bluuebunny/crossref_metadata_2025 huggingface dataset:
Relationship between Hope and Quality of Life in Primary Care Patients: Vitality as a Mechanism
Authors: Lucas Abigael G , Chang Edward C , Morris Lily E , Angoff Harrison D , Chang Olivia D , Duong Ashley H , Li Mingqi , Hirsch Jameson K
Published: April 2019

The present study examined the role of vitality as a mediator of the association between dispositional hope and quality of life (QoL) (namely, physical health, psychological health, social relationships, and environment) in a sample of 101 adult primary care patients. Vitality was found to fully mediate the relationship between hope and physical health, social relationships, and environment. In addition, vitality was found to partially mediate the association between hope and psychological health. The present findings are consistent with a model in which vitality represents an important mechanism through which hope affects QoL in adults. Accordingly, these findings point to the importance of fostering both hope and vitality in efforts to promote positive QoL in adults.
Strengthening the Voice of Those with Mental Health Issues: A Community Approach to Developing a Mental Health Identification System
Authors: Quinn Andrew , Otteson Mary
Published: April 2019

This article describes how an action research approach was used to involve a community of individuals with mental health issues and their support systems in the development and adoption of a mental health identification (ID) card. The intent of the card was to provide individuals with mental health issues a way to communicate and manage the idiosyncratic nature of their behaviors. A credit card–size ID card was developed that has the individual’s picture, address, diagnosis, idiosyncratic behaviors, best approach with the individual when those behaviors are present, medications, allergies, and emergency contact information. Benefits and concerns about the ID system in regard to the cardholder, card recipients, the provision of consent, Health Insurance Portability and Accountability Act compliance, and the balancing of reducing and increasing stigmas and stereotypes emerged throughout the process. In the end, the ID card has come to be seen as a social justice mechanism that allows for communication and awareness for those with mental health issues.
The Relative Importance of Modeling Site Pattern Heterogeneity Versus Partition-Wise Heterotachy in Phylogenomic Inference
Authors: Wang Huai-Chun , Susko Edward , Roger Andrew J
Published: April 2019

Large taxa-rich genome-scale data sets are often necessary for resolving ancient phylogenetic relationships. But accurate phylogenetic inference requires that they are analyzed with realistic models that account for the heterogeneity in substitution patterns amongst the sites, genes and lineages. Two kinds of adjustments are frequently used: models that account for heterogeneity in amino acid frequencies at sites in proteins, and partitioned models that accommodate the heterogeneity in rates (branch lengths) among different proteins in different lineages (protein-wise heterotachy). Although partitioned and site-heterogeneous models are both widely used in isolation, their relative importance to the inference of correct phylogenies has not been carefully evaluated. We conducted several empirical analyses and a large set of simulations to compare the relative performances of partitioned models, site-heterogeneous models, and combined partitioned site heterogeneous models. In general, site-homogeneous models (partitioned or not) performed worse than site heterogeneous, except in simulations with extreme protein-wise heterotachy. Furthermore, simulations using empirically-derived realistic parameter settings showed a marked long-branch attraction (LBA) problem for analyses employing protein-wise partitioning even when the generating model included partitioning. This LBA problem results from a small sample bias compounded over many single protein alignments. In some cases, this problem was ameliorated by clustering similarly-evolving proteins together into larger partitions using the PartitionFinder method. Similar results were obtained under simulations with larger numbers of taxa or heterogeneity in simulating topologies over genes. For an empirical Microsporidia test data set, all but one tested site-heterogeneous models (with or without partitioning) obtain the correct Microsporidia+Fungi grouping, whereas site-homogenous models (with or without partitioning) did not. The single exception was the fully partitioned site-heterogeneous analysis that succumbed to the compounded small sample LBA bias. In general unless protein-wise heterotachy effects are extreme, it is more important to model site-heterogeneity than protein-wise heterotachy in phylogenomic analyses. Complete protein-wise partitioning should be avoided as it can lead to a serious LBA bias. In cases of extreme protein-wise heterotachy, approaches that cluster similarly-evolving proteins together and coupled with site-heterogeneous models work well for phylogenetic estimation.
Metapopulation Vicariance, Age of Island Taxa and Dispersal: A Case Study Using the Pacific Plant Genus Planchonella (Sapotaceae)
Authors: Swenson Ulf , Havran J Christopher , Munzinger Jérôme , Mcloughlin Stephen , Nylinder Stephan
Published: April 2019

