bluuebunny/crossref_metadata_2025 huggingface dataset:
A Population Health Driver Diagram to Address Neonatal Abstinence Syndrome
Authors: Erwin Paul Campbell , Meschke Laurie L. , Ehrlich Samantha F. , Moran John W.
Published: March 2017

This article describes the process for developing a population health driver diagram to address a priority health issue in East Tennessee: neonatal abstinence syndrome (NAS). Population health driver diagrams are used in quality improvement processes for determining and aligning actions that a community can take to achieve a specified outcome. The Tennessee Department of Health contracted with the University of Tennessee's Department of Public Health to conduct a community participatory process to contribute to a statewide health improvement plan. Colleagues in local public health practice identified NAS as the leading perinatal health issue, and community engagement was achieved by involving community health councils. Qualitative and quantitative data were collected, analyzed, and provided to these councils. A region-wide stakeholders' meeting resulted in the development of a population health driver diagram to address NAS. We describe this process and provide lessons learned that can be valuable in other settings. Population health diagrams have important implications for practice because of their use as a framework for community action, especially in the context of a community health assessment.
Overdose Education and Naloxone Distribution Program Attendees: Who Attends, What Do They Know, and How Do They Feel?
Authors: Heavey Sarah Cercone , Burstein Gale , Moore Cheryll , Homish Gregory G.
Published: March 2017

Context:

The United States is in the midst of an opioid overdose epidemic. Opioids killed more than 28 000 people in 2014, more than any year on record. One approach to addressing this growing epidemic is Opioid Overdose Education and Naloxone Distribution (OEND) training. Little is known about these programs' participants and their effectiveness across different demographic groups.

Objectives:

To examine (1) whether knowledge and attitudes improved over the course of the training programs; (2) whether training outcomes differ by demographics; and (3) what overdose experiences do attendees have, and whether those experiences influence their knowledge and attitudes.

Design:

A pre- and posttest survey was used to collect data on participants' demographics, overdose experiences, and opioid overdose knowledge and attitudes.

Setting:

Surveys that took place at community-wide OEND programs were offered throughout Erie County, New York, during October and November 2015.

Participants:

Community members who elected to attend the training programs, were at least 18 years of age, spoke English, and were willing and able to participate were included in the sample (N = 198).

Intervention:

N/A.

Main Outcome Measure:

The Opioid Overdose Knowledge and Attitudes Scale.

Results:

Knowledge and attitude scores significantly improved from pre- to posttest assessments, increasing by 23.1% and 15.4%, respectively (Ps < .001). There were significant demographic differences in knowledge and attitudes at the pretest assessment, but these differences were ameliorated by the OEND program and did not persist at posttest assessment. In addition, 62.9% of participants had never experienced, witnessed, or known someone who had overdosed.

Conclusion:

Results indicate that OEND programs are effective at improving knowledge and attitudes toward opioid overdose. These results indicate that OEND programs are not reaching the highest risk individuals but are instead attracting concerned family and significant others. Future programs should focus on reaching current opioid users, overdose victims, and their families to ensure OEND programs are reaching the target audiences.
Foodborne Illness Outbreak Investigation Training Needs: A Survey Among State Public Health Staff in the Northeast and Mid-Atlantic United States
Authors: Ho Alphina , Pennell-Huth Paula , Newman Alexandra , Zansky Shelley , Wiedmann Martin
Published: March 2017

Context:

In 2011, the Food Safety and Modernization Act established Integrated Food Safety Centers of Excellence across the United States to train, educate, and enhance the skill of foodborne illness outbreak investigation teams. To target regional training efforts, the New York Integrated Food Safety Center of Excellence (NYCoE) identified training needs in food safety and foodborne illness investigations among public heath staff in 11 states and 1 large metropolitan area in the Northeast.

Objective:

To identify topics so as to develop training materials relevant to food safety and foodborne disease outbreaks in order to improve and impact foodborne outbreak investigations regionally and nationally.

Design:

Cross-sectional, paper-based survey conducted in January-February 2016.

Setting:

Eleven Northeast and Mid-Atlantic states, and 1 large metropolitan area.

Participants:

Foodborne illness outbreak investigators in the NYCoE region.

Main Outcome Measures:

Identification of training needs, as self-reported by participants, regarding general foodborne outbreak investigation needs and those specific to epidemiologists, environmental health specialists, and laboratorians. Topics included basic food safety/processing knowledge, communication and metrics, and training formats. Information regarding demographics, utility of the NYCoE, and certificate programs was also collected.

Results:

Surveys returned from 33 respondents (from 10 states and 1 metropolitan area) identified metrics (100%), increasing use of culture-independent diagnostic tests (85%), and guidance on implementation of the Council to Improve Foodborne Outbreak Response (guidelines (89%) as the top training needs. By field, epidemiologists cited training in applying whole genome sequencing (100%), environmental health specialists cited training on the National Outbreak Reporting System (67%), and laboratorians cited training on whole genome sequencing (91%) as important. Short, online, or in-person, 1- to 2-day trainings were the preferred training formats (≥91%). Respondents wanted certificate programs in food safety (73%).

