bluuebunny/crossref_metadata_2025 huggingface dataset:
The Impact of Pazopanib on the Cardiovascular System
Authors: Justice Cody N. , Derbala Mohamed H. , Baich Tesla M. , Kempton Amber N. , Guo Aaron S. , Ho Thai H. , Smith Sakima A.
Published: April 2018

Pazopanib is an approved treatment for renal cell carcinoma and a second-line treatment for nonadipocytic soft-tissue sarcoma. However, its clinical efficacy is limited by its cardiovascular side effects. Pazopanib and other vascular endothelial growth factor receptor tyrosine kinase inhibitors have been associated with the development of hypertension, QT interval prolongation, and other cardiovascular events; however, these mechanisms are largely unknown. Gaining a deeper understanding of these mechanisms is essential for the development of appropriate surveillance strategies and possible diagnostic biomarkers to allow us to monitor patients and modulate therapy prior to significant cardiac insult. This approach will be vital in keeping patients on these life-saving therapies and may be applicable to other tyrosine kinase inhibitors as well. In this review, we provide a comprehensive overview of the preclinical and clinical side effects of pazopanib with a focus on the mechanisms responsible for its toxicity to the cardiovascular system.
Racial and Ethnic Differences in Medicaid Acceptance by Primary Care Physicians: A Geospatial Analysis
Authors: Daly Michael R. , Mellor Jennifer M.
Published: April 2018

Physician acceptance is an important dimension of access to care, especially for Medicaid patients. We constructed two new measures to quantify primary care physician (PCP) acceptance of Medicaid patients using geocoded Virginia physician addresses and population data and geospatial methods. For each Census block group, we measured the shares of “accessible PCPs” accepting any Medicaid patients or new Medicaid patients. Accessible PCPs were defined as those located within 30-minute travel from patient locations and patient locations were proxied by Census block group geographic centroids. We found that the shares of accessible PCPs accepting Medicaid varied within Virginia, and were significantly lower in urban communities where larger fractions of the population were Hispanic, even controlling for unobserved market-level traits associated with Medicaid acceptance. Policy makers and Medicaid program officials should continue to improve nonfinancial access to primary care, especially by addressing access barriers in communities with high shares of minority residents.
Readings That Rock Our Worlds
Authors: Bridges-Rhoads Sarah , Hughes Hilary E. , Van Cleave Jessica
Published: April 2018

During doctoral programs, many scholars have experiences with texts that disrupt, that interrupt, that somehow open up unforeseen ways of being, thinking, feeling, and knowing. In this article, we provide short contributions from a wide swath of scholars who explore the many ways reading can change everything, electrifying us with possibilities of what might be thinkable now, and terrifying us because ideas and knowledge that we’d held dear all of a sudden feel tenuous and fragile. In short, reading rocks our worlds and, as a result, shapes the kind of inquiry we do.
Working Memory and Intraindividual Variability in Response Time Mediate Fluid Intelligence Deficits Associated With ADHD Symptomology
Authors: Brydges Christopher R. , Ozolnieks Krista L. , Roberts Gareth
Published: April 2018

Objective: To determine if decreased fluid intelligence was associated with ADHD, and was mediated by deficits in working memory and intraindividual variability in motor responding. Method: The present study tested 142 young adults from the general population on a range of working memory, response time, and fluid intelligence tasks, and an ADHD self-report symptoms questionnaire. Results: Total and hyperactive ADHD symptoms correlated significantly and negatively with fluid intelligence, but this association was fully mediated by both working memory and intraindividual variability in response time. However, inattentive symptoms were not associated with fluid intelligence. Conclusion: These results have important implications for clinicians using speeded psychometric tests as part of their assessment battery, working memory interventions for ADHD patients that focus on performance improvement without controlling for response consistency, and also demonstrate potential differences in the neuropsychological profiles of ADHD subtypes.
Evaluating Social Innovations
Authors: Svensson Kate , Szijarto Barbara , Milley Peter , Cousins J. Bradley
Published: April 2018

Social innovations (SIs) frequently bring previously unrelated actors, ideas, and practices together in new configurations with the goal of addressing social needs. However, the dizzying variety of definitions of SI and their dynamic, exploratory character raise dilemmas for evaluators tasked with their evaluations. This article is based on a systematic review of research on evaluation, specifically an analysis of 28 published peer-reviewed empirical studies, within SI contexts. Given that design considerations are becoming increasingly important to evaluators as the complexity of social interventions grows, our objectives were to identify influences on design of evaluations of SI and clarify, which SI features should be taken into account when designing evaluations. We ultimately developed a conceptual framework to aid evaluators in recognizing some differences between SI and conventional social interventions, and correspondingly, implications for evaluation design. This framework is discussed in terms of its implications for ongoing research and practice.
Recognising and assessing feline emotions during the consultation: History, body language and behaviour
Authors: Ellis Sarah LH
Published: April 2018

Practical relevance:

Crucial to successful treatment of problem behaviour and optimising the welfare of the individual cat is determining which underpinning emotion(s) are involved in the presentation of the behaviour. Feline emotions are not feelings per se, but motivational-emotional systems that are responsible for instinctual emotional arousal. Often different interventions are required to alleviate different negative emotional motivations.

