bluuebunny/crossref_metadata_2025 huggingface dataset:
Immune regulation by fibroblasts in tissue injury depends on uPARAP-mediated uptake of collectins
Authors: Jürgensen Henrik J. , Nørregaard Kirstine S. , Sibree Megan M. , Santoni-Rugiu Eric , Madsen Daniel H. , Wassilew Katharina , Krustrup Dorrit , Garred Peter , Bugge Thomas H. , Engelholm Lars H. , Behrendt Niels
Published: October 2018

Collectins such as mannose-binding lectin (MBL) and surfactant protein D (SP-D) become temporarily deposited in extravascular compartments after tissue injury and perform immune-stimulatory or inflammation-limiting functions. However, their turnover mechanisms, necessary to prevent excessive tissue damage, are virtually unknown. In this study, we show that fibroblasts in injured tissues undertake the clearance of collectins by using the endocytic collagen receptor uPARAP. In cellular assays, several types of collectins were endocytosed in a highly specific uPARAP-dependent process, not shared by the closely related receptor MR/CD206. When introduced into dermis or bleomycin-injured lungs of mice, collectins MBL and SP-D were endocytosed and routed for lysosomal degradation by uPARAP-positive fibroblasts. Fibroblast-specific expression of uPARAP governed endogenous SP-D levels and overall survival after lung injury. In lung tissue from idiopathic pulmonary fibrosis patients, a strong up-regulation of uPARAP was observed in fibroblasts adjacent to regions with SP-D secretion. This study demonstrates a novel immune-regulatory function of fibroblasts and identifies uPARAP as an endocytic receptor in immunity.
Quantitative measurement of contact area and electron transport across platinum nanocontacts for scanning probe microscopy and electrical nanodevices
Authors: Vishnubhotla Sai Bharadwaj , Chen Rimei , Khanal Subarna R , Li Jing , Stach Eric A , Martini Ashlie , Jacobs Tevis D B
Published: October 2018

Conductive modes of atomic force microscopy are widely used to characterize the electronic properties of materials, and in such measurements, contact size is typically determined from current flow. Conversely, in nanodevice applications, the current flow is predicted from the estimated contact size. In both cases, it is very common to relate the contact size and current flow using well-established ballistic electron transport theory. Here we performed 19 electromechanical tests of platinum nanocontacts with in situ transmission electron microscopy to measure contact size and conductance. We also used molecular dynamics simulations of matched nanocontacts to investigate the nature of contact on the atomic scale. Together, these tests show that the ballistic transport equations under-predict the contact size by more than an order of magnitude. The measurements suggest that the low conductance of the contact cannot be explained by the scattering of electrons at defects nor by patchy contact due to surface roughness; instead, the lower-than-expected contact conductance is attributed to approximately a monolayer of insulating surface species on the platinum. Surprisingly, the low conductance persists throughout loading and even after significant sliding of the contact in vacuum. We apply tunneling theory and extract best-fit barrier parameters that describe the properties of this surface layer. The implications of this investigation are that electron transport in device-relevant platinum nanocontacts can be significantly limited by the presence and persistence of surface species, resulting in current flow that is better described by tunneling theory than ballistic electron transport, even for cleaned pure-platinum surfaces and even after loading and sliding in vacuum.
simGWAS: a fast method for simulation of large scale case–control GWAS summary statistics
Authors: Fortune Mary D , Wallace Chris
Published: October 2018

Motivation

Methods for analysis of GWAS summary statistics have encouraged data sharing and democratized the analysis of different diseases. Ideal validation for such methods is application to simulated data, where some ‘truth’ is known. As GWAS increase in size, so does the computational complexity of such evaluations; standard practice repeatedly simulates and analyses genotype data for all individuals in an example study.

Results

We have developed a novel method based on an alternative approach, directly simulating GWAS summary data, without individual data as an intermediate step. We mathematically derive the expected statistics for any set of causal variants and their effect sizes, conditional upon control haplotype frequencies (available from public reference datasets). Simulation of GWAS summary output can be conducted independently of sample size by simulating random variates about these expected values. Across a range of scenarios, our method, produces very similar output to that from simulating individual genotypes with a substantial gain in speed even for modest sample sizes. Fast simulation of GWAS summary statistics will enable more complete and rapid evaluation of summary statistic methods as well as opening new potential avenues of research in fine mapping and gene set enrichment analysis.

Availability and implementation

Our method is available under a GPL license as an R package from http://github.com/chr1swallace/simGWAS.