Oceanic islands originate from volcanism or tectonic activity without connections to continental landmasses, are colonized by organisms, and eventually vanish due to erosion and subsidence. Colonization of oceanic islands occurs through long-distance dispersals (LDDs) or metapopulation vicariance, the latter resulting in lineages being older than the islands they inhabit. If metapopulation vicariance is valid, island ages cannot be reliably used to provide maximum age constraints for molecular dating. We explore the relationships between the ages of members of a widespread plant genus (Planchonella, Sapotaceae) and their host islands across the Pacific to test various assumptions of dispersal and metapopulation vicariance. We sampled three nuclear DNA markers from 156 accessions representing some 100 Sapotaceae taxa, and analyzed these in BEAST with a relaxed clock to estimate divergence times and with a phylogeographic diffusion model to estimate range expansions over time. The phylogeny was calibrated with a secondary point (the root) and fossils from New Zealand. The dated phylogeny reveals that the ages of Planchonella species are, in most cases, consistent with the ages of the islands they inhabit. Planchonella is inferred to have originated in the Sahul Shelf region, to which it back-dispersed multiple times. Fiji has been an important source for range expansion in the Pacific for the past 23 myr. Our analyses reject metapopulation vicariance in all cases tested, including between oceanic islands, evolution of an endemic Fiji–Vanuatu flora, and westward rollback vicariance between Vanuatu and the Loyalty Islands. Repeated dispersal is the only mechanism able to explain the empirical data. The longest (8900 km) identified dispersal is between Palau in the Pacific and the Seychelles in the Indian Ocean, estimated at 2.2 Ma (0.4–4.8 Ma). The first split in a Hawaiian lineage (P. sandwicensis) matches the age of Necker Island (11.0 Ma), when its ancestor diverged into two species that are distinguished by purple and yellow fruits. Subsequent establishment across the Hawaiian archipelago supports, in part, progression rule colonization. In summary, we found no explanatory power in metapopulation vicariance and conclude that Planchonella has expanded its range across the Pacific by LDD. We contend that this will be seen in many other groups when analyzed in detail.
Quizalofop-p-Ethyl Induces Adipogenesis in 3T3-L1 Adipocytes
Authors: Biserni Martina , Mesnage Robin , Ferro Raquel , Wozniak Eva , Xenakis Theodoros , Mein Charles A , Antoniou Michael N
Published: April 2019

Exposure to endocrine disrupting chemicals is an established risk factor for obesity. The most commonly used pesticide active ingredients have never been tested in an adipogenesis assay. We tested for the first time the potential of glyphosate, 2, 4-dichlorophenoxyacetic acid, dicamba, mesotrione, isoxaflutole, and quizalofop-p-ethyl (QpE) to induce lipid accumulation in murine 3T3-L1 adipocytes. Only QpE caused a dose-dependent statistically significant triglyceride accumulation from a concentration of 5 up to 100 µM. The QpE commercial formulation Targa Super was 100 times more cytotoxic than QpE alone. Neither the estrogen receptor antagonist ICI 182, 780 nor the glucocorticoid receptor antagonist RU486 was able to block the QpE-induced lipid accumulation. RNAseq analysis of 3T3-L1 adipocytes exposed to QpE suggests that this compound exerts its lipid accumulation effects via a peroxisome proliferator-activated receptor gamma (PPARγ)-mediated pathway, a nuclear receptor whose modulation influences lipid metabolism. QpE was further shown to be active in a PPARγ reporter gene assay at 100 µM, reaching 4% of the maximal response produced by rosiglitazone, which acts as a positive control. This indicates that lipid accumulation induced by QpE is only in part caused by PPARγ activation. The lipid accumulation capability of QpE we observe suggest that this pesticide, whose use is likely to increase in coming years may have a hitherto unsuspected obesogenic property.
Blockade of the NLRP3/Caspase-1 Axis Ameliorates Airway Neutrophilic Inflammation in a Toluene Diisocyanate-Induced Murine Asthma Model
Authors: Chen Shuyu , Yao Lihong , Huang Peikai , He Qiaoling , Guan Hongbing , Luo Yiqin , Zou Zehong , Wei Shushan , Peng Guoyou , Yan Jie , Chen Rongchang , Zhang Qingling , Tao Ailin
Published: April 2019

Multiple studies have addressed the vital role of Nod-like receptor protein 3(NLRP3)/caspase-1/IL-1β signaling in asthma. Yet, the role of NLRP3/caspase-1 in toluene diisocyanate (TDI)-induced asthma is still obscure. The aim of this study is to investigate the role of the NLRP3/caspase-1 axis in TDI-induced asthma. Using an established murine model of TDI-induced asthma as described previously, we gave the asthmatic mice a highly selective NLRP3 inhibitor, MCC950, as well as the specific caspase-1 inhibitors VX-765 and Ac-YVAD-CHO for therapeutic purposes. Airway resistance was measured and bronchoalveolar lavage fluid was analyzed. Lungs were examined by histology, immunohistochemistry, Western blotting, and flow cytometry. TDI exposure elevated the expression of NLRP3 and caspase-1 that was coupled with increased airway hyperresponsiveness (AHR), neutrophil-dominated cell infiltration, pronounced goblet cell metaplasia, extensive collagen deposition, and increased TH2/TH17 responses. Both VX-765 and Ac-YVAD-CHO effectively inhibited the activation of caspase-1 in TDI-asthmatic mice that was accompanied by dramatic attenuation of AHR, airway inflammation, and airway remodeling, in addition to a decreased TH2 response and lower levels of IL-18 and IL-1β. MCC950 blocked the activation of NLRP3 and downregulated protein expression of caspase-1, IL-1β, and IL-18 in TDI-exposed mice. Furthermore, MCC950 remarkably alleviated AHR, airway inflammation, airway remodeling, and significantly suppressed TH2/TH17 responses. These findings suggested that blockade of the NLRP3/caspase-1 axis effectively prevents the progression of TDI-induced asthma and could be used as therapeutic targets for asthmatics.
International transferability of macro-level safety performance functions: a case study of the United States and Italy
Authors: Lee Jaeyoung , Abdel-Aty Mohamed , de Blasiis Maria Rosaria , Wang Xuesong , Mattei Ilaria
Published: April 2019

