bluuebunny/crossref_metadata_2025 huggingface dataset:
Technology, Productivity, and Costs in Healthcare
Authors: Okunade Albert A. , Osmani Ahmad Reshad
Published: May 2018

Healthcare cost encompasses expenditures on the totality of scarce resources (implicit and explicit) given up (or allocated) to produce healthcare goods (e.g., drugs and medical devices) and services (e.g., hospital care and physician office services are major components). Healthcare cost accounting components (sources and uses of funds) tend to differ but can be similar enough across most of the world countries. The healthcare cost concept usually differs for consumers, politicians and health policy decision-makers, health insurers, employers, and the government. All else given, inefficient healthcare production implies higher economic cost and lower productivity of the resources deployed in the process. Healthcare productivity varies across health systems of the world countries, the production technologies used, regulatory instruments, and institutional settings. Healthcare production often involves some specific (e.g., drugs and medical devices, information and communication technologies) or general technology for diagnosing, treating, or curing diseases in order to improve or restore human health conditions.

In the last half century, the different healthcare systems of the world countries have undergone fundamental transformations in the structural designs, institutional regulations, and socio-economic and demographic dimensions. The nations have allocated a rising share of total economic resources or incomes (i.e., Gross National Product, or GDP) to the healthcare sector and are consequently enjoying substantial increases in population health status and life expectancies. There are complex and interacting linkages among escalating healthcare costs, longer life expectancies, technological progress (or “the march of science”), and sectoral productivities in the health services sectors of the advanced economies. Healthcare policy debates often concentrate on cost-containment strategies and search for improved efficient resource allocation and equitable distribution of the sector’s outputs. Consequently, this contribution is a broad review of the body of literature on technological progress, productivity, and cost: three important dimensions of the evolving modern healthcare systems. It provides a logical integration of three strands of work linking healthcare cost to technology and research evidence on sectoral productivity measurements. Finally, some important aspects of the existing study limitations are noted to motivate new research directions for future investigations to explore in the growing health sector economies.
The Common Core Thesis in the Study of Mysticism
Authors: Hood Ralph W.
Published: May 2018

The common core thesis contends that mystical experience is an ultimate non-sensuous experience of unity of all things. It can be identified within major faith traditions, whether explicitly religious or not. Its roots are in the work of William James who explored mystical experience outside the limits imposed by what he perceived as only a provisional natural science assumption of the newly emerging discipline of empirical psychology. Following the explicit phenomenological work of Walter Stace, the phenomenology of a universal core to mystical experience has been operationalized and an explicit psychometric measure developed to allow empirical assessment of the claim to a common core to mysticism. It is the linkage of psychometric approaches to the work of James and Stace that is now known explicitly as the common core thesis. The common core thesis needs to be delineated from the perennialist thesis popularized by Aldous Huxley in which there is postulated not only a common core experience, but also values and practices claimed to be associated with this experience if not directly derived from it. Psychometric and empirical evidence for the common core thesis is substantial and continues to accumulate. The common core thesis is restricted to mystical experience and assumes that this experience seeks to express itself in various faith traditions, whether religious or not, but is not restricted to or defined adequately by the culture or language with which this experience is interpreted. Unlike the perennialist thesis, the common core thesis does not assume that any common theology, philosophy, or practice necessarily follows from mystical experience.
Revivals, Awakenings, and Conversion in American Protestantism
Authors: Richardson Kip
Published: May 2018

From at least the 18th century to the present, religious revivals have been a defining feature of American Protestantism. Though the size, scale, and formatting of revivals have varied over time, their basic function has not: to refresh the faithful, to reclaim the backslidden, and to secure the conversion of the uninitiated. A revival, in any age, was a mass phenomenon, a collective experiential encounter with the divine, whether held within a single congregation or conducted as a regional or even national campaign. As a result, significant numbers of Americans have traced their own conversion experiences to participation in a revival service, and the rhythms of revivalism have given crucial shape to American Protestant church life and history. From colonial Presbyterians to contemporary Pentecostals, the religious lives of a large and diverse swath of the American people have been formed by the vocabulary and ritual technologies of the revival tradition.

Beyond its evident importance to the religious lives of practitioners, however, much about the revival tradition has been disputed. Historians and theologians have variously interpreted revivalism as either democratizing or socially conservative, as enabling radical politics or reinforcing the status quo, as genuine outpourings of the Holy Spirit or enthusiastic delusion. The meaning of “conversion,” particularly in regard to Native American and African populations in the colonial and early American periods, has been subject to widespread criticism as an oversimplified term implying a linear movement from one identity to another. Even the broad historical narrative of American revivalism has been subject to debate, including the reality, cohesiveness, and long-term effects of the First and Second Great Awakenings as well as the Pentecostal and healing revivals of the mid-20th century. To survey the history and literature of American revivalism is therefore to confront a wide array of characterizations and conclusions, defying easy assessment.
Cyberspace and Religion in America
Authors: Cowan Douglas E.
Published: May 2018

