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  • Springer (CrossRef)  (7)
  • 1
    Language: English
    In: Current Obstetrics and Gynecology Reports, 2015, Vol.4(1), pp.53-60
    Description: Adolescent pregnancy rates in the USA have reached an all-time low from their peak in the 1980s and 1990s. However, the USA maintains the highest rate of teenage pregnancy among developed nations. Adolescents experience higher typical use failure rates for user-dependent contraceptives compared to their adult counterparts. Long-acting reversible contraception (LARC), intrauterine devices (IUDs), and implants have failure rates that are both very low and independent of user age. In settings where the most effective methods are prioritized and access barriers are removed, the majority of adolescents initiate LARC. Use of LARC by adolescents significantly reduces rates of overall and repeat teen pregnancy. All methods of contraception are safe for use in teens, including IUDs and depot medroxyprogesterone acetate (DMPA). Dual use of LARC and barrier methods to reduce risk of sexually transmitted infection is the optimal contraceptive strategy for most adolescents. Adolescent access to evidence-based and confidential contraceptive services, provided in a manner that respects autonomy, is a vital public health goal.
    Keywords: Adolescent ; Teen ; IUD ; Implant ; LARC ; Contraception ; Birth control ; Oral contraceptives ; Injectable contraceptive ; DMPA ; Condoms ; Barrier methods ; Emergency contraception ; Dual method ; Pregnancy
    E-ISSN: 2161-3303
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  • 2
    Language: English
    In: Journal of Gastrointestinal Surgery, 2016, Vol.20(5), pp.1012-1019
    Description: This study analyzes the relationship between hospital teaching status, failure to rescue, and time of year in select gastrointestinal operations. Procedure codes for laparoscopic cholecystectomy, colectomy, and pancreatectomy were queried from the Nationwide Inpatient Sample (2004–2011). Failure to rescue was defined as inpatient mortality when ≥1 complication. A total of 2,777,267 laparoscopic cholecystectomies, 2,519,903 colectomies, and 129,619 pancreatectomies were performed. Teaching hospitals had increased overall rates of failure to rescue compared to non-teaching hospitals, 10.0 vs. 9.5 % ( p  = 0.0187), particularly between May and August. There was greater inter-month variability in non-teaching hospitals amongst individual operations. On multivariable analysis, July was not predictive of increased odds of failure to rescue. Teaching status, hospital characteristics, and patient demographics were associated with increased odds of failure to rescue. Although teaching hospitals have a higher overall failure to rescue rate amongst the selected gastrointestinal operations, odds of failure to rescue are not increased in the month of July. Non-teaching hospitals tend to exhibit more monthly variation in failure to rescue rates, and hospital/patient demographics are predictive of failure to rescue. Further investigation targeted at identifying drivers of temporal variation is warranted to optimize patient outcomes.
    Keywords: Failure to rescue ; July effect ; Teaching hospitals
    ISSN: 1091-255X
    E-ISSN: 1873-4626
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  • 3
    Language: English
    In: Journal of Gastrointestinal Surgery, 2014, Vol.18(10), pp.1863-1869
    Description: Byline: Catherine J. Yang (1,3), Lindsay A. Bliss (1), Emily F. Schapira (1), Steven D. Freedman (2), Sing Chau Ng (1), John A. Windsor (3), Jennifer F. Tseng (1) Keywords: Surgery; Surgical management; Chronic pancreatitis; Pain; Pain management; Pancreatic function; Diabetes; Steatorrhea; Re-intervention Abstract: Background Surgical intervention has traditionally been reserved as the last management option for pain in chronic pancreatitis. Recently, there has been a call for surgery to be offered earlier in the disease process. The objectives of this review were to evaluate the effect of early surgery on postoperative pain, pancreatic function, and re-intervention rates in chronic pancreatitis. Methods A systematic literature search through EMBASE, Cochrane Review, and PubMed from January 1950 to January 2014 was conducted. Citations found in relevant papers are hand-searched. Data which could be pooled were analyzed using Revman (v5.2). Risk of bias analysis was conducted. Results Of the 2,886 potentially eligible studies identified, 11 studies met the inclusion criteria. There was large heterogeneity in the study designs, and studies were conducted over a lengthy time span. Seven studies examined pain, three studies examined pancreatic function, and