Safety performance functions (SPFs), or crash-prediction models, have played an important role in identifying the factors contributing to crashes, predicting crash counts and identifying hotspots. Since a great deal of time and effort is needed to estimate an SPF, previous studies have sought to determine the transferability of particular SPFs; that is, the extent to which they can be applied to data from other regions. Although many efforts have been made to examine micro-level SPF transferability, few studies have focused on macro-level SPF transferability. There has been little transferability analysis of macro-level SPFs in the international context, especially between western countries. This study therefore evaluates the transferability of SPFs for several states in the USA (Illinois, Florida and Colorado) and for Italy. The SPFs were developed using data from counties in the United States and provincias in Italy, and the results revealed multiple common significant variables between the two countries. Transferability indexes were then calculated between the SPFs. These showed that the Italy SPFs for total crashes and bicycle crashes were transferable to US data after calibration factors were applied, whereas the US SPFs for total and bicycle crashes, with the exception of the Colorado SPF, could not be transferred to the Italian data. On the other hand, none of the pedestrian SPFs developed was transferable to other countries. This paper provides insights into the applicability of macro-level SPFs between the USA and Italy, and shows a good potential for international SPF transferability. Nevertheless, further investigation is needed of SPF transferability between a wider range of countries.
Field Infection of Virus-Free Sugarcane by Sugarcane Yellow Leaf Virus and Effect of Yellow Leaf on Sugarcane Grown on Organic and on Mineral Soils in Florida
Authors: Boukari Wardatou , Kaye Claudia , Wei Chunyan , Hincapie Martha , LaBorde Chris , Irey Michael , Rott Philippe
Published: April 2019

Sugarcane yellow leaf virus (SCYLV), the causal agent of yellow leaf, is widespread in Florida. Two field trials were set up, one on organic soil and one on mineral soil, to investigate the rate and timing of sugarcane infection by SCYLV under field conditions and the effect of the virus on yield. Each trial consisted of plots planted with healthy or SCYLV-infected seed cane of two commercial cultivars. Virus prevalence varied from 83 to 100% in plots planted with infected seed cane regardless of cultivar, location, and crop season. On organic soil, plants of virus-free plots became progressively infected in plant cane and first ratoon crops. On mineral soil, healthy sugarcane became initially infected in the first ratoon crop. After three crop seasons, the highest SCYLV prevalence rates were 33 and 7% on organic and mineral soils, respectively. No significant negative effect of SCYLV on yield was found in plant cane crop regardless of cultivar and soil type. However, yield reductions in ratoon crops varied from nonsignificant to 27% depending on cultivar and soil type. Low virus prevalence observed after three crop seasons suggested that planting virus-free seed cane should limit the impact of SCYLV on sugarcane production in Florida.
Proteomic and Metabolomic Analyses of Xylella fastidiosa OMV-Enriched Fractions Reveal Association with Virulence Factors and Signaling Molecules of the DSF Family
Authors: Feitosa-Junior Oséias R. , Stefanello Eliezer , Zaini Paulo A. , Nascimento Rafael , Pierry Paulo M. , Dandekar Abhaya M. , Lindow Steven E. , da Silva Aline M.
Published: April 2019

Xylella fastidiosa releases outer membrane vesicles (OMVs) known to play a role in the systemic dissemination of this pathogen. OMVs inhibit bacterial attachment to xylem wall and traffic lipases/esterases that act on the degradation of plant cell wall. Here, we extended the characterization of X. fastidiosa OMVs by identifying proteins and metabolites potentially associated with OMVs produced by Temecula1, a Pierce’s disease strain, and by 9a5c and Fb7, two citrus variegated chlorosis strains. These results strengthen that one of the OMVs multiple functions is to carry determinants of virulence, such as lipases/esterases, adhesins, proteases, porins, and a pectin lyase-like protein. For the first time, we show that the two citrus variegated chlorosis strains produce X. fastidiosa diffusible signaling factor 2 (DSF2) and citrus variegated chlorosis-DSF (likewise, Temecula1) and most importantly, that these compounds of the DSF (X. fastidiosa DSF) family are associated with OMV-enriched fractions. Altogether, our findings widen the potential functions of X. fastidiosa OMVs in intercellular signaling and host–pathogen interactions.
Analysis of Pyricularia oryzae and P. grisea from Different Hosts Based on Multilocus Phylogeny and Pathogenicity Associated with Host Preference in China
Authors: Qi Hexing , Yang Jun , Yin Changfa , Zhao Jian , Ren Xianxian , Jia Shishuang , Zhang Guozhen
Published: April 2019