Invented in 1989 and popularly accessible since the mid-1990s, the World Wide Web has always hosted a wide variety of religious content, ranging from early text-based discussion forums to live-stream video, and from rudimentary online communities to cross-platform social media activism. Known colloquially as “religion in cyberspace,” these computer-mediated, faith-based environments raise important questions in terms of how religious discourse is enacted and religious ritual performed. More than that, they challenge whether the notion of physical place will remain paramount in religious life, or if it can be displaced as believers and adherents shift aspects of their activity to electronically mediated communication space. Although initial enthusiasm for the Internet and its presumed potential led some scholars to predict large-scale uploading of religious life, there are a number of reasons to conclude that offline religious practice will continue to be important in the lives of believers despite any online activity they may pursue. That said, there are also significant ways in which online religious activity has encouraged adherents to reimagine the nature of sacred space, to envision new ways of understanding religious practice, and to enact new forms of religious community.
Liturgical Vestments, Vessels, and Objects in Christian Worship
Authors: Pierce Joanne M.
Published: May 2018

Any history of Christian liturgy must address the origins and development of the various material elements that are used during these celebrations. These have their own specific history, just as does the architectural and artistic context of the liturgy. Many of the specialized garments, or vestments, worn by ministers during liturgical services in several contemporary Christian churches originated in elements of ordinary or honorific dress used in the ancient Roman Empire. Over the course of several centuries, the style and type of vestments used in Western Christianity diverged from those used in Eastern Christianity, until today the differences are more striking than the similarities, even in shared individual elements like the stole and the chasuble. In addition, different kinds of vestments are used by different ministers (for example, the deacon, priest, or bishop) and in different kinds of sacramental and liturgical ceremonies. What a minister might wear at one service, for example evening prayer or the administration of baptism, might not be the same as those expected for the celebration of the Eucharist (the Mass, the holy communion, or the divine liturgy). The same is true for the essential vessels used during the celebration of the Eucharist: the chalice to hold the wine, and the paten, or plate, on which rests the bread to be blessed. Both of these have developed in distinctive styles in both West and East over time. The same is true of many of the other vessels and implements needed for the Eucharist and those used in other liturgical services. Examples include containers designed to hold water, oil, or incense as well as the number and style of altar cloths, veils, and candles utilized at different times and places.
The Six Nara Schools
Authors: Bauer Mikaël
Published: May 2018

During the Nara period (710–794), the Japanese religious and political landscape saw tremendous change. A new capital was built, Chinese legal codes were implemented, and the Buddhist temples grew in size and number. Traditionally, Nara period Buddhism has been described in terms of the so-called “Six Schools.” It is certainly the case that the 8th century became the cornerstone of later doctrinal and ritual developments, but the Buddhist context was more complex and intertwined than these six forms of Buddhism.
Buddhism in Film
Authors: Suh Sharon A.
Published: May 2018

Film serves as one of the most recent contributions to the variety of Buddhist visual forms that can offer a perspectival shift in interpretation for its viewers akin to other meditative devices such as mandalas. As a relatively recent subject of study, Buddhist films present innovative opportunities to visualize the Buddha, Buddhism, and the self in nuanced ways. Buddhist film can be understood as a spiritual technology that reshapes vision, and the act of viewing becomes a ritual process and contemplative practice. Ranging from films with an explicitly Buddhist theme and content to more abstract films without obvious Buddhist references, Buddhist films have become the subject of scholarly studies of Buddhism as well as occasions to reimagine Buddhism on and off screen. Buddhist films found in Asia and the West have proliferated globally through the rise of international Buddhist film festivals over the past fifteen years that have increased both the interest in Buddhism and the field of Buddhism and film itself. Most studies of Buddhism in film indicate that what constitutes a Buddhist film continually evolves and, as such, can be seen as a contemporary instantiation of the skillful means of the Buddha.
Healing and Religion in the United States
Authors: Hendrickson Brett
Published: May 2018

Religions, in almost every case, are concerned with healing the sick and the broken. Of course, healing is not the sole feature or function of religion, but for many people, restoration of wellness and wholeness is a central component of their religious experience. Religious healing comes in many forms, from miraculous supernatural intervention, to the manipulation of metaphysical energies, to the proper ordering of healthy human relationships and societies. Some religions rely on the ministrations of healing specialists such as shamans, parish nurses, or gifted miracle workers. Others focus on therapeutic modes of self-help, while yet others link healing with redemption from iniquity. In many cases, various kinds of religious healing overlap, all in service of that which is most efficacious in providing relief and recovery. The history of religions in the United States is likewise full of instances and varieties of religious healing. Americans of many creeds and diverse heritages have often sought healing within their religious traditions, and they have innovated new religious movements that focus primarily on the alleviation of suffering. Moreover, the attention to healing within American religions predates the rise of scientific biomedicine, evolves alongside of it, and endures through the present. Finally, recurrence to religious healing has often played a role in ethnic identity construction and maintenance in this largely immigrant nation.