Supplementary information

Supplementary data are available at Bioinformatics online.
Transmission of Eastern Equine Encephalitis Virus From an Organ Donor to 3 Transplant Recipients
Authors: Pouch Stephanie M , Katugaha Shalika B , Shieh Wun-Ju , Annambhotla Pallavi , Walker William L , Basavaraju Sridhar V , Jones Jefferson , Huynh Thanhthao , Reagan-Steiner Sarah , Bhatnagar Julu , Grimm Kacie , Stramer Susan L , Gabel Julie , Lyon G Marshall , Mehta Aneesh K , Kandiah Prem , Neujahr David C , Javidfar Jeffrey , Subramanian Ram M , Parekh Samir M , Shah Palak , Cooper Lauren , Psotka Mitchell A , Radcliffe Rachel , Williams Carl , Zaki Sherif R , Staples J Erin , Fischer Marc , Panella Amanda J , Lanciotti Robert S , Laven Janeen J , Kosoy Olga , Rabe Ingrid B , Gould Carolyn V ,   Eastern Equine Encephalitis Virus Transplant Transmission Investigation Team
Published: October 2018

Background

In fall 2017, 3 solid organ transplant (SOT) recipients from a common donor developed encephalitis within 1 week of transplantation, prompting suspicion of transplant-transmitted infection. Eastern equine encephalitis virus (EEEV) infection was identified during testing of endomyocardial tissue from the heart recipient.

Methods

We reviewed medical records of the organ donor and transplant recipients and tested serum, whole blood, cerebrospinal fluid, and tissue from the donor and recipients for evidence of EEEV infection by multiple assays. We investigated blood transfusion as a possible source of organ donor infection by testing remaining components and serum specimens from blood donors. We reviewed data from the pretransplant organ donor evaluation and local EEEV surveillance.

Results

We found laboratory evidence of recent EEEV infection in all organ recipients and the common donor. Serum collected from the organ donor upon hospital admission tested negative, but subsequent samples obtained prior to organ recovery were positive for EEEV RNA. There was no evidence of EEEV infection among donors of the 8 blood products transfused into the organ donor or in products derived from these donations. Veterinary and mosquito surveillance showed recent EEEV activity in counties nearby the organ donor’s county of residence. Neuroinvasive EEEV infection directly contributed to the death of 1 organ recipient and likely contributed to death in another.

Conclusions

Our investigation demonstrated EEEV transmission through SOT. Mosquito-borne transmission of EEEV to the organ donor was the likely source of infection. Clinicians should be aware of EEEV as a cause of transplant-associated encephalitis.
Minimal incision palatoplasty with or without muscle reconstruction in patients with isolated cleft palate—a cephalometric study at 5 and 10 years
Authors: Parikakis Konstantinos , Larson Ola , Karsten Agneta
Published: October 2018

Objective

To compare differences in facial growth in patients with isolated clefts of the hard and/or soft palate treated with the minimal incision technique without (MI) or with muscle reconstruction (MMI).

Subjects and method

A consecutive series of 170 Caucasian children born with isolated cleft palate were studied. Individuals with other craniofacial malformations, apart from Pierre Robin sequence (PRS), were excluded. The patients were treated surgically with MI (n = 85) or MMI (n = 85) palatoplasty (mean age: 13 months) and divided further into two subgroups: clefts within the soft palate only (small cleft, n = 51) and within the hard and soft palate (big cleft, n = 119). A retrospective evaluation at 5 (mean 5.4) and 10 (mean 10.3) years was performed using lateral cephalograms. Twelve skeletal and one soft tissue measurement was evaluated. Both 95% and 99% confidence intervals were calculated, two-way ANOVA and mixed model analysis was performed including/excluding PRS.

Results

At 5 years, statistically significant increased inclination of the palatal plane in the big MMI cleft group (P < 0.01), increased posterior upper face height (P < 0.01), and longer mandibular length (P < 0.001) in the small MI cleft group was observed. At 10 years, statistically significant increased inclination of the palatal plane (P < 0.001), decreased posterior upper face height (P < 0.001), and longer palatal length (P < 0.01) was seen in the big MMI group.

Limitations

Retrospective single centre study, limited sample size, three surgeons.

Conclusion

Minor differences in craniofacial morphology were found between patients with isolated clefts treated with MI or MMI technique and between small and big cleft lengths.
Directly ageing the Caribbean spiny lobster, Panulirus argus with validated band counts from gastric mill ossicles
Authors: Gnanalingam Gaya , Butler Mark J , Matthews Thomas R , Hutchinson Emily , Kilada Raouf
Published: October 2018

In crustaceans, ecdysis was long believed to result in the loss and replacement of all calcified structures, precluding the use of conventional ageing methods. However, the discovery of bands in the gastric ossicles of several crustaceans with some correlation with age suggests that direct age estimation may be possible. We applied this method to a tropical spiny lobster, Panulirus argus, one of the most iconic and economically valuable species in the Caribbean. The presence of growth bands was investigated using wild lobsters of unknown age and was validated with captive reared lobsters of known age (1.5–10 years) from the Florida Keys, Florida (USA). Bands were consistently identified in ptero- and zygo-cardiac ossicles of the gastric mill and did not appear to be associated with moulting. Validation with known age animals confirms that bands form annually. Counts between independent readers were reproducible with coefficients of variation ranging from 11% to 26% depending on reader experience and the structure used. This study demonstrates, for the first time, that direct age determination of P. argus is possible.
Shifting boundaries of water, ice, flora, fauna, people, and institutions in the Arctic and Subarctic
Authors: Drinkwater Kenneth F , Mueter Franz J , Saitoh Sei-Ichi
Published: October 2018

