bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementation and Operational Research: Impact of a Systems Engineering Intervention on PMTCT Service Delivery in Côte d'Ivoire, Kenya, Mozambique: A Cluster Randomized Trial
Authors: Rustagi Alison Silvis , Gimbel Sarah , Nduati Ruth , Cuembelo Maria de Fatima , Wasserheit Judith N. , Farquhar Carey , Gloyd Stephen , Sherr Kenneth ,   with input from the SAIA Study Team
Published: April 2016

Background:
Efficacious interventions to prevent mother-to-child HIV transmission (PMTCT) have not translated well into effective programs. Previous studies of systems engineering applications to PMTCT lacked comparison groups or randomization.

Methods:
Thirty-six health facilities in Côte d'Ivoire, Kenya, and Mozambique were randomized to usual care or a systems engineering intervention, stratified by country and volume. The intervention guided facility staff to iteratively identify and then rectify barriers to PMTCT implementation. Registry data quantified coverage of HIV testing during first antenatal care visit, antiretrovirals (ARVs) for HIV-positive pregnant women, and screening HIV-exposed infants (HEI) for HIV by 6–8 weeks. We compared the change between baseline (January 2013–January 2014) and postintervention (January 2015–March 2015) periods using t-tests. All analyses were intent-to-treat.

Results:
ARV coverage increased 3-fold [+13.3% points (95% CI: 0.5 to 26.0) in intervention vs. +4.1 (−12.6 to 20.7) in control facilities] and HEI screening increased 17-fold [+11.6 (−2.6 to 25.7) in intervention vs. +0.7 (−12.9 to 14.4) in control facilities]. In prespecified subgroup analyses, ARV coverage increased significantly in Kenya [+20.9 (−3.1 to 44.9) in intervention vs. −21.2 (−52.7 to 10.4) in controls; P = 0.02]. HEI screening increased significantly in Mozambique [+23.1 (10.3 to 35.8) in intervention vs. +3.7 (−13.1 to 20.6) in controls; P = 0.04]. HIV testing did not differ significantly between arms.

Conclusions:
In this first randomized trial of systems engineering to improve PMTCT, we saw substantially larger improvements in ARV coverage and HEI screening in intervention facilities compared with controls, which were significant in prespecified subgroups. Systems engineering could strengthen PMTCT service delivery and protect infants from HIV.
Contributions of the Musculus Uvulae to Velopharyngeal Closure Quantified With a 3-Dimensional Multimuscle Computational Model
Authors: Inouye Joshua M. , Lin Kant Y. , Perry Jamie L. , Blemker Silvia S. 
Published: April 2016

Abstract
The convexity of the dorsal surface of the velum is critical for normal velopharyngeal (VP) function and is largely attributed to the levator veli palatini (LVP) and musculus uvulae (MU). Studies have correlated a concave or flat nasal velar surface to symptoms of VP dysfunction including hypernasality and nasal air emission. In the context of surgical repair of cleft palates, the MU has been given relatively little attention in the literature compared with the larger LVP. A greater understanding of the mechanics of the MU will provide insight into understanding the influence of a dysmorphic MU, as seen in cleft palate, as it relates to VP function. The purpose of this study was to quantify the contributions of the MU to VP closure in a computational model. We created a novel 3-dimensional (3D) finite element model of the VP mechanism from magnetic resonance imaging data collected from an individual with healthy noncleft VP anatomy. The model components included the velum, posterior pharyngeal wall (PPW), LVP, and MU. Simulations were based on the muscle and soft tissue mechanical properties from the literature. We found that, similar to previous hypotheses, the MU acts as (i) a space-occupying structure and (ii) a velar extensor. As a space-occupying structure, the MU helps to nearly triple the midline VP contact length. As a velar extensor, the MU acting alone without the LVP decreases the VP distance 62%. Furthermore, activation of the MU decreases the LVP activation required for closure almost 3-fold, from 20% (without MU) to 8% (with MU). Our study suggests that any possible salvaging and anatomical reconstruction of viable MU tissue in a cleft patient may improve VP closure due to its mechanical function. In the absence or dysfunction of MU tissue, implantation of autologous or engineered tissues at the velar midline, as a possible substitute for the MU, may produce a geometric convexity more favorable to VP closure. In the future, more complex models will provide further insight into optimal surgical reconstruction of the VP musculature in normal and cleft palate populations.
Simulation-Based Assessment of ECMO Clinical Specialists
Authors: Fehr James J. , Shepard Mark , McBride Mary E. , Mehegan Mary , Reddy Kavya , Murray David J. , Boulet John R. 
Published: April 2016