Conclusion:

New diagnostic and molecular techniques are highly desirable topics for trainings, as is understanding national guidelines and outcome measures. Shorter and hands-on training formats, as well as certificate programs, are desirable. The NYCoE used the results of this survey to (i) select training topics for a Food Safety symposium conducted in July 2016 and to (ii) drive other activities.
Climate Change and Public Health Surveillance: Toward a Comprehensive Strategy
Authors: Moulton Anthony Drummond , Schramm Paul John
Published: March 2017

Context:

Climate change poses a host of serious threats to human health that robust public health surveillance systems can help address. It is unknown, however, whether existing surveillance systems in the United States have adequate capacity to serve that role, nor what actions may be needed to develop adequate capacity.

Objective:

Our goals were to review efforts to assess and strengthen the capacity of public health surveillance systems to support health-related adaptation to climate change in the United States and to determine whether additional efforts are warranted.

Methods:

Building on frameworks issued by the Intergovernmental Panel on Climate Change and the Centers for Disease Control and Prevention, we specified 4 core components of public health surveillance capacity relevant to climate change health threats. Using standard methods, we next identified and analyzed multiple assessments of the existing, relevant capacity of public health surveillance systems as well as attempts to improve that capacity. We also received information from selected national public health associations.

Findings:

Multiple federal, state, and local public health agencies, professional associations, and researchers have made valuable, initial efforts to assess and strengthen surveillance capacity. These efforts, however, have been made by entities working independently and without the benefit of a shared conceptual framework or strategy. Their principal focus has been on identifying suitable indicators and data sources largely to the exclusion of other core components of surveillance capacity.

Conclusions:

A more comprehensive and strategic approach is needed to build the public health surveillance capacity required to protect the health of Americans in a world of rapidly evolving climate change. Public health practitioners and policy makers at all levels can use the findings and issues reviewed in this article as they lead design and execution of a coordinated, multisector strategic plan to create and sustain that capacity.
Implementing a Multipartner HPV Vaccination Assessment and Feedback Intervention in an Integrated Health System
Authors: Groom Holly C. , Irving Stephanie A. , Caldwell Jessica , Larsen Rex , Beaudrault Sara , Luther Lydia M. , Naleway Allison L.
Published: March 2017

Context:

Human papillomavirus (HPV) vaccine initiation rates are persistently lower than rates for other adolescent-recommended vaccines. Assessment and feedback interventions are a recommended strategy for improving vaccination rates.

Objective:

To provide a guide for implementing a multipartner intervention to increase HPV vaccine initiation rates.

Setting:

Nine primary care facilities within the Kaiser Permanente Northwest (KPNW) health care system.

Intervention:

In 2015-2016, we implemented a system-wide assessment and feedback intervention to promote HPV vaccination. In partnership with the Centers for Disease Control and Prevention, the Oregon Immunization Program, and KPNW's leadership, we developed an education session combining information on HPV infection, parental communication strategies, and facility-specific coverage data.

Results:

Twelve months postintervention, HPV dose 1 vaccination coverage increased from 71% to 72% among females and from 65% to 68% among males.

Conclusions:

A collaborative approach was critical to engaging leadership and enlisting support from providers and to developing appropriate materials for clinical audiences. Information provided here can be used as a guide for conducting assessment and feedback interventions focused on HPV vaccination initiation.
The stoichiometric ‘signature’ ofRhodopsin-family G protein-coupled receptors
Authors: Felce James H. , Latty Sarah L. , Knox Rachel G. , Mattick Susan R. , Lui Yuan , Lee Steven F. , Klenerman David , Davis Simon J.
Published: March 2017

WhetherRhodopsin-family G protein-coupled receptors (GPCRs) form dimers is highly controversial, with much data both for and against emerging from studies of mostly individual receptors. The types of large-scale comparative studies from which a consensus could eventually emerge have not previously been attempted. Here, we sought to determine the stoichiometric “signatures” of 60 GPCRs expressed by a single human cell-line using orthogonal bioluminescence resonance energy transfer-based and single-molecule microscopy assays. We observed that a relatively small fraction ofRhodopsin-family GPCRs behaved as dimers and that these receptors otherwise appeared to be monomeric. Mapped onto the entire family the analysis predicted that fewer than 20% of the ~700Rhodopsin- family receptors form dimers. The clustered distribution ofRhodopsin-familydimers, and a striking correlation between receptor stoichiometry and GPCR family-size that we also identified, suggested that evolution has tended to favor the lineage expansion of monomers rather than dimers.