An international Open Science Meeting entitled Moving in, out, and across the Subarctic and Arctic marine ecosystems: shifting boundaries of water, ice, flora, fauna, people, and institutions, took place 11–15 June 2017 in Tromsø, Norway. Organized by the Ecosystem Studies of Subarctic and Arctic Seas programme and cosponsored by the International Council for the Exploration of the Sea and the North Pacific Marine Science Organization, the primary aim of the meeting was to examine past, present, and future ecosystem responses to climate variability and ocean acidification (OA) and their effect on fishing communities, the fishing industry and fisheries management in the northern Pacific and Atlantic oceans and the Arctic. This symposium issue contains several papers from the meeting covering topics from climate and OA, ecosystem responses to environmental change, and fisheries management including: a synthesis of the ecosystem responses to the AMO-linked cold period of the 1970s and 1980s;a novel approach to understand responses to OA in northern climes using natural carbonate chemistry gradients, such as CO2 vents, methane cold seeps, and upwelling area;the possibility that warm temperatures are allowing two generations of Calanus finmarchicus per year to be produced;a new hypothesis suggesting that in areas where sea ice disappears there could be an increase of fish species with swim bladders;results from laboratory experiments on the effects of temperature and food on Arctic and boreal fish larvae;the application of ecosystem-based management in northern regions; anda description of the United States National Oceanic and Atmospheric Administration approach to marine conservation and how it affects fish populations and fisheries.
Development and user evaluation of a rare disease gene prioritization workflow based on cognitive ergonomics
Authors: Lee Jessica J Y , van Karnebeek Clara D M , Wasserman Wyeth W
Published: October 2018

Objective

The clinical diagnosis of genetic disorders is undergoing transformation, driven by whole exome sequencing and whole genome sequencing (WES/WGS). However, such nucleotide-level resolution technologies create an interpretive challenge. Prior literature suggests that clinicians may employ characteristic cognitive processes during WES/WGS investigations to identify disruptions in genes causal for the observed disease. Based on cognitive ergonomics, we designed and evaluated a gene prioritization workflow that supported these cognitive processes.

Materials and Methods

We designed a novel workflow in which clinicians recalled known genetic diseases with similarity to patient phenotypes to inform WES/WGS data interpretation. This prototype-based workflow was evaluated against the common computational approach based on physician-specified sets of individual patient phenotypes. The evaluation was conducted as a web-based user study, in which 18 clinicians analyzed 2 simulated patient scenarios using a randomly assigned workflow. Data analysis compared the 2 workflows with respect to accuracy and efficiency in diagnostic interpretation, efficacy in collecting detailed phenotypic information, and user satisfaction.

Results

Participants interpreted genetic diagnoses faster using prototype-based workflows. The 2 workflows did not differ in other evaluated aspects.

Discussion

The user study findings indicate that prototype-based approaches, which are designed to model experts’ cognitive processes, can expedite gene prioritization and provide utility in synergy with common phenotype-driven variant/gene prioritization approaches. However, further research of the extent of this effect across diverse genetic diseases is required.

Conclusion

The findings demonstrate potential for prototype-based phenotype description to accelerate computer-assisted variant/gene prioritization through complementation of skills and knowledge of clinical experts via human–computer interaction.
Advantages of Serum Anti-Müllerian Hormone as a Marker for Polycystic Ovarian Syndrome
Authors: Shi Xinyan , Peng Duo , Liu Yanfei , Miao Xiaofen , Ye Hui , Zhang Jun
Published: October 2018

Objective

To evaluate the advantages of using anti-Müllerian hormone (AMH) in the diagnosis of polycystic ovary syndrome (PCOS).

Methods

We compared data from 56 Han Chinese patients with PCOS and 52 female control Han Chinese individuals in terms of biochemical markers and the antral follicle count (AFC). Then, the correlation between serum AMH levels and various endocrine and metabolic factors was analyzed. We generated receiver operating characteristic (ROC) curves to assess the usefulness of AMH, AFC, the luteinizing hormone/follicle-stimulating hormone (LH/FSH) ratio, and testosterone (T), to discriminate between the PCOS and control groups.

Results

The LH/FSH ratio, homeostatis model assessment of insulin resistance (HOMA-IR), testosterone (T), blood glucose (Glu), triglyceride (TG), body mass index (BMI), AFC and, in particular, serum AMH level were significantly higher in the PCOS group than in the control group (P <.05; P <.001). The serum AMH level had a significant positive effect on the likelihood of AFC changes in patients with PCOS and control-group women. The areas under the ROC curve (AUC) of AMH, AFC, LH/FSH ratio, and T were 0.952, 0.778, 0.760, and 0.665, respectively. The best cutoff point for AMH was 6.09 ng per mL, with sensitivity of 88% and specificity of 88%.
Antibiotics
Authors: Chehab Monzer , Antypas Elias , Kirsch Matthias J. , Venkatesan Aradhana M.
Published: October 2018