Clinical challenges:

Identifying different emotional motivations and the arousal level associated with them solely from observations of behaviour and body language is a difficult task because, as with any species, the behavioural repertoire of the domestic cat is finite and the same behaviour may occur with the activation of different emotional systems. In addition, cats, like people, may experience more than one emotion at the same time or switch quickly between emotional motivations, and this further complicates identification. The behavioural assessment of pain is also notoriously difficult in cats.

Evidence base:

This review draws on the published literature where available and, where there is a paucity of research, on hypotheses derived from observations of professionals in the field.

Global importance:

Being able to recognise and assess feline emotional motivations in order to address problem behaviours and improve welfare is important for all veterinarians who see cats.
Mechanisms and Measurement of Changes in Gene Expression
Authors: Singh Komal P. , Miaskowski Christine , Dhruva Anand A. , Flowers Elena , Kober Kord M.
Published: April 2018

Research on gene expression (GE) provides insights into the physiology of a cell or group of cells at a given point in time. Studies of changes in GE can be used to identify patients at higher risk for various medical conditions, a higher symptom burden, and/or the adverse consequences associated with various treatments. The aims of this article are as follows: (1) to describe the different types of RNA transcripts, (2) to describe the processes involved in GE (i.e., RNA transcription, epigenetics, and posttranscriptional modifications), (3) to describe common sources of variation in GE, (4) to describe the most common methods used to measure GE, and (5) to discuss factors to consider when choosing tissue for a GE study. This article begins with an overview of the mechanisms involved in GE. Then, the factors that can influence the findings from GE experiments (e.g., tissue specificity, host age, host gender, and time of sample collection) are described and potential solutions are presented. This article concludes with a discussion of how the types of tissue used in GE studies can affect study findings. Given that the costs associated with the measurement of changes in GE are decreasing and the methods to analyze GE data are becoming easier to use, nurse scientists need to understand the basic principles that underlie any GE study.
Myrna’s Children’s Village: Reflections on a dynamic early childhood laboratory school community in southern New Mexico
Authors: Pérez Michelle Salazar , Kim Koeun , Cahill Betsy
Published: April 2018

In this article, the authors reflect on Myrna’s Children’s Village, their university laboratory school located in southern New Mexico in the USA. The Village serves children from the age of six weeks to five years through an array of early childhood programs. This diversity provides a unique context, while also posing issues and concerns, such as lack of collaboration across programs, and also how the authors’ critically framed teacher education program is in many ways disconnected from the developmental philosophies that guide most of the Village’s programs. Based on their discussions as faculty of early childhood who work with the Children’s Village, the authors offer their thoughts and insights about how the Village came to be, its purposes, and who they are as faculty in relation to the Village. The authors then offer possible new directions for the Children’s Village in which greater collaboration across programs is fostered along with stronger faculty engagement. The purpose of sharing these reflections is to encourage a shift in how, as a field, university laboratory schools are conceptualized and how collaboration might be enhanced within dynamic early childhood contexts.
All forest, no trees? Data journalism and the construction of abstract categories
Authors: Lowrey Wilson , Hou Jue
Published: April 2018

This study takes a sociology of quantification approach in exploring the impact of ‘commensurative’ processes in data journalism, in which distinct incidents and entities are rendered similar, aggregated, and shaped into elaborate abstract constructs. This literature emphasizes the political-economic contexts of data production and predicts a heavy reliance on government data, use of national over local data, and a tendency to take data categories for granted, with inconsistent scrutiny. A content analysis of data journalism projects at legacy and non-legacy outlets reveals some support for the expectations from this literature. Findings show an increasing tendency to portray events as abstract metrics and decreasing attention to personal, lived anecdotes. Findings also show a growing tendency to provide indeterminate data sources and limited overt and accessible evidence of data scrutiny. We also see a higher percentage of national-level sourcing than local sourcing across all years, and a decline in government sourcing coupled with a rise in self-gathered, crowdsourced data online. Legacy outlets were more likely than non-legacy outlets to use local data sources, to provide anecdotal reporting in connection with the data presentation, and to use government data sources. Non-legacy outlets were more likely to produce complex abstract metrics.
Investigating tourists’ and local residents’ perceptions of a Chinese film site
Authors: Zhang Xiaoyu , Ryan Chris
Published: April 2018

Film tourism is a growing phenomenon worldwide. The shooting of popular films and TV series at a destination can be seen as a very efficient driver for attracting tourists. This study focuses on a Chinese film site, Grand View Garden, located in Beijing. As the existing studies focus mainly on Western film sites, this study fills the gap with respect to the lack of research in the literature focusing on Chinese film tourism. This article examines both tourists’ and local residents’ motives for using such attractions, as well as the attitudes residents have toward tourists, and suggests that residents play a role in the creation of a sense of place that is valued by tourists. By using qualitative methods, this article provides a comparative view between tourists’ and local residents’ perceptions. Tourists thought the Garden’s interpretation services were poor and questioned the authenticity of the site, while local residents were concerned more about the Garden’s basic services and facilities. However, both classes of visitor attached importance to the retention of the heritage and culture of the Garden.
Public perspectives toward long-term care staff's interventions in the sexual relationships of residents with dementia
Authors: Yelland Erin , Stanfield M. Hunter
Published: April 2018

