bluuebunny/crossref_metadata_2025 huggingface dataset:
Surgical Outcome of Replacing a Failed Ahmed Glaucoma Valve by a Baerveldt Glaucoma Implant in the Same Quadrant in Refractory Glaucoma
Authors: Zuo Wenzhen , Lesk Mark R.
Published: February 2018

Purpose:

The purpose of this study was to describe the surgical technique and outcomes in eyes that underwent surgery to replace a failed Ahmed valve by a Baerveldt glaucoma implant in the same quadrant.

Methods:

This study was a retrospective case series of 9 patients. Parameters analyzed include age, glaucoma type, prior surgery, complications, intraocular pressure (IOP), visual acuity, and number of glaucoma medications before and after the surgery. Surgical success was defined as having either an IOP below 21 mm Hg or a 20% IOP reduction, with or without hypotensive agent.

Results:

The mean follow-up duration was 47 months. After surgery, at the time of final follow-up, the mean IOP decreased from 29.9 mm Hg to 16.7 mm Hg (36% of mean IOP reduction; P=0.008). There was a significant reduction of hypotensive agents from a mean of 4.33 to 2.22 (P=0.02). The visual acuity did not have a significant deterioration (P=0.07). In the final visit, 5 of 9 patients met total success criteria and 2 patients were qualified successes. Two cases failed totally after 69 and 125 months of follow-up. The cumulative probability of total success after 6 months was 76% and this rate remained stable until the sixth year. One patient had bullous keratopathy. Two patients had early postoperative pressure spikes: the first patient was treated by trabeculectomy, and the second by vitrectomy.

Conclusions:

A replacement of the failed Ahmed glaucoma valve by a new Baerveldt glaucoma implant in the same quadrant can be a reasonable choice to control refractory glaucoma.
Suprasternal Transcatheter Aortic Valve Replacement in Patients with Marginal Femoral Access
Authors: Kiser Andy C. , Caranasos Thomas G. , Peterson Mark D. , Holzhey David M. , Kiefer Philipp , Wiley Nifong L. , Borger Michael A.
Published: February 2018

Objective

Recently, the PARTNER 2A trial reported results of transcatheter aortic valve replacement versus surgical aortic valve replacement in 2032 intermediate-risk patients at 2 years. Two hundred thirty-six patients (24%) required an access route other than transfemoral. Compared with transfemoral and surgical aortic valve replacement, nontransfemoral transcatheter aortic valve replacement was associated with a numerically higher rate of death and disabling stroke at 30 days. This underscores the need for a better alternative surgical approach for patients with marginal femoral access. We reviewed our multicenter experience with minimally invasive suprasternal transcatheter aortic valve replacement.

Methods

Consecutive patients with symptomatic severe aortic stenosis at high or intermediate risk for surgical aortic valve replacement underwent suprasternal transcatheter aortic valve replacement. A commercially available transcatheter heart valve was deployed under fluoroscopic guidance through the innominate artery or ascending aorta. Using a 3-cm skin incision just above the sternal notch, the Aegis Transit System (Aegis Surgical Ltd, Galway, Ireland) provided illuminated access to the mediastinum without bone disruption. Through a purse-string suture placed in the innominate artery or ascending aorta, transcatheter aortic valve replacement proceeded similarly to the direct aortic approach.

Results

Thirty patients at six medical centers successfully underwent suprasternal transcatheter aortic valve replacement. Implanted valves included 2 CoreValve and 12 Evolut-R (Medtronic, Inc, Minneapolis, MN USA), as well as 10 SAPIEN 3 and 6 SAPIEN XT (Edwards Lifesciences, Corp, Irvine, CA USA) with sizes ranging from 23 to 31 mm. Median procedure time was 90 minutes and median hospital stay was 4 days. Postoperatively, new permanent pacemaker (n = 3) was the most common Vascular Academic Research Consortium 2 complication.

Conclusions

These data demonstrate the early clinical feasibility of suprasternal transcatheter aortic valve replacement. Key advantages of this approach include direct access to the innominate artery and ascending aorta, precise sheath control, and confident arterial closure. Additional experience is warranted to confirm these favorable results.
Acute Heart Failure at the Time of Transcatheter Aortic Valve Replacement Does not Increase Mortality
Authors: Burke William T. , Trivedi Jaimin R. , Flaherty Michael P. , Grubb Kendra J.
Published: February 2018

Objective

Patients presenting for transcatheter aortic valve replacement are often in acute on chronic heart failure, as indicated by elevated N-terminal pro-B-type natriuretic peptide. Many believe that elevated N-terminal pro-B-type natriuretic peptide is an indication to treat medically, reserving surgery until the patient is medically optimized.

Methods

A single-center transcatheter aortic valve replacement database was queried from December 2015 to November 2016 to identify patients undergoing transcatheter aortic valve replacement. Patients were divided into two cohorts based on preoperative N-terminal pro-B-type natriuretic peptide level. An analysis was then completed to assess outcomes such as length of intensive care unit stay, total length of stay, discharge to home, major complications, and mortality at 30 days.

Results

There were 142 patients (median age = 80 years, 44% female) with preoperative N-terminal pro-B-type natriuretic peptide data included (range = 106–73,500 pg/mL). The mean Society of Thoracic Surgeons predicative risk of mortality was 8%, and 46 patients (32%) had N-terminal pro-B-type natriuretic peptide of greater than 3000 pg/mL. N-terminal pro-B-type natriuretic peptide of greater than 3000 pg/mL was associated only with increased intensive care unit length of stay of greater than 24 hours (35% vs 9%, P = 0.0001). There was no statistical difference between cohorts with regard to total length of stay of greater than 3 days (24% vs 15%, P = 0.2), discharge to home (74% vs 83%, P = 0.3), major complication, or mortality at 30 days.

