bluuebunny/crossref_metadata_2025 huggingface dataset:
Item Generation and Reduction Toward Developing a Patient‐reported Outcome for Pediatric Ulcerative Colitis (TUMMY‐UC)
Authors: Marcovitch Liron , Nissan Anat , Mack David , Otley Anthony , Hussey Seamus , Mclean Beth , Lewis Mary , Croft Nick , Barakat Farah M. , Griffiths Anne M. , Turner Dan
Published: May 2016

Background:

The Pediatric Ulcerative Colitis Activity Index (PUCAI) is a noninvasive clinician‐based index, which reflects disease severity in pediatric ulcerative colitis (UC) when no endoscopy is performed. Here, we aimed to explore signs and symptoms important to children with UC and their caregivers as the first stage of developing a patient‐reported outcome (PRO) measure for pediatric UC (ie, the TUMMY‐UC index) to supplement endoscopic assessment.

Methods:

Concept elicitation qualitative interviews were performed with children who have UC and their caregivers in 6 centers. Items were rank‐ordered by the interviewees according to the frequency of endorsement and importance, graded on a 1 to 5 scale.

Results:

A total of 46 children (ages 12.5 ± 3.3 years, range 7–18, 48% boys, 83% with pancolitis, 24% with moderate–severe disease) and 33 caregivers were interviewed (ie, 79 interviews). The following items were identified by the children, in decreasing order of weights: abdominal pain (importance × frequency weight 3.9), rectal bleeding (3.6), stool frequency (3.0), stool consistency (3.0), general well‐being/fatigue (2.9), urgency (1.9), and nocturnal stools (1.6). Two other items were scored lower: lack of appetite (1.1) and weight loss (0.6). Children 13 to 18 years comprehended adult vocabulary, children 8 to 12 years comprehended simple vocabulary, and younger children had poor understanding in completing the questions.

Conclusions:

In this first stage of the TUMMY‐UC development, items were generated and ranked by input from patients. These items are now being explored for optimal vocabulary and response options. The TUMMY‐UC will supplement the PUCAI in clinical trial outcome assessment.
Validity and Reliability of Turkish Version of the Functional Assessment of Cancer Therapy–Brain Questionnaire
Authors: Arli Senay K. , Gurkan Aysel
Published: May 2016

Background:

Assessing the quality of life (QOL) of patients with brain tumors is ever more important, given increasing survivorship and the higher likelihood of developing potential morbidities associated with new therapies.

Objective:

The aim of this study was to adapt the Functional Assessment of Cancer Therapy–Brain (FACT-Br) Questionnaire for Turkish populations and test its validity and reliability.

Methods:

The questionnaire was first translated into Turkish and back-translated, adapting it to the Turkish culture. This Turkish version of the FACT-Br was administered to 500 patients. Confirmatory factor analysis was conducted to examine the scale’s construct validity. Test-retest and Cronbach’s α reliability coefficients were calculated to determine reliability of the total questionnaire and all subdimensions.

Results:

The questionnaire’s factor structure demonstrated good fit, implying that it could be applied to the Turkish population. Interclass correlation coefficients were between 0.93 and 0.99. The 5 subscales demonstrated good internal consistency, with Cronbach’s α ranging from .72 to .87. Overall, the reliability estimate for the total scale was 0.93. There was no difference between a 15-day test and retest coefficients for subscale and total scores, indicating stability.

Conclusions:

The Turkish version of the FACT-Br is a valid and reliable instrument that can be used to measure the QOL of patients with a brain tumor in Turkey.

Implications for Practice:

This assessment tool can be used in treatment evaluations and to evaluate other measures of QOL.
Clinical Nursing Education
Authors: Williams Margaret G. , Voss Autumn , Vahle Barb , Capp Sheila
Published: May 2016

Nursing students often find it difficult to address spirituality in clinical practice. The purpose of this study was to examine the effect of students’ use of the FICA Spiritual History Tool during clinical practice on their own spirituality and comfort with the provision of spiritual care. The students (N = 31) completed the Spirituality and Spiritual Care Rating Scale at the beginning and end of the semester, which revealed changes, although not statistically significant, in students’ spirituality, religiosity, and their provision of spiritual care.
Reactive Stepping After Stroke: Determinants of Time to Foot Off in the Paretic and Nonparetic Limb
Authors: Inness Elizabeth L. , Mansfield Avril , Bayley Mark , McIlroy William E.
Published: May 2016

Background and Purpose:

Impaired features of reactive stepping, specifically delays in the early time to foot off (TFO) phase, are associated with increased fall rates after stroke. This study aimed to determine differences in, and determinants of, paretic and nonparetic limb TFO, and to determine whether both paretic and nonparetic TFO were associated with perturbation-evoked falls.

Methods:

Retrospective chart review of 105 individuals with stroke was performed within an inpatient rehabilitation setting; each had received a standardized assessment of reactive balance control (in response to a perturbation) at time of discharge.

Results:

There were no significant differences in paretic (351 ms) and nonparetic (365 ms) TFO. The capacity to maximally load the nonparetic limb, the amplitude of the perturbation, and the capacity to load the paretic limb were all negatively associated with paretic step TFO, explaining 23.8% of the variance. The amplitude of the perturbation and the preperturbation load under the nonparetic stepping limb were, respectively, negatively and positively associated with nonparetic step TFO, explaining 22.7% of the variance. The likelihood of a perturbation-evoked fall was associated with mean nonparetic limb TFO but not paretic limb TFO.

