bluuebunny/crossref_metadata_2025 huggingface dataset:
Allyl isothiocyanate increases carbohydrate oxidation through enhancing insulin secretion by TRPV1
Authors: Mori Noriyuki , Kurata Manami , Yamazaki Hanae , Matsumura Shigenobu , Hashimoto Takashi , Kanazawa Kazuki , Nadamoto Tomonori , Inoue Kazuo , Fushiki Tohru
Published: December 2017

The transient receptor potential (TRP) V1 is a cation channel belonging to the TRP channel family and it has been reported to be involved in energy metabolism, especially glucose metabolism. While, we have previously shown that intragastric administration of allyl isothiocyanate (AITC) enhanced glucose metabolism via TRPV1, the underlying mechanism has not been elucidated. In this study, we examined the relationship between insulin secretion and the increase in carbohydrate oxidation due to AITC. Intragastric administration of AITC elevated blood insulin levels in mice and AITC directly enhanced insulin secretion from isolated islets. These observations were not reproduced in TRPV1 knockout mice. Furthermore, AITC did not increase carbohydrate oxidation in streptozotocin-treated mice. These results suggest that intragastric administration of AITC could induce insulin secretion from islets via TRPV1 and that enhancement of insulin secretion was related to the increased carbohydrate oxidation due to AITC.
Intake of green-plant membrane with dietary oil suppresses postprandial hypertriglyceridemia in rats via promoting excretion of bile acids
Authors: Matsuda Hiroko , Ooi Shinpei , Otokozawa Ryo , Kumazaki Kodai , Udagawa Eri , Asakura Masaya , Suzuki Daisuke , Shirai Takaaki
Published: December 2017

Green-plant membrane is a phytonutrient present in green leafy vegetables at high concentration. Postprandial increases in blood triglyceride levels result in insulin resistance and type 2 diabetes. Additionally, dietary life and eating order also affect postprandial hypertriglyceridemia. In this study, the effects of once-daily intake of green-plant membrane with dietary oil on postprandial hypertriglyceridemia were investigated in vitro and in vivo. In vitro, green-plant membrane bound hydrophobic bile acids but did not inhibit pancreatic lipase activity. Following the administration, green-plant membrane with dietary oil in rats, oral fat tolerance tests, increases in serum triglycerides levels were significantly reduced. Moreover, fecal total lipid and bile acid volumes were significantly increased in rats that administered 200 mg/mL green-plant membrane. These results suggest that green-plant membrane with dietary oil inhibits dietary fat absorption via promotion of bile acid excretion in feces and the effectiveness of eating green-plant membrane, such as green leafy vegetables, with meals.
Rhetorical Accretion and Rhetorical Criticism in William Hazlitt’sEloquence of the British Senate
Authors: Homar Katie
Published: December 2017

This paper examines William Hazlitt’s collection, Eloquence of the British Senate (1807), alongside our interest in reception, accretion, and the rhetorical culture of Parliament. I trace Hazlitt’s interpretation of oratory, including his analysis of remediated, printed speech. Hazlitt investigates the circulation and power of oratory in modern print culture, while beginning a multidisciplinary, career-long interest in rhetoric. By mapping how Hazlitt criticizes the status quo while avoiding partisan exposes of corruption, I argue he thinks like a critical rhetorician in ways that enrich our histories of nineteenth-century rhetoric and help us reflect on our own enterprise as historians of rhetoric.
Voices of the rational and aesthetic in Jung: thermodynamics resonating into complexity
Authors: Schenk Ronald
Published: December 2017

Jung's writing displays many perspectives, each of which is undergirded by a distinct set of assumptions, style of language, and sensibility of world and psyche. This paper traces some of these perspectives with an eye toward showing how the contemporary cutting edge science of complexity, in fact, is anticipated by and embodied in Jung's work, especially that which gives expression to the psyche as an aesthetic enterprise, particularly alchemy.
Unconventional secretion of FABP4 by endosomes and secretory lysosomes
Authors: Villeneuve Julien , Bassaganyas Laia , Lepreux Sebastien , Chiritoiu Marioara , Costet Pierre , Ripoche Jean , Malhotra Vivek , Schekman Randy
Published: December 2017

An appreciation of the functional properties of the cytoplasmic fatty acid binding protein 4 (FABP4) has advanced with the recent demonstration that an extracellular form secreted by adipocytes regulates a wide range of physiological functions. Little, however, is known about the mechanisms that mediate the unconventional secretion of FABP4. Here, we demonstrate that FABP4 secretion is mediated by a membrane-bounded compartment, independent of the conventional endoplasmic reticulum–Golgi secretory pathway. We show that FABP4 secretion is also independent of GRASP proteins, autophagy, and multivesicular bodies but involves enclosure within endosomes and secretory lysosomes. We highlight the physiological significance of this pathway with the demonstration that an increase in plasma levels of FABP4 is inhibited by chloroquine treatment of mice. These findings chart the pathway of FABP4 secretion and provide a potential therapeutic means to control metabolic disorders associated with its dysregulated secretion.
The spherical Hecke algebra, partition functions, and motivic integration
Authors: Casselman William , Cely Jorge , Hales Thomas
Published: December 2017