Background and objectives

Sexual expression is an essential component of older adults’ quality of life, including those with lower cognitive functioning. Issues have been raised with long-term care facility policies related to aspects of staff intervention, permissibility of degree of intimacy, and how involved partners of residents with cognitive decline may be in decision-making processes. Research design and methods: This study used a multiple segment factorial vignette to explore the attitudes of the public toward a dementia-caused non-spousal sexual relationship in a long-term care facility. Specific elements examined included the degree of intimacy, obligation of long-term care staff to intervene in the relationship, and the healthy spouse’s disposition. Respondents ( N = 318) were contacted using a list-assisted random-digit dialing method and read a version of the vignette with the independent variables randomly generated. Two logistic regression models and one ordinal regression model were used to analyze the main effects of the independent design variables and respondent characteristics.

Results

The majority of respondents report the need for long-term care staff to intervene in sexual relationships and an obligation to inform the healthy spouse of a resident’s sexual relationship. Results suggest differences of opinion exist based on respondent characteristics of education and religiosity. Discussion and implications: Public opinion is in favor of long-term care facilities incorporating spousal involvement into decisions regarding a cognitively impaired resident’s ability to engage in an intimate relationship. Implications for long-term care policy focusing on staff training about sexual expression and intervention in addition to incorporating the spouse into decision-making processes are discussed.
Evolution of the Proximal Sealing Rings of the Anaconda Stent-Graft After Endovascular Aneurysm Repair
Authors: Koenrades Maaike A. , Klein Almar , Leferink Anne M. , Slump Cornelis H. , Geelkerken Robert H.
Published: April 2018

Purpose: To provide insight into the evolution of the saddle-shaped proximal sealing rings of the Anaconda stent-graft after endovascular aneurysm repair (EVAR). Methods: Eighteen abdominal aortic aneurysm patients were consecutively enrolled in a single-center, prospective, observational cohort study (LSPEAS; Trialregister.nl identifier NTR4276). The patients were treated electively using an Anaconda stent-graft with a mean 31% oversizing (range 17–47). According to protocol, participants were to be followed for 2 years, during which 5 noncontrast electrocardiogram-gated computed tomography scans would be conducted. Three patients were eliminated within 30 days (1 withdrew, 1 died, and a third was converted before stent-graft deployment), leaving 15 patients (mean age 72.8±3.7 years; 14 men) for this analysis. Evolution in size and shape (symmetry) of both proximal infrarenal sealing rings were assessed from discharge to 24 months using dedicated postprocessing algorithms. Results: At 24 months, the mean diameters of the first and second ring stents had increased significantly (first ring: 2.2±1.0 mm, p<0.001; second ring: 2.7±1.1 mm, p<0.001). At 6 months, the first and second rings had expanded to a mean 96.6%±2.1% and 94.8%±2.7%, respectively, of their nominal diameter, after which the rings expanded slowly; ring diameters stabilized to near nominal size (first ring, 98.3%±1.1%; second ring, 97.2%±1.4%) at 24 months irrespective of initial oversizing. No type I or III endoleaks or aneurysm-, device-, or procedure-related adverse events were noted in follow-up. The difference in the diametric distances between the peaks and valleys of the saddle-shaped rings was marked at discharge but became smaller after 24 months for both rings (first ring: median 2.0 vs 1.2 mm, p=0.191; second ring: median 2.8 vs 0.8 mm; p=0.013). Conclusion: Irrespective of initial oversizing, the Anaconda proximal sealing rings radially expanded to near nominal size within 6 months after EVAR. Initial oval-shaped rings conformed symmetrically and became nearly circular through 24 months. These findings should be taken into account in planning and follow-up.
Considerations and examples of a modular open systems approach in defense systems
Authors: Zimmerman Philomena , Ofori Monique , Barrett Donald , Soler Joseph , Harriman Anthony
Published: April 2018

This paper provides an overview of modular open systems approach (MOSA) design principles and open business practices in Department of Defense (DoD) programs, as well as selected examples of MOSA implementations by the Military Departments. The National Defense Authorization Act (NDAA) for Fiscal Year (FY) 2017 (Public Law 114-328) Section 805(a) requires DoD to implement MOSA, and an increasing body of evidence indicates MOSA can enable outcomes that merit consideration and advancement. Most DoD programs had already incorporated MOSA to some extent before the NDAA required it, but the formal acknowledgment in law further emphasizes the currency of the approach.

MOSA has multiple, similar definitions. For the purposes of this paper, MOSA is defined as a method to design systems with highly cohesive, loosely coupled, and severable modules that DoD can compete separately and acquire from independent vendors. MOSA is an approach rather than a technical or warfighting requirement. The approach allows the Department to flexibly acquire full capabilities and individual components – including systems, subsystems, and software – and create end item systems and services that can respond to changing threats and missions, allow for technology advances, upgrade and sustain when necessary, and maintain appropriate security assurances.