Objective
The aims of the study were (1) to create multiple scenarios that simulate a range of urgent and emergent extracorporeal membrane oxygenation (ECMO) events and (2) to determine whether these scenarios can provide reliable and valid measures of a specialist’s advanced skill in managing ECMO emergencies.

Design
Multiscenario simulation-based performance assessment was performed.

Setting
The study was conducted in the Saigh Pediatric Simulation Center at St. Louis Children’s Hospital.

Subjects
ECMO clinical specialists participated in the study.

Measurements and Main Results
Twenty-five ECMO specialists completed 8 scenarios presenting acute events in simulated ECMO patients. Participants were evaluated by 2 separate reviewers for completion of key actions and for global performance. The scores were highest for the hemodilution scenario, whereas the air entrainment scenario had the lowest scores. Psychometric analysis demonstrated that ECMO specialists with more than 1 year of experience outperformed the specialists with less than 1 year of experience. Participants endorsed these sessions as important and representative of events that might be encountered in practice.

Conclusions
The scenarios could serve as a component of an ECMO education curriculum and be used to assess clinical specialists’ readiness to manage ECMO emergencies.
Laparoscopic Versus Open Adhesiolysis for Small Bowel Obstruction: A Single-Center Retrospective Case-Control Study
Authors: Lin Hao , Li Jiante , Xie Zhiyuan , Zhang Wentao , Lv Xiaopeng 
Published: April 2016

Aim:
This study is to investigate the short-term outcomes of small bowel obstruction (SBO) patients undergoing laparoscopic versus open adhesiolysis.

Patients and Methods:
A total of 202 patients with SBO were enrolled in this study. The patients underwent either laparoscopic (n=101) or open adhesiolysis (n=101). The primary end point was 30-day overall complications and secondary outcomes included major complications such as superficial and deep wound infections, mortality, postoperative length of stay, and operative time.

Results:
There was no statistically significant difference in the demographic parameters between laparoscopic and open adhesiolysis populations. The mean operative time for laparoscopic adhesiolysis was significantly less than open adhesiolysis (70±34.2 vs. 101±50.2, P=0.01). Statistically significant differences in flatus day (3.5±1.2 vs. 4.5±1.8, P=0.035) and postoperative hospital stay (6.4±2.1 vs. 7.2±2.9, P=0.041) were identified in favor of laparoscopic group, whereas the medical expenses for both groups were not different (31012.0±3412.9 vs. 30029.0±3100.9, P>0.05). The overall complications for open and laparoscopic group were 19.8% and 9.9%, respectively (P=0.048). The important factors that led to a significantly lower overall complications rate in laparoscopic group might result from the lower wound (9.9% vs. 2.0%, P=0.017) and infectious (10.9% vs. 3.0%, P=0.027) complications.

Conclusions:
The laparoscopic approach for SBO is feasible because of its fewer complications and hospital stay.
Pelvic Floor Symptoms and Spinal Curvature in Women
Authors: Meyer Isuzu , McArthur Tatum A. , Tang Ying , McKinney Jessica L. , Morgan Sarah L. , Richter Holly E. 
Published: April 2016

Objectives
To characterize the association between thoracic (T) and lumbar (L) spinal curvature and pelvic floor (PF) symptoms (pelvic organ prolapse, urinary incontinence [UI], fecal incontinence [FI]).

Methods
Of women undergoing a bone mineral density scan from January 2007 to October 2010, patients who completed PF symptom questionnaires and had T and/or L spine radiographs or computed tomography examinations within 3 years of questionnaire completion were included in this study. The spine angles were measured using the Cobb angle method. The T and L curvatures were categorized as hypokyphosis (<20°), normal T kyphosis (20–40°), hyperkyphosis (>40°), hypolordosis (<40°), normal L lordosis (40–70°), and hyperlordosis (>70°). The presence and type of UI were identified with the 3 Incontinence Questionnaire and FI with the Modified Manchester Questionnaire. Pelvic organ prolapse was defined as a positive response to the presence of a bulge question from the PF Distress Inventory-20.