three studies examined rates of re-intervention. Meta-analysis of the three studies with comparative raw data regarding complete pain relief showed that early surgery was associated with an increased likelihood of complete postoperative pain relief (RR=1.67, 95 % CI 1.09--2.56, p=0.02). Early surgery was also associated with reduced risk of pancreatic insufficiency and low re-intervention rates. Conclusions Data from this study supports considering early surgery for pain management in patients with chronic pancreatitis, with the potential of a reduced risk of pancreatic insufficiency and the need for further intervention. Further prospective randomized studies are warranted comparing early surgery against conservative step-up approaches. Author Affiliation: (1) Surgical Outcomes Analysis & Research, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Stoneman 9, Boston, MA, USA (2) Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, USA (3) Department of Surgery, The University of Auckland, Auckland, New Zealand Article History: Registration Date: 06/06/2014 Received Date: 23/04/2014 Accepted Date: 06/06/2014 Online Date: 19/06/2014
    Keywords: Surgery ; Surgical management ; Chronic pancreatitis ; Pain ; Pain management ; Pancreatic function ; Diabetes ; Steatorrhea ; Re-intervention
    ISSN: 1091-255X
    E-ISSN: 1873-4626
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  • 4
    Language: English
    In: Journal of Gastrointestinal Surgery, 2016, Vol.20(8), pp.1539-1539
    Description: To access, purchase, authenticate, or subscribe to the full-text of this article, please visit this link: http://dx.doi.org/10.1007/s11605-016-3183-2 Byline: Ammara A. Watkins (1), Lindsay A. Bliss (1), Danielle B. Cameron (2), Mariam F. Eskander (1), Jennifer F. Tseng (1), Tara S. Kent (1) Author Affiliation: (1) Beth Israel Deaconess Medical Center, 330 Brookline Ave. Stoneman 9, Boston, MA, 02215, USA (2) Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02115, USA Article History: Registration Date: 27/05/2016 Online Date: 09/06/2016 Article note: The online version of the original article can be found at http://dx.doi.org/10.1007/s11605-016-3120-4. The online version of the original article can be found at http://dx.doi.org/10.1007/s11605-016-3120-4.
    Keywords: Medicine & Public Health ; Surgery ; Gastroenterology ; Medicine;
    ISSN: 1091-255X
    E-ISSN: 1873-4626
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  • 5
    Language: English
    In: Surgical Endoscopy, 2015, Vol.29(7), pp.1897-1902
    Description: Acute appendicitis is the second most common gastrointestinal diagnosis mandating urgent operation in the U.S. The current state of adult appendectomy, including patient and hospital characteristics, complications, and predictors for complications, are unknown.Retrospective review of U.S. Nationwide Inpatient Sample 2003–2011 for appendectomy in ≥18-year-olds was performed. Primary outcomes measures included postoperative complications, length of stay, and patient mortality. Categorical variables were analyzed by χ2, trend analyses by Cochran–Armitage. Multivariable logistic regression was performed to adjust for predictors of developing complications.1,663,238 weighted appendectomy discharges occurred. Over the study period, complications increased from 3.2 to 3.8 % (p 〈 0.0001), but the overall mortality decreased from 0.14 to 0.09 % (p 〈 0.0001) and mean LOS decreased from 3.1 to 2.6 days (p 〈 0.0001). The proportion of laparoscopic appendectomy increased over time, 41.7–80.1 % (p 〈 0.0001). Patients were increasingly older (≥65 years: 9.4–11.6 %, p 〈 0.0001), more obese (3.8–8.9 %, p 〈 0.0001), and with more comorbidities (Elixhauser score ≥3: 4.7–9.8 %, p 〈 0.0001). After adjustment, independent predictors for postoperative complications included: open surgery (OR 1.5, 95 % C.I. 1.4–1.5), male sex (OR 1.6, 95 % CI 1.5–1.6), black race (vs. white: OR 1.5, 95 % CI 1.4–1.6), perforated appendix (OR 2.8, 95 % CI 2.7–3.0), greater comorbidity (Elixhauser ≥3 vs. 0, OR 11.3, 95 % CI 10.5–12.1), non-private insurance status (vs. private: Medicaid OR 1.3, 95 % CI 1.2–1.4; Medicare OR 1.7, 95 % CI 1.6–1.8), increasing age (〉52 years vs. ≤27: OR 1.3; 95 % CI 1.2–1.4), and hospital volume (vs. high: low OR 1.2; 95 % CI 1.1–1.3). Predictors of laparoscopic appendectomy were age, ethnicity, insurance status, comorbidities, and hospital location.Laparoscopic appendectomy is increasing but is unevenly deployed across patient groups. Appendectomy patients were increasingly older, with more comorbidities and with increasing rates of obesity. Black patients and patients with public insurance had less utilization of laparoscopy and inferior outcomes.