This article gives a proof of the Langlands-Shelstad fundamental lemma for the spherical Hecke algebra for every unramified

p
p

-adic reductive group

G
G

in large positive characteristic. The proof is based on the transfer principle for constructible motivic integration. To carry this out, we introduce a general family of partition functions attached to the complex

L
L

-group of the unramified

p
p

-adic group

G
G

. Our partition functions specialize to Kostant’s

q
q

-partition function for complex connected groups and also specialize to the Langlands

L
L

-function of a spherical representation. These partition functions are used to extend numerous results that were previously known only when the

L
L

-group is connected (that is, when the

p
p

-adic group is split). We give explicit formulas for branching rules, the inverse of the weight multiplicity matrix, the Kato-Lusztig formula for the inverse Satake transform, the Plancherel measure, and Macdonald’s formula for the spherical Hecke algebra on a nonconnected complex group (that is, nonsplit unramified

p
p

-adic group).
1. Introduction
Authors: Nowell-Smith Geoffrey
Published: December 2017

What is cinema? What is history? And what is the history of cinema? Cinema is a complex of things: a technology, an industry, an art form, a way or ways of rendering the world as images and sounds, and as a component of the imaginary world each of us keeps inside our head. These different parts stand in constantly changing relationships with each other and with aspects of the world outside its immediate boundaries. The Introduction explains how there is no single template for how cinema history is to be written, but this VSI provides an idea of what it took for cinema to become the major art of the 20th century.
2. Technology
Authors: Nowell-Smith Geoffrey
Published: December 2017

‘Technology’ considers a range of technological developments that were important in the evolution of cinema: making images move, the introduction and synchronization of sound, colour film, widescreen and stereo sound, animation and special effects, and the digital revolution, which has affected the cinema at every level. But do these developments represent progress? Gains in one quarter are often losses in another. Industrial and artistic factors intervene, as do changes in audience tastes. Many of these major innovations were also costly to introduce and were pioneered and exploited by the big studios, giving them a head start over independent producers and exhibitors who could not afford the expenditure.
4. Cinema as art form
Authors: Nowell-Smith Geoffrey
Published: December 2017

In the years before World War I there were few people who thought that cinema was or might become an art form. From about 1910, however, signs emerged that cinema was on the road to acquiring some sort of legitimacy. These signs initially pointed in different directions, but eventually a cluster of forms developed, which were to become the cinema as we know it today. ‘Cinema as art form’ considers how cinema has developed through the evolution of editing and narrative techniques and sound synchronization, and then discusses different types of film genre, the neo-realism movement, and the diverse varieties of modern cinema.
5. Cinema and the outer world
Authors: Nowell-Smith Geoffrey
Published: December 2017

The world in which cinema grew up was one of constant change, not always for the better. There was technological change, of which the cinema itself was part. There were wars and revolutions, leading to changes in the world order. There was social and demographic change as more and more people across the world entered into the orbit of global capitalism. ‘Cinema and the outer world’ explains how cinema recorded and reflected these changes, but how it also changed or was forced to change in response to them. The cinema also played a major role in shaping the world, or at least what we imagine the world to be.
Miracles: A Very Short Introduction
Authors: Nagasawa Yujin
Published: December 2017

What exactly is a miracle? What types of miracles are believed in the world’s great religions? What do recent scientific findings tell us about miracles? Can we rationally believe that miracles have really taken place? Can there be acts that are more religiously significant than miracles? Drawing on a vast variety of fascinating examples from across the major religions, Miracles: A Very Short Introduction discusses the lively debate on miracles, ranging from reported miracles in ancient scriptures in the East and West to cutting-edge scientific research on belief formation. Throughout, it drives us to ask ourselves if and how we can still believe in miracles in the 21st century.
5. Can there be miracles without the supernatural?
Authors: Nagasawa Yujin
Published: December 2017

The unique feature of miracles is their violation of the laws of nature. However, this very feature makes it difficult to justify belief in miracles because the laws of nature have been confirmed through solid and uniform scientific observation. If belief in miracles cannot be justified, what are the closest acts to miracles that we can rationally believe in? ‘Can there be miracles without the supernatural?’ considers altruistic acts, concluding that extremely altruistic acts are as close to miracles as any acts one can perform within the laws of nature and belief. It also asks whether altruism is a product of evolution or an incoherent concept.
1. What is the immune system?
Authors: Klenerman Paul
Published: December 2017

The immune system resists threats from outside as well as from within the body. ‘What is the immune system?’ considers the basic mechanisms of immunity and describes the specific structures in the immune system where more complex activities take place. The critical cells—‘white blood cells’ or leukocytes—are generated in the bone marrow. Leukocytes are highly diverse, each with its own specialist function, but broadly divided into the myeloid (develops in the marrow) and the lymphoid (develops in lymphoid structures including the thymus, lymph nodes, and spleen) leukocyte. We have both ‘innate’ (which we are born with) and ‘adaptive’ (which encompasses learned, very specific responses to individual infections) immunity.
2. First responders: the innate immune response
Authors: Klenerman Paul
Published: December 2017