Pyricularia oryzae and P. grisea are important agents of major diseases on a wide range of gramineous hosts. Whereas P. oryzae is the most important pathogen causing outbreaks of rice blast, P. grisea is mainly a pathogen of crabgrass. In this study, 103 P. oryzae and 20 P. grisea isolates were collected from seven species of plants, and we analyzed their phylogeny, pathogenicity, and relationship with host preferences to investigate the differences among them from different hosts. Based on phylogenetic analysis of multilocus sequences, 16 isolates from crabgrass and four isolates from green bristlegrass were identified as P. grisea and another 103 isolates from crabgrass, green bristlegrass, goose grass, foxtail millet, wild millet, rice, and sedge belonged to P. oryzae. Results of pathogenicity tests by artificial inoculation demonstrated that six of 10 P. oryzae isolates from rice and three of 44 P. oryzae isolates from green bristlegrass showed cross-infectivity on green bristlegrass and rice, respectively. Taken together, our results demonstrated that isolates from green bristlegrass and crabgrass consist of both P. oryzae and P. grisea and that P. oryzae isolates showed cross-infectivity between rice and green bristlegrass, suggesting that host shifts may occur for P. oryzae and P. grisea.
Knowing Your Personal Brand: What Academics Can Learn From Marketing 101
Authors: Borman-Shoap Emily , Li Su-Ting T. , St Clair Nicole E. , Rosenbluth Glenn , Pitt Susan , Pitt Michael B.
Published: April 2019

Academic departments are increasingly borrowing from the business world as they encourage faculty members to consider their personal mission, vision, and values statements in crafting their plans for engagement and advancement. Business organizations have long known that although doing the work necessary to refine these internal guideposts is important, failing to understand what consumers actually perceive about their product is detrimental. In the business world, perception is reality, and understanding the external shorthand of what consumers perceive—that is, the brand—is essential. Academic clinicians have a brand whether they take ownership of it or not. A faculty member’s brand is both what their work (academic products) and how they do their work say about them to those who encounter it. In this Perspective, the authors explore the brand framework informed by marketing literature, and they outline a four-step process for faculty members to identify their own personal brands. The authors share how knowing one’s academic brand can (1) help faculty members approach projects and other responsibilities through the lens of building or detracting from that brand, (2) provide a framework for determining how faculty members might best work within their institutions, and (3) help faculty members better understand and advocate their own engagement and advancement. The authors also share a paradigm for finding one’s brand sweet spot at the intersection of passion, skill, and institutional need, and they propose how working outside of this sweet spot is a setup for failure.
The Population Health Value Framework: Creating Value by Reducing Costs of Care for Patient Subpopulations With Chronic Conditions
Authors: Gupta Reshma , Roh Lily , Lee Connie , Reuben David , Naeim Arash , Wilson James , Skootsky Samuel A.
Published: April 2019

Problem

With the growth in risk-based and accountable care organization contracts, creating value by redesigning care to reduce costs and improve outcomes and the patient experience has become an urgent priority for health care systems.

Approach

In 2016, UCLA (University of California, Los Angeles) Health implemented a system-wide population health approach to identify patient populations with high expenses and promote proactive, value-based care. The authors created the Patient Health Value framework to guide value creation: (1) identify patient populations with high expenses and reasons for spending, (2) create design teams to understand the patient story, (3) create custom analytics and spending-based risk stratification, and (4) develop care pathways based on spending risk tiers. Primary care patients with three chronic conditions—dementia, chronic kidney disease (CKD), and cancer—were identified as high-cost subpopulations.

Outcomes

For each patient subpopulation, a multispecialty, multidisciplinary design team identified reasons for spending and created care pathways to meet patient needs according to spending risk. Larger, lower-risk cohorts received necessary but less intensive interventions, while smaller, higher-risk cohorts received more intensive interventions. Preliminary analyses showed a 1% monthly decrease in inpatient bed day utilization among dementia patients (incident rate ratio [IRR] 0.99, P < .03) and a 2% monthly decrease in hospitalizations (IRR 0.98, P < .001) among CKD patients.

Next Steps

Use of the Patient Health Value framework is expanding across other high-cost subpopulations with chronic conditions. UCLA Health is using the framework to organize care across specialties, build capacity, and grow a culture for value.
One Size Does Not Fit All: Balancing Individual and System Needs in Primary Care and Beyond
Authors: Whitehead Cynthia , Paradis Elise
Published: April 2019

In this issue, Dewan and Norcini invite readers to reconsider the basic minimum standards for independent primary care practice. Their willingness to push boundaries, question turf wars, and suggest innovative ways forward is laudable. Although their piece is timely and provocative, it does not fully consider the interplay between individual and system factors that influence people to pursue different kinds of degrees and practice in this context. In this Invited Commentary, the authors discuss imperatives that are underacknowledged by Dewan and Norcini: the importance of diversity in health system planning; status, power, and privilege; the extension of their argument beyond primary care; the conflation of time in training with competence; and important issues of distribution of health care resources. Ultimately, the authors argue that there may be strength in diversity, one that should not be obscured by attempts to normalize training time.
Patient Factors Affecting Emergency Department Utilization and Hospital Readmission Rates After Primary Anterior Cervical Discectomy and Fusion
Authors: Sheha Evan D. , Salzmann Stephan N. , Khormaee Sariah , Yang Jingyan , Girardi Federico P. , Cammisa Frank P. , Sama Andrew A. , Lyman Stephen , Hughes Alexander P.
Published: April 2019

Study Design.

Retrospective database analysis.

Objective.

To identify preoperative risk factors for emergency department (ED) visit and unplanned hospital readmission after primary anterior cervical discectomy and fusion (ACDF) at 30 and 90 days.

Summary of Background Data.

Limited data exist to identify factors associated with ED visit or readmission after primary ACDF within the first 3 months following surgery.

Methods.

Patients undergoing ACDF from 2005 to 2012 were identified in the Statewide Planning and Research Cooperative System database. Multivariable regression models were created based on patient-level and surgical characteristics to identify independent risk factors for hospital revisit.