Conclusions

Transcatheter aortic valve replacement is an appropriate and effective treatment for patients with aortic stenosis presenting with high N-terminal pro-B-type natriuretic peptide and acute on chronic heart failure.
Aerococcus urinae as the Causative Agent in Infective Endocarditis of the Aortic Valve in a Pediatric Patient
Authors: Qureshi Nadia K. , Patel Ekta
Published: February 2018

Aerococcus species were first described in 1953. They have been previously described as the causative agent of urinary tract infections in the elderly but rarely the causative agent for severe infections. However, there are very few cases reported in the pediatric population. To our knowledge, we report the first case of an adolescent with infective endocarditis caused by Aerococcus urinae.
Emphysematous Gastritis Is a Severe Infectious Disease
Authors: Fromentin Melanie , Troche Gilles , Bruneel Fabrice , Mezghani Julien , Samama Charles-Marc , Bedos Jean Pierre
Published: February 2018

Purpose

Emphysematous gastritis (EG) is a rare form of infectious gastritis reported in many immunocompromised patient with extreme severity and many potential comorbidities. However, despite lots of critically ill case reports, there is a trend towards conservative management. Furthermore, it has never been described in refractory septic intensive care unit patient treated successfully with a sleeve gastrectomy. We wanted to focus on the progress made in diagnosis and treatments since the early 2000s and to report a case.

Methods

We report the case of a critically ill and immunocompromised 45-year-old women, who presented an EG secondary to an ileus due to a high dose of barbiturates for a refractory epilepticus status. Then, we conducted a literature search for reported adult cases of EG since 2000.

Results

Study cohort included 53 new cases of EG since 2000. Mean age was 54, and mean (SD) length of stay was 23 ± 36 days. Diabetes mellitus is still the main predisposing factor identified. Causative pathogen was found in only 40% of the cases, mostly Enterobacteriaceae, Enterococcus spp, and Streptococcus. An emergent surgery was required in only 6 cases of refractory septic shock or gastric necrosis. The global mortality rate reached 34%.

Conclusions

Emphysematous gastritis remains a severe disease, which can evolve quickly in septic shock or in gastric necrosis. Early diagnosis and management are warranted to favor a conservative management, even for severe forms and prevent further complications. Cases refractory to supportive measures can be successfully managed with minimally invasive surgery.
Epidemiology and the Changing Face of HIV Infection in Qatar
Authors: Al Soub Hussam , Al-khal A. Latif , Al Maslamani Muna , Dousa Khalid , Ahmed Abubaker , Fabella Ameera
Published: February 2018

Background

The aim of the study was to study the demographics, modes of transmission, clinical features, and outcome of human immunodeficiency virus (HIV) infection in Qatar and the change in epidemiology over time before and after 2000.

Method

Review of the records of all cases of HIV infection diagnosed in Qatar between 1984 and October 2014 was conducted.

Results

During the study period, 306 cases of HIV infection were diagnosed in Qatar. Files were available for review for only 148 patients. Males were more than females with a ratio of 2.5:1. The male to female ratio in those diagnosed after 2000 (group 2) was significantly more than in those diagnosed before 2000 (group 1). Almost half of the cases were Qatari. The most common mode of transmission was sexual (72%); however, in a significant proportion (43%) of those in group 1, the mode of transmission was blood transfusion. Fifty-four percent of patients had a late presentation with an acquired immunodeficiency syndrome defining condition or with CD+4 less than 350 cells/mm3. The mean CD+4 cell count at presentation was 359 cells/mm3, and there was no significant difference between the two groups. Evidence of previous infection with hepatitis B virus, hepatitis C virus, syphilis, and toxoplasmosis was low (10%, 4%, 2.5%, and 11%, respectively); however, the difference between the two groups was significant only for HCV infection. One hundred four patients (70%) are still alive despite some of them were diagnosed early in HIV epidemic.

Conclusions

Qatar remains a low prevalence country for HIV infection. The disease affects mainly young male adults with many of them presenting late in the disease. The epidemiology of HIV infection in Qatar has changed over time with infection being mostly sexually transmitted in later years. More non-Qataris are being diagnosed compared with earlier years, and this reflects the change in population that occurred in Qatar in recent years. More efforts are needed to educate the public especially the young in prevention measures and to improve early diagnosis.
Participants’ Experiences of a Sexual Counseling Intervention During Cardiac Rehabilitation
Authors: D’Eath Maureen , Byrne Molly , Murphy Patrick , Jaarsma Tiny , McSharry Jenny , Murphy Andrew W. , Doherty Sally , Noone Chris , Casey Dympna
Published: February 2018

Background:

International guidelines recommend sexual assessment and counseling be offered to all patients with cardiovascular disease during cardiac rehabilitation. However, sexual problems are infrequently addressed. The Cardiac Health and Relationship Management and Sexuality (CHARMS) intervention is a complex, multilevel intervention designed to increase the provision of sexual counseling in cardiac rehabilitation. It was piloted in 2 cardiac rehabilitation centers to assess the acceptability and feasibility of the intervention and to inform and refine a definitive cluster randomized controlled trial protocol.

Objectives:

The aim of this study was to explore the experiences, perceptions, and opinions of patients, partners, and cardiac rehabilitation staff who participated in the CHARMS staff-led patient education class.