Through this paper, the Office of the Deputy Assistant Secretary of Defense for Systems Engineering (ODASD(SE)) discusses considerations for implementing MOSA, provides three examples of specific implementations by the Air Force, Army, and Navy, and discusses the vision for the future of MOSA application in DoD. The information is based on a literature review of published DoD reports and public documents, interviews with DoD Services discussing lessons, the Services’ written responses to the authors’ requests of exemplars, and review and comments from stakeholders across DoD. The authors concluded that the DoD Services and Agencies’ initiatives contribute to the MOSA body of knowledge and practice.
“The Worst Thing Was…”: Prostate Cancer Patients’ Evaluations of Their Diagnosis and Treatment Experiences
Authors: Sharpley Christopher F , Bitsika Vicki , Christie David R. H.
Published: April 2018

The objective of the current study was to identify the patient-perceived “worst aspects” of their diagnostic and treatment processes for prostate cancer (PCa) so as to inform targeted interventions aimed at reducing patient anxiety and depression. Two hundred and fifty-two patients who had received their diagnoses less than 8 years ago answered a postal survey about (a) background information, (b) their own descriptions of the worst aspects of their diagnosis and treatment, and (c) their ratings of 13 aspects of that process for (i) how these aspects made them feel stressed, anxious, and depressed and (ii) how they affected their relationships with significant others. They also answered standardized scales of anxiety and depression. The worst aspects reported by patients were receiving the initial diagnosis of PCa, plus the unknown outcome of that diagnosis, because of the possibility of death, loss of quality of life and/or partner, and the shock of the diagnosis. The most common coping strategy was to “just deal with it,” but participants also thought that more information would help. Principal contributors to feeling stressed, anxious, and depressed were also the diagnosis itself, followed by surgery treatment effects. The aspects that most affected relationships were receiving the diagnosis and the side effects of hormone therapy. The identification of these specific worst aspects of the PCa experience provides a set of potential treatment and prevention “targets” for psychosocial care in PCa patients.
Descriptive study of differences in acute kidney injury progression patterns in General and Cardiac Intensive Care Units
Authors: Pachucki Marcin A , Ghosh Erina , Eshelman Larry , Palanisamy Krishnamoorthy , Gould Timothy , Thomas Matthew , Bourdeaux Chris P
Published: April 2018

Background

Acute kidney injury is common in critically ill patients with detrimental effects on mortality, length of stay and post-discharge outcomes. The Acute Kidney Injury Network developed guidelines based on urine output and serum creatinine to classify patients into stages of acute kidney injury.

Methods

In this analysis we utilize the Acute Kidney Injury Network guidelines to evaluate the acute kidney injury stage in patients admitted to general and cardiac intensive care units over a period of 18 months. Acute kidney injury stage was calculated in real time hourly based on the guidelines and using these temporal stage scores calculated for the population; the prevalence and progression of acute kidney injury stage was compared between the two units. We hypothesized that the prevalence and progression of acute kidney injury stage between the two units may be different.

Results

More cardiac intensive care unit patients had no acute kidney injury (stage <1) during their intensive care unit stay but more cardiac intensive care unit patients developed acute kidney injury (stage >1), compared to the General Intensive Care Unit. Both at intensive care unit admission and discharge, more General Intensive Care Unit patients had acute kidney injury; however, the number of cardiac intensive care unit patients with acute kidney injury was three times higher at discharge than admission. Acute kidney injury developed in a different pattern in the two intensive care units over five days of intensive care unit stay. In the General Intensive Care Unit, acute kidney injury was most prevalent on second day of intensive care unit stay and in cardiac intensive care unit acute kidney injury was most prevalent on the third day of intensive care unit stay. We observed the biggest increase in new acute kidney injury in the first day of General Intensive Care Unit and second day of the cardiac intensive care unit stay.

Conclusions

The study demonstrates the different trends of acute kidney injury pattern in general and cardiac intensive care unit patient populations highlighting the earlier development of acute kidney injury on General Intensive Care Unit and more prevalence of acute kidney injury on discharge from cardiac intensive care unit.
Hoarseness
Authors: Perenyei Miklos , Curran John F , Moorhouse Tobias E
Published: April 2018

Hoarse voice, or dysphonia, is a common presenting complaint in primary care and an important source of patient morbidity. The underlying pathology can vary from benign to immediately life-threatening and structured clinical assessment is essential in differentiating causes and determining management. In this article, we discuss the clinical approach, aetiology and management of the wide range of conditions that lead to dysphonia and provide guidance on referral to specialist care.
The impact of right ventricular pressure and function on survival in patients with pulmonary vein stenosis
Authors: Sykes Michelle C. , Ireland Christina , McSweeney Julia E. , Rosenholm Emily , Andren Kristofer G. , Kulik Thomas J.
Published: April 2018

Pulmonary vein stenosis (PVS) is associated with pulmonary hypertension (PH), but there is little information regarding the impact of PH on right ventricular (RV) systolic function and survival. We conducted a retrospective cohort study of our patients to explore this and other aspects of pulmonary hemodynamics with PVS. RV function was assessed using qualitative two‐dimensional echocardiography. The ratio of systolic pulmonary artery (PA) and aortic pressures (PA:Ao) at cardiac catheterization reflected pulmonary hemodynamics. Reactivity testing employed inhaled nitric oxide + 100% fiO2, or 100% fiO2 only; “reactivity” was a ≥ 20% decrease in PA:Ao.