Results.

Of 41,813 patients identified, 2514 (6.0%) returned to the ED within 30 days of discharge. Risk factors included age < 35, black race (OR 1.19), Charlson Comorbidity index score > 1, length of stay (LOS) greater than 1 day (OR 1.23), and fusion of > 2 levels (OR 1.17). Four thousand six hundred nine (11.0%) patients returned to the ED within 90 days. Risk factors mirrored those at 30 days. Patients having private insurance or those discharged to rehab were less likely to present to the ED. One thousand three hundred ninety-four (3.3%) patients were readmitted by 30 days. Risk factors included male sex, Medicare, or Medicaid insurance (OR 1.71 and 1.79 respectively), Charlson comorbidity index > 1, discharge to a skilled nursing facility (OR 2.90), infectious/pathologic (OR 3.296), or traumatic (OR 1.409) surgical indication, LOS > 1 day (OR 1.66), or in-hospital complication. 2223 (5.3%) patients were readmitted by 90 days. Risk factors mirrored those at 30 days. No differences in readmission were seen based on race or number of levels fused. Patients aged 18 to 34 were less likely to be readmitted versus patients older than 35.

Conclusion.

Insurance status, comorbidities, and LOS consistently predicted an unplanned hospital visit at 30 and 90 days. Although nondegenerative surgical indications and in-hospital complications did not predict ED visits, these factors increased the risk for readmission.

Level of Evidence: 3
Epidemiology, Tumor Characteristics, and Survival in Patients With Primary Pancreatic Lymphoma
Authors: Mukhija Dhruvika , Nagpal Sajan Jiv Singh , Sohal Davendra P.S.
Published: April 2019

Introduction:

Primary pancreatic lymphoma (PPL) is an extranodal manifestation of non-Hodgkin lymphoma originating in the pancreas, which constitutes <1% of all pancreatic neoplasms. Because of the rarity of the disease, most data on PPL are derived from case reports and small case series. To provide better insight into the epidemiology, treatment, and outcomes of these patients, we conducted an analysis of patients with PPL from the Surveillance, Epidemiology and End Results (SEER) database, which is presented in this study.

Methods:

Patients with PPL were identified using the International Classification of Disease for Oncology, third edition histology codes for lymphoma (9590/3-9734/3), with pancreas (C25.0-C25.9) listed as the primary disease site. We collected data on patient demographics, year of diagnosis, primary tumor site, histology, first line of treatment received, and survival until death or last follow-up for the period 1973-2014.

Results:

Overall, 835 patients were included. The median (range) age of the study population was 67 (2 to 98) years. The median (95% confidence interval) overall survival for the cohort was 53 (37 to 73) months. On univariable analyses, age, stage, and use of chemotherapy were statistically associated with improved overall survival. Besides these factors, white race was associated with improved cause-specific survival on multivariable analysis.

Conclusions:

This large population-based series describes PPL in detail. Younger age, white race, early stage, and initial treatment with chemotherapy are associated with improved survival in patients with PPL.
Extramedullary Hematopoiesis: An Unusual Finding in Angiolymphoid Hyperplasia With Eosinophilia
Authors: Johnson Nathan M. , Thomas Raj J. , Grider Douglas J.
Published: April 2019

Extramedullary hematopoiesis is the process of blood cell synthesis occurring outside the medulla of the bone marrow. During fetal development, extramedullary hematopoiesis is considered physiological; however, it is considered pathologic when occurring outside the neonatal period. Angiolymphoid hyperplasia with eosinophilia (ALHE) describes a lesion characterized histologically by plump endothelial cells associated with a mixed inflammatory infiltrate of lymphocytes, plasma cells, mast cells, and eosinophils. This report describes an adolescent boy with an isolated preauricular facial lesion. After excision, histopathology confirmed a diagnosis of ALHE with the additional finding of trilineage extramedullary hematopoiesis. To the authors' knowledge, this is the first reported case of extramedullary hematopoiesis in ALHE.
Impact of Prenatal Selective Serotonin Reuptake Inhibitor Antidepressant Exposure and Maternal Mood on Physical Activity, Dietary Intake, and Markers of Adiposity at Age 6 Years
Authors: Hutchison Sarah M. , Mâsse Louise C. , Glier Melissa B. , Brain Ursula , Devlin Angela M. , Oberlander Tim F.
Published: April 2019

Objective:

This study assessed associations between maternal depressive symptoms, prenatal maternal antidepressant treatment, maternal estimates of child physical activity (PA), dietary total intake, and markers of adiposity.

Methods:

Mothers and their children (N = 116) were part of a longitudinal cohort study examining the effects of prenatal exposure to selective serotonin reuptake inhibitor (SSRI) antidepressants and maternal depression (SSRI exposed, n = 42; nonexposed, n = 74). Maternal depression symptoms were assessed prenatally and postnatally. At 6 years, PA was assessed using maternal report, 3-day dietary total intakes were obtained using objective records of intake, portion sizes, and product brand names, and birth weight, weight, height, and waist circumference (WC) at age 6 years were also collected. Body mass index (BMI) and WC z-scores standardized for sex and age were computed as markers of adiposity.