Discussion and Conclusions:

Unique stroke-related impairments of dynamic balance control and limb-load asymmetry may differentially influence paretic and nonparetic reactive step TFO, in response to a loss of balance. The amplitude of the perturbation influences reactive step TFO in both limbs. The results of the current study have implications for the future development of standardized clinical assessment methodologies and training strategies to evaluate and remediate reactive stepping and reduce fall risk.

Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A133).
Pulmonary Physical Therapy Techniques to Enhance Survival in Amyotrophic Lateral Sclerosis: A Systematic Review
Authors: Macpherson Chelsea E. , Bassile Clare C.
Published: May 2016

Background and Purpose:

Respiratory insufficiency is the primary cause of morbidity and mortality in individuals with amyotrophic lateral sclerosis (ALS). Although mechanical interventions are effective in prolonging survival through respiratory support, pulmonary physical therapy interventions are being investigated. The purpose of this systematic review was to examine the effectiveness of pulmonary physical therapy interventions across the progressive stages of ALS.

Methods:

Six databases were searched for articles from inception to December 2014 investigating pulmonary physical therapy interventions in the ALS population. The search strategy followed Cochrane Collaboration guidelines with replication per database. Effect sizes (ES) were calculated for primary outcome measures: forced vital capacity (FVC) and peak cough expiratory flow (PCEF).

Results:

Seven studies met inclusion criteria. Four studies used control groups whereas the remainder used repeated measures. With the exception of diaphragmatic breathing, pulmonary physical therapy interventions were effective in improving multiple respiratory outcome measures in this population. Inspiratory muscle training (IMT) was shown to prolong respiratory muscle strength with a strong effect size (ES = 1.48) for FVC. In addition, mean length of survival increased by 12 months. Lung volume recruitment training (LVRT) strongly enhanced immediate cough efficacy with improved FVC (ES = 1.02) and PCEF (ES = 1.82). Manually assisted cough (MAC) only improved PCEF by a small amount (ES = 0.15, bulbar ALS; ES = 0.16, classical ALS groups).

Discussion and Conclusions:

Specific pulmonary physical therapy interventions (IMT, LVRT, and MAC) have effectiveness in improving respiratory outcome measures and increasing survival. These should be routinely incorporated into the comprehensive management of individuals with ALS. More rigorous methodological investigations should be performed to replicate these findings.

Video abstract available with brief technique demonstration of IMT and LVRT (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A136).
Immunoexpression of Androgen Receptors in Poroid Neoplasms
Authors: Fernandez-Flores Angel , Cassarino David S.
Published: May 2016

Some poroid neoplasias are known to show apocrine differentiation (ie, differentiation toward the folliculosebaceous and the apocrine units). In this sense, it is somewhat surprising that the immunoexpression of androgen receptors (ARs) has not been investigated yet in poroid neoplasias. In this study, we examined the immunoexpression of ARs in 40 poroid neoplasms (8 porocarcinomas and 32 poromas). We found intense and diffuse immunoexpression of ARs in 1 porocarcinoma. In addition, 7 poromas and 2 porocarcinomas showed focal immunoexpression of ARs. Nine of these 10 positive cases were found in men. We conclude that poroid neoplasias express ARs in about 25% of the cases, but the expression is usually focal/weak. However, the expression of this marker is not incompatible with a diagnosis of poroid neoplasia.
Hepatocyte-like Versus Mesenchymal Stem Cells in CCl4-induced Liver Fibrosis
Authors: Ewida Suzy Fayez , Abdou Asmaa Gaber , El-Rasol Elhosary Amal Abd , El-Ghane Metawe Shaimaa Abd
Published: May 2016

It is still a matter of debate as to whether in vitro mesenchymal stem cell (MSC)-derived hepatocytes may efficiently repopulate a host liver to provide adequate functional substitution. The aim of this study is to assess the efficacy and consistency of in vitro hepatic differentiation from Wharton jelly–derived MSCs, and to validate their therapeutic potential in experimentally induced liver fibrosis compared with nondifferentiated MSCs. Forty adult male albino rats were divided into 4 main groups: (I) normal control group; (II) carbon tetrachloride (CCl4)-treated group (injected CCl4 solution twice a week for 8 wk); (III) MSC-treated group (a single intravenous dose of MSCs from human umbilical cord at the fourth week of induction of fibrosis); and (IV) hepatocyte-like stem cells (HLCs)-treated group (a single intravenous dose of MSCs after in vitro conversion to hepatocyte at the fourth week of induction of fibrosis). Portal blood flow velocity and resistance, serum alanine transaminase, aspartate transaminase, albumin, and total bilirubin were measured. Liver homogenate was prepared for malondialdehyde, superoxide dismutase (SOD), nitric oxide (measured as nitrites), and TGFβ (transforming growth factor beta) assessment. Assessment of human cells homing into liver rat and their function was performed using immunohistochemistry for detection of human hepatocytes and α-fetoprotein antigens. Significant elevation of serum alanine transaminase, aspartate transaminase, and bilirubin, liver malondialdehyde, nitrites, TGFβ, fibrotic score, and significant reduction in serum albumin, liver SOD, and portal flow velocity in the CCl4-treated group were found when compared with normal rats. All these parameters significantly reversed in MSC-treated and hepatocyte-treated groups when compared with the CCl4-treated group. The MSC-treated group shows statistically better results in most liver function and oxidation parameters when compared with the HLC-treated group. Human MSCs can differentiate in vitro into functional HLCs. Transplantation of both MSCs and HLCs was feasible and effective in a liver fibrosis rat model. However, MSCs were better in regaining liver function. Future studies should address strategies to improve long-term implantation of MSCs and HLCs in the host liver.
Malignant Peripheral Nerve Sheath Tumor Is a Challenging Diagnosis
Authors: Le Guellec Sophie , Decouvelaere Anne-Valérie , Filleron Thomas , Valo Isabelle , Charon-Barra Céline , Robin Yves-Marie , Terrier Philippe , Chevreau Christine , Coindre Jean-Michel
Published: May 2016

