bluuebunny/crossref_metadata_2025_split huggingface dataset:
Detection of Virulence Genes in Enterococci Isolated From the Human Normal Flora by Multiplex-Polymerase Chain Reaction
Authors: Khanmohammadian Shirin , Enayati Mohsen , Sadeghi Javad , Irajian Gholamreza , Amirmozafari Nour , Talebi Malihe 
Published: March 2016

Background

Enterococcus species recently evolved from a common avirulent normal flora into a multidrug–resistant, health care–associated pathogen causing difficult-to-treat diseases. The aim of the current study was the detection of aggregation substance (asa), hyaluronidase (hyl), cytolysin (cyl), enterococcal surface protein (esp), collagen-binding protein (acm), gelatinase (gelE), and Enterococcus faecalis endocarditis antigen genes in Enterococcus faecium isolated from healthy volunteers by the Multiplex-polymerase chain reaction (PCR) method.

Methods
Stool samples were obtained from 24 healthy volunteers. After biochemical and microbiological tests, all isolates were tested for the presence of the virulence genes by Multiplex-PCR.

Results
In total, 91 E. faecium strains were collected from 54 different REP-PCR patterns. The distribution of the virulence genes showed that 33 (36%), 14 (15%), 3 (3%), 1 (1.1%), and 0 isolates were positive for acm, asa, esp, cylA, hyl, and gelE genes, respectively.

Conclusions
Despite the fact that E. faecium isolated from normal human intestines usually shows low incidence of virulence genes, they may act as harbors of virulence factors, allowing the distribution of these genes to the human normal flora through the food chain.
Incremental health care costs for chronic pain in Ontario, Canada: a population-based matched cohort study of adolescents and adults using administrative data
Authors: Hogan Mary-Ellen , Taddio Anna , Katz Joel , Shah Vibhuti , Krahn Murray 
Published: March 2016

Abstract
Little is known about the economic burden of chronic pain and how chronic pain affects health care utilization. We aimed to estimate the annual per-person incremental medical cost and health care utilization for chronic pain in the Ontario population from the perspective of the public payer. We performed a retrospective cohort study using Ontario health care databases and the electronically linked Canadian Community Health Survey (CCHS) from 2000 to 2011. We identified subjects aged ≥12 years from the CCHS with chronic pain and closely matched them to individuals without pain using propensity score matching methods. We used linked data to determine mean 1-year per-person health care costs and utilization for each group and mean incremental cost for chronic pain. All costs are reported in 2014 Canadian dollars. After matching, we had 19,138 pairs of CCHS respondents with and without chronic pain. The average age was 55 years (SD = 18) and 61% were female. The incremental cost to manage chronic pain was $1742 per person (95% confidence interval [CI], $1488-$2020), 51% more than the control group. The largest contributor to the incremental cost was hospitalization ($514; 95% CI, $364-$683). Incremental costs were the highest in those with severe pain ($3960; 95% CI, $3186-$4680) and in those with most activity limitation ($4365; 95% CI, $3631-$5147). The per-person cost to manage chronic pain is substantial and more than 50% higher than a comparable patient without chronic pain. Costs are higher in people with more severe pain and activity limitations.
Food Costs Are Higher in Counties With Poor Health Rankings
Authors: Hardin-Fanning Frances , Wiggins Amanda T. 
Published: March 2016

Background:
Poor dietary habits are associated with higher rates of cardiovascular disease. However, the cost of foods associated with lower risk of cardiovascular disease can be a significant barrier to healthy eating.

Objective:
The aim of this study is to determine whether food prices per serving differed across Kentucky counties based on health ranking and overall nutritional quality.

Methods:
Fifteen counties were randomly selected based on County Health Ranking. Overall Nutritional Quality Index and cost of 75 foods were assessed in all 15 counties in the same week. A generalized estimating equations model and post hoc analyses were used to assess differences in food cost by nutritional quality and health ranking.

Results:
Food prices were significantly less in the most healthy counties compared with the least healthy (Z = 3.8; P < .001; $0.08 per serving). Prices were also significantly higher in least healthy counties (tertile 3) compared with moderately healthy counties (tertile 2) (Z = 2.3; P = .024; $0.05 per serving).