Results
Of 1665 eligible women, 824 and 302 (mean age 64 ± 10 for both) had T and L spine images, respectively. No differences in PF symptoms were observed in the T or L spine groups categorized by hypo-, normal, and hyperkyphosis/lordosis except for urgency UI being more prevalent in the hypolordosis group (P = 0.01). However, upon further characterization using logistic regression, no association was noted between PF symptoms and T or L spine angles; no differences in the mean angles were found between women with versus without PF symptoms (P ≥ 0.05).

Conclusions
The current study shows that the T and L spinal curvatures are not associated with the presence of PF symptoms.
Is Occult Stress Urinary Incontinence a Reliable Predictive Marker?
Authors: Manodoro Stefano , Spelzini Federico , Frigerio Matteo , Nicoli Elena , Verri Debora , Milani Rodolfo 
Published: April 2016

Objective
Pelvic reconstructive surgery can be associated to correction, persistence, or onset of stress urinary incontinence. The aim of our study was to evaluate the incidence of stress incontinence (SI) after prolapse repair in 3 groups with different preoperative urodynamic findings and to find out the predictiveness of occult SI.

Methods
Patients undergoing vaginal hysterectomy, uterus-sacral ligament colposuspension, and traditional anterior repair for pelvic prolapse were retrospectively analyzed. No patient underwent any additional anti-incontinence procedure. Preoperative evaluation included clinical history, physical examination, and urodynamic assessment with a pessary reduction test. According to urodynamic findings, women were divided into SI (A), occult SI (B), and continence (C) groups. Primary outcome was to compare the incidence of postoperative SI among groups. Secondary outcome was to assess postoperative quality of life with International Consultation on Incontinence questionnaire-short form questionnaire.

Results
One hundred fifty patients were analyzed (A: n = 30; B: n = 43; C: n = 77). Mean follow-up was 18.4 ± 0.9 months without differences among groups. Patients in group B did not have higher postoperative SI rate compared to group C. There were no differences in International Consultation on Incontinence questionnaire-short form scores in symptomatic women among groups.

Conclusions
In our series, occult stress urinary incontinence is a poor urodynamic marker to predict the development of postoperative SI.
Effect of Supervised Pelvic Floor Biofeedback and Electrical Stimulation in Women With Mixed and Stress Urinary Incontinence
Authors: Richmond Cherrilyn F. , Martin Deanna K. , Yip Sallis O. , Dick Madeline A. , Erekson Elisabeth A. 
Published: April 2016

Objective
The aim of this study was to compare the symptomatic change in urinary symptom distress before and after treatment with pelvic floor biofeedback and electrical stimulation in women with mixed urinary incontinence (MUI) and stress urinary incontinence (SUI).

Methods
We conducted a retrospective cohort study of women who underwent supervised pelvic floor biofeedback therapy and electrostimulation for the treatment of MUI and SUI. Our primary outcome was change in the Urinary Distress Inventory-6 (UDI-6) score before and after therapy.

Results
Overall, a significant drop in UDI-6 score was seen in women with MUI (mean decrease, 29.1 [27.5]; P < 0.001), and a nonsignificant drop was seen in women with SUI (mean decrease, 6.8 [20.3]; P = 0.07) after treatment. Significantly greater change in UDI-6 score from baseline to follow-up was noted in women with MUI compared with those with SUI (P = 0.002).

Conclusions
Women with MUI have greater urinary distress symptoms than women with SUI. Both women with MUI and SUI experienced significant improvement in their urinary distress symptoms after pelvic floor biofeedback and electrostimulation.
New Measures for Predicting Birth-Related Pelvic Floor Trauma
Authors: Rostaminia Ghazaleh , Peck Jennifer D. , Van Delft Kim , Thakar Ranee , Sultan Abdul , Shobeiri S. Abbas 
Published: April 2016

Objectives
The aim of this study was to establish the predictive role of obstetric variables for obstetric outcomes and birth related levator ani muscle (LAM) trauma.