Although infectious complications are rare in interventional radiology (IR), their occurrence can have serious consequences. Considerations for antibiotic prophylaxis and selection of an appropriate antibiotic agent and dosing regimen are essential components of the preprocedural evaluation of patients presenting for IR procedures. As the breadth and complexity of patients and procedures expand, it is critical for the interventional radiologist to have a thorough knowledge of the pathogenesis of infection, the rationale behind prophylaxis in specific clinical scenarios, and the appropriate use of antibiotic agents. The goal of this chapter is to provide the trainee with a comprehensive overview of antibiotic prophylaxis for the most commonly performed procedures in interventional radiology.
Contrast Agents
Authors: Charalel Resmi A. , Prince Martin R.
Published: October 2018

Imaging is reliant upon the contrast between different body elements, which may be present naturally or may require the introduction of extrinsic contrast agents. Since the 1920s, the use of contrast agents has been refined to enhance the diagnostic potential of multiple imaging modalities. Contrast agents are a vital part of diagnosis and treatment algorithms involving image guidance. Given the wealth of contrast agents on the market, a basic understanding of the various types is critical for budding interventional radiologists who need to use such agents judiciously on a daily basis. Such contrast agents may be administered intravenously, intraarterially, intrathecally, orally, via inhalation, transrectally, or via indwelling tubes or catheters cannulating a specific viscus. In this chapter, we review the key categories, contraindications, and alternatives for such agents, with special attention to their use in an interventional radiology (IR) practice.
Introduction to Ablative Techniques
Authors: Brace Christopher L. , Laeseke Paul F.
Published: October 2018

Tumor ablation has become an important technique for treating many cancers of the abdomen, chest, and bones. Over the last 30 years, several different ablation modalities have been evaluated, relying primarily on chemical or thermal mechanisms of action. Early results with percutaneous ethanol injection and radiofrequency (RF) ablation encouraged refinements in technology and techniques, with microwave, laser, ultrasound, and electroporation sources now commercially available. Thermal ablation is now affixed in multiple treatment guidelines for the liver, lung, kidney, and bone, with other applications emerging as well. This chapter presents an overview of thermal ablation for the interventional radiologist. Available modalities are outlined and clinical utilization described, with references to the most compelling contemporary sources for more in-depth exploration.
Suprascapular Neuropathy
Authors: Maldonado Andrés A. , Spinner Robert J.
Published: October 2018

Suprascapular neuropathy results from a lesion affecting the suprascapular nerve and is typically due to compression or traction in association with other injuries. The differential diagnosis of suprascapular neuropathy includes rotator cuff pathology, cervical radiculopathy, and Parsonage-Turner syndrome. Suprascapular neuropathy leads to a spectrum of clinical symptoms, including pain and selected weakness in shoulder abduction and external rotation of the arm. Atrophy of the shoulder musculature affecting the spinati muscles (supraspinatus and infraspinatus) often becomes apparent after some months. Suprascapular neuropathy is a challenging diagnosis to make based on the history and physical examination alone, especially since shoulder pain is relatively common and multifactorial; in addition, suprascapular neuropathy can often coexist with other shoulder pathology. The indications for a surgical procedure are the failure of nonoperative management, with lack of clinical or electrical improvement in 6 to 9 months, and the presence of a space-occupying lesion causing compression of the suprascapular nerve. Direct nerve decompression by release of the suprascapular ligament is typically recommended in cases of symptomatic isolated suprascapular neuropathy.
Introduction
Authors: Rushton Cynda Hylton
Published: October 2018

This introductory chapter covers the book editor’s personal and professional journey to provide the background for the book. The contours of the book are outlined. They include the nature of moral suffering and illustrate moral distress as a type of moral suffering. A pathway for examining moral adversity as the instigator of moral stress, which unrelieved can lead to moral suffering including moral distress, moral outrage and moral injury and the role of moral resilience including moral repair is outlined. The concept of integrity as the core of moral resilience and the dimensions of resilience that inform the concept of moral resilience are applied in the context of healthcare. Individual strategies to transform moral suffering and cultivate moral resilience and restore integrity are suggested. System transformation is possible by applying the Conscious Full Spectrum approach as a template for moral resilience and ethical practice in healthcare.
Mapping the Path of Moral Adversity
Authors: Rushton Cynda Hylton
Published: October 2018

An alternative path for addressing moral adversity and the resultant moral suffering engages the focal points in a cycle of imperiled integrity in response to moral harms, wrongs, failures, or other forms of moral adversity. Initially moral stress, a neutral state of readiness to respond that will eventually involve an appraisal as positive or negative, may be experienced. Depending on this appraisal and individual capabilities, moral stress may be rebalanced, released, or resolved, engaging our moral resilience to proactively or prospectively respond to moral adversity. Alternatively, when the moral stress of imperiled integrity exceeds our capacities and becomes unmanageable or overwhelming, it can instigate a pathway leading to moral suffering that includes moral distress, outrage, and injury. In some instances moral suffering leads to recalcitrant or persistent forms of moral decline. When moral resilience including a process of moral repair is leveraged, integrity can be restored.
Pathophysiology of Pain and Pain Pathways
Authors: Trigo Blanco Paula , Roche Rodriguez Maricarmen , Vadivelu Nalini
Published: October 2018

