bluuebunny/crossref_metadata_2025 huggingface dataset:
Children with life-limiting conditions in paediatric intensive care units: a national cohort, data linkage study
Authors: Fraser Lorna K , Parslow Roger
Published: July 2017

Objective

To determine how many children are admitted to paediatric intensive care unit (PICU) with life-limiting conditions (LLCs) and their outcomes.

Design

National cohort, data-linkage study.

Setting

PICUs in England.

Patients

Children admitted to a UK PICU (1 January 2004 and 31 March 2015) were identified in the Paediatric Intensive Care Audit Network dataset. Linkage to hospital episodes statistics enabled identification of children with a LLC using an International Classification of Diseases (ICD10) code list.

Main outcome measures

Random-effects logistic regression was undertaken to assess risk of death in PICU. Flexible parametric survival modelling was used to assess survival in the year after discharge.

Results

Overall, 57.6% (n=89 127) of PICU admissions and 72.90% (n=4821) of deaths in PICU were for an individual with a LLC.

The crude mortality rate in PICU was 5.4% for those with a LLC and 2.7% of those without a LLC. In the fully adjusted model, children with a LLC were 75% more likely than those without a LLC to die in PICU (OR 1.75 (95% CI 1.64 to 1.87)).

Although overall survival to 1 year postdischarge was 96%, children with a LLC were 2.5 times more likely to die in that year than children without a LLC (OR 2.59 (95% CI 2.47 to 2.71)).

Conclusions

Children with a LLC accounted for a large proportion of the PICU population. There is an opportunity to integrate specialist paediatric palliative care services with paediatric critical care to enable choice around place of care for these children and families.
Utility of microscope-integrated optical coherence tomography (MIOCT) in the treatment of myopic macular hole retinal detachment
Authors: Kumar Atul , Kakkar Prateek , Ravani Raghav Dinesh , Markan Ashish
Published: July 2017

Macular hole-associated retinal detachment in high myopia is described as a final stage in progression of myopic traction maculopathy (MTM).1â€“3Shimadaet al4described the progressive stages of MTM from macular retinoschisis to serous retinal detachment in high myopia. Stage 4 MTM is characterised as disappearance of retinoschisis with progression to retinal detachment due to macular hole formation. It is hypothesised that vitreoschisis and abnormal vitreo-retinal interface create the premacular tangential traction.5 6Intraoperative triamcinolone acetonide is used to visualise the residual posterior vitreous cortex (PVC). We hereby describe the utility of microscope-integrated optical coherence tomography (MIOCT) in assisting complete removal of PVC and internal limiting membrane (ILM) peeling with multilayered inverted ILM flap in the treatment of myopic macular hole retinal detachment. MIOCT helped identify vitreoschisis and confirm the position of ILM flaps over the macular hole intraoperatively.
Leucocytoclastic vasculitis following influenza vaccination
Authors: Cao Sissi , Sun Dongmei
Published: July 2017

Background

Influenza vaccinations are commonly administered and effectively prevent influenza. Most vaccine reactions are mild and self-limiting with few reported cases of vasculitis. We present a case of vasculitis post-vaccination unique for its dramatic visual presentation and rapid response to treatment with the aim to emphasise possible causation and timely treatment.

Case presentation

This is a case of a 60-year-old man with chronic idiopathic pulmonary fibrosis, with fever, arthralgias and rash characterised by extensive erythematous plaques on his limbs and trunk 5â€‰days after influenza vaccination. Skin biopsy revealed leucocytoclastic vasculitis. Rash and symptoms resolved 10 days after initiating treatment with oral prednisone.

Conclusions

Influenza vaccines can potentially precipitate cutaneous vasculitis, and timely treatment reduces morbidity in the elderly.
A rare case of atypical chronic lymphocytic leukaemia presenting as nephrotic syndrome
Authors: Soldarini Martina , Farina Lucia , Genderini Augusto , Bolli Niccolo
Published: July 2017

Chronic lymphocytic leukaemia (CLL) is characterised by a lymphocytosis of mature-appearing clonal CD5+, CD23+ B lymphocytes. CLL cells arise from the bone marrow and infiltrate lymphoid tissues such as lymph nodes and spleen. Presentation is usually through discovery of lymphocytosis or lymphadenopathy. Unusual presentations, especially paraneoplastic syndromes are rare. Here, we describe a rare case presenting with severe nephrotic syndrome associated with the presence of a monoclonal protein in serum. Workup for suspected plasma cell dyscrasia led instead to the diagnosis of bone marrow infiltration by atypical CLL without lymphocytosis. Renal biopsy showed a glomerulonephritis that turned out to be paraneoplastic as it went into remission after treatment for CLL. Our case shows an unusual presentation of CLL and prompts for increased awareness of lymphoproliferative disorders in the context of seemingly unrelated conditions that may be paraneoplastic in origin.
Venobiliary fistula with haemobilia: a rare complication of percutaneous liver biopsy
Authors: Ayoola Rotimi , Jamindar Parth , Williams Renee
Published: July 2017

