry period, 11 months post‐burning). Additionally, we monitored wildlife use of these areas.

Prescribed burning enhanced cattle nutrition, but only in areas cattle did not share with wildlife. Shared foraging with wildlife reduced cattle forage and nutrient intake rates by 37–97% in burned areas (burns), but not in unburned areas; these reductions corresponded with reduced herbage availability in the shared burns.

In May (the wet period), cattle met their nutrient intake requirements in burns, regardless of whether they were sharing these areas with wildlife. However, in February (the dry period), nutrient requirements were unmet or tended to be unmet in burns shared with wildlife; requirements were met or significantly exceeded in the unshared burns.

Experimental exclusion of megaherbivores did not moderate these effects, suggesting that they were primarily caused by medium‐sized wild ungulates which were highly attracted to burns.

Synthesis and applications. Prescribed burning produces negative nutritional outcomes for cattle when sharing habitat with wild ungulates. Because these effects could negatively influence livestock–wildlife coexistence, burning should be applied prudently in such human‐occupied savanna landscapes. Specifically, because unburned areas serve as refuge foraging areas during the dry season, interspersing burns with unburned areas could minimize fire‐driven negative interactions between cattle and wild ungulates. Conversely, burning could be used to draw wildlife away from valuable cattle foraging areas, such as those near available water.
Variations in very preterm birth rates in 30 high‐income countries: are valid international comparisons possible using routine data?
Authors: Delnord M , Hindori‐Mohangoo AD , Smith LK , Szamotulska K , Richards JL , Deb‐Rinker P , Rouleau J , Velebil P , Zile I , Sakkeus L , Gissler M , Morisaki N , Dolan SM , Kramer MR , Kramer MS , Zeitlin J ,   the Euro‐Peristat Scientific Committee
Published: September 2016

Objective

Concerns about differences in registration practices across countries have limited the use of routine data for international very preterm birth (VPT) rate comparisons.

Design

Population‐based study.

Setting

Twenty‐seven European countries, the United States, Canada and Japan in 2010.

Population

A total of 9 376 252 singleton births.

Method

We requested aggregated gestational age data on live births, stillbirths and terminations of pregnancy (TOP) before 32 weeks of gestation, and information on registration practices for these births. We compared VPT rates and assessed the impact of births at 22–23 weeks of gestation, and different criteria for inclusion of stillbirths and TOP on country rates and rankings.

Main outcome measures

Singleton very preterm birth rate, defined as singleton stillbirths and live births before 32 completed weeks of gestation per 1000 total births, excluding TOP if identifiable in the data source.

Results

Rates varied from 5.7 to 15.7 per 1000 total births and 4.0 to 11.9 per 1000 live births. Country registration practices were related to percentage of births at 22–23 weeks of gestation (between 1% and 23% of very preterm births) and stillbirths (between 6% and 40% of very preterm births). After excluding births at 22–23 weeks, rate variations remained high and with a few exceptions, country rankings were unchanged.

Conclusions

International comparisons of very preterm birth rates using routine data should exclude births at 22–23 weeks of gestation and terminations of pregnancy. The persistent large rate variations after these exclusions warrant continued surveillance of VPT rates at 24 weeks and over in high‐income countries.

Tweetable abstract

International comparisons of VPT rates should exclude births at 22–23 weeks of gestation and terminations of pregnancy.
A case of pneumatosis cystoides intestinalis in connective tissue disease
Authors: Fung Arthur MY , Ng Ka‐Chun , Tsui Wilson MS , Wong Kwok‐Wa
Published: September 2016

Pneumatosis cystoides intestinalis (PCI) with spontaneous pneumoperitoneum is a rare but important condition in patients with connective tissue disease. In the present study, we report on a woman with mixed connective tissue disease who presented with PCI, and subsequently symptoms, of chronic intestinal pseudo‐obstruction. Prompt surgical resection of the bowel segment with pneumatosis should be considered to prevent a condition of gas leakage from turning into full‐blown chemical peritonitis.
Can percutaneous cholecystostomy be a definitive treatment in the elderly?
Authors: Solaini Leonardo , Paro Barbara , Marcianò Paolo , Pennacchio Giacomo V. , Farfaglia Roberto
Published: September 2016

Aim

The aim of the present study was to discuss our experience with percutaneous cholecystostomy (PC), analysing the outcomes and investigating the clinical factors, which might predict the future need for surgery.

Patients and Methods

Forty‐two patients with acute calculous cholecystitis underwent PC over a 122‐month period at a single institution. Patients' demographics, clinical features and management were retrospectively analysed.

