bluuebunny/crossref_metadata_2025 huggingface dataset:
Industry, Commerce, and Urbanization in the United States, 1790–1870
Authors: Schley David
Published: June 2018

The eighty years from 1790 to 1870 were marked by dramatic economic and demographic changes in the United States. Cities in this period grew faster than the country as a whole, drawing migrants from the countryside and immigrants from overseas. This dynamism stemmed from cities’ roles as spearheads of commercial change and sites of new forms of production. Internal improvements such as canals and railroads expanded urban hinterlands in the early republic, while urban institutions such as banks facilitated market exchange. Both of these worked to the advantage of urban manufacturers. By paying low wages to workers performing repetitive tasks, manufacturers enlarged the market for their products but also engendered opposition from a workforce internally divided along lines of sex and race, and at times slavery and freedom. The Civil War affirmed the legitimacy of wage labor and enhanced the power of corporations, setting the stage for the postwar growth of large-scale, mechanized industry.
Maritime Buddhism
Authors: Acri Andrea
Published: June 2018

The spread of Buddhism across Asia has been studied mainly from a perspective focusing on the transmission through the overland routes popularly known as “Silk Roads” and emphasizing Central Asia as an important transit corridor and contact zone between South and East Asia. However, recent scholarship has increasingly recognized the significant role played by the sea routes or maritime “Silk Roads” in shaping premodern intra-Asian connectivity. This has paved the way for an appreciation of the important contribution of the southern rim of Asia—especially South India, Sri Lanka, and Southeast Asia—to the genesis, transformation, and circulation of various forms of Buddhism.

Evidence of the long-distance transfer of Buddhism from its northeastern Indian cradle to the outlying regions of South India, Sri Lanka, Southeast Asia, and China via the maritime routes goes back to the early centuries of the Current Era. From the 5th century onward, written and material vestiges from the southern rim of Asia became more substantial, testifying to an efflorescence of long-distance maritime contacts that were to last several centuries. As is shown by textual, epigraphic, and art historical materials—including icons, ritual accoutrements, dhāraṇīs, manuscripts, and monuments—Buddhist cults, imaginaries, and ritual technologies flourished across the vast swathe of littoral, island, and hinterland territory that can be conceptualized as the sociospatial grouping of “Maritime Asia.” Buddhist vestiges recovered from the Indian Subcontinent littorals, Sri Lanka, the Maldives Islands, peninsular and coastal mainland Southeast Asia, and what are now called the Indonesian Archipelago and the Philippine islands, speak in favor of the existence of pervasive and sustained multidirectional Buddhist exchanges among interconnected nodes linking South Asia and the Western Indian Ocean to China, Korea, and Japan through the maritime routes. A polycentric, geographically wide, and maritime-based approach is necessary to fully appreciate how religious, mercantile, and diplomatic networks acted as catalysts for transmission of Buddhism far and wide across Asia over nearly two millennia.
The Culture of a Multi-Ethnic Colony
Authors: Lipsett-Rivera Sonya
Published: June 2018

The very nature of Spanish colonization meant that New Spain brought together people from different cultures, ethnicities, religions, and attitudes. Mexico City was the meeting place of all these various populaces. Before the conquest, Tenochtitlan had neighborhoods composed of residents from various parts of the empire. Apart from the many indigenous cultures, colonization also meant the addition of Spaniards, Africans, and Asians, some of whom were enslaved and others simply migrants. The result was a culture that expressed itself both in high and popular culture with a melding of elements—a joyous cacophony that reflected its mestizo nature. This culture was played out not only in institutional settings such as the viceregal court, ceremonies, the theater, and in church but also in the streets, parks, and taverns that dotted towns and cities. Although culture, to a certain extent, reflected New Spain’s hierarchical nature, separation between high and low was never absolute. In the cathedral, as in many other institutions, popular pursuits and music infiltrated the formal singing. This pattern of cultural slippage prevailed within many areas of daily life as the colonial world of New Spain layered pastimes and pursuits from its many constituents.
The Economy during the Mexican Revolution
Authors: Wasserman Mark
Published: June 2018

The Mexican economy consisted of activities at the international, national, and local levels, including the export of minerals and agricultural commodities, manufactures and agriculture for domestic markets, and production of goods for everyday consumption, respectively. The impact of a decade of civil wars between 1910 and 1920, which comprised the Mexican Revolution, on the economy varied according to which level, the time period, and the geographical region. The crucial aspects of the economy consisted of transportation and communications, banking, mining, export agriculture, and government policies and actions. The important factors were the intensity of the violence, inflation, and the availability of capital.