Methods:

A qualitative, descriptive study using semistructured interviews to collect the data. Cardiac rehabilitation staff (n = 8) were interviewed when the intervention commenced in their center and 3 months later (n = 6). Patients (n = 19) and partners (n = 2) were interviewed after delivery of the class; 7 were interviewed again 3 months postintervention to explore temporal changes in opinions.

Results:

Most cardiac rehabilitation staff were comfortable delivering the CHARMS intervention but would prefer a less structured format. Some staff perceived discomfort among patients. Few patients reported discomfort. Most patients and partners considered that the intervention was a welcome and acceptable part of a cardiac rehabilitation program.

Conclusion:

Incorporating sexual counseling into cardiac rehabilitation programs is feasible. Although the views of the patients and staff diverged on a number of issues including the perceived comfort of patients, its inclusion was welcomed by patients and was acceptable overall to both staff and patients.
Agreement Between Automated and Human Measurements of Heart Rate in Patients With Atrial Fibrillation
Authors: Lin Ting-Tse , Wang Chia-Ling , Liao Min-Tsun , Lai Chao-Lun
Published: February 2018

Background:

The accuracy of heart rate (HR) measurement by automated blood pressure monitors in patients with atrial fibrillation (AF) remains unclear. The authors investigate the agreement between HR measurements by 2 automated devices and human counting in patients with AF.

Methods:

In 47 patients with persistent AF, HR was recorded using 2 automated blood pressure monitors: Omron M5-I and Microlife BPA100 Plus. Human counting of HR by a stethoscope was used as the reference. For each method, 3 readings were made and the mean was calculated for comparison. In addition to Wilcoxon signed rank test, the correlation between HR measurements by automated devices and human counting was determined using Spearman's rank correlation coefficient (r), and the agreement between HR measurements by both devices and human counting was validated by the Bland-Altman plot and intraclass correlation coefficient (ICC).

Results:

Overall, we found no significant difference in HR measurements between devices and human counting (Omron vs human counting, 81.1 ± 11.1 vs 80.2 ± 10.8 beats per minute [bpm]; P = .21, r = 0.911; ICC, 0.954; Microlife vs human counting, 81.3 ± 10.8 vs 80.2 ± 10.8 bpm; P = .22, r = 0.842; ICC, 0.912). However, in patients with HR greater than 80 bpm, the HR measured by the Microlife device was significantly higher than that measured by human counting (91.1 ± 5.2 vs 87.1 ± 8.6 bpm, P = .034).

Conclusion:

There was a high agreement between HR measurements by 2 automated devices and human counting, but the Microlife device may overestimate HR in AF patients with HR greater than 80 bpm.
Design and Construction of a New Partial Foot Prosthesis Based on High-Pressure Points in a Patient with Diabetes with Transmetatarsal Amputation: A Technical Note
Authors: Zarezadeh Fatemeh , Arazpour Mokhtar , Bahramizadeh Mahmood , Mardani Mohammad Ali , Head John
Published: February 2018

INTRODUCTION

Diabetic foot ulcers are significant complications of diabetes that can lead to amputation. Partial foot prostheses can be used to redistribute the plantar pressure on the residual limb to alleviate local pressures. The aim of this study was to describe the fabrication of an original silicone foot prosthesis that provided an improved functional outcome for a patient with a transmetatarsal amputation due to diabetes.

METHODS

High-pressure areas on the foot were identified using Force-Sensing Resistor sensors. During prosthetic fabrication, silicone with low shore was injected in these areas. Different silicone stiffness was used to reduce pressure accordingly. The silicone injection was achieved in two stages, using cast formers and wax.

DISCUSSION

The bespoke method of fabrication used in this study and the use of various levels of silicone stiffness provided a highly cosmetic prosthesis that offered improved pressure distribution.
Anticoagulant therapy for venous thromboembolism in patients with inflammatory bowel disease
Authors: Lobo Jose L. , Garcia-Fuertes Julia A. , Trujillo-Santos Javier , Merah Adel , Blanco-Molina María Á. , Casado Ignacio , Hirmerova Jana , De Miguel Javier , Salgado Estuardo , Monreal Manuel
Published: February 2018

Background

There is lack of evidence to guide the type, intensity, and the duration of anticoagulation following venous thromboembolism (VTE) in patients with inflammatory bowel disease (IBD).

Patients and methods

Registro Informatizado Enfermedad Trombo Embólica (RIETE) is an ongoing, multicenter, observational registry of consecutive patients with symptomatic, objectively confirmed, acute VTE. We used the RIETE database to compare the rate of VTE recurrences and major bleeding during the course of anticoagulation in noncancer patients with or without IBD.

Results

As of October 2014, 41 927 patients without active cancer have been recruited in RIETE. Of these, 265 (0.63%) had IBD and 85 (32%) had the VTE during an acute flare. The duration of anticoagulation was similar in patients with VTE during an acute flare (8.3±8.8 months), in remission (9.4±11.5 months), or without IBD (10.0±12.8 months). The rate of VTE recurrences [7.25, 95% confidence interval (CI): 1.46–21.2; 8.84, 95% CI: 3.23–19.2; and 5.85, 95% CI: 5.46–6.26 per 100 patient-years, respectively] and major bleeding (7.25, 95% CI: 1.46–21.2; 2.95, 95% CI: 0.33–10.6; and 4.79, 95% CI: 4.44–5.15, respectively) were similar in all three subgroups. Propensity score matching analysis confirmed the absence of differences in the rate of VTE recurrences (rate ratio: 1.16, 95% CI: 0.54–2.47) or major bleeding (rate ratio: 0.84, 95% CI: 0.31–2.23) between patients with or without IBD.