An accurate histopathologic diagnosis is essential for an adequate treatment of soft tissue sarcomas. The diagnosis of malignant peripheral nerve sheath tumor (MPNST) can be complex, particularly outside the neurofibromatosis type 1 (NF1) context. MPNST is a rare malignancy, and due to the lack of specific histologic criteria, several differential diagnoses must be considered. A total of 350 patients diagnosed with MPNST (from 1990 to 2013) were retrieved from the French sarcoma network (RRePS) and the Conticabase (Connective Tissue Cancer Network database). Tumor samples were available for 160 cases (45.2%). Pathology review, immunohistochemistry (IHC), and molecular analysis (when dealing with a monomorphic sarcoma) were systematically performed. Patient, tumor, and treatment characteristics were evaluated to identify prognostic factors for the definitive primary MPNST (n=106) cohort. Twenty-nine tumors (18.1%) initially diagnosed as MPNST were reclassified on the basis of histologic review, IHC, and molecular analysis. Patients with NF1 disease comprised 64% of the remaining cohort. The 5-year overall survival for patients from the entire cohort was 47%, 34.8% for NF1 patients, and 68.5% for patients without NF1 disease, making NF1 syndrome an independent poor prognostic factor of survival. Positive margins and lack of radiation therapy were independent predictors of local recurrence. The Fédération Nationale des Centres de Lutte Contre le Cancer tumor grade was an independent prognostic indicator of metastasis. Given the therapeutic implications of a misdiagnosis, the systematic pathology review, IHC, and molecular analysis (when dealing with monomorphic sarcoma) strategy allowed reclassification of 20% of cases, mainly the sporadic MPNSTs.
Hemodynamic Effects of Phenylephrine, Vasopressin, and Epinephrine in Children With Pulmonary Hypertension: A Pilot Study*
Authors: Siehr Stephanie L. , Feinstein Jeffrey A. , Yang Weiguang , Peng Lynn F. , Ogawa Michelle T. , Ramamoorthy Chandra
Published: May 2016

Objectives:

During a pulmonary hypertensive crisis, the marked increase in pulmonary vascular resistance can result in acute right ventricular failure and death. Currently, there are no therapeutic guidelines for managing an acute crisis. This pilot study examined the hemodynamic effects of phenylephrine, arginine vasopressin, and epinephrine in pediatric patients with pulmonary hypertension.

Design:

In this prospective, open-label, nonrandomized pilot study, we enrolled pediatric patients previously diagnosed with pulmonary hypertensive who were scheduled electively for cardiac catheterization. Primary outcome was a change in the ratio of pulmonary-to-systemic vascular resistance. Baseline hemodynamic data were collected before and after the study drug was administered.

Patients:

Eleven of 15 participants were women, median age was 9.2 years (range, 1.7–14.9 yr), and median weight was 26.8 kg (range, 8.5–55.2 kg). Baseline mean pulmonary artery pressure was 49 ± 19 mm Hg, and mean indexed pulmonary vascular resistance was 10 ± 5.4 Wood units. Etiology of pulmonary hypertensive varied, and all were on systemic pulmonary hypertensive medications.

Interventions:

Patients 1–5 received phenylephrine 1 μg/kg; patients 6–10 received arginine vasopressin 0.03 U/kg; and patients 11–15 received epinephrine 1 μg/kg. Hemodynamics was measured continuously for up to 10 minutes following study drug administration.

Measurements and Main Results:

After study drug administration, the ratio of pulmonary-to-systemic vascular resistance decreased in three of five patients receiving phenylephrine, five of five patients receiving arginine vasopressin, and three of five patients receiving epinephrine. Although all three medications resulted in an increase in aortic pressure, only arginine vasopressin consistently resulted in a decrease in the ratio of systolic pulmonary artery-to-aortic pressure.

Conclusions:

This prospective pilot study of phenylephrine, arginine vasopressin, and epinephrine in pediatric patients with pulmonary hypertensive showed an increase in aortic pressure with all drugs although only vasopressin resulted in a consistent decrease in the ratio of pulmonary-to-systemic vascular resistance. Studies with more subjects are warranted to define optimal dosing strategies of these medications in an acute pulmonary hypertensive crisis.
Early Electroencephalographic Findings Correlate With Neurologic Outcome in Children Following Cardiac Arrest
Authors: Ostendorf Adam P. , Hartman Mary E. , Friess Stuart H.
Published: May 2016

Objectives:

To determine the clinical and electroencephalographic findings associated with prognosis in nonneonate children following cardiac arrest.

Design:

Retrospective observational study.

Setting:

PICU and cardiac ICU.

Patients:

Nonneonate children with a history of cardiac arrest more than 2 minutes.

Interventions:

Electroencephalographic monitoring within 72 hours of return of spontaneous circulation.

