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https://www.readbyqxmd.com/read/28319986/perceived-ethics-dilemmas-among-pioneer-accountable-care-organizations
#1
Craig R Westling, Thom Walsh, William A Nelson
This study of Pioneer accountable care organizations (ACOs) suggests that the ACO model is creating moral distress for physicians and business leaders in seven critical ways:Despite an overall sense of optimism associated with the ACO model, our research identified an underlying sense of moral distress at most sites. A clear opportunity exists for ACOs to use a more comprehensive, coordinated approach to proactively resolving ethical dilemmas while continuing the march toward risk-based contracts.
January 2017: Journal of Healthcare Management / American College of Healthcare Executives
https://www.readbyqxmd.com/read/28319476/anesthesia-in-patients-with-infectious-disease-caused-by-multi-drug-resistant-bacteria
#2
Sharon Einav, Yonit Wiener-Well
PURPOSE OF REVIEW: Up to 50% of specific bacterial strains in healthcare admission facilities are multidrug-resistant organisms (MDROs). Involvement of anesthesiologists in management of patients carrying/at risk of carrying MDROs may decrease transmission in the Operating Room (OR). RECENT FINDINGS: Anesthesiologists, their work area and tools have all been implicated in MDRO outbreaks. Causes include contamination of external ventilation circuits and noncontribution of filters to prevention, inappropriate decontamination procedures for nondisposable equipment (e...
March 17, 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28319463/solid-cancer-incidence-among-the-life-span-study-of-atomic-bomb-survivors-1958-2009
#3
Eric J Grant, Alina Brenner, Hiromi Sugiyama, Ritsu Sakata, Atsuko Sadakane, Mai Utada, Elizabeth K Cahoon, Caitlin M Milder, Midori Soda, Harry M Cullings, Dale L Preston, Kiyohiko Mabuchi, Kotaro Ozasa
This is the third analysis of solid cancer incidence among the Life Span Study (LSS) cohort of atomic bomb survivors in Hiroshima and Nagasaki, adding eleven years of follow-up data since the previously reported analysis. For this analysis, several changes and improvements were implemented, including updated dose estimates (DS02R1) and adjustment for smoking. Here, we focus on all solid cancers in aggregate. The eligible cohort included 105,444 subjects who were alive and had no known history of cancer at the start of follow-up...
March 20, 2017: Radiation Research
https://www.readbyqxmd.com/read/28319242/quality-of-cancer-surveillance-clinical-practice-guidelines-specificity-and-consistency-of-recommendations
#4
Ryan P Merkow, Deborah Korenstein, Rubaya Yeahia, Peter B Bach, Shrujal S Baxi
Importance: Primary care clinicians, who are increasingly responsible for caring for the growing population of cancer survivors, may be unfamiliar with appropriate cancer surveillance strategies. Clinical practice guidelines can inform cancer follow-up care and surveillance testing. Vague recommendations and inconsistencies among guidelines can lead to overuse and underuse of health care resources and have a negative impact on cost and quality of survivorship care. Objective: To examine the specificity and consistency of recommendations for surveillance after active treatment across cancer guidelines...
March 20, 2017: JAMA Internal Medicine
https://www.readbyqxmd.com/read/28319197/the-hiv-care-cascade-japanese-perspectives
#5
Aikichi Iwamoto, Rikizo Taira, Yoshiyuki Yokomaku, Tomohiko Koibuchi, Mahbubur Rahman, Yoko Izumi, Kenji Tadokoro
Japan has been known as a low HIV-prevalence country with a concentrated epidemic among high-risk groups. However, it has not been determined whether Japan meets the 90-90-90 goals set by the Joint United Nations Programme on HIV/AIDS (UNAIDS)/World Health Organization (WHO). Moreover, to date, the HIV care cascade has not been examined. We estimated the total number of diagnosed people living with HIV/AIDS (PLWHA) (n = 22,840) based on legal reports to the Ministry of Health, Labour and Welfare by subtracting the number of foreigners who left Japan (n = 2,273) and deaths (n = 2,321) from the cumulative diagnosis report (n = 27,434)...