Methods
In this prospective study, women underwent 3-dimensional pelvic floor ultrasound at their first appointment at 36 weeks and also 3 months postpartum. The measurements included minimal levator hiatus circumference (MLHC) and the ratio of fetal head circumference to MLHC = head-induced stretch ratio (HISR) as an indicator of the discrepancy between passage and passing canal. To derive the true impact of baby's mass on the levator ani musculature, we devised the levator ani stretch ratio (LASR), which was calculated by multiplying the HISR and the baby's weight.

Results
Data set of 173 women was available for analysis. Mean HISR and LASR values were statistically different across all binary outcome categories, with 1 exception for HISR and levator ani injury. The odds ratios for LASR indicated positive and statistically significant associations with all obstetric outcomes examined. The probability of the LASR correctly classifying those with the adverse obstetric outcome, as estimated by the area under the curve, ranged from 0.64 to 0.80 with the strongest discriminatory ability observed for severe LAM trauma.

Conclusions
Fetal head circumference/mother MLHC ratio (HISR) is associated with longer length of second stage of labor, assisted delivery, and increased severity of perineal trauma. Similar associations were observed for LASR, but in addition, LASR had good discriminatory ability to identify severe LAM trauma.
Rescue Therapy Using Rituximab for Multiple Sclerosis
Authors: Berenguer-Ruiz Leticia , Sempere Angel P. , Gimenez-Martinez Juana , Gabaldon-Torres Laura , Tahoces Luisa , Sanchez-Perez Rosa , Diaz-Marin Carmen 
Published: April 2016

Objectives
The aim of the study was to describe the effectiveness and safety data of rituximab in a group of patients with relapsing-remitting multiple sclerosis (MS) treated with rituximab due to failure of previous treatments or concomitant autoimmune diseases.

Methods
This is an observational study. Rituximab was considered in case of failure of the second-line therapy, failure of the first-line therapy and a contraindication to second-line therapies, or concomitant autoimmune disease. Relapses, the Expanded Disability Status Scale, the EQ VAS, and magnetic resonance imaging activity were assessed.

Results
This study included 12 patients with relapsing-remitting MS. The mean (range) age of the patients was 35 (19–54) years. Ten patients were treated with rituximab because of treatment failure, and 2 patients were treated with rituximab because of the development of idiopathic thrombocytopenic purpura. The mean (range) follow-up duration after beginning rituximab was 40 (18–72) months. Rituximab was well tolerated, because no patient experienced serious adverse reactions or discontinued treatment. During treatment with rituximab, no patient suffered a clinical relapse, and magnetic resonance imaging activity was not detected. The Expanded Disability Status Scale scores improved in 11 of 12 patients and remained stable in 1 patient. The EuroQol visual analogue scale scores improved in 8 of 9 patients in whom the EuroQol visual analogue scale was assessed.

Conclusions
Treatment with rituximab seems to be safe and effective for some patients with relapsing-remitting MS who have failed to respond to first- and second-line therapies and may also be a useful option for patients with concomitant autoimmune disorders.
Statin Use and Cognitive Impairment in Patients With Type 1 Diabetes: An Observational Study
Authors: Moryś Joanna M. , Kozera Grzegorz M. , Neubauer-Geryk Jolanta , Kruszewski Piotr , Wolnik Bogumił , Nyka Walenty M. , Bieniaszewski Leszek 
Published: April 2016

Objective
We aimed to assess a wide range of cognitive functions in patients with type 1 diabetes (DM1) compared with healthy control subjects and to evaluate the effects of statins on cognitive functions in DM1 patients.

Materials and Methods
The sample studied consisted of 55 DM1 patients (80.0% with hyperlipidemia, 20% with statin treatment) and 36 age-matched control subjects (77.8% with hyperlipidemia) without diabetes or statin use. Their cognitive functions (attention, memory, and executive functions) were evaluated with the trail making test, controlled oral word association test (COWAT), Rey-Osterrieth complex figure test, brain damage test (diagnosticum für cerebralschädigung, DCS), Wisconsin card sorting test (WCST), and digit span and block design tests from the revised Wechsler adult intelligence scale.

