Supporting Breastfeeding in Infants Hospitalized for Jaundice.

Background: Infants readmitted for neonatal hyperbilirubinemia requiring phototherapy are less likely to exclusively breastfeed than infants who are not readmitted for phototherapy. Our aim for this study was to increase breastfeeding exclusivity for infants admitted for neonatal hyperbilirubinemia.

Methods: Using the Model for Improvement, we conducted 3 plan-do-study-act cycles to improve exclusive breastfeeding (EB).

Discovery of stroke-related blood biomarkers from gene expression network models.

Background: Identifying molecular biomarkers characteristic of ischemic stroke has the potential to aid in distinguishing stroke cases from stroke mimicking symptoms, as well as advancing the understanding of the physiological changes that underlie the body's response to stroke. This study uses machine learning-based analysis of gene co-expression to identify transcription patterns characteristic of patients with acute ischemic stroke.

Methods: Mutual information values for the expression levels among 13,243 quantified transcripts were computed for blood samples from 82 stroke patients and 68 controls to construct a co-expression network of genes (separately) for stroke and control samples.

The Global academic research organization network: Data sharing to cure diseases and enable learning health systems.

Introduction: Global data sharing is essential. This is the premise of the Academic Research Organization (ARO) Council, which was initiated in Japan in 2013 and has since been expanding throughout Asia and into Europe and the United States. The volume of data is growing exponentially, providing not only challenges but also the clear opportunity to understand and treat diseases in ways not previously considered.

Driving stroke quality improvement at scale in EDs across a nationwide network of hospitals: strategies and interventions.

Objectives: Reducing the treatment time while increasing the proportion of eligible stroke patients who receive intravenous tissue plasminogen activator (tPA) has been a priority for many quality improvement efforts. Recent studies have primarily focused on identifying interventions that reduce door-to-needle (DTN) time, while comparatively little has been done to determine whether these interventions also improve tPA rates.

Methods: In order to investigate interventions related to process improvements, an electronic dashboard serving as a stroke performance tool was implemented to store and retrieve patient outcome data.

Higher Incidence of Ischemic Stroke in Patients Taking Novel Oral Anticoagulants.

Background and Purpose- The increased use of novel oral anticoagulants (NOACs) to control atrial fibrillation is largely driven by the assumption that they are equally effective as warfarin at preventing ischemic stroke while putting patients at lower risk of hemorrhages. To test this hypothesis, a retrospective study of the relative incidence of strokes among patients taking NOACs versus those taking warfarin is performed. Methods- Relative stroke incidence in the 2 groups of patients was compared using odds ratios and Fisher exact tests for significance using a data set of 71 365 on NOACs and 59 546 patients on warfarin.

Bivalent Chromatin Domains in Glioblastoma Reveal a Subtype-Specific Signature of Glioma Stem Cells.

Glioblastoma multiforme (GBM) can be clustered by gene expression into four main subtypes associated with prognosis and survival, but enhancers and other gene-regulatory elements have not yet been identified in primary tumors. Here, we profiled six histone modifications and binding as well as gene expression in primary gliomas and identified chromatin states that define distinct regulatory elements across the tumor genome. Enhancers in mesenchymal and classical tumor subtypes drove gene expression associated with cell migration and invasion, whereas enhancers in proneural tumors controlled genes associated with a less aggressive phenotype in GBM.

One-year outcomes of early-crossover patients in a cohort receiving nonoperative care for lumbar disc herniation.

OBJECTIVE The authors comprehensively studied the recovery course and 1-year outcomes of early-crossover patients who were randomized to the nonoperative care arm of the Leiden-The Hague Spine Intervention Prognostic Study. The primary goal was to gain insight into the differences in the recovery patterns of early-crossover patients and those treated nonoperatively; secondary goals were to identify predictors of good 1-year outcomes, and to understand when and why patients were likely to cross over. METHODS Individual EuroQol-5D scores were obtained at baseline and at 2, 4, 8, 12, 26, 38, and 52 weeks for 142 patients.

