bluuebunny/crossref_metadata_2025 huggingface dataset:
General medical disorders with psychiatric implications
Authors: Garcia Erik J. , Ferguson Warren J.
Published: September 2017

Traditionally the domain of consultation/ liaison psychiatry, the challenge of recognizing and then appropriately treating the psychiatric complications of general medical disorders requires thoughtful planning and attention in corrections. Medical conditions that have psychiatric symptoms represent a significant diagnostic dilemma, particularly in the correctional health setting. Over half of the inmates in the United States have symptoms of a major mental illness, but the pervasiveness of substance use disorders, the increasing prevalence of elderly inmates, and limited access to a patient’s past medical and psychiatric records all contribute to the challenge of discerning when a psychiatric presentation results from an underlying medical condition. One early study underscored this challenge, noting that 46% of the patients admitted to community psychiatric wards had an unrecognized medical illness that either caused or exacerbated their psychiatric illness. A more recent study observed that 2.8% of admissions to inpatient psychiatry were due to unrecognized medical conditions. Emergency room medical clearance of patients presenting for psychiatric admission has revealed an increased risk for such underlying medical conditions among patients with any of five characteristics: elderly, a history of substance abuse, no prior history of mental illness, lower socioeconomic status, or significant preexisting medical illnesses. This chapter examines several of these risk groups and focuses on the presenting symptoms of delirium, mood disorders, and psychosis and the underlying medical conditions that can mimic or exacerbate them.
A Theory- and Evidence-Based Approach to the Definition of Torture
Authors: Bașoğlu Metin
Published: September 2017

Any attempt to define torture requires a sound theory-based understanding of the psychological mechanisms by which it induces “severe mental pain or suffering.” Among the different theories advanced for this purpose, learning theory of trauma is the one that has been most extensively tested and empirically validated. Substantial research with both animals and humans has shown that the unpredictability and uncontrollability of stressor events lead to helplessness and hopelessness responses, including anxiety and depression. This chapter presents a learning theory model of trauma, provides a definition of “pain or suffering,” demonstrates a contextual/cumulative approach to captivity stressors, and describes a methodology for assessment of captivity-induced pain or suffering. It also proposes a learning theory formulation of torture as “helplessness under the control of others” and reviews its implications for the distinction between torture and cruel, inhuman, or degrading treatment and emerging trends in international law in interpretation of torture.
Evolving Standards for Torture in International Law
Authors: Méndez Juan E. , Nicolescu Andra
Published: September 2017

The legal definition of torture is not limited to pain and suffering inflicted during interrogation or as punishment. Other practices, like domestic violence and female genital mutilation, have gradually been incorporated into the definition of torture and other ill-treatment. The absolute prohibition of torture extends to practices justified on grounds of “medical necessity” or “therapeutic purpose,” but which nevertheless inflict pain crossing the requisite threshold of severity, including the denial of pain relief and legally available abortions, or practices affecting persons with psychosocial disabilities or suffering from drug addiction. This chapter illustrates the gray areas where health care and the prohibited infliction of pain collide, discussing the rapidly evolving legal definition of torture and concepts like legal capacity, consent, and medical necessity. It recognizes that international law on the subject is far from settled, especially with regard to standards enacted by the recent Convention on the Rights of Persons With Disabilities.
Making Human Rights Sense of The Torture Definition
Authors: Ginbar Yuval
Published: September 2017

In this chapter, the author first argues that the definition of torture in the Convention Against Torture “makes human rights sense”—that it is sound morally, legally, and practically, strict enough to define a serious violation and crime but flexible enough to accommodate new interpretations. Second, the author advocates a “torture minus” approach to distinguishing, where necessary, between torture and the wider violation of cruel, inhuman, or degrading treatment or punishment (CIDT/P), holding that CIDT/P is ill-treatment that lacks any one (or more) of the torture definition’s key requirements. Finally, without underestimating past and possibly future US interrogational torture, the author calls for a focus on the lived realities of torture—its victims are mostly individuals from poor, marginalized communities being “beaten up,” rather than suspected terrorists subjected to sophisticated “enhanced interrogation techniques.” Approaches to “pain or suffering” discussed elsewhere in this volume are threaded into the analysis.
The Gendered Dimensions of Torture
Authors: Davis Lisa
Published: September 2017

Through decades of concerted grassroots organizing and creative lawyering, women’s and gender justice activists achieved the international recognition that gender-based violence is not just a “private” matter, but is, in fact, violence that can rise to the level of torture in certain cases. As states and other actors continue to resist this development by rejecting their due diligence obligations, it is vital that human rights advocates understand the history and theories underlying this critical gain. This chapter focuses on the development of the legal determination that rape specifically can rise to the level of torture, as it has the most developed legal history, and thus provides a useful means for understanding the struggle to eliminate gender-based violence. Alongside case analysis and theory, the chapter presents the women’s rights movement history, its subsequent deepening to include LGBTI persons, and the successes that these movements achieved at the international level.
Neuronal and mixed neuronal–glial tumours
Authors: Soffietti Riccardo , Duffau Hugues , Bauman Glenn , Walker David
Published: September 2017