There were 105 PVS patients, although not all had data at every time point. (1) The mean PA:Ao at first cardiac catheterization (n = 77) was 0.79 ± 0.36; at last catheterization (n = 54), PA:Ao = 0.69 ± 0.30; 90% had systolic PAP > one‐half systemic. Survival was shorter with PA:Ao > 0.5. (2) Differences in survival relative to RV dysfunction on the first echocardiogram were not significant, although they were using the last echocardiogram. (3) The magnitude of RV dysfunction was positively correlated with PA:Ao. (4) Balloon dilation of PV acutely decreased PA:Ao (–0.13 ± 0.37, P = 0.03 [n = 40 patients]). 5. Of 20 patients tested, 13 were acutely reactive to vasodilators.

PH is a major feature of PVS. Reduced RV function and PA:Ao appear to be predictors of survival. Given the importance of PH in this disease, clinical studies of PVS treatments should include measures of PAP and RV function as important variables of interest.
Thoracic endovascular aortic repair to treat uncomplicated Stanford type B aortic dissection: The surgeon’s dilemma to preventing future complications
Authors: Tozzi Piergiorgio
Published: April 2018

Uncomplicated type B aortic dissections have traditionally been managed non-operatively with aggressive blood pressure control. However, the best medical treatment is associated with a considerable risk of disease progression to complicated dissection or aneurysmal degeneration of the affected aortic segment. Thoracic endovascular aortic repair could prevent long-term complications but, because the dissected aorta is vulnerable, it is a high-risk procedure performed in asymptomatic patient. Therefore, endovascular treatment is not a solution for all patients and it should be performed only in the subgroup prone to developing progression of the disease and future complications. A number of studies have suggested several prognostic factors of early or late adverse events such as the patency of the false lumen in the follow-up, an initial aortic diameter ≥4 cm with a patent false lumen, an initial false lumen diameter ≥22 mm in the proximal descending aorta, visceral involvement and recurrent or refractory pain or hypertension. Partial false lumen thrombosis and a proximal entry tear size >10 mm have also been suggested to be associated with an increased rate of aortic growth. We need randomised trials focused on these prognostic factors to reach level 1, class A recommendation for the optimal timing of intervention. Meanwhile, we have to discuss with the patient the pro and cons of this prophylactic, low-invasive but high-risk treatment to personalise medical care and provide the optimal risk-to-benefit ratio.
Gender differences in outcomes after aortic aneurysm surgery should foster further research to improve screening and prevention programmes
Authors: Nicolini Francesco , Vezzani Antonella , Corradi Francesco , Gherli Riccardo , Benassi Filippo , Manca Tullio , Gherli Tiziano
Published: April 2018

Background

Gender-related biases in outcomes after thoracic aortic surgery are an important factor to consider in the prevention of potential complications related to aortic diseases and in the analysis of surgical results.

Methods

The aim of this study is to provide an up-to-date review of gender-related differences in the epidemiology, specific risk factors, outcome, and screening and prevention programmes in aortic aneurysms.

Results

Female patients affected by aortic disease still have worse outcomes and higher early and late mortality than men. It is difficult to plan new specific strategies to improve outcomes in women undergoing major aortic surgery, given that the true explanations for their poorer outcomes are as yet not clearly identified. Some authors recommend further investigation of hormonal or molecular explanations for the sex differences in aortic disease. Others stress the need for quality improvement projects to quantify the preoperative risk in high-risk populations using non-invasive tests such as cardiopulmonary exercise testing.

Conclusions

The treatment of patients classified as high risk could thus be optimised before surgery becomes necessary by means of numerous strategies, such as the administration of high-dose statin therapy, antiplatelet treatment, optimal control of hypertension, lifestyle improvement with smoking cessation, weight loss and careful control of diabetes. Future efforts are needed to understand better the gender differences in the diagnosis, management and outcome of aortic aneurysm disease, and for appropriate and modern management of female patients.
A New Method for Assessing Masking and Residual Inhibition of Tinnitus
Authors: Fournier Philippe , Cuvillier Anne-Flore , Gallego Stéphane , Paolino Fabien , Paolino Michel , Quemar Anne , Londero Alain , Norena Arnaud
Published: April 2018