Molecular Predictors of Long-Term Survival in Glioblastoma Multiforme Patients.

Glioblastoma multiforme (GBM) is the most common and aggressive adult primary brain cancer, with <10% of patients surviving for more than 3 years. Demographic and clinical factors (e.g.

Reproducibility of SNV-calling in multiple sequencing runs from single tumors.

We examined 55 technical sequencing replicates of Glioblastoma multiforme (GBM) tumors from The Cancer Genome Atlas (TCGA) to ascertain the degree of repeatability in calling single-nucleotide variants (SNVs). We used the same mutation-calling pipeline on all pairs of samples, and we measured the extent of the overlap between two replicates; that is, how many specific point mutations were found in both replicates. We further tested whether additional filtering increased or decreased the size of the overlap.

Three-dimensional brain magnetic resonance imaging segmentation via knowledge-driven decision theory.

Brain tissue segmentation on magnetic resonance (MR) imaging is a difficult task because of significant intensity overlap between the tissue classes. We present a new knowledge-driven decision theory (KDT) approach that incorporates prior information of the relative extents of intensity overlap between tissue class pairs for volumetric MR tissue segmentation. The proposed approach better handles intensity overlap between tissues without explicitly employing methods for removal of MR image corruptions (such as bias field).

Rapid and convergent evolution in the glioblastoma multiforme genome.

Determining which mutations drive tumor progression is a defining question in cancer genomics. We analyzed sequence evolution in Glioblastoma multiforme (GBM) by computing the number of parallel mutations and by estimating ω=dN/dS, a measure of the strength and direction of selection. The ω values of almost all 7617 mutated genes in GBM are much higher than in germline genes.

Effects of genetic variation on the dynamics of neurodegeneration in Alzheimer's disease.

Although many genetic markers are identified as being associated with Alzheimer's disease (AD), not much is known about their association with the structural changes that happen as the disease progresses. In this study, we investigate the genetic etiology of neurodegeneration in AD by associating genetic markers with atrophy profiles obtained using patient data from the Alzheimer's Disease Neuroimaging Initiative (ADNI) cohort. The atrophy profiles were quantified using a linear least-squares regression model over the span of patient enrollment, and used as imaging features throughout the analysis.

Cilia gene expression patterns in cancer.

Non-motile cilia are thought to be important determinants of the progression of many types of cancers. Our goal was to identify patterns of cilia gene dysregulation in eight cancer types (glioblastoma multiforme, colon adenocarcinoma, breast adenocarcinoma, kidney renal clear cell carcinoma, lung squamous cell carcinoma, lung adenocarcinoma, rectal adenocarcinoma, and ovarian cancer) profiled by The Cancer Genome Atlas. Among these types, 2.

An eQTL analysis of the human glioblastoma multiforme genome.

In this paper we use eQTL mapping to identify associations between gene dysregulation and single nucleotide polymorphism (SNP) genotypes in glioblastoma multiforme (GBM). A set of 532,954 SNPs was evaluated as predictors of the expression levels of 22,279 expression probes. We identified SNPs associated with fold change in expression level rather than raw expression levels in the tumor.

Superpixels in brain MR image analysis.

A large number of sophisticated techniques have been proposed over the last few decades for automatic analysis of brain MR images to help clinicians better diagnose and understand anatomical changes due to neurological disorders. While significant improvements in performance have been achieved, almost all techniques suffer from a common limitation of high computational complexity due to the large number of voxels present in a typical MR volume. Computational complexity is a major hurdle in the clinical application of these sophisticated image analysis techniques.

The impact of early recovery on long-term outcomes in a cohort of patients undergoing prolonged nonoperative treatment for lumbar disc herniation: clinical article.