Results:

Children with SSRI exposure had lower levels of PA than children without SSRI exposure. Total dietary energy intakes did not vary between exposure groups. SSRI exposure was not associated with BMI or WC z-scores of the children. Importantly, although lower birth weight was observed in SSRI-exposed children, differences did not remain, accounting for gestational age.

Conclusion:

Although SSRI exposure was associated with lower estimates of PA, such exposure was not associated with markers of adiposity or total diet energy intake at age 6 years. The implications across subsequent measures in childhood remain to be determined.
Teaching Nurses From a Holistic Comfort Perspective
Authors: Bice April A. , Bramlett Traci
Published: April 2019

Nursing students in various degree programs experience an array of stressful and demanding circumstances. As such, nursing faculty have a unique opportunity to provide student-centered teaching from a holistic comfort perspective. Holistic comfort is a concept supported by evidence symbolizing more than just the relief of pain. It involves caring for the whole person. The majority of research surrounding holistic comfort has been focused on patients—but, what about students in nursing? In this article, the authors aim to explain and expand upon the role of teaching from a holistic comfort perspective. Holistic comfort has been well documented in the literature and it is delivered in one (or more) of 4 different contexts: the physical, psychospiritual, sociocultural, and/or environmental context. Implementing a program of teaching focused on comforting students has implications for nursing education, organizational policy, and nursing practice.
Endothelin-1 Concentration in Aqueous Humor Predicts Postoperative Late Low Intraocular Pressure in Primary Open-angle Glaucoma After Trabeculectomy
Authors: Liu Yuejun , Han Bing , Li Fang , Liu Hui
Published: April 2019

Background:

This study aimed to evaluate the potential risk factors for postoperative late low intraocular pressure (IOP) in patients with primary open-angle glaucoma (POAG) after trabeculectomy.

Materials and Methods:

Adult patients who were diagnosed with POAG and scheduled to undergo primary unilateral trabeculectomy in our hospital were consecutively included. Blood samples before the surgery and aqueous humor samples during the surgery of each participant were collected. Patient demographics, preoperative assessments, and laboratory tests were compared in patients with or without late low IOP. The risk factors for late low IOP were evaluated using logistic regression modeling. The predictive value of endothelin-1 (ET-1) in aqueous humor for late low IOP was evaluated by receiver operating characteristic curve analysis.

Results:

Thirty-nine of 222 enrolled patients were cases of late low IOP with an incidence of 17.6% (39/222). The multivariate logistic regression analysis indicated that ET-1 concentration in aqueous humor was the only independent risk factor for late low IOP after trabeculectomy (odds ratio, 0.89; 95% confidence interval, 0.79-0.98; P=0.021). Receiver operating characteristic curve analysis showed that ET-1 concentration in aqueous humor was a predictor for late low IOP after trabeculectomy with an area under the curve of 0.639, a specificity of 84.62%, and a sensitivity of 39.89%, respectively (P=0.006).

Conclusions:

Our study indicated that ET-1 concentration in aqueous humor was an independent risk factor for late low IOP in patients with POAG after trabeculectomy.
The Outcomes of a Comprehensive Program for Maintenance of Goldmann Applanation Tonometer
Authors: Choudhari Nikhil S. , Richhariya Ashutosh , Wadke Vidya , Deshmukh Sanket P. , George Ronnie , Senthil Sirisha , Chandra Sekhar Garudadri
Published: April 2019

Precis:

We checked 190 tonometers every month and repaired faulty ones. Calibration error (CE) frequency reduced from 23% to 0.6% at 1 year. Tonometers needing one or >1 CE repair differed in survival but not in age.

Purpose:

The purpose of this study was to report the outcomes of a comprehensive program to maintain calibration status of the Goldmann applanation tonometer.

Methods:

This prospective cohort study was carried out at 2 tertiary eye care referral centers. We included 190 slit-lamp mounted Goldmann applanation tonometers (Model AT 900 C/M). Health care providers (error checking and reporting) and clinical engineers (maintenance) participated. The team carried out CE check once a month, and repair of faulty tonometers, if any, within 24 hours. Failure of tonometer was defined as development of unacceptable CE beyond the third repair. The main outcome measures were the frequency of CE and survival function of the tonometer over 1 year.

Results:

The median age of the tonometers was 10.7 (range, 0.2 to 25.1) years. The total number of repairs was 86. The proportion (95% confidence interval) of faulty tonometers reduced from 23.1% (17.7, 29.6) in the first month to 0.6% (0.1, 3.3) at 1 year (P<0.01). The median age of the tonometer did not differ between those needing (n=63, 9.4 y) and not needing (n=127, 10.7 y; P=0.24) repair. All tonometers requiring 1 CE repair (n=49, 25.7%) survived until 1 year. The survival of tonometers requiring >1 CE repair (n=14, 7.3%) was 40% at 1 year.

Conclusions:

Our in-house program maintained 92.6% tonometers error free. Number of repairs rather than age determined the need for replacement/sending back the tonometer to the manufacturer. Our simple and easy to follow maintenance program has the potential for wide application.
Overuse and Underuse of Visual Field Testing Over 15 Years
Authors: Ben-Artsi Elad , Goldenfeld Modi , Zehavi-Dorin Tzukit , Cohen Asaf , Porath Avi , Levkovitch-Verbin Hani
Published: April 2019

Précis:

A 15-year analysis of 198,843 visual field (VF) tests revealed a growing trend for their performance for nonglaucoma indications. Adherence to glaucoma management guidelines was suboptimal. Guidelines for referral to VF assessments should be established.