How does the immune system know when to respond? ‘First responders: the innate immune response’ considers this fundamental question that is central to understanding both normal (e.g. to infections) and abnormal (e.g. in auto-immune diseases) responses; and designing vaccines and new therapies in cancer and infectious diseases. It looks at how ‘danger’ is sensed by the immune system through pathogen-associated molecular patterns and damage-associated molecular patterns. Having been alerted, it is important that rapid action is taken to limit the spread of a pathogen. A number of responses can be initiated immediately, forming a critical part of our innate immunity, which are followed by the acute phase response.
5. Too little immunity: immunological failure
Authors: Klenerman Paul
Published: December 2017

The immune system is continuously active, preventing severe infection from the micro-organisms that colonize our skin and our gut, and suppressing the chronic virus infections most of us picked up as infants. In certain individuals, or under certain conditions, the immune response may, however, fail and this can lead to severe disease—the exact disease depends on the precise mechanism of the failure. ‘Too little immunity: immunological failure’ examines how such failures may occur, specifically through genetic changes, such as redundancy and polymorphisms, and through HIV infection and AIDS. It also considers what we may learn from them about the working of the normal immune system.
1. Hope
Authors: Jeffrey Craig
Published: December 2017

India is the fastest growing major economy in the world with a large and rapidly growing middle class. It has established an identity as a major power in terms of Information Technology and has become a global player in terms of foreign policy. Despite this, however, India has a GDP per capita below that of Sudan. Economic reforms in India have widened social inequalities across the subcontinent. Poverty, inequality, and exclusion in contemporary India are the norm for many ordinary Indians. But there is hope. These hopes are not only economic, but also social and political—people have an awareness of rights and their entitlements as citizens.
How many things are there?
Authors: Beaney Michael
Published: December 2017

‘How many things are there?’ introduces Gottlob Frege (1848–1925), one of the main founders of analytic philosophy whose central concern was with the nature of mathematics, and arithmetic in particular. It considers the question ‘How many things are there?’, concluding a simple answer is not permitted without specifying the relevant concept(s) by means of which to think of the things. If how to answer a given question is not immediately obvious, then we need to identify its possible meanings. Perhaps we will find the intended or relevant meaning by understanding the context; if not, then we may need to imagine possible contexts in which the question has an answer.
Do you know what I mean?
Authors: Beaney Michael
Published: December 2017

From the very origins of philosophy, philosophers have been especially conscious of the inadequacies and limitations of language. But they have disagreed on whether this reflects a corresponding deficiency in thought, on what its explanation and implications are, and on how we should respond—in short, on what this itself means. ‘Do you know what I mean?’ explains that in actual cases of analysis, three different dimensions—interpretive, decompositional, and regressive—are typically involved. It also introduces G. E. Moore (1873–1958) who, alongside Russell, inaugurated analytic philosophy in Britain. Moore’s main interests lay with epistemology (the theory of knowledge) and ethics. The paradox of analysis is also discussed.
6. Big data, big business
Authors: Holmes Dawn E.
Published: December 2017

Since the use of computers became feasible in commercial enterprise, there has been interest in using computers to improve efficiency, cut costs, and generate profits. When IBM launched the IBM-PC in 1981, with the use of floppy disks for data storage, the idea really took off for business, but it was the widespread adoption of the Internet that made e-commerce a practical proposition. ‘Big data, big business’ considers pay-per-click advertising, cookies, targeted advertising, recommender systems, and collaborative filtering used by a wide range of businesses. Alongside the analysis of business practices it provides case studies on Amazon and Netflix, each highlighting different features of marketing using big data.
8. Big data and society
Authors: Holmes Dawn E.
Published: December 2017

‘Big data and society’ considers how big data is changing the society we live in, through the development of sophisticated robots and their role in the workplace. It discusses smart vehicles, smart homes, and smart cities of the future. The data generated by the world is only going to get bigger. The big data revolution marks a sea-change in the way the world works, and as with all technological developments, individuals, scientists, and governments together have a moral responsibility to ensure its proper use. Big data is power. Its potential for good is enormous. How we prevent its abuse is up to us.
Development of the place-based Adelante social marketing campaign for prevention of substance use, sexual risk and violence among Latino immigrant youth
Authors: Andrade E L , Evans W D , Barrett N D , Cleary S D , Edberg M C , Alvayero R D , Kierstead E C , Beltran A
Published: December 2017

Immigrant Latino youth represent a high-risk subgroup that should be targeted with health promotion efforts. However, there are considerable barriers to engagement in health-related programming. Little is known about the engagement possibilities of social marketing campaigns and digital strategies for traditionally ‘hard-to-reach’ immigrants, underscoring the importance of testing these techniques with immigrant Latino adolescents. We developed and piloted a place-based social marketing campaign in coordination with the branded, Positive Youth Development-based (PYD) Adelante intervention targeting risk factors for co-occurring youth substance abuse, sexual risk and violence. Building on prior research, we conducted a four-phase formative research process, and planned the Adelante social marketing campaign based on findings from one group interview and ongoing consultation with Adelante staff (n=8) and four focus groups with youth (n=35). Participants identified four overarching campaign themes, and suggested portrayal of resilient, proud youth who achieved goals despite adversity. Youth guided selection of campaign features and engagement strategies, including message/visual content, stylistic elements, and a mixed language approach. We developed a 12-month campaign to be delivered via print ads, multi-platform social media promotion, contests, youth-generated videos, blog posts, and text messaging. We describe the process and outcome of campaign development and make recommendations for future campaigns.
Institutions, Models of Capitalism and Inequality in Income Distribution: An Empirical Investigation
Authors: Antonelli Gilberto , Calia Pinuccia P , Guidetti Giovanni
Published: December 2017