Chronologically, there were several stages to the economic history of the Revolution. The first consisted of the years of the Madero rebellion and presidency, 1910–1913, when there was little damage done and growth continued. The second and worst period was during 1914, 1915, and 1916, when the counterrevolutionary Huerta regime battled the rebel Constitutionalists and after the latter’s victory the ensuing civil war between the divided winners. The third stage occurred with the defeat of the radical factions of the Revolution led by Zapata and Villa and the restoration of a semblance of order in 1917. The fourth included the establishment of the Sonoran dynasty of de la Huerta, Obregón, and Calles and the slow reconstruction of the economy.
Okinawan Language
Authors: Miyara Shinsho
Published: June 2018

Within the Ryukyuan branch of the Japonic family of languages, present-day Okinawan retains numerous regional variants which have evolved for over a thousand years in the Ryukyuan Archipelago. Okinawan is one of the six Ryukyuan languages that UNESCO identified as endangered. One of the theoretically fascinating features is that there is substantial evidence for establishing a high central phonemic vowel in Okinawan although there is currently no overt surface [ï]. Moreover, the word-initial glottal stop [ʔ] in Okinawan is more salient than that in Japanese when followed by vowels, enabling recognition that all Okinawan words are consonant-initial. Except for a few particles, all Okinawan words are composed of two or more morae. Suffixation or vowel lengthening (on nouns, verbs, and adjectives) provides the means for signifying persons as well as things related to human consumption or production. Every finite verb in Okinawan terminates with a mood element. Okinawan exhibits a complex interplay of mood or negative elements and focusing particles. Evidentiality is also realized as an obligatory verbal suffix.
Phonetics of Singing in Western Classical Style
Authors: Sundberg Johan
Published: June 2018

The function of the voice organ is basically the same in classical singing as in speech. However, loud orchestral accompaniment has necessitated the use of the voice in an economical way. As a consequence, the vowel sounds tend to deviate considerably from those in speech. Male voices cluster formant three, four, and five, so that a marked peak is produced in spectrum envelope near 3,000 Hz. This helps them to get heard through a loud orchestral accompaniment. They seem to achieve this effect by widening the lower pharynx, which makes the vowels more centralized than in speech. Singers often sing at fundamental frequencies higher than the normal first formant frequency of the vowel in the lyrics. In such cases they raise the first formant frequency so that it gets somewhat higher than the fundamental frequency. This is achieved by reducing the degree of vocal tract constriction or by widening the lip and jaw openings, constricting the vocal tract in the pharyngeal end and widening it in the mouth. These deviations from speech cause difficulties in vowel identification, particularly at high fundamental frequencies. Actually, vowel identification is almost impossible above 700 Hz (pitch F5).

Another great difference between vocal sound produced in speech and the classical singing tradition concerns female voices, which need to reduce the timbral differences between voice registers. Females normally speak in modal or chest register, and the transition to falsetto tends to happen somewhere above 350 Hz. The great timbral differences between these registers are avoided by establishing control over the register function, that is, over the vocal fold vibration characteristics, so that seamless transitions are achieved.

In many other respects, there are more or less close similarities between speech and singing. Thus, marking phrase structure, emphasizing important events, and emotional coloring are common principles, which may make vocal artists deviate considerably from the score’s nominal description of fundamental frequency and syllable duration.
Formants
Authors: Aalto Daniel , Malinen Jarmo , Vainio Martti
Published: June 2018

Formant frequencies are the positions of the local maxima of the power spectral envelope of a sound signal. They arise from acoustic resonances of the vocal tract air column, and they provide substantial information about both consonants and vowels. In running speech, formants are crucial in signaling the movements with respect to place of articulation. Formants are normally defined as accumulations of acoustic energy estimated from the spectral envelope of a signal. However, not all such peaks can be related to resonances in the vocal tract, as they can be caused by the acoustic properties of the environment outside the vocal tract, and sometimes resonances are not seen in the spectrum. Such formants are called spurious and latent, respectively. By analogy, spectral maxima of synthesized speech are called formants, although they arise from a digital filter. Conversely, speech processing algorithms can detect formants in natural or synthetic speech by modeling its power spectral envelope using a digital filter. Such detection is most successful for male speech with a low fundamental frequency where many harmonic overtones excite each of the vocal tract resonances that lie at higher frequencies. For the same reason, reliable formant detection from females with high pitch or children’s speech is inherently difficult, and many algorithms fail to faithfully detect the formants corresponding to the lowest vocal tract resonant frequencies.
Nominalization: General Overview and Theoretical Issues
Authors: Lieber Rochelle
Published: June 2018

Nominalization refers both to the process by which complex nouns are created and to the complex nouns that are derived by that process. Nominalizations common in the languages of the world include event/result nouns, personal or participant nouns (agent, patient, location, etc.), as well as collectives and abstracts. It is common for nominalizations to be highly polysemous. Theoretical issues concerning nominalization typically stem from the question of how to account for this pervasive polysemy. Within generative grammar, both syntactic and lexicalist approaches have been proposed. The issue of polysemy in nominalization has also been of interest within cognitive and functional frameworks. The article considers, finally, the extent to which nominalization is subject to competition and blocking.
Morphological Entities: Overview and General Issues
Authors: Bauer Laurie
Published: June 2018

Some of the basic terminology for the major entities in morphological study is introduced, focusing on the word and elements within the word. This is done in a way which is deliberately introductory in nature and omits a great deal of detail about the elements that are introduced.
Linking Risk Reduction and Community Resilience
Authors: Ji Hyunjung
Published: June 2018

Risk reduction is a policy priority in governments at all levels. Building community resilience is one of the keys to reducing disaster risks. Resilience-focused risk reduction considers the wider social, political, and cultural environments of a community and emphasizes the importance of working with community members. This is in stark contrast to the previous vulnerability-focused risk management that treats disasters as unavoidable natural events and recognizes people as passive or helpless under the unavoidable disasters.