Conclusion

Therapeutic anticoagulation for patients with IBD and VTE is as safe and effective as for those with VTE without IBD.
Patient tolerance and acceptance of different colonic imaging modalities: an observational cohort study
Authors: Ojidu Hannah , Palmer Hansa , Lewandowski Jakub , Hampton James , Blakeborough Tony , Epstein Owen , McAlindon Mark E.
Published: February 2018

Background

Less invasive alternatives to optical colonoscopy (OC) may improve patient compliance with investigation, but study of patient preference is limited.

Objectives

The aims of this study were to determine patient tolerance and acceptability of OC, computed tomography colonography (CTC) and colon capsule endoscopy (CCE) and also to determine the choice of investigation made by fully informed members of the lay public.

Patients and methods

Patients assigned a Gloucester Comfort Score (GCS, 1–5; as did endoscopists), an overall test experience score (visual analogue scale, 0–10) and completed a ‘Friends and Family Test’ following OC, CTC or CCE. In the second part of the study, members of the public were given information detailing the nature, tolerance, acceptability, risks and outcomes and invited to choose which test they would prefer in the event that one was needed.

Results

Assessed by endoscopist and patient, respectively, 24.2 and 49.3% (P<0.005) of symptomatic and 27.3 and 22.1% (P=0.4) of Bowel Cancer Screening Programme patients suffered moderate to severe discomfort (GCS: 4–5) [GCS (mean±SEM): 3.32±0.085, 1.96±0.083 and 1.30±0.088 (P<0.001); overall experience: 5.43, 2.35 and 3.80 (P<0.001)]. In all, 93.6, 96.1 and 85.7% of OC, CTC and CCE patients, respectively, were willing to undergo the same test under the same circumstances. The lay public (n=100) chose a noninvasive test (CTC or CCE) in 55% of the cases to investigate symptoms and chose a Bowel Cancer Screening Programme test in 29% of the cases (P<0.001).

Conclusion

Patient tolerance and experience favours CTC and CCE over OC and informed about all aspects of each procedure; a noninvasive option is commonly chosen by the lay public.
Medicare Advantage Penetration and Hospital Costs Before and After the Affordable Care Act
Authors: Henke Rachel Mosher , Karaca Zeynal , Gibson Teresa B. , Cutler Eli , White Chapin , Wong Herbert S.
Published: February 2018

Background:

Research has suggested that growth in the Medicare Advantage (MA) program indirectly benefits the entire 65+-year-old population by reducing overall expenditures and creating spillover effects of patient care practices. Medicare programs and innovations initiated by the Affordable Care Act (ACA) have encouraged practices to adopt models applying to all patient populations, which may influence the continued benefits of MA program growth.

Objective:

This study investigated the relationship between MA program growth and inpatient hospital costs and utilization before and after the ACA.

Methods:

Primary data sources were 2005–2014 Health Care Cost and Utilization Project hospital data and 2004–2013 Centers for Medicare & Medicaid Services enrollment data. County-year-level regression analysis with fixed effects examined the relationship between Medicare managed care penetration and hospital cost per enrollee. We decomposed results into changes in utilization, severity, and severity-adjusted inpatient resource use. Analyses were stratified by whether the admission was urgent or nonurgent.

Principal Findings:

A 10% increase in MA penetration was associated with a 3-percentage point decrease in inpatient cost per Medicare enrollee before the ACA. This effect was more prominent in nonurgent admissions and diminished after the ACA.

Conclusions:

Results suggest that MA enrollment growth is associated with diminished spillover reductions in hospital admission costs after the ACA. We did not observe a strong relationship between MA enrollment and inpatient days per enrollee. Future research should examine whether spillover effects still are observed in outpatient settings.
Developing competent videofluoroscopic swallowing study analysts
Authors: Edwards Ann , Froude Elspeth , Sharpe Gabriella
Published: February 2018

Purpose of review

This review examines the recent literature concerning the development of VFSS analysts.

Recent findings

Face-to-face and blended methods of training improve reliability and accuracy of VFSS analysis. However, with the exception of the literature describing the MBSImP training, most studies investigate relatively brief training for specific VFSS rating tools. The influence of training mode and trainee factors has received limited attention.

There is a lack of controlled studies investigating the influences of training methods for VFSS analysis. Pilot data is emerging concerning VFSS analysis training ‘packages’ but without information about the relative influence of training mode, it is difficult to determine the most efficient and cost-effective way of training VFSS analysts. Future research should investigate the contribution of trainee-related factors to succeed in VFSS analysis training, and the relative benefits and disadvantages of online, peer, independent, and blended modes of training.
Evidence supporting laparoscopic hernia repair in children
Authors: Jessula Samuel , Davies Dafydd A.
Published: February 2018

Purpose of review

Pediatric inguinal hernias are a commonly performed surgical procedure. Currently, they can be approached via open or laparoscopic surgery. We summarize the current evidence for laparoscopic inguinal hernia repairs in children.

Recent findings

Laparoscopic and open inguinal hernia repair in children are associated with similar operative times for unilateral hernia, as well as similar cosmesis, complication rates and recurrence rates. Bilateral hernia repair has been shown to be faster through a laparoscopic approach. The laparoscopic approach is associated with decreased pain scores and earlier recovery, although only in the initial postoperative period. Laparoscopy allows for easy evaluation of the patency of contralateral processus vaginalis, although the clinical significance of and need for repair of an identified defect is unclear.

