bluuebunny/crossref_metadata_2025 huggingface dataset:
How Formal Parliamentary Negotiation Affects Policy-Making: Evidence from Taiwan
Authors: Huang Shih-hao
Published: April 2018

Does parliamentary negotiation help facilitate legislation? This article applies propensity score matching to empirically investigate the effect of a unique formal negotiation mechanism in Taiwan’s parliament. The analysis of legislative initiatives between 2012 and 2015 shows that the so-called Party Negotiation Mechanism, while being invented to revive legislation amid stalemates, substantially reduces the chance of successful legislation. By extension, the undercut probability of legislative success under Taiwan’s majoritarian system implies that the conventional majoritarian–consensus framework has overlooked a crucial parameter that directly shapes the patterns of policy-making—the internal organisation of a parliament.
The Relative Occurrence of Grapevine leafroll-associated virus 3 and Grapevine red blotch virus in Washington State Vineyards
Authors: Adiputra Jati , Kesoju Sandya R. , Naidu Rayapati A.
Published: April 2018

Vineyard surveys were conducted for three consecutive seasons in eastern Washington State, the major grapevine-growing region in the state, to document the occurrence of Grapevine leafroll-associated virus 3 (GLRaV-3) and Grapevine red blotch virus (GRBV). The majority of samples were collected from red-berried wine grape (Vitis vinifera) cultivars exhibiting symptoms of or suspected for grapevine leafroll (GLD) and red blotch (GRBD) diseases. A limited number of samples from white-berried cultivars were collected randomly due to the lack of visual symptoms. Samples were collected from a total of 2,063 grapevines from 18 red-berried cultivars and seven white-berried cultivars planted in eight American Viticultural Areas and tested for GLRaV-3 and GRBV using RT-PCR and PCR, respectively. The results showed 67.77% and 6.01% of total samples positive for GLRaV-3 and GRBV, respectively, and 9.06% of samples positive for both viruses. About 17% of samples tested negative for the two viruses, but some of these samples were positive for GLRaV-2 and GLRaV-4. Overall results indicated that GLRaV-3 was more common than GRBV, independent of cultivars and the geographic origin of samples. Due to variability in symptoms in red-berried cultivars, virus-specific diagnostic assays were deemed necessary for reliable identification of GLRaV-3 and GRBV and to differentiate GLD and GRBD symptoms from those induced by biotic and abiotic stresses in vineyards. A multiplex PCR protocol was developed for simultaneous detection of GLRaV-3 and GRBV in grapevine samples. A global phylogenetic analysis of GRBV genome sequences revealed segregation of virus isolates from Washington State vineyards into two distinct clades, with the majority of isolates belonging to clade II.
Using Analgesics for Emotional Modulation is Associated With Increased Distress, Depression, and Risk of Opioid and Alcohol Misuse
Authors: Vowles Kevin E. , Bailey Robert W. , McEntee Mindy L. , Pielech Melissa , Edwards Karlyn A. , Bolling Lena A. , Rivers W. Evan
Published: April 2018

Objectives:

It is important to identify aspects of analgesic use that are associated with harm in chronic pain. Historically, the focus has been patterns of use (eg, overuse). This study evaluated another aspect of use—rather than evaluating how analgesics were being used, the primary interest was in why they were being used.

Methods:

In total, 334 analgesic using individuals with chronic pain responded to a pool of items assessing reasons for analgesic use. Measures of pain intensity, distress, depression, and opioid and alcohol misuse were also completed.

Results:

Exploratory factor analyses indicated 3 overarching reasons for use, including taking analgesics: (1) for pain reduction/functional improvement; (2) for emotional modulation/sedation; and (3) to be compliant with prescriber instructions. Correlation and regression analyses indicated that the second factor had the strongest relations with the other measures used, such that greater endorsement of analgesic use for emotional modulation was associated with greater distress, depression, and opioid and alcohol misuse. Using analgesics for pain reduction/functional improvement was associated with greater pain-related distress and depression. Using analgesics to be compliant was not associated with any measure. This pattern of results was generally replicated when a subsample of 131 individuals taking opioids was examined.

Discussion:

Results support the utility of examining reasons for analgesic use; use to achieve emotional modulation/sedation may be particularly associated with risk. The data also provide support for the questionnaire developed, the Reasons for Analgesic Use Measure.
Proximal both-bone forearm fractures in children: factors predicting outcome
Authors: Littleton Travis W. , Pharr Zachary K. , Kelly Derek M. , Moisan Alice
Published: April 2018

Background:

The literature is replete with outcomes studies on pediatric forearm fractures; however, information concerning the outcomes of both-bone fractures of the proximal radius and ulna is limited. The purpose of our study was to evaluate the prognosis and outcomes in children with combined fractures of the proximal radius and ulna, with special attention to complications.

Methods:

A single-center, retrospective study identified patients ages 3 to 15 yr old with proximal forearm fractures treated between January of 1994 and February of 2014. Patients were excluded if they did not have both-bone fractures of the proximal forearm. Records were reviewed with a focus on outcomes and their association with age at the time of injury, severity of injury, type of treatment, and complications.