Purpose:

The purpose of this study was to identify trends in VF assessments over 15 years among patients with and without suspected or confirmed glaucoma, in a large healthcare maintenance organization.

Methods:

This was a population-based retrospective cohort study, conducted by means of electronic medical database analyses. Study population: Maccabi Healthcare Services is an healthcare maintenance organization that insures 2 million members constituting 25% of the population. All members who underwent at least 1 VF test between January 2000 and December 2014 were included. In addition, all members with glaucoma or suspected glaucoma diagnosis or who were prescribed with antiglaucoma medications were evaluated. Main outcome measures: VF performance rates.

Results:

A total of 93,617 Maccabi Healthcare Services members underwent 198,843 VF tests; of whom 47.9% involved patients without any glaucoma-related conditions. There was a growing trend over time toward more of those members to undergo VF tests and, by 2014, non–glaucoma-related members comprised 74.0% of new VF assessments. In contrast, 32.3% of glaucoma-related patients did not perform even 1 VF test throughout the entire study period. Although over 2 years (25.95±6.33 mo) passed between the first glaucoma-related diagnosis and first VF test, once a patient underwent the first VF test, an average once-a-year VF follow-up (0.95±0.37 annual tests) began.

Conclusion:

There is a growing trend for VF tests being apparently overused for indications other than glaucoma. Concurrently, adherence to glaucoma management guidelines on VF tests is suboptimal, leading to discernible underuse. Guidelines for VF assessments in nonglaucoma patients should be established. Adherence to existing glaucoma management guidelines should be improved.
Patients' Intensive Telephone-Based Care Program Reduces Depression in Coronary Artery Disease Patients and May Contribute to Favorable Overall Survival by Decreasing Depression
Authors: Yang Lanju , Wang Xuemei , Cui Xiaoning
Published: April 2019

Objective:

The aim of this study was to investigate the effectiveness of patients' intensive telephone-based care program (PITC) on depression and its correlation with overall survival in patients with coronary artery disease who have depression.

Methods:

A total of 224 patients with coronary artery disease who were complicated with depression were allocated randomly to the PITC group and control group in a 1:1 ratio. In the PITC group, PITC and usual care were performed, whereas in the control group, only usual care was given. Depression was assessed using Hospital Anxiety and Depression Scale–Depression (HADS-D) score and Zung Self-Rating Depression Scale (SDS) score.

Results:

No difference in baseline characteristics was found between the PITC and control groups (all P > .05). There were changes the HADS-D score (P = .002) and SDS score (P = .019) from baseline (M0) to month 12 (M12) in the PITC group. Those in the PITC group had a reduced depression rate (assessed by HADS-D score <8 at month 12) (P = .005). As for overall survival analysis, Kaplan-Meier curves revealed that overall survival was numerically longer in the PITC group compared with the control group but displayed no statistical significance (P = .061), whereas patients without depression at month 12 presented with better overall survival compared with patients with depression at month 12, as assessed by HADS-D (P = .041) or SDS (P = .014).

Conclusions:

A PITC could serve as an effective means to decrease depression, and it might contribute to favorable overall survival by decreasing depression in patients with coronary artery disease.
Gastrointestinal Bleeding After HeartMate II or HVAD Implantation: Incidence, Location, Etiology, and Effect on Survival
Authors: Kawabori Masashi , Kurihara Chitaru , Critsinelis Andre C. , Sugiura Tadahisa , Kaku Yuji , Civitello Andrew B. , Rosengart Todd K. , Morgan Jeffrey A.
Published: April 2019

The number of patients on destination therapy is increasing as long-term survival on continuous-flow left ventricular assist device (CF-LVAD) therapy has improved. Gastrointestinal bleeding (GIB) is a common complication after CF-LVAD implantation, and its risk correlates with longer support time, emphasizing the importance of GIB management. The lower pulsatility of CF-LVADs may promote arteriovenous malformations, which amplify the bleeding risk. Here, we retrospectively analyzed the location, incidence, and survival effect of GIB events in HeartMate II (HM-II) and HeartWare Ventricular Assist Device (HVAD) recipients to provide specific details regarding these complications. From November 2003 to March 2016, 526 patients with chronic heart failure underwent primary implantation of an HM-II (n = 403) or HVAD (n = 123) CF-LVAD at our center. Of the 526 patients, 140 (26.6%) had a GIB event (HM-II: n = 100; HVAD: n = 40), 92 (17.5%) had a single GIB event, and 48 (9.1%) had multiple GIB events (range: 2–9 events). HVAD recipients had a higher incidence of both upper and lower GIB events (p < 0.001 and P = 0.002, respectively) than HM-II recipients. Arteriovenous malformation was the most common etiology for GIB (50 patients/72 events); for this group, the average time-to-event was 300.4 days, the recurrence rate was 34%, and the 90-day and 1-year survival rates were 88.3% and 66.7%, respectively. Age at implantation was the only predictor of GIB. In conclusion, our study provides detailed information about GIB events associated with current CF-LVADs. Additional studies are required to evaluate strategies to reduce the incidence of GIB morbidity.
Medicaid Expansion at Title X Clinics
Authors: Boudreaux Michel , Choi Yoon Sun , Xie Liyang , Marthey Daniel
Published: April 2019

Background:

Title X supports access to family planning and preventive care services. Given its focus on low-income clients, Title X clinics may have been particularly affected by the Affordable Care Act’s Medicaid expansion.