We describe a case of a 36-year-old man with a history of chronic hepatitis C who presented with abdominal pain 3 days after undergoing a percutaneous ultrasound-guided liver biopsy. Initial investigations revealed a venobiliary fistula with haemobilia and obstructive jaundice with direct bilirubin peaking at 9.2 mg/dL. He underwent an endoscopic retrograde cholangiopancreatography with sphincterotomy and stent placement, bilirubin decreased to 3.7 mg/dL, and the patient was discharged. The patient returned with recurrent abdominal pain and upper gastrointestinal bleeding with haemoglobin of 8.6 g/dL, requiring multiple transfusions. He underwent transcatheter arterial embolisation but continued bleeding. Radiofrequency ablation was pursued and was able to achieve haemostasis. The patient was discharged. The patient returned again with a fever of 39.2 °C and was found to have a large right hepatic lobe abscess. The patient underwent abscess drainage with drain placement and was treated with antibiotics for 6 weeks. He followed up in the clinic with resolution of symptoms and infection.
Organ-sparing surgery for large cell calcifying Sertoli cell tumour in a patient with Carney complex
Authors: Freire Maria José , Nunes Pedro , Sousa LuÃ­s , Figueiredo Arnaldo
Published: July 2017

Carney complex is a rare genetic disease characterised by a complex of myxomas, spotty pigmentation and endocrine overactivity. At diagnosis, about one-third of male patients presents with testicular tumours, namely large cell calcifying Sertoli cell tumours, which are often multicentric and/or bilateral and have a low malignant potential. Although radical orchiectomy is the gold standard for the treatment of testicular neoplasms, a conservative approach with partial orchiectomy or tumourectomy may be the best treatment option for these patients, allowing the preservation of endocrine function, fertility and body image. We present a case of a 19-year-old man with a known history of Carney complex with early identification of a small testicular tumour treated with organ-sparing surgery.
Focal neurological presentation in Hashimoto's encephalopathy mimicking a vascular occlusion of the middle cerebral artery
Authors: Alazzeh Ahmad , Jaroudi Sarah , Gooch Matthew , Peiris Alan N.
Published: July 2017

Hashimoto’s encephalopathy is a rare form of autoimmune encephalopathy. It is likely an underdiagnosed entity especially in the setting of focal neurological defects. We report a case of a 49-year-old man who presented with “strange behavior”of a day’s duration. Examination was significant only for lethargy, poor attention span and agitation. Routine labs revealed leucocytosis. Head CT scan was unremarkable. Lumbar puncture showed high white blood cells with lymphocytosis and elevated protein level. The patient was empirically treated for meningitis without improvement. His symptoms progressed to sudden right-sided weakness, ataxia and right facial droop. The MRI and magnetic resonance angiogram (MRA)were normal. The patientâ€™s focal neurological signs improved spontaneously. Encephalopathy work-up was negative except for positive anti-Thyroid Peroxidaseand antithyroglobulin. The patient was treated as Hashimoto encephalopathy with steroids and azathioprine with marked improvement. Our case highlights how focal neurological findings can potentially mislead the provider to consider vascular aetiologies in Hashimoto’s encephalopathy.
Laparoscopic excision of an inflammatory myofibroblastic tumour of the bladder disguised as deep infiltrating endometriosis
Authors: Koukoura Ourania , Alevra Zoi , Pavlakis Kitty , Pistofidis George
Published: July 2017

Inflammatory myofibroblastic tumour (IMT) of the bladder is a rare tumour of indeterminate malignant potential with myofibroblastic differentiation, with a generally benign but rarely aggressive behaviour. Vesical IMT is usually treated by transurethral resection or partial cystectomy. Herein we describe a case of a woman who underwent laparoscopic excision of an IMT of the bladder, initially diagnosed as deep infiltrating endometriosis.
Marantic endocarditis and paraneoplastic pulmonary embolism
Authors: Lobo Ferreira Tiago , Alves Rosa , Judas Tiago , Delerue Maria F
Published: July 2017

Cancer is frequently associated with a hypercoagulable state. Almost 15% of patients with cancer will suffer a thromboembolic event during their clinical course. The aetiology of this hypercoagulable state is multifactorial and includes procoagulant factors associated with malignancy as well as the host's inflammatory response. Cancer-associated thrombophilia can present as venous thromboembolism, migratory superficial thrombophlebitis, arterial thrombosis, disseminated intravascular coagulation, thrombotic microangiopathy and rarely non-bacterial thrombotic endocarditis (NBTE). In this paper, we will describe an uncommon presentation of lung cancer on a non-smoker middle-aged woman, with recent diagnosis of pulmonary embolism, who develops malignant recurrent pleural effusion, NBTE with cutaneous and neurological manifestations, with a rapid evolution into shock, culminating in death. Diagnosis of NBTE requires a high degree of clinical suspicion. The mainstay of treatment is systemic anticoagulation to prevent further embolisation and underlying cancer control whenever is possible.
Anaphylaxis secondary toParietaria judaica(wall pellitory)
Authors: Vella Chiara , Sammut Patrick
Published: July 2017

Aeroallergens are an unusual cause of anaphylaxis with sparse reports in the literature. We describe a case of suspected anaphylaxis toParietaria judaicapollen and the difficulties encountered in confirming this diagnosis.
Peritoneal tuberculosis as a cause of ascites in a patient with cirrhosis
Authors: Vaz Ana Margarida , Peixe Bruno , Ornelas Rita , Guerreiro Horácio
Published: July 2017