Results:

Thirty-one patients met the inclusion criteria. Significant differences were seen between patients younger than 10 yr of age and patients older than 10 yr of age in rates of requiring operative treatment (P=0.048) and returning to the operating room (P=0.037). There was no significant difference in nerve injury (P=0.519) or range-of-motion deficits (P=0.872) based on age. In addition, no difference was seen in range-of-motion deficits based on severity of injury as determined by displacement (complete or none) (P=0.139).

Conclusions:

Most proximal both-bone forearm fractures in children, including olecranon and radial neck fractures, Monteggia type IV fractures, and nonspecific proximal both-bone forearm fractures, have good-to-excellent results. In our study, older age, defined as 10 yr of age or older at the time of injury, resulted in more frequent need for operative intervention, a higher rate of return to the operating room, and greater risk of nerve injury. The older children were not more likely to have range of motion deficits despite a more involved course, which contradicts previous reports, and older age at the time of injury did not necessarily predict poorer outcomes.

Level of Evidence:

Level IV, case series.
A Comparison of Isolated Lumbar Extension Strength Between Healthy Asymptomatic Participants and Chronic Low Back Pain Participants Without Previous Lumbar Spine Surgery
Authors: Conway Rebecca , Behennah Jessica , Fisher James , Osborne Neil , Steele James
Published: April 2018

Study Design.

Cross-sectional case-control study.

Objective.

To compare isolated lumbar extension strength between healthy asymptomatic participants and participants with chronic low back pain (CLBP), while controlling for previous lumbar spine surgery.

Summary of Background Data.

Deconditioning of the lumbar musculature is common in those with previous lumbar surgery, resulting in decreased strength and endurance. Evidence is required to support whether this is the case for participants with CLBP yet no previous surgery compared with asymptomatic participants.

Methods.

Forty-two healthy (25 males and 17 females) asymptomatic participants, and 53 participants with non-specific CLBP (30 males and 23 females) aged between 19 and 76 years were recruited. Maximal isometric isolated lumbar extension (ILEX) strength was examined.

Results.

A Mann–Whitney U test indicated that ILEX strength was significantly greater in the asymptomatic group compared with the CLBP group (Z = 1441.00, P = 0.014). Post-hoc effect size was calculated to be d = 0.56, showing a moderate effect.

Conclusion.

These results indicate that ILEX weakness and lumbar extensor deconditioning is present independent of surgery and may be a factor involved in CLBP. As such, lumbar extensor deconditioning would appear to be a reasonable target for interventions in CLBP.

Level of Evidence: 3
Selected proliferation markers correlated with dynamics of growth in colorectal cancer
Authors: Luo Wu-Xia , Chen Ye , Li Yun-Tao , Tang Jie , Ding Jing , Du Yang , Wu Qiang , Liu Ji-Yan
Published: April 2018

For treatment of metastatic colorectal cancer, the dynamics of tumor growth is an important factor for treatment decision. However, it is difficult to evaluate the dynamics of tumor growth, especially those of synchronous metastatic diseases. This study aimed to find some indicators related to tumor proliferation to judge the dynamics of tumor progression. The pathological reports and clinical data of 1205 patients with metastatic colorectal cancer were retrospectively reviewed; 75 patients with known relapse time after radical resection were included, and the expression of proliferation-associated proteins was detected by immunohistochemistry. Relapse-free time (RFT) from radical resection to relapse was obtained to analyze the relationship with expression of these factors. Kaplan–Meier univariate analysis showed that the overexpression of cyclin D1 and epidermal growth factor receptor (EGFR) and late pathological stage after surgery indicated shorter RFT. Multivariate analysis showed that EGFR and the stage were independent predictors of RFT. Expression of EGFR and cyclin D1 and the pathological stage were included as combination risk factors for RFT analysis; more risk factors were correlated with shorter RFT. EGFR and cyclin D1 seemed to be indicators of the dynamics of tumor growth, and overexpression of those molecules may suggest rapid growth and poor prognosis.
Impact of Adoption of a Comprehensive Electronic Health Record on Nursing Work and Caring Efficacy
Authors: Schenk Elizabeth , Schleyer Ruth , Jones Cami R. , Fincham Sarah , Daratha Kenn B. , Monsen Karen A.
Published: April 2018

Nurses in acute care settings are affected by the technologies they use, including electronic health records. This study investigated the impacts of adoption of a comprehensive electronic health record by measuring nursing locations and interventions in three units before and 12 months after adoption. Time-motion methodology with a handheld recording platform based on Omaha System standardized terminology was used to collect location and intervention data. In addition, investigators administered the Caring Efficacy Scale to better understand the effects of the electronic health record on nursing care efficacy. Several differences were noted after the electronic health record was adopted. Nurses spent significantly more time in patient rooms and less in other measured locations. They spent more time overall performing nursing interventions, with increased time in documentation and medication administration, but less time reporting and providing patient-family teaching. Both before and after electronic health record adoption, nurses spent most of their time in case management interventions (coordinating, planning, and communicating). Nurses showed a slight decrease in perceived caring efficacy after adoption. While initial findings demonstrated a trend toward increased time efficiency, questions remain regarding nurse satisfaction, patient satisfaction, quality and safety outcomes, and cost.
Impact of long-term temporal trends in fine particulate matter (PM2.5) on associations of annual PM2.5 exposure and mortality
Authors: Eum Ki-Do , Suh Helen H. , Pun Vivian Chit , Manjourides Justin
Published: April 2018