Measurements and Main Results:

Clinical and features, neurophysiologic data, and Pediatric Cerebral Performance Category scores were collected. Electroencephalographic traces were reviewed in a blinded manner, all seizures and electroencephalographic findings noted, and the electroencephalography was scored at 1 hour, 24 hours, and continuous electroencephalographic end. Discrete data regarding specific characteristics of the electroencephalographic background and seizures were studied. Univariate and multivariate analyses were performed to identify associations between clinical variables, electroencephalographic findings, and Pediatric Cerebral Performance Category score at hospital discharge. Multivariate analysis of 73 children revealed duration of cardiac arrest less than 20 minutes or continuous electroencephalographic background activity within 12 hours postreturn of spontaneous circulation were associated with good short term neurologic outcome. Change in electroencephalographic background score over time and electroencephalographic data collected after the initial hour were not associated with outcome.

Conclusions:

Following pediatric cardiac arrest, an initially normal electroencephalography or generalized slowing of the electroencephalographic background was associated with good neurologic outcome at hospital discharge.
Using HIV Viral Load From Surveillance to Estimate the Timing of Antiretroviral Therapy Initiation
Authors: Braunstein Sarah L. , Robertson McKaylee M. , Myers Julie , Nash Denis
Published: May 2016

Introduction:

HIV surveillance programs do not typically collect comprehensive data on antiretroviral therapy (ART). We validated a population-based measure of ART initiation that uses HIV viral load (VL) results in the absence of data on ART.

Methods:

We used CD4/VL data reported to NYC HIV Surveillance for persons aged ≥13 years and diagnosed with HIV from 2006 to 2012 to validate estimates of ART initiation date based on 3 ART initiation definitions: (1) ≥1-log decline in copies per milliliter between 2 VLs over 3 months; (2) ≥2-log decline in copies per milliliter between 2 VLs over 3 months; and (3) the earliest of either a ≥1-log decline in VL over 3 months, or a change from detectable VL to undetectable VL (<400 copies/mL) over any interval. We plotted median CD4 counts by quarter before and after ART initiation to compare estimated initiation date with nadir of the CD4 trajectory.

Results:

A total of 24,348 persons were diagnosed with HIV in NYC from 2006 to 2012. In all, 12,123 persons had probable ART initiation based on ≥2-log decline, 12,719 based on ≥1-log decline, and 14,311 based on ≥1-log decline or detectable–undetectable change. Lowest median CD4 count occurred at the estimated ART initiation date for all 3 definitions. The definition based on a ≥1-log VL decline or a change from detectable to undetectable VL captured more ART initiations and identified earlier initiation dates.

Conclusions:

Serial VL measures are a valid source for estimating ART initiation. A definition that includes a ≥1-log VL decline or a change from detectable to undetectable VL performed best.
Implementation and Operational Research: Use of Symptom Screening and Sputum Microscopy Testing for Active Tuberculosis Case Detection Among HIV-Infected Patients in Real-World Clinical Practice in Uganda
Authors: Roy Monika , Muyindike Winnie , Vijayan Tara , Kanyesigye Michael , Bwana Mwebesa , Wenger Megan , Martin Jeffrey , Geng Elvin
Published: May 2016

Background:

The uptake of intensified active TB case-finding among HIV-infected patients using symptom screening is not well understood. We evaluated the rate and completeness of each interim step in the TB pulmonary “diagnostic cascade” to understand real-world barriers to active TB case detection.

Methods:

We conducted a cohort analysis of new, antiretroviral therapy–naive, HIV-infected patients who attended a large HIV clinic in Mbarara, Uganda (March 1, 2012—September 30, 2013). We used medical records to extract date of completion of each step in the diagnostic cascade: symptom screen, order, collection, processing, and result. Factors associated with lack of sputum order were evaluated using multivariate Poisson regression and chart review of 50 screen-positive patients.

Results:

Of 2613 patients, 2439 (93%) were screened for TB and 682 (28%) screened positive. Only 90 (13.2%) had a sputum order. Of this group, 83% completed the diagnostic cascade, 13% were diagnosed with TB, and 50% had a sputum result within 1 day of their visit. Sputum ordering was associated with WHO stage 3 or 4 HIV disease and greater number of symptoms. The main identifiable reasons for lack of sputum order in chart review were treatment of presumed malaria (51%) or bacterial infection (43%).

Conclusions:

The majority of newly enrolled HIV-infected patients who screened positive for suspected TB did not have a sputum order, and those who did were more likely to have more symptoms and advanced HIV disease. Further evaluation of provider behavior in the management of screen-positive patients could improve active TB case detection rates.
Identification of a Specific miRNA Profile in HIV-Exposed Seronegative Individuals
Authors: Yahyaei Sara , Biasin Mara , Saulle Irma , Gnudi Federica , De Luca Mariacristina , Tasca Karen I. , Trabattoni Daria , Lo Caputo Sergio , Mazzotta Francesco , Clerici Mario
Published: May 2016

Objective:

MicroRNAs (miRNAs) are small noncoding RNAs involved in the posttranscriptional regulation of gene expression that play important roles in viral infections. Alterations of specific miRNAs are described in HIV infection, suggesting a role for miRNAs in pathogenesis of this disease. We verified whether a particular miRNA signature could be identified in natural resistance to HIV-1.

Methods:

Expression level of 84 miRNAs was analyzed by RT-qPCR in plasma and unstimulated peripheral blood mononuclear cell (PBMC) of 30 seronegative individuals repeatedly exposed to HIV-1 (HESN), 30 HIV seropositive subjects (HIV+), and 30 healthy controls (HC). Results were confirmed by individual RT-qPCR in in vitro HIV-1-infected PBMC and in their cell culture medium. Dicer and Drosha expression was analyzed in basal PBMC.