Community resilience is a critical concept in identifying visions and directions for risk reduction strategies. Community resilience has two major qualities: inherent community conditions (inherent resilience) and the community’s adaptive capacity (adaptive resilience). There are at least four components that should be included in risk reduction strategies to enhance both inherent and adaptive community resilience: risk governance, community-based risk reduction policies, non-governmental disaster entrepreneurs, and people-centered risk reduction measures.

Risk governance is required to bridge the gap between national policies and local practices, scientific knowledge of natural hazards and locally accumulated knowledge, and national assistance and local actions. Community-based risk reduction policies should complement national disaster policies to reflect locally specific patterns of hazard, exposure, and resilience that are otherwise ignored in policy design process at the international and national levels. Risk reduction strategies should also encourage emergence of non-governmental entrepreneurs who can contribute to the speed and success of community relief and recovery following a disaster by resolving the immediate needs of the affected communities and transitioning people toward autonomy and self-reliance. Finally, risk reduction strategies should include people-centered policy measures that are designed to change the awareness, attitudes, and behaviors of people so that they are more prepared when facing a disaster.
Disasters and Large-Scale Population Dislocations: International and National Responses
Authors: Oliver-Smith Anthony
Published: June 2018

Large-scale displacement takes place in the context of disaster because the threat or occurrence of hazard onset makes the region of residence of a population uninhabitable, either temporarily or permanently. Contributing to that outcome, the wide array of disaster events is invariably complicated by human institutions and practices that can contribute to large-scale population displacements. Growing trends of socially driven exposure and vulnerability around the world as well as the global intensification and frequency of climate-related hazards have increased both the incidence and the likelihood of large-scale population dislocations in the near future. However, legally binding international and national accords and conventions have not yet been put in place to deal with the serious impacts, and material, health-related, and sociocultural losses and human rights violations that are experienced by the millions of people being swept up in the events and processes of disasters and mass population displacements. Effective policy development is challenged by the increasing complexity of disaster risk and occurrence as well as issues of causation, adequate information, lack of capacity, and legal responsibility. States, international organizations, state and international development and aid agencies must frame, define, and categorize appropriately disaster forced displacement and resettlement to influence effective institutional responses in emergency humanitarian assistance, transitional shelter and care, and durable solutions in managing migration and resettlement if return is not possible. The forms that disaster-associated forced displacements are projected to take and corresponding national responses are explored in the Indian Ocean tsunami of 2004 in Sri Lanka, a massive disaster in a nation riven by civil conflict; Hurricane Katrina of 2005 in the United States, where the scale and nature of displacement bore little relation to hazard intensity; and the 2011 Great East Japan Earthquake, Tsunami, and nuclear exposure incident exemplifying the emerging trend of complex, concatenating, multihazard disasters that bring about large-scale population displacements.
Unraveling the role of low-frequency mutated genes in breast cancer
Authors: Lusito Eleonora , Felice Barbara , D’Ario Giovanni , Ogier Alessandro , Montani Francesca , Di Fiore Pier Paolo , Bianchi Fabrizio
Published: June 2018

Motivation

Breast cancer is the most commonly diagnosed malignancy in women and the second cause of cancer death in developed countries. While advancements in early detection and therapeutic options have led to a significant decrease in mortality, response to treatment is affected by the genetic heterogeneity of the disease. Recent genome-wide DNA mutation analyses revealed the existence of hundreds of low-frequency mutated genes, in addition to known cancer drivers: a finding that is prompting research into the impact of these genes on the pathogenesis of the disease.

Results

Herein, we describe a strategy towards the characterization of the role of low-frequency mutated genes in breast cancer. Through the combined analyses of publicly available gene expression and mutational datasets, we identified several Cancer Gene Modules (CMs) that we re-organized in Gene Regulatory Networks (GRN) enriched in low-frequency mutated genes. Importantly, these low-frequency mutated genes were mutually exclusive with known cancer drivers. Finally, we provide evidence that gene expression analysis of these mutated GRNs can predict resistance/sensitivity to chemotherapeutic drugs for breast cancer treatment.

Availability and implementation

Datasets are available at https://www.ncbi.nlm.nih.gov/geo/ and at https://www.ebi.ac.uk/ega/datasets/. Molecular signatures and GSEA software are available at http://www.gsea-msigdb.org/gsea/index.jsp. Source codes are available at https://github.com/EleonoraLusito/Reverse_Engineering_BC_GRNs.