One Sentence Summary

Analysis of 71 GPCRs from a single cell reveals the strong tendency ofRhodopsin-family receptors to exist as monomers rather than form dimers.
Reconstructing a metazoan genetic pathway with transcriptome-wide epistasis measurements
Authors: Angeles-Albores David , Robinson Carmie Puckett , Williams Brian A. , Wold Barbara J. , Sternberg Paul W.
Published: March 2017

RNA-seq is commonly used to identify genetic modules that respond to perturbations. In single cells, transcriptomes have been used as phenotypes, but this concept has not been applied to whole-organism RNA-seq. Linear models can quantify expression effects of individual mutants and identify epistatic effects in double mutants. To make interpretation of these high-dimensional measurements intuitive, we developed a single coefficient to quantify transcriptome-wide epistasis that accurately reflects the underlying interactions. To demonstrate our approach, we sequenced four single and two double mutants ofCaenorhabditis elegans. From these mutants, we reconstructed the known hypoxia pathway. In addition, we uncovered a class of 56 genes that have opposing changes in expression inegl-9(lf)compared tovhl-1(lf)but theegl-9(lf); vhl-1(lf)mutant has the same phenotype asegl-9(lf). This class violates the classical model of HIF-1 regulation, but can be explained by postulating a role of hydroxylated HIF-1 in transcriptional control.

Significance Statement

Transcriptome profiling is a way to quickly and quantitatively measure gene expression level. Because of their quantitative nature, there is widespread interest in using transcriptomic profiles as a phenotype for genetic analysis. However, a source of major concern is that whole-animal transcriptomic profiles mix the expression signatures of multiple cellular states, making it hard to accurately reconstruct genetic interactions. Additionally, it has been difficult to quantify epistasis, the signature of genetic interaction between two genes, in these molecular phenotypes. Here, we show that it is possible to accurately reconstruct genetic interactions between genes using whole-animal RNA sequencing, and we demonstrate a powerful new way to measure and understand epistasis arising from these measurements. This suggests that whole-organism RNA-seq can be a powerful tool with which to understand genetic interactions in entire organisms and not only in isolated cells. With the advent of genome engineering tools, generating mutants has become easier and faster for many organisms. As mutants become easier to create, phenotyping them has become a major bottleneck in understanding the biological functions of the genes in question. Our work presents a possible solution to this problem, because transcriptome profiling is fast and sensitive to genetic perturbations regardless of the context they operate in.
Developing a 670k genotyping array to tag ∼2M SNPs across 24 horse breeds
Authors: Schaefer Robert J. , Schubert Mikkel , Bailey Ernest , Bannasch Danika L. , Barrey Eric , Bar-Gal Gila Kahila , Brem Gottfried , Brooks Samantha A. , Distl Ottmar , Fries Ruedi , Finno Carrie J. , Gerber Vinzenz , Haase Bianca , Jagannathan Vidhya , Kalbfleisch Ted , Leeb Tosso , Lindgren Gabriella , Lopes Maria Susana , Mach Nuria , Machado Artur da Câmara , MacLeod James N. , McCoy Annette , Metzger Julia , Penedo Cecilia , Polani Sagi , Rieder Stefan , Tammen Imke , Tetens Jens , Thaller Georg , Verini-Supplizi Andrea , Wade Claire M. , Wallner Barbara , Orlando Ludovic , Mickelson James R. , McCue Molly E.
Published: March 2017

Background

To date, genome-scale analyses in the domestic horse have been limited by suboptimal single nucleotide polymorphism (SNP) density and uneven genomic coverage of the current SNP genotyping arrays. The recent availability of whole genome sequences has created the opportunity to develop a next generation, high-density equine SNP array.

Results

Using whole genome sequence from 153 individuals representing 24 distinct breeds collated by the equine genomics community, we cataloged over 23 millionde novodiscovered genetic variants. Leveraging genotype data from individuals with both whole genome sequence, and genotypes from lower-density, legacy SNP arrays, a subset of ∼5 million high-quality, high-density array candidate SNPs were selected based on breed representation and uniform spacing across the genome. Considering probe design recommendations from a commercial vendor (Affymetrix, now Thermo Fisher Scientific) a set of ∼2 million SNPs were selected for a next-generation high-density SNP chip (MNEc2M). Genotype data were generated using the MNEc2M array from a cohort of 332 horses from 20 breeds and a lower-density array, consisting of ∼670 thousand SNPs (MNEc670k), was designed for genotype imputation.

Conclusions

Here, we document the steps taken to design both the MNEc2M and MNEc670k arrays, report genomic and technical properties of these genotyping platforms, and demonstrate the imputation capabilities of these tools for the domestic horse.
Task-specific sensory coding strategies matched to detection and discrimination behaviors inApteronotus leptorhynchus
Authors: Allen K.M. , Marsat G.
Published: March 2017

All sensory systems must reliably translate information about the environment into a neural code, mediating perception. The most relevant aspects of stimuli may change as behavioral context changes, making efficient encoding of information more challenging. Sensory systems must balance rapid detection of a stimulus with perception of fine details that enable discrimination between similar stimuli. We show that in a species of weakly electric fish,Apteronotus leptorhynchus,two coding strategies are employed for these separate behavioral tasks. Using communication signals produced in different contexts, we demonstrate a strong correlation between neural coding strategies and behavioral performance on a discrimination task. Extracellular recordings of pyramidal cells within the electrosensory lateral line lobe of alert fish show two distinct response patterns, either burst discharges with little variation between different signals of the same category, or a graded, heterogeneous response that contains enough information to discriminate between signals with slight variations. When faced with a discrimination-based task, the behavioral performance of the fish closely matches predictions based on coding strategy. Comparisons of these results with neural and behavioral responses observed in other model systems suggest that our study highlights a general principle in the way different neural codes are utilized in the sensory system.