Results:

Whereas Dicer and Drosha expression was comparable in HESN, HIV+ and HC, several miRNAs were upregulated both in HESN and HIV+ compared with HC. Furthermore, miRNA-29a and miR-223 were upregulated in both unstimulated PBMC and plasma of HESN alone; their expression was reduced upon in vitro HIV-1 infection of HESN PBMC indicating that, upon infection, they are secreted in the extracellular milieu. These results were confirmed by individual qPCR.

Conclusions:

Our studies demonstrate that HIV-1 exposure modifies miRNAs expression even in the absence of productive infection. Because those miRNAs that are specifically increased only in HESN have been known to reduce HIV-1 replication, their modulation could represent an important mechanism in resistance to HIV-1 infection.
Disparities Within the Disparity—Determining HIV Risk Factors Among Latino Gay and Bisexual Men Attending a Community-Based Clinic in Los Angeles, CA
Authors: Beymer Matthew R. , Weiss Robert E. , Halkitis Perry N. , Kapadia Farzana , Ompad Danielle C. , Bourque Linda , Bolan Robert K.
Published: May 2016

Background:

Latino gay, bisexual, and other men who have sex with men (MSM) in the United States have a 50% greater incidence of HIV when compared with White MSM. Previous studies have analyzed factors contributing to condomless anal intercourse among Latino MSM, but few studies have followed cohorts of HIV-negative Latino MSM to determine circumstances for HIV infection. Informed by Syndemics theory, we examine behavioral, biological, and contextual factors associated with HIV infection for Latino MSM.

Methods:

Risk assessment and HIV testing data were analyzed for all initially HIV negative, Latino MSM (n = 3111) visiting a community-based clinic in Los Angeles, CA from January 2009 to June 2014. Survival analyses were used to determine characteristics of Latino MSM who became HIV positive during the study time frame.

Results:

Similar to previous studies of MSM, self-reported history of chlamydia, gonorrhea, and/or syphilis (adjusted hazard ratio (aHR): 1.97; CI: 1.28 to 3.04), receptive condomless anal intercourse (aHR: 1.7; CI: 1.16 to 2.49), and methamphetamine use (aHR: 1.99; CI: 1.15 to 3.43) predicted HIV infection. In addition, originating from Central America (aHR: 2.31; CI: 1.41 to 3.79), Latino ethnicity of the last sex partner (aHR: 1.67; CI: 1.16 to 2.39) and experiencing intimate partner violence (IPV) (aHR: 1.73; CI: 1.13 to 2.64) were also associated with HIV infection among Latino MSM.

Conclusions:

This is the first study to show independent associations between IPV and HIV infection among Latino MSM. This study shows that psychosocial conditions such as IPV fuel HIV incidence among Latino MSM, and psychosocial interventions should be considered to reduce HIV disparities among Latino MSM.
Chronic Morbidity Among Older Children and Adolescents at Diagnosis of HIV Infection
Authors: McHugh Grace , Rylance Jamie , Mujuru Hilda , Nathoo Kusum , Chonzi Prosper , Dauya Ethel , Bandason Tsitsi , Simms Victoria , Kranzer Katharina , Ferrand Rashida A.
Published: May 2016

Background:

Substantial numbers of children with HIV present to health care services in older childhood and adolescence, previously undiagnosed. These “slow-progressors” may experience considerable chronic ill health, which is not well characterized. We investigated the prevalence of chronic morbidity among children aged 6–15 years at diagnosis of HIV infection.

Methods:

A cross-sectional study was performed at 7 primary care clinics in Harare, Zimbabwe. Children aged 6–15 years who tested HIV positive following provider-initiated HIV testing and counseling were recruited. A detailed clinical history and standardized clinical examination was undertaken. The association between chronic disease and CD4 count was investigated using multivariate logistic regression.

Results:

Of the 385 participants recruited [52% female, median age 11 years (interquartile range 8–13)], 95% were perinatally HIV infected. The median CD4 count was 375 (interquartile range 215–599) cells per cubic millimeter. Although 78% had previous contact with health care services, HIV testing had not been performed. There was a high burden of chronic morbidity: 23% were stunted, 21% had pubertal delay, 25% had chronic skin disease, 54% had a chronic cough of more than 1 month-duration, 28% had abnormal lung function, and 12% reported hearing impairment. There was no association between CD4 count of <500 cells per cubic millimeter or <350 cells per cubic millimeter with WHO stage or these chronic conditions.

Conclusions:

In children with slow-progressing HIV, there is a substantial burden of chronic morbidity even when CD4 count is relatively preserved. Timely HIV testing and prompt antiretroviral therapy initiation are urgently needed to prevent development of chronic complications.
Patient Comfort During Contrast Media Injection in Coronary Computed Tomographic Angiography Using Varying Contrast Media Concentrations and Flow Rates
Authors: Kok Madeleine , Mihl Casper , Hendriks Babs M.F. , Altintas Sibel , Eijsvoogel Nienke G. , Kietselaer Bas L.J.H. , Wildberger Joachim E. , Das Marco
Published: May 2016

Purpose

Pain sensation and extravasation are potential drawbacks of contrast media (CM) injection during computed tomographic angiography. The purpose was to evaluate safety and patient comfort of higher flow rates in different CM protocols during coronary computed tomographic angiography.