Decreasing ambient fine particulate matter (PM2.5) concentrations over time together with increasing life expectancy raise concerns about temporal confounding of associations between PM2.5 and mortality. To address this issue, we examined PM2.5-associated mortality risk ratios (MRRs) estimated for approximately 20,000,000 US Medicare beneficiaries, who lived within six miles of an Environmental Protection Agency air quality monitoring site, between December 2000 and December 2012. We assessed temporal confounding by examining whether PM2.5-associated MRRs vary by study period length. We then evaluated three approaches to control for temporal confounding: (1) assessing exposures using the residual of PM2.5 regressed on time; (2) adding a penalized spline term for time to the health model; and (3) including a term that describes temporal variability in PM2.5 into the health model, with this term estimated using decomposition approaches. We found a 10 μg/m3 increase in PM2.5 exposure to be associated with a 1.20 times (95% confidence interval [CI] = 1.20, 1.21) higher risk of mortality across the 13-year study period, with the magnitude of the association decreasing with shorter study periods. MRRs remained statistically significant but were attenuated when models adjusted for long-term time trends in PM2.5. The residual-based, time-adjusted MRR equaled 1.12 (95% CI = 1.11, 1.12) per 10 μg/m3 for the 13-year study period and did not change when shorter study periods were examined. Spline- and decomposition-based approaches produced similar but less-stable MRRs. Our findings suggest that epidemiological studies of long-term PM2.5 can be confounded by long-term time trends, and this confounding can be controlled using the residuals of PM2.5 regressed on time.
Radiologic Aspects of the Diagnosis of Pulmonary Embolism in Pregnancy
Authors: HARRIS BENJAMIN S. , BISHOP KATHERINE C. , KULLER JEFFREY A.
Published: April 2018

Pulmonary embolism in pregnancy is a leading cause of maternal mortality. The clinical presentation is often nonspecific, making imaging essential for accurate diagnosis. After reviewing the literature on the radiologic diagnosis of pulmonary embolism in pregnancy, we concluded that both computed tomography pulmonary angiography and lung perfusion scintigraphy are sensitive with high positive predictive values in the presence of high clinical suspicion, but lung perfusion scintigraphy is recommended given lower maternal breast exposure to ionizing radiation and lower fetal contrast exposure. However, if a chest x-ray is abnormal, computed tomography pulmonary angiography is preferred due to high nondiagnostic rates of lung perfusion scintigraphy.
Performance Testing of Criticality Accident Detectors with the Godiva Burst Reactor
Authors: Vickers Linda
Published: April 2018

Criticality accident detectors are required for all operations involving fissile materials in which a criticality accident can occur and cause personnel to receive unacceptable exposure to radiation (ANSI/ANS 8.3‐R2012). Recently, the U.S. Department of Energy Y‐12 National Security Complex tested six criticality accident detectors and eight Portable Radiation Detection Instruments (PRDIs) to verify their performance under actual criticality conditions. The tests were performed by Los Alamos National Laboratory using the Godiva critical assembly located at the National Criticality Experiments Research Center at the U.S. Department of Energy Nevada National Security Site. All six criticality accident detectors and eight Portable Radiation Detection Instruments passed the performance tests. The test results provide reasonable assurance that the Y-12 criticality accident detectors and PRDIs will detect a criticality accident and warn workers to evacuate the area to minimize their exposure to this life-threatening hazard.
Totally Endoscopic Resection of Giant Left Atrial Myxoma without Robotic Assistance
Authors: Dang Quang-Huy , Le Ngoc-Thanh , Tran Dac-Dai , Ngo Thi-Hai-Linh
Published: April 2018

There was no report on the application of totally endoscopic surgery for giant atrial myxoma resection. A 62-year-old female patient with giant atrial myxoma causing severe mitral stenosis and acute pulmonary edema underwent a successful operation by totally endoscopic techniques without the assistance of robotic systems using four small trocar ports (three 5-mm trocars and one 12-mm trocar). The patient recovered uneventfully and was satisfied with cosmetic results.
Development of pain in older adults: a latent class analysis of biopsychosocial risk factors
Authors: O'Neill Aoife , O'Sullivan Kieran , O'Keeffe Mary , Hannigan Ailish , Walsh Cathal , Purtill Helen
Published: April 2018

Pain significantly restricts the quality of life and well-being of older adults. With our increasingly ageing population, it is important to examine whether differing classes of biopsychosocial risk factors can predict the development of pain in older adults. Latent class analysis provides a model-based approach to identifying underlying subgroups in a population, based on some measured characteristics. In this study, latent class analysis was used to identify biopsychosocial risk classes in people aged 50 years and older, from The Irish Longitudinal Study on Ageing, who reported not often being troubled by pain at wave 1 and completed the 2-year follow-up at wave 2 (n = 4458). Four classes were identified based on 11 potential risk factors at wave 1. These classes were characterised as “Low Risk,” “Physical Health Risk,” “Mental Health Risk,” and “High Risk.” The Low-Risk class accounted for over half the sample (51.2%), whereas the High-Risk class represented 7.8% of the sample. At follow-up (wave 2), 797 (17.9%) participants reported being troubled by pain. Associations between the biopsychosocial risk classes and developing pain were examined using logistic regression, adjusting for sociodemographic variables. The High-Risk class was more likely to develop pain compared with the Low-Risk class (adjusted OR = 3.16, 95% CI = 2.40-4.16). These results add to existing data in other populations supporting the role of a range of biopsychosocial risk factors that increase the risk of developing pain. These findings have important implications for the identification, and potential moderation, of these risk factors.
Baby-Friendly as a Regional Collaborative Quality Improvement Project in an Academic Medical Center Environment
Authors: Krauss Martha J. , Sharp Michelle
Published: April 2018