Conclusions:
Disproportionately higher food costs are associated with poor health outcomes in Kentucky counties. Community-based interventions can potentially improve access to affordable healthy foods. Current supplemental nutritional policies do not address disparate food costs. Health professionals should advocate for policy changes that are reflective of these food cost disparities.
Environmental Enteric Dysfunction in Children
Authors: Syed Sana , Ali Asad , Duggan Christopher 
Published: March 2016

ABSTRACTDiarrheal diseases are a major cause of childhood death in resource‐poor countries, killing approximately 760,000 children younger than 5 years each year. Although deaths due to diarrhea have declined dramatically, high rates of stunting and malnutrition have persisted. Environmental enteric dysfunction (EED) is a subclinical condition caused by constant fecal‐oral contamination with resultant intestinal inflammation and villous blunting. These histological changes were first described in the 1960s, but the clinical effect of EED is only just being recognized in the context of failure of nutritional interventions and oral vaccines in resource‐poor countries. We review the existing literature regarding the underlying causes of and potential interventions for EED in children, highlighting the epidemiology, clinical and histologic classification of the entity, and discussing novel biomarkers and possible therapies. Future research priorities are also discussed.
Use of Indirect Calorimetry to Detect Overfeeding in Critically Ill Children
Authors: Kerklaan Dorian , Hulst Jessie M. , Verhoeven Jennifer J. , Verbruggen Sascha C.A.T. , Joosten Koen F.M. 
Published: March 2016

ABSTRACTObjectives:Overfeeding during critical illness is associated with adverse effects such as metabolic disturbances and increased risk of infection. Because of the lack of sound studies with clinical endpoints, overfeeding is arbitrarily defined as the ratio caloric intake/measured resting energy expenditure (mREE) or alternatively as a comparison of measured respiratory quotient (RQ) to the predicted RQ based on the macronutrient intake (RQmacr). We aimed to compare definitions of overfeeding in critically ill mechanically ventilated children based on mREE, RQ, and caloric intake to find an appropriate definition.Methods:Indirect calorimetry measurements were performed in 78 mechanically ventilated children, median age 6.3 months. Enteral and/or parenteral nutrition was provided according to the local guidelines. Definitions used to indicate overfeeding were the ratio caloric intake/mREE of >110% and >120% and by the measured RQ > RQmacr + 0.05.Results:The proportion of patients identified as overfed varied widely depending on the definition used, ranging from 22% (RQ > RQmacr + 0.05), to 40% and 50% (caloric intake/mREE of >120% and >110%, respectively). Linear regression analysis showed that all patients would be identified as overfed with the definition RQ > RQmacr + 0.05 when the ratio caloric intake/mREE exceeded 165%. Caloric intake was higher in children with a standard deviation‐score weight for age <−2.Conclusions:The proportion of mechanically ventilated patients identified as overfed ranged widely depending on the definition applied. These currently used definitions fail to take into account several relevant factors affecting metabolism during critical illness and are therefore not generally applicable to the pediatric intensive care unit population.
Integration of VEGF and α-SMA Expression Improves the Prediction Accuracy of Fibrosis in Chronic Hepatitis C Liver Biopsy
Authors: Elzamly Shaimaa , Agina Hala A. , Elbalshy Abd El-Latif , Abuhashim Maha , Saad Eman , Abd Elmageed Zakaria Y. 
Published: March 2016

Introduction:
The progression of fibrosis in chronic hepatitis C (CHC) is a multifactorial process. The high adverse effects and the cost of standard health care increase the demand to discover new predictors for the progression of fibrosis in CHC patients. Our study aims to establish the relation between the angiogenic marker [vascular endothelial growth factor (VEGF)] and activated hepatic stellate cells (HSCs) represented by the expression of α-smooth muscle actin (α-SMA) and whether these 2 markers can be used as predictors for the progression of fibrosis in patients with CHC.

Materials and Methods:
Histopathologic and immunohistochemical analyses were used for examining the morphology and the expression of VEGF and α-SMA in 60 CHC biopsies procured from CHC patients. Multivariate analysis was used to correlate the protein expression with staging and grading of liver fibrosis. Cutoff values of α-SMA and VEGF were determined by the receiver operating characteristics curve.

Results:
There was a positive correlation between VEGF and HSCs expressing α-SMA (ρ=0.287, P=0.026) and both factors were correlated with the stage of fibrosis (P<0.001). Using the receiver operating characteristics curve, both VEGF (area under the curve=0.71, P<0.006) and α-SMA (area under the curve=0.82, P<0.001) were positive predictors for moderate and severe fibrosis.