Laparoscopic surgery for pediatric inguinal hernias offers some advantages over open repair with most outcomes being equal. It should be considered a safe alternative to open repair to children and their caregivers.
An Innovative Partnership to Improve Student Health
Authors: Dillon Judy , Norris Himes Judy , Reynolds Kristine , Schirm Victoria
Published: February 2018

This community nursing partnership for student health is a well-recognized innovation, regionally and statewide. The initiative exemplifies 1 department of nursing’s commitment to community involvement that originated from the forward thinking of nurse leaders. The journey to engaging intraprofessional partners and firmly establishing the partnership within the community is described.
A Nursing Leadership Immersion Program
Authors: Pedersen Anne , Sorensen Joanne , Babcock Tyler , Bradley Marci , Donaldson Nicole , Donnelly James E. , Edgar William
Published: February 2018

This article describes the inception and evolution of a 3-month immersion experience between hospital and nurse leaders where sociological principles were applied to support nurse leader succession. Unique to this program, the bedside nurse joins the nursing executive team full time to participate in all organizational leadership activities as part of the experience.
Intrahepatic Cholestasis of Pregnancy: A Review of Diagnosis and Management
Authors: Wood Amber M. , Livingston Elizabeth G. , Hughes Brenna L. , Kuller Jeffrey A.
Published: February 2018

Importance

Intrahepatic cholestasis of pregnancy (ICP) complicates approximately 0.2% to 2% of pregnancies and can lead to increased fetal risks in pregnancy.

Objective

This review aims to increase the knowledge of women's health care providers regarding the diagnosis, management, and fetal risks associated with ICP.

Results

The diagnosis of ICP is based on symptoms of pruritus that typically include the palms and soles, as well as elevated bile acid levels. Other liver function tests such as alanine aminotransferase and aspartate aminotransferase are also frequently elevated, and other causes of liver dysfunction should be ruled out. Fetal risks of ICP include increased risk of preterm birth, meconium-stained amniotic fluid, respiratory distress syndrome, or stillbirth. There is evidence that as bile acid levels increase, so does the risk of adverse neonatal outcomes. Ursodeoxycholic acid treatment has been shown to improve maternal pruritus symptoms, as well as biochemical tests, but no treatment has been shown to definitively improve fetal outcomes.

Conclusions and Relevance

Providers should be aware of the signs and symptoms of ICP and provide accurate diagnosis and management of affected women. Women with a diagnosis of ICP should be treated with ursodeoxycholic acid to improve maternal symptoms. Given the increased risk of stillbirth in the setting of ICP, delivery may be considered at 37 weeks' gestation.

Target Audience

Obstetricians and gynecologists, family physicians.

Learning Objectives

After completing this activity, the learner should be better able to identify symptoms of and diagnose ICP, counsel patients on neonatal risks associated with the diagnosis of ICP, and provide treatment for women with a diagnosis of ICP.
Improving Shoulder Dystocia Management and Outcomes With a Targeted Quality Assurance Program
Authors: Gurewitsch Allen Edith D. , Brown Will Susan E. , Allen Robert H. , Satin Andrew J.
Published: February 2018

(Abstracted from Am J Perinatol 2017;34:1088–1096)

Simulation-based training has been shown by several investigators to help obstetric trainees in mastering shoulder dystocia management skills and in reducing rates of brachial plexus injury. However, the comparative effectiveness of specific simulation schemes is still debatable.
Repeatability of Monocular Acuity Testing in Adults with and without Down Syndrome
Authors: Ravikumar Ayeswarya , Benoit Julia S. , Morrison Kelsie B. , Marsack Jason D. , Anderson Heather A.
Published: February 2018

PURPOSE

Individuals with Down syndrome may experience greater difficulty reliably performing visual acuity (VA) tests because of intellectual disability and limitations in visual quality. This study evaluated the repeatability of acuity (Bailey-Lovie [BL] and HOTV) in subjects with and without Down syndrome.

METHODS

High-contrast VA was measured in both eyes of 30 subjects with Down syndrome (mean, 30 years; range, 18 to 50 years) and 24 control subjects without Down syndrome (mean, 29 years; range, 18 to 50 years). In the Down syndrome group, 23 subjects performed BL, and 7 subjects performed HOTV. All control subjects performed both BL and HOTV, but for HOTV analysis, only seven age-matched control subjects were included. For each eye, subjects performed VA three times on different charts (computer controlled, single-line display) until five total letters were missed on each chart. A repeated-measure ANOVA was used to compare the acuity measures between groups.

RESULTS

The average logMAR VA for subjects with Down syndrome was approximately six lines worse than the control subjects (BL: Down syndrome = right eye: 0.51 ± 0.16, left eye: 0.53 ± 0.18; control = right eye: −0.06 ± 0.06, left eye: −0.06 ± 0.08,P< .0001; HOTV: Down syndrome = right eye: 0.47 ± 0.19, left eye: 0.46 ± 0.16; control: right eye = −0.11 ± 0.09, left eye: −0.07 ± 0.07,P< .001). Bailey-Lovie VA repeatability (1.96 *Sw* √2) was 0.13 logMAR (6.5 letters) for Down syndrome and 0.09 logMAR (4.5 letters) for control subjects. HOTV VA repeatability was 0.16 logMAR (eight letters) for both Down syndrome and control subjects.