Results

There were 20 females (47.6 per cent) and 22 males (52.4 per cent), with a median age of 83 years (interquartile range: 75–87 years). The American Society of Anesthesiologists (ASA) score was III for 7 patients and IV for 35 patients. Thirty‐one patients (71.4 per cent) had moderate cholecystitis, and 11 (26.2 per cent) had severe cholecystitis. During the index admission, six patients (14.2 per cent) required endoscopic retrograde cholangiopancreatography (ERCP), cholecystectomy was performed in three (7.2 per cent) and four patients (9.5 per cent) died due to septic shock. Nine patients were readmitted for recurrent biliary symptoms, and six of them underwent cholecystectomy. All patients who underwent cholecystostomy and ERCP did not have any recurrence and/or cholecystectomy. The Charlson Comorbidity Index score was significantly higher in patients who did not have subsequent surgery (9 vs 7, P = 0.02).

Conclusions

PC can be a valuable treatment option for high‐risk patients, and a definitive treatment for the elderly with high CCI. Patients who have undergone PC and ERCP might have a lower probability to develop recurrent biliary symptoms than those who have undergone PC alone.
Novel technique in the management of large prostate and bladder stones with bipolar transurethral enucleation of the prostate and open cystolithotomy
Authors: Cho Chak‐Lam , Leung Clarence LH , Chan Wayne KW , Chu Ringo WH , Law In‐Chak
Published: September 2016

Aim

The surgical management of a large prostate in the presence of large or multiple bladder stones still poses a challenge to urologists. The traditional approach by open prostatic adenomectomy and cystolithotomy carries significant morbidities. However, endoscopic procedure might not be feasible to deal with both conditions in a single procedure, despite advances in surgical techniques and instrumentation. We propose a novel method to manage a large prostate together with significant bladder stone load in a single operation by a combined endoscopic and open approach.

Patients and Methods

Three patients had bipolar transurethral enucleation of the prostate (TUEP) and open cystolithotomy performed at our unit from September 2013 to January 2016. The surgical technique and perioperative outcomes are summarized in the present study.

Results

The mean age of the patients was 77.3 years. Bipolar TUEP was performed, with a mean pathological specimen weight of 114 g retrieved. All bladder stones were successfully removed by open cystolithotomy. The mean operating time was 158.3 min. Haemoglobin dropped by 2.27 g/dL on average. No transfusion was required. Bladder irrigation was stopped on postoperative day 2. All patients were weaned off the catheter successfully 5–10 days after the operation.

Conclusions

Bipolar TUEP and open cystolithotomy is a safe option in managing large prostate and bladder stones in a single procedure.
Is β‐cell aging involved in the pathogenesis of diabetes?
Authors: Wen Junping , Xue Ting , Huang Ying , Chen Xiaoyan , Xue Ying , Lin Wei , Zhang Lizhen , Yao Jin , Huang Huibin , Liang Jixing , Li Liantao , Lin Lixiang , Shi Lidan , Cai Liangchun , Zhu Zhuangli , Chen Gang
Published: September 2016

Background

β‐Cells at different stages have different functions and capacity for proliferation, regenerative and apoptosis. The aim of the present study was to investigate whether there are changes in β‐cell phonotype in the development of diabetes to identify potential β‐cell targets to prevent the progression of diabetes.

Methods

A cross‐sectional study was performed on pancreatic tissues obtained from 80 patients classified into three groups: 25 with type 2 diabetes (T2D), 25 with impaired fasting glucose (IFG), and 30 non‐diabetics (ND). The ratio of the insulin‐positive area to pancreatic area was used as an indirect marker of β‐cell mass. Insulin‐positive duct cells and scattered β‐cells were defined as newly generated β‐cells, whereas insulin/neurogenin 3 (Ngn3), insulin/v‐maf musculoaponeurotic fibrosarcoma oncogene family, protein A (MafA) and insulin/P16 double‐positive cells were defined as immature, mature, and senescent β‐cells, respectively; Ki67 was used as a marker of cell proliferation, and terminal deoxyribonucleotidyl transferase‐mediated dUTP–digoxigenin nick end‐labeling (TUNEL) was used as a marker of cell apoptosis. Data were analyzed using the Kruskal–Wallis test.

Results

There were no significant differences in β‐cell mass, the prevalence of insulin‐positive duct cells, scattered β‐cells, or insulin/Ngn3, insulin/MafA, and Insulin/Ki67 double‐positive cells among groups. The incidence of insulin/P16 double‐positive cells was significantly higher in T2D than ND. β‐Cell apoptosis was significantly higher in T2D and IFG than ND.