Pain is a distressing experience and an important cause of suffering and disability. Pain usually signals the presence of injury or disease and generates a complex physiologic and emotional response. It has a protective function in order to restore homeostasis at the autonomic and psychological levels. This chapter reviews the physiology and mechanisms of pain, as well as the pathways in the central and peripheral nervous system that transmit nociceptive information. The chapter divides the pain anatomical pathways into the peripheral nervous system, the spinal cord with the medullary dorsal horn system, and the ascending and supraspinal system. The authors explain the pain pathways as a three-neuron pathway that carries noxious information from the periphery to the cerebral cortex. This chapter defines important concepts such as sensitization, hyperalgesia, and allodynia, as well as describes the modulation process of nociception.
Perioperative Opioid Analgesics of Use in Pain Management for Spine Surgery
Authors: Fomberstein Kenneth , Rubin Marissa , Patel Dipan , Sara John-Paul , Gupta Abhishek
Published: October 2018

This chapter compares the basic properties of several opioid analgesics and explores their applications in perioperative pain control in spine surgery. Parenteral opioids have long been the cornerstone of treatment for postoperative pain; they work by inhibiting voltage-gated calcium channels and increasing potassium influx, which results in reduced neuronal excitability, thereby inhibiting the ascending transmission of painful stimuli and activating the descending inhibitory pathways. This chapter reviews concepts including opioid conversion and rotation, opioid tolerance, and opioid cross-tolerance. It discusses common opioid side effects, and it explores the perioperative use of several specific opioids including remifentanil, sufentanil, methadone, oxycodone, morphine, and tapentadol and discusses their use in spine surgery. Additionally, this chapter discusses patient-controlled analgesia (PCA) and its importance in postoperative pain control.
Lumbosacral Pain
Authors: Kim Chang-Yeon , Chang Charles , Cabrejo Raysa , Yue James
Published: October 2018

This chapter examines the options for managing pain after orthopedic spinal surgery in the lumbosacral spine. It reviews the pain syndromes associated with different approaches to the lumbar spine. The chapter explores specific pain syndromes such as failed back syndrome while noting that the majority of pain after spinal surgery results from dissection of soft tissue and muscles. The chapter then discusses oral and parenteral methods for analgesia, as well as spinal and regional nerve blockade. It provides details on the common regimens for pain management including the use of opioids, nonsteroidal anti-inflammatory drugs, gabapentin, acetaminophen, ketamine, and patient-controlled analgesia (both classical intravenous and transdermal iterations). The chapter also notes the use of multimodal analgesic regimens to promote pain control while reducing the risk of opioid-related adverse effects.
Lumbar Neurogenic Claudication
Authors: Gala Raj J. , Yue James
Published: October 2018

Lumbar neurogenic claudication, sometimes referred to as pseudoclaudication, is the clinical syndrome of back pain radiating down one or both legs during ambulation. Classically, the symptoms abate with forward flexion of the lumbar spine and worsen with extension. The condition arises from lumbar spinal stenosis, which is common in the elderly population. Many asymptomatic individuals have lumbar spinal stenosis seen on magnetic resonance imaging (MRI), so this syndrome is a clinical diagnosis. The majority of patients have favorable responses with conservative treatment, which includes physical therapy, bracing, medications, and epidural steroid injections. Patients who do not improve may go on to have surgery. Spinal stenosis has become one of the most common reasons to undergo lumbar spinal surgery in patients older than 65 years of age.
Needle Placement
Authors: Candido Kenneth D. , Kusper Teresa M.
Published: October 2018

Interventional pain management techniques are invaluable in the treatment of pain from various etiologies. Routine and advanced interventional pain management needle placement is essential not only to guarantee success with intended pain-relieving procedures, but also to minimize known complications from these same procedures. Knowledge of relevant anatomy is crucial. The focus of this chapter is to provide a brief description of various interventional pain management injection techniques. A short summary of the relevant anatomy, landmarks used for needle placement and important safety considerations is provided along with a selection of digital and radiographic photographs depicting the ideal needle placement and contrast flow at or in the immediate proximity of the targeted structures.
Comprehensive Review of Discography in Spinal Pain
Authors: Hadley Graham R. , Novitch Matthew , Jones Mark R. , Orhurhu Vwaire , Kaye Alan D. , Diwan Sudhir A.
Published: October 2018

Neck and back pain are common in the adult population, with many adults experiencing such pain at any one point in time. Both are a common cause of disability and socioeconomic burden, with relatively high annual prevalence rates. The aim of discography involves determination of the morphology of the nucleus pulposus and annulus fibrosus of the intervertebral disc. The knowledge of structural integrity of the disc is the fundamental principle in determining whether the neck or back pain is discogenic in nature. This chapter discusses the safety profile and diagnostic utility of discography, as well as the controversy that still remains over its clinical use, with respect to the cervical, thoracic, and lumbar spine regions.
Measures and Outcomes in Implementation Science
Authors: Lewis Cara C. , Mettert Kayne D. , Dorsey Caitlin N. , Weiner Bryan J.
Published: October 2018