Given the scope and impact of healing on U.S. religious history, it is imperative to consider how the idea of healing has captivated and motivated religious actors. Of particular interest is the complex and sometimes violent process by which religious ideas and practices related to healing have been exchanged, modified, and even appropriated. Throughout the course of American history, religious healing—in its many expressions—has been characterized by ongoing competition, collaboration, overlap, and constant change. Ultimately, it bears little fruit to look for a common thread that might run among all the various traditions and formulations of American religious healing. Rather, it is more rewarding to consider carefully the interactions and evolutions of healing in the ever-changing American religious scene.
Parícutin: Volcano in a Cornfield
Authors: Perrott Claire
Published: May 2018

In February 1943, a small but powerful volcano emerged from a cornfield in the vicinity of Uruapan, Michoacán, México. A stunned farmer, Dionisio Pulido, alerted the nearby town of San Juan Parangaricutiro, and a group of villagers went to investigate the growing mound in Pulido’s field. The new volcano, named Parícutin by Mexican scientist Dr. Ezequiel Ordóñez, emitted smoke, ash, and lava until 1952. The ash fall and lava flows severely changed life in five of the surrounding villages. Most villagers in the affected areas were reluctant to move, but the ash fall made it nearly impossible to cultivate their crops, polluted the air and water sources, and made their animals sick. In the end, two villages completely evacuated with the help of the national government.

A few days after the volcano emerged, scientists from México and the United States flocked to the area for the unique opportunity to study a volcano from its birth. They recorded lava flows, eruption patterns, ash fall, and damage to the surrounding agricultural land. A significant relationship blossomed between a U.S. Geological Survey scientist, Carl Fries Jr., and a local Purépecha man, Celedonio Gutiérrez. Although Gutiérrez had only a minimal education, his knowledge of the environment and the local people proved essential to foreign academics studying the volcano. Working together, the two men published at least eight scientific articles in the U.S. weekly magazine Eos, based on daily observations of the volcano.

Parícutin fascinated people from México and the United States since the moment it grew into a cinder cone. Artists such as Dr. Atl used the volcano for inspiration, producing countless sketches and paintings, some of which were published. Reporters, tourists, and artists from around the world visited Parícutin, excited at the possibility of seeing an active volcano up close. Authors and illustrators also expressed the fascinating story of the volcano and the affected Purépecha community in children’s stories. In the 21st century, Parícutin remains a popular tourist destination.

A half-buried church in what was San Juan Parangaricutiro is all that remains of a once lively village and stands as a testament to the strength and reach of Parícutin. Despite the destruction, the eruption serves as a reminder of the importance of volcanoes in Mexican culture and provides a lens to examine the long-established relationship between people and volcanoes. The study of Parícutin fits into the wider scholarship of Latin American environmental history because it highlights the connections between culture and environment. This story demonstrates the interplay between the perspectives different groups of people had of the volcano and how landscape affects the social and cultural history of a place and its people.
Chiapas and the Zapatista National Liberation Army
Authors: Estrada-Saavedra Marco
Published: May 2018

The 1994 Zapatista uprising in the southern Mexican state of Chiapas was the culmination of centuries of repression and exploitation of the country’s indigenous minority at the hands of its Spanish and mestizo leaders and the landed elite. The Liberal Reform initiated in 1854, followed by the “modernizing” policies of President Porfirio Díaz (1877–1880; 1884–1911), and then the revolution that ousted him, would strengthen and institutionalize a new set of institutional frameworks, discourses, and practices that lasted through the 20th century. The Ejército Zapatista de Liberación Nacional (Zapatista National Liberation Army, or EZLN) emerged from a history of complex and volatile relationships between indigenous peoples of the impoverished state and its economic and political elite, relationships that began a process of redefinition in the 1950s. Zapatismo is one of the expressions of indigenous and working-class struggles in this social and historical context. It can be distinguished from other rural and indigenous movements by its repudiation of the strategies of protest and negotiation within an institutional framework, its adoption of armed struggle, and its rejection of the conventional objectives of land and commercial agricultural production in favor of territorial autonomy and de facto self-government.
Mexican Women Writers, 1960 to the Present
Authors: Anderson Sarah
Published: May 2018

Since the early 1960s, Mexican women writers have relentlessly fought to become recognized within a traditionally male-dominated literary canon.

In the 20th century, women’s writing began to flourish, in many cases emerging as a counternarrative to the patriarchal discourse that had dominated the literary scene for decades after the Mexican Revolution (1910–1920). The work of women writers can be examined according to three different phases: from 1960 to the 1970s, 1980 to the 1990s, and 2000 to the present, and by highlighting in particular a group of women writers from the northern border region, who have faced additional obstacles in their path to becoming published writers. All in all, each of the writers discussed here contributes to a snapshot of the literature written by women from the 1960s to today. The chronological trajectory of their literary voices underscores Mexico’s rich cultural and historical past through the eyes and voices of those traditionally silenced and marginalized in the patriarchal and hierarchical spaces of power.
Afroasiatic Languages
Authors: Frajzyngier Zygmunt
Published: May 2018

Afroasiatic languages are the fourth largest linguistic phylum, spoken by some 350 million people in North, West, Central, and East Africa, in the Middle East, and in scattered communities in Europe, the United States, and the Caucasus. Some Afroasiatic languages, such as Arabic, Hausa, Amharic, Somali, and Oromo, are spoken by millions of people, while others are endangered with extinction. As of the early 21st century, the phylum is composed of six families: Egyptian (extinct), Semitic, Cushitic, Omotic, Berber, and Chadic. There are some typological features shared by all families, particularly in the domain of phonology. Languages are also typologically quite distinct with respect to syntax and functions encoded in the grammatical systems.