Supplementary information

Supplementary data are available at Bioinformatics online.
GeneCT: a generalizable cancerous status and tissue origin classifier for pan-cancer biopsies
Authors: Sun Kun , Wang Jiguang , Wang Huating , Sun Hao
Published: June 2018

Motivation

Tissue biopsy is commonly used in cancer diagnosis and molecular studies. However, advanced skills are required for determining cancerous status of biopsies and tissue origin of tumor for cancerous ones. Correct classification is essential for downstream experiment design and result interpretation, especially in molecular cancer studies. Methods for accurate classification of cancerous status and tissue origin for pan-cancer biopsies are thus urgently needed.

Results

We developed a deep learning-based classifier, named GeneCT, for predicting cancerous status and tissue origin of pan-cancer biopsies. GeneCT showed high performance on pan-cancer datasets from various sources and outperformed existing tools. We believe that GeneCT can potentially facilitate cancer diagnosis, tumor origin determination and molecular cancer studies.

Availability and implementation

GeneCT is implemented in Perl/R and supported on GNU/Linux platforms. Source code, testing data and webserver are freely available at http://sunlab.cpy.cuhk.edu.hk/GeneCT/.

Supplementary information

Supplementary data are available at Bioinformatics online.
How do universities implement the Health Promoting University concept?
Authors: Suárez-Reyes Mónica , Muñoz Serrano Mónica , Van den Broucke Stephan
Published: June 2018

The Health Promoting University (HPU) concept encourages universities to incorporate health into the university culture, processes and policies in an effort to promote the health of the university community. Universities worldwide have adopted the approach and a framework for action has been developed to guide universities to become a HPU. However, information on how universities translate the framework into actions is scarce. This study explored the way in which 54 universities from 25 countries across the world implemented the HPU framework. An online questionnaire was used to assess the action areas and items of work addressed by the universities and to determine their adherence to the components of the HPU framework: use of the whole systems approach; multiservice collaboration; recognition by the university authorities; funding availability; membership of a HPU network and evaluation of the initiative. The results showed that these components were addressed by most universities. A Multi Correspondence and cluster analysis identified four types of universities based on the implementation of the components: ‘emerging’ HPUs that are not recognized by the university authorities and tend to not apply the whole systems approach or evaluation of the initiative, and ‘established’ HPUs that are recognized by the authorities, apply the whole systems approach and evaluate the initiative but that differ with regard to funding and membership of a HPU network. These results demonstrate that universities implement the HPU framework for action differently in order to become a Health Promoting University.
Predictors of Varenicline Adherence Among Cancer Patients Treated for Tobacco Dependence and its Association With Smoking Cessation
Authors: Crawford Grace , Weisbrot Jessica , Bastian Joseph , Flitter Alex , Jao Nancy C , Carroll Allison , Kalhan Ravi , Leone Frank , Hitsman Brian , Schnoll Robert
Published: June 2018

Introduction

The degree to which smokers adhere to pharmacotherapy predicts treatment success. The development of interventions to increase adherence requires identification of predictors of treatment adherence, particularly among specific clinical populations.

Methods

Using data from a 12-week open-label phase of a clinical trial of varenicline for tobacco dependence among cancer patients (N = 207), we examined: (1) the relationship between self-reported varenicline adherence and verified smoking cessation and (2) demographic and disease-related variables, and early changes in cognition, affect, withdrawal, the reinforcing effects of smoking, and medication side effects, as correlates of varenicline adherence.

Results

At the end of 12 weeks, 35% of the sample had quit smoking and 52% reported taking ≥80% of varenicline. Varenicline adherence was associated with cessation (p < .001): 58% of participants who were adherent had quit smoking versus 11% of those who were not. Participants who experienced early reductions in depressed mood and satisfaction from smoking and experienced an increase in the toxic effects of smoking, showed greater varenicline adherence (p < .05); the relationship between greater adherence and improved cognition, reduced craving, and reduced sleep problems and vomiting approached significance (p < .10).

Conclusions

Among cancer patients treated for tobacco dependence with varenicline, adherence is associated with smoking cessation. Initial changes in depressed mood and the reinforcing effects of smoking are predictive of adherence.

Implications

The benefits of varenicline for treating tobacco dependence among cancer patients may depend upon boosting adherence by addressing early signs of depression and reducing the reinforcing dimensions of cigarettes.
Hookah Use Among US Youth: A Systematic Review of the Literature From 2009 to 2017
Authors: Cooper Maria , Pacek Lauren R , Guy Mignonne C , Barrington-Trimis Jessica L , Simon Patricia , Stanton Cassandra , Kong Grace
Published: June 2018

Introduction

Given the US Food and Drug Administration (FDA)’s authority to regulate hookah, more research is needed to inform regulations intended to prevent youth from using hookah. This systematic review summarizes and assesses the literature related to hookah use among adolescents (11 to ≤18 years of age) in the United States from 2009 to 2017.