Conclusions:
This study demonstrates the relation between VEGF expression and the activated HSCs denoted by the expression of α-SMA in CHC biopsies and together can be used as a predictor for the progression of fibrosis.
Brief Report: Apparent Antiretroviral Overadherence by Pill Count is Associated With HIV Treatment Failure in Adolescents
Authors: Okatch Harriet , Beiter Kaylin , Eby Jessica , Chapman Jennifer , Marukutira Tafireyi , Tshume Ontibile , Matshaba Mogomotsi , Anabwani Gabriel M. , Gross Robert , Lowenthal Elizabeth 
Published: March 2016

Abstract:
Pill counts with calculated adherence percentages are used in many settings to monitor adherence, but can be undermined by patients discarding pills to hide nonadherence. Pill counts suggesting that >100% of prescribed doses were taken can signal “pill dumping.” We defined “overadherence” among a cohort of 300 HIV-infected adolescents as having greater than one-third of pill counts with >100% adherence during a year of follow-up. Apparent overadherence was more common in those with virologic failure than in those with suppressed viral loads (33% vs 13%, χ2
P = 0.001). Pill count adherence repeatedly >100% may identify HIV-infected adolescents at increased risk of treatment failure.
Pemetrexed‐induced scleroderma‐like conditions in the lower legs of a patient with non‐small cell lung carcinoma
Authors: Ishikawa Kazushi , Sakai Takashi , Saito‐Shono Tomoko , Miyawaki Michiyo , Osoegawa Atsushi , Sugio Kenji , Ono Asami , Mori Hiromu , Nishida Haruto , Yokoyama Shigeo , Okamoto Osamu , Fujiwara Sakuhei , Hatano Yutaka 
Published: March 2016

AbstractPemetrexed, which is used for the treatment of non‐small cell lung carcinoma and malignant mesothelioma, induces cutaneous adverse reactions in approximately 20% of patients. There are also reports of the induction of fibrosing disorders. We describe a case of pemetrexed‐induced scleroderma‐like conditions in the lower legs of a patient whose pulmonary carcinoma has been relatively well controlled, with prolongation of the dose interval, in spite of the discomfort in both his legs. Skin biopsy revealed dermal fibrosis and dilated lymph vessels in the dermis, but lymphocytic infiltration around the lymph vessels, in contrast to the blood vessels, was minimal. Immunohistochemical staining revealed that the major subsets of T cells that had infiltrated around blood vessels were CD3 and CD45Ro, but no B cells were detected. High serum levels of interleukin (IL)‐4 and IL‐6 suggested that T cells, which secrete these cytokines, may be involved in the pathogenesis of this condition. Magnetic resonance imaging of the lower extremities revealed muscular and fascial involvement. Several chemotherapeutic agents, such as taxanes, gemcitabine and bleomycin, are known to induce scleroderma‐like changes, and we should also keep the side‐effects of pemetrexed in mind when we encounter patients with fibrosing conditions.
Myoepithelial carcinoma on the right shoulder: Case report with published work review
Authors: Yokose Chiharu , Asai Jun , Kan Saori , Nomiyama Tomoko , Takenaka Hideya , Konishi Eiichi , Goto Keisuke , Ansai Shin‐ichi , Katoh Norito 
Published: March 2016

AbstractMyoepithelial carcinoma is a malignant tumor that can differentiate towards myoepithelial cells and commonly occur in the salivary glands. There have been only a few reports of primary cutaneous myoepithelial carcinoma; however, most cases showed subcutaneous involvement and could also be diagnosed as soft tissue myoepithelial carcinoma arising from the subcutis with dermal involvement. It may thus be impossible to distinguish a primary cutaneous from a soft tissue myoepithelial carcinoma. Herein, we describe a case of myoepithelial carcinoma on the shoulder in an 85‐year‐old Japanese woman. The tumor was located in the whole dermis and subcutis; therefore, it could be diagnosed as either a cutaneous or soft tissue myoepithelial carcinoma. We reviewed previous cases of primary cutaneous and soft tissue myoepithelial carcinomas and compared their clinical and immunohistological features. We found no obvious differences in anatomical distribution or immunohistochemical findings. However, the recurrence rate of cutaneous myoepithelial carcinomas seems to be lower than that of soft tissue carcinomas. Such a difference may be attributable to the adequate surgical margin in cutaneous carcinomas compared with the deep‐seated soft tissue carcinomas. The metastatic frequency did not significantly differ between the two types. Although we could summarize from only a small number of cases, these results indicate the difficulty in distinguishing between cutaneous and soft tissue myoepithelial carcinomas; furthermore, it may not be suitable to distinguish them on the basis of aggressive behavior.
Effects of State Cervical Cancer Insurance Mandates on Pap Test Rates
Authors: Bitler Marianne P. , Carpenter Christopher S. 
Published: March 2016