Neuronal and mixed neuronal-glial tumours are rare tumours of the central nervous system that occur more commonly in children. Despite a generally benign course, most tumours cause medically intractable seizures, and have been denominated as ‘long-term epilepsy-associated tumours’. The World Health Organization classification distinguishes nine histological variants: dysplastic gangliocytoma of the cerebellum/Lhermitte–Duclos disease, desmoplastic infantile astrocytoma and ganglioglioma, dysembryoplastic neuroepithelial tumour, gangliocytoma and ganglioglioma, central neurocytoma and extraventricular neurocytoma, cerebellar liponeurocytoma, papillary glioneuronal tumour, rosette-forming glioneuronal tumour of the fourth ventricle, and spinal paraganglioma. Early surgery with complete resection may significantly improve the likelihood of postoperative epilepsy freedom. Conformal radiotherapy can be considered in case of patients with incompletely resected symptomatic tumours, atypical or high-grade tumours, or in the case of multiple recurrences despite resections. The role of chemotherapy in these lesions remains poorly defined, while targeted therapies are now available to impact some molecular alterations.
Meningiomas
Authors: Jalali Rakesih , Wen Patrick Y. , Fujimaki Takamitsu
Published: September 2017

Meningiomas are the most common type of primary brain tumour, comprising approximately one-third of all intracranial neoplasms. It is therefore important for all neuro-oncologists to understand the biology and optimal managements of these tumours. The majority of meningiomas are World Health Organization grade I benign tumours, but grade II (atypical) or grade III (anaplastic) tumours are not uncommon. Total surgical removal is the standard of care but may not be feasible if the tumour involves critical structures such as cranial nerves or important blood vessels. Conventional radiation therapy, stereotactic radiosurgery, or particle irradiation is used for residual or recurrent tumours. To date, medical treatments have had a limited role, except for controlling seizures. However, there are ongoing clinical trials with molecularly targeted drugs and immunotherapies based on improved understanding of the molecular pathogenesis of these tumours. In this chapter, the clinical presentation, biology, and therapy for these tumours are discussed.
Other tumours of the meninges
Authors: Yashar M. , Kalani S. , Sathornsumetee Sith , Teo Charles
Published: September 2017

Non-meningothelial tumours of the meninges constitute a rare but diverse group of pathologies and consist of mesenchymal, melanocytic, and metastatic lesions. Haemangioblastomas constitute a separate but related lesion that can affect the meninges. Although the bulk of the literature on these lesions is limited to case reports and small series, the general guidelines for treatment of most of these pathologies is based on treatment protocols for non-meningeal lesions. Guidelines from the National Comprehensive Cancer Network and other professional organizations are not available. This chapter presents the combined surgical, chemotherapeutic, and radiosurgical treatment of these lesions.
What are the First Signs and Symptoms of Dementia?
Authors: Rosenberg Paul B.
Published: September 2017

Mild cognitive impairment (MCI) is a syndrome where persons have mild cognitive complaints and deficits on exam but are still functioning well in their daily lives. Persons with MCI are at markedly increased risk of developing dementia in the near-term and thus are an important target for preventive interventions. In the office it is crucial to take a careful history and to have an informant (usually a family member). Prodromal Alzheimer’s disease is typified by problems in short-term recall likely due to hippocampal dysfunction, and depression and anxiety are relatively common. Brief cognitive tests such as the Mini-Mental State Exam (MMSE) or Montreal Cognitive Assessment (MoCA) are useful. A thorough physical/neurological exam and laboratory screening are important for ruling out other neurologic illnesses such as Parkinsons’ or stroke and for screening for treatable causes of cognitive impairment such as hypothyroidism or vitamin B12 deficiency. Biomarkers are gradually becoming more useful for diagnosis including MRI and amyloid PET scan.
Treatment of Depression
Authors: Steinberg Martin
Published: September 2017

Most depression in the elderly can be effectively treated in the primary care setting. Psychiatric referral should be considered in the setting of severe depression, suicidal ideation, prior suicide attempts, multiple risk factors, psychotic symptoms, bipolar disorder, poor response to prior treatment, or high medical comorbidity. Combining pharmacological and psychosocial interventions is most likely to be effective. Available antidepressants include serotonin-specific reuptake inhibitors, serotonin norepinephrine reuptake inhibitors, novel mechanism agents, tricyclic antidepressants, and monoamine oxidase inhibitors. Antidepressant selection should take into account adverse effects, medical comorbidities, potential medication interactions, and patient preferences. Additional strategies (e.g. augmentation) are available for treatment resistant depression. Available psychotherapies include supportive, cognitive-behavioral, interpersonal, and problem solving. Lifestyle interventions (e.g. exercise) may be helpful adjuncts. Given limited evidence for antidepressant treatment in cognitive impairment, for those with mild to moderate depression severity, non-pharmacological interventions should be attempted first.
RISE: a database of RNA interactome from sequencing experiments
Authors: Gong Jing , Shao Di , Xu Kui , Lu Zhipeng , Lu Zhi John , Yang Yucheng T , Zhang Qiangfeng Cliff
Published: September 2017