Methods

Database searches yielded 867 peer-reviewed articles. After duplicates were removed, authors reviewed 461 articles for inclusion. Included articles (n = 55) were coded for study themes, study quality, and their relevance to FDA’s research priorities. A qualitative synthesis is presented.

Results

The following themes were identified: (1) prevalence of hookah use (n = 42), (2) tobacco use transitions (n = 7), (3) sociodemographic correlates (n = 35), (4) psychosocial risk factors (n = 21), (5) concurrent use of other tobacco products (n = 31), (6) concurrent use of other substances (n = 9), and (7) other (n = 15)—which includes low prevalence themes. The qualitative synthesis showed increasing rates of hookah use. Older age, male gender, positive social normative beliefs, higher peer use, as well as lower perceived risk were associated with hookah use. Longitudinal studies of youth hookah use showed bidirectional relationships between use of hookah and other tobacco products. All articles fell within FDA’s research priority related to “behavior,” and three priorities (“impact analysis,” “health effects,” and “toxicity”) have not been explored for hookah use among US youth since 2009.

Conclusions

The prevalence of hookah use among youth in the United States is increasing, thus more research is needed to inform policies targeted to protect this vulnerable population.

Implications

This study represents a novel contribution to our understanding of hookah use among youth in the United States from 2009—the year that the Family Smoking Prevention and Tobacco Control Act was passed—to 2017. In recent years, hookah has become a more popular tobacco product among US youth; however, to date, no systematic reviews of hookah use among this population exist. Results highlight implications for future US FDA regulatory policy and identify gaps in research to be addressed in future studies.
Hybrid semiparametric systems for quantitative sequence-activity modeling of synthetic biological parts
Authors: Portela Rui M C , von Stosch Moritz , Oliveira Rui
Published: June 2018

Predicting the activity of modified biological parts is difficult due to the typically large size of nucleotide sequences, resulting in combinatorial designs that suffer from the “curse of dimensionality” problem. Mechanistic design methods are often limited by knowledge availability. Empirical methods typically require large data sets, which are difficult and/or costly to obtain. In this study, we explore for the first time the combination of both approaches within a formal hybrid semiparametric framework in an attempt to overcome the limitations of the current approaches. Protein translation as a function of the 5’ untranslated region sequence in Escherichia coli is taken as case study. Thermodynamic modeling, partial least squares (PLS) and hybrid parallel combinations thereof are compared for different data sets and data partitioning scenarios. The results suggest a significant and systematic reduction of both calibration and prediction errors by the hybrid approach in comparison to standalone thermodynamic or PLS modeling. Although with different magnitudes, improvements are observed irrespective of sample size and partitioning method. All in all the results suggest an increase of predictive power by the hybrid method potentially leading to a more efficient design of biological parts.
ACOG Clinical Updates Summary: Incidental Radiologic Findings
Authors: Olpin Jeffrey , Linstroth Laura
Published: June 2018

Over the past several decades, the use of cross-sectional imaging has steadily increased largely because of increasing refinements in imaging technology. The progressive improvement in both spatial and temporal resolution of imaging modalities over the years has enabled radiologists to diagnose and characterize disorders with increasing accuracy. However, improved resolution has led to the increased detection of imaging findings that may or may not be clinically relevant. Such incidental findings or “incidentalomas” may be difficult to differentiate from clinically relevant lesions. Radiologists may provide disparate recommendations regarding incidental or indeterminate findings when interpreting results of gynecologic and obstetric imaging examinations in routine clinical practice. Vague recommendations pose challenges for referring clinicians who are unable to determine the clinical relevance of such lesions. Therefore, a general awareness of incidental lesions for any given abdominal or thoracic organ is important for obstetrician–gynecologists involved in the management of patients who require imaging studies. The aim of this monograph is to aid obstetrician–gynecologists in the detection, characterization, and management of incidentally detected lesions that may be encountered on routine women’s imaging examinations.
What Factors Influence Reimbursement for 1 to 2 Level Anterior Cervical Discectomy and Fusion Procedures?
Authors: Virk Sohrab S. , Phillips Frank M. , Moffatt-Bruce Susan D. , Khan Safdar N.
Published: June 2018

Study Design.

Retrospective review.

Objective.

To determine reimbursement associated with an anterior cervical discectomy and fusion (ACDF) and the demographic factors influencing reimbursement for an ACDF.

Summary of Background Data.

ACDF has been shown to be a cost-effective procedure. However, there has been minimal analysis of factors influencing reimbursement for this procedure.

Methods.

Clinical and financial data were retrospectively reviewed for 176 patients undergoing an ACDF procedure in 2013 and 2014. Patients were included if they had primary ACDF and excluded if they were treated for a traumatic cervical spine fracture, infection, failed primary procedure, front/back procedure, or total disc replacement procedure. Clinical factors analyzed included number of levels fused, surgical time, length of stay in the hospital, estimated blood loss, implant type, Charleson Comorbidity Index (CCI), and preoperative diagnosis. Payer type and reimbursement associated with physician and hospital fees were collected for each patient. A multiple linear regression model determined the factors influencing reimbursement data using a backward conditional stepwise methodology. Variables were only included in multivariate analysis if there was a significant (P < 0.05) impact on reimbursement within univariate analysis.