Some Afroasiatic languages, such as Egyptian, Akkadian, Phoenician, Hebrew, Arabic, and Ge’ez, have a longtime written tradition, but for many languages no writing system has yet been proposed or adopted. The Old Semitic writing system gave rise to the modern alphabets used in thousands of unrelated contemporary languages. Two Semitic languages, Hebrew (with some Aramaic) and Arabic, were used to write the Old Testament and the Koran, the holy books of Judaism and Islam.
PEPA test: fast and powerful differential analysis from relative quantitative proteomics data using shared peptides
Authors: Jacob Laurent , Combes Florence , Burger Thomas
Published: May 2018

We propose a new hypothesis test for the differential abundance of proteins in mass-spectrometry based relative quantification. An important feature of this type of high-throughput analyses is that it involves an enzymatic digestion of the sample proteins into peptides prior to identification and quantification. Due to numerous homology sequences, different proteins can lead to peptides with identical amino acid chains, so that their parent protein is ambiguous. These so-called shared peptides make the protein-level statistical analysis a challenge and are often not accounted for. In this article, we use a linear model describing peptide–protein relationships to build a likelihood ratio test of differential abundance for proteins. We show that the likelihood ratio statistic can be computed in linear time with the number of peptides. We also provide the asymptotic null distribution of a regularized version of our statistic. Experiments on both real and simulated datasets show that our procedures outperforms state-of-the-art methods. The procedures are available via the pepa.test function of the DAPAR Bioconductor R package.
A Bayesian space–time model for clustering areal units based on their disease trends
Authors: Napier Gary , Lee Duncan , Robertson Chris , Lawson Andrew
Published: May 2018

Population-level disease risk across a set of non-overlapping areal units varies in space and time, and a large research literature has developed methodology for identifying clusters of areal units exhibiting elevated risks. However, almost no research has extended the clustering paradigm to identify groups of areal units exhibiting similar temporal disease trends. We present a novel Bayesian hierarchical mixture model for achieving this goal, with inference based on a Metropolis-coupled Markov chain Monte Carlo ((MC)$^3$) algorithm. The effectiveness of the (MC)$^3$ algorithm compared to a standard Markov chain Monte Carlo implementation is demonstrated in a simulation study, and the methodology is motivated by two important case studies in the United Kingdom. The first concerns the impact on measles susceptibility of the discredited paper linking the measles, mumps, and rubella vaccination to an increased risk of Autism and investigates whether all areas in the Scotland were equally affected. The second concerns respiratory hospitalizations and investigates over a 10 year period which parts of Glasgow have shown increased, decreased, and no change in risk.
A Turning IR Landscape in a Shifting Media Ecology: The State of IR Literature on New Media1
Authors: Jackson Susan T
Published: May 2018

Each year the prevalence of digitized information becomes more entrenched, not least with the amount of activity on social media. Yet, new media studies pose a number of challenges to international relations scholarship, which are only beginning to be addressed. With some exceptions IR scholars who conduct this research tend to rely on traditional qualitative methods and have been hesitant to embrace interdisciplinary collaboration—especially with those disciplines outside of the social sciences—as well as methodological pluralism across interpretive and quantitative approaches within the social sciences. This tendency shows a general lack of understanding of what new/social media might mean, not only as a source of and tool for generating information but also as a structural factor in how we conduct IR research and practice international relations. In this way, social media can provoke IR scholars to ask questions about their own discipline. This article aims to address these challenges and to provide suggestions on how to bring structural aspects of new media into IR research. In particular, it incorporates ideas centered on the shifting media ecology as fundamental to examining these structural challenges in terms of practicing international relations and in the visual turn in IR.
Capsule-Negative emm Types Are an Increasing Cause of Pediatric Group A Streptococcal Infections at a Large Pediatric Hospital in Texas
Authors: Flores Anthony R , Chase McNeil J , Shah Brittany , Van Beneden Chris , Shelburne Samuel A
Published: May 2018

Disease caused by group A Streptococcus (GAS) remains a substantial burden in pediatric populations. We are witnessing a shift in the epidemiology of GAS disease with increasing frequency of capsule-negative serotypes in the Houston, Texas, metropolitan area.
Urinary peptidomic biomarkers of renal function in heart transplant recipients
Authors: Huang Qi-Fang , Zhang Zhen-Yu , Van Keer Jan , Trenson Sander , Nkuipou-Kenfack Esther , Yang Wen-Yi , Thijs Lutgarde , Vanhaecke Johan , Van Aelst Lucas N L , Van Cleemput Johan , Janssens Stefan , Verhamme Peter , Mischak Harald , Staessen Jan A
Published: May 2018

Background

Chronic kidney disease (CKD) is common in patients after heart transplantation (HTx). We assessed whether in HTx recipients the proteomic urinary classifier CKD273 or sequenced urinary peptides revealing the parental proteins correlated with the estimated glomerular filtration rate (eGFR).