Tinnitus masking and residual inhibition (RI) are two well-known psychoacoustic measures of tinnitus. While it has long been suggested that they may provide diagnostic and prognostic information, these measures are still rarely performed in clinics, as they are too time consuming. Given this issue, the main goal of the present study was to validate a new method for assessing these measures. An acoustic sequence made of pulsed stimuli, which included a fixed stimulus duration and interstimulus interval, was applied to 68 tinnitus patients at two testing sites. First, the minimum masking level (MML) was measured by raising the stimulus intensity until the tinnitus was unheard during the stimulus presentation. Second, the level of the stimulus was further increased until the tinnitus was suppressed during the silence interval between the acoustic pulses. This level was called the minimum residual inhibition level (MRIL). The sequential measurement of MML and MRIL from the same stimulus condition offers several advantages such as time efficiency and the ability to compare results between the MRIL and MML. Our study confirms that, from this new approach, MML and MRIL can be easily and quickly obtained from a wide variety of patients displaying either normal hearing or different hearing loss configurations. Indeed, MML was obtained in all patients except one (98.5%), and some level of MRIL was found on 59 patients (86.7%). More so, this approach allows the categorization of tinnitus patients into different subgroups based on the properties of their MRIL.
Improving Speech Recognition in Bilateral Cochlear Implant Users by Listening With the Better Ear
Authors: Kan Alan
Published: April 2018

For patients with bilateral cochlear implants (BiCIs), understanding a target talker in a noisy situation can be difficult. Current efforts for improving speech-in-noise understanding have focused on improving signal-to-noise ratio by using multiple microphones or signal processing, with only moderate improvements in speech understanding performance. However, BiCI users typically report having a better ear for listening which can lead to an asymmetry in speech unmasking performance. This work proposes a novel listening strategy for improving speech-in-noise understanding by combining (a) a priori knowledge of a better ear and having a BiCI user selectively attend to a target talker in that ear with (b) signal processing that delivers the target talker to the better ear and the noisy background to the opposite ear. This strategy is different from traditional noise reduction strategies because it maintains situational awareness (background sounds are delivered to the ear contralateral to the better ear) while improving speech understanding. Speech recognition performance was evaluated with and without the better ear strategy in a speech-in-noise listening test using a virtual auditory space created from individualized head-related transfer functions. Listeners showed an average improvement of 4.4 dB signal-to-noise ratio in their speech reception threshold when using the better ear strategy with no listener showing a decrement in performance. This implies that the strategy has the potential to boost speech-in-noise recognition in BiCI users and may be useful in other hearing assistance devices such as hearing aids.
Prophylactic Antibiotics After Stented, Distal Hypospadias Repair: Randomized Pilot Study
Authors: Canon Stephen , Marquette Mary K. , Crane Adam , Patel Ashay , Zamilpa Ismael , Bai Shasha
Published: April 2018

The usage of prophylactic oral antibiotics following distal hypospadias repair with stenting has been recently challenged. This study evaluated the incidence of symptomatic urinary tract infections (UTIs) following stented, distal hypospadias repair and the impact of prophylactic antibiotic therapy. Subjects 0 to 5 years of age with distal hypospadias were randomized to either Group 1 (antibiotics) or Group 2 (no prophylactic therapy). Urinalysis/urine culture was obtained intraoperatively with no preoperative antibiotics given. Phone interviews at 1 month and 3 months after surgery were done. Forty-eight patients were successfully randomized to either Group 1 (24) or Group 2 (24). The incidence of symptomatic UTI in this pilot study is low, and prophylactic antibiotic therapy does not appear to lower the incidence of symptomatic UTI. A larger, randomized, multicenter trial is needed to determine whether antibiotic prophylaxis reduces the risk of symptomatic UTIs following stented, distal hypospadias repair.
Geographically Localized Medicine House-Staff Teams and Patient Satisfaction
Authors: Siddiqui Zishan , Bertram Amanda , Berry Stephen , Niessen Timothy , Allen Lisa , Durkin Nowella , Feldman Leonard , Herzke Carrie , Qayyum Rehan , Pronovost Peter , Brotman Daniel J
Published: April 2018

Background:

Geographically localized care teams may demonstrate improved communication between team members and patients, potentially enhancing coordination of care. However, the impact of geographically localized team on patient experience scores is not well understood.

Objective:

To compare experience scores of patients on resident teams home clinical units with patients assigned to them off of their home units over a 10-year period.

Participants:

Patients admitted to any of the 4 chief resident staffed internal medicine inpatient service were included. Patients admitted to the house-staff teams’ home clinical unit comprised the exposure group and their patients off of their home units comprised the control patients.

Measurement:

Top-box experience scores calculated from the physician Hospital Consumer Assessment of Healthcare and Provider Systems (HCAHPS) and Press Ganey patient satisfaction surveys.

Results:

There were 3012 patients included in the study. There were no significant differences in experience scores with physician communication, nursing communication, pain, or discharge planning between the 2 groups. Patients did not report satisfaction more often with the time physicians spent with them on localized teams (48.6% vs 47.5%; P = .54) or that staff were better at working together (63.2% vs 61.3%; P = .29). This did not change during a 45-month period when the proportion of patients on home units exceeded 75% and multidisciplinary rounds were started.