Results.

One hundred and twenty-eight patients met inclusion criteria. The average reimbursement per patient was $24,622 (+/- standard deviation of 14,616). The only significant factors influencing reimbursement was payer type (P < 0.001) and length of hospital stay (P < 0.001). These two independent multivariate determinants of reimbursement only accounted for 18.6% of reimbursement variability.

Conclusion.

There is substantial variability in reimbursement for ACDF procedures. Multivariate analysis indicates that payer type and length of hospital stay significantly influence reimbursement. Our model, however, only explained a small proportion of reimbursement variability indicating that factors outside our analysis may significantly affect hospital reimbursement.

Level of Evidence: 3
Outcomes of patients with a pretransplant history of early-stage melanoma
Authors: Puza Charles J. , Barbas Andrew S. , Mosca Paul J.
Published: June 2018

A history of melanoma within the preceding 5 years is commonly considered a contraindication to solid organ transplantation. We investigated how a pretransplant history of melanoma impacts patient survival and melanoma recurrence. Institutional Review Board approval was obtained, and Duke’s retrospective database was used to identify 4552 patients who underwent a solid organ transplant at Duke University from 1 January 2001 to 31 December 2016. Data with regard to the transplant, melanoma characteristics, rejection episodes, and survival were recorded. Of 4552 patients who underwent a solid organ transplant, 12 (0.3%) had a history of melanoma before transplant (six with melanoma in situ and six with stage I disease). The median time between melanoma diagnosis and transplant was 4.13 years (range: 1.1–13.3 years). The study cohort consisted of four liver transplants, four lung transplants, one kidney transplant, one heart transplant, one small bowel transplant, and one multivisceral transplant. At the median follow-up time of 2.8 years, 10 (83.3%) patients were alive. In nonmelanoma cohorts, the 3-year survival is 70% for thoracic transplants, 78% for liver transplants, and 88% for kidney transplants. In well-selected patients with a history of early-stage melanoma and an appropriate time interval between melanoma treatment and transplant, post-transplant outcomes are favorable.
Characteristics, Therapeutic Needs, and Scope of Patients With a Continuous-Flow Left Ventricular Device Entering Cardiac Rehabilitation
Authors: Hildebrandt Anke , Willemsen Detlev , Reiss Nils , Bartsch Petra , Schmidt Thomas , Bjarnason-Wehrens Birna
Published: June 2018

Background:

With an increasing number of left ventricular assist devices (LVADs) being implanted, the need for adequate cardiac rehabilitation (CR) regimens meeting the special needs of these patients arises. Only a few studies have reported experience gained on this topic. Structured CR strategies are poorly implemented. The aim was to evaluate the characteristics, therapeutic needs, and scope of LVAD patients at admission to CR within a greater cohort in order to identify their special CR needs.

Methods:

Retrospective single-center study; 69 LVAD patients (50.7 ± 13.6 y; 59 male; 48 HVAD; 21 HeartMate II) who completed first inpatient CR were included. Patient records were used to document relevant medical information (including the results of a 6-min walk test and a maximal isometric strength test for quadriceps femoral muscles in both legs) and the International Classification of Functioning, Disability and Health for classification of health and health-related domains.

Results:

Patient characteristics demonstrated a heterogeneous group: CR was started 44 ± 38.6 d after implantation; CR duration was 28 ± 9.7 d. Despite similar etiology, physical and psychological condition was diverse, although, overall a high degree of impairment was present, especially in the body function (79.7%) and activity and participation (95.7%) domains. The results demonstrated the need for a highly individualized approach in the somatic and also in the education, psychosocial, and social therapeutic regimes.

Conclusion:

The results demonstrate a heterogeneous group with a high level of impairment and special needs in many CR domains. The development and evaluation of a special highly individualized approach of CR, which meets the special needs of these patients, is needed.
Evaluation of Long-Term Silicone Hydrogel Use on Ocular Surface Inflammation and Tear Function in Patients With and Without Meibomian Gland Dysfunction
Authors: Yucekul Burcu , Mocan Mehmet C. , Kocabeyoglu Sibel , Tan Cagman , Irkec Murat
Published: June 2018

Objectives:

To determine whether silicone hydrogel (SH) contact lens (CL) use, with or without meibomian gland dysfunction (MGD), promotes ocular surface inflammation.