A 59-year-old Portuguese Caucasian man with a history of heavy alcohol intake and no significant medical history presented with ascites, weight loss and general malaise. The ascitic fluid analysis showed 921 cells/mm3with mononuclear predominance (93.6%), elevated total proteins and a slightly elevated serum-ascites albumin gradient. The abdominal ultrasound confirmed the presence of chronic liver disease with ascites, and additionally on CT there was evidence of peritoneal thickening. On repeat paracentesis, the ascitic fluid analysis showed elevated adenosine deaminase but it was negative for the presence of mycobacteria by Ziehl-Neelsen stain, Löwenstein-Jensen culture and PCR amplification. Due to the persistent suspicion of tuberculosis, a laparoscopy was performed showing multiple small white tubercles scattered over the peritoneum. Peritoneal biopsies showed the presence of necrotising granulomas and cultures were positive forMycobacterium tuberculosiscomplex. After a 6-month course of tuberculostatics, the ascites resolved completely. The patient remained asymptomatic.
Pseudomonas aeruginosaas an unusual cause of cavitating lung lesion
Authors: Salciccioli Justin D , Woodcock Hannah , Darmalingam Mathina
Published: July 2017

A 31-year-old woman with systemic lupus erythematosus presented to the emergency department with cough for 1â€‰week. Chest radiograph demonstrated cavitating lesion in the right upper zone with surrounding ground-glass change. Blood culture results from the day of hospital presentation grewPseudomonas aeruginosa. Sputum sample and pleural fluid grewP. aeruginosaand were negative for acid-fast bacilli.P. aeruginosais a rare cause of cavitating lung lesion and has been associated with immunocompromised hosts. Most reports of cavitatingP. aeruginosalesions have been identified in patients who are immunocompromised secondary to HIV.The current case highlights the potential for infection in patients who are immunosuppressed therapeutically and appropriate investigations are necessary to rule out common causes of cavitating lung lesions.
Mapping global policy discourse on antimicrobial resistance
Authors: Wernli Didier , Jørgensen Peter S , Morel Chantal M , Carroll Scott , Harbarth Stephan , Levrat Nicolas , Pittet Didier
Published: July 2017

The rising importance of antimicrobial resistance (AMR) to the global health agenda is associated with a growing number of parties voicing their concern about the issue. With more recommendations and policies appearing, understanding the policy process requires making sense of the views, values, interests and goals of each participant. Policy frame analysis provides a method to understand both the scientific view and the actions advocated by global health actors to tackle AMR. Here we review and refine policy frame analyses of AMR using a deductive approach. Among several policy frames previously defined in the field of global health, we identify ‘AMR as healthcare’, ‘AMR as development’, ‘AMR as innovation’ and ‘AMR as security’ as frequent frames used in dealing with AMR. In addition, we found that ‘AMR as One Health’ constitutes a recent framing of the topic that seeks to provide an integrated understanding between human and animal health. Each frame originates in distinct scientific fields, conceptualises the main causes of AMR and prioritises different interventions and measurements. Better understanding and integration of these frames into an overarching social and ecological framework will support policy progress in tackling AMR.
Periconception endogenous and exogenous maternal sex steroid hormones and risk of asthma and allergy in offspring: protocol for a systematic review and meta-analysis
Authors: Talovic Merhunisa , Sheikh Aziz , McCleary Nicola , Erkkola Maijaliisa , Kaila Minna , Virtanen Suvi M , Nwaru Bright I
Published: July 2017

Introduction

Pregnancy is associated with several hormonal changes which influence the developing fetus. Variations in maternal endogenous hormones and prepregnancy use of hormonal preparations have been linked to asthma and allergy in the offspring, but findings are inconsistent. We plan to undertake a systematic review to synthesise the evidence on the association between endogenous and exogenous maternal sex hormones and the risk of asthma and allergy in the offspring.

Methods and analysis

We will search Medline, Embase, Cochrane Library, Institute of Scientific Information Web of Science, Cumulative Index of Nursing and Allied Health, Scopus, Google Scholar, Allied and Complementary Medicine Database, Global Health, Psychological Information (PsycINFO), Centre for Agriculture and Bioscience (CAB) International and WHO Global Health Library from inception until 2016 to identify relevant studies on the topic. Additional studies will be identified by searching databases of proceedings of international conferences, contacting international experts in the field and searching the references cited in identified studies. We will include analytical epidemiological studies. Two researchers will independently screen identified studies, undertake data extraction and assess risk of bias in eligible studies, while a third reviewer will arbitrate any disagreement. We will use the Effective Public Health Practice Project tool to assess the risk of bias in the studies. We will perform a random-effects meta-analysis to synthesise the evidence. We will use the Grading of Recommendations Assessment, Development and Evaluation approach to rate the strength and quality of the overall evidence with respect to each outcome.

Ethics and dissemination

Ethical approval is not required since the study is a systematic review of published literature. Our findings will be reported in a peer-reviewed scientific journal.

PROSPERO registration number

CRD42016048324
Evaluation of the geriatric co-management for patients with fragility fractures of the proximal femur (Geriatric Fracture Centre (GFC) concept): protocol for a prospective multicentre cohort study
Authors: Joeris Alexander , Hurtado-Chong Anahí , Hess Denise , Kalampoki Vasiliki , Blauth Michael
Published: July 2017

Introduction

Treatment of fractures in the elderly population is a clinical challenge due partly to the presence of comorbidities. In a Geriatric Fracture Centre (GFC), patients are co-managed by a geriatrician in an attempt to improve clinical outcomes and reduce morbidity and mortality. Until now the beneficial effect of orthogeriatric co-management has not been definitively proven. The primary objective of this study is to determine the effect of GFC on predefined major adverse events related to a hip fracture compared to usual care centres (UCC). The secondary objectives include assessments in quality of life, patient-reported outcomes and cost-effectiveness.