CONCLUSIONS

Despite poorer acuity in individuals with Down syndrome, repeatability of VA measurements was comparable to control subjects for both BL and HOTV techniques.
Breslow Density Is a Novel Prognostic Feature That Adds Value to Melanoma Staging
Authors: Saldanha Gerald , Yarrow Jeremy , Pancholi Jay , Flatman Katarina , Teo Kah Wee , Elsheik Somaia , Harrison Rebecca , O’Riordan Marie , Bamford Mark
Published: February 2018

Histomorphologic prognostic biomarkers that can be measured using only an hematoxylin and eosin stain are very attractive because they are simple and cheap. We conceived an entirely novel biomarker of this type, the Breslow density (BD), which measures invasive melanoma cell density at the site where Breslow thickness (BT) is measured. This study assessed BD’s prognostic value. In this study, BD was measured in 1329 melanoma patients. Measurement accuracy and precision was assessed using intraclass correlation coefficient (ICC). Survival was assessed with a primary end-point of melanoma-specific survival (MSS) and also overall survival and metastasis-free survival. We found that BD measurement was accurate compared with gold standard image analysis (ICC, 0.84). Precision was excellent for 3 observers with different experience (ICC, 0.93) and for an observer using only written instructions (ICC, 0.93). BD was a highly significant predictor in multivariable analysis for overall survival, MSS, and metastasis-free survival (each, P<0.001) and it explained MSS better than BT, but BT and BD together had best explanatory capability. A BD cut point of ≥65% was trained in 970 melanomas and validated in 359. This cut point showed promise as a novel way to upstage melanoma from T stage “a” to “b.” BD was combined with BT to create a targeted burden score. This was a validated as an adjunct to American Joint Committee on Cancer stage. In summary, BD can be measured accurately and precisely. It demonstrated independent prognostic value and explained MSS better than BT alone. Notably, we demonstrated ways that BD could be used with American Joint Committee on Cancer version 8 staging.
Billing and Volunteers Substantially Reduced School-Located Influenza Vaccination Costs, 2 Oregon Counties, 2010-2011
Authors: Patel Suchita A. , Groom Holly C. , Cho Bo-Hyun , Martin Kelly , Moore Robert
Published: February 2018

Background and Objectives:

After the 2009 pandemic influenza seasons, the financial sustainability of school-located vaccination (SLV) clinics drew much attention. This study estimated and compared the labor costs of SLV clinics and reimbursements for influenza vaccinations for students attending 5 schools in 2 Oregon counties during 2010-2011.

Design/Setting:

Using a biweekly, Web-based survey, staff and volunteers prospectively tracked the time they spent on SLV clinic planning, implementation, and billing. They also tracked claims submitted and reimbursements by payment source.

Main Outcome Measure:

We report labor hours and associated costs for implementing school-based vaccination clinics; number of claims submitted and the reimbursement rate; and total and net costs.

Results:

In county A, 260 doses were administered at a total cost of $5009 and received $3620 in payment. For county B, 165 doses were administered at a cost of $5598 and received $3807 in payments. With billing, the net cost per dose decreased from $19.74 to $8.57 and $38.08 to $16.17, for county A and county B, respectively.

Conclusions:

Reimbursements reduced cost per dose by 48% across SLV clinics across both Oregon counties. Local health departments can bill local health insurers to offset costs for implementing school-based vaccination clinics. Efforts to set up billing processes require dedicated billing staff who can effectively manage claims submission processes with multiple health insurers.
A Patient Safety Toolkit for Family Practices
Authors: Campbell Stephen M. , Bell Brian G. , Marsden Kate , Spencer Rachel , Kadam Umesh , Perryman Katherine , Rodgers Sarah , Litchfield Ian , Reeves David , Chuter Antony , Doos Lucy , Ricci-Cabello Ignacio , Gill Paramjit , Esmail Aneez , Greenfield Sheila , Slight Sarah , Middleton Karen , Barnett Jane , Moore Michael , Valderas Jose M. , Sheikh Aziz , Avery Anthony J.
Published: February 2018

Objective

Major gaps remain in our understanding of primary care patient safety. We describe a toolkit for measuring patient safety in family practices.

Methods

Six tools were used in 46 practices. These tools were as follows: National Health Service Education for Scotland Trigger Tool, National Health Service Education for Scotland Medicines Reconciliation Tool, Primary Care Safequest, Prescribing Safety Indicators, Patient Reported Experiences and Outcomes of Safety in Primary Care, and Concise Safe Systems Checklist.

Results

Primary Care Safequest showed that most practices had a well-developed safety climate. However, the trigger tool revealed that a quarter of events identified were associated with moderate or substantial harm, with a third originating in primary care and avoidable. Although medicines reconciliation was undertaken within 2 days in more than 70% of cases, necessary discussions with a patient/carer did not always occur. The prescribing safety indicators identified 1435 instances of potentially hazardous prescribing or lack of recommended monitoring (from 92,649 patients). The Concise Safe Systems Checklist found that 25% of staff thought that their practice provided inadequate follow-up for vulnerable patients discharged from hospital and inadequate monitoring of noncollection of prescriptions. Most patients had a positive perception of the safety of their practice although 45% identified at least one safety problem in the past year.

Conclusions

Patient safety is complex and multidimensional. The Patient Safety Toolkit is easy to use and hosted on a single platform with a collection of tools generating practical and actionable information. It enables family practices to identify safety deficits that they can review and change procedures to improve their patient safety across a key sets of patient safety issues.
Characterizing injury severity in nonaccidental trauma: Does Injury Severity Score miss the mark?
Authors: Brown Joshua B. , Gestring Mark L. , Leeper Christine M. , Sperry Jason L. , Peitzman Andrew B. , Billiar Timothy R. , Gaines Barbara A.
Published: February 2018

BACKGROUND

Children suffering nonaccidental trauma (NAT) are at high risk of death. It is unclear whether markers of injury severity for trauma center/system benchmarking such as Injury Severity Score (ISS) adequately characterize this. Our objective was to evaluate mortality prediction of ISS in children with NAT compared with accidental trauma (AT).