Methods

In 368 HTx patients, we measured the urinary peptidome and analysed CKD273 and 48 urinary peptides with a detectable signal in >95% of participants. After 9.1 months (median), eGFR and the urinary biomarkers were reassessed.

Results

In multivariable Bonferroni-corrected analyses of the baseline data, a 1-SD increase in CKD273 was associated with a 11.4 [95% confidence interval (CI) 7.25–15.5] mL/min/1.73 m2 lower eGFR and an odds ratio of 2.63 (1.56–4.46) for having eGFR <60 mL/min/1.73 m2. While relating eGFR category at follow-up to baseline urinary biomarkers, CKD273 had higher (P = 0.007) area under the curve (0.75; 95% CI 0.70–0.80) than 24-h proteinuria (0.64; 95% CI 0.58–0.69), but additional adjustment for baseline eGFR removed significance of both biomarkers. In partial least squares analysis, the strongest correlates of the multivariable-adjusted baseline eGFR were fragments of collagen I (positive) and the mucin-1 subunit α (inverse). Associations between the changes in eGFR and the urinary markers were inverse for CKD273 and mucin-1 and positive for urinary collagen I.

Conclusions

With the exception of baseline eGFR, CKD273 was more closer associated with imminent renal dysfunction than 24-h proteinuria. Fragments of collagen I and mucin-1—respectively, positively and inversely associated with eGFR and change in eGFR—are single-peptide markers associated with renal dysfunction.
Nurses Wanted—Almost Everywhere
Authors: Kennedy Maureen Shawn
Published: May 2018

It seems the nursing shortage has arrived.
Antibiotic May Increase CV Risk in those with Heart Disease
Authors: Aschenbrenner Diane S.
Published: May 2018

The Food and Drug Administration is urging providers to use caution when prescribing clarithromycin to patients with heart disease because the drug may increase their risk of cardiovascular morbidity or death.

This risk can extend for several years after use of the antibiotic.
Bladder Cancer Drug Approved to Treat Stage III Non–Small Cell Lung Cancer
Authors: Aschenbrenner Diane S.
Published: May 2018

Imfinzi (durvalumab), a drug previously approved to treat locally advanced or metastatic bladder cancer, is now also approved to treat stage III non–small cell lung cancer with tumors that are unresectable and have not progressed after chemoradiation.

New warnings for durvalumab include risk of infusion reactions and embryo–fetal toxicity.
When Disaster Strikes
Authors: Ortelli Tracy A.
Published: May 2018

Apps, websites, and volunteer organizations can provide assistance.
Patients' Body Image Improves After Mohs Micrographic Surgery for Nonmelanoma Head and Neck Skin Cancer
Authors: Beal Brandon T. , White Emily K. , Behera Anit K. , Zavell Amy E. , McGuinness Ashley E. , Blangger Holly , Armbrecht Eric S. , Maher Ian A.
Published: May 2018

BACKGROUND

Most skin cancers occur on the head and neck, areas of the body that are significant to an individual's body image (BI) perception. Poor BI is a robust risk factor for depression and decreased quality of life. Thus, patients with nonmelanoma head and neck skin cancer (NMHNSC) may be more vulnerable to BI disturbance and the negative sequelae of poor BI.

OBJECTIVE

Describe the nature of BI concerns in patients diagnosed with NMHNSC and assess how BI changes with treatment.

METHODS AND MATERIALS

Patients undergoing Mohs micrographic surgery (MMS) for NMHNSC completed assessments of BI and well-being before (N = 239) and 6 months after (N = 80) treatment with MMS. Demographic and tumor data were gathered through retrospective chart review.

RESULTS

Body image improved significantly 6 months after MMS, and the magnitude of this change was large (η2 = 0.18). Repair length (length of final scar irrespective of repair type) >4 cm predicted poorer BI at 6-month follow-up.

CONCLUSION

Patients' BI improves after treatment with MMS for NMHNSC.
A Review of the Use of Ultrasound for Skin Tightening, Body Contouring, and Cellulite Reduction in Dermatology
Authors: Juhász Margit , Korta Dorota , Mesinkovska Natasha Atanaskova
Published: May 2018

BACKGROUND

Ultrasound (US) technology uses acoustic waves to heat tissue, resulting in thermal damage and coagulative necrosis leading to the renewal of skin elasticity, body contouring, and destruction of cellulite.

OBJECTIVE

This review will discuss the use of US for skin tightening, body contouring/sculpting, and cellulite reduction.

MATERIALS AND METHODS

A literature search identified studies using US for skin tightening, body contouring/sculpting, and cellulite reduction.

RESULTS

Two hundred thirty-one studies were identified using US technology. Twenty studies each were identified addressing body contouring/sculpting and skin tightening, and 2 studies for cellulite reduction. Ultrasound is efficacious for skin rejuvenation, body contouring, and reduction of cellulite of the face, décolletage, abdomen, and thighs. Ultrasound lipolysis results in a 2- to 4.6-cm decrease in abdominal circumference. Ultrasound is safe and can be used in all skin types with minimal concern for postinflammatory hyperpigmentation.