Methods and analysis

Two hundred and sixty-six elderly patients diagnosedwith hip fracture and planned to be treated with osteosynthesis or endoprosthesis in either a GFC or UCC study site will be recruited, 133 per type of centre. All procedures and management will be done according to the site's standard of care. Study-related visits will be performed at the following time points: preoperative, intraoperative, discharge from the orthopaedic/trauma department, discharge to definite residential status, 12 weeks and 12 months postsurgery. Data collected include demographics, residential status, adverse events, patient-reported outcomes, fall history, costs and resources related to treatment. The risk of major adverse events at 12 months will be calculated for each centre type; patient-reported outcomes will be analysed by mixed effects regression models to estimate differences in mean scores between baseline and follow-ups whereas cost-effectiveness will be assessed using the incremental cost-effectiveness ratio.

Ethics and dissemination

Ethics approval for this study was granted from the local Ethics Committees or Institutional Review Board from each of the participating sites prior to patient enrolment. The results of this study will be published in peer-reviewed journals and presented at different conferences.

Trial registration number

ClinicalTrials.gov:NCT02297581; pre-results.
Improving site selection in clinical studies: a standardised, objective, multistep method and first experience results
Authors: Hurtado-Chong Anahí , Joeris Alexander , Hess Denise , Blauth Michael
Published: July 2017

Introduction

A considerable number of clinical studies experience delays, which result in increased duration and costs. In multicentre studies, patient recruitment is among the leading causes of delays. Poor site selection can result in low recruitment and bad data quality. Site selection is therefore crucial for study quality and completion, but currently no specific guidelines are available.

Material and methods

Selection of sites adequate to participate in a prospective multicentre cohort study was performed through an open call using a newly developed objective multistep approach. The method is based on use of a network, definition of objective criteria and a systematic screening process.

Illustrative example of the method at work

Out of 266 interested sites, 24 were shortlisted and finally 12 sites were selected to participate in the study. The steps in the process included an open call through a network, use of selection questionnaires tailored to the study, evaluation of responses using objective criteria and scripted telephone interviews. At each step, the number of candidate sites was quickly reduced leaving only the most promising candidates. Recruitment and quality of data went according to expectations in spite of the contracting problems faced with some sites.

Conclusion

The results of our first experience with a standardised and objective method of site selection are encouraging. The site selection method described here can serve as a guideline for other researchers performing multicentre studies.

Trial registration number

ClinicalTrials.gov:NCT02297581.
PREDICT-CP: study protocol of implementation of comprehensive surveillance to predict outcomes for school-aged children with cerebral palsy
Authors: Boyd Roslyn N , Davies Peter SW , Ziviani Jenny , Trost Stewart , Barber Lee , Ware Robert , Rose Stephen , Whittingham Koa , Sakzewski Leanne , Bell Kristie , Carty Christopher , Obst Steven , Benfer Katherine , Reedman Sarah , Edwards Priya , Kentish Megan , Copeland Lisa , Weir Kelly , Davenport Camilla , Brooks Denise , Coulthard Alan , Pelekanos Rebecca , Guzzetta Andrea , Fiori Simona , Wynter Meredith , Finn Christine , Burgess Andrea , Morris Kym , Walsh John , Lloyd Owen , Whitty Jennifer A , Scuffham Paul A
Published: July 2017

Objectives

Cerebral palsy (CP) remains the world’s most common childhood physical disability with total annual costs of care and lost well-being of $A3.87b. The PREDICT-CP (NHMRC 1077257 Partnership Project: Comprehensive surveillance to PREDICT outcomes for school age children with CP) study will investigate the influence of brain structure, body composition, dietary intake, oropharyngeal function, habitual physical activity, musculoskeletal development (hip status, bone health) and muscle performance on motor attainment, cognition, executive function, communication, participation, quality of life and related health resource use costs. The PREDICT-CP cohort provides further follow-up at 8–12 years of two overlapping preschool-age cohorts examined from 1.5 to 5 years (NHMRC 465128 motor and brain development; NHMRC 569605 growth, nutrition and physical activity).

Methods and analyses

This population-based cohort study undertakes state-wide surveillance of 245 children with CP born in Queensland (birth years 2006–2009). Children will be classified for Gross Motor Function Classification System; Manual Ability Classification System, Communication Function Classification System and Eating and Drinking Ability Classification System. Outcomes include gross motor function, musculoskeletal development (hip displacement, spasticity, muscle contracture), upper limb function, communication difficulties, oropharyngeal dysphagia, dietary intake and body composition, participation, parent-reported and child-reported quality of life and medical and allied health resource use. These detailed phenotypical data will be compared with brain macrostructure and microstructure using 3 Tesla MRI (3T MRI). Relationships between brain lesion severity and outcomes will be analysed using multilevel mixed-effects models.

Ethics and dissemination

The PREDICT-CP protocol is a prospectively registered and ethically accepted study protocol. The study combines data at 1.5–5 then 8–12 years of direct clinical assessment to enable prediction of outcomes and healthcare needs essential for tailoring interventions (eg, rehabilitation, orthopaedic surgery and nutritional supplements) and the projected healthcare utilisation.

Trial registration number

ACTRN: 12616001488493
Does neutrophil-to-lymphocyte ratio predict 1-year mortality in patients with primary biliary cholangitis? Results from a retrospective study with validation cohort
Authors: Lin Lin , Piao Meiyu , Jiang Xihui , Lv Houning , Zhao Ningning , Yang Fang , Sun Chao
Published: July 2017

Objectives

Neutrophil-to-lymphocyte ratio (NLR) has been used to predict prognosis in various liver diseases, but its role in primary biliary cholangitis (PBC) is not clarified. We aimed to investigate the prognostic usefulness of NLR for 1-year mortality in PBC.