ObjectiveTo evaluate the effects of state insurance mandates requiring insurance plans to cover Pap tests, the standard screening for cervical cancer that is recommended for nearly all adult women.Data SourcesIndividual‐level data on 600,000 women age 19–64 from the CDC's Behavioral Risk Factor Surveillance System.Study DesignTwenty‐four states adopted state mandates requiring private insurers in the state to cover Pap tests from 1988 to 2000. We performed a difference‐in‐differences analysis comparing within‐state changes in Pap test rates before and after adoption of a mandate, controlling for the associated changes in other states that did not adopt a mandate.Principal FindingsDifference‐in‐differences estimates indicated that the Pap test mandates significantly increased past 2‐year cervical cancer screenings by 1.3 percentage points, with larger effects for Hispanic and non‐Hispanic white women. These effects are plausibly concentrated among insured women.ConclusionsMandating more generous insurance coverage for even inexpensive, routine services with already high utilization rates such as Pap tests can significantly further increase utilization.
Identifying Older Adults with Serious Illness: A Critical Step toward Improving the Value of Health Care
Authors: Kelley Amy S. , Covinsky Kenneth E. , Gorges Rebecca J. , McKendrick Karen , Bollens‐Lund Evan , Morrison R. Sean , Ritchie Christine S. 
Published: March 2016

ObjectiveTo create and test three prospective, increasingly restrictive definitions of serious illness.Data SourcesHealth and Retirement Study, 2000–2012.Study DesignWe evaluated subjects’ 1‐year outcomes from the interview date when they first met each definition: (A) one or more severe medical conditions (Condition) and/or receiving assistance with activities of daily living (Functional Limitation); (B) Condition and/or Functional Limitation and hospital admission in the last 12 months and/or residing in a nursing home (Utilization); and (C) Condition and Functional Limitation and Utilization. Definitions are increasingly restrictive, but not mutually exclusive.Data CollectionOf 11,577 eligible subjects, 5,297 met definition A; 3,151 definition B; and 1,447 definition C.Principal FindingsOne‐year outcomes were as follows: hospitalization 33 percent (A), 44 percent (B), 47 percent (C); total average Medicare costs $20,566 (A), $26,349 (B), and $30,828 (C); and mortality 13 percent (A), 19 percent (B), 28 percent (C). In comparison, among those meeting no definition, 12 percent had hospitalizations, total Medicare costs averaged $7,789, and 2 percent died.ConclusionsProspective identification of older adults with serious illness is feasible using clinically accessible criteria and may be a critical step toward improving health care value. These definitions may aid clinicians and health systems in targeting patients who could benefit from additional services.
Double‐dorsal versus single‐volar digital subcutaneous anaesthetic injection for finger injuries in the emergency department: A randomised controlled trial
Authors: Martin Shane P , Chu Kevin H , Mahmoud Ibrahim , Greenslade Jaimi H , Brown Anthony FT 
Published: March 2016

AbstractObjectiveThe objective of this present study is to compare pain associated with the double‐dorsal versus a single‐volar subcutaneous injection in the provision of digital anaesthesia for finger injuries presenting to the ED.MethodsA randomised controlled trial from November 2012 to January 2014 at a single adult tertiary‐referral hospital. ED patients with finger injuries requiring digital anaesthesia was randomised to either the double‐dorsal or a single‐volar subcutaneous injection technique. The primary outcome was patient reported injection pain measured on a 100 mm visual analogue scale with the assessor blinded to the injection technique. The secondary outcome was success of anaesthesia defined as ability to perform the assessment and treatment without further anaesthetic supplementation after 5 min.ResultsEighty‐six patients were enrolled. Median (IQR) age was 34 (24–47) years and 79% were men. The majority (66.3%) had distal phalanx injuries. Forty patients were randomised to the double‐dorsal and 46 to a single‐volar subcutaneous injection technique. The mean (standard deviation) pain score of the double‐dorsal injection was 39.1 (24.2) and a single‐volar injection was 37.3 (24.5) with a difference of 1.8 (95% CI –8.8 to 12.3). Digital anaesthesia was successful in 64.9% of the double‐dorsal and 71.7% of the single‐volar subcutaneous injections, a difference of 6.8% (95% CI –12.7 to 26.3).ConclusionIn ED patients with finger injuries requiring digital anaesthesia, both the double‐dorsal or single‐volar subcutaneous injection techniques have similar pain of injection and success rates of anaesthesia. Single‐volar injection appears suitable alternative to the commonly performed double‐dorsal injection in the ED.
Utility of Ultrasonography of the Median Nerve With a High‐Frequency Probe for the Diagnosis of Dialysis‐Related Carpal Tunnel Syndrome
Authors: Yamazaki Tadashi , Kawahara Naomi , Arai Kazunori , Oyoshi Koji , Oshima Masami , Koike Sachiko , Miyauchi Akiko , Hayasaka Tokie , Saito Tetsuo , Tsuruoka Shuichi 
Published: March 2016