The article analyses the role of institutions in the determination of income inequality in a sample of OECD countries. Basing on the seminal approach by Amable, the article discusses the theoretical definition of model of capitalism. The basic idea is that each model of capitalism is defined by the cobweb of complementary relationships established among different institutions. Using a set of statistical indicators of the operation of institutions in two different years, 1995 and 2010, the empirical analysis points out five models of capitalism and exhibits how their composition has changed in this lapse of 15 years. In the following sections of the article, we investigate the role played by the model of capitalism in the determination of income distribution, measured through a standard Gini index. After controlling for a set of variables, the econometric evidence shows that different models of capitalism present significantly different levels of income inequality.
Timing and Risk Factors of Postpartum Stroke
Authors: Too Gloria , Wen Timothy , Boehme Amelia K. , Miller Eliza C. , Leffert Lisa R. , Attenello Frank J. , Mack William J. , D'Alton Mary E. , Friedman Alexander M.
Published: December 2017

OBJECTIVE:

To characterize risk and timing of postpartum stroke readmission after delivery hospitalization discharge.

METHODS:

The Healthcare Cost and Utilization Project's Nationwide Readmissions Database for calendar years 2013 and 2014 was used to perform a retrospective cohort study evaluating risk of readmission for stroke within 60 days of discharge from a delivery hospitalization. Risk was characterized as odds ratios (ORs) with 95% CIs based on whether patients had hypertensive diseases of pregnancy (gestational hypertension or preeclampsia), or chronic hypertension, or neither disorder during the index hospitalization. Adjusted models for stroke readmission risk were created.

RESULTS:

From January 1, 2013, to October 31, 2013, and January 1, 2014, to October 31, 2014, 6,272,136 delivery hospitalizations were included in the analysis. One thousand five hundred five cases of readmission for postpartum stroke were identified. Two hundred fourteen (14.2%) cases of stroke occurred among patients with hypertensive diseases of pregnancy, 66 (4.4%) with chronic hypertension, and 1,225 (81.4%) without hypertension. The majority of stroke readmissions occurred within 10 days of hospital discharge (58.4%), including 53.2% of patients with hypertensive diseases of pregnancy during the index hospitalization, 66.7% with chronic hypertension, and 58.9% with no hypertension. Hypertensive diseases of pregnancy and chronic hypertension were associated with increased risk of stroke readmission compared with no hypertension (OR 1.74, 95% CI 1.33–2.27 and OR 1.88, 95% CI 1.19–2.96, respectively). Median times to readmission were 8.9 days for hypertensive diseases of pregnancy, 7.8 days for chronic hypertension, and 8.3 days without either condition.

CONCLUSION:

Although patients with chronic hypertension and hypertensive diseases of pregnancy are at higher risk of postpartum stroke, they account for a minority of such strokes. The majority of readmissions for postpartum stroke occur within 10 days of discharge; optimal blood pressure management may be particularly important during this period.
Treatment of Low-Risk Endometrial Cancer and Complex Atypical Hyperplasia With the Levonorgestrel-Releasing Intrauterine Device
Authors: Pal Navdeep , Broaddus Russell R. , Urbauer Diana L. , Balakrishnan Nyla , Milbourne Andrea , Schmeler Kathleen M. , Meyer Larissa A. , Soliman Pamela T. , Lu Karen H. , Ramirez Pedro T. , Ramondetta Lois , Bodurka Diane C. , Westin Shannon N.
Published: December 2017

OBJECTIVE:

To assess efficacy of the levonorgestrel-releasing intrauterine device (LNG-IUD) for treatment of complex atypical hyperplasia or low-grade endometrial cancer.

METHODS:

This retrospective case series included all patients treated with the LNG-IUD for complex atypical hyperplasia or early-grade endometrial cancer from January 2003 to June 2013. Response rates were calculated and the association of response with clinicopathologic factors, including age, body mass index, and uterine size, was determined.

RESULTS:

Forty-six patients diagnosed with complex atypical hyperplasia or early-grade endometrial cancer were treated with the LNG-IUD. Of 32 evaluable patients at the 6-month time point, 15 had complex atypical hyperplasia (47%), nine had G1 endometrial cancer (28%), and eight had grade 2 endometrial cancer (25%). Overall response rate was 75% (95% CI 57–89) at 6 months; 80% (95% CI 52–96) in complex atypical hyperplasia, 67% (95% CI 30–93) in grade 1 endometrial cancer, and 75% (CI 35–97) in grade 2 endometrial cancer. Of the clinicopathologic features evaluated, there was a trend toward the association of lack of exogenous progesterone effect in the pathology specimen with nonresponse to the IUD (P=.05). Median uterine diameter was 1.3 cm larger in women who did not respond to the IUD (P=.04).