Methods

The study recruited a retrospective cohort with 88 patients with PBC and a prospective validation cohort with 63 participants who were followed-up for 1 year. NLR and other laboratory measurements were analysed by multivariate regression model for identifying independent factors for early mortality. The cut-off threshold of NLR was determined by calculating the area under the receiver operating characteristics curve (AUROC) and used in a subsequent Kaplan-Meier survival analysis.

Results

Univariate and multivariate analyses showed that Mayo Risk Score (MRS), serum creatinine and NLR were independent indicators for mortality. NLR yielded significantly higher AUROC (0.86) than those of platelet-to-lymphocyte ratio (0.58, p=0.03), but comparable with MRS (0.87, p=0.88). Spearman’s correlation analysis represented a positive correlation between escalating NLR and aggravating Child-Pugh grade (r=0.44, p<0.001). Patients with NLR <2.18 exhibited higher survival (with 100% sensitivity and 67.1% specificity) within 1 year follow-up duration, and NLR ≥2.18 was indicative of higher mortality (log-rank test, p<0.001). In addition, these results were internally confirmed by a validation cohort.

Conclusion

NLR is closely related to short-term mortality in patients with PBC.
Changes in psychosocial and physical working conditions and psychotropic medication in ageing public sector employees: a record-linkage follow-up study
Authors: Kouvonen Anne , Mänty Minna , Lallukka Tea , Pietiläinen Olli , Lahelma Eero , Rahkonen Ossi
Published: July 2017

Objectives

To investigate whether changes in psychosocial and physical working conditions are associated with subsequent psychotropic medication in ageing employees.

Methods

Data were from the Helsinki Health Study, a cohort study of Finnish municipal employees, aged 40–60 years at phase 1 (2000–2002). Changes in psychosocial and physical working conditions were measured between phase 1 and phase 2 (2007). Survey data were longitudinally linked to data on prescribed, reimbursed psychotropic medication purchases (Anatomical Therapeutic Chemical) obtained from the registers of the Social Insurance Institution of Finland between the phase 2 survey and December 2013 (N=3587; 80% women). Outcomes were any psychotropic medication; antidepressants (N06A); anxiolytics (N05B); and sedatives and hypnotics (N05C). Cox regression analyses were performed.

Results

During the follow-up, 28% of the participants were prescribed psychotropic medication. Repeated exposures to low job control, high job demands and high physical work load were associated with an increased risk of subsequent antidepressant and anxiolytic medication. Increased and repeated exposure to high physical work load, increased job control and repeated high job demands were associated with subsequent sedative and hypnotic medication. Age and sex-adjusted HR varied from 1.18 to 1.66. Improvement in job control was associated with a lower risk of anxiolytic, but with a higher risk of sedatives and hypnotic medication. Decreased physical work load was associated with a lower risk of antidepressant and anxiolytic medications.

Conclusion

Improvement in working conditions could lower the risk of mental ill-health indicated by psychotropic medication.
Medical service use and usual care of common shoulder disorders in Korea: a cross-sectional study using the Health Insurance Review and Assessment Service National Patient Sample
Authors: Joo Hwansoo , Lee Yoon Jae , Shin Joon-Shik , Lee Jinho , Kim Me-riong , Koh Wonil , Park Yeoncheol , Song Yun Kyung , Cho Jae-Heung , Ha In-Hyuk
Published: July 2017

Objectives

This study examined National Health Insurance claims data to investigate the epidemiology of shoulder disorders in Korea. Detailed information on medical services and related costs was assessed by major shoulder disorder category.

Design and setting

The 2014 National Patient Sample dataset provided by the Health Insurance Review and Assessment Service was analysed. Among shoulder-related diagnosis codes, adhesive capsulitis of the shoulder (ACS), rotator cuff syndrome (RCS) and shoulder impingement syndrome (SIS) categories were of highest prevalence. Sociodemographic characteristics and medical service use, frequency and medical costs regarding common shoulder disorders were evaluated.

Results

The majority of patients with shoulder disorder received ambulatory care (97%). Total and per-patient expenses were highest in patients with RCS. The number of inpatients with RCS was more than twice that of the other two groups, and patients with RCS were more likely to receive surgical management compared with patients with ACS and SIS. Prevalence of shoulder disorders was highest among subjects in their 50s for all three groups. Primary care physicians treated 75.80% of patients with ACS, 56.99% of patients with RCS and 48.06% of patients with SIS, respectively, outlining the difference in medical institution usage patterns. In all three groups, the highest proportion of patients visited orthopaedic surgeons out of medical departments. In the ACS and SIS groups, cost of visits (consultations) took up the largest part of total expenses at 32.30% and 18.88%, respectively, while cost of procedure/surgery constituted the largest portion in patients with RCS (37.77%). The usage proportion of subcutaneous or intramuscular and intra-articular injections ranged between 20% and 30% for outpatients in all three groups.