2017: PloS One
https://www.readbyqxmd.com/read/28319183/an-integrated-analysis-of-micro-and-macro-habitat-features-as-a-tool-to-detect-weather-driven-constraints-a-case-study-with-cavity-nesters
#6
D Campobello, J Lindström, R Di Maggio, M Sarà
The effects of climate change on animal populations may be shaped by habitat characteristics at both micro- and macro-habitat level, however, empirical studies integrating these two scales of observation are lacking. As analyses of the effects of climate change commonly rely on data from a much larger scale than the microhabitat level organisms are affected at, this mismatch risks hampering progress in developing understanding of the details of the ecological and evolutionary responses of organisms and, ultimately, effective actions to preserve their populations...
2017: PloS One
https://www.readbyqxmd.com/read/28319143/toxicity-effects-of-di-2-ethylhexyl-phthalate-to-eisenia-fetida-at-enzyme-cellular-and-genetic-levels
#7
Tingting Ma, Wei Zhou, Li'ke Chen, Longhua Wu, Peter Christie, Haibo Zhang, Yongming Luo
Di-(2-ethylhexyl) phthalate (DEHP) is a dominant phthalic acid ester (PAE) that has aroused public concern due to its resistance to degradation and its toxicity as an endocrine-disrupting compound. Effects of different concentrations of DEHP on Eisenia fetida in spiked natural soil have been studied in the body of the earthworm by means of soil cultivation tests 7, 14, 21 and 28 days after exposure. The results indicated that, in general, superoxide dismutase (SOD) activity, malondialdehyde (MDA) content, metallothionein (MT) content, the expression of heat shock protein 70 (HSP 70) and all the tested geno-toxicity parameters are promoted as time elapses and with increasing concentration of DEHP...
2017: PloS One
https://www.readbyqxmd.com/read/28318787/municipal-wastewater-treatment-plant-effluent-induced-effects-on-freshwater-mussel-populations-and-the-role-of-mussel-refugia-in-recolonizing-an-extirpated-reach
#8
Patricia L Gillis, Rodney McInnis, Joseph Salerno, Shane R de Solla, Mark R Servos, Erin M Leonard
Global human population and urbanization continually increase the volume of wastewater entering aquatic environments. Despite efforts to treat these effluents, they contribute a diverse suite of substances that enter watersheds at concentrations that have the potential to elicit adverse effects on aquatic organisms. The relationship between wastewater treatment plant (WWTP) effluent exposure and biological responses within aquatic ecosystems remains poorly understood, especially at the population level. To examine the effect of WWTP effluents on sentinel invertebrates, freshwater mussels were assessed in the Grand River, Ontario, in populations associated with the outfall of a major WWTP...
March 15, 2017: Environmental Pollution
https://www.readbyqxmd.com/read/28318744/calculated-panel-reactive-antibody-predicts-outcomes-on-the-heart-transplant-waiting-list
#9
Evan P Kransdorf, Michelle M Kittleson, Jignesh K Patel, Marcelo J Pando, D Eric Steidley, Jon A Kobashigawa
BACKGROUND: Sensitized heart transplant candidates spend more time and have higher mortality on the waiting list. Although the calculated panel-reactive antibody (CPRA) value is used to assign allocation priority to kidney transplant candidates in the United States, the relationship between CPRA and outcomes on the heart transplant waiting list is unknown. METHODS: A data set of patients listed for heart transplant with unacceptable human leukocyte antigens (HLA) entered was obtained from the United Network for Organ Sharing...
February 17, 2017: Journal of Heart and Lung Transplantation
https://www.readbyqxmd.com/read/28318644/comparison-of-outcomes-for-mr-guided-versus-ct-guided-high-dose-rate-interstitial-brachytherapy-in-women-with-locally-advanced-carcinoma-of-the-cervix
#10
Sophia C Kamran, Matthias M Manuel, Linda P Cho, Antonio L Damato, Ehud J Schmidt, Clare Tempany, Robert A Cormack, Akila N Viswanathan
OBJECTIVE: The purpose was to compare local control (LC), overall survival (OS) and dose to the organs at risk (OAR) in women with locally advanced cervical cancer treated with MR-guided versus CT-guided interstitial brachytherapy (BT). METHODS: 56 patients (29 MR, 27 CT) were treated with high-dose-rate (HDR) interstitial BT between 2005-2015. The MR patients had been prospectively enrolled on a Phase II clinical trial. Data were analyzed using Kaplan-Meier (K-M) and Cox proportional hazards statistical modeling in JMP® & R®...