    Keywords: Appendectomy ; Acute appendicitis ; NIS ; Laparoscopy ; Complications
    ISSN: 0930-2794
    E-ISSN: 1432-2218
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  • 6
    Language: English
    In: Chromosome research : an international journal on the molecular, supramolecular and evolutionary aspects of chromosome biology, June 2017, Vol.25(2), pp.101-113
    Description: Heterogametic species require chromosome-wide gene regulation to compensate for differences in sex chromosome gene dosage. In Drosophila melanogaster, transcriptional output from the single male X-chromosome is equalized to that of XX females by recruitment of the male-specific lethal (MSL) complex, which increases transcript levels of active genes 2-fold. The MSL complex contains several protein components and two non-coding RNA on the X ( roX) RNAs that are transcriptionally activated by the MSL complex. We previously discovered that targeting of the MSL complex to the X-chromosome is dependent on the chromatin-linked adapter for MSL proteins (CLAMP) zinc finger protein. To better understand CLAMP function, we used the CRISPR/Cas9 genome editing system to generate a frameshift mutation in the clamp gene that eliminates expression of the CLAMP protein. We found that clamp null females die at the third instar larval stage, while almost all clamp null males die at earlier developmental stages. Moreover, we found that in clamp null females roX gene expression is activated, whereas in clamp null males roX gene expression is reduced. Therefore, CLAMP regulates roX abundance in a sex-specific manner. Our results provide new insights into sex-specific gene regulation by an essential transcription factor.
    Keywords: Drosophila ; Dosage Compensation ; Gene Regulation ; Transcription Factor ; Dosage Compensation, Genetic ; Gene Expression Regulation ; DNA-Binding Proteins -- Genetics ; Drosophila Proteins -- Genetics ; Drosophila Melanogaster -- Genetics ; Nuclear Proteins -- Physiology ; Transcription Factors -- Genetics ; X Chromosome -- Genetics
    ISSN: 09673849
    E-ISSN: 1573-6849
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  • 7
    Language: English
    In: Journal of Gastrointestinal Surgery, 2016, Vol.20(1), pp.85-92
    Description: Adjuvant chemotherapy plays a critical role in the treatment of resected pancreatic cancer patients. However, the role of adjuvant radiation remains controversial. This study compares survival between resected pancreatic cancer patients who received adjuvant radiation and no adjuvant radiation. Medical records of patients with pancreatic ductal adenocarcinoma who underwent surgical resection from January 2003 through 2013 at medical centers in Boston and Leiden were retrospectively reviewed. Propensity score matching was used to correct for potential selection bias in the allocation of adjuvant chemoradiation versus chemotherapy alone. Three hundred fifty total patients were identified, of whom 138 (39.4 %) received adjuvant radiation. On pathological staging, 245 (70.0 %) had positive lymph nodes, and these patients gained a significant survival benefit from adjuvant radiation (hazard ratio (HR) 0.74; 95 % confidence interval (CI) 0.56–0.99) in the complete cohort. After propensity score matching, adjuvant radiation lost its prognostic significance in the complete cohort. However, after matching, patients who survived longer than 12 months and had positive lymph nodes ( n  = 108) demonstrated a significant (log-rank p  = 0.04) survival benefit from adjuvant radiation. This study, while non-randomized, suggests that adjuvant radiation may be associated with a survival benefit for resected pancreatic cancer patients in specific situations.
    Keywords: Pancreatic neoplasm ; Adjuvant chemoradiotherapy ; Adjuvant radiotherapy ; Survival
    ISSN: 1091-255X
    E-ISSN: 1873-4626
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