SIGNIFICANCE STATEMENT

Research relating the structure of stimuli to the response of sensory neurons has left us with a detailed understanding of how different neural codes can represent information. Although various aspects of neural responses have been related to perceptual abilities, general principles relating behavioral tasks to sensory coding strategies are lacking. A major distinction can be made between signals that must simply be detected versus stimuli that must also be finely discriminated and evaluated. We show that these two different perceptual tasks are systematically matched by distinct neural coding strategies and we argue that our study identifies a general principle that is observed in various sensory systems.

Conflict of interest statement

The authors declare no competing financial interests.
15-keto-prostaglandin E2activates host peroxisome proliferator-activated receptor gamma (PPAR-γ) to promoteCryptococcus neoformansgrowth during infection
Authors: Evans Robert J. , Pline Katherine , Loynes Catherine A. , Needs Sarah , Aldrovandi Maceler , Tiefenbach Jens , Bielska Ewa , Rubino Rachel E. , Nicol Christopher J. , May Robin C. , Krause Henry M. , O’Donnell Valerie B. , Renshaw Stephen A. , Johnston Simon A.
Published: March 2017

Cryptococcus neoformansis one of the leading causes of invasive fungal infection in humans worldwide.C. neoformansuses macrophages as a proliferative niche to increase infective burden and avoid immune surveillance. However, the specific mechanisms by whichC. neoformansmanipulates host immunity to promote its growth during infection remain ill-defined. Here we demonstrate that eicosanoid lipid mediators manipulated and/or produced byC. neoformansplay a key role in regulating pathogenesis.C. neoformansis known to secrete several eicosanoids that are highly similar to those found in vertebrate hosts. Using eicosanoid deficient cryptococcal mutantsΔplb1andΔlac1, we demonstrate that prostaglandin E2is required byC. neoformansfor proliferation within macrophages andin vivoduring infection. Genetic and pharmacological disruption of host PGE2synthesis is not required for promotion of cryptococcal growth by eicosanoid production. We find that PGE2must be dehydrogenated into 15-keto-PGE2to promote fungal growth, a finding that implicated the host nuclear receptor PPAR-γ.C. neoformansinfection of macrophages activates host PPAR-γand its inhibition is sufficient to abrogate the effect of 15-keto-PGE2in promoting fungal growth during infection. Thus, we describe the first mechanism of reliance on pathogen-derived eicosanoids in fungal pathogenesis and the specific role of 15-keto-PGE2and host PPAR-γin cryptococcosis.

Author Summary

Cryptococcus neoformansis an opportunistic fungal pathogen that is responsible for significant numbers of deaths in the immunocompromised population worldwide. Here we address whether eicosanoids produced byC. neoformansmanipulate host innate immune cells during infection.Cryptococcus neoformansproduces several eicosanoids that are notable for their similarity to vertebrate eicosanoids, it is therefore possible that fungal-derived eicosanoids may provoke physiological effects in the host. Using a combination ofin vitroandin vivoinfection models we identify a specific eicosanoid species - prostaglandin E2– that is required byC. neoformansfor growth during infection. We subsequently show that prostaglandin E2must be converted to 15-keto-prostaglandin E2within the host before it has these effects. Furthermore, we find that prostaglandin E2/15-keto-prostaglandin E2mediated virulence is via activation of host PPAR-γ– an intracellular eicosanoid receptor known to interact with 15-keto-PGE2.
Recently evolved human-specific methylated regions are enriched in schizophrenia signals
Authors: Banerjee Niladri , Polushina Tatiana , Bettella Francesco , Giddaluru Sudheer , Steen Vidar M. , Andreassen Ole A. , Hellard Stephanie Le
Published: March 2017

Background

One explanation for the persistence of schizophrenia despite the reduced fertility of patients is that it is a by-product of recent human evolution. This hypothesis is supported by evidence suggesting that recently-evolved genomic regions in humans are involved in the genetic risk for schizophrenia. Using summary statistics from genome-wide association studies (GWAS) of schizophrenia and 11 other phenotypes, we tested for enrichment of association with GWAS traits in regions that have undergone methylation changes in the human lineage compared to Neanderthals and Denisovans, i.e. human-specific differentially methylated regions (DMRs). We used analytical tools that evaluate polygenic enrichment of a subset of genomic variants against all variants.

Results

Schizophrenia was the only trait in which DMR SNPs showed clear enrichment of association that passed the genome-wide significance threshold. The enrichment was not observed for Neanderthal or Denisovan DMRs. The enrichment seen in human DMRs is comparable to that for genomic regions tagged by Neanderthal Selective Sweep markers, and stronger than that for Human Accelerated Regions. The enrichment survives multiple testing performed through permutation (n=10,000) and bootstrapping (n=5,000) in INRICH (p<0.01). Some enrichment of association with height was observed at the gene level.