Methods:

Subjects wearing SH-CL for at least 6 months who also had coexisting MGD (group 1, n=20), SH-CL users who did not have MGD (group 2, n=20), patients who had MGD but did not use CL (group 3, n=20), and healthy CL-naive individuals with no known systemic or ocular diseases (group 4, n=20) were included in this cross-sectional, single-center study. All subjects underwent tear function tests consisting of tear break-up time (tBUT), ocular surface staining, Schirmer test, and the Ocular Surface Disease Index (OSDI) questionnaire, as well as determination of tear IL-1RA, IL-1β, IL-2, IL-2R, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IL-12, IL-13, IL-15, IL-17, IFN-α, IFN-γ, TNF-α, granulocyte-macrophage colony-stimulating factor, IP-10, monokine induced by gamma interferon, RANTES, eotaxin, MIP-1α, MIP-1β, and MCP-1 levels using Luminex multicytokine immunobead assay. Intergroup comparisons were made using one-way analysis of variance or Kruskal–Wallis test.

Results:

The tBUT was lower (P=0.048) and ocular surface staining (P=0.032) as well as OSDI scores (P=0.001) were higher in group 1 but not in groups 2 or 3 when compared with those in the control group. Tear cytokine levels were similar across all groups. None of the tear cytokine levels were elevated in CL wearers (groups 1 and 2) or those with MGD (groups 1 and 3) as compared to those in control subjects.

Conclusion:

Silicone hydrogel contact lens use with concomitant MGD is not associated with cytokine-driven ocular surface inflammation but may impact tear function leading to dry eye symptoms.
Sway Balance Mobile Application: Reliability, Acclimation, and Baseline Administration
Authors: Mummareddy Nishit , Brett Benjamin L. , Yengo-Kahn Aaron M. , Solomon Gary S. , Zuckerman Scott L.
Published: June 2018

Objectives:

To describe historic baseline session administration practices, to assess the utility of a practice trial (an acclimation trial) before the official balance session, and to examine the within-session reliability of the Sway Balance Mobile Application (SBMA).

Design:

Retrospective observational study.

Setting:

Middle schools, high schools, and colleges across the United States.

Participants:

More than 17 000 student-athletes were included in the Sway Medical database with 7968 individuals meeting this study's inclusion criteria.

Independent Variables:

The Sway Medical database included the following subject characteristics for each student-athlete: age, sex, weight, and height.

Main Outcome Measures:

Balance assessment score generated by the SBMA.

Results:

Variable administration practices with significant differences between baseline session averages across methods were found. Individuals who performed an acclimation trial had a significantly higher baseline session average than those who did not. Within-session reliability estimates were in the low to adequate range (r = 0.53-0.78), with higher estimates found for 2 consecutive baseline tests (r = 0.75-0.78).

Conclusions:

For maximum clinical utility, a standardized protocol for postural control baseline acquisition is necessary. Acclimation trial should be administered before a baseline session to minimize variability, especially with only 1 to 2 baseline tests. The highest reliability was observed across 2 consecutive baseline tests within the same baseline session. We suggest obtaining baseline balance measurements with an acclimation trial followed by a baseline session with 2 baseline tests. Prospective studies are required for validation.
Comparative Effectiveness and Safety of Radiofrequency Ablation Versus Argon Plasma Coagulation for Treatment of Gastric Antral Vascular Ectasia
Authors: McCarty Thomas R. , Rustagi Tarun
Published: June 2018

Background and Aims:

Although argon plasma coagulation (APC) is the current standard endoscopic treatment for gastric antral vascular ectasia (GAVE), radiofrequency ablation (RFA) has emerged as an attractive alternative. The aim of this study was to perform a systematic review and meta-analysis to evaluate the comparative effectiveness and safety of RFA and APC in the treatment of GAVE.

Materials and Methods:

Searches of PubMed, EMBASE, Web of Science, and Cochrane Library databases along with major gastroenterology annual meetings were performed through March 2017. Measured outcomes for comparative effectiveness and safety including improvement in hemoglobin levels, transfusion dependence, number of treatment sessions, complications, follow-up, and author-reported endoscopic success were compared among RFA and APC studies.

Results:

In total, 24 studies (n=508) involving APC and 9 studies (n=104) on RFA were included. Mean age of patients included was comparable in both groups (65.33±7.80 y for APC vs. 66.96±6.23 y for RFA; P=0.98). Pooled mean follow-up was significantly longer for APC compared with RFA (19.52±13.11 vs. 7.43±3.72 mo; P<0.001). In total, 47% of RFA patients were refractory to previous treatment with APC. RFA required fewer mean treatment sessions compared with APC (2.10 vs. 3.39, respectively; P<0.001). RFA resulted in fewer and less severe complications as compared with APC (1.92% vs. 5.12%, respectively; P<0.001). Although the reported endoscopic success was better with RFA compared with APC (97% vs. 66%; P<0.001), the posttreatment pooled hemoglobin increase and reduction in transfusion dependence was higher for APC compared with RFA [weighted mean difference 3.10 g/dL (95% confidence interval, 2.92-3.28) vs. 1.95 g/dL (95% confidence interval, 1.62-2.26); P<0.001; and 88% vs. 66%; P<0.001, for APC and RFA, respectively].