In 2012, the state of South Carolina lacked any Baby-Friendly designated hospitals. The Medical University of South Carolina had a strong lactation service since 2002 but continued to struggle with improving breastfeeding rates. The Baby-Friendly Hospital Initiative was the catalyst to increase breastfeeding rates at this academic medical center. In 2012, membership in the Best Fed Beginnings Learning Collaborative heightened awareness of the importance of interdisciplinary collaboration. Participation in the regional collaborative provided evidence-based breastfeeding education and best clinical practices that supported the maternal-infant dyad. These improved practices are achieved by implementation of the Ten Steps to Successful Breastfeeding. The collaborative model accelerated change, and the goals to reach 80% of each metric were met. The exclusive breastfeeding rate increased by 30%. As a result of swiftly achieving designation, the institution was then able to focus on sustainability issues and efforts to expand breastfeeding support into the community. The purpose of this article is to review one hospital's journey while providing guidance to other organizations undergoing the process of becoming Baby-Friendly. The invaluable membership in the Best Fed Beginnings Learning Collaborative quality improvement initiative proved to be a major incentive and source of support in efficiently achieving Baby-Friendly status.
Benefits of Bimodal Hearing With Cochlear and Middle Ear Implants: Preliminary Results in Four Patients
Authors: Lee Hyun Jin , Kim Sung Huhn , Moon In Seok , Jung Jinsei , Lee Jeon Mi , Choi Jae Young
Published: April 2018

Objective:

Conventional hearing aids have some limitations in overcoming a large air-bone gap or in cases of severe high-frequency hearing loss. The authors aimed to evaluate the benefit of a new bimodal hearing configuration combining cochlear implantation (CI) and middle ear implant (MEI) in patients with severe mixed conductive and ski-slope hearing loss.

Study Design:

Retrospective case review.

Setting:

Tertiary referral center.

Patients:

Four patients with severe to profound hearing loss, who underwent CI in one ear and MEI in the other, were enrolled.

Intervention:

Audiological outcomes were assessed at least 6 months after the MEI/CI operation. Pure-tone audiometry (PTA) in unaided, CI-aided, and MEI-aided conditions were measured.

Main Outcome Measures:

Average threshold changes in bands of frequencies (<1 kHz, ≥1 kHz) were compared between MEI-aided and HA-aided conditions. The Korean version of the Hearing-in-Noise Test (K-HINT), and speech perception score in noisy and quiet conditions were evaluated in the bimodal configuration (i.e., MEI with CI).

Results:

MEI-aided PTA was especially increased in high-frequency areas (≥1 kHz). Speech perception in noisy and quiet conditions demonstrated better scores in the bimodal configuration. K-HINT also demonstrated better scores in the bimodal configuration.

Conclusions:

There is an increasing number of patients with unilateral CI and residual hearing in the contralateral ear. The benefits of a new bimodal hearing configuration with CI and MEI were demonstrated in patients with severe high-frequency hearing loss or mixed conductive hearing loss in the contralateral ear.
Short article: Crohn’s disease and pemphigus: is there an association?: a population-based study
Authors: Kridin Khalaf , Comaneshter Doron , Cohen Arnon D.
Published: April 2018

Background

Although the coexistence of Crohn’s disease (CD) and pemphigus has been reported in several individuals, the association between the two conditions was not investigated systematically in the past. A recent association between pemphigus and ulcerative colitis has been reported. The study aims to estimate the association between pemphigus and CD using a large-scale real-life computerized database.

Patients and methods

A cross-sectional study was carried out comparing pemphigus patients with age-matched, sex-matched, and ethnicity-matched control participants in terms of the prevalence of CD. χ
2-Test and t-test were used for univariate analysis and a logistic regression model was used for multivariate analysis. The study was carried out utilizing the computerized database of Clalit Health Services ensuring 4.5 million patients.

Results

A total of 1985 pemphigus patients and 9874 controls were included in the study. The prevalence of CD was comparable in patients with pemphigus and controls [0.4 vs. 0.3%, respectively; odds ratio (OR): 1.2; 95% confidence interval (CI): 0.5–2.5; P=0.688]. In an age-stratified analysis, a significant association was observed between pemphigus and CD in patients younger than 40 years (2.1 vs. 0.4%, respectively; OR: 5.1; 95% CI: 1.0–25.7; P=0.027). In a multivariate analysis adjusting for potential confounding factors, no independent association between the two conditions was found (OR: 0.9; 95% CI: 0.4–2.0; P=0.828). Study findings were robust to sensitivity analysis that included patients under pemphigus-specific treatments.