We present RISE (http://rise.zhanglab.net), a database of RNA Interactome from Sequencing Experiments. RNA-RNA interactions (RRIs) are essential for RNA regulation and function. RISE provides a comprehensive collection of RRIs that mainly come from recent transcriptome-wide sequencing-based experiments like PARIS, SPLASH, LIGR-seq, and MARIO, as well as targeted studies like RIA-seq, RAP-RNA and CLASH. It also includes interactions aggregated from other primary databases and publications. The RISE database currently contains 328,811 RNA-RNA interactions mainly in human, mouse and yeast. While most existing RNA databases mainly contain interactions of miRNA targeting, notably, more than half of the RRIs in RISE are among mRNA and long non-coding RNAs. We compared different RRI datasets in RISE and found limited overlaps in interactions resolved by different techniques and in different cell lines. It may suggest technology preference and also dynamic natures of RRIs. We also analyzed the basic features of the human and mouse RRI networks and found that they tend to be scale-free, small-world, hierarchical and modular. The analysis may nominate important RNAs or RRIs for further investigation. Finally, RISE provides a Circos plot and several table views for integrative visualization, with extensive molecular and functional annotations to facilitate exploration of biological functions for any RRI of interest.
Approaches to the removal of T-lymphocytes to minimize graft-versus-host disease in patients with primary immunodeficiencies who do not have a matched sibling donor
Authors: Slatter Mary A. , Gennery Andrew R.
Published: September 2017

Purpose of review

Since the advent of T-lymphocyte depletion in hematopoietic stem cell transplantation (HSCT) for primary immunodeficiency, survival following this procedure has remained poor compared to results when using matched sibling or matched unrelated donors, over the last 40 years. However, three new techniques are radically altering the approach to HSCT for those with no matched donor, particularly those with primary immunodeficiencies which are not severe combined immunodeficiency.

Recent findings

Three main techniques of T-lymphocyte depletion are altering donor choice for patients with primary immunodeficiencies and have improved transplant survival for primary immunodeficiencies to over 90%, equivalent to that for matched sibling and matched unrelated donor transplants. CD3+ T cell receptor (TCR)αβ+ CD19+ depletion, CD45RA depletion and use of posttransplant cyclophosphamide give similar overall survival of 90%, although viral reactivation remains a concern. Further modification of CD3+ TCRαβ+ CD19+ depletion by adding back inducible caspase-9 suicide gene-modified CD3+ TCRαβ+ T-lymphocytes may further improve outcomes for patients with systemic viral infection.

Over the last 5 years, the outcomes of HSCT using new T-lymphocyte depletion methods have improved to the extent that they are equivalent to outcomes of matched sibling donors and may be preferred in the absence of a fully matched sibling donor, over an unrelated donor to reduce the risk of graft versus host disease.
Sevoflurane Acts on Ubiquitination–Proteasome Pathway to Reduce Postsynaptic Density 95 Protein Levels in Young Mice
Authors: Lu Han , Liufu Ning , Dong Yuanlin , Xu Guanghong , Zhang Yiying , Shu Liqi , Soriano Sulpicio G. , Zheng Hui , Yu Buwei , Xie Zhongcong
Published: September 2017

Background

Children with multiple exposures to anesthesia and surgery may have an increased risk of developing cognitive impairment. Sevoflurane, a commonly used anesthetic in children, has been reported to decrease levels of postsynaptic density 95 protein. However, the upstream mechanisms and downstream consequences of the sevoflurane-induced reduction in postsynaptic density 95 protein levels remains largely unknown. We therefore set out to assess whether sevoflurane acts on ubiquitination–proteasome pathway to facilitate postsynaptic density 95 protein degradation.

Methods

Six-day-old wild-type mice received anesthesia with 3% sevoflurane 2 h daily for 3 days starting on postnatal day 6. We determined the effects of the sevoflurane anesthesia on mRNA, protein and ubiquitinated levels of postsynaptic density 95 protein in neurons, and synaptosomes and hippocampus of young mice. Cognitive function in the mice was determined at postnatal day 31 by using a Morris water maze. Proteasome inhibitor MG132 and E3 ligase mouse double mutant 2 homolog inhibitor Nutlin-3 were used for the interaction studies.

Results

The sevoflurane anesthesia decreased protein, but not mRNA, levels of postsynaptic density 95, and reduced ubiquitinated postsynaptic density 95 protein levels in neurons, synaptosomes, and hippocampus of young mice. Both MG132 and Nutlin-3 blocked these sevoflurane-induced effects. Sevoflurane promoted the interaction of mouse double mutant 2 homolog and postsynaptic density 95 protein in neurons. Finally, MG132 and Nutlin-3 ameliorated the sevoflurane-induced cognitive impairment in the mice.

Conclusions

These data suggest that sevoflurane acts on the ubiquitination–proteasome pathway to facilitate postsynaptic density 95 protein degradation, which then decreases postsynaptic density 95 protein levels, leading to cognitive impairment in young mice. These studies would further promote the mechanistic investigation of anesthesia neurotoxicity in the developing brain.
Association of Hospital-level Neuraxial Anesthesia Use for Hip Fracture Surgery with Outcomes
Authors: McIsaac Daniel I. , Wijeysundera Duminda N. , Huang Allen , Bryson Gregory L. , van Walraven Carl
Published: September 2017

Background

There is consistent and significant variation in neuraxial anesthesia use for hip fracture surgery across jurisdictions. We measured the association of hospital-level utilization of neuraxial anesthesia, independent of patient-level use, with 30-day survival (primary outcome) and length of stay and costs (secondary outcomes).

