List Of Medical Conditions Research Articles

Poverty and Intellectual Development in Childhood.

Objectives and ApproachThe effects of the timing and duration of economic deprivation and maternal mental health on intellectual development is researched using unique linkable databases following almost 90 thousand children born in the Canadian province of Manitoba. This paper studies such questions as: How important are differences in measurement of poverty in assessing intellectual development? How do various differences change over childhood? ResultsConcentrating on those born in 2000-2002 generated a total of 7,424 children having scores on all six measures of intellectual development. Such person-specific information controlled for many individual factors and extended from ages 5 through 17. Major differences were found in the scores associated with exposure to the two kinds of poverty and to poor maternal mental health. In summary, differences emerge by age 5, with administration of the Early Development Index. These differences are largely the same at age 8, even though another measure (the Grade 3 Competencies Index) is used. ConclusionsIf household poverty is taken as a definition of poverty, poverty seems much more important than maternal mental health in affecting a child’s intellectual development. However, if neighborhood poverty is used to define poverty, maternal mental health and poverty have effects on childhood intellectual development which are more similar. Definition plays a critical role in interpretation. ImplicationsThese population-based data, with multiple measures and multiple time points, suggest many analytical possibilities. If childhood conditions are included, the list of medical conditions which might correlate with intellectual development multiplies.

(130) PREVALENCE OF CONDITIONS INVOLVING ABERRANT MAST CELL ACTIVITY IN PATIENTS WITH NEUROPROLIFERATIVE VESTIBULODYNIA

Abstract Introduction Neuroproliferative vestibulodynia (NPV) is a provoked vestibular pain shown to be associated with excess immunohistochemical staining for CD117 and PGP9.5, consistent with mast cells and nerves, respectively. NPV is distinguished from control tissue by having >8 mast cells/high power field. Objective In patients with a histopathologically confirmed diagnosis of NPV, we wished to assess the prevalence of concomitant conditions involving other aberrant mast cell activity. Methods Medical records from people with vulvas who underwent vestibulectomy between June 1, 2019 and October 31, 2023 at a single facility were retrospectively reviewed. All had histopathologically confirmed NPV, having observed > 8 positive CD117 stained cells/high power field in the sub-epithelial stroma. As part of their history, each patient provided a list of medical conditions which included disorders where aberrant mast cell activity has been reported. The following eight conditions were included in medical history forms: asthma, chronic sinusitis, endometriosis, food allergy/intolerance, interstitial cystitis, irritable bowel syndrome, migraine, and postural orthostatic tachycardia syndrome. Results A total of 88 NPV patients were included in this chart review. A total of 34 (39%) reported no other aberrant mast cell activity, however 54 (61%) had at least one concomitant condition. The most common conditions were migraine (n=21; 24%), interstitial cystitis (n=17; 19%) and endometriosis (n=15; 17%), followed by food allergy/intolerance (n=12; 14%), irritable bowel syndrome (n=9; 10%), asthma (n=9; 10%), chronic sinusitis (n=5; 6%) and postural orthostatic tachycardia syndrome (n=2; 2%). Among these 88 patients, a total of 33 (38%), 13 (15%), 3 (6%), 1 (1%) and 2 (2%) had one, two, three, four and five other conditions involving aberrant mast cell activity, respectively. There was no correlation between the number of concomitant conditions with aberrant mast cell activity reported and the density of CD117-immunopositive staining in the overall NPV cohort, whether diagnosed with lifelong or acquired NPV. Conclusions Patients with histopathologically confirmed NPV have a high prevalence of concomitant conditions associated with aberrant mast cell activity, possibly due to a genetic predisposition. While more studies are needed, NPV is likely part of a broader systemic collection of conditions associated with aberrant mast cell activity. This finding is relevant in terms of future diagnostic and treatment options for patients with NPV. Disclosure No.

Blockchain-secure patