bluuebunny/crossref_metadata_2025 huggingface dataset:
Variability and Errors of Manually Digitized Goldmann Visual Fields
Authors: Barry Michael P. , Bittner Ava K. , Yang Liancheng , Marcus Rebecca , Iftikhar Mian Haris , Dagnelie Gislin
Published: April 2016

Purpose

Goldmann visual fields (GVFs) are useful for tracking changes in areas of functional retina, including the periphery, in inherited retinal degeneration patients. Quantitative GVF analysis requires digitization of the chart coordinates for the main axes and isopter points marked by the GVF operator during testing. This study investigated inter- and intra-digitizer variability among users of a manual GVF digitization program.

Methods

Ten digitizers were trained for 1 hour, then digitized 23 different GVFs from inherited retinal degeneration patients in each of three testing blocks. Digitizers labeled each isopter as seeing or non-seeing, and its target size. Isopters with the same test target within each GVF were grouped to create isopter groups.

Results

The standard deviation of isopter group area showed an approximate square-root relationship with total isopter group area. Accordingly, the coefficient of variation for isopter group area decreased from 68% to 0.2% with increasing isopter group area. A bootstrap version of ANOVA did not reveal a significant effect of digitizers on isopter group area. Simulations involving random sampling of digitizers showed that five to seven digitizers would be required to catch 95% to 99% of labeling errors and isopter misses, on the basis of data discrepancies, with 99% probability.

Conclusions

These data suggest that any minimally trained digitizer would be capable of reliably determining any isopter area, regardless of size. Studies using this software could either use five to seven minimally trained digitizers for each GVF, three digitizers who demonstrate low frequencies of errors on a practice set of GVFs, or two digitizers with an expert reader to adjudicate discrepancies and catch errors.
Low Vision Rehabilitation for Adult African Americans in Two Settings
Authors: Draper Erin M. , Feng Rui , Appel Sarah D. , Graboyes Marcy , Engle Erin , Ciner Elise B. , Ellenberg Jonas H. , Stambolian Dwight
Published: April 2016

Purpose

The Vision Rehabilitation for African Americans with Central Vision Impairment (VISRAC) study is a demonstration project evaluating how modifications in vision rehabilitation can improve the use of functional vision.

Methods

Fifty-five African Americans 40 years of age and older with central vision impairment were randomly assigned to receive either clinic-based (CB) or home-based (HB) low vision rehabilitation services. Forty-eight subjects completed the study. The primary outcome was the change in functional vision in activities of daily living, as assessed with the Veteran’s Administration Low-Vision Visual Function Questionnaire (VFQ-48). This included scores for overall visual ability and visual ability domains (reading, mobility, visual information processing, and visual motor skills). Each score was normalized into logit estimates by Rasch analysis. Linear regression models were used to compare the difference in the total score and each domain score between the two intervention groups. The significance level for each comparison was set at 0.05.

Results

Both CB and HB groups showed significant improvement in overall visual ability at the final visit compared with baseline. The CB group showed greater improvement than the HB group (mean of 1.28 vs. 0.87 logits change), though the group difference is not significant (p = 0.057). The CB group visual motor skills score showed significant improvement over the HB group score (mean of 3.30 vs. 1.34 logits change, p = 0.044). The differences in improvement of the reading and visual information processing scores were not significant (p = 0.054 and p = 0.509) between groups. Neither group had significant improvement in the mobility score, which was not part of the rehabilitation program.

Conclusions

Vision rehabilitation is effective for this study population regardless of location. Possible reasons why the CB group performed better than the HB group include a number of psychosocial factors as well as the more standardized distraction-free work environment within the clinic setting.
Comparison of Ishihara Booklet with Color Vision Smartphone Applications
Authors: Sorkin Nir , Rosenblatt Amir , Cohen Eyal , Ohana Oded , Stolovitch Chaim , Dotan Gad
Published: April 2016

Purpose

To compare the standard Ishihara booklet with color-vision-testing smartphone applications.

Methods

A prospective observational diagnostic study on 42 normal trichromats and 38 color-deficient subjects. Patients were presented with three color vision tests in random order: an Ishihara test booklet and two color-vision-testing smartphone applications: Eye2Phone and the Color Vision Test application (CVT app). Sensitivity and specificity of the electronic tests was compared with Ishihara results, and in each one of these applications every plate was individually analyzed for success/failure rate.

Results

Average age was 42.7 ± 12.9 years. There were 57 males (71.2%). Sensitivity and specificity of each test was 100% (38/38) and 95.2% (40/42) for the Eye2Phone, and 100% (38/38) and 54.8% (23/42) for the CVT app. There was no significant difference between the Ishihara booklet and the Eye2Phone (p = 0.500), with a high kappa measure of agreement (0.950, p < 0.001). The CVT app was significantly different than both other tests (p < 0.001) with a low kappa measure of agreement (0.535 with the Ishihara and 0.575 with the Eye2Phone). Of the 21 tested plates, color-deficient subjects failed 11.8 ± 3.1 plates in the Ishihara booklet and 14.1 ± 2.1 plates in the Eye2Phone (p < 0.001). Significant plate-specific differences for the color-deficient group were found in plate numbers 3, 6, 7, 8, 9, 15, and 16. Both tests were poorly able to give an indication of the specific dichromatism type. The Ishihara booklet was rated more comfortable and clearer than the Eye2Phone in color-deficient subjects. The CVT app was rated lowest for comfort and clarity in both groups.

Conclusions

Smartphone applications testing for color vision deficiency are readily available; however, users of these apps should be aware that some may have different sensitivity for detection of color vision deficiency compared to Ishihara booklet, limiting their usefulness for clinical use. Therefore, further validation of these applications is required.
A Selected Immunohistochemical Panel Aids in Differential Diagnosis and Prognostic Stratification of Subtypes of High-grade Endometrial Carcinoma: A Clinicopathologic and Immunohistochemical Study at a Single Institution
Authors: Taskin Orhun Çiğ , Onder Semen , Topuz Samet , Sozen Hamdullah , Sen Fatma , Ilhan Ridvan , Yavuz Ekrem
Published: April 2016

This study aimed to investigate whether a selected immunohistochemical panel (estrogen receptor, p53, ARID1A, PPP2R1A, HNF-1β) could contribute to the diagnostic process of high-grade endometrial carcinomas (HG-ECs). We also aimed to analyze the correlation of these immunohistochemical results with several morphologic variables and survival data. After revising the diagnosis of 78 HG-ECs, immunohistochemical analysis was performed for each case. After immunohistochemical analysis, a specific diagnosis of prototypic HG-EC was established in most of the cases that were uncertain due to morphologic ambiguity. In the univariate analysis, older patient age, type II morphology, undifferentiated carcinoma and carcinosarcoma type of histology, altered p53 immunostaining, strong membranous staining of PPP2R1A, presence of lymphovascular invasion in serous carcinoma, and microcystic, elongated, and fragmented-type infiltration pattern in endometrioid carcinoma were significantly related to poor prognosis. In the multivariate analysis, only older patient age and carcinosarcoma or undifferentiated/dedifferentiated carcinoma type histology were found to be significantly poor prognostic factors (P=0.011), whereas advanced FIGO stage and type II histology were found to be correlated with poor prognosis, but did not reach statistical significance. We suggest that immunohistochemistry should be used in the differential diagnosis of HG-ECs, especially those with ambiguous morphology. Markers used in this study made a valuable contribution to the diagnostic process as well as prediction of prognosis.
Expression of OCT4 and SALL4 in Diffuse Large B-cell Lymphoma
Authors: Williams Andrew S. , Shawwa Allam , Merrimen Jennifer , Dakin Haché Kelly
Published: April 2016

OCT4 and SALL4 are transcription factors within a complex network that functions to maintain pluripotency in primitive stem cells and germ cells. Nuclear expression of OCT4 is widely cited as sensitive and specific for primary and metastatic germ cell tumors and is commonly used in the diagnosis of central nervous system (CNS) germinomas. Studies have failed to systematically examine the expression of OCT4 or SALL4 in diffuse large B-cell lymphoma (DLBCL), although this entity enters the morphologic differential diagnosis of some germ cell tumors. A retrospective review was conducted on 145 consecutive cases of DLBCL and testicular lymphoma to evaluate the prevalence of OCT4 and SALL4 expression. Nuclear OCT4 expression was present in 2/11 (18%) testicular DLBCLs and 6/134 (4.5%) nontesticular DLBCLs. Most OCT4+ cases demonstrated moderate to strong expression in >50% of neoplastic cells. Rare, weak nuclear SALL4 expression was detected in only 3 nontesticular DLBCLs. Within the extratesticular DLBCL group, 2/6 (33%) primary CNS DLBCLs expressed nuclear OCT4. In addition, OCT4+ DLBCL showed an overall predilection toward non–germinal center B-cell phenotype (7/8; 88%) and had a higher than expected rate of CD5 coexpression (4/8, 50%). These results are cautionary against using OCT4 as a sole marker of germ cell differentiation in testicular and extratesticular sites, especially in the CNS. The apparent associations of OCT4 expression with primary CNS DLBCL, non–germinal center B-cell phenotype, and CD5 coexpression raise the question of whether OCT4 expression in DLBCL may reflect more aggressive biology.
Hepatoblastoma Arising in a Pigmented β-catenin-activated Hepatocellular Adenoma
Authors: Louie Christine Y. , Concepcion Waldo , Park Joseph K. , Rangaswami Arun , Finegold Milton J. , Hazard Florette K.
Published: April 2016

Hepatoblastoma is the most common malignant liver tumor in childhood. It has been associated with a variety of constitutional syndromes and gene mutations. However, there are very few reports of associations with pediatric hepatocellular adenomas (HCAs) and no reported associations with pigmented HCAs (P-HCAs). We present a unique case of hepatoblastoma arising in a background of 2 β-catenin-activated HCAs, one of which is pigmented, in a 4-year-old child. The gross, histologic, and immunohistochemical features are described for each tumor. In addition, the literature is reviewed with specific emphasis on the clinical and pathologic features of B-HCAs. Although the potential of β-catenin-activated HCAs to progress to hepatocellular carcinoma has been well documented, there are very few reports of their potential to progress to hepatoblastoma. We not only present such a case, but, to our knowledge, we also present the first case of a P-HCA in a child.
Do Ancillary Studies Aid Detection and Classification of Barrett Esophagus?
Authors: Panarelli Nicole C. , Yantiss Rhonda K.
Published: April 2016

Barrett esophagus is a preneoplastic condition defined by the presence of intestinal metaplasia (ie, goblet cells) in an endoscopically apparent columnar-lined esophagus. Dysplasia is the most important risk factor for cancer development among patients with Barrett esophagus; approximately 6% of patients with high-grade dysplasia progress to adenocarcinoma within 1 year. Surgical pathologists are generally expected to address 2 clinical concerns when evaluating mucosal biopsy samples from patients with suspected Barrett esophagus; they should note the presence, or absence, of goblet cells and comment on the grade of dysplasia when it is identified. Biopsy samples from patients with Barrett esophagus are categorized as negative for dysplasia, indefinite for dysplasia, or positive for dysplasia; in the latter situation, the severity of dysplasia is classified as low or high grade. Several histochemical stains, immunohistochemical stains, and molecular techniques can be used to facilitate detection of goblet cells and classify dysplasia in patients with Barrett esophagus, although their added value to routine morphologic assessment is not entirely clear. The purpose of this review is to discuss the state of the art regarding application of ancillary studies to esophageal samples from patients with a columnar-lined esophagus.
Functional Outcomes and Physical Impairments in Pediatric Critical Care Survivors: A Scoping Review*
Authors: Ong Chengsi , Lee Jan Hau , Leow Melvin K. S. , Puthucheary Zudin A.
Published: April 2016

Objective:

Although more children are surviving critical illness, little is known about long-term physical impairment. This scoping review aims to critically appraise existing literature on functional outcome measurement tools, prevalence, and risk factors for physical impairments in pediatric critical care survivors.

Data Sources:

PubMed, Embase, and Cumulative Index to Nursing and Allied Health Literature, using a combination of MeSH terms and keywords (critical illness, intensive care, and functional outcomes/status).

Study Selection:

All human studies reporting functional outcomes in children 0–18 years old admitted to the PICU. Non-English language, adult and preterm infant studies were excluded.

Data Synthesis:

Three global assessment tools and eight multidimensional measures were used to measure functional outcome in pediatric survivors of critical illness. Rates of acquired functional impairment in a general pediatric intensive care cohort ranged from 10% to 36% at discharge and 10% to 13% after more than 2 years. Risk factors for acquired functional impairment include illness severity, the presence of organ dysfunction, length of ICU stay, and younger age. There is some evidence that physical impairment may be more severe and persistent than psychosocial components.

Conclusions:

Functional impairment may be persistent in pediatric survivors of critical care. Unfortunately, studies varied largely in measurement timing and tools used. The lack of differentiation between impairment in different functional domains limited the generalizability of data. Further studies using a combination of standardized measures at various time points of the disease process can help establish more comprehensive rates of physical impairment.
Evaluation of the “Early” Use of Albumin in Children with Extensive Burns: A Randomized Controlled Trial*
Authors: Müller Dittrich Maria Helena , Brunow de Carvalho Werther , Lopes Lavado Edson
Published: April 2016

Objective:

To compare early versus delayed albumin resuscitation in children with burns in terms of clinical outcome and response.

Design:

Randomized controlled trial.

Setting:

Burn center at a tertiary care teaching hospital.

Patients:

Forty-six children aged 1–12 years with burns greater than 15–45% total body surface area admitted within 12 hours of burn injury.

Interventions:

Fluid resuscitation was based on the Parkland formula (3 mL/kg/% total body surface area), adjusted according to urine output. Patients received 5% albumin solution between 8 and 12 hours post burn in the intervention group (n = 23) and 24 hours post burn in the control group (n = 23). Both groups were assessed for reduction in crystalloid fluid infusion during resuscitation, development of fluid creep, and length of hospital stay.

Measurements and Main Results:

There was no difference between groups regarding age, weight, sex, % total body surface area, cause of burn, or severity scores. The median crystalloid fluid volume required during the first 3 days post burn was lower in the intervention than in the control group (2.04 vs 3.05 mL/kg/% total body surface area; p = 0.025 on day 1; 1.2 vs 1.71 mL/kg/% total body surface area; p = 0.002 on day 2; and 0.82 vs 1.3 mL/kg/% total body surface area; p = 0.002 on day 3). The median urine output showed no difference between intervention and control groups (2.1 vs 2.0 mL/kg/hr; p = 0.152 on day 1; 2.58 vs 2.54 mL/kg/hr; p = 0.482 on day 2; and 2.9 vs 3.0 mL/kg/hr; p = 0.093 on day 3). Fluid creep was observed in 13 controls (56.5%) and in one patient (4.3%) in the intervention group. The median length of hospital stay was 18 days (range, 15–21 d) for controls and 14 days (range, 10–17 d) in the intervention group (p = 0.004).

Conclusions:

Early albumin infusion in children with burns greater than 15–45% total body surface area reduced the need for crystalloid fluid infusion during resuscitation. Significantly fewer cases of fluid creep and shorter hospital stay were also observed in this group of patients.
Impact of an Offline Pain Management Protocol on Prehospital Provider Self-Efficacy
Authors: Jaeger April , Dudley Nanette , Holsti Maija , Sheng Xiaoming , Gurley Kristin Lauria , Adelgais Kathleen
Published: April 2016

Background

Pain in children is inadequately treated in the prehospital setting despite the reported recognition by prehospital providers (PHPs) of pain treatment as an important part of patient care. The impact of pediatric pain management protocol (PPP) implementation on PHP self-efficacy (SE), a measure congruent with performance, is unknown.

Objective

The aim of this study was to evaluate the impact of PPP implementation and pain management education on PHP SE.

Methods

This was a prospective study evaluating the change in PHP SE after a PPP was implemented. Prehospital providers were randomized to 3 groups: protocol introduction alone, protocol introduction with education, and protocol introduction with education and a 3-month interim review. Prehospital provider SE was assessed for pain management given 3 age-based scenarios. Self-efficacy was measured with a tool that uses a ranked ordinal scale ranging from “certain I cannot do it” (0) to “completely certain I can do it” (100) for 10 pain management actions: pain assessment (3), medication administration (4), dosing (1), and reassessment (2). An averaged composite score (0-100) was calculated for each of the 3 age groups (adult, child, toddler). Paired-sample t tests compared post-PPP and 13-month scores to pre-PPP scores.

Results

Of 264 PHPs who completed initial surveys, 142 PHPs completed 13-month surveys. Ninety-three (65%) received education with protocol review, and 49 (35%) had protocol review only. Self-efficacy scores increased over the study period, most notably for pain assessment. This increase persisted at 13 months for child (6.6 [95% confidence interval {CI}, 1.4–11.8]) and toddler pain assessment (22.3 [95% CI, 16.4–28.3]). Composite SE scores increased immediately for all age groups (adult, 3.1 [95% CI, 1.3–4.9]; child, 6.1 [95% CI, 3.8–8.5]; toddler, 12.0 [95% CI, 9.5–14.5]) and persisted at 13 months for the toddler group alone (7.0 [95% CI, 4.3–9.7]). There was no difference between groups who received protocol review alone compared with those with education or education plus a 3-month interim review.

Conclusions

After a pain management protocol was introduced, SE scores among PHPs increased immediately and remained elevated for some individual actions involved in pain management, most notably pain assessment. Prehospital provider pain assessment SE scores declined 13 months after protocol introduction for adults, but remained elevated compared with baseline for the pediatric age groups.
Pediatric Emergency Medicine Online Curriculum Improves Resident Knowledge Scores, But Will They Use It?
Authors: Little-Wienert Kim , Hsu Deborah , Torrey Susan , Lemke Daniel , Patel Binita , Turner Teri , Doughty Cara
Published: April 2016

Objective

Shift work on a pediatric emergency medicine (PEM) rotation makes didactic scheduling difficult, thereby limiting teaching opportunities. These constraints make this rotation an ideal setting to supplement resident education with an online curriculum. We aimed to determine if implementation of an online curriculum during a resident PEM rotation improves posttest performance and increases satisfaction with resident educational experience.

Methods

This was a prospective before/after study of pediatric and emergency medicine residents on a 1-month rotation in a tertiary care pediatric emergency department. A curriculum was developed consisting of 17 online modules. In the first 5 months of the study, 42 control residents received traditional bedside teaching. In the last 12 months, 80 intervention residents completed at least 8 modules during their rotation. Both groups completed a pretest at rotation start and a posttest and end-of-rotation survey at rotation end.

Results

Control group pretest and posttest scores were not significantly different. In the intervention group, posttest scores were significantly increased compared with pretest scores (68 vs 59, P < 0.01). A low percentage of residents completed the study. Only 42% of the 189 residents enrolled in the intervention group completed the posttest and 28% completed the survey.

Conclusions

Implementing an online PEM curriculum significantly improved knowledge. As residency programs face new duty hour requirements, online curricula may provide an effective way to supplement teaching. However, to capitalize on this self-directed curriculum, the low participation rates in this study suggest we must first determine and establish ways to overcome barriers to online learning.
Radiologic Safety Events Within a Pediatric Emergency Medicine Network
Authors: Blumberg Stephen M. , Mahajan Prashant V. , O'Connell Karen J. , Chamberlain James M. , Shaw Kathy N. , Ruddy Richard M. , Lichenstein Richard , Funai Tomohiko , Lillis Kathleen A.
Published: April 2016

Objectives

The aim of this study was to describe the epidemiology of radiologic safety events using an analysis of deidentified incident reports (IRs) collected within a large multicenter pediatric emergency medicine network.

Methods

This study is a report of a planned subanalysis of IRs that were classified as radiologic events. The parent study was performed in the PECARN (Pediatric Emergency Care Applied Research Network). Incident reports involving radiology were classified into subtypes: delay in test, delay in results, misread or changed reading, wrong patient, wrong site, or other. The severity of radiology-related incidents was characterized. Contributing factors were identified and classified as environmental, equipment, human (employee), information technology systems, parent or guardian, or systems based.

Results

Two hundred three (7.0%) of the 2906 IRs submitted during the study period involved radiology. Eighteen of the hospitals submitted at least 1 IR and 15 of these hospitals reported at least 1 radiologic event. The most common type of radiologic event was misread/changed reading, which accounted for over half of all IRs (50.3%). Human factors were the most frequent contributing factor identified and accounted for 67.6% of all factors. The severity of events ranged from unsafe conditions to events with temporary harm that required hospitalization.

Conclusions

We described the epidemiology of radiology-related IRs from a large multicenter pediatric emergency research network. The study identified specific themes regarding types of radiologic errors, including the systems issues and the contributing factors associated with those errors. Results from this analysis may help identify effective intervention strategies to ameliorate the frequency of radiology-related safety events in the emergency department setting.
Axillary and Tympanic Temperature Measurement in Children and Normal Values for Ages
Authors: Oguz Fatma , Yildiz Ismail , Varkal Muhammet Ali , Hizli Zeynep , Toprak Sadik , Kaymakci Kevser , Saygili Seha Kamil , Kilic Ayşe , Unuvar Emin
Published: April 2016

Aim

The aim of the study was define the normal values of tympanic and axillary body temperature in healthy children.

Methods

This observational cross-sectional study was performed in healthy children aged 0 to 17 years who visited the ambulatory general pediatric of Istanbul Medical Faculty.

Results

Of 1364 children, 651 (47.7%) were girls and 713 were boys, the mean (SD, range) age was 72.5 (53.6, 1–204) months. The mean (SD) axillary body temperature was 36.04°C (0.46°C; minimum, 35.0°C; maximum, 37.6°C). The 95th and 99th percentiles were 36.8°C and 37.0°C, respectively. The mean (SD) tympanic body temperature was 36.91°C (0.46°C; minimum, 35.15°C; maximum, 37.9°C). The 95th and 99th percentiles were 37.6°C and 37.8°C, respectively. There were statistically significant differences between sexes for only tympanic body temperatures. Both axillary and tympanic body temperatures were statistically higher in 0 to 2 months compared with other age groups. For this age group, the 99th percentile was 37.5°C for axillary and 37.85°C for tympanic temperature.

Conclusions

Axillary and tympanic body temperatures should be considered as fever when they are more than 37.0°C and 37.8°C, respectively. For 0 to 2 months, fever is 37.5°C and 37.85°C in axillary and tympanic temperatures, respectively.
Effect of Knee Orthoses on Hamstring Contracture in Children With Cerebral Palsy: Multiple Single-Subject Study
Authors: Laessker-Alkema Kristina , Eek Meta Nyström
Published: April 2016

Purpose:

To examine the effect of knee orthoses on extensibility of the hamstrings in children with spastic cerebral palsy (CP).

Methods:

The short-term effects of knee orthoses on passive range of motion (ROM), spasticity, and gross motor function of the hamstrings. Ten children with spastic CP, aged 5 to 14 years, at Gross Motor Function Classification System levels I to V, were followed. The orthoses were worn for a minimum of 30 minutes day, 5 days per week, during the intervention period of 8 weeks.

Results:

Visual analysis using the Two Standard Deviation Band Method supported improvements in passive ROM for all 20 hamstring muscles and in 12 of 14 knee extension measurements. Analyses with the Wilcoxon signed rank test confirm the individual results and support a significant increase in hamstring muscles (P = .005) and knee extension (right: P =.028; left: P =.018) compared with baseline.

Conclusions:

In children with spastic CP, 8 weeks of treatment with knee orthoses can improve extensibility of the hamstrings.
Long-Term Patency of Lymphovenous Anastomoses: A Systematic Review
Authors: Tourani Saam S. , Taylor G. Ian , Ashton Mark W.
Published: April 2016

Background:

With advancements in technology and microsurgical techniques, lymphovenous anastomosis has become a popular reconstructive procedure in the treatment of chronic lymphedema. However, the long-term patency of these anastomoses is not clear in the literature.

Methods:

A systematic review of the MEDLINE and EMBASE databases was performed to assess the reported long-term patency of lymphovenous anastomoses.

Results:

A total of eight studies satisfied the inclusion criteria. Pooled data from four similar experiments in normal dogs showed an average long-term (≥5 months) patency of 52 percent. The only experiment in dogs with chronic lymphedema failed to show any long-term patency.

Conclusions:

The creation of peripheral lymphovenous anastomoses with a moderate long-term patency rate has become technically possible. However, the long-term results in chronic lymphedema are limited.
Examining the Crux of Autonomic Dysfunction in Posttraumatic Stress Disorder: Whether Chronic or Situational Distress Underlies Elevated Heart Rate and Attenuated Heart Rate Variability
Authors: Dennis Paul A. , Dedert Eric A. , Van Voorhees Elizabeth E. , Watkins Lana L. , Hayano Junichiro , Calhoun Patrick S. , Sherwood Andrew , Dennis Michelle F. , Beckham Jean C.
Published: April 2016

Objective

Posttraumatic stress disorder (PTSD) has been linked to elevated heart rate (HR) and reduced heart rate variability (HRV) in cross-sectional research. Using ecological momentary assessment and minute-to-minute HRV/HR monitoring, we examined whether cross-sectional associations between PTSD symptom severity and HRV/HR were due to overall elevations in distress levels or to attenuated autonomic regulation during episodes of acute distress.

Methods

Two hundred nineteen young adults (18–39 years old), 99 with PTSD, underwent 1 day of Holter monitoring and concurrently reported distress levels via ecological momentary assessment. Using multilevel modeling, we examined the associations between momentary distress and the 5-minute means for low-frequency (LF) and high-frequency (HF) HRV and HR immediately following distress ratings, and whether PTSD symptom severity moderated these associations.

Results

Compared with the controls, participants with PTSD recorded higher ambulatory distress (mean [standard deviation] = 1.7 [0.5] versus 1.2 [0.3], p < .001) and HR (87.2 [11.8] versus 82.9 [12.6] beats/min, p = .011), and lower ambulatory LF HRV (36.9 [14.7] versus 43.7 [16.9 ms, p = .002) and HF HRV (22.6 [12.3] versus 26.4 [14.6] milliseconds, p = .043). Overall distress level was not predictive of HR or HRV (p values > .27). However, baseline PTSD symptom severity was associated with elevated HR (t(1257) = 2.76, p = .006) and attenuated LF (t(1257) = −3.86, p < .001) and HF (t(1257) = −2.62, p = .009) in response to acute momentary distress.

Conclusions

Results suggest that PTSD is associated with heightened arousal after situational distress and could explain prior findings associating PTSD with HR/HRV. Implications for treatment and cardiovascular risk are discussed.
Brief Report: APOL1 Renal Risk Variants Are Associated With Chronic Kidney Disease in Children and Youth With Perinatal HIV Infection
Authors: Purswani Murli U. , Patel Kunjal , Winkler Cheryl A. , Spector Stephen A. , Hazra Rohan , Seage George R. , Mofenson Lynne , Karalius Brad , Scott Gwendolyn B. , Van Dyke Russell B. , Kopp Jeffrey B. ,   for the Pediatric HIV/AIDS Cohort Study
Published: April 2016

APOL1 renal risk alleles are associated with chronic kidney disease (CKD) in adults, with the strongest effect being for HIV-associated nephropathy. Their role in youth with perinatal HIV-1 infection (PHIV) has not been studied. In a nested case–control study of 451 PHIV participants in the Pediatric HIV/AIDS Cohort Study, we found a 3.5-fold increased odds of CKD in those carrying high-risk APOL1 genotypes using a recessive model [95% confidence interval (CI): 1.2 to 10.0]. We report an unadjusted incidence of 1.2 CKD cases/100 person-years (95% CI: 0.5 to 2.5) in PHIV youth carrying APOL1 high-risk genotypes, with important implications for sub-Saharan Africa.
Sizanani: A Randomized Trial of Health System Navigators to Improve Linkage to HIV and TB Care in South Africa
Authors: Bassett Ingrid V. , Coleman Sharon M. , Giddy Janet , Bogart Laura M. , Chaisson Christine E. , Ross Douglas , Jacobsen Margo M. , Robine Marion , Govender Tessa , Freedberg Kenneth A. , Katz Jeffrey N. , Walensky Rochelle P. , Losina Elena
Published: April 2016

Background:

A fraction of HIV-diagnosed individuals promptly initiate antiretroviral therapy (ART). We evaluated the efficacy of health system navigators for improving linkage to HIV and tuberculosis (TB) care among newly diagnosed HIV-infected outpatients in Durban, South Africa.

Methods:

We conducted a randomized controlled trial (Sizanani Trial, NCT01188941) among adults (≥18 years) at 4 sites. Participants underwent TB screening and randomization into a health system navigator intervention or usual care. Intervention participants had an in-person interview at enrollment and received phone calls and text messages over 4 months. We assessed 9-month outcomes via medical records and the National Population Registry. Primary outcome was completion of at least 3 months of ART or 6 months of TB treatment for coinfected participants.

Results:

Four thousand nine hundred three participants were enrolled and randomized; 1899 (39%) were HIV-infected, with 1146 (60%) ART-eligible and 523 (28%) TB coinfected at baseline. In the intervention, 212 (39% of outcome-eligible) reached primary outcome compared to 197 (42%) in usual care (RR 0.93, 95% CI: 0.80 to 1.08). One hundred thirty-one (14%) HIV-infected intervention participants died compared to 119 (13%) in usual care; death rates did not differ between arms (RR 1.06, 95% CI: 0.84 to 1.34). In the as-treated analysis, participants reached for ≥5 navigator calls were more likely to achieve study outcome.

Conclusions:

∼40% of ART-eligible participants in both study arms reached the primary outcome 9 months after HIV diagnosis. Low rates of engagement in care, high death rates, and lack of navigator efficacy highlight the urgency of identifying more effective strategies for improving HIV and TB care outcomes.
War-Related Abduction and History of Incarceration Linked to High Burden of HIV Among Female Sex Workers in Conflict-Affected Northern Uganda
Authors: Goldenberg Shira M. , Muzaaya Godfrey , Akello Monica , Nguyen Paul , Birungi Josephine , Shannon Kate
Published: April 2016

Objective:

Sex workers (SWs) in sub-Saharan Africa face a disproportionate HIV burden and growing concerns of severe human rights violations. Given the dearth of evidence on the burden and correlates of HIV among SWs in sub-Saharan Africa, particularly within conflict-affected settings, we examined the relationship between structural determinants (eg, war-related abduction, incarceration) and HIV infection among conflict-affected SWs in Northern Uganda.

Design:

Cross-sectional community-based research study among female SWs in conflict-affected Gulu, Northern Uganda.

Methods:

Interview questionnaires and voluntary HIV testing were conducted with participants recruited through SW/peer-led outreach and time–location sampling from 2011 to 2012. HIV prevalence was calculated, and bivariable and multivariable logistic regression was used to identify independent associations with HIV seroprevalence.

Results:

Of 400 SWs, 135 (33.75%) were HIV seropositive; of whom one-third were new/previously undiagnosed HIV infections. In multivariable analysis, after adjusting for age of sex work entry and education, lifetime incarceration (adjusted odds ratio: 1.93, 95% confidence interval: 1.17 to −3.20) was independently associated with HIV seroprevalence, and history of wartime abduction (adjusted odds ratio: 1.62, 95% confidence interval: 1.00 to 2.63) was marginally associated (P = 0.051).

Conclusions:

This study documented a high rate of undiagnosed HIV infections and associations between war-related human rights violations, incarceration, and a heavy HIV burden among SWs in conflict-affected Northern Uganda. These findings highlight the serious harms of conflict and criminalization of marginalized women in sub-Saharan African contexts. SW-led interventions that address conflict experiences and policy shifts to promote a rights-based approach to HIV prevention and care remain critically needed.
Learning Neonatal Intubation Using the Videolaryngoscope
Authors: Assaad Michael-Andrew , Lachance Christian , Moussa Ahmed
Published: April 2016

Introduction

The use of the videolaryngoscope (VL) facilitates intubation in adults and children, but experience in neonates is scarce. The objective of this study was to compare the VL with the classic laryngoscope (CL) in acquiring the skill of neonatal endotracheal intubation (ETI) and evaluate transferability of skill from VL to CL. We hypothesize that, on a neonatal mannequin, the VL will be superior to the CL with regard to success rate and that the skill will be transferred from VL to CL.