Methods

We conducted a population-based cohort study using linked administrative data in Ontario, Canada. We identified all hip fracture patients more than 65 yr of age from 2002 to 2014. For each patient, we measured the proportion of hip fracture patients at their hospital who received neuraxial anesthesia in the year before their surgery. Multilevel, multivariable regression was used to measure the association of log-transformed hospital-level neuraxial anesthetic-use proportion with outcomes, controlling for patient-level anesthesia type and confounders.

Results

Of 107,317 patients, 57,080 (53.2%) had a neuraxial anesthetic; utilization varied from 0 to 100% between hospitals. In total, 9,122 (8.5%) of patients died within 30 days of surgery. Survival independently improved as hospital-level neuraxial use increased (P = 0.009). Primary and sensitivity analyses demonstrated that most of the survival benefit was realized with increase in hospital-level neuraxial use above 20 to 25%; there did not appear to be a substantial increase in survival above this point. No significant associations between hospital neuraxial anesthesia-use and other outcomes existed.

Conclusions

Hip fracture surgery patients at hospitals that use more than 20 to 25% neuraxial anesthesia have improved survival independent of patient-level anesthesia type and other confounders. The underlying causal mechanism for this association requires a prospective study to guide improvements in perioperative care and outcomes of hip fracture patients.
Anterior cruciate ligament reconstruction in patients over age sixty years
Authors: Troyer Joshua D. , Flanigan David C. , Kaeding Christopher C. , Magnussen Robert A.
Published: September 2017

Background:

We sought to determine outcomes of anterior cruciate ligament reconstruction (ACLR) in patients over 60 yr of age at the time of reconstruction.

Methods:

All patients over the age of 60 yr who underwent ACLR at our institution between 2005 and 2014 were identified. Patients were subsequently contacted and each completed a questionnaire that included a Knee injury and Osteoarthritis Outcome Score (KOOS), Marx and Tegner Activity Scores, patient satisfaction with the operation, and details of any subsequent surgical procedures on the index knee.

Results:

Ten patients met inclusion criteria, and all 10 were contacted at a mean of 4.4 yr after ACLR (range: 1.3-9.4 yr). The mean KOOS scores for each subscale were: pain 95.9, symptoms 90.4, activities of daily life 95.0, sport and recreation function 80.5, and knee-related quality of life 79.7. No patient underwent repeat surgery on the index knee. The median Tegner activity score was 3 (range, 2-6). Nine of the 10 patients reported that they were able to return to their preoperative activity level. All patients were subjectively satisfied with the results of their surgery and stated that they would do the operation again if given the choice.

Conclusions:

ACL reconstruction in patients over the age of 60 yr yields excellent patient-reported outcomes, high rates of return to preinjury activity level, and low revision risk when performed for symptomatic instability in the absence of significant osteoarthritis.
Relationship Between Problematic Internet Use and Time Management Among Nursing Students
Authors: Öksüz Emine , Guvenc Gulten , Mumcu Şule
Published: September 2017

The Internet is an essential part of everyday life, particularly for the younger generation. The aims of this study were to evaluate nursing students' problematic Internet use and time management skills and to assess relationship between Internet use and time management. This descriptive study was conducted with 311 nursing students in Ankara, Turkey, from February to April 2016. The data were collected using the Problematic Internet Use Scale and Time Management Inventory. The Problematic Internet Use Scale and Time Management Inventory median scores were 59.58 ± 20.69 and 89.18 ± 11.28, respectively. There were statistically significant differences between both nursing students' Problematic Internet Use Scale and Time Management Inventory median scores and some variables (school grade, the time spent on the Internet). Fourth-year students were more prone to excessive use of the Internet and the resulting negative consequences than students from other year levels (P < .05). A significant negative relationship was also found between problematic Internet use and time management (P < .05). This study demonstrates that the Internet use of participants was not problematic and their time management skills were on a moderate level.
Clinical Characteristics of Patients Experiencing Pathologic Complete Response Following Neoadjuvant Therapy for Borderline Resectable/Locally Advanced Pancreatic Adenocarcinoma
Authors: Hashemi-Sadraei Neda , Gbolahan Olumide B. , Salfity Hai , O’Neil Bert , House Michael G. , Shahda Safi
Published: September 2017

Objectives:

The purpose of this study is to describe clinical characteristics and outcomes of patients with borderline resectable pancreatic cancer (BRPC) or locally advanced pancreatic cancer (LAPC) who achieved pathologic complete response (pCR) following neoadjuvant therapy.

Materials and Methods:

A single institution clinical database for patients with pancreatic ductal adenocarcinoma was queried. Between 2008 and 2014 patients were identified with BRPC and LAPC, who underwent surgical resection after receiving neoadjuvant treatment. Clinical and pathologic features of the patients who achieved pCR were acquired retrospectively.