Conclusions

Regions where DNA methylation modifications have changed during recent human evolution show enrichment of association with schizophrenia and possibly with height. Our study further supports the hypothesis that genetic variants conferring risk of schizophrenia co-occur in genomic regions that have changed as the human species evolved. Since methylation is an epigenetic mark, potentially mediated by environmental changes, our results also suggest that interaction with the environment might have contributed to that association.
Simple rules for an efficient use of Geographic Information Systems in molecular ecology
Authors: Leempoel Kevin , Duruz Solange , Rochat Estelle , Widmer Ivo , Orozco-terWengel Pablo , Joost Stéphane
Published: March 2017

Geographic Information Systems (GIS) are becoming increasingly popular in the context of molecular ecology and conservation biology thanks to their display options efficiency, flexibility and management of geodata. Indeed, spatial data for wildlife and livestock species is becoming a trend with many researchers publishing genomic data that is specifically suitable for landscape studies. GIS uniquely reveal the possibility to overlay genetic information with environmental data and, as such, allow us to locate and analyze genetic boundaries of various plant and animal species or to study gene-environment associations (GEA). This means that, using GIS, we can potentially identify the genetic bases of species adaptation to particular geographic conditions or to climate change. However, many biologists are not familiar with the use of GIS and underlying concepts and thus experience difficulties in finding relevant information and instructions on how to use them. In this paper, we illustrate the power of free and open source GIS approaches and provide essential information for their successful application in molecular ecology. First, we introduce key concepts related to GIS than are too often overlooked in the literature, for example coordinate systems, GPS accuracy and scale. We then provide an overview of the most employed open-source GIS-related software, file formats and refer to major environmental databases. We also reconsider sampling strategies as high costs of Next Generation Sequencing (NGS) data currently diminish the number of samples that can be sequenced per location. Thereafter, we detail methods of data exploration and spatial statistics suited for the analysis of large genetic datasets. Finally, we provide suggestions to properly edit maps and to make them as comprehensive as possible, either manually or trough programming languages.
Self-stigma in military personnel with alcohol dependence: comparison with a civilian sample before qualified withdrawal treatment
Authors: Wesemann Ulrich , Kahn Christian , Zimmermann Peter Lutz , Willmund Gerd Dieter , Schomerus Georg
Published: March 2017

Purpose

The purpose of this paper is to highlight the differences in self-stigma between a military and a civilian sample in order to infer military-specific aspects of the stigmatization process.

Design/methodology/approach

Before undergoing a three-week course of qualified withdrawal treatment, 55 German military personnel were examined in terms of self-stigma, abstinence self-efficacy, duration of alcohol abuse, severity of alcohol dependence, and current mental disorders. Afterwards, the participants were compared with a non-military sample of 173 subjects with alcohol dependence in a civilian psychiatric clinic that had not yet undergone qualified withdrawal treatment.

Findings

While awareness of stigmatization is significantly greater among military personnel than in the civilian comparison group (t(171)=3.83, p<0.01), there is far less agreement with such stigmatization (t(170)=−3.20, p<0.01). More severe mental disorders and low abstinence self-efficacy have a significant influence on self-esteem decrement for the entire group.

Research limitations/implications

Both samples only consisted of male participants who wanted to receive treatment.

Originality/value

Since most studies refer to civilian patients, a comparative study of the influence of stigmatization of alcohol use disorders in the armed forces is of particular interest. The study indicates that military personnel are more aware of stigmatization by colleagues and superiors than is the case among civilian patients. This could be a significant obstacle when it comes to seeking professional help. Prevention programs need to give greater priority to this subject.
Performance assessment of human resource by integration of HSE and ergonomics and EFQM management system
Authors: Sadegh Amalnick Mohsen , Zarrin Mansour
Published: March 2017

Purpose

The purpose of this paper is to present an integrated framework for performance evaluation and analysis of human resource (HR) with respect to the factors of health, safety, environment and ergonomics (HSEE) management system, and also the criteria of European federation for quality management (EFQM) as one of the well-known business excellence models.

Design/methodology/approach

In this study, an intelligent algorithm based on adaptive neuro-fuzzy inference system (ANFIS) along with fuzzy data envelopment analysis (FDEA) are developed and employed to assess the performance of the company. Furthermore, the impact of the factors on the company’s performance as well as their strengths and weaknesses are identified by conducting a sensitivity analysis on the results. Similarly, a design of experiment is performed to prioritize the factors in the order of importance.

Findings

The results show that EFQM model has a far greater impact upon the company’s performance than HSEE management system. According to the obtained results, it can be argued that integration of HSEE and EFQM leads to the performance improvement in the company.

Practical implications

In current study, the required data for executing the proposed framework are collected via valid questionnaires which are filled in by the staff of an aviation industry located in Tehran, Iran.