METHODS

Pediatric patients younger than 16 years from the Pennsylvania state trauma registry 2000 to 2013 were included. Logistic regression predicted mortality from ISS for NAT and AT patients. Multilevel logistic regression determined the association between mortality and ISS while adjusting for age, vital signs, and injury pattern in NAT and AT patients. Similar models were performed for head Abbreviated Injury Scale (AIS). Sensitivity analysis examined impaired functional independence at discharge as an alternate outcome.

RESULTS

Fifty thousand five hundred seventy-nine patients were included with 1,866 (3.7%) NAT patients. Nonaccidental trauma patients had a similar rate of mortality at an ISS of 13 as an ISS of 25 for AT patients. Nonaccidental trauma patients also have higher mortality for a given head AIS level (range, 1.2-fold to 5.9-fold higher). Injury Severity Score was a significantly greater predictor of mortality in AT patients (adjusted odds rations [AOR], 1.14; 95% confidence interval [CI], 1.13–1.15; p < 0.01) than NAT patients (AOR, 1.09; 95% CI, 1.07–1.12; p < 0.01) per 1-point ISS increase, while head injury was a significantly greater predictor of mortality in NAT patients (AOR, 3.48; 95% CI, 1.54–8.32; p < 0.01) than AT patients (AOR, 1.21; 95% CI, 0.95–1.45; p = 0.12). Nonaccidental trauma patients had a higher rate of impaired functional independence at any given ISS or head AIS level than AT patients.

CONCLUSION

Nonaccidental trauma patients have higher mortality and impaired function at a given ISS/head AIS than AT patients. Conventional ISS thresholds may underestimate risk and head injury is a more important predictor of mortality in the NAT population. These findings should be considered in system performance improvement and benchmarking efforts that rely on ISS for injury characterization.

LEVEL OF EVIDENCE

Epidemiologic study, level III.
A novel, minimally invasive approach to assure hemostasis for intercostal bleeding after trauma
Authors: Park Habeeba , Glaser Jacob , Florecki Katherine , Schmoekel Nathan , DuBose Joseph , Stein Deborah , Scalea Thomas
Published: February 2018

Intercostal artery injury can cause large hemothoraces. While many patients with intercostal artery injury present hemodynamically unstable and require emergent thoracotomy for hemostasis, some tamponade spontaneously. They may rebleed later, however, and cause recurrent hemothorax or retained hemothorax. Video-assisted thoracic surgery (VATS) is an effective way to evacuate retained hemothorax. However, assessing and ligating intercostal artery injury during VATS can be difficult, and often, open thoracotomy is pursued. Even with open surgery, ligation of the intercostal artery can be a challenge. We present a minimally invasive method of definitive intercostal artery ligation during VATS or open thoracotomy.
Single-Nucleotide-Resolution Computing and Memory in Living Cells
Authors: Farzadfard Fahim , Gharaei Nava , Higashikuni Yasutomi , Jung Giyoung , Cao Jicong , Lu Timothy K.
Published: February 2018

Computing and memory in living cells are central to encoding next-generation therapies and studying in situ biology, but existing strategies have limited encoding capacity and are challenging to scale. To overcome this bottleneck, we developed a highly scalable, robust and compact platform for encoding logic and memory operations in living bacterial and human cells. This platform, named DOMINO for DNA-based Ordered Memory and Iteration Network Operator, converts DNA in living cells into an addressable, readable, and writable computation and storage medium via a single-nucleotide resolution read-write head that enables dynamic and highly efficient DNA manipulation. We demonstrate that the order and combination of DNA writing events can be programmed by biological cues and multiple molecular recorders can be coordinated to encode a wide range of order-independent, sequential, and temporal logic and memory operations. Furthermore, we show that these operators can be used to perform both digital and analog computation, and record signaling dynamics and cellular states in a long-term, autonomous, and minimally disruptive fashion. Finally, we show that the platform can be functionalized with gene regulatory modules and interfaced with cellular circuits to continuously monitor cellular phenotypes and engineer gene circuits with artificial learning capacities. We envision that highly scalable, compact, and modular DOMINO operators will lay the foundation for building robust and sophisticated synthetic gene circuits for numerous biotechnological and biomedical applications.

One Sentence Summary

A programmable read-write head with single-nucleotide-resolution for genomic DNA enables robust and scalable computing and memory operations in living cells.
Genome survey of the freshwater mussel Venustaconcha ellipsiformis (Bivalvia: Unionida) using a hybrid de novo assembly approach
Authors: Renaut Sébastien , Guerra Davide , Hoeh Walter R. , Stewart Donald T. , Bogan Arthur E. , Ghiselli Fabrizio , Milani Liliana , Passamonti Marco , Breton Sophie
Published: February 2018