Objectives:

To examine the impact of the Affordable Care Act’s Medicaid expansion on Title X client volumes, health insurance coverage, and contraceptive method mix.

Research Design:

A difference-in-differences design compared changes in the outcomes of interest before and after expansion, for expansion versus nonexpansion states.

Subjects:

Administrative data from Family Planning Annual Reports that describe Title X clients who sought services.

Measures:

Female client volume was measured using a participation ratio defined as the number of female clients per 100 women aged 15–44 with incomes <250% of the federal poverty line. We also examined the share of clients by insurance type and contraceptive method type.

Results:

We did not find evidence that expansion was related to changes in client volume. We did find a significant 9.9 percentage point increase in the share of clients with Medicaid and a significant 10.0 percentage point decrease in the share of clients without coverage. We found suggestive evidence that expansion was associated with increased use of long-acting reversible contraceptives, but those results were somewhat sensitive to model specification.

Conclusions:

Expansion was associated with meaningful increases in Medicaid coverage at Title X clinics and declines in uninsurance. Our results have important implications for the financial stability of Title X clinics in light of historical declines in Title X grant revenues.
Home visits by occupational therapists in acute hospital care: a systematic review
Authors: Fukumoto Miki , Watanabe Tomomi , Yasufuku Yuichi , Furudate Ken , Momosaki Ryo
Published: April 2019

The aim of this review was to determine the utility of home visits by occupational therapists before and after a patient is discharged from an acute care hospital. All relevant published studies were identified by searching the CENTRAL, MEDLINE, EMBASE, Occupational Therapy Systematic Evaluation of Evidence, and WHO International Clinical Trials Registry Platform databases. Randomized controlled trials were included regardless of sex, age, disease, and duration of acute hospitalization. The intervention was predischarge and postdischarge home visits made by an occupational therapist. The primary outcome was the ability to perform activities of daily living at 1 month after the intervention. We identified eight trials (including 1029 patients) that were eligible for inclusion. More than half of the trials had a low risk of bias in random sequence generation, and allocation concealment and the other half had a high risk of bias with regard to blinding of participants. However, the risk of bias in terms of blinding for outcomes assessment was low in more than half the studies. We found that home visits by an occupational therapist in a single study significantly reduced the prevalence of falls but had no significant effects on ability to perform activities of daily living, quality of life, or mood. We could not find adequate evidence to support routine home visits by an occupational therapist in the acute care. In the future, studies with larger sample sizes are needed to validate home visits by occupational therapists in patients after acute care hospitalization.
Composite Lymphoma Containing Mantle Cell and Peripheral T-cell Lymphoma, Not Otherwise Specified: A Report of 2 Cases Treated With Up-front Autologous Stem Cell Transplantation
Authors: González-Gascón y Marín Isabel , Menarguez Javier , Kwon Mi , Burdaspal Ana , Martínez-Laperche Carolina , Castro Yolanda , Infante María Stefania , Díez-Martín José-Luis , Hernández-Rivas José-Ángel
Published: April 2019

We report 2 cases of composite lymphoma comprising mantle cell lymphoma and peripheral T-cell lymphoma, not otherwise specified, a rare association that has only been reported twice in the literature. In case 1, a 64-year-old woman presented with massive splenomegaly and lymphadenopathy. Immunohistochemical studies of the lymph node biopsy suggested the presence of 2 lymphomas, a predominant component of a peripheral T-cell lymphoma, not otherwise specified and an in situ mantle cell neoplasia. These suspicions were confirmed with polymerase chain reaction and fluorescence in situ hybridization studies. In case 2, a 45-year-old man presented with an enlarged right tonsil. Contrary to case 1, the biopsy suggested a predominant infiltration of a classical mantle cell lymphoma and an atypical proliferation of T cells. Biclonality was also confirmed with fluorescence in situ hybridization and molecular techniques. Both cases were treated with an up-front autologous stem cell transplantation after achieving first complete remission, and they remained free of disease for a long period of time.
Multiple Abusive Fractures in an Infant With a Concurrent Parathyroid Hormone–Related Peptide–Secreting Renal Tumor
Authors: Keblawi Samir S. , Wright Jason N. , Otjen Jeffrey P. , Verma Arushi , Brown Emily C. , Ness Kate D. , Feldman Kenneth W.
Published: April 2019

Background

When evaluating an infant with unexplained fractures for child abuse, it is important to evaluate for possible causes of underlying bone fragility.

Case

A 7-month-old infant was found to have a parathyroid hormone (PTH)–related peptide–secreting mesoblastic nephroma. In spite of having an elevated serum calcium, depressed serum phosphate, and high levels of PTH-related peptide, he had no demineralization or other hyper parathyroid–related bone changes. Instead, he had multiple classic metaphyseal lesions, fractures of differing ages including a proximal clavicle fracture, and current and past bruising. No fractures typical of bone insufficiency were present. These findings are highly indicative of abuse in addition to his hormone-secreting tumor.

Conclusions

In spite of this child's abuse findings, endogenous or tumor-related hyper PTH should be in the differential of underlying bone fragility. Children with disorders that could cause injury susceptibility can also be abused.