March 17, 2017: Gynecologic Oncology
https://www.readbyqxmd.com/read/28318585/lactoferrin-reduces-mortality-in-preweaned-calves-with-diarrhea
#11
G Habing, K Harris, G M Schuenemann, J M Piñeiro, J Lakritz, X Alcaraz Clavijo
Calf diarrhea is the most common reason for mortality and antimicrobial therapy in preweaned calves on dairy farms in the United States. Conventional and organic livestock producers require alternative therapies for calf diarrhea to reduce the necessity of conventional antimicrobials. Alternatives administered for mild cases or early in the disease course may be useful to mitigate disease progression and reduce the likelihood of septicemia and negative sequelae. Lactoferrin is a bioactive protein naturally found in colostrum that has been shown to prevent septicemia in high-risk infants...
March 16, 2017: Journal of Dairy Science
https://www.readbyqxmd.com/read/28318465/lunch-at-the-library-examination-of-a-community-based-approach-to-addressing-summer-food-insecurity
#12
Janine S Bruce, Monica M De La Cruz, Gala Moreno, Lisa J Chamberlain
OBJECTIVE: To examine a library-based approach to addressing food insecurity through a child and adult summer meal programme. The study examines: (i) risk of household food insecurity among participants; (ii) perspectives on the library meal programme; and (iii) barriers to utilizing other community food resources. DESIGN: Quantitative surveys with adult participants and qualitative semi-structured interviews with a sub-sample of adult participants. SETTING: Ten libraries using public and private funding to serve meals to children and adults for six to eight weeks in low-income Silicon Valley communities (California, USA) during summer 2015...
March 20, 2017: Public Health Nutrition
https://www.readbyqxmd.com/read/28318101/individual-volume-based-3d-gamma-indices-for-pretreatment-vmat-qa
#13
Jinling Yi, Ce Han, Xiaomin Zheng, Yongqiang Zhou, Zhenxiang Deng, Congying Xie, Xiance Jin, Fu Jin
Although gamma analysis is still a widely accepted quantitative tool to analyze and report patient-specific QA for intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT), the correlation between the 2D percentage gamma passing rate (%GP), and the clinical dosimetric difference for IMRT and VMAT has been questioned. The purpose of this study was to investigate the feasibility of individual volume-based 3D gamma indices for pretreatment VMAT QA. Percentage dosimetric errors (%DE) of dose-volume histogram metrics (includes target volumes and organ at risks) between the treatment planning system and QA-reconstructed dose distribution, %GPs for individual volume and global gamma indices, as well their correlations and sensitivities were investigated for one- and two-arc VMAT plans...
March 20, 2017: Journal of Applied Clinical Medical Physics
https://www.readbyqxmd.com/read/28318080/hepatitis-e-and-pregnancy-current-state
#14
REVIEW
María Teresa Pérez-Gracia, Beatriz Suay-García, María Luisa Mateos-Lindemann
Hepatitis E virus (HEV) is responsible for more than 50% of acute viral hepatitis cases in endemic countries. Approximately 2 billion individuals live in hepatitis E-endemic areas and, therefore, are at risk of infection. According to World Health Organization, HEV causes about 20.1 million infections and 70 000 deaths every year. In developing countries with poor sanitation, this disease is transmitted through contaminated water and is associated with large outbreaks, affecting hundreds or thousands of people...
March 20, 2017: Reviews in Medical Virology
https://www.readbyqxmd.com/read/28318072/lifetime-risk-of-mortality-due-to-different-levels-of-alcohol-consumption-in-seven-european-countries-implications-for-low-risk-drinking-guidelines
#15
Kevin D Shield, Gerrit Gmel, Gerhard Gmel, Pia Mäkelä, Charlotte Probst, Robin Room, Jürgen Rehm
BACKGROUND AND AIMS: Low-risk alcohol drinking guidelines require a scientific basis that extends beyond individual or group judgements of risk. Lifetime mortality risks, judged against established thresholds for acceptable risk, may provide such a basis for guidelines. Therefore, the aim of this study was to estimate alcohol mortality risks for seven European countries based on different average daily alcohol consumption amounts. METHODS: The maximum acceptable voluntary premature mortality risk was determined to be 1 in 1,000, with sensitivity analyses of 1 in 100...