Conclusion

The senescence and apoptosis of β‐cells may be involved in the course of diabetes.
Diagnosis of a rare primary pulmonary synovial sarcoma with endobronchial ultrasound‐guided transbronchial needle aspiration
Authors: Wang Cai‐hua , Xu Chuan‐cai , Jiang Jun‐hong , Chen Yan‐bin , Zhan Sheng‐hua
Published: September 2016

Primary pulmonary synovial sarcoma (PPSS) is a rare disease. Diagnosis is made postoperatively following resection of the tumor. We describe the case of a 39‐year‐old non‐smoking woman whose chest imaging revealed a heterogeneous mass (5.4 cm × 4.6 cm), with soft tissue density in the right upper lobe and pleural effusion in the right hemithorax. The tumor was enhanced on a computed tomography scan, in which enlargement of the mediastinal lymph nodes compressing the adjacent superior vena cava was observed. Endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) was then performed, which demonstrated PPSS, subsequently confirmed by immunohistochemistry and the detection of a SYT‐SSX fusion gene. We believe that a diagnostic approach of EBUS‐TBNA for lung sarcoma would provide helpful information to clinicians.
Examining the Ethical Behavior of Ontario Chartered Accountants: A Longitudinal Review of the Disciplinary Process
Authors: Leonard Valorie M. , Bélanger Charles H. , Wardley Leslie J.
Published: September 2016

The governing bodies of the Chartered Accountant (CA) profession and business schools go to great lengths to ensure accounting professionals are equipped with a skill set that meets technical, professional, ethical, and other general requirements. In spite of a strict code of ethics, violations of the professional conduct rules leading to disciplinary action are a reality. Using the total CA membership (N = 36,465) of Ontario, Canada, this study makes a 27‐year retrospective assessment of the frequency of disciplinary cases, the characteristics of offenders, the disciplinary process, and the sanctions imposed. Results indicate that: (i) approximately 1.38 percent of the members have been charged with violations of the Rules of Professional Conduct by the Institute of Chartered Accountants over that period; (ii) most were sole proprietors engaged in public accounting; (iii) on average, men make up 76 percent of the CA membership, outnumbering women by three to one (3:1); yet, men were 16 times more likely than women to be charged; (iv) the majority of the offences occurred while members with public accounting licenses were conducting external audits; and (v) sanctions ranged from a “rap on the knuckles” admonishment to expulsion from the CA profession. This study is exploring the CA disciplinary process as observed through disciplinary notices and suggests improvements to the system.
Identifying and Managing Control System Benefits and Costs
Authors: Sheehan Norman T.
Published: September 2016

A well‐functioning management control system is essential to ensure the organization's strategy is executed as planned. While accounting students are provided many opportunities to master the design of management control systems, students are provided fewer opportunities to practice applying management control systems. This interactive role play allows students to experience the challenges managers face when applying organizational control systems. The role play fits best at the end of the unit where instructors have reviewed management control system design and application and is best suited for undergraduate and MBA students who have little or no supervisory experience. Students rated the role play as highly effective, as 97 percent (n = 38) of the students recommend that instructors at other institutions adopt this exercise.
Chesapeake Energy Corporation
Authors: Lane Brian , Moriarity Shane
Published: September 2016

This case provides a summary of events reported in the proxy statements filed with the SEC by Chesapeake Energy Corporation from its initial public offering in 1993 through 2011. These actual events provide a vehicle for the discussion of corporate governance issues and the means to effect a change in governance practices. Students are asked to perform two tasks. The first is to identify possible governance issues. The second is to suggest actions a shareholder might take. The objective of the first task is to provide students with experience in critically evaluating the governance structure and related actions taken by an actual board of directors. On completion, students should be better prepared to recognize signs of governance weakness beyond commonly discussed structural elements. The second task asks students to create a list of tactics that could be employed to influence corporate policies. The objective is to highlight the limited options available to most investors and to prompt some students to pursue corporate activism or the defenses against activism. The case is intended for use at the graduate level.
What happened to the HIV epidemic among non‐injecting drug users in New York City?
Authors: Des Jarlais Don C. , Arasteh Kamyar , McKnight Courtney , Feelemyer Jonathan , Campbell Aimee N. C. , Tross Susan , Cooper Hannah L. F. , Hagan Holly , Perlman David C.
Published: September 2016

Background and aims

HIV has reached high prevalence in many non‐injecting drug user (NIDU) populations. The aims of this study were to (1) examine the trend in HIV prevalence among non‐injecting cocaine and heroin NIDUs in New York City, (2) identify factors potentially associated with the trend and (3) estimate HIV incidence among NIDUs.