Conclusions

Medical service use, frequency and cost distributions relating to major shoulder disorders in Korea were assessed using nationwide claims data. These findings are expected to aid policy-makers as well as researchers and practitioners as basic healthcare data.
Can enhanced screening of men with a history of prior syphilis infection stem the epidemic in men who have sex with men? A mathematical modelling study
Authors: Tuite Ashleigh R , Shaw Souradet , Reimer Joss N , Ross Craig P , Fisman David N , Mishra Sharmistha
Published: July 2017

Objectives

The aim of this study is to determine the transmission impact of using prior syphilis infection to guide a focused syphilis screening intervention among men who have sex with men (MSM).

Methods

We parameterised a deterministic model of syphilis transmission in MSM to reflect the 2011–2015 syphilis outbreak in Winnipeg, Canada. Enhanced screening of 75% of men with prior syphilis every 3 months (A) was compared with distributing equivalent number tests to all MSM (B) or those with the highest partner number (C). We compared early syphilis incidence, diagnoses and prevalence after 10 years, relative to a base case of 30% of MSM screened annually.

Results

Strategy A was expected to avert 52% of incident infections, 44% of diagnosed cases and reduce early syphilis prevalence by 89%. Strategy B had the least impact. Strategy C was most effective, averting 59% of incident cases. When screening frequency was semiannual or annual, strategy A was the most effective.

Conclusions

Enhanced screening of MSM with prior syphilis may efficiently reduce transmission, especially when identification of high-risk men via self-reported partner numbers or high-frequency screening is difficult to achieve.
Evaluation of strategies to communicate harmful and potentially harmful constituent (HPHC) information through cigarette package inserts: a discrete choice experiment
Authors: Salloum Ramzi G , Louviere Jordan J , Getz Kayla R , Islam Farahnaz , Anshari Dien , Cho Yoojin , O’Connor Richard J , Hammond David , Thrasher James F
Published: July 2017

Background

The US Food and Drug Administration (FDA) has regulatory authority to use inserts to communicate with consumers about harmful and potentially harmful constituents (HPHCs) in tobacco products; however, little is known about the most effective manner for presenting HPHC information.

Methods

In a discrete choice experiment, participants evaluated eight choice sets, each of which showed two cigarette packages from four different brands and tar levels (high vs low), accompanied by an insert that included between-subject manipulations (ie, listing of HPHCs vs grouping by disease outcome and numeric values ascribed to HPHCs vs no numbers) and within-subject manipulations (ie, 1 of 4 warning topics; statement linking an HPHC with disease vs statement with no HPHC link). For each choice set, participants were asked: (1) which package is more harmful and (2) which motivates them to not smoke; each with a ’no difference' option. Alternative-specific logit models regressed choice on attribute levels.

Results

1212 participants were recruited from an online consumer panel (725 18–29-year-old smokers and susceptible non-smokers and 487 30–64-year-old smokers). Participants were more likely to endorse high-tar products as more harmful than low-tar products, with a greater effect when numeric HPHC information was present. Compared with a simple warning statement, the statement linking HPHCs with disease encouraged quit motivation.

Conclusions

Numeric HPHC information on inserts appears to produce misunderstandings that some cigarettes are less harmful than others. Furthermore, brief narratives that link HPHCs to smoking-related disease may promote cessation versus communications that do not explicitly link HPHCs to disease.
Influence of cross correlation between nominal load and resistance on reliability-based design for simple linear soil-structure limit states
Authors: Lin Peiyuan , Bathurst Richard J.
Published: July 2017

Cross correlations between nominal load and resistance terms in limit state functions for geotechnical soil–structure interaction problems can be expected. A closed-form solution for the reliability index for a simple linear limit state function is used to examine the influence of nominal load and resistance correlations on computed margins of safety. The formulation also includes the contribution of the underlying accuracy of the load and resistance equations (method bias) and bias dependencies with the magnitude of nominal load and resistance values assumed in the limit state design function. Sensitivity analyses and example problems for the external sliding limit state for a cantilever wall and the pullout limit state for internal stability of reinforced soil walls with different soil reinforcement types are presented. Ignoring nominal correlations where they exist is shown to underestimate the reliability index in some cases and to overestimate the reliability index in other cases. In the example problems, these differences are shown to exceed one order of magnitude in terms of probability of failure, but in the sensitivity analyses using a wider range of input parameter values, the differences can be several orders of magnitude.
Comonotonic Random Sets and Its Additivity of Choquet Integrals
Authors: Zong Gaofeng , Chen Zengjing , Shahzad Faisal
Published: July 2017

In this paper, we propose a concept of comonotonicity of random sets, which is a set inclusion relation and generalized notion of comonotonicity of real-valued random variables. Then we study some elementary properties of comonotonicity of random sets and comonotonic additivity of real-valued Choquet integral for random set mappings. After this, some other properties of this kind of real-valued Choquet integral for random set mappings are characterized by the comonotonic additivity, for instance, translation invariance, sup-norm continuous, positive homogeneity.
Fuzzy Linguistic Summarization with Genetic Algorithm: An Application with Operational and Financial Healthcare Data
Authors: Altintop Tunahan , Yager Ronald R. , Akay Diyar , Boran Fatih Emre , Ünal Muhammet
Published: July 2017