Originality/value

Managing HR performance results in improving usability, maintainability and reliability and finally in a significant reduction in the commercial aviation accident rate. Also, study of factors affecting HR performance authorities participate in developing systems in order to help operators better manage human error. This paper for the first time presents an intelligent framework based on ANFIS, FDEA and statistical tests for HR performance assessment and analysis with the ability of handling uncertainty and vagueness existing in real world environment.
Use of failure mode effect analysis (FMEA) to improve medication management process
Authors: Jain Khushboo
Published: March 2017

Purpose

Medication management is a complex process, at high risk of error with life threatening consequences. The focus should be on devising strategies to avoid errors and make the process self-reliable by ensuring prevention of errors and/or error detection at subsequent stages. The purpose of this paper is to use failure mode effect analysis (FMEA), a systematic proactive tool, to identify the likelihood and the causes for the process to fail at various steps and prioritise them to devise risk reduction strategies to improve patient safety.

Design/methodology/approach

The study was designed as an observational analytical study of medication management process in the inpatient area of a multi-speciality hospital in Gurgaon, Haryana, India. A team was made to study the complex process of medication management in the hospital. FMEA tool was used. Corrective actions were developed based on the prioritised failure modes which were implemented and monitored.

Findings

The percentage distribution of medication errors as per the observation made by the team was found to be maximum of transcription errors (37 per cent) followed by administration errors (29 per cent) indicating the need to identify the causes and effects of their occurrence. In all, 11 failure modes were identified out of which major five were prioritised based on the risk priority number (RPN). The process was repeated after corrective actions were taken which resulted in about 40 per cent (average) and around 60 per cent reduction in the RPN of prioritised failure modes.

Research limitations/implications

FMEA is a time consuming process and requires a multidisciplinary team which has good understanding of the process being analysed. FMEA only helps in identifying the possibilities of a process to fail, it does not eliminate them, additional efforts are required to develop action plans and implement them. Frank discussion and agreement among the team members is required not only for successfully conducing FMEA but also for implementing the corrective actions.

Practical implications

FMEA is an effective proactive risk-assessment tool and is a continuous process which can be continued in phases. The corrective actions taken resulted in reduction in RPN, subjected to further evaluation and usage by others depending on the facility type.

Originality/value

The application of the tool helped the hospital in identifying failures in medication management process, thereby prioritising and correcting them leading to improvement.
The age of Agile
Authors: Denning Stephen
Published: March 2017

Purpose

Because too many firms are stuck on the treadmill of producing quarterly returns, often to be achieved through financial engineering, a new management mindset is needed set them to exploring new opportunities through innovation.

Design/methodology/approach

A new kind of management is emerging–called the Agile model– in which firms emphasize searching out opportunities, finding solutions through rapid experimentation, and achieving agility through decisiveness.

Findings

In organizations that have implemented the Agile model Agile, the distinction between exploration and exploitation tends to blur and even dissolve. Those involved in exploitation are also continuously looking for ways to improve performance. Those involved in exploration and development are continuously seeking ways to deliver value to customers sooner

Practical implications

Agile managements are learning to shift from scalable efficiency to scalable learning, where everyone is driven by the need to learn faster and accelerate performance improvement

Originality/value

This overview of how explains how all members of a organization–from the CEO to the front-line worker–will need to be involved in the implementation of the Agile model.
Cutaneous side‐effects of biologics in immune‐mediated disorders: A histopathological perspective
Authors: Succaria Farah , Bhawan Jag
Published: March 2017

Advances in understanding molecular mechanisms and targets in immune regulation have led to the widespread use of biologic targeted therapies, and, as such, reformed the course of many disabling diseases. However, with their expanded use, various side‐effects, including cutaneous, have emerged. Many times a clear‐cut relationship exists between the drug and the clinical manifestations; however, when a biopsy is warranted, various histopathological patterns may be observed and may cause confusion to the dermatopathologist. The aim of this review is to shed light on the different histopathological patterns observed as a manifestation secondary to biologics.
Mimickers of classic acantholytic diseases
Authors: Ho Jonathan , Bhawan Jag
Published: March 2017

Acantholysis is a commonly encountered histological pattern which typically generates a differential of the pemphigus variants, Hailey–Hailey, Darier's and Grover's diseases. In addition to these diseases, the dermatologist and dermatopathologist must be aware of entities that mimic classic acantholytic dermatoses and of rare disease variants, which are characterized by acantholysis.
Non‐bullous lesions as the first manifestation of bullous pemphigoid: A retrospective analysis of 181 cases
Authors: Zhang Yu , Luo Yang , Han Yue , Tian Rong , Li Wei , Yao Xu
Published: March 2017

The aim of the present study was to explore the clinical and histopathological characteristics and treatment of patients with bullous pemphigoid (BP) that initially manifested as non‐bullous lesions and provide information for early diagnosis and improved treatment. Medical records of 491 cases of BP were collected. The clinical and histopathological characteristics, treatment and outcomes of patients who initially presented with non‐bullous lesions (prodromal BP, PBP) were analyzed and compared with those from patients who initially presented with bullous lesions (classical BP, cBP). Of the BP patients studied, 36.8% had PBP and presented with diversified initial lesions before the appearance of typical bullae, with erythema as the most frequent (31.67%), followed by concurrent erythema and papules (30.4%). The mean duration before bullae appearance was 15.91 ± 0.65 months. The degree of itch in PBP patients was higher than that in cBP patients. There was no difference in the hospital stay and time to disease control between the PBP and cBP patients. However, the mean glucocorticoid dose for control of the lesions in PBP patients was significantly higher than that in cBP patients. In addition, the PBP patients experienced side‐effects more frequently than did the cBP patients (87.85% vs 17.41%). In conclusion, intensive treatment is required for PBP patients due to delayed diagnosis and advanced development of the disease. Itching, concurrent erythema and papules occurring in the elderly may be clues for the early diagnosis of PBP.
Effect of Organizational Identity Change on Integration Approaches in Acquisitions: Role of Organizational Dominance
Authors: Wei Tian , Clegg Jeremy
Published: March 2017