Results:

Six patients were identified to have pCR on pathology of the postoperative specimen. On the basis of pretreatment clinical staging, 2 patients were considered to have BRPC and 4 LAPC. Four patients received gemcitabine-based chemotherapy and 2 patients received FOLFIRINOX (5-fluorouracil, oxaliplatin, irinotecan, and leucovorin). Five of 6 patients received radiation therapy before operative resection. Operative procedures included distal pancreatectomy (n=3) and pancreatoduodenectomy (n=3). Pancreatic intraepithelial neoplasia 1 to 2 was present in 3 cases, and pancreatic intraepithelial neoplasia 3 in 1 case. During a median follow-up of 21.3 months, 2 patients died, with a median survival of 11.0 months (range, 10.4 to 11.6 mo). Four patients are alive and continue to follow-up with median survival of 28.7 months (range, 20.1 to 42.4 mo).

Conclusions:

Multimodality neoadjuvant therapy may lead to complete pathologic response in a small number of patients with borderline resectable/locally advanced pancreatic adenocarcinoma. pCR to neoadjuvant therapy does not lead to cure in most cases, and the majority of patients appear to relapse locally or systemically.
Interstitial Granulomatous Variant of Scleromyxedema—A Diagnostic Pitfall
Authors: Long Valencia , Tan Weisheng , Lee Siong See Joyce , Thng Tien Guan Steven
Published: September 2017

Scleromyxedema is a rare disorder where patients may develop systemic manifestations such as monoclonal gammopathy, inflammatory polyarthritis, and esophageal and neurological dysfunction. Histologically, there may be atypical variants of scleromyxedema showing features resembling interstitial granuloma annulare. We report an unusual case of scleromyxedema with interstitial granulomatous pattern and highlight potential diagnostic pitfalls when encountered with such a variant.
Estimating Risk of Hematopoietic Acute Radiation Syndrome in Children
Authors: Adams Grace G. , Sumner Louise E. , Casagrande Rocco
Published: September 2017

Following a radiological terrorist attack or radiation accident, the general public may be exposed to radiation. Historically, modeling efforts have focused on radiation effects on a “reference man”—a 70‐kg, 180‐cm-tall, 20‐ to 30‐y-old male—which does not adequately reflect radiation hazard to special populations, particularly children. This work examines the radiosensitivity of children with respect to reference man to develop a set of parameters for modeling hematopoetic acute radiation syndrome in children. This analysis was performed using animal studies and the results verified using data from medical studies. Overall, the hematopoietic system in children is much more radiosensitive than that in adults, with the LD50 for children being 56% to 91% of the LD50 of adults, depending on age.
The Johns Hopkins Fall Risk Assessment Tool
Authors: Poe Stephanie S. , Dawson Patricia B. , Cvach Maria , Burnett Margaret , Kumble Sowmya , Lewis Maureen , Thompson Carol B. , Hill Elizabeth E.
Published: September 2017

Patient falls and fall-related injury remain a safety concern. The Johns Hopkins Fall Risk Assessment Tool (JHFRAT) was developed to facilitate early detection of risk for anticipated physiologic falls in adult inpatients. Psychometric properties in acute care settings have not yet been fully established; this study sought to fill that gap. Results indicate that the JHFRAT is reliable, with high sensitivity and negative predictive validity. Specificity and positive predictive validity were lower than expected.
Are Androgen and Estrogen Receptors in DCIS Patients Prognostic Indicators of Relapse Independently of Treatment?
Authors: Ravaioli Sara , Puccetti Maurizio , Tumedei Maria Maddalena , Silvestrini Rosella , Bedei Lucia , Bravaccini Sara
Published: September 2017

Ductal carcinoma in situ (DCIS) is a highly heterogenous tumor that is now more frequently diagnosed because of the increased number of screening programs. Women with DCIS are mainly treated with conservative surgery almost always followed by radiotherapy. Although conventional biomarkers, i.e. ER, PgR, Ki67, and HER2, have been extensively investigated in invasive tumors, little is known about their role in DCIS, especially that of the androgen receptor (AR). In the present study, the expression of conventional biomarkers and AR was determined by immunohistochemistry in 85 DCIS samples from patients monitored for a maximum of 13 years: 43 patients were treated with quadrantectomy and 42 patients underwent quadrantectomy and radiotherapy. Of these, 5 and 11 patients relapsed, respectively. Our findings showed that ER and PgR were higher in nonrelapsed than in relapsed patients (P=0.025 and 0.0038). In contrast, AR expression and the AR/ER ratio were higher in relapsed patients than in the nonrelapsed group (P=0.0069 and 0.0012). At the best cut-off value of 1.1, the AR/ER ratio showed an overall accuracy of 92% and 80% in predicting in situ relapse or progression to invasive carcinoma in DCIS patients treated with surgery and those treated with surgery plus radiotherapy, respectively. AR would therefore appear to be an independent prognostic biomarker in the latter group. Our preliminary results highlight the potentially important role of the AR/ER ratio as a predictive indicator of DCIS relapse, independently of treatment.
Training Community Health Workers to Enhance Disaster Resilience
Authors: Nicholls Keith , Picou Steven J. , McCord Selena C.
Published: September 2017