CONCLUSION:

Levonorgestrel-releasing IUD therapy for the conservative treatment of complex atypical hyperplasia or early-grade endometrial cancer resulted in return to normal histology in a majority of patients.
Low-Fidelity Simulator for the Standardized Training of Fetoscopic Meningomyelocele Repair
Authors: Belfort Michael A. , Whitehead William E. , Bednov Andrey , Shamshirsaz Alireza A.
Published: December 2017

BACKGROUND:

Fetoscopic meningomyelocele repair in a gas-filled uterus is a new technique performed in very few centers. There are few opportunities as well as ethical prohibitions on the initial development and subsequent refinement of innovative fetal surgery techniques in humans, and using an animal model is both very expensive and logistically difficult.

METHOD:

We developed a low-fidelity endoscopic fetal surgery simulation using a plastic doll and pieces of chicken breast to simulate a fetal meningomyelocele, and a polyurethane ball to simulate a gas-filled uterus, along with a standard endoscopy system and instruments.

EXPERIENCE:

A unique two-port technique with significant differences from the standard laparoscopic surgery procedure was developed and refined through an iterative phase into a standardized methodology, and the simulator was then used to train three other teams to perform standardized fetoscopic meningomyelocele repair.

CONCLUSION:

A low-fidelity fetoscopic surgery simulator is a useful tool for developing new fetoscopic operations and for training multidisciplinary fetal surgery teams without the need for extensive use of an animal model. This simulator may be used to further explore the human uterus as a new surgical space for additional fetal surgeries.
Ethical Considerations Concerning Amnioinfusions for Treating Fetal Bilateral Renal Agenesis
Authors: Sugarman Jeremy , Anderson Jean , Baschat Ahmet A. , Herrera Beutler Jaime , Bienstock Jessica L. , Bunchman Timothy E. , Desai Niraj M. , Gates Elena , Goldberg Aviva , Grimm Paul C. , Henry Leslie Meltzer , Jelin Eric B. , Johnson Emily , Hertenstein Christine B. , Mastroianni Anna C. , Mercurio Mark R. , Neu Alicia , Nogee Lawrence M. , Polzin William J. , Ralston Steven J. , Ramus Ronald M. , Singleton Megan Kasimatis , Somers Michael J. G. , Wang Karen C. , Boss Renee
Published: December 2017

Congenital bilateral renal agenesis has been considered a uniformly fatal condition. However, the report of using serial amnioinfusions followed by the live birth in 2012 and ongoing survival of a child with bilateral renal agenesis has generated hope, but also considerable controversy over an array of complex clinical and ethical concerns. To assess the ethical concerns associated with using serial amnioinfusions for bilateral renal agenesis, we assembled a multidisciplinary group to map the ethical issues relevant to this novel intervention. The key ethical issues identified were related to 1) potential risks and benefits, 2) clinical care compared with innovation compared with research, 3) counseling of expectant parents, 4) consent, 5) outcome measures, 6) access and justice, 7) conflicts of interest, 8) effects on clinicians, 9) effects on institutions, and 10) long-term societal implications. These ethical issues should be addressed in conjunction with systematic efforts to examine whether this intervention is safe and effective. Future work should capture the experiences of expectant parents, women who undergo serial amnioinfusions, those born with bilateral renal agenesis and their families as well as clinicians confronted with making difficult choices related to it.
Clomiphene Stair-Step Protocol for Women With Polycystic Ovary Syndrome
Authors: Jones Tiffanny , Ho Jacqueline R. , Gualtieri Marc , Bruno-Gaston Janet , Chung Karine , Paulson Richard J. , Bendikson Kristin A.
Published: December 2017

OBJECTIVE:

To compare time to ovulation, ovulation rates, and side effect profile of traditional and the stair-step protocol for ovulation induction using clomiphene citrate in women with polycystic ovary syndrome (PCOS).

METHODS:

We performed a retrospective study of women seeking care for infertility with a diagnosis of PCOS at a university-based infertility clinic from July 2012 to July 2014. We included patients who were resistant to the initial starting dose of 50 mg clomiphene. The primary outcome was time to ovulation. Secondary outcomes included ovulation rates, clinical pregnancy rates, and mild and moderate-to-severe side effects based on dose. For the traditional protocol, higher doses of clomiphene were used each subsequent month if no ovulation occurred. For the stair-step protocol, higher doses of clomiphene were given 7 days after the last dose if no dominant follicles were seen on ultrasonography. Our study had 80% power to detect a 20% difference in ovulation.

RESULTS:

One hundred nine patients were included in the analysis with 66 (60.6%) in the traditional and 43 (39.4%) in the stair-step protocol. Age and body mass index were similar between groups. The time to ovulation was decreased in the stair-step protocol group compared with the traditional protocol group (23.1±0.9 days vs 47.5±6.3 days). Ovulation rates were increased in the stair-step group compared with the traditional group at 150 mg (16 [37%] vs 8 [12%], P=.004) and at 200 mg (9 [21%] vs 3 [5%], P=.01). Pregnancy rates were similar between groups once ovulation was achieved (12 [18.1%] vs 7 [16.3%], P=.08). The stair-step protocol had an increased incidence of mild side effects (vasomotor flushes, headaches, gastrointestinal disturbance, mastalgia, changes in mood; 18 [41%] vs 8 [12%]), but there was no difference in the incidence of severe side effects (headaches, visual disturbances).