The main focus of this study is the role that organizational dominance in organizational identity change plays in shaping integration approaches in acquisitions. Using four in‐depth case studies, this study categorizes the organizational identity change process into three stages: forms of resistance; conformation of new organizational identity; and integration approaches. The authors first identify two distinct roles of organizational dominance in organizational identity change after acquisition: multilevel resistance and power struggles, which are the prerequisites for developing integration approaches, according to the social identity theory. Second, they further investigate the conformation of new organizational identity with each of these two roles. They conclude that target firms completely lose their organizational identity when there is high organizational dominance after the acquisition. Conversely, target firms work with acquirers in developing integration approaches, and the power winner dominates the integration when there is low organizational dominance. Third, this study contributes to the understanding of integration approaches by connecting three specific integration approaches to the changed organizational identity. The study contributes to the literature on both organizational identity change and acquisition.
The Legally Disruptive Nature of Climate Change
Authors: Fisher Elizabeth , Scotford Eloise , Barritt Emily
Published: March 2017

Climate change gives rise to disputes and problems not easily addressed by existing legal doctrines and frameworks. This is because it is a polycentric problem; the assessment of future climate impacts must deal with uncertainty; climate change is socio‐politically controversial; and addressing climate change requires recognising a dynamic physical environment. As such, climate change can be thought of as legally disruptive in that it requires lawyers and legal scholars to reconcile the legal issues raised by climate change with existing legal orders. The legal disruption catalysed by climate change has not only led to the creation of new legal regimes but also given rise to a multitude of legal disputes that require adjudication. A study of some of these cases highlights the need for active and deliberate reflection about the nature of adjudication and the legal reasoning embedded in it when confronted by a disruptive phenomenon like climate change.
Differences between Proxy and Patient Assessments of Cancer Care Experiences and Quality Ratings
Authors: Roydhouse Jessica K. , Gutman Roee , Keating Nancy L. , Mor Vincent , Wilson Ira B.
Published: March 2017

Objective

To assess the impact of proxy survey responses on cancer care experience reports and quality ratings.

Data Sources/Study Setting

Secondary analysis of data from Cancer Care Outcomes Research and Surveillance (CanCORS). Recruitment occurred from 2003 to 2005.

Study Design

The study was a cross‐sectional observational study. The respondents were patients with incident colorectal or lung cancer or their proxies.

Data Collection/Extraction Methods

Analyses used linear regression models with an independent variable for proxy versus patient responses as well as study site and clinical covariates. The outcomes were experiences with medical care, nursing care, care coordination, and care quality rating. Multiple imputation was used for missing data.

Principal Findings

Among 6,471 respondents, 1,011 (16 percent) were proxies. The proportion of proxy respondents varied from 6 percent to 28 percent across study sites. Adjusted proxy scores were modestly higher for medical care experiences (+1.28 points [95 percent CI:+ 0.05 to +2.51]), but lower for nursing care (−2.81 [95 percent CI: −4.11 to −1.50]) and care coordination experiences (−2.98 [95 percent CI: −4.15 to −1.81]). There were no significant differences between adjusted patient and proxy ratings of quality.

Conclusions

Proxy responses have small but statistically significant differences from patient responses. However, if ratings of care are used for financial incentives, such differences could be exaggerated across practices or areas if proxy use varies.
Strata of the Political: Epigenetic and Microbial Imaginaries in Post‐Apartheid Cape Town
Authors: Pentecost Michelle , Cousins Thomas
Published: March 2017

The epigenetic and microbiomic imaginaries that animate public health discourse on perinatal nutrition and the infant gut in South Africa offer a case study through which to reconsider the ontological presuppositions of “space” that frame epigenetic biopolitics. We suggest that the mutual constitution of the relations at stake in and around questions of nutrition, mothers and infants, the gut and sanitation in Khayelitsha, can be understood through a Deleuzian geomorphological image of “strata of the political”. Strata are conjunctural entanglements that temporarily stabilise when distinctions hold briefly, and that bring into alignment particular relations and forces that distribute life and non‐life. This analytic makes visible and available to political life the spatio‐temporal, socio‐natural blurring of categories that epigenetic and microbiomic discourses could afford. Grounded ethnographic descriptions of these processes of “mattering” can challenge political epistemologies and take further critical perspectives on space to open up possibilities for a robust postgenomic politics.
Letter: CYP3A4/5 genotype status and outcome of vonoprazan‐containing Helicobacter pylori eradication therapy in Japan
Authors: Sugimoto M. , Ban H. , Hira D. , Kamiya T. , Otsuka T. , Inatomi O. , Bamba S. , Terada T. , Andoh A.
Published: March 2017