Community health workers (CHWs) have significant potential to contribute to public health in the United States by promoting disaster preparedness, speeding postdisaster recovery, and building disaster resilience in their communities. To maximize this potential, however, they must undergo rigorous and relevant training. As part of the Gulf Region Health Outreach Program, an appropriate curriculum was developed and delivered in several training sessions conducted from 2013 to 2016. This article provides insights into the primary issues associated with such training and offers a detailed elaboration of the basic and specialized curricula as presented and adapted over the course of the program. We present lessons learned from these training experiences, as reflected in participants' initial ratings and comments, training staff debriefings, and feedback from CHWs working in the field. Informed by this feedback, as well as additional research and conceptual development, we offer recommendations aimed at expanding and refining CHW training curricula in the areas of chronic disease, psychosocial symptoms, community resilience, and environmental health. In addition to curriculum changes, we review policy implications aimed at promoting and facilitating the inclusion of CHWs in disaster response and recovery teams.
Integration of Mental and Behavioral Health in Pediatric Health Care Clinics
Authors: Hansel Tonya , Rohrer Glenn , Osofsky Joy , Osofsky Howard , Arthur Elizabeth , Barker Chikira
Published: September 2017

Objective:

Integrating behavioral health services into primary and pediatric health care settings is important to increase availability and access to quality mental and behavioral health care for children and adolescents. The Mental and Behavioral Health Capacity Project implemented models of pediatric integrated health care at Federally Qualified Health Clinics covering largely rural communities in Louisiana and impacted communities on the Florida Panhandle. The objectives of this article are to describe the programs and demonstrate sustainability and effectiveness of services provided.

Design:

A subsample from the Louisiana clinics collected data at intake and follow-up at 1, 3, and 6-month intervals. The hypotheses were that child behavior problems and parenting stress would significantly decrease over the course of treatment.

Setting:

This study was conducted at 2 Federally Qualified Health Clinics in rural southeast Louisiana that provide pediatric primary health care.

Participants:

Sample parameters were child patients younger than 18 years presenting at primary health care clinics in Southeast Louisiana (N = 177); the mean age was 9.8 years (standard deviation = 4.3 years).

Intervention:

Brief behavioral health services included parental education, medication management, stress management, empowerment, and psychodynamic interventions.

Main Outcome Measure:

The main outcome measures were the Pediatric Symptom Checklist and the Parenting Stress Index.

Results:

Statistically significant decreases in child behavior problems and parenting stress were revealed, with 87% reporting satisfaction with services.

Conclusions:

Utilizing community-based and culturally sensitive approaches, mental and behavioral health integrated into pediatric health care clinics can be sustainable and effective at improving child behavior problems, parenting stress, and overall family functioning.
Utilizing Actionable Data Analytics to Support Patient Navigation Enrollment and Retention Within Federally Qualified Health Centers
Authors: Robinson Melody M. , Stone Gregory , Tokarz Stephanie , Wortham Benjamin
Published: September 2017

Introduction:

Emergency departments (EDs) have become the primary source of care for increasing number of patients, leading to treatment of nonemergent cases, which divert resources from true emergency situations and represent poor cost-effectiveness for treating such cases. There is evidence that suggests that patient navigation (PN) integrated into the ED and other case management techniques can help reduce the number of primary care–related ED visits and these navigation programs are more cost-effective than the ED visits themselves. The Greater New Orleans Community Health Connection Primary Care Capacity Project Quality Improvement Initiative (GNOPQii) is a pilot project aimed at improving the efficiency of PN for patients who have had avoidable ED encounters or inpatient readmissions through applied data and technology program.

Methods:

Partnering Federally Qualified Health Centers were equipped with actionable ED utilization data to integrate with their own patient clinical data to track patient ED activity. The pilot design also included the use of patient navigators to address the nonclinical cultural and behavioral barriers to care. As part of the overall evaluation, comparisons of data utilization and PN services pre- and post-GNOPQii were conducted.

Results:

A total of 337 referrals were made, and 145 patients were enrolled into the GNOPQii pilot program. The direct services needed the most by patients were transportation and medication resources. Of those who enrolled (N = 145), 63 patients graduated, meaning program compliance and 90 days without visits to the ED, resulting in a 43% success rate.

Discussion:

If an estimated $1898 savings for every nonemergency ED encounter replaced by an office-based encounter is applied to our results, the GNOPQii program contributed to a minimum of $119 574.00 savings even if only 1 deterred ED visit per graduate is assumed. Future research is needed to systematically test the efficacy of GNOPQii in reducing nonemergent ED visits.
Planning and Implementing Immunization Billing Programs at State and Local Health Departments: Barriers and Possible Solutions
Authors: Corriero Rosemary , Redmon Ginger
Published: September 2017

Context:

Before participating in a project funded by the Centers for Disease Control and Prevention, most state and local health departments (LHDs) were not seeking reimbursement or being fully reimbursed by insurance plans for the cost of immunization services (including vaccine costs and administration fees) they provided to insured patients. Centers for Disease Control and Prevention's Billables Project was designed to enable state and LHDs to bill public and private insurance plans for immunization services provided to insured patients.

Objective:

Identify and describe key barriers state and LHDs may encounter while planning and implementing a billing program, as well as possible solutions for overcoming those barriers.

Design:

This study used reports from Billables Project participants to explore barriers they encountered when planning and implementing a billing program and steps taken to address those barriers.

Setting and Participants:

Thirty-eight state immunization programs.