This chapter provides an overview of the state of implementation outcome measurement in general and specific to the cancer control continuum. A novel conceptualization of the timing of implementation outcome assessment is presented as it pertains to the Exploration, Preparation, Implementation, and Sustainment model. An environmental scan revealed 40 measures across eight implementation outcomes in use across the cancer control continuum. The quality of measures in use is either poor or not yet established. Five key measurement challenges are broached, with recommendations for resolving them provided wherever possible. The chapter closes with emerging advances in implementation outcome, context, and process measurement and a list of resources for the field.
Study Design, Data Collection, and Analysis in Implementation Science
Authors: Sklar Marisa , Moullin Joanna C. , Aarons Gregory A.
Published: October 2018

This chapter provides an introduction to study design, data collection, and analysis in implementation science. Although the randomized controlled trial is frequently employed in implementation science, a number of alternatives are relied on for addressing the unique challenges present. Alternatives include the cluster randomized control trial, roll-out designs such as the stepped wedge, cumulative trial, and effectiveness–implementation hybrid designs. Data collection and data analytic techniques must also address the unique challenges present in implementation science. Often, implementation occurs over time, often, across complex, multilevel contexts. Implementation scientists frequently utilize mixed, qualitative, and quantitative methodologies for collecting, analyzing, and interpreting data. Data represent the outer context of service systems and the inner context of organizations such that the data are often nested and hierarchical in nature. This chapter highlights the previously mentioned topics, particularly as they relate to currently funded implementation studies focused on the cancer control continuum.
Implementation Strategies for Increasing Rates of Human Papillomavirus Vaccination
Authors: Vanderpool Robin C. , Brandt Heather M. , Pilar Meagan R.
Published: October 2018

This case study describes the unique issues associated with human papillomavirus (HPV) vaccination, including its role in cancer prevention, suboptimal initiation and completion rates among adolescents nationwide, and barriers to population-level uptake of the vaccine. It also provides an overview of evidence-based implementation strategies that have been used broadly within the HPV vaccination context and within specific projects that have capitalized on community partnerships, clinical systems changes, alternative settings, and multipronged approaches to improve vaccine outcomes. In addition, it outlines an agenda for improving HPV vaccination outcomes across the population and among disparate communities through the lens of implementation science, including the use of multilevel interventions focused on varying levels of influence ranging from intrapersonal to policy.
Integrating Concurrent Palliative Care into Cancer Care Delivery Settings
Authors: Whisenant Meagan , Mooney Kathi
Published: October 2018

This case study reviews the evidence for adoption of concurrent palliative care (CPC) during treatment for advanced cancer. Increasing research evidence and expert panel consensus has resulted in national guidelines and professional society endorsement of early integration of palliative care into oncology care. However, there is variable uptake of these guidelines and penetration of CPC into practice. Barriers to implementation include the need to increase awareness of existing evidence and guidelines, stigma, adequacy of a workforce for scale-up, lack of models for integration and delivery, and restrictive reimbursement mechanisms. Changing health care models that emphasize value-based care over fee-for-service can accelerate adoption. Use of technology can also overcome barriers related to scalability and resource use. The case study concludes with the recommendation that implementation science methodologies be used to guide successful integration of CPC in outpatient and home-based settings for patients with advanced cancer and their family caregivers.
Enhancing Fidelity to Cancer Treatment Guidelines
Authors: Helzlsouer Kathy J. , Varanasi Arti Patel
Published: October 2018

Cancer treatment has become increasingly complex with the rapid development of new therapies and treatment modalities. Guidelines for optimum cancer treatment are produced by several organizations, but ensuring that the patient receives the treatment requires both provider awareness and patient support to follow a complex treatment plan. An individual diagnosed with cancer must simultaneously come to terms with the diagnosis, make difficult shared decisions about treatment with his or her provider, and commence treatment in a matter of a few days or weeks. Ensuring optimum treatment is an increasingly complex process that involves multiple people and steps. Well-documented disparities exist in the receipt of and adherence to appropriate treatment by demographic and social factors, such as age, race, ethnicity, socioeconomic status, and geography. This case study provides an example of how the process of providing optimum cancer treatment may be improved through a technology-enhanced navigation program.
Organization- and System-Level Factors Influencing Implementation Overview of Case Studies
Authors: Wheeler Stephanie B.
Published: October 2018

Organization- and health system-level determinants of cancer outcomes are critical to understand. Studies focusing only on individual- or provider-level factors contributing to differential outcomes may mask the important, and often far-reaching, influence of organizational and system-wide structures, policies, norms, and behaviors that drive outcomes. This chapter explores case studies including implementation of patient reported outcomes symptom monitoring within a large academic medical center; cancer patient navigation programs to reduce social, economic, cultural, and system barriers to timely cancer care; how psychosocial support has been integrated into community-based and Veterans Administration (VA) oncology programs; and implementing Lynch syndrome testing within a VA integrated health care system.
Implementing Distress Screening in a Community and Veteran’s Administration Oncology Clinic
Authors: Montgomery Paul , Thurston Nicole , Betts Michelle , Smith C. Scott
Published: October 2018