AbstractThis cross‐sectional study aimed to determine the utility of ultrasonography with improved resolution using a high‐frequency probe for dialysis‐related carpal tunnel syndrome (CTS). This study targeted 125 hemodialysis patients at our hospital. A 12 MHz probe was placed on the carpal tunnel area to identify the median nerve. The compression rate of the nerve was calculated by measuring the smallest diameter of the compressed nerve and largest diameter of the unaffected part. To quantify CTS symptoms, we determined the presence of Tinel's sign, measured pinch strength, and used questionnaires to assess numbness and pain. The association of these clinical data with the compression rate was examined. Mean compression rate was 12.1 ± 1.1%. The compression rate cutoff value for those positive with Tinel's sign was 25%, (sensitivity and specificity were 0.80 and 0.91, respectively), and that for those with a history of CTS surgery was 25% (sensitivity and specificity were 0.67 and 0.89, respectively). Multiple regression analysis identified duration of dialysis, β2‐microglobulin(β2‐Mg) concentration, positivity for Tinel's sign, history of CTS surgery, and pinch strength as independent compression rate determinants. Notably, compression rates were significantly higher in patients with a ≥4‐year duration of dialysis and a β2‐Mg level of 20 mg/L or more. The compression rate of the median nerve measured by an improved ultrasound device significantly correlated with clinical symptoms, medical history, and serological features associated with dialysis‐related CTS. Because ultrasonography is non‐invasive, the examination might be a simple method especially for early diagnosis of dialysis‐related CTS.
Evaluation of an electronic tool to assess food label literacy in adult Australians: A pilot study
Authors: Ringland Emma M. , Gifford Janelle A. , Denyer Gareth S. , Thai Danny , Franklin Janet L. , Stevenson Marie M. , Prvan Tania , O'connor Helen T. 
Published: March 2016

AbstractAimThis pilot study aimed to evaluate the food label literacy component of an electronic‐Nutrition Literacy Tool (e‐NutLiT) designed to assess nutrition literacy in adult Australians, and explore the influence of demographic factors.MethodsObese participants (OP) from an Australian obesity clinic and a criterion group of dietetic students (DS) from two Australian dietetic programs were recruited to complete the e‐NutLit; OP also completed the ‘Newest Vital Sign’ (NVS), a health literacy screening tool. Construct validity was assessed by comparing scores from the two groups. Associations between demographic factors and e‐NutLit scores were also explored.ResultsSixty‐one participants (OP: n = 32; DS: n = 29) completed the study. The total e‐NutLit scores for OP was significantly lower than that of DS (71.9 ± 17.9%; 94.5 ± 5.6%, respectively: P = 0.01). Items requiring calculation of nutrient intake from the nutrition information panel (NIP) and interpreting endorsement logos were the worst performing sections on the e‐NutLit in both OP (35.9%; 71.9%) and DS (86.2%; 75.8%). Adequate health literacy, indicated by an NVS ≥ 4, was strongly associated with higher scores on the e‐NutLit in OP (P = 0.01). Level of education (≤year 10) and lack of engagement in food shopping were significantly associated with poorer competency on the e‐NutLit (P < 0.05).ConclusionsComparison of scores indicated that construct validity was established on most items for participants with lower literacy. The e‐NutLit identified specific weaknesses, such as nutrient calculations and interpretation of endorsement logos. This pilot study will help inform further development of the e‐NutLit.