CONCLUSION

Ultrasound seems to be an efficacious, effective, and safe modality for correction of skin laxity, lipolysis, and decrease the appearance of cellulite. Adverse effects are minimal including procedural pain, postprocedure erythema, and swelling. Clinicians and patients are both satisfied with results after treatment. In this review, the authors will provide an update on the use of US in the dermatologic field.
Carboxytherapy Versus Skin Microneedling in Treatment of Atrophic Postacne Scars: A Comparative Clinical, Histopathological, and Histometrical Study
Authors: Moftah Noha H. , El Khayyat Mohammad A.M. , Ragai Maha H. , Alaa Heba
Published: May 2018

BACKGROUND

Acne scarring has been a challenge to treat. Microneedling gained popularity in treatment of such scars. Meanwhile, carboxytherapy (CXT) is considered a novel treatment modality for acne scars.

OBJECTIVE

To evaluate efficacy of CXT versus microneedling in treatment of acne scars.

METHODS AND MATERIALS

Thirty-two patients with atrophic acne scars received 6 sessions of microneedling and CXT on right and left sides of face, respectively. Clinical evaluation with histopathological and computerized morphometric analysis was performed at 2 months after treatment.

RESULTS

After either microneedling or CXT, there was significant decrease of total acne scars and its 3 types separately (icepicks, boxcar, and rolling) (p≤ .001). Comparing both sides of face, there was no significant difference regarding grading response and reduction percentage of total scars and its types (p> .05). Histopathologically, there was an improvement of character and organization of collagen and elastic fibers in addition to significant increase in epidermal thickness on both sides of face, with no significant difference between them (p> .05).

CONCLUSION

Both CXT and microneedling are equally effective, tolerable, safe, and noninvasive treatment modalities of atrophic acne scars. Similar histopathological changes were observed after both modalities, helping in better understanding their action.
Preliminary Evidence for Enhanced Thymine Absorption: A Putative New Phenotype Associated With Fluoropyrimidine Toxicity in Cancer Patients
Authors: Duley John A. , Ni Ming , Shannon Catherine , Norris Ross L. , Sheffield Leslie , Cowley David , Harris Marion , van Kuilenburg André B. P. , Helsby Nuala , George Rani , Charles Bruce G.
Published: May 2018

Background:

Chemotherapy for colorectal, head and neck, and breast cancer continues to rely heavily on 5-fluorouracil and its oral prodrug capecitabine. Associations of serious fluoropyrimidine adverse effects have focused on inherited deficiency of the catabolic enzyme, dihydropyrimidine dehydrogenase. However, abnormal dihydropyrimidine dehydrogenase activity accounts for only about one-third of observed toxicity cases. Thus, the cause of most fluorouracil toxicity cases remains unexplained.

Methods:

For this small cohort study, thymine (THY) 250 mg was administered orally to 6 patients who had experienced severe toxicity during treatment with 5FU or capecitabine. Plasma and urine were analyzed for THY and its catabolites dihydrothymine (DHT) and β-ureidoisobutyrate.

Results:

Of the 6 patients, 2 had decreased THY elimination and raised urinary THY recovery consistent with inherited partial dihydropyrimidine dehydrogenase deficiency, confirmed byDPYDsequencing. Unexpectedly, 3 patients displayed grossly raised plasma THY concentrations but normal elimination profiles (compared with a normal range for healthy volunteers previously published by the authors).DPYDandDPYSsequencing of these 3 patients did not reveal any significant loss-of-activity allelic variants. The authors labeled the phenotype in these 3 patients as “enhanced thymine absorption”. Only 1 of the 6 cases of toxicity had a normal postdose plasma profile for THY and its catabolites. Postdose urine collections from all 6 patients had THY/DHT urinary ratios above 4.0, clearly separated from the ratios in healthy subjects that were all below 3.0.

Conclusions:

This small cohort provided evidence for a hypothesis that fluorouracil toxicity cases may include a previously undescribed pyrimidine absorption variant, “enhanced thymine absorption,” and elevated THY/DHT ratios in urine may predict fluorouracil toxicity. A prospective study is currently being conducted.
Group B Streptococci
Authors: Wicker Esther , Lander Fabian , Weidemann Felix , Hufnagel Markus , Berner Reinhard , Krause Gérard
Published: May 2018