The complexities of cancer treatment present a myriad of life-altering impacts for patients. These impacts can be addressed only if health care systems have been designed to detect and address all of these challenges. One significant, but often hidden, challenge is distress. This reaction to the myriad obstacles that cancer presents can impact the quality of life, and influence outcomes, of patients with cancer. Health systems have been slow to address these problems, and a prime example is the implementation of a distress screening and management system. This case study summarizes distress screening in a community oncology clinic compared to a Department of Veterans Affairs (VA) oncology clinic. The community clinic responded to accreditation and grant-driven initiatives, whereas the VA responded to mental health and integrated primary care initiatives. This case study explores the history and the ongoing challenges of distress screening in these community-based health care systems.
Implementing an Evidence-Based Exercise Program for Breast Cancer Survivors
Authors: Schmitz Kathryn H. , Beidas Rinad
Published: October 2018

Multiple persistent adverse effects of breast cancer treatment are improved with regular exercise. This case study describes a safe and effective exercise program for breast cancer survivors that was adapted into an evidence-based intervention offered through physical therapy (Strength After Breast Cancer). The program was successfully translated and implemented, and it showed equal safety and efficacy as the parent program with regard to lymphedema symptoms, muscular strength, quality of life, and body image. Evaluation of the implementation process revealed multiple facilitators and barriers to implementation. Barriers included the intervention characteristics and challenges with the referral process from oncology. Facilitators included getting the program covered by insurance, a champion in the outpatient clinic, and adaptations to the program and referral process that resulted in successful implementation. Future research is needed to further the goal of ensuring all breast cancer survivors are connected to safe and effective exercise programming.
Harnessing Big Data-Based Technologies to Improve Cancer Care
Authors: Randhawa Gurvaneet S. , Lomotan Edwin A.
Published: October 2018

Big data promises to harness the power of advanced computing to transform health and health care, including cancer research and care delivery. In health care, big data can be generated by administrative and clinical processes, by patients and families, and by machines. Ultimately, the goal of big data is to transform data into actionable knowledge with attention to four dimensions: person-level data collection; data access, exchange, and aggregation; population-level analytics; and provider, researcher, or patient-facing clinical decision support. A fabric of trust forms the basis for policies for governance, privacy and security, and confidentiality. This chapter offers several examples of the application of big data along the cancer care continuum, ranging from primary prevention through diagnosis, survivorship, and end-of-life care. Challenges to the effective collection and use of big data include its integration with health care delivery; interoperability; and the need for validated, well-designed informatics tools.
Electrolyte Disturbance in Pyloric Stenosis
Authors: Turner Ben , Tjia Imelda
Published: October 2018

Pyloric stenosis is the most common surgical cause of nonprojectile vomiting in a male infant between 3 and 6 weeks of age. While this condition may result in severe dehydration if not managed promptly, management must be addressed as a medical emergency and not a surgical emergency. Correction of the metabolic alkalosis that affected babies typically present with is paramount prior to surgical repair. The failure of this to occur preoperatively may lead to postoperative complications such as postoperative apnea. This chapter presents a case study of a baby with electrolyte imbalance due to pyloric stenosis and discusses surgical and anesthetic considerations.
Preoperative Fasting in the Pediatric Patient
Authors: Hagerman Nancy , Wittkugel Eric
Published: October 2018

Preoperative fasting guidelines are designed to reduce the volume of gastric contents and to minimize the risk of pulmonary aspiration of gastric contents. Perioperative pulmonary aspiration in children is uncommon, with an incidence of between 1 and 10 per 10,000 anesthetics. It is associated with low morbidity and mortality. While fasting is important, it does not guarantee an empty stomach. Prolonged fasting in infants and children does not further reduce gastric volumes or increase safety but can be associated with unwanted effects such as irritability, parental dissatisfaction, hypoglycemia, dehydration, hypotension on the induction of anesthesia, difficult venous access, and possibly decreased compliance with the preoperative fast. Since pulmonary aspiration is a rare occurrence, few evidence-based recommendations for ideal fasting intervals exist. An understanding of the research involved in the creation of these guidelines is useful in ensuring the maximum safety of patients while minimizing the disadvantages of prolonged fasting.
Craniosynostosis Repair
Authors: Karlberg Helena
Published: October 2018

Craniosynostosis is the fusion of one or more cranial sutures; such fusion occurs due to multiple factors and typically occurs in utero. Depending on the sutures involved, the infant can have significant abnormalities in skull shape. The structural abnormality is corrected surgically, frequently after a series of operations starting from infancy and occurring even late in childhood, depending on the sutures that are fused. During these surgeries, an infant can lose substantial volumes of blood, increasing the risk of hypovolemia and venous air embolism. It is imperative for the pediatric anesthesiologist to employ various modalities to minimize blood loss and also recognize clinical signs indicating the need for transfusion.
Mediastinal Mass Biopsy
Authors: Caplan Lisa
Published: October 2018