Design

Serial‐cross sectional surveys of people entering drug treatment programs. People were permitted to participate only once per year, but could participate in multiple years.

Setting

Mount Sinai Beth Israel drug treatment programs in New York City, USA.

Participants

We recruited 3298 non‐injecting cocaine and heroin users from 2005 to 2014. Participants were 78.7% male, 6.1% white, 25.7% Hispanic and 65.8% African American. Smoking crack cocaine was the most common non‐injecting drug practice.

Measures

Trend tests were used to examine HIV prevalence, demographics, drug use, sexual behavior and use of antiretroviral treatment (ART) by calendar year; χ2 and multivariable logistic regression were used to compare 2005–10 versus 2011–14.

Findings

HIV prevalence declined approximately 1% per year (P < 0.001), with a decline from 16% in 2005–10 to 8% in 2011–14 (P < 0.001). The percentages of participants smoking crack and having multiple sexual partners declined and the percentage of HIV‐positive people on ART increased. HIV incidence among repeat participants was 1.2 per 1000 person‐years (95% confidence interval = 0.03/1000–7/1000).

Conclusions

HIV prevalence has declined and a high percentage of HIV‐positive non‐injecting drug users (NIDUs) are receiving antiretroviral treatment, suggesting an end to the HIV epidemic among NIDUs in New York City. These results can be considered a proof of concept that it is possible to control non‐injecting drug use related sexual transmission HIV epidemics.
Evaluating the impact of a national naloxone programme on ambulance attendance at overdose incidents: a controlled time–series analysis
Authors: McAuley Andrew , Bouttell Janet , Barnsdale Lee , Mackay Daniel , Lewsey Jim , Hunter Carole , Robinson Mark
Published: September 2016

Background and Aims

It has been suggested that distributing naloxone to people who inject drugs (PWID) will lead to fewer attendances by emergency medical services at opioid‐related overdose incidents if peer administration of naloxone was perceived to have resuscitated the overdose victim successfully. This study evaluated the impact of a national naloxone programme (NNP) on ambulance attendance at opioid‐related overdose incidents throughout Scotland. Specifically, we aimed to answer the following research questions: is there evidence of an association between ambulance call‐outs to opioid‐related overdose incidents and the cumulative number of ‘take‐home naloxone’ (THN) kits in issue; and is there evidence of an association between ambulance call‐outs to opioid‐related overdose incidents in early adopter (pilot) or later adopting (non‐pilot) regions and the cumulative number of THN kits issued in those areas?

Design

Controlled time–series analysis.

Setting

Scotland, UK, 2008–15.

Participants

Pre‐NNP implementation period for the evaluation was defined as 1 April 2008 to 31 March 2011 and the post‐implementation period as 1 April 2011 to 31 March 2015. In total, 3721 ambulance attendances at opioid‐related overdose were recorded for the pre‐NNP implementation period across 158 weeks (mean 23.6 attendances per week) and 5258 attendances across 212 weeks in the post‐implementation period (mean 24.8 attendances per week).

Intervention

Scotland's NNP; formally implemented on 1 April 2011.

Measurements

Primary outcome measure was weekly incidence (counts) of call‐outs to opioid‐related overdoses at national and regional Health Board level. Data were acquired from the Scottish Ambulance Service (SAS). Models were adjusted for opioid replacement therapy using data acquired from the Information Services Division on monthly sums of all dispensed methadone and buprenorphine in the study period. Models were adjusted further for a control group: weekly incidence (counts) of call‐outs to heroin‐related overdose in the London Borough area acquired from the London Ambulance Service.

Findings

There was no significant association between SAS call‐outs to opioid‐related overdose incidents and THN kits in issue for Scotland as a whole (coefficient 0.009, 95% confidence intervals = −0.01, 0.03, P = 0.39). In addition, the magnitude of association between THN kits and SAS call‐outs did not differ significantly between pilot and non‐pilot regions (interaction test, P = 0.62).

Conclusions

The supply of take‐home naloxone kits through a National Naloxone Programme in Scotland was not associated clearly with a decrease in ambulance attendance at opioid‐related overdose incidents in the 4‐year period after it was implemented in April 2011.
Impact of laws restricting the sale of tobacco to minors on adolescent smoking and perceived obtainability of cigarettes: an intervention–control pre–post study of 19 European Union countries
Authors: Kuipers Mirte A. G. , Brandhof Stephanie D. , Monshouwer Karin , Stronks Karien , Kunst Anton E.
Published: September 2016

Aims

To estimate the impact of introducing sales restriction laws in Europe by measuring changes in adolescent smoking prevalence and perceived obtainability of cigarettes over time in countries that have recently introduced sales restriction laws (intervention countries). These countries were compared with countries where such laws were already in force (control countries). The secondary aim was to test whether these trends differed between adolescents of higher and lower socio‐economic position (SEP).