Group B streptococcus (GBS) is a leading cause of morbidity and mortality in newborns worldwide. From 2000 to 2008, national guidelines in Germany recommended intrapartum antibiotic prophylaxis for pregnant women displaying risk factors (eg, perinatal anogenital GBS colonization, rupture of the membranes ≥18 hours before birth) for the vertical transmission of GBS to their children. In 2008, these guidelines were revised to advocate universal, culture-based screening for GBS colonization among all pregnant women between 35 and 37 weeks of gestation. For the period 2009–2010, our prospective active surveillance study assessed the incidence of invasive GBS infections in infants 0–90 days of age in Germany. We did this by means of a capture–recapture analysis of 2 separate, independent systems (pediatric reporting versus laboratory reporting). We compared our results with those from a previous study by employing an equivalent design (2001–2003). We detected a 32% reduction in GBS incidence, from 0.47 per 1000 live births (n = 679) in 2001–2003 to 0.34 per 1000 live births (n = 450) in 2009–2010. This decline primarily is tied to a reduced number of GBS cases in children under 1 week of age. In 2009–2010, the ratio of early-onset disease to late-onset disease reversed from 1.52 (206:136), as determined in 2001–2003, to 0.75 (92:122). This study is the first to assess changes in the incidence of invasive GBS in Germany after the implementation of the guidelines for intrapartum prophylaxis for pregnant women colonized with GBS.
Introduction to four reviews addressing critical topics identified by the 2015 Nurse Practitioner Research Agenda Roundtable: Priorities for policy, workforce, education, and practice
Authors: Buchholz Susan W. , Klein Tracy , Cooke Cindy , Cook Michelle L. , Knestrick Joyce , Dickins Kirsten
Published: May 2018

Background and Purpose:

In 2015, an invitational think tank was convened by the Fellows of the American Association of Nurse Practitioners to update the 2010 Nurse Practitioner (NP) Research Agenda Roundtable. This effort was undertaken to provide guidance for future health care research. The purpose of this article is to introduce the process used for conducting four reviews that address critical topics related to specific research priorities emanating from the 2015 NP Research Agenda Roundtable. The four reviews are published in this issue of Journal of the American Association of Nurse Practitioners (JAANP) to address the state of current research relevant to NP policy, workforce, education, and practice.

Methods:

This introductory article provides an overview of the systematic process used to evaluate the four topical area. The type of review selected, the search strategy, critical appraisal, data extraction, and data synthesis will be further described in the four review articles.

Conclusions:

Four reviews that examine literature regarding specific aims important to NPs will address strengths as well as gaps in the literature.

Implications for Practice:

The knowledge offered by the four reviews has the potential to inform future research, which will benefit NPs and other health care stakeholders.
Optimizing adult diabetes care in community health
Authors: Nelson Elizabeth , Bobade Rohit , Hunt Vicki , Mundi Manpreet S.
Published: May 2018

Background and purpose:

Diabetes mellitus is an epidemic. Many organizations and states have established reportable quality care measures. Our organization explored novel ways of chronic disease management. The purpose of this article is to decrease the percentage of patients with a hemoglobin A1c (HbA1c) more than 8%.

Methods:

Prospective, pre- and postintervention, quality improvement project was implemented in the Employee and Community Health Clinic using an endocrinology nurse practitioner (NP) to coordinate and provide care to adult patients with diabetes. A convenience sample of 103 patients with diabetes was selected for this project. Patients were excluded from the project if they did not complete preintervention satisfaction surveys or did not sign research release forms.

Conclusions:

One hundred three patients were referred, and two met exclusion criteria. Of those patients, 51% were female with an average HbA1c of 9.1%. Eighty-one of the referred patients attended their appointment. The patients who sought care had a reduction in HbA1c from 9.0% ± 1.8% to 8.3% ± 1.7% (p value < .001). Patients who did not appear had no significant change in their HbA1c from 9.8% ± 3.1% to 9.4% ± 2.7% (p value = .61).

Implications for practice:

Incorporating specialty trained NPs can lead to improvements in HbA1c, patient-reported control of diabetes, and a reduction in the frequency of hypoglycemia.
MicroRNAs: markers of β-cell stress and autoimmunity
Authors: Dotta Francesco , Ventriglia Giuliana , Snowhite Isaac V. , Pugliese Alberto
Published: May 2018

Purpose of review

We discuss current knowledge about microRNAs (miRNAs) in type 1 diabetes (T1D), an autoimmune disease leading to severe loss of pancreatic β-cells. We describe: the role of cellular miRNAs in regulating immune functions and pathways impacting insulin secretion and β-cell survival; circulating miRNAs as disease biomarkers.

Recent findings

Studies examined miRNAs in experimental models and patients, including analysis of tissues from organ donors, peripheral blood cells, and circulating miRNAs in serum, plasma, and exosomes. Studies employed diverse designs and methodologies to detect miRNAs and measure their levels. Selected miRNAs have been linked to the regulation of key biological pathways and disease pathogenesis; several circulating miRNAs are associated with having T1D, islet autoimmunity, disease progression, and immune and metabolic functions, for example, C-peptide secretion, in multiple studies.

A growing literature reveals multiple roles of miRNAs in T1D, provide new clues into the regulation of disease mechanisms, and identify reproducible associations. Yet challenges remain, and the field will benefit from joint efforts to analyze results, compare methodologies, formally test the robustness of miRNA associations, and ultimately move towards validating robust miRNA biomarkers.
Monogenic diabetes: the impact of making the right diagnosis
Authors: Harris Anastasia G. , Letourneau Lisa R. , Greeley Siri Atma W.
Published: May 2018

Purpose of review

Monogenic forms of diabetes have received increased attention and genetic testing is more widely available; however, many patients are still misdiagnosed as having type 1 (T1D) or type 2 diabetes. This review will address updates to monogenic diabetes prevalence, identification, treatment, and genetic testing.