Methods

Two hundred consecutive patients of a double-blind randomized controlled trial (NCT02462044) were analyzed. Patients were randomized to receive 94 mL of prewarmed iopromide 240 mg I/mL at 8.3 mL/s (group I), 75 mL of 300 mg I/mL at 6.7 mL/s (group II), or 61 mL of 370 mg I/mL at 5.4 mL/s (group III), respectively. Iodine delivery rate (2.0 g I/s) and total iodine load (22.5 g I) were kept identical. Outcome was defined as intravascular enhancement, patient comfort during injection, and injection safety, expressed as the occurrence of extravasation. Patients completed a questionnaire for comfort, pain, and stress during CM injection. Comfort was graded using a 5-point scale, 1 representing “very bad” and 5 “very well.” Pain was graded using a 10-point scale, 0 representing “no pain” and 10 “severe pain.” Stress was graded using a 5-point scale, 1 representing “no stress” and 5 “unsustainable stress.”

Results

Mean enhancement levels within the coronary arteries were as follows: 437 ± 104 Hounsfield units (HU) (group I), 448 ± 111 HU (group II), and 447 ± 106 HU (group III), with P ≥ 0.18. Extravasation occurred in none of the patients. Median (interquartile range) for comfort, pain, and stress was, respectively, 4 (4–5), 0 (0–0), and 1 (1–2), with P ≥ 0.68.

Conclusions

High flow rates of prewarmed CM were safely injected without discomfort, pain, or stress. Therefore, the use of high flow rates should not be considered a drawback for CM administration in clinical practice.
Mandibular Distraction in a Patient With Type II Collagenopathy
Authors: Garza Rebecca M. , Alyono Jennifer C. , Dorfman David W. , Wan Derrick C.
Published: May 2016

Kniest dysplasia is an extremely rare form of type II collagenopathy associated with cleft palate, micrognathia, shortened trunk, arms and legs, and club foot. The authors present a case of an infant with this disorder who also had micrognathia and respiratory distress for which mandibular distraction was performed. Although abnormal collagen and impaired endochondral ossification is noted with Kniest dysplasia, adequate bone formation was observed across the distraction gap. Nonetheless, despite stable mandibular advancement, failure to consider concomitant restrictive lung disease resulted in tracheostomy dependence. The authors demonstrate that while successful bone regeneration can be achieved through distraction of intramembranous facial bones, discretion must still be employed in patients with collagenopathies.
Urinary Incontinence and Health-Seeking Behavior Among White, Black, and Latina Women
Authors: Siddiqui Nazema Y. , Ammarell Natalie , Wu Jennifer M. , Sandoval Juan S. , Bosworth Hayden B.
Published: May 2016

Objective

Fewer than half of women with urinary incontinence (UI) seek care for their condition. Our objective was to qualitatively assess the themes surrounding treatment-seeking behaviors.

Methods

We conducted 12 focus groups with women and, using purposive sampling, we stratified by racial or ethnic group (white, black, Latina) and by UI frequency. All sessions were transcribed and coded for common themes. Comparative thematic analysis was used to describe similarities and differences among groups.

Results

In total, 113 (39 white, 41 black, and 33 Latina) community-dwelling women participated in focus groups. There were no differences in treatment-seeking themes between groups with different UI frequency. However, certain themes emerged when comparing racial/ethnic groups. Women from all groups shared experiences of embarrassment and isolation because of UI, which were impediments to care seeking. White and black women described discussions with close friends or family that led to normalization of symptoms and prevented care seeking. Latina women maintained more secrecy about UI and reported the longest delays in seeking care. Women articulated a higher likelihood of seeking care if they had knowledge of treatment options, but white women were more likely to seek UI-related knowledge compared with black or Latina women. Physician communication barriers were identified in all groups.

Conclusions

Despite similar experiences, there are different perceptions about care seeking among white, black, and Latina women. Culturally relevant educational resources that focus on a range of treatment options may improve knowledge and thus improve care-seeking behaviors in women with UI.
Results of the TOP Study: Prospectively Randomized Multicenter Trial of an Ex Vivo Tacrolimus Rinse Before Transplantation in EDC Livers
Authors: Pratschke Sebastian , Arnold Hannah , Zollner Alfred , Heise Michael , Pascher Andreas , Schemmer Peter , Scherer Marcus N. , Bauer Andreas , Jauch Karl-Walter , Werner Jens , Guba Markus , Angele Martin K.
Published: May 2016

Background

Organ shortage results in the transplantation of extended donor criteria (EDC) livers which is associated with increased ischemia-reperfusion injury (IRI). Experimental studies indicate that an organ rinse with the calcineurin inhibitor tacrolimus before implantation protects against IRI. The tacrolimus organ perfusion study was initiated to examine the effects of ex vivo tacrolimus perfusion on IRI in transplantation of EDC livers.

Methods

A prospective randomized multicenter trial comparing ex vivo perfusion of marginal liver grafts (≥2 EDC according to Eurotransplant manual) with tacrolimus (20 ng/mL) or histidine-tryptophane-ketoglutarate solution (control) was carried out at 5 German liver transplant centers (Munich Ludwig-Maximilians University, Berlin, Heidelberg, Mainz, Regensburg) between October 2011 and July 2013. Primary endpoint was the maximum alanine transaminase (ALT) level within 48 hours after transplantation. Secondary endpoints were aspartate transaminase (AST), prothrombine ratio, and graft-patient survival within an observation period of 1 week. After an interim analysis, the study was terminated by the scientific committee after the treatment of 24 patients (tacrolimus n = 11, Control n = 13).