Methods

A randomized controlled trial was held at Sainte-Justine Hospital’s simulation center. Third- and fourth-year medical students were randomized into group A, which used VL for the first phase and CL for the second phase, and group B, which used CL for both phases. Each subject performed 9 ETI on 3 simulated neonatal airways in each phase.

Results

Thirty-four students performed 612 intubations. Success in group A was higher than in group B in the first phase of the study (96.5% vs. 84.6%, P < 0.001). During phase 2, group A’s success did not change significantly (91.7% vs. 96.5%, P = 0.07). Time to successful intubation was longer using the VL (27.6 vs. 15.6 seconds, P < 0.001), but there was no difference in phase 2 (12.5 vs. 10.2 seconds, P = 0.24). There were no esophageal intubations using the VL.

Conclusions

Success rate of ETI on mannequins was improved, and esophageal intubations decreased while learning ETI using the VL compared with the CL. Once ETI is learned on mannequins using the VL, this skill is transferrable to the CL.
Technical, Oncological, and Functional Safety of Bilateral Axillo-Breast Approach (BABA) Robotic Total Thyroidectomy
Authors: Bae Dong S. , Suh Byoung J. , Park Jong K. , Koo Do H.
Published: April 2016

Background:

The aim of this study was to identify whether bilateral axillo-breast approach (BABA) robotic total thyroidectomy (RoTT) is technically, oncologically, and functionally safe.

Materials and Methods:

One hundred eighteen patients underwent BABA robotic thyroidectomy between July 2010 and February 2013. Ninety-one (77.1%) patients underwent RoTT, and 27 (22.9%) underwent robotic unilateral lobectomy.

Results:

RoTT (n=91) resulted in lower rate of surgical complication and in higher rate of transient hypocalcemia comparing with robotic unilateral lobectomy (n=27) (35.16% vs. 3.7%; P<0.013), but not in a permanent hypocalcemia, transient, or permanent recurrent laryngeal nerve palsy (2.2% vs. 0%; P=1.000, 3.3% vs. 0%; P=1.000, and 0% vs. 0%; P=NS), respectively. Successful remnant ablation rate for the patients with RoTT was 100% on a subsequent 6 months follow-up. No significant differences between 2 groups existed in mean Voice Handicap Index-10 scores during postoperative 6 months (P=0.308).

Conclusions:

BABA RoTT might be oncologically safe as well as technically and functionally safe procedure.
Utilizing Technology in Assessment of Lower Urinary Tract Symptoms: A Randomized Trial of Electronic Versus Paper Voiding Diaries
Authors: Sussman Rachael D. , Richter Lee A. , Tefera Eshetu , Park Amy J. , Sokol Andrew I. , Gutman Robert E. , Iglesia Cheryl B.
Published: April 2016

Objectives

The aim of this study was to compare a Web app developed by the American Urogynecologic Society, called “BladderTrakHer,” to the traditional paper voiding diary (PVD) for reliability and satisfaction.

Methods

Women presenting to our urogynecology practice with lower urinary tract symptom and access to an iPhone/iPad were randomized to a 3-day electronic voiding diary (EVD), using the BladderTrakHer Web app or PVD. Participants then completed a second voiding diary using the alternate format. Estimated fluid intake and output, number of voids, and episodes of incontinence were compared between formats. Patient and practitioner surveys assessed ease of use, ease of data interpretation, time to data entry, and overall satisfaction.

Results

Thirty-one of 122 patients completed both diary formats and the survey. The EVD and PVD showed good test-retest reliability. Patients recorded a higher number of entries for both voids and leaks while using the PVD (28.0 vs 25.5 [P = 0.03] and 4.5 vs 2.8 [P = 0.02], respectively). There was no significant difference in time to data entry among diary formats; 51.6% of patients preferred the EVD, and 78% of patients would prefer an electronic format if the app were improved. Four of 6 practitioners found the PVD easier to interpret, but all stated a preference for an EVD if the data were presented in a more organized fashion.

Conclusions

The use of an EVD is acceptable and reliable in our population of adult female patients with lower urinary tract symptom. Electronic voiding diary and PVD have good test-retest reliability, although the number of voids and leaks entered is slightly lower for the EVD.
A Large Retrospective Series of Pregnancy and Delivery After Midurethral Sling for Stress Urinary Incontinence
Authors: Adams-Piper Emily , Buono Kristen , Whitcomb Emily , Mallipeddi Padma , Castillo Peter , Guaderrama Noelani
Published: April 2016

Objectives

The aim of this study was to review the complete medical course, including safety, efficacy, and medical decision making, of patients who delivered a pregnancy after the placement of midurethral sling (MUS) within a large health maintenance organization.

Methods

We conducted a retrospective case series of patients within the Northern and Southern California Permanente Medical Group who were identified based on procedural codes for placement of MUS for stress urinary incontinence. Electronic medical records with MUS code were referenced against records of live births within the health care system. Demographic and clinical data were abstracted through extensive, standardized physician review of the electronic medical records of all identified patients.

Results

Twenty-six patients were identified and included in analysis. Sixteen patients had a retropubic MUS, and 10 had a transobturator MUS. Twenty-one of 26 patients reported subjective resolution of urinary incontinence after MUS. Fourteen of the 25 first deliveries after MUS were cesarean section (CS). Of these, 5 CS were elective primary for the indication of previous MUS, 5 were elective repeat CS, and the remaining 4 were for fetal indications. Eleven patients had spontaneous vaginal deliveries. There were no MUS-related pregnancy complications. One patient developed recurrent stress urinary incontinence postpartum, for which she underwent repeat MUS within a year resulting in cure of incontinence.