Conclusion

Unlike ulcerative colitis, CD was not associated with pemphigus. Further research is warranted to understand the pathophysiology of these observations better.
ETS transcription factor ETV2/ER71/Etsrp in haematopoietic regeneration
Authors: Choi Kyunghee
Published: April 2018

Purpose of review

Recent studies have established that haematopoietic stem cells (HSCs) remain quiescent in homeostatic conditions, and minimally contribute to haematopoietic homeostasis. However, they undergo extensive cell cycle and expansion upon bone marrow transplantation or haematopoietic injury to reestablish the haematopoietic system. Molecular basis for the HSC activation and expansion is not completely understood. Here, we review the recent study elucidating the role of the developmentally critical Ets transcription factor Etv2 in reestablishing haematopoietic system upon injury through promoting HSC regeneration.

Recent findings

We recently demonstrated that the ETS transcription factor Etv2, a critical factor for haematopoietic and vascular development, is also required for haematopoietic regeneration. Etv2, which is silent in homeostatic HSCs, was transiently activated in regenerating HSPCs and was required for the HSC expansion and regeneration following bone marrow transplantation or haematopoietic injury. As such, while Etv2 is dispensable for maintaining HSCs in steady states, it is required for emergency haematopoiesis.

Etv2 has been identified as a novel regulator of haematopoietic regeneration. Comprehensive understanding of the upstream regulators and downstream effectors of Etv2 in haematopoietic regeneration would be critical for fundamental understanding of haematopoietic stem cell biology, and the findings will be broadly applicable to clinical practice involving haematopoietic regenerative medicine; bone marrow transplantation, gene therapy and in-vitro HSC expansion.
An Update on the Clinicopathologic Features and Pathologic Diagnosis of Hepatitis E in Liver Specimens
Authors: Lenggenhager Daniela , Weber Achim
Published: April 2018

Infection with the hepatitis E virus (HEV) is globally seen a leading cause of hepatitis. Now increasingly recognized also in industrialized countries, hepatitis E constitutes a significant health problem worldwide. The patient’s immune status determines the clinical course and histopathology of hepatitis E. In immunocompetent patients, hepatitis E usually follows an asymptomatic or subclinical course, but may also present with acute hepatitis. In contrast, immunocompromised patients may develop chronic hepatitis, and patients with preexisting liver diseases are at risk for liver decompensation with potentially fatal outcome. Whereas pathologists only occasionally encounter liver biopsies from immunocompetent individuals with hepatitis E, they are more likely exposed to biopsies from patients with preexisting liver disease or immunocompromised individuals. Histopathologic hallmarks of hepatitis E in immunocompetent patients comprise lobular disarray, lobular, and portal inflammation, as well as hepatocyte necrosis of varying extend and regeneration. Thus, it is similar to acute non–E viral hepatitis, yet further differential diagnoses include autoimmune hepatitis and drug-induced liver injury. Histopathologic findings of hepatitis E in preexisting liver disease are determined by the underlying pathology, but may be more severe. Histopathologic presentation of hepatitis E in immunocompromised patients is highly variable, ranging from minimal active hepatitis to chronic hepatitis with severe activity and progressive fibrosis. Taken together, the variability of the histologic features depending on the clinical context and the overlap with other liver diseases make the histopathologic diagnosis of hepatitis E challenging. Immunohistochemistry for HEV open reading frame 2 protein and molecular testing for HEV RNA are useful tissue-based ancillary tools.
A Mixed Presentation of Serotonin Syndrome vs Neuroleptic Malignant Syndrome in a 12-Year-Old Boy
Authors: Sun Christie , Sweet Hannah , Minns Alicia B. , Shapiro Desiree , Jenkins Willough
Published: April 2018

Background

Neuroleptic malignant syndrome (NMS) and serotonin syndrome (SS) are serious medical conditions associated with commonly prescribed psychiatric medications. Although the mechanisms differ, they can be clinically difficult to distinguish. We report a case of a pediatric patient with complicated psychiatric history that developed features of both syndromes in the setting of polypharmacy.

Case

A 12-year-old boy with a history of developmental delay, attention-deficit hyperactivity disorder, and posttraumatic stress disorder presented to the emergency department with behavior changes consisting of delayed reactions, gait instability, drooling, and slowed movements. Ten days before presentation, his outpatient psychiatrist had made multiple medication changes including discontinuation of cyproheptadine (an appetite stimulant) and initiation of aripiprazole. On arrival, the patient was noted to be tachycardia and hypertensive for age. He was disoriented, intermittently agitated, and tremulous with increased tonicity, clonus in the lower extremities, and mydriasis. He was supportively treated with lorazepam and intravenous fluids while discontinuing potential offending agents. His course was complicated by hypertension and agitation managed with dexmedetomidine infusion and benzodiazepines. His mental status, tremors, and laboratory values began to improve over the next 2 days, and eventually transitioned to the inpatient psychiatric unit on hospital day 7.

Discussion

Diagnosis of NMS or SS can be difficult when there is overlap between syndromes, particularly in the setting of multiple potential offending agents or underlying developmental delay. In addition, pediatric patients may present atypically as compared with adult patients with the same condition.