It is now well recognized that knowledge extracted from rich healthcare data play a vital role for delivery, management and planning of healthcare services. So far, however, there is not much study done on the domain of operational and financial healthcare data since, up to now, a great deal of works are dedicated to clinical/medical healthcare data for the purposes of diagnosis and treatment of diseases. In this paper, an attempt is made, by applying fuzzy linguistic summarization, for the first time to discover knowledge from operational and financial healthcare data. Fuzzy linguistic summarization, in its simplest term, provides natural language based summaries from a dataset in a human consistent way along with a degree of truth attached to each summary. While basically valuable, its benefit can be increased by only generating summaries with a degree of truth above than an indicated threshold value. A genetic algorithm is developed within this context in order to eliminate less promising and useless linguistic summaries. We assess the proposed approach experimentally on a real data and evaluate the generated summaries to gain actionable insights from them.
Bayesian Prediction of Structural Response Under Crowd-Induced Walking Load
Authors: Dai Lu , Yang Na , Yang Qingshan
Published: July 2017

Research on modeling the walking-induced dynamic load and its effects on structures has been increasing in recent years. Existing standards for estimating the acceleration response excited by crowd takes [Formula: see text] ([Formula: see text] is the number of walking persons in a crowd) times the single pedestrian load as the crowd load, neglecting uncertainties in the related parameters. This paper proposes a method for predicting the crowd-induced structural acceleration response based on the Bayesian theory. Parameters of the crowd include the distribution of stepping frequency, the interval of arriving time and the weight of pedestrians. By combining the existing methods for calculating the structural response to a pedestrian load and the Bayesian theory, the root-mean-square acceleration along with the crowd parameters are obtained. A field investigation is conducted to study the walking characteristics of pedestrians, including the distribution of stepping frequency, walking velocity and step length. The case of a crowd moving across a simply supported beam bridge is taken for illustration. The acceleration response under the crowd load with different stepping frequencies is calculated. A comparison between the results from the Bayesian method and the design standards is conducted. The proposed method is found to yield acceptable results, and is then applied to estimating the acceleration response of a typical Tibetan heritage building, with the result compared with a field measurement.
Study of Intellectual Capital Dimensions in IT Industry Using DEMATEL Method
Authors: Sekhar Chandra , Patwardhan Manoj , Vyas Vishal
Published: July 2017

The purpose of this paper is to analyse the causal relation structure among the dimensions of Intellectual Capital (IC) by using the DEMATEL method. In this study, the dimensions of IC comprise human, structural, and relational capital. This study empirically analyses the causal relation structure with a sample of 18 (12 national and 6 multi-national) Information Technology (IT) firms operating in India. The respondents were the experts from IT firms encompassing chief executive officers, general managers, Human Resource (HR) managers, senior managers, and the IT consultants. Decision-Making Trial and Evaluation Laboratory (DEMATEL) method is used for the statistical treatment of the data. On the human, structural, and relational capital fronts, findings of the study suggest that “motivation of the personnel”, “operation process”, “brand value”, respectively, have the maximum causing properties. The study is limited to IT industry of India only. The dimensions of IC will differently trigger the attitude and behaviours of employees relevant for the parent organisation that helps the management to deal with different dynamic circumstances resulting in different outcomes. Study empirically assessed that there are synergy and causal relation structure between the dimensions. Present study contributes to retention and engagement of human capital and prefers potentially important policy implications. Examining the interrelationship among the dimensions of IC in the context of Indian IT is the novel contribution of the present study. Theoretically and empirically assessing the causal interrelationship and addressing the research gaps summarised from the literature will contribute to the IC research.
TNF-α receptor 1 knockdown in the subfornical organ ameliorates sympathetic excitation and cardiac hemodynamics in heart failure rats
Authors: Yu Yang , Wei Shun-Guang , Weiss Robert M. , Felder Robert B.
Published: July 2017

In systolic heart failure (HF), circulating proinflammatory cytokines upregulate inflammation and renin-angiotensin system (RAS) activity in cardiovascular regions of the brain, contributing to sympathetic excitation and cardiac dysfunction. Important among these is the subfornical organ (SFO), a forebrain circumventricular organ that lacks an effective blood-brain barrier and senses circulating humors. We hypothesized that the tumor necrosis factor-α (TNF-α) receptor 1 (TNFR1) in the SFO contributes to sympathetic excitation and cardiac dysfunction in HF rats. Rats received SFO microinjections of a TNFR1 shRNA or a scrambled shRNA lentiviral vector carrying green fluorescent protein, or vehicle. One week later, some rats were euthanized to confirm the accuracy of the SFO microinjections and the transfection potential of the lentiviral vector. Other rats underwent coronary artery ligation (CL) to induce HF or a sham operation. Four weeks after CL, vehicle- and scrambled shRNA-treated HF rats had significant increases in TNFR1 mRNA and protein, NF-κB activity, and mRNA for inflammatory mediators, RAS components and c-Fos protein in the SFO and downstream in the hypothalamic paraventricular nucleus, along with increased plasma norepinephrine levels and impaired cardiac function, compared with vehicle-treated sham-operated rats. In HF rats treated with TNFR1 shRNA, TNFR1 was reduced in the SFO but not paraventricular nucleus, and the central and peripheral manifestations of HF were ameliorated. In sham-operated rats treated with TNFR1 shRNA, TNFR1 expression was also reduced in the SFO but there were no other effects. These results suggest a key role for TNFR1 in the SFO in the pathophysiology of systolic HF.