Freshwater mussels (Bivalvia: Unionida) serve an important role as aquatic ecosystem engineers but are one of the most critically imperilled groups of animals. Here, we used a combination of sequencing strategies to assemble and annotate a draft genome of Venustaconcha ellipsiformis, which will serve as a valuable genomic resource given the ecological value and unique “doubly uniparental inheritance” mode of mitochondrial DNA transmission of freshwater mussels. The genome described here was obtained by combining high coverage short reads (65X genome coverage of Illumina paired-end and 11X genome coverage of mate-pairs sequences) with low coverage Pacific Biosciences long reads (0.3X genome coverage). Briefly, the final scaffold assembly accounted for a total size of 1.54Gb (366,926 scaffolds, N50 = 6.5Kb, with 2.3% of “N” nucleotides), representing 86% of the predicted genome size of 1.80Gb, while over one third of the genome (37.5%) consisted of repeated elements and more than 85% of the core eukaryotic genes were recovered. Given the repeated genetic bottlenecks of V. ellipsiformis populations as a result of glaciations events, heterozygosity was also found to be remarkably low (0.6%), in contrast to most other sequenced bivalve species. Finally, we reassembled the full mitochondrial genome and found six polymorphic sites with respect to the previously published reference. This resource opens the way to comparative genomics studies to identify genes related to the unique adaptations of freshwater mussels and their distinctive mitochondrial inheritance mechanism.
Coordinate based meta-analysis of whole-brain voxel-based morphometry studies does not show evidence of grey matter loss specific to PTSD
Authors: Tench Christopher R. , Tanasescu Radu , Jethwa Ketan D. , Constantinescu Cris S.
Published: February 2018

Neuroimaging studies have detected structural alteration in post-traumatic stress disorder (PTSD), but findings are inconsistent. This might be explained by heterogeneity between subjects with PTSD in terms of common comorbidities such as depressive and anxiety disorders and also in traumatic experience. Despite this, coordinate based meta-analysis (CBMA) has been used to try and identify localised grey matter changes, and does suggest some PTSD specific pathology. However, there are multiple technical issues that make the meta-analytic evidence questionable, warranting a re-evaluation.

A literature search for voxel-based morphometry studies was performed. Only whole-brain studies using subjects with a current diagnosis of PTSD, and having a comparison group of either healthy or trauma exposed controls, were included. Twenty one voxel-based morphometry studies met the inclusion criteria. CBMA was performed to identify altered grey matter (GM) structures.

Using a novel coordinate based random effect size meta-analysis, no grey matter structure was identified as being consistently altered in PTSD compared to controls. This was also verified using the activation likelihood estimate algorithm.

There is no evidence, from CBMA, of consistent localised grey matter changes specific to PTSD. Inconsistency may reflect true heterogeneity in PTSD pathology or methodological issues with imaging and/or analysis, limiting the detection of PTSD specific pathology.
Resistance to pentamidine is mediated by AdeAB, regulated by AdeRS, and influenced by growth conditions inAcinetobacter baumanniiATCC 17978
Authors: Adams Felise G. , Stroeher Uwe H. , Hassan Karl A. , Marri Shashikanth , Brown Melissa H.
Published: February 2018

In recent years, effective treatment of infections caused byAcinetobacter baumanniihas become challenging due to the ability of the bacterium to acquire or up-regulate antimicrobial resistance determinants. Two component signal transduction systems are known to regulate expression of virulence factors including multidrug efflux pumps. Here, we investigated the role of the AdeRS two component signal transduction system in regulating the AdeAB efflux system, determined whether AdeA and/or AdeB can individually confer antimicrobial resistance, and explored the interplay between pentamidine resistance and growth conditions inA. baumanniiATCC 17978. Results identified that deletion ofadeRSaffected resistance towards chlorhexidine and 4’,6-diamidino-2-phenylindole dihydrochloride, two previously defined AdeABC substrates, and also identified an 8-fold decrease in resistance to pentamidine. Examination of ΔadeA, ΔadeBand ΔadeABcells augmented results seen for ΔadeRSand identified a set of dicationic AdeAB substrates. RNA-sequencing of ΔadeRSrevealed transcription of 290 genes were ≥2-fold altered compared to the wildtype. Pentamidine shock significantly increasedadeAexpression in the wildtype, but decreased it in ΔadeRS, implying that AdeRS activatesadeABtranscription in ATCC 17978. Investigation under multiple growth conditions, including the use of Biolog phenotypic microarrays, revealed resistance to pentamidine in ATCC 17978 and mutants could be altered by bioavailability of iron or utilization of different carbon sources. In conclusion, the results of this study provide evidence that AdeAB in ATCC 17978 can confer intrinsic resistance to a subset of dicationic compounds and in particular, resistance to pentamidine can be significantly altered depending on the growth conditions.
GenoGAM 2.0: Scalable and efficient implementation of genome-wide generalized additive models for gigabase-scale genomes
Authors: Stricker Georg , Galinier Mathilde , Gagneur Julien
Published: February 2018

GenoGAM (Genome-wide generalized additive models) is a powerful statistical modeling tool for the analysis of ChIP-Seq data with flexible factorial design experiments. However large runtime and memory requirements of its current implementation prohibit its application to gigabase-scale genomes such as mammalian genomes.

Here we present GenoGAM 2.0 a scalable and efficient implementation that is 2-3 orders of magnitude faster than the previous version. This is achieved by exploiting the sparsity of the model using the SuperLU direct solver for parameter fitting, and sparse Cholesky factorization together with the sparse inverse subset algorithm for computing standard errors. Furthermore the HDF5 library is employed to store data efficiently on hard drive, reducing memory footprint while keeping I/O low. Whole-genome fits for human ChIP-seq datasets (ca. 300 million parameters) could be obtained in less than 9 hours on a standard 60-core server. GenoGAM 2.0 is implemented as an open source R package and currently available on GitHub. A Bioconductor release of the new version is in preparation.

We have vastly improved the performance of the GenoGAM framework, opening up its application to all types of organisms. Moreover, our algorithmic improvements for fitting large GAMs could be of interest to the statistical community beyond the genomics field.