CONCLUSION:

For women with PCOS, the stair-step clomiphene protocol is associated with decreased time to ovulation and increased ovulation rates at higher doses when compared with the traditional protocol.
Switching From Ticagrelor or Prasugrel to Clopidogrel
Authors: Nawarskas James J. , Montoya Tiffany N.
Published: December 2017

Ticagrelor and prasugrel are newer antiplatelet drugs which, like clopidogrel, block the P2Y12 platelet receptor to inhibit platelet aggregation. Compared with clopidogrel, both ticagrelor and prasugrel have greater clinical efficacy but also have a higher risk of bleeding and are much more costly. Therefore, some institutions and providers switch patients from ticagrelor or prasugrel to clopidogrel in an effort to lower bleeding risk, stem costs, or otherwise ensure that patients can safely adhere to long-term P2Y12 inhibitor therapy. From a pharmacodynamic perspective, switching patients from ticagrelor or prasugrel to clopidogrel comes at a cost of less antiplatelet efficacy. However, it is unclear if antiplatelet efficacy is diminished enough to affect clinical outcomes. This is because clinical trial data investigating such a switch is scant, leaving the clinician unsure as to the acceptability of this practice. Current clinical trial data have thus far not shown any clinical detriment from switching from ticagrelor or prasugrel to clopidogrel, but there are many limitations to these investigations. So although a large-scale switch of patients from ticagrelor or prasugrel to clopidogrel is not recommended, if the patient is unable to adhere to long-term ticagrelor or prasugrel therapy, switching him/her to clopidogrel seems to be a reasonable practice to maintain chronic suppression of platelet aggregation and minimize the risk of ischemic events.
Achieving High Reliability with People, Processes, and Technology
Authors: Saunders Candice L. , Brennan John A.
Published: December 2017

High reliability as a corporate value in healthcare can be achieved by meeting the “Quadruple Aim” of improving population health, reducing per capita costs, enhancing the patient experience, and improving provider wellness. This drive starts with the board of trustees, CEO, and other senior leaders who ingrain high reliability throughout the organization. At WellStar Health System, the board developed an ambitious goal to become a top-decile health system in safety and quality metrics. To achieve this goal, WellStar has embarked on a journey toward high reliability and has committed to Lean management practices consistent with the Institute for Healthcare Improvement’s definition of a high-reliability organization (HRO): one that is committed to the prevention of failure, early identification and mitigation of failure, and redesign of processes based on identifiable failures. In the end, a successful HRO can provide safe, effective, patient- and family-centered, timely, efficient, and equitable care through a convergence of people, processes, and technology.
Engaging All Employees in Efforts to Achieve High Reliability
Authors: Benedicto Anne Marie
Published: December 2017

Dramatic and numerous advances in science, technology, and medicine provide new opportunities to keep people healthy as well as to diagnose, treat, and cure disease. Unfortunately, increasing complexity increases opportunities for mistakes and errors, particularly in healthcare organizations as they struggle to prevent patient harm (Chassin and Loeb 2011). Safety problems persist and harm to patients continues despite widespread attention to the need for improvement (Stelfox et al. 2006).

An engaged and empowered workforce is critical to improving the patient experience, improving health outcomes, and correcting unsafe conditions (Rathert and May 2007). However, all healthcare workers—nurses, physicians, security guards, chaplains, and so many others—are subject to the same stressors and system failures that lead to patient harm. This situation compromises the workforce’s ability to ensure care that is consistently excellent and safe. Patient harm events are further exacerbated by employee fatigue, disengagement, burnout, intimidation, bullying, and violence in the work place.
The Strategic Value of Affiliation Partnerships in Securing Future Relevance
Authors: Saunders Ninfa M.
Published: December 2017

Finding the best route to navigate the changing landscape of healthcare has become an obsession for many organizations. Their quest to stay competitive, significant, and ultimately relevant is a continuous discovery process. Many hospitals and health systems have considered affiliations and partnerships as important tactical options. Partnerships can range from loose arrangements, such as nonequity collaborations and management agreements, to total affiliation, as in a merger and acquisition. Whichever option an organization decides to pursue, a comprehensive assessment is necessary to find the best partner—the right fit. Addressing the “why,” “when,” “how,” and “with whom” questions is fundamental. Having the depth and breadth of resources to manage the discovery process is equally important.

Learning from others who have experienced this journey is helpful, as is the support of industry experts. However, one task that cannot be delegated is discerning whether affiliation is right for an organization. That is the responsibility of an organization’s leadership team, which must consider the dynamic forces in play when evaluating an affiliation partnership. Many of the suggested modalities revolve around how the affiliation partnership can provide a value proposition for the entities involved. Furthermore, inevitable challenges emerge when fiercely independent and successful organizations come together at different levels of need and readiness. Anticipating and providing for the potential exit of any member are matters that the partnership must accept and prepare for, and the ability to execute can make or break the trajectory toward a value proposition. A strong resolve to monitor, measure, calibrate, and recalibrate can give a partnership the agility to pivot toward relevance and sustainability.