Results

Tacrolimus rinse did not reduce postoperative ALT peaks compared with control (P = 0.207; tacrolimus: median, 812; range, 362-3403 vs control: median, 652; range, 147-2034). Moreover, ALT (P = 0.100), prothrombine ratio (P = 0.553), and bilirubin (P = 0.815) did not differ between the groups. AST was higher in patients treated with tacrolimus (P = 0.011). Survival was comparable in both groups (P > 0.05).

Conclusions

Contrary to experimental findings, tacrolimus rinse failed to improve the primary endpoint of the study (ALT). Because 1 secondary endpoint (AST) was even higher in the intervention group, the study was terminated prematurely. Thus, tacrolimus rinse cannot be recommended in transplantation of EDC livers.
How human behavior drives the propagation of an emerging infection: the case of the 2014 Chikungunya outbreak in Martinique
Authors: Roche Benjamin , Gaillard Béatrice , Léger Lucas , Moutenda Renélise , Sochacki Thomas , Cazelles Bernard , Ledrans Martine , Blateau Alain , Fontenille Didier , Etienne Manuel , Simard Frédéric , Salathé Marcel , Yébakima André
Published: May 2016

Understanding the spatio-temporal dynamics of endemic infections is of critical importance for a deeper understanding of pathogen transmission, and for the design of more efficient public health strategies. However, very few studies in this domain have focused on emerging infections, generating a gap of knowledge that hampers epidemiological response planning. Here, we analyze the case of a Chikungunya outbreak that occurred in Martinique in 2014. Using time series estimates from a network of sentinel practitioners covering the entire island, we first analyze the spatio-temporal dynamics and show that the largest city has served as the epicenter of this epidemic. We further show that the epidemic spread from there through two different propagation waves moving northwards and southwards, probably by individuals moving along the road network. We then develop a mathematical model to explore the drivers of the temporal dynamics of this mosquito-borne virus. Finally, we show that human behavior, inferred by a textual analysis of messages published on the social network Twitter, is required to explain the epidemiological dynamics over time. Overall, our results suggest that human behavior has been a key component of the outbreak propagation, and we argue that such results can lead to more efficient public health strategies specifically targeting the propagation process.
Maftools: Efficient analysis, visualization and summarization of MAF files from large-scale cohort based cancer studies
Authors: Mayakonda Anand , Koeffler H Phillip
Published: May 2016

Mutation Annotation Format (MAF) has become a standard file format for storing somatic/germline variants derived from sequencing of large cohort of cancer samples. MAF files contain a list of all variants detected in a sample along with various annotations associated with the putative variant. MAF file forms the basis for many downstream analyses and provides complete landscape of the cohort. Here we introduce maftools–an R package that provides rich source of functions for performing various analyses, visualizations and summarization of MAF files. Maftools uses data.table library for faster processing/summarization and ggplot2 for generating rich and publication quality visualizations. Maftools also takes advantages of S4 class system for better data representation, with easy to use and flexible functions.

Availability and Implementation

maftools is implemented as an R package available athttps://github.com/PoisonAlien/maftools

Contact

csiamt@nus.edu.sg
Robust high throughput prokaryotede novoassembly and improvement pipeline for Illumina data
Authors: Page Andrew J. , De Silva Nishadi , Hunt Martin , Quail Michael A. , Parkhill Julian , Harris Simon R. , Otto Thomas D. , Keane Jacqueline A.
Published: May 2016

The rapidly reducing cost of bacterial genome sequencing has lead to its routine use in large scale microbial analysis. Though mapping approaches can be used to find differences relative to the reference, many bacteria are subject to constant evolutionary pressures resulting in events such as the loss and gain of mobile genetic elements, horizontal gene transfer through recombination and genomic rearrangements.De novoassembly is the reconstruction of the underlying genome sequence, an essential step to understanding bacterial genome diversity. Here we present a high throughput bacterial assembly and improvement pipeline that has been used to generate nearly 20,000 draft genome assemblies in public databases. We demonstrate its performance on a public data set of 9,404 genomes. We find all the genes used in MLST schema present in 99.6% of assembled genomes. When tested on low, neutral and high GC organisms, more than 94% of genes were present and completely intact. The pipeline has proven to be scalable and robust with a wide variety of datasets without requiring human intervention. All of the software is available on GitHub under the GNU GPL open source license.

DATA SUMMARY

The assembly pipeline software is available from Github under the GNU GPL open source license; (url -https://github.com/sanger-pathogens/vr-codebase)

The assembly improvement software is available from Github under the GNU GPL open source license; (url -https://github.com/sanger-pathogens/assembly_improvement)

Accession numbers for 9,404 assemblies are provided in the supplementary material.

TheBordetella pertussissample has sample accession ERS1058649, sequencing reads accession ERR1274624 and assembly accessions FJMX01000001-FJMX01000249.

TheSalmonella enterica subsp. enterica serovarPullorum sample has sample accession ERS1058652, sequencing reads accession ERR1274625 and assembly accession FJMV01000001-FJMV01000026.

TheStaphylococcus aureussample has sample accession ERS1058648, sequencing reads accession ERR1274626 and assembly accessions FJMW01000001-FJMW01000040.