Object: The authors comprehensively studied the recovery of individual patients undergoing treatment for lumbar disc herniation. The primary goal was to gain insight into the variability of individual patient utility scores within a treatment cohort. The secondary goal was to determine how the rates and variability of patient recovery over time, represented by improvement in utility scores, affected long-term patient outcomes.

Variational level set approach for automatic correction of multiplicative and additive intensity inhomogeneities in brain MR Images.

Retrospective correction of intensity inhomogeneities in magnetic resonance images of the brain is an essential pre-processing step before any sophisticated image analysis task can be performed. A popular choice when defining the degradation model in MR images is to use multiplicative intensity inhomogeneities that slowly varying across the image domain; this approach has been extensively used for bias field estimation. However, such a multiplicative model is often insufficient given that some of the most dominant physical causes of intensity inhomogeneities in MRI (such as nonuniform excitation strength) have a non-linear relationship with the receptor signal intensity.

Differentiating tumor recurrence from treatment necrosis: a review of neuro-oncologic imaging strategies.

Differentiating treatment-induced necrosis from tumor recurrence is a central challenge in neuro-oncology. These 2 very different outcomes after brain tumor treatment often appear similarly on routine follow-up imaging studies. They may even manifest with similar clinical symptoms, further confounding an already difficult process for physicians attempting to characterize a new contrast-enhancing lesion appearing on a patient's follow-up imaging.

Model-driven, probabilistic level set based segmentation of magnetic resonance images of the brain.

Accurate segmentation of magnetic resonance (MR) images of the brain to differentiate features such as soft tissue, tumor, edema and necrosis is critical for both diagnosis and treatment purposes. Region-based formulations of geometric active contour models are popular choices for segmentation of MR and other medical images. Most of the traditional region-based formulations model local region intensity by assuming a piecewise constant approximation.

Dysphagia after anterior cervical spine surgery: incidence and risk factors.

Objective: To evaluate risk factors for the development of dysphagia after anterior cervical surgery.

Methods: The records of 249 patients who underwent anterior cervical surgery were reviewed. The presence and severity of dysphagia were assessed with the Dysphagia Disability Index 6 weeks and 3, 6, and 12 months after surgery.

An analysis of admissions from 155 United States hospitals to determine the influence of weather on stroke incidence.

Weather is the most frequently proposed factor driving apparent seasonal trends in stroke admissions. Here, we present the largest study of the association between weather and ischemic stroke in the USA to date. We consider admissions to 155 United States hospitals in 20 states during the five-year period from 2004 to 2008.

Treatment course and outcomes following drug and alcohol-related traumatic injuries.

Background: Alcohol and drug use is known to be a major factor affecting the incidence of traumatic injury. However, the ways in which immediate pre-injury substance use affects patients' clinical care and outcomes remains unclear. The goal of the present study is to determine the associations between pre-injury use of alcohol or drugs and patient injury severity, hospital course, and clinical outcome.

The association between weather and spontaneous subarachnoid hemorrhage: an analysis of 155 US hospitals.

Background: A seasonal and meteorological influence on the incidence of spontaneous subarachnoid hemorrhage (SAH) has been suggested, but a consensus in the literature has yet to emerge.

Objective: This study examines the impact of weather patterns on the incidence of SAH using a geographically broad analysis of hospital admissions and represents the largest study of the topic to date.

Methods: We retrospectively analyzed SAH admissions to 155 US hospitals during the calendar years 2004 to 2008 (N = 7758).

Genome-wide association studies: a powerful tool for neurogenomics.

As their power and utility increase, genome-wide association (GWA) studies are poised to become an important element of the neurosurgeon's toolkit for diagnosing and treating disease. In this paper, the authors review recent findings and discuss issues associated with gathering and analyzing GWA data for the study of neurological diseases and disorders, including those of neurosurgical importance. Their goal is to provide neurosurgeons and other clinicians with a better understanding of the practical and theoretical issues associated with this line of research.