Conclusion:

Patients cared for by geographically localized teams did not have better patient experience. Other factors such as physician communication skills or limited time spent in direct care may overshadow the impact of having localized teams. Further research is needed to better understand organizational, team, and individual factors impacting patient experience.
Immunosuppressive Safety Data of Cyclosporine Use in Psoriasis Patients
Authors: Behnam Shahrad M. , Fife Douglas , Behnam Shahdad E. , Koo John
Published: April 2018

Cyclosporine is an immunosuppressive agent that has been traditionally used in organ transplant patients. Although it has been used with success in psoriasis patients, its serious side effects in the transplant population have hindered many dermatologists from exploiting its therapeutic capabilities. Over the last decade, there have been many anecdotal reports and systematic studies reporting cases of lymphomas, internal malignancies, leukemia, skin cancers and serious infections in dermatology patients on cyclosporine therapy. However, none of these studies have firmly established the malignancy or infection risk of cyclosporine at dermatological dosage. The recently published 5-year cohort study is the largest and most rigorous data to date on the long-term immunosuppressive safety profile of cyclosporine. Contrary to current belief, it demonstrates no significantly increased risk of lymphomas, leukemia, other internal malignancies or melanoma. However, it does indicate a 3.3-fold increase of non-melanoma skin cancer if cumulative cyclosporine use exceeds two years. Review of literature demonstrates only two case reports of serious infections without any suggestions of opportunistic infections or tuberculosis reactivation. Although more long-term studies are still needed, these data suggest that cyclosporine is safe at dermatological dosage and dermatologists can consider using it in their patient population.
Joint Damage in Psoriatic Arthritis: Can It be Prevented and is this Important?
Authors: Mease Philip J.
Published: April 2018

Psoriatic arthritis (PsA) is a form of inflammatory arthritis which occurs in patients with psoriasis. Recent surveys of psoriasis patients in the United States and Europe suggest that PsA occurs in 11% to 30% of all patients with psoriasis.1,2 The likelihood of development of PsA may in part be due to the severity of psoriasis.1 It is possible that the disease prevalence may be underestimated if it is mistakenly classified as another, more common form of arthritis, such as osteoarthritis or rheumatoid arthritis, or if it is present but not clinically evident to the patient.3 The clinical features, pathogenesis and management of PsA have been reviewed in journals, and in Psoriasis Forum.4–10
Biologics and Lymphoma: Association or Coincidence?
Authors: Goldovsky Marina , Koo John Y. M.
Published: April 2018

Immunosuppressive agents are associated with an increase in lymphoproliferative diseases. Because biologics target the immune system, there is concern that they might predispose to the development of lymphomas even though they are substantially less immunosuppressive than medications used for organ transplantation. Various databases were searched to look for associations between biologic therapies and malignancies. While there have been reports of malignancies—and particularly lymphomas—in patients treated with biologic agents, many of the patients reported were also on other immunosuppressive therapies. Nevertheless, because of a possible association with malignancies and specifically with lymphomas, biologic agents should not be used in patients with mild disease and should be reserved for patients with moderate to severe psoriasis.
Efficacy and Safety of Adalimumab Treatment in Patients with Moderate to Severe Psoriasis: A Double-Blind, Randomized Clinical Trial
Authors: Gordon Kenneth B. , Blum Robin R. , Papp Kim A. , Matheson Robert , Bolduc Chantal , Hamilton Tiffani , Heffernan Michael , Alan Menter M. , Okun Martin M. , Zhong Jianhua , Kaul Martin , Camez Anne
Published: April 2018

Background

Tumor necrosis factor-alpha (TNF-α) is pivotal in the pathogenesis of psoriasis, an immune-mediated disease. Adalimumab is a fully human, IgG1 monoclonal antibody that inhibits TNF-α.

Objectives

The aims of this study were to assess the efficacy and safety of adalimumab therapy for patients with moderate to severe plaque psoriasis and evaluate the duration of treatment response after withdrawal from or dosage reduction of adalimumab therapy.

Methods

In this multicenter, randomized, double-blind, placebo-controlled study, patients with moderate to severe plaque psoriasis received 12-week, open-label therapy with subcutaneous adalimumab, consisting of 80 mg of adalimumab at weeks 0 and 1, followed by 40 mg weekly at weeks 2–11. At week 12, patients who had an improvement in Psoriasis Area and Severity Index (PASI) score of ≥50% were randomized to blinded therapy and received either adalimumab 40 mg every other week (eow) or placebo for an additional 12 weeks.

Results

A total of 148 patients enrolled. Clinical response was rapid, with a PASI 50 response rate of 28% at week 2 of adalimumab therapy. At week 12, 91.9% (136/148) of patients had achieved ≥50% reduction in PASI (PASI 50) vs. baseline, 76.4% (113/148) had achieved PASI 75, and 47.3% (70/148) had achieved PASI 90. Of patients who were randomized to placebo at week 12, 30.9% (21/68) experienced a relapse (<PASI 50 improvement vs. baseline) by week 24, compared with 16.2% (11/68) of patients who received adalimumab 40 mg eow. In addition, 48.5% (33/68) of patients who were randomized to placebo at week 12 were PASI 75 responded at week 24, compared with 67.6% (46/68) of patients randomized to adalimumab 40 mg eow (p=0.032). And, 27.9% (19/68) of patients who were randomized to placebo at week 12 were PASI 90 responders at week 24, compared with 47.1% (32/68) of patients randomized to adalimumab 40 mg eow (p=0.028). Adalimumab was generally well-tolerated, and the rates of adverse events were comparable between the adalimumab and placebo groups.