Results
Cognitive performance was impaired in DM1 patients when compared with the control group with regard to semantic verbal fluency (COWAT_animals), visual learning (DCS), conceptual-level responses, executive functions (WCST random errors), and WCST trials to complete the first category. Subgroups of DM1 patients distinguished on the basis of statin therapy did not differ with regard to verbal fluency (COWAT_animals), visual learning (DCS), conceptual-level responses, executive functions (WCST random errors), and WCST trials to complete the first category. Multivariate analysis also does not show the impact of statin therapy on cognitive functioning regardless of the duration of education, microangiopathic evidence, the presence of hyperlipidemia, or antihypertensive therapy.

Conclusions
We find impairment of cognitive functions in DM1 patients when compared with control subjects without diabetes. However, we show neither the effect of statins nor the significant influence of metabolic control, microangiopathic complications, or the presence of hyperlipidemia on cognitive functions in DM1 patients.
Exploiting Homeostatic Repopulation to Increase DC Vaccine Efficacy in Multiple Myeloma
Authors: Gatenbee Chandler D. , Folguera-Blasco Núria , Daneils Charlie , Gallaher Jill , Rockne Russell C. , Adams Casey , Nicholson Michael , Maniati Eleni , Kennedy John , Luddy Kimberly , Locke Frederick L. , Robertson-Tessi Mark 
Published: April 2016

AbstractStandard of care for multiple myeloma involves autologous hematopoietic cell transplant (AHCT), which can extend life by a year; however the disease remains incurable. A dendritic cell vaccine developed at Moffitt will be used both immediately before and after AHCT, with the aim of achieving complete response. Data will be collected during the trial to test the biological activity of the vaccine. This data will parameterize a model that facilitates the exploration of outcomes when varying the timing of vaccination. This calibrated model will also inform the design of a follow-up trial, which will include vaccination in conjunction with other immunotherapies.
Mega-analysis of 31,396 individuals from 6 countries uncovers strong gene-environment interaction for human fertility
Authors: Tropf Felix C. , Verweij Renske M. , van der Most Peter J. , Stulp Gert , Bakshi Andrew , Briley Daniel A. , Robinson Matthew , Numan Anastasia , Esko Tõnu , Metspalu Andres , Medland Sarah E. , Martin Nicholas G. , Snieder Harold , Lee S. Hong , Mills Melinda C. 
Published: April 2016

AbstractFamily and twin studies suggest that up to 50% of individual differences in human fertility within a population might be heritable. However, it remains unclear whether the genes associated with fertility outcomes such as number of children ever born (NEB) or age at first birth (AFB) are the same across geographical and historical environments. By not taking this into account, previous genetic studies implicitly assumed that the genetic effects are constant across time and space. We conduct a mega-analysis applying whole genome methods on 31,396 unrelated men and women from six Western countries. Across all individuals and environments, common single-nucleotide polymorphisms (SNPs) explained only ~4% of the variance in NEB and AFB. We then extend these models to test whether genetic effects are shared across different environments or unique to them. For individuals belonging to the same population and demographic cohort (born before or after the 20thcentury fertility decline), SNP-based heritability was almost five times higher at 22% for NEB and 19% for AFB. We also found no evidence suggesting that genetic effects on fertility are shared across time and space. Our findings imply that the environment strongly modifies genetic effects on the tempo and quantum of fertility, that currently ongoing natural selection is heterogeneous across environments, and that gene-environment interactions may partly account for missing heritability in fertility. Future research needs to combine efforts from genetic research and from the social sciences to better understand human fertility.Authors SummaryFertility behavior – such as age at first birth and number of children – varies strongly across historical time and geographical space. Yet, family and twin studies, which suggest that up to 50% of individual differences in fertility are heritable, implicitly assume that the genes important for fertility are the same across both time and space. Using molecular genetic data (SNPs) from over 30,000 unrelated individuals from six different countries, we show that different genes influence fertility in different time periods and different countries, and that the genetic effects consistently related to fertility are presumably small. The fact that genetic effects on fertility appear not to be universal could have tremendous implications for research in the area of reproductive medicine, social science and evolutionary biology alike.