Design

Repeated cross‐sectional data were used in a quasi‐experimental pre–post design. Intervention countries raised tobacco sales restrictions to 18 years in 2007, 2008 or 2009. Control countries have had sales restrictions of 18 years since at least 2004.

Setting

Nineteen European Union (EU) countries in 2007 and 2011.

Participants

Data of 97 245 15‐ and 16‐year‐old adolescents from the 2007 and 2011 European Survey Project on Alcohol and other Drugs (ESPAD) surveys.

Measurements

Dependent variables were smoking status (weekly smoking versus non‐smoking or less than weekly smoking) and perceived obtainability of tobacco (easy versus difficult). Key independent variables were time (2007 or 2011), intervention exposure (intervention or control country) and their interaction (time × intervention). Covariates included sex, SEP, the tobacco control scale (TCS), gross domestic product (GDP) and adult smoking prevalence.

Findings

We did not find a difference in the change in smoking prevalence between intervention and control countries [odds ratio (OR) = 1.00, 95% confidence interval (CI) = 0.93–1.07]. However, sales restrictions were associated with a significantly greater decrease in perceived ease of cigarette obtainability in intervention countries (OR = 0.75, 95% CI = 0.70–0.80). No significant differential effects between high and low SEP adolescents were found (OR = 1.01, 95% CI = 0.81–1.25).

Conclusion

Laws prohibiting the sales of tobacco to minors in Europe do not appear to be associated with a reduction in adolescent smoking rates, but lower the perceived obtainability of cigarettes irrespective of their socio‐economic position.
Haemodynamic effects of parenteral vs. enteral paracetamol in critically ill patients: a randomised controlled trial
Authors: Kelly S. J. , Moran J. L. , Williams P. J. , Burns K. , Rowland A. , Miners J. O. , Peake S. L.
Published: September 2016

Paracetamol is a commonly used drug in the intensive care unit. There have been reports in the literature of an association with significant hypotension, a potentially important interaction for labile critically ill patients. Route of administration may influence the incidence of hypotension. This single‐centre, prospective, open‐label, randomised, parallel‐arm, active‐control trial was designed to determine the incidence of hypotension following the administration of paracetamol to critically ill patients. Fifty adult patients receiving paracetamol for analgesia or pyrexia were randomly assigned to receive either the parenteral or enteral formulation of the drug. Paracetamol concentrations were measured at baseline and at multiple time points over 24 h. The maximal plasma paracetamol concentration was significantly different between routes; 156 vs. 73 micromol.l−1 [p = 0.0005] following the first dose of parenteral or enteral paracetamol, respectively. Sixteen hypotensive events occurred in 12 patients: parenteral n = 12; enteral n = 4. The incident rate ratio for parenteral vs. enteral paracetamol was 2.94 (95% CI 0.97–8.92; p = 0.06). The incidence of hypotension associated with paracetamol administration is higher than previously reported and tends to be more frequent with parenteral paracetamol.
The analgesic efficacy of sciatic nerve block in addition to femoral nerve block in patients undergoing total knee arthroplasty: a systematic review and meta‐analysis
Authors: Grape S. , Kirkham K. R. , Baeriswyl M. , Albrecht E.
Published: September 2016

The aim of this meta‐analysis was to assess the postoperative analgesic efficacy of sciatic nerve block when combined with femoral nerve block after total knee arthroplasty. Outcomes included resting pain scores (analogue scale, 0–100), intravenous morphine consumption at 12 h, 24 h and 48 h postoperatively, and functional outcomes comprising knee flexion, distance walked, and length of stay. Twelve randomised controlled trials were included, with a total of 600 patients. When combined with femoral nerve block, sciatic nerve block significantly reduced resting pain scores at 12 h postoperatively with a mean difference of 10 (95% CI: −15 to −5; p < 0.00001). Resting pain scores at 24 h, and intravenous morphine consumption at 12 h, 24 h and 48 h postoperatively were also significantly reduced, but without clinical significance beyond 12 h and without affecting functional outcomes. In conclusion, sciatic nerve block confers additional postoperative analgesia within the first 12 postoperative hours compared with femoral nerve block alone for patients undergoing total knee arthroplasty.