NEW & NOTEWORTHY Activation of TNF-α receptor 1 in the subfornical organ (SFO) contributes to sympathetic excitation in heart failure rats by increasing inflammation and renin-angiotensin system activity in the SFO and downstream in the hypothalamic paraventricular nucleus. Cytokine receptors in the SFO may be a target for central intervention in cardiovascular conditions characterized by peripheral inflammation.
Is normobaric hypoxia an effective treatment for sustaining previously acquired altitude acclimatization?
Authors: Beidleman Beth A. , Fulco Charles S. , Cadarette Bruce S. , Cymerman Allen , Buller Mark J. , Salgado Roy M. , Posch Alexander M. , Staab Janet E. , Sils Ingrid V. , Yurkevicius Beau R. , Luippold Adam J. , Welles Alexander P. , Muza Stephen R.
Published: July 2017

This study examined whether normobaric hypoxia (NH) treatment is more efficacious for sustaining high-altitude (HA) acclimatization-induced improvements in ventilatory and hematologic responses, acute mountain sickness (AMS), and cognitive function during reintroduction to altitude (RA) than no treatment at all. Seventeen sea-level (SL) residents (age = 23 ± 6 yr; means ± SE) completed in the following order: 1) 4 days of SL testing; 2) 12 days of HA acclimatization at 4,300 m; 3) 12 days at SL post-HA acclimatization (Post) where each received either NH ( n = 9, [Formula: see text] = 0.122) or Sham ( n = 8; [Formula: see text] = 0.207) treatment; and 4) 24-h reintroduction to 4,300-m altitude (RA) in a hypobaric chamber (460 Torr). End-tidal carbon dioxide pressure ([Formula: see text]), hematocrit (Hct), and AMS cerebral factor score were assessed at SL, on HA2 and HA11, and after 20 h of RA. Cognitive function was assessed using the SynWin multitask performance test at SL, on HA1 and HA11, and after 4 h of RA. There was no difference between NH and Sham treatment, so data were combined. [Formula: see text] (mmHg) decreased from SL (37.2 ± 0.5) to HA2 (32.2 ± 0.6), decreased further by HA11 (27.1 ± 0.4), and then increased from HA11 during RA (29.3 ± 0.6). Hct (%) increased from SL (42.3 ± 1.1) to HA2 (45.9 ± 1.0), increased again from HA2 to HA11 (48.5 ± 0.8), and then decreased from HA11 during RA (46.4 ± 1.2). AMS prevalence (%) increased from SL (0 ± 0) to HA2 (76 ± 11) and then decreased at HA11 (0 ± 0) and remained depressed during RA (17 ± 10). SynWin scores decreased from SL (1,615 ± 62) to HA1 (1,306 ± 94), improved from HA1 to HA11 (1,770 ± 82), and remained increased during RA (1,707 ± 75). These results demonstrate that HA acclimatization-induced improvements in ventilatory and hematologic responses, AMS, and cognitive function are partially retained during RA after 12 days at SL whether or not NH treatment is utilized.

NEW & NOTEWORTHY This study demonstrates that normobaric hypoxia treatment over a 12-day period at sea level was not more effective for sustaining high-altitude (HA) acclimatization during reintroduction to HA than no treatment at all. The noteworthy aspect is that athletes, mountaineers, and military personnel do not have to go to extraordinary means to retain HA acclimatization to an easily accessible and relevant altitude if reexposure occurs within a 2-wk time period.
Local Delivery of OncoVEXmGM-CSF Generates Systemic Antitumor Immune Responses Enhanced by Cytotoxic T-Lymphocyte–Associated Protein Blockade
Authors: Moesta Achim K. , Cooke Keegan , Piasecki Julia , Mitchell Petia , Rottman James B. , Fitzgerald Karen , Zhan Jinghui , Yang Becky , Le Tiep , Belmontes Brian , Ikotun Oluwatayo F. , Merriam Kim , Glaus Charles , Ganley Kenneth , Cordover David H. , Boden Andrea M. , Ponce Rafael , Beers Courtney , Beltran Pedro J.
Published: July 2017

Purpose: Talimogene laherparepvec, a new oncolytic immunotherapy, has been recently approved for the treatment of melanoma. Using a murine version of the virus, we characterized local and systemic antitumor immune responses driving efficacy in murine syngeneic models.

Experimental Design: The activity of talimogene laherparepvec was characterized against melanoma cell lines using an in vitro viability assay. Efficacy of OncoVEXmGM-CSF (talimogene laherparepvec with the mouse granulocyte-macrophage colony-stimulating factor transgene) alone or in combination with checkpoint blockade was characterized in A20 and CT-26 contralateral murine tumor models. CD8+ depletion, adoptive T-cell transfers, and Enzyme-Linked ImmunoSpot assays were used to study the mechanism of action (MOA) of systemic immune responses.

Results: Treatment with OncoVEXmGM-CSF cured all injected A20 tumors and half of contralateral tumors. Viral presence was limited to injected tumors and was not responsible for systemic efficacy. A significant increase in T cells (CD3+/CD8+) was observed in injected and contralateral tumors at 168 hours. Ex vivo analyses showed these cytotoxic T lymphocytes were tumor-specific. Increased neutrophils, monocytes, and chemokines were observed in injected tumors only. Importantly, depletion of CD8+ T cells abolished all systemic efficacy and significantly decreased local efficacy. In addition, immune cell transfer from OncoVEXmGM-CSF-cured mice significantly protected from tumor challenge. Finally, combination of OncoVEXmGM-CSF and checkpoint blockade resulted in increased tumor-specific CD8+ anti-AH1 T cells and systemic efficacy.

Conclusions: The data support a dual MOA for OncoVEXmGM-CSF that involves direct oncolysis of injected tumors and activation of a CD8+-dependent systemic response that clears injected and contralateral tumors when combined with checkpoint inhibition. Clin Cancer Res; 23(20); 6190–202. ©2017 AACR.