Conclusions

Weekly adalimumab therapy rapidly improved psoriasis during an initial 12-week period. Improvement was sustained in most, but not all patients, despite dosage reduction to every other week. No patients randomized to adalimumab withdrawal (placebo at week 12) experienced rebound, and most maintained >PASI 50 improvement, relative to baseline, during the 3 months following adalimumab discontinuation. Overall, greater efficacy rates at week 24 were observed for patients randomized to continuous adalimumab therapy than for patients who were withdrawn from therapy at week 12.
A Randomized, Double-Blind, Vehicle-Controlled, Right/Left Comparative Study of the Efficacy of Acitretin with and without the Co-Administration of 0.1% Tacrolimus Topical Ointment in the Treatment of Moderate to Severe Psoriasis
Authors: Nelson Andrew A. , Krejci-Manwaring Jennifer , Carroll Christie L. , Ann McCarty Martha , Willard Joy , Fleischer Alan B. , Feldman Steven R.
Published: April 2018

Background

Topical tacrolimus is effective as monotherapy for inverse psoriasis. Its use in combination with other systemic agents may be an effective treatment for psoriasis in less sensitive areas.

Objective

To determine if topical tacrolimus in combination with oral acitretin is more effective than oral acitretin and vehicle ointment.

Methods

All patients received oral acitretin; subjects were randomized to apply topical tacrolimus to one side of their body and vehicle to the other.

Results

Topical tacrolimus was more effective than vehicle ointment as early as week 4. There were no serious adverse events thought to be due to drug or dose changes during the study.

Limitations

Due to the short time horizon of the study, it may not be appropriate to generalize the results to longer treatment periods.

Conclusions

Topical tacrolimus is an effective psoriasis treatment and was well-tolerated when combined with systemic acitretin in the treatment of psoriasis.
Consistency of Infliximab Response across Subgroups of Patients with Psoriasis: Integrated Results from Randomized Clinical Trials
Authors: Reich Kristian , Menter Alan , Plotnick Michael , Guzzo Cynthia , Li Shu , Gottlieb Alice B.
Published: April 2018

Background

To assess the consistency of infliximab (Remicade) response among different subgroups of patients with moderate to severe psoriasis, the impact of gender, obesity, age, baseline psoriasis severity, concomitant psoriatic arthritis (PsA), or prior therapies on response to infliximab was studied in an integrated efficacy analysis.

Methods

Data from three randomized, placebo-controlled clinical trials (SPIRIT, EXPRESS and EXPRESS II) that evaluated the use of infliximab in patients with moderate to severe psoriasis were included in this integrated analysis. Patients received placebo, infliximab 3 mg/kg, or infliximab 5 mg/kg at 0, 2 and 6 wks. The common primary end point at week 10 was the proportion of patients achieving ≥75% improvement in the Psoriasis Area and Severity Index (PASI 75) from baseline. Safety data through week 16 were pooled for analysis.

Results

Of the 1,462 patients included in this analysis, 70.6% and 79.3% in the infliximab 3 and 5 mg/kg groups, respectively, achieved at least a PASI 75 response at week 10, compared with 2.7% in the placebo group (both p<0.001). The proportions of patients achieving PASI 75 at week 10 were consistent in subgroups defined by baseline demographic characteristics (gender, age, body mass index) and also defined by baseline disease characteristics (PASI severity, body surface area, presence of psoriatic arthritis). Consistent results were also observed regardless of psoriasis therapeutic history. Infliximab treatment was generally well-tolerated by the majority of study participants.

Conclusion

A consistently high level of clinical response to infliximab was demonstrated across subgroups defined by a variety of baseline demographic and disease characteristics in patients with psoriasis. Infliximab was similarly effective regardless of previous use of phototherapy or major conventional systemic therapies.
Safety and Tolerability of 60 Weeks' Extended Efalizumab Therapy in Patients with Chronic Moderate to Severe Plaque Psoriasis
Authors: Gottlieb Alice B. , Hamilton Tiffani K. , Caro Ivor , Compton Peter , Leonardi Craig L.
Published: April 2018

The chronic nature of psoriasis calls for long-term maintenance of control; thus, it is important to understand the long-term safety profile of effective therapies. We present long-term safety data for the T-cell inhibitor efalizumab in the treatment of moderate to severe psoriasis. To further assess the safety profile of efalizumab over extended therapy periods, we evaluated pooled results from 1,004 patients enrolled in two studies where patients were to be treated for 60 weeks. The most frequently observed adverse events (AEs) were acute-type AEs, predefined as headache, fever, chills, nausea, vomiting and myalgia occurring within 48 hours of efalizumab dosing. The rate of infection was comparable to rates reported in other efalizumab trials. The most common infections were colds and upper respiratory tract infections. The incidence of malignancy was <1% in any 12-week period. These studies demonstrate that the safety profile for efalizumab is maintained for up to 60 weeks.