Conclusion

The use of antipsychotic medications for young children with behavioral problems has risen dramatically in the last decade, increasing their risk for developing SS or NMS.
Unintentional Exposure of an Infant to Synthetic Cannabinoid (Bonzai) Related to the Parent's Use
Authors: Dinleyici Meltem , Kiral Eylem , Sahin Sabiha , Carman Kursat Bora
Published: April 2018

The increase of available synthetic cannabinoids poses an emerging public health threat worldwide. Synthetic cannabinoid use has been mainly reported in adolescent cases in pediatric practices; there are few reported cases involving infants affected by unintentional use. In this case report, we present the youngest age of synthetic cannabinoid bonzai exposure in the literature, discussing a 3-month-old child affected by exposure to the parents' use of bonzai in the home environment. Because unintentional exposure to synthetic cannabinoids like bonzai might be encountered, pediatric emergency teams should be aware of this condition and child protection teams should be informed of suspicions of child negligence and abuse as a part of the medical approach.
Lung Metastases of Intracranial Atypical Meningioma Diagnosed on Posttherapeutic Imaging After 177Lu-DOTATATE Therapy
Authors: Backhaus Philipp , Huss Sebastian , Kösek Volkan , Weckesser Matthias , Rahbar Kambiz
Published: April 2018

Meningiomas are typically benign solitary intracranial tumors. Atypical (World Health Organization [WHO] grade II) or malignant/anaplastic (WHO grade III) meningiomas are seldom, and distant metastases occur only in rare exceptions. We present a case of a 54-year-old male patient with atypical (WHO grade II) meningioma who underwent 1 cycle of peptide receptor radionuclide therapy. Previous imaging studies were confined to the head, but posttherapeutic whole-body 177Lu-DOTATATE scintigraphy revealed thoracic uptake arising from previously undetected pulmonic meningioma metastases. The case highlights the importance of consideration of rare/untypical metastatic sides and the value of radiotracer whole-body imaging in identifying these.
Prediction of Normal Organ Absorbed Doses for [177Lu]Lu-PSMA-617 Using [44Sc]Sc-PSMA-617 Pharmacokinetics in Patients With Metastatic Castration Resistant Prostate Carcinoma
Authors: Khawar Ambreen , Eppard Elisabeth , Sinnes Jean Phlippe , Roesch Frank , Ahmadzadehfar Hojjat , Kürpig Stefan , Meisenheimer Michael , Gaertner Florian C. , Essler Markus , Bundschuh Ralph A.
Published: April 2018

Aim

In vivo pharmacokinetic analysis of [44Sc]Sc-PSMA-617 was used to determine the normal organ-absorbed doses that may result from therapeutic activity of [177Lu]Lu-PSMA-617 and to predict the maximum permissible activity of [177Lu]Lu-PSMA-617 for patients with metastatic castration-resistant prostate carcinoma.

Methods

Pharmacokinetics of [44Sc]Sc-PSMA-617 was evaluated in 5 patients with metastatic castration-resistant prostate carcinoma using dynamic PET/CT, followed by 3 static PET/CT acquisitions and blood sample collection over 19.5 hours, as well as urine sample collection at 2 time points. Total activity measured in source organs by PET imaging, as well as counts per milliliter measured in blood and urine samples, was decay corrected back to the time of injection using the half-life of 44Sc. Afterward, forward decay correction using the half-life of 177Lu was performed, extrapolating the pharmacokinetics of [44Sc]Sc-PSMA-617 to that of [177Lu]Lu-PSMA-617. Source organs residence times and organ-absorbed doses for [177Lu]Lu-PSMA-617 were calculated using OLINDA/EXM software. Bone marrow self-dose was determined with indirect blood-based method, and urinary bladder contents residence time was estimated by trapezoidal approximation. The maximum permissible activity of [177Lu]Lu-PSMA-617 was calculated for each patient considering external beam radiotherapy toxicity limits for radiation absorbed doses to kidneys, bone marrow, salivary glands, and whole body.

Results

The predicted mean organ-absorbed doses were highest in the kidneys (0.44 mSv/MBq), followed by the salivary glands (0.23 mSv/MBq). The maximum permissible activity was highly variable among patients; limited by whole body–absorbed dose (1 patient), marrow-absorbed dose (1 patient), and kidney-absorbed dose (3 patients).

Conclusions

[44Sc]Sc-PSMA-617 PET/CT imaging is feasible and allows theoretical extrapolation of the pharmacokinetics of [44Sc]Sc-PSMA-617 to that of [177Lu]Lu-PSMA-617, with the intent of predicting normal organ-absorbed doses and maximum permissible activity in patients scheduled for therapy with [177Lu]Lu-PSMA-617.
The Challenge of Measuring Surgeon Spending for Payment Policies
Authors: VonAchen Paige , Hayward Rodney A. , Norton Edward C. , Denton Brian , Ellimoottil Chad
Published: April 2018

Objective:

Our objective was to understand the reliability of profiling surgeons on average health care spending.

Summary of Background Data:

Under its Merit-based Incentive Payment System (MIPS), Medicare will measure surgeon spending and tie performance to payments. Although the intent of this cost-profiling is to reward low-cost surgeons, it is unknown whether surgeons can be accurately distinguished from their peers.