Results:

Based on project participants' reports, barriers were noted in 7 categories: (1) funding and costs, (2) staff, (3) health department characteristics, (4) third-party payers and insurance plans, (5) software, (6) patient insurance status, and (7) other barriers. Possible solutions for overcoming those barriers included hiring or seeking external help, creating billing guides and training modules, streamlining workflows, and modifying existing software systems.

Conclusion:

Overcoming barriers during planning and implementation of a billing program can be challenging for state and LHDs, but the experiences and suggestions of past Billables Project participants can help guide future billing program efforts.
A Comparative Study of the Aesthetic Outcome of Two Techniques for Unilateral Complete Cleft Lip Repair
Authors: Phillips Georgina S. A. , Swan Marc C. , Sawyer Adam R. , Goodacre Tim E. E. , Cadier Michael
Published: September 2017

Background:

Cleft lip repair aims to create symmetric nasolabial morphology with minimal scarring. Poor aesthetic outcomes may have damaging psychosocial implications. Determining the optimal method of recreating lip symmetry is a major goal of applied cleft clinical research. This study aims to determine whether subjective assessment could differentiate aesthetic outcome between two surgeons who use two different surgical techniques for unilateral cleft lip repair.

Methods:

Surgeon A uses a modified rotation-advancement technique incorporating a supra–white roll flap and Noordhoff-style vermilion flap. Surgeon B uses an upper and lower triangle technique. Neither surgeon used presurgical orthopedics. Five-year postoperative frontal photographs (cropped according to the Asher-McDade aesthetic index) were analyzed by a panel of 40 blinded surgical and lay reviewers using a five-point Likert scale. The assessments were repeated after a 2-week interval to assess intrarater reliability.

Results:

Thirty-nine consecutive complete unilateral cleft lip and palate patients were assessed for each surgeon. The mean Likert score for surgical/lay assessors was 3.07/3.00 for surgeon A and 2.67/2.61 for surgeon B. This difference was statistically significant (p < 0.05). The interrater reliability was excellent and the intrarater reliability was fair. There was good correlation between lay and surgical assessors.

Conclusion:

Subjective assessment of clinical photography provides a reliable method of differentiating aesthetic outcome after unilateral cleft lip repair and presents a rapid and straightforward clinically relevant method of comparing surgical outcomes.
Unusual Aspergillus Infection After Dermal Filler Injection
Authors: Shin Jin Yong , An Mun-Young , Roh Si-Gyun , Chang Suk Choo , Lee Nae-Ho
Published: September 2017

According to a great desire for facial rejuvenation, dermal filler is promising for improving people's appearance without surgery. In a society of plastic surgery, injection of dermal filler is one of the most common procedures for a younger appearance. An increase in patients who have filler injection has been paralleled by a rise in various adverse reactions. Formation of inflammatory or infected nodules is one of the most common long-term complications. Infections can be increased because of improper disinfection of the patient's skin, a poor injection technique, decreased general immunity, and the presence of pathogens. The majority of bacteria are aerobic or facultative aerobic bacteria. This expectation of pathogens is critical for deciding on the antibiotic treatment before confirming the pathogen by microbial culture. The authors experienced unusual culture results in a patient with a chronic inflammatory nodule with abscess formation. The authors report a unique Aspergillus-cultured infection after filler injection.
Reconstruction of Mandibular Segmental Detects Using Transport Disk Distraction Osteogenesis
Authors: Li Tao , Man Yi , Bi Ruiye , Jiang Nan , Li Yunfeng , Zhu Songsong
Published: September 2017

Background:

Distraction osteogenesis (DO) has become an important alternative for bone defect reconstruction. The study aims to investigate the clinical feasibility and efficiency of transport disc DO (TDDO) for reconstruction of segmental defect of mandible and further dental implant treatment.

Methods:

A serial of 6 patients diagnosed with ameloblastoma or keratocystic odontogenic tumor were included in this study. Computed tomography (CT) scanning and panoramic radiograph were performed for preoperative evaluation and surgery planning. Transport disc DO was applied simultaneously with tumor resection for reconstruction of mandibular defects. The postoperative panoramic radiographs and CT scans were taken for evaluation of the ossification level. Then a second surgery was performed for removal of the distraction apparatus. Bone graft and rigid internal fixation were also used to fill the gap between the transport disc and the stump of the residual ramus. Further dental implant treatment was also finished or in progress.

Results:

All patients finished the whole treatment period, and no distraction device failure or tumor recurrence occurred. The distraction length ranged from 35 to 48 mm and the whole treatment period of TDDO ranged from 21 to 33 weeks. High degree of ossification was confirmed at the end of treatment by postoperative radiographs and intraoperative observation. Infection occurred in 1 of the 6 patients, and the symptom was controlled by surgical dressing change and flushing. Results of final facial profile in all patients were good. Three patients finished dental implant treatment with good occlusion.