March 20, 2017: Addiction
https://www.readbyqxmd.com/read/28317129/towards-robust-adaptive-radiation-therapy-strategies
#16
Michelle Böck, Anders Forsgren, Kjell Eriksson, Björn Hårdemark
PURPOSE: To set up a framework combining robust treatment planning with adaptive reoptimization in order to maintain high treatment quality, to respond to interfractional geometric variations and to identify those patients who will benefit the most from an adaptive fractionation schedule. METHODS: The authors propose robust adaptive strategies based on stochastic minimax optimization for a series of simulated treatments on a one-dimensional patient phantom. The plan applied during the first fractions should be able to handle anticipated systematic and random errors...
March 20, 2017: Medical Physics
https://www.readbyqxmd.com/read/28316234/modeling-exposure-in-the-tox21-in-vitro-bioassays
#17
Fabian Christoph Fischer, Luise Henneberger, Maria König, Kai Bittermann, Lukas Linden, Kai-Uwe Goss, Beate I Escher
High-throughput in vitro bioassays are becoming increasingly important in the risk characterization of anthropogenic chemicals. Large databases gather nominal effect concentrations (Cnom) for diverse modes of action. However, the biologically effective concentration can substantially deviate due to differences in chemical partitioning. In this study, we modeled freely dissolved (Cfree), cellular (Ccell), and membrane concentrations (Cmem) in the Tox21 GeneBLAzer bioassays for a set of neutral and ionogenic organic chemicals covering a large physicochemical space...
March 19, 2017: Chemical Research in Toxicology
https://www.readbyqxmd.com/read/28315885/advancement-in-texture-in-early-complementary-feeding-and-the-relevance-to-developmental-outcomes
#18
Jordan R Green, Meg Simione, Benjamin Le Révérend, Erin M Wilson, Brian Richburg, Marc Alder, Mirna Del Valle, Chrystel Loret
A child's transition to independent eating is a protracted process that progresses over the course of many years. Although major health agencies, such as the World Health Organization, now offer clear guidance when to begin introducing solids, advice about how to safely transition to progressively challenging foods is varied and comes from a staggering number of sources. The resulting conflicting views have promoted parental confusion and anxiety about what foods are appropriate and when to advance to new textures...
2017: Nestlé Nutrition Institute Workshop Series
https://www.readbyqxmd.com/read/28315861/the-risk-factors-for-metastasis-in-non-ampullary-duodenal-neuroendocrine-tumors-measuring-20-mm-or-less-in-diameter
#19
Waku Hatta, Tomoyuki Koike, Katsunori Iijima, Kiyotaka Asanuma, Naoki Asano, Hiroaki Musha, Yoshifumi Inomata, Toshikazu Sano, Hiroyuki Endo, Atsushi Ikehata, Toru Horii, Motoki Ohyauchi, Satoshi Yokosawa, Atsuko Kasajima, Fumiyoshi Fujishima, Hironobu Sasano, Naoki Nakaya, Tomohiro Nakamura, Tooru Shimosegawa
BACKGROUND/AIMS: The treatment strategy for non-ampullary duodenal neuroendocrine tumors (NAD-NETs) ≤20 mm in diameter has not been established. In this study, we aimed to evaluate the detailed characteristics of NAD-NETs ≤20 mm in diameter to clarify the risk factors of subsequent metastasis. METHODS: The patients with NAD-NETs ≤20 mm in diameter who had been treated at 12 institutions between 1992 and 2013 were enrolled. Clinical records were retrieved, and histopathological findings of all cases were centrally reviewed by 2 pathologists...
March 18, 2017: Digestion
https://www.readbyqxmd.com/read/28315744/cardiac-implantable-electronic-device-infections-who-is-at-greatest-risk
#20
Parijat Saurav Joy, Gagan Kumar, Jeanne E Poole, Barry London, Brian Olshansky
BACKGROUND: Cardiac Implantable Electronic Device (CIED) infections are associated with hospitalization, mortality, increased costs and adverse outcomes. OBJECTIVE: Determine the burden of infections for CIEDs based on device type, associated comorbidities and clinical characteristics over a 12-year period. METHODS: Utilizing the National Inpatient Sample database from 2000-2012, procedures for device related infection (DRI) were identified using ICD-9-CM code for CIED removal with diagnosis codes for device-related infection or systemic infection...
March 15, 2017: Heart Rhythm: the Official Journal of the Heart Rhythm Society
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