Methods:

We used Michigan Medicare and commercial payer claims data to construct episodes of surgical care and to calculate average annual spending for individual surgeons. We then estimated the “reliability” (ie, the ability to distinguish surgeons from their peers) of these cost-profiles and the case-volume that surgeons would need in order to achieve high reliability [intraclass correlation coefficient (ICC) >0.8]. Finally, we calculated the reliability of 2 alternative methods of profiling surgeons (ie, using multiple years of data and grouping surgeons by hospitals).

Results:

We found that annual cost-profiles of individual surgeons had poor reliability; the ICC ranged from <0.001 for CABG to 0.061 for cholecystectomy. We found that few surgeons in the state of Michigan have sufficient case-volume to be reliably compared; 1% had the minimum yearly case. Finally, we found that the reliability of the cost-profiles can be improved by measuring spending at the hospital-level and/or by incorporating additional years of data.

Conclusion:

These findings suggest that the Medicare program should measure surgeon spending at a group level or incorporate multiple years of data to reduce misclassification of surgeon performance in the MIPS program.
Potential Impact of “Take the Volume Pledge” on Access and Outcomes for Gastrointestinal Cancer Surgery
Authors: Jacobs Ryan C. , Groth Shawn , Farjah Farhood , Wilson Mark A. , Petersen Laura A. , Massarweh Nader N.
Published: April 2018

Objective:

To quantify the number of US hospitals that would meet “Take the Volume Pledge” (TVP) volume thresholds and compare outcomes at hospitals meeting and not meeting TVP thresholds.

Summary Background Data:

TVP aims to regionalize complex cancer resections to hospitals meeting established annual average volume thresholds. There is little data describing the potential impact on patient access if this initiative were broadly implemented or the relationship between these volume thresholds and quality of oncologic care.

Methods:

Hospitals in the National Cancer Database (2006–2012) performing esophagectomy (n = 968), proctectomy (n = 1250), or pancreatectomy (n = 1068) were categorized based on frequency meeting TVP thresholds: always low volume (LV); low annual average and intermittently low volume (ILV); high annual average and intermittently high volume (IHV); always high volume (HV). Multivariable generalized estimating equations were used to evaluate the association between hospital TVP category, oncologic care processes, and perioperative outcomes.

Results:

Few hospitals met annual TVP thresholds (HV or IHV)—esophagectomy 1.6%; proctectomy 19.7%; pancreatectomy 6.6%. The majority of esophagectomy (77.8%) and pancreatectomy (53.4%) and 48.1% of proctectomy patients received care at hospitals not meeting annual TVP thresholds (LV or ILV). While performance for all three procedures was generally better at ILV, IHV, and HV hospitals relative to LV hospitals, there were few differences (none of which were consistent) when comparing ILV, IHV, and HV hospitals to each other.

Conclusions and Relevance:

Few hospitals would meet TVP volume thresholds for complex cancer resections with little difference in outcomes between ILV, IHV, and HV hospitals. While a policy to regionalize complex surgical care may have merit, it could also compromise patient autonomy and limit access to care if patients are unable or unwilling to travel.
Chinese herbal medicines in the prevention and treatment of chemotherapy-induced nausea and vomiting
Authors: Lv Chang , Shi Chengjin , Li Lifen , Wen Xuesen , Xian Cory J.
Published: April 2018

Purpose of review

Chemotherapy-induced nausea and vomiting (CINV) critically impact on cancer patients’ quality of life, causing various complications, and increasing the risk of chemotherapeutic failure. Current treatments addressing CINV are reasonably costly and have many side effects. Chinese herbal medicines (CHMs) have been widely used in treating CINV in China. Clinical trials and modern experimental studies on CINV using CHMs are reviewed for clues that may help us to better prevent and treat CINV with CHMs, and develop safe and effective treatments.

Recent findings

Since 1985, 92 clinical trials on CINV were identified, which comprised of 3778 patients with different cancer types, chemotherapy regimens, prescriptions, treatment durations, and combinations with Western medicines. The most frequently used herbs are Pinellia Rhizoma, Glycyrrhizae Radix et Rhizoma, Poria, and Atractylodis Macrocephalae Rhizoma, aiming to regulate the flow of Qi and remove phlegm and dampness residing in the stomach and spleen. Although all of the reported trials are randomized open trials, the curative effects range from 55.81 to 100%.

CHMs seem effective in the prevention and treatment of CINV based on the clinical trials and some animal experiments, although the scientific validity of many clinical studies remain to be confirmed as many of them were inadequately designed. Further well designed clinical trials and more preclinical studies with reliable markers are required to confirm the usefulness of CHMs as complementary medicines for treating CINV and to use CHMs as rational prescriptions rather than based only on empirical knowledge.
rawDiag - an R package supporting rational LC-MS method optimization for bottom-up proteomics
Authors: Trachsel Christian , Panse Christian , Kockmann Tobias , Wolski Witold E. , Grossmann Jonas , Schlapbach Ralph
Published: April 2018

Optimizing methods for liquid chromatography coupled to mass spectrometry (LC-MS) is a non-trivial task. Here we present rawDiag, a software tool supporting rational method optimization by providing MS operator-tailored diagnostic plots of scan level metadata. rawDiag is implemented as R package and can be executed on the command line, or through a graphical user interface (GUI) for less experienced users. The code runs platform independent and can process a hundred raw files in less than three minutes on current consumer hardware as we show by our benchmark. In order to demonstrate the functionality of our package, we included a real-world example taken from our daily core facility business.
Measuring the Impact of an Open Online Prescribing Data Analysis Service on Clinical Practice: a Cohort Study in NHS England Data
Authors: Walker Alex J , Curtis Helen J , Croker Richard , Bacon Seb , Goldacre Ben
Published: April 2018

Background

OpenPrescribing is a freely accessible service that enables any user to view and analyse NHS primary care prescribing data at the level of individual practices. This tool is intended to improve the quality, safety, and cost-effectiveness of prescribing.