Conclusion:

Results in this study suggest the clinical feasibility and efficiency of TDDO for reconstruction of segmental defect of mandible and further dental implant treatment.
A Pediatric Patient With an Orbital Respiratory Epithelial Cyst
Authors: Cohn Jason E. , Bahrami Arash , Monteleone Christina , Pascasio Judy Mae , Davis Wellington J.
Published: September 2017

Respiratory epithelial cysts are rare orbital cysts that can arise secondary to choristomatous rests of respiratory epithelium. Approximately 15 congenital cases have been described in the literature, making it a rare disease entity. We present a case of a 14-month-old Middle Eastern male with a right infraorbital respiratory epithelial cyst. Magnetic resonance imaging of the brain and orbits revealed a right infraorbital cyst hyperintense on T1-weighted images and followed fluid density on T2-weighted images. This cyst was noted to displace the globe superiorly and inferior rectus muscle laterally. This cyst was excised using a transconjunctival approach. Histologically, the cyst wall was lined by ciliated columnar cells with interspersed mucus-containing cells and ciliated transitional epithelium was present, establishing the diagnosis of respiratory epithelial cyst. To our knowledge, this is the youngest patient with a respiratory epithelial cyst of the orbit reported in the literature.
Management of Zygomatic Fixture Complication Case Using Extra-Short Implants
Authors: Benatto Guilherme Bertolotti , Bueno Cleuber Rodrigo de Souza , Curvêllo Victor Prado , Nary Filho Hugo
Published: September 2017

The oral rehabilitation of a patient with atrophic maxilla is one of the main challenges in implant-supported rehabilitations. The implant placement in the posterior region of the maxilla is limited by a deficiency of bone quantity and quality, besides the anatomic restriction of the maxillary sinus. The use of zygoma fixtures, anchoraged in the zygomatic bone, is a useful technique to enable the full arch rehabilitation. However, complications related to this procedure bring a lot of difficulty in solving. This study presents the use of extra-short implants as a strategy to treat a patient in whom the zygoma fixture and the fixed prosthesis failed, associated with sinusitis and alveolar bone loss.
Metabolomics reveals that dietary xenoestrogens alter cellular metabolism induced by palbociclib/letrozole combination cancer therapy
Authors: Warth Benedikt , Raffeiner Philipp , Granados Ana , Huan Tao , Fang Mingliang , Forsberg Erica M , Benton H. Paul , Goetz Laura , Johnson Caroline H. , Siuzdak Gary
Published: September 2017

Highlights

Synergism of combined palbociclib/letrozole chemotherapy was examined by global metabolomics

Combination therapy led to more pronounced effects on the MCF-7 metabolome than single agents

Dietary phyto- and mycoestrogens significantly affected the metabolic and anti-oncogenic response of the drugs

Implications of these bio-active chemicals on therapeutic success in breast cancer patients appear plausible

In Brief

Warth et al. used innovative global metabolomics and pathway prediction technology to describe the metabolic effects of the combined palbociclib/letrozole breast cancer therapy. Moreover, the role of dietary xenoestrogens on this treatment was examined by metabolite data, proliferation experiments, and functional assays.

Recently, the palbociclib/letrozole combination therapy was granted accelerated FDA approval for the treatment of estrogen receptor (ER) positive breast cancer. Since the underlying metabolic effects of these drugs are yet unknown, we investigated their synergism at the metabolome level in MCF-7 cells. As xenoestrogens interact with the ER, we additionally aimed at deciphering the impact of the phytoestrogen genistein, and the estrogenic mycotoxin zearalenone on this treatment. A global metabolomics approach was applied to unravel metabolite and pathway modifications. The results clearly showed that the combined effects of palbociclib and letrozole on cellular metabolism were far more pronounced than that of each agent alone and potently influenced by xenoestrogens. This behavior was confirmed in proliferation experiments and functional assays. Specifically, amino acids and central carbon metabolites were attenuated while higher abundances were observed for fatty acids and most nucleic acid related metabolites. Interestingly, exposure to model xenoestrogens appeared to partially counteract these effects.
THE HOXD CLUSTER IS A DYNAMIC AND RESILIENT TAD BOUNDARY CONTROLLING THE SEGREGATION OF ANTAGONISTIC REGULATORY LANDSCAPES
Authors: Rodríguez-Carballo Eddie , Lopez-Delisle Lucille , Zhan Ye , Fabre Pierre J. , Beccari Leonardo , El-Idrissi Imane , Nguyen Huynh Thi Hahn , Ozadam Hakan , Dekker Job , Duboule Denis
Published: September 2017

The mammalianHoxDcluster lies between two topologically associating domains (TADs) matching distinct, enhancer-rich regulatory landscapes. During limb development, the telomeric TAD controls the early transcription ofHoxdgene in forearm cells, whereas the centromeric TAD subsequently regulates more posteriorHoxdgenes in digit cells. Therefore, the TAD boundary prevents the terminalHoxd13gene to respond to forearm enhancers, thereby allowing proper limb patterning. To assess the nature and function of this CTCF-rich DNA regionin embryo,we compared chromatin interaction profiles between proximal and distal limb bud cells isolated from mutant stocks where various parts or this boundary region were removed. The resulting progressive release in boundary effect triggered inter-TAD contacts, favored by the activity of the newly accessed enhancers. However, the boundary was highly resilient and only a 400kb large deletion including the whole gene cluster was eventually able to merge the neighboring TADs into a single structure. In this unified TAD, both proximal and distal limb enhancers nevertheless continued to work independently over a targeted transgenic reporter construct. We propose that the wholeHoxDcluster is a dynamic TAD border and that the exact boundary position varies depending on both the transcriptional status and the developmental context.