Stratus Healthcare applied principles of alignment and affiliation in creating the largest collaborative partnership of hospitals in the southeastern United States. Drawing from its affiliation partnership experience with Navicent Health and other member organizations, it has many lessons to share.
Fat Distribution in Schizophrenia Patients
Authors: Sapra Mamta , Lawson Donna , Iranmanesh Ali
Published: December 2017

Background

Introduction of second-generation antipsychotics (SGAs) has reduced neurologic toxicity but are associated with increased weight gain and obesity. The objective of this pilot study is to compare the effects of first-generation antipsychotics (FGAs) and SGAs in patients with schizophrenia on body fat and presumed concomitant metabolic parameters.

Methods

Study compared schizophrenia nondiabetic men treated with FGAs (group 1, n = 5) and men treated with SGAs (group 2, n = 9). Each subject completed psychiatric and endocrine evaluation including severity of psychiatric symptoms, adverse effects, body weight, body composition, and measurements of glucose, insulin, adipokines, and inflammatory markers. Student t test was used for statistical analysis.

Results

Men treated with FGAs had a lower mean body mass index with a trend toward statistical significance (25.3 ± 1.4 vs 29.3 ± 1.7, P = 0.06). Treatment with FGAs was associated with lower waist/height ratio (0.55 ± 0.02 vs 0.62 ± 0.02, P = 0.036) and android fat mass index (0.62 ± 0.01 vs 0.96 ± 0.1, P = 0.03). Homeostasis Model Assessment for insulin resistance values were suggestive of significantly lower peripheral insulin resistance in men treated with FGAs (0.92 ± 0.15 vs 2.3 ± 0.34, P = 0.014).

Conclusions

The results of this study are significant for decreased peripheral insulin resistance in men treated with SGAs in a setting of no significant age difference and only a trend toward higher body mass index, but consistent documentation of increased abdominal fat by 3 different methodologies. Future studies involving larger number of subjects are warranted to verify the present findings.
End-of-Life Care Discussion for Residents With Dementia in Long-Term Care Facilities
Authors: HUANG Hsiu-Li , WENG Li-Chueh , HU Wen-Yu , SHYU Yea-Ing Lotus , YU Wen-Pin , CHEN Kang-Hua
Published: December 2017

Background:

Healthcare professionals play an important role in end-of-life care decisions. Although the factors affecting end-of-life care in long-term care facilities have been well studied in Western contexts, few studies have examined factors affecting end-of-life care discussions for residents with dementia among multidisciplinary professionals in Asian or Taiwanese contexts.

Purpose:

The aim of this study was to explore the factors related to the end-of-life care discussions of registered nurses, social workers, and physicians with residents with dementia and their families.

Methods:

This is a cross-sectional and correlational study. A stratified random sampling was conducted, and self-administered questionnaires were mailed to physicians, registered nurses, and social workers who work in long-term care facilities with accreditation ranks ≥ Grade A in Taiwan.

Results:

Questionnaires were returned by 478 participants (response rate = 94.1%). Fewer than 10% of the participants reported often discussing end-of-life care with residents with dementia and their families. Physicians were significantly more likely to discuss life-sustaining treatment than nurses and social workers. The frequency of professionals discussing advance directives and life-sustaining treatment for residents with dementia was predicted by higher confidence in end-of-life care skills and greater perceived facility support.

Conclusions/Implications for Practice:

Most professionals did not frequently discuss end-of-life care with residents with dementia and their caregivers. Discussions of end-of-life care in long-term care facilities should be promoted by enhancing the confidence of these professionals in providing end-of-life care and creating a supportive environment for end-of-life discussions and care.
Institution of Just Culture Physician Peer Review in an Academic Medical Center
Authors: Volkar Judith K. , Phrampus Paul , English Dennis , Johnson Ronald , Medeiros Ashley , Zacharia Mark , Beigi Richard
Published: December 2017

Objectives

For academic medical centers to improve quality outcomes, identification and optimization of opportunities for improvement are necessary. Effective clinical peer review frequently has limitations on timeliness, transparency, and consideration of system processes related to untoward clinical outcomes. We developed a process to overcome these barriers and capture opportunities for process improvement identified within the clinical peer review system.

Methods

A multidisciplinary committee was formed to evaluate the current process of physician peer review at Magee Womens Hospital of the University of Pittsburgh Medical Center. Evaluation of current peer review triggers, processes, communication, transparency, and actionable outcomes was performed. A new approach was established that incorporated a protected electronic portal to improve communication and provider engagement, as well as initiation of a Just Culture peer review algorithm to realize opportunities for system improvements.

Results

The new process has been operative for 2 years. After initiation, the average time necessary for full case review decreased by 66% (6–2 months). Provider engagement and input have increased to 71%, from less than 10% before implementation. Most cases (51%) were identified as having more than one causative factor, with systems issues being the most frequent contributor to untoward outcomes.