Anterior mediastinal masses (AMMs) comprise a heterogeneous collection of neoplasms. The mass effect of these neoplasms can compress the trachea, main stem bronchi, heart, or large vessels. Preoperative anesthetic plans should consider presenting signs, symptoms, and cardiopulmonary involvement to help risk stratify and select the proper airway technique and sedation plan. This chapter will enable readers to identify signs and symptoms that contribute to the pathophysiology of children who present with AMMs, perform a risk assessment of patient symptomatology, design a perioperative care plan, and risk stratify patients and procedures to determine appropriate anesthetic and airway techniques.
Obesity
Authors: Nguyen Kim-Phuong , Glover Chris D.
Published: October 2018

Childhood obesity has become a major public health concern. Obesity affects perioperative anesthetic management from airway management and drug selection to postoperative monitoring requirements. This chapter explains the perioperative implications of childhood obesity and addresses multiple considerations in the formulation of an anesthetic plan for the obese child. The chapter examines the anesthetic implications of obesity and its effects on various body systems, discusses the principles of perioperative management of obese children, and grants a working knowledge of pharmacokinetics of common anesthetic drugs in obese children and dosage implications. A case study of an obese 13-year-old boy with late-onset Blount disease who presents for proximal tibial osteotomy with internal fixation is presented to illustrate the concepts in the chapter.
Thyroid Mass Resection
Authors: Govindan Kalyani
Published: October 2018

Pediatric thyroid nodules are fairly uncommon. However, thyroid nodules that do exist in the pediatric population are more likely to be of a malignant nature compared to the adult population. Malignancy occurs anywhere from 16% to as high as 26% in pediatrics compared to 5% in the adult population. The thyroid mass poses several concepts to consider. Depending on the size of the mass, potential for discomfort, and respiratory compromise, the anesthesiologist must be able to identify patients who are at risk for cardiopulmonary complications and formulate an acceptable anesthetic plan. This chapter reviews the overall causes, studies, symptoms, and treatment of the pediatric patient with a thyroid mass.
Former Premature Infant for Hernia Repair
Authors: Frawley Geoff
Published: October 2018

Inguinal hernia repair is the most common surgery in ex-premature infants. These infants have demonstrated a significantly higher incidence of postoperative apnea with risk inversely related to gestational age. Both awake regional anesthesia without sedation and general anesthesia have been described in this age group, and each has advantages and drawbacks. In the case of awake regional techniques, the major drawback is the block failure rate which is directly related to provider experience. In the case of general anesthesia, the limiting factor is the much higher rate of postoperative respiratory complications including apnea and hypoventilation. The rate of respiratory complications (which has been reported to be as high as 30% with halothane and enflurane) is between 5% and 10% with sevoflurane and desflurane and is inversely related to gestational age. The association between neonatal exposure to volatile anesthesia and subsequent neurodevelopmental delay has promoted use of regional anesthesia when possible.
Anesthesia for Ex Utero Intrapartum Therapy
Authors: Sutton Caitlin D. , Olutoye Olutoyin A.
Published: October 2018

Fetuses with congenital head and neck anomalies which will result in impaired spontaneous respiration and difficulty in securing the airway after delivery may suffer asphyxia at birth. The ex utero intrapartum therapy (EXIT) offers such affected babies a chance at survival by allowing airway manipulations to occur after partial delivery of the baby, while the baby remains on utero-placental support. This very unique procedure requires extensive planning and multidisciplinary coordination with a multiplicity of specialties including maternal fetal medicine, pediatric surgery, pediatric otolaryngology, pediatric anesthesiology, neonatology, and pediatric cardiology. The preoperative planning takes place several days prior to the procedure and also involves meeting with the family. It is the intricacies of multidisciplinary team that require EXIT procedures to take place in certain highly specialized tertiary care fetal centers.
Caudal versus Penile Block
Authors: Maenpaa Cheryl , Hendrickson Michele , Goldschneider Kenneth R.
Published: October 2018

Circumcision is a commonly performed operation. Regional analgesia is provided either by penile block or caudal block. Each approach to anesthetizing the penis has attendant risk and benefits. The provider has several decision points to observe when choosing which, if either, technique to apply. The basic anatomic factors (including the identification and significance of sacral dimples), technical steps, risks, and considerations of each are discussed. Overall, each block offers benefit to the patient, and choosing between them can be based on need for ambulation postoperatively, operator experience, and availability of appropriate equipment. When available, ultrasound can enhance the efficacy of penile nerve blocks.
Complex Regional Pain Syndrome for Ambulatory Surgery
Authors: Monico Caro
Published: October 2018

Complex regional pain syndrome (CRPS) is a disease of the nervous system characterized by pain localized in an extremity. This pain is typically out of proportion to the inciting event and is accompanied by sensory disturbances, as well as motor, vasomotor, and sudomotor signs and symptoms. CRPS is a challenging clinical presentation and diagnosis. The etiology of this previously rare condition in children, is typically post-traumatic. It’s management requires a biopsychosocial approach. The principal modality that will improve pain and function in children with CRPS is physical therapy together with an interdisciplinary approach to management. The key to successful treatment involves early appropriate intervention, education for the child and family, and excellent communication between team members. This chapter uses a case study of a 12-year-old girl with CRPS to illustrate these concepts.