I/We confirm all supporting data, code and protocols have been provided within the article or through supplementary data files.☑

IMPACT STATEMENT

The pipeline described in this paper has been used to assemble and annotate 30% of all bacterial genome assemblies in GenBank (18,080 out of 59,536, accessed 16/2/16). The automated generation ofde novoassemblies is a critical step to explore bacterial genome diversity. MLST genes are found in 99.6% of cases, making it at least as good as existing typing methods. In the test genomes we present, more than 94% of genes are correctly assembled into intact reading frames.
Efficient Maximum-Likelihood Inference For The Isolation-With-Initial-Migration Model With Potentially Asymmetric Gene Flow
Authors: Costa Rui J. , Wilkinson-Herbots Hilde
Published: May 2016

The isolation-with-migration (IM) model is commonly used to make inferences about gene flow during speciation, using polymorphism data. However, Becquet and Przeworski (2009) report that the parameter estimates obtained by fitting the IM model are very sensitive to the model's assumptions (including the assumption of constant gene flow until the present). This paper is concerned with the isolation-with-initial-migration (IIM) model of Wilkinson-Herbots (2012), which drops precisely this assumption. In the IIM model, one ancestral population divides into two descendant subpopulations, between which there is an initial period of gene flow and a subsequent period of isolation. We derive a very fast method of fitting an extended version of the IIM model, which also allows for asymmetric gene flow and unequal population sizes. This is a maximum-likelihood method, applicable to data on the number of segregating sites between pairs of DNA sequences from a large number of independent loci. In addition to obtaining parameter estimates, our method can also be used to distinguish between alternative models representing different evolutionary scenarios, by means of likelihood ratio tests. We illustrate the procedure on pairs of Drosophila sequences from approximately 30,000 loci. The computing time needed to fit the most complex version of the model to this data set is only a couple of minutes. The R code to fit the IIM model can be found in the supplementary files of this paper.
Can healthcare servicescape affect customer’s attitude? A study of the mediating role of image congruence and moderating role of customer’s prior experience
Authors: S. Sreejesh , Sahoo Debjani , Mitra Amarnath
Published: May 2016

Purpose

– The purpose of this paper is twofold. First, develop and test a conceptual model to understand the relationship between customers’ servicescape perceptions, self-image congruity and attitude in healthcare context. Second, to examine the extent to which the relationship between customers’ self-image congruity to attitude in a fully mediated model is moderated by their prior experience.

Design/methodology/approach

– Utilizing a self-administered survey of 320 customers, the study tested the proposed relationships with robust data analytic techniques.

Findings

– The results show that favorable servicescape perceptions help customers to form image congruence in terms of symbolic and functional elements and thereby strengthen their attitude. Further, servicescape accentuated image congruence have varying effects on customers’ attitude depending up on customers’ prior experience.

Research limitations/implications

– This study emphasized the role of servicescape on self-image congruity formation and customer attitude in a new service context (healthcare), and contribute to the body of existing knowledge on servicescapes and image congruity and further verify the soundness and robustness of the integrative theoretical framework.

Practical implications

– Favorable servicescape perceptions may encourage customers to form image congruence and attitude. In this respect, managers should make efforts to signal desired servicescape perceptions in order to retain existing customers and attract new ones.

Originality/value

– This study was the first to apply an integrative perspective of inference theory and image congruity theory to the context of hospital services to understand the relationship between servicescape, image-congruity and customer attitude.
Determinants of acquisitions in Chinese technology firms: an empirical investigation
Authors: Das Arindam , kapil sheeba
Published: May 2016

Purpose

– Globalization, increasing intensity of competition and access to capital markets have enabled emerging market firms to explore inorganic growth through merger and acquisitions (M & A) over the past two decades. The purpose of this paper is to analyze the role of firm-specific factors on M & A propensity in Chinese technology firms.

Design/methodology/approach

– The authors analyze data on 152 firms from Mainland China, Hong Kong and Taiwan over a period of 2001-2011 using logistic and count data regression.

Findings

– The authors find that the factors that influence M & As in these firms differ from the established factors found in M & A in developed economies. Large, low-debt firms have higher acquisition propensity irrespective of their technological strength and they tend to be serial acquirer too.

Originality/value

– The findings provide new insights into inorganic growth behavior of emerging market technology firms and indicate presence of both exploitative and exploratory motives.
“Raw, free”, and “almost rude”: educating warders’ children on St Helena Penal Establishment
Authors: Brady Tony James
Published: May 2016

Purpose

– The purpose of this paper is to examine the education of children at St Helena Penal Establishment in Queensland and the trials faced by the educators that delivered their formal schooling. The paper will add to the growing research into the prison island and will provide an insight into a unique facet of education in the newly established Australian State of Queensland.

Design/methodology/approach

– The historical analysis draws on original documents and published works to chronicle the provision of education to the children of warders at the St Helena Penal Establishment.

Findings

– The establishment of the Department of Public Instruction and the introduction of the State Education Act of 1875 were intended to provide Queensland children from 6 to 12 years of age with free, compulsory, and secular primary education. The full implementation of the Act took until 1900, and in the process, initiatives like St Helena State School No. 12, through issues of administrative control, saw teachers excluded from the Department of Public Instruction in order to include schoolchildren under the auspices of the same department.

Research limitations/implications

– The research paper is an initial investigation into the subject and limited by the paucity of primary data available on the topic.

Originality/value

– The case study adds to the growing literature on other aspects of the prison at St Helena, Queensland and adds to knowledge of life on the island. Furthermore, the aspects of control over staff on the island and the requirement for the teachers to double as guards, ready to take up arms in defence of the prison, provides new insights into the obligations placed on some early educators.