Conclusions

Given the recognized benefits, this approach is being considered for implementation on a broader scale within service-line quality initiatives across the University of Pittsburgh Medical Center health system. Although first implemented among faculty, consideration of incorporation into graduate medical education programs is ongoing.
Robotic Gastrotomy With Intracorporeal Suture for Patients With Gastric Gastrointestinal Stromal Tumors Located at Cardia and Subcardiac Region
Authors: Zhao Jian , Wang Gang , Jiang Zhiwei , Jiang Chuanwei , Liu Jiang , Zhou Jiahui , Li Jieshou
Published: December 2017

Purpose:

Few studies of robotic gastric gastrointestinal stromal tumors (GISTs) resection have been conducted. This study was aimed to evaluate the robotic gastrotomy with intracorporeal suture for patients with GISTs located at cardia and subcardiac region.

Materials and Methods:

From January 2014 to August 2016, 11 patients with GISTs located at cardia and subcardiac region underwent robotic gastrotomy with intracorporeal suture. Data of these patients were collected.

Results:

The mean operative time was 82.7 minutes and the mean blood loss was 30.0 mL. No complication was reported. The postoperative length of stay was 3.3 days. On postoperative day 14, inflammation recovered to preoperative level. On postoperative month 6, the nutritional status was similar to that before the surgery. After 25.5 months follow-up, all patients survived with no recurrence or metastasis.

Conclusions:

Robotic gastrotomy with intracorporeal suture for patients with GISTs located at cardia and subcardiac region is safe and feasible.
Historical Trends in the Diagnosis of Peduncular Hallucinosis
Authors: Galetta Kristin M. , Prasad Sashank
Published: December 2017

Background:

Peduncular hallucinosis (PH) describes the clinical syndrome of vivid, dream-like visual hallucinations that intrude on normal wakefulness. Additional clinical deficits, especially ophthalmoparesis, have historically been an important part of the diagnosis and localization of this syndrome. We examined how modern neuroimaging has impacted the diagnosis of PH.

Methods:

We reviewed all available cases of PH, including 3 of ours and all previously reported in the literature. We determined whether other eye movement abnormalities were part of the clinical presentation and whether a neuroimaging study was performed to make the diagnosis.

Results:

A total of 85 cases were identified and evaluated. Eye movement abnormalities were present in 12/15 (80%) without a neuroimaging study but in only 24/70 (34%) of cases in which a neuroimaging study was performed (P = 0.001).

Conclusions:

Although eye movement abnormalities historically have been considered a key localizing clinical feature supporting the diagnosis of PH, we found that in the era of modern neuroimaging, co-occurring eye movement abnormalities are far less frequent and are not a requisite feature of the diagnosis.
Generalized Periodic Discharges With and Without Triphasic Morphology
Authors: Alkhachroum Ayham M. , Al-Abri Haifa , Sachdeva Alok , Maturu Sarita , Waldron Jennifer , Wang Han , Rizvi Macym , Fernandez-Baca Vaca Guadalupe , Lüders Hans O.
Published: December 2017

Purpose:

Generalized periodic discharges (GPDs) with a triphasic morphology have been associated with nonepileptic encephalopathies. We conducted the study to assess the reliability in which electroencephalographers can differentiate triphasic from nontriphasic periodic discharges and to evaluate for the presence of electroencephalogram and clinical characteristics that are associated with a higher risk of seizures.

Methods:

We studied prospectively 92 patients between May 2016 and February 2017. Each pattern was analyzed by two readers, who were blinded to clinical data.

Results:

The interrater agreement was “substantial” (Kappa 0.67). The following features significantly increased the risk of developing seizures: the absence of triphasic morphology, focality on electroencephalogram, interburst suppression, a history of epilepsy, and an abnormal scan. The “GPD score” includes a history of epilepsy, focality on electroencephalogram, and the absence of triphasic morphology. A GPD score of 0 has 13% risk of seizures, whereas a score of 5 to 6 has a 94% risk.

Conclusions:

Triphasic morphology GPDs confer less risk of seizures when compared with patients with GPDs without triphasic morphology. Features with a higher risk of seizures include focality on electroencephalogram, interburst suppression, a history of epilepsy, and an abnormal scan. The GPD score can be used to assess the risk of developing seizures in patients with GPDs.
Model-based image analysis of a tethered Brownian fibre for shear stress sensing
Authors: Gallagher M. T. , Neal C. V. , Arkill K. P. , Smith D. J.
Published: December 2017

The measurement of fluid dynamic shear stress acting on a biologically relevant surface is a challenging problem, particularly in the complex environment of, for example, the vasculature. While an experimental method for the direct detection of wall shear stress via the imaging of a synthetic biology nanorod has recently been developed, the data interpretation so far has been limited to phenomenological random walk modelling, small-angle approximation, and image analysis techniques which do not take into account the production of an image from a three-dimensional subject. In this report, we develop a mathematical and statistical framework to estimate shear stress from rapid imaging sequences based firstly on stochastic modelling of the dynamics of a tethered Brownian fibre in shear flow, and secondly on a novel model-based image analysis, which reconstructs fibre positions by solving the inverse problem of image formation. This framework is tested on experimental data, providing the first mechanistically rational analysis of the novel assay. What follows further develops the established theory for an untethered particle in a semi-dilute suspension, which is of relevance to, for example, the study of Brownian nanowires without flow, and presents new ideas in the field of multi-disciplinary image analysis.