Linked Content

This article is linked to Sakurai et al and Mori and Okamoto papers. To view this article visit https://doi.org/10.1111/apt.13325.
Pro‐contractile effects of perivascular fat in health and disease
Authors: Ramirez J G , O'Malley E J , Ho W S V
Published: March 2017

Perivascular adipose tissue (PVAT) is now recognized as an active player in vascular homeostasis. The expansion of PVAT in obesity and its possible role in vascular dysfunction have attracted much interest. In terms of the regulation of vascular tone and blood pressure, PVAT has been shown to release vasoactive mediators, for instance, angiotensin peptides, reactive oxygen species, chemokines and cytokines. The secretory profile of PVAT is altered by obesity, hypertension and other cardiovascular diseases, leading to an imbalance between its pro‐contractile and anti‐contractile effects. PVAT adipocytes represent an important source of the mediators, but infiltrating immune cells may become more important under conditions of hypoxia and inflammation. This review describes recent advances in the effects of PVAT on the regulation of vascular tone, highlighting the evidence for a pro‐contractile action in health and disease. The role of the endothelium, vascular smooth muscle, immune cells and probably perivascular nerves in PVAT function is also discussed.

Linked Articles

This article is part of a themed section on Molecular Mechanisms Regulating Perivascular Adipose Tissue – Potential Pharmacological Targets? To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v174.20/issuetoc
Meat consumption and colorectal cancer risk in Japan: The Takayama study
Authors: Wada Keiko , Oba Shino , Tsuji Michiko , Tamura Takashi , Konishi Kie , Goto Yuko , Mizuta Fumi , Koda Sachi , Hori Akihiro , Tanabashi Shinobu , Matsushita Shogen , Tokimitsu Naoki , Nagata Chisato
Published: March 2017

Compared with the abundant data from Western countries, evidence regarding meat consumption and colorectal cancer is limited in the Japanese population. We evaluated colorectal cancer risk in relation to meat consumption in a population‐based prospective cohort study in Japan. Participants were 13 957 men and 16 374 women aged ≥35 years in September 1992. Meat intake, assessed with a validated food frequency questionnaire, was controlled for the total energy intake. The incidence of colorectal cancer was confirmed through regional population‐based cancer registries and histological identification from colonoscopy in two main hospitals in the study area. From September 1992 to March 2008, 429 men and 343 women developed colorectal cancer. After adjustments for multiple confounders, a significantly increased relative risk of colorectal cancer was observed in the highest versus lowest quartile of the intake of total and red meat among men; the estimated hazard ratios were 1.36 (95% CI: 1.03, 1.79) for total meat (P for trend = 0.022), and 1.44 (95% CI: 1.10, 1.89) for red meat (P for trend = 0.009). A positive association between processed meat intake and colon cancer risk was also observed in men. There was no significant association between colorectal cancer and meat consumption in women. These results suggest that the intake of red and processed meat increases the risk of colorectal or colon cancer among Japanese men. Abstaining from excessive consumption of meat might be protective against developing colorectal cancer.
Novel small molecule inhibiting CDCP1‐PKCδ pathway reduces tumor metastasis and proliferation
Authors: Nakashima Katsuhiko , Uekita Takamasa , Yano Shigenobu , Kikuchi Jun‐ichi , Nakanishi Ruri , Sakamoto Nozomi , Fukumoto Keisuke , Nomoto Akihiro , Kawamoto Keisuke , Shibahara Takashi , Yamaguchi Hideki , Sakai Ryuichi
Published: March 2017

CUB domain‐containing protein‐1 (CDCP1) is a trans‐membrane protein predominantly expressed in various cancer cells and involved in tumor progression. CDCP1 is phosphorylated at tyrosine residues in the intracellular domain by Src family kinases and recruits PKCδ to the plasma membrane through tyrosine phosphorylation‐dependent association with the C2 domain of PKCδ, which in turn induces a survival signal in an anchorage‐independent condition. In this study, we used our cell‐free screening system to identify a small compound, glycoconjugated palladium complex (Pd‐Oqn), which significantly inhibited the interaction between the C2 domain of PKCδ and phosphorylated CDCP1. Immunoprecipitation assays demonstrated that Pd‐Oqn hindered the intercellular interaction of phosphorylated CDCP1 with PKCδ and also suppressed the phosphorylation of PKCδ but not that of ERK or AKT. In addition, Pd‐Oqn inhibited the colony formation of gastric adenocarcinoma 44As3 cells in soft agar as well as their invasion. In mouse models, Pd‐Oqn markedly reduced the peritoneal dissemination of gastric adenocarcinoma cells and the tumor growth of pancreatic cancer orthotopic xenografts. These results suggest that the novel compound Pd‐Oqn reduces tumor metastasis and growth by inhibiting the association between CDCP1 and PKCδ, thus potentially representing a promising candidate among therapeutic reagents targeting protein–protein interaction.