Conclusions

This case series corroborates previous series demonstrating the safety and durability of MUS after subsequent pregnancy.
Foot-and-mouth disease virus replicates independently of phosphatidylinositol 4-phosphate and type III phosphatidylinositol 4-kinases
Authors: Berryman Stephen , Moffat Katy , Harak Christian , Lohmann Volker , Jackson Terry
Published: April 2016

Picornaviruses form replication complexes in association with membranes in structures called replication organelles. Common themes to emerge from studies of picornavirus replication are the need for cholesterol and phosphatidylinositol 4-phosphate (PI4P). In infected cells, type III phosphatidylinositol 4-kinases (PI4KIIIs) generate elevated levels of PI4P, which is then exchanged for cholesterol at replication organelles. For the enteroviruses, replication organelles form at Golgi membranes in a process that utilizes PI4KIIIβ. Other picornaviruses, for example the cardioviruses, are believed to initiate replication at the endoplasmic reticulum and subvert PI4KIIIα to generate PI4P. Here we investigated the role of PI4KIII in foot-and-mouth disease virus (FMDV) replication. Our results showed that, in contrast to the enteroviruses and the cardioviruses, FMDV replication does not require PI4KIII (PI4KIIIα and PI4KIIIβ), and PI4P levels do not increase in FMDV-infected cells and PI4P is not seen at replication organelles. These results point to a unique requirement towards lipids at the FMDV replication membranes.
Discrete step sizes of molecular motors lead to bimodal non-Gaussian velocity distributions under force
Authors: Vu Huong T , Chakrabarti Shaon , Hinczewski Michael , Thirumalai D
Published: April 2016

Fluctuations in the physical properties of biological machines are inextricably linked to their functions. Distributions of run-lengths and velocities of processive molecular motors, like kinesin-1, are accessible through single molecule techniques, yet there is lack a rigorous theoretical model for these probabilities up to now. We derive exact analytic results for a kinetic model to predict the resistive force (F) dependent velocity (P(v)) and run-length (P(n)) distribution functions of generic finitely processive molecular motors that take forward and backward steps on a track. Our theory quantitatively explains the zero force kinesin-1 data for bothP(n) andP(v) using the detachment rate as the only parameter, thus allowing us to obtain the variations of these quantities under load. At non-zeroF,P(v) is non-Gaussian, and is bimodal with peaks at positive and negative values ofv. The prediction thatP(v) is bimodal is a consequence of the discrete step-size of kinesin-1, and remains even when the step-size distribution is taken into account. Although the predictions are based on analyses of kinesin-1 data, our results are general and should hold for any processive motor, which walks on a track by taking discrete steps.
Membrane binding by CHMP7 coordinates ESCRT-III dependent nuclear envelope reformation
Authors: Olmos Yolanda , Perdrix Anna , Carlton Jeremy G
Published: April 2016

Amongst other cellular functions, the Endosomal Sorting Complex Required for Transport-III (ESCRT-III) machinery controls nuclear envelope (NE) reformation during mitotic exit by sealing holes in the reforming NE. ESCRT-III also acts to repair this organelle upon migration-induced rupture. The ESCRT-III component CHMP7 is responsible for recruitment of ESCRT-III to the NE. Here, we show that the N-terminus of CHMP7, comprising tandem Winged Helix (WH)-domains, is a membrane-binding module. This activity allows CHMP7 to bind to the Endoplasmic Reticulum (ER), an organelle continuous with the NE, and provides a platform to direct NE-recruitment of ESCRT-III during mitotic exit. Point mutations that disrupt membrane-binding prevent CHMP7 localising to the ER and its subsequent enrichment at the reforming NE. These mutations prevent both assembly of downstream ESCRT-III components at the reforming NE and proper establishment of post-mitotic nucleo-cytoplasmic compartmentalisation. These data identify a novel membrane-binding activity within an ESCRT-III subunit that is essential for post-mitotic nuclear regeneration.

One Sentence Summary

CHMP7’s atypical N-terminus is a membrane-binding module that allows assembly and function of ESCRT-III at the nuclear envelope during mitotic exit.
In situultra-small-angle X-ray scattering study under uniaxial stretching of colloidal crystals prepared by silica nanoparticles bearing hydrogen-bonding polymer grafts
Authors: Ishige Ryohei , Williams Gregory A. , Higaki Yuji , Ohta Noboru , Sato Masugu , Takahara Atsushi , Guan Zhibin
Published: April 2016

A molded film of single-component polymer-grafted nanoparticles (SPNP), consisting of a spherical silica core and densely grafted polymer chains bearing hydrogen-bonding side groups capable of physical crosslinking, was investigated byin situultra-small-angle X-ray scattering (USAXS) measurement during a uniaxial stretching process. Static USAXS revealed that the molded SPNP formed a highly oriented twinned face-centered cubic (f.c.c.) lattice structure with the [11−1] plane aligned nearly parallel to the film surface in the initial state. Structural analysis ofin situUSAXS using a model of uniaxial deformation induced by rearrangement of the nanoparticles revealed that the f.c.c. lattice was distorted in the stretching direction in proportion to the macroscopic strain until the strain reached 35%, and subsequently changed into other f.c.c. lattices with different orientations. The lattice distortion and structural transition behavior corresponded well to the elastic and plastic deformation regimes, respectively, observed in the stress–strain curve. The attractive interaction of the hydrogen bond is considered to form only at the top surface of the shell and then plays an effective role in cross-linking between nanoparticles. The rearrangement mechanism of the nanoparticles is well accounted for by a strong repulsive interaction between the densely grafted polymer shells of neighboring particles.