Objectives

We set out to measure the impact of OpenPrescribing being viewed on subsequent prescribing.

Methods

Having pre-registered our protocol and code, we measured three different metrics of prescribing quality (mean percentile across 34 existing OpenPrescribing quality measures, available “price-per-unit” savings, and total “low-priority prescribing” spend) to see if they changed after CCG and practice pages were viewed. We also measured whether practices whose data were viewed on OpenPrescribing differed in prescribing, prior to viewing, to those who were not. We used fixed effects and between effects linear panel regression, to isolate change over time and differences between practices respectively. We adjusted for month of prescribing in the fixed effects model, to remove underlying trends in outcome measures.

Results

We found a reduction in available price-per-unit savings for both practices and CCGs after their pages were viewed. The saving was greater at the practice level (−£40.42 per thousand patients per month, 95% confidence interval −54.04 to −26.01) than at CCG level (−£14.70 per thousand patients per month, 95% confidence interval −25.56 to −3.84). We estimate a total saving since launch of £243k at practice level and £1.47m at CCG level between the feature launch and end of follow-up (August to November 2017) among practices viewed. If the observed savings from practices viewed were extrapolated to all practices, this would generate £26.8m in annual savings for the NHS, approximately 20% of the total possible savings from this method. The other two measures were not different after CCGs/practices were viewed. Practices which were viewed had worse prescribing quality scores overall, prior to viewing.

Conclusions

We found a clinically significant positive impact from use of OpenPrescribing, specifically for the class of savings opportunities that can only be identified by using this tool. We also show that it is possible to conduct a robust analysis of the impact of such an online service on clinical practice.
Gene regulatory mechanisms underlying the evolutionary loss of a polygenic trait
Authors: Lammers Mark , Kraaijeveld Ken , Mariën Janine , Ellers Jacintha
Published: April 2018

Trait loss is a pervasive phenomenon in evolution, yet the underlying molecular causes have been identified in only a handful of cases. Most of these involve loss-of-function mutations in one or more trait-specific genes. Parasitoid insects are fatty acid auxotrophs: they lost the ability to convert dietary sugars into fatty acids, a trait that is ubiquitous among non-parasitoid animals and is enabled by a highly conserved set of genes. Earlier research suggests that lack of lipogenesis is caused by changes in gene regulation, rather than gene decay. We compared transcriptome-wide responses to sugar-feeding in the non-lipogenic parasitoid species Nasonia vitripennis and the lipogenic Drosophila melanogaster. Both species adjusted their metabolism within four hours after feeding, but there was little overlap at the gene level between the responses of the two species. Even at the pathway-level, there were sharp differences between the expression profiles of the two species, especially in carbohydrate and lipid metabolic pathways. Several genes coding for key enzymes in acetyl-CoA metabolism, such as malonyl-CoA decarboxylase (MCD) and HMG-CoA synthase differed in expression between the two species. Their combined action likely blocks lipogenesis in the parasitoid species. Network analysis indicates most genes involved in these pathways to be highly connected, which suggest they have pleiotropic effects and could explain the absence of gene degradation. Our results indicate that modification of expression levels of only a few non-connected genes, such as MCD, is sufficient to enable complete loss of lipogenesis in N. vitripennis.
Auxin: a molecular trigger of seed development
Authors: Figueiredo Duarte D. , Köhler Claudia
Published: April 2018

The evolution of seeds defines a remarkable landmark in the history of land plants. A developing seed contains three genetically distinct structures: the embryo, the nourishing tissue, and the seed coat. While fertilization is necessary to initiate seed development in most plant species, apomicts have evolved mechanisms allowing seed formation independently of fertilization. Despite their socio–economical relevance, the molecular mechanisms driving seed development have only recently begun to be understood. Here we review the current knowledge on the role of the hormone auxin for the initial development of the three seed structures and as a trigger of fertilization-independent seed development.
A convolutional neural network-based screening tool for X-ray serial crystallography
Authors: Ke Tsung-Wei , Brewster Aaron S. , Yu Stella X. , Ushizima Daniela , Yang Chao , Sauter Nicholas K.
Published: April 2018

A new tool is introduced for screening macromolecular X-ray crystallography diffraction images produced at an X-ray free-electron laser light source. Based on a data-driven deep learning approach, the proposed tool executes a convolutional neural network to detect Bragg spots. Automatic image processing algorithms described can enable the classification of large data sets, acquired under realistic conditions consisting of noisy data with experimental artifacts. Outcomes are compared for different data regimes, including samples from multiple instruments and differing amounts of training data for neural network optimization.