Recent findings

The creation of a T1D genetic risk score and the use of noninvasive urinary C-peptide creatinine ratios have provided new tools to aid in the discrimination of possible monogenic diabetes from likely T1D. Early, high-dose sulfonylurea treatment in infants with a KCNJ11 or ABCC8 mutation continues to be well tolerated and effective. As the field moves towards more comprehensive genetic testing methods, there is an increased opportunity to identify novel genetic causes. Genetic testing results continue to allow for personalized treatment but should provide patient information at an appropriate health literacy level.

Although there have been clinical and genetic advances in monogenic diabetes, patients are still misdiagnosed. Improved insurance coverage of genetic testing is needed. The majority of data on monogenic diabetes has been collected from Caucasian populations, therefore, research studies should endeavor to include broader ethnic and racial diversity to provide comprehensive information for all populations.
Infantile hemangiomas: what have we learned from propranolol?
Authors: Hagen Rachael , Ghareeb Erica , Jalali Omid , Zinn Zachary
Published: May 2018

Purpose of review

Infantile hemangiomas are the most common vascular tumor of infancy. Treatment of infantile hemangiomas was revolutionized when propranolol, a nonselective β-blocker, was reported to be effective therapy. In this review, we highlight the lessons learned using propranolol to treat infantile hemangiomas. We also describe the ongoing effort to understand the mechanism of action of propranolol.

Recent findings

Although the pathogenesis of infantile hemangiomas is not fully understood, maternal hypoxic stress and embolization of placental tissue are suggested to be critical components in their development. The mechanism of action of propranolol remains unclear, however various molecular mechanisms are detailed in this review. Propranolol treatment remains a well tolerated therapy, with low risk of adverse events or long-term neurocognitive effects. Dosing recommendations and optimal treatment duration vary among studies, and should be altered in patients with certain medical conditions such as Posterior fossa anomalies, Hemangioma, Arterial lesions, Cardiac abnormalities/coarctation of the aorta, Eye anomalies (PHACE) syndrome.

Propranolol is a well tolerated and effective treatment for infantile hemangiomas. The efficacy of propranolol for infantile hemangiomas is clear, however questions pertaining to mechanism of action, pretreatment risk stratification, and optimal dosing remain unanswered. The guidelines for managing infantile hemangiomas with propranolol will continue to adapt as research catches up to clinical experience.
Nonsuicidal self-injury in adolescents: current developments to help inform assessment and treatment
Authors: Pluhar Emily , Lois Rebecca H. , Burton Elvin Thomaseo
Published: May 2018

Purpose of review

This review summarizes the recent literature examining nonsuicidal self-injury (NSSI) in adolescents, with a particular focus on how primary care pediatricians (PCPs) might assess and intervene as a common first point of contact. This NSSI review is timely and relevant, given the prevalence rates among adolescents, as well as its link to suicidal behaviors.

Recent findings

NSSI is most prevalent among adolescents, with lifetime prevalence rates between 17 and 60%. With evidence that the most common age of onset is between 12 and 14 years, evaluating NSSI is a challenging yet necessary aspect of a comprehensive adolescent medical examination. The function of NSSI behaviors may have implications for effective treatment and should be included in assessment. The majority of research has indicated that NSSI serves an emotion regulation function, in that the behavior results in a decrease in intensity of adverse emotional states in the absence of more effective coping strategies.

Considering the prevalence of self-injury among adolescents, the likelihood that PCPs will encounter NSSI in their practice is quite high. Given that more than 50% of youth do not receive needed mental health services, it is critical that PCPs assess for NSSI and intervene accordingly.
Validating the Changes to Self-identity After Total Laryngectomy
Authors: Bickford Jane , Coveney John , Baker Janet , Hersh Deborah
Published: May 2018

Background

A total laryngectomy often prolongs life but results in long-term disablement, disfigurement, and complex care needs. Current clinical practice addresses the surgical options, procedures, and immediate recovery. Less support is available longer-term despite significant changes to aspects of personhood and ongoing medical needs.

Objective

The aim of this study was to explore the experience of living with and/or supporting individuals with a laryngectomy at least 1 year after surgery.

Methods

Constructivist grounded theory methods and symbolic interactionism were used to guide collection and analysis of interview data from 28 participants (12 individuals with a laryngectomy, 9 primary supporters, and 7 health professionals).

Results

The phenomena of “validating the altered self after total laryngectomy” highlighted how individuals, postlaryngectomy, navigate and negotiate interactions due to the disruption of their self-expression, related competencies, and roles. Several reframing patterns representing validation of the self emerged from the narratives. They were as follows: destabilized, resigned, resolute, and transformed. The data describe the influence of the processes of developing competence and building resilience, combined with contextual factors, for example, timing and turning points; being supported; and personal factors on these reframing patterns.

Conclusion

The findings further our understanding of the long-term subjective experience of identity change after laryngectomy and call attention to the persisting need for psychosocial support.

Implications for Practice

This research provides important evidence for evaluating and strengthening the continuum of services (specialist to community) and supporting social participation, regardless of communication method, and for competency training for all involved to optimize person-centered practices.