Conclusions:

There is limited long-term data on RFA for GAVE; however, available evidence suggests RFA has a comparable efficacy and tolerability compared with APC. In addition, RFA seems to be effective for APC-refractory GAVE patients. Future controlled trials are needed to directly compare treatment efficacy, long-term durability, safety, and cost-effectiveness between these interventions.
Physical Activity and Skipping Breakfast Have Independent Effects on Body Fatness Among Adolescents
Authors: Cayres Suziane U. , Urban Jacqueline B. , Fernandes Rômulo A.
Published: June 2018

Objective:

We analyzed the longitudinal relationship between breakfast intake and adiposity among adolescents, and the possible mediation role of physical activity on this phenomenon.

Methods:

We conducted the longitudinal study composed of 86 adolescents (11–14 years old), absence of any known chronic diseases and no regular medicine use that returned the formal consent and assent both signed. Breakfast intake was reported through face‐to‐face interviews. Adiposity was assessed using a densitometry scanner. Physical activity was estimated through step counts performed using pedometers. Biological maturation was estimated through the maturity level. Student t test for independent samples was used to compare adolescents who were “nonskipping breakfast” and “skipping breakfast,” whereas the relationship between adiposity, physical activity, and skipping breakfast was assessed using Pearson correlation. Structural equation model was created to identify the mediation role of physical activity on the relationship between nonskipping breakfast and adiposity.

Results:

After 12 months, adolescents who had consumed breakfast regularly presented decreased trunk fatness (−3.5% [95% confidence interval (CI): −6.9 to −0.2]) and body fatness (−2.3% [95% CI: −3.9 to −0.7]) compared with their counterparts. Physical activity had an inverse relationship with trunk fatness (r = −0.270 [95% CI: −0.457 to −0.060]). Nonskipping breakfast was, however, not significantly related to trunk fatness; however, physical activity seems to reduce trunk fatness in our sample (r = −0.281; 95% CI: −0.479 to −0.083).

Conclusions:

Adolescents who ate breakfast regularly presented lower body fatness independent of physical activity, whereas trunk fatness decreased in adolescents who improved physical activity.
Psychosocial Factors and Preterm Birth Among Black Mothers and Fathers
Authors: Giurgescu Carmen , Misra Dawn P.
Published: June 2018

Objective:

Black women are more likely to live in disadvantaged neighborhoods and experience racial discrimination and psychological stress compared with White women. These factors have been related to preterm birth (PTB). However, research is limited on the associations of disadvantaged neighborhoods, racial discrimination, and psychological stress among expectant Black fathers and PTB. This review focuses on what is known about psychosocial factors in relation to PTB among Black parents.

Methods:

The Scopus database was used to search for studies using keywords of adverse childhood experiences, neighborhood environment, racial discrimination, psychological stress, depressive symptoms/depression, coping, locus of control, social support, and mother–father relationship. Each of these keywords was combined with the term preterm birth. This review focused on the associations of these psychosocial factors collected during the prenatal period and risk for PTB. However, due to lack of data for some of these factors during the prenatal period, studies conducted in the immediate period after birth were included. The focus of this review was on research conducted with Black expectant fathers given the limited data on the association between paternal psychosocial factors and PTB. This review only highlights studies that examined the associations of maternal psychosocial factors and PTB. It does not present a comprehensive review of studies on maternal factors given the extent of the studies that examined these associations.

Results:

Pregnant Black women are more likely to report living in disadvantaged neighborhoods; experiencing racial discrimination, psychological stress, and depressive symptoms; using avoidance coping; and reporting lower levels of social support compared with White women. Limited data suggest that Black expectant fathers experience higher rates of everyday unfair treatment because of race/ethnicity compared with White fathers. Research suggests that these psychosocial factors have been related to PTB among pregnant Black women; however, research is limited on examining these associations among expectant Black fathers.

Clinical Implications:

Maternal–child nurses are in the position to assess these psychosocial factors among expectant parents. Nurses should also assess risk factors for PTB for both expectant parents and provide support to couples who are at risk for PTB.
Enhancing Financial Performance: An Application of Lean Six Sigma to Reduce Insurance Claim Denials
Authors: Kovach Jamison V. , Borikar Shrutika
Published: June 2018

Health systems typically lose approximately 3% to 5% of net revenues annually due to insurance claim denials. While most denials can be appealed, the administrative burden of sorting through and appealing them can be time consuming and delays the revenue collection process. This article describes how the Lean Six Sigma methodology was used to improve the revenue cycle by reducing insurance claim denials for a leading pediatric hospital in the United States. The use of this approach is demonstrated through a case example focused on reducing denials by improving the hospital's Emergency Center registration process. Multiple pilot tests were performed to ensure the proposed changes sufficiently addressed the problem of missing/incomplete insurance information. Results indicated that the revised registration form reduced missing/incomplete fields by 67%. As a result, the revised form was implemented, which helped greatly reduce insurance claim denials. In addition to providing an example from which other health systems can learn to successfully implement Lean Six Sigma to enhance the performance of their revenue cycle, this work helped the hospital in which this research was performed improve its patient experience by making it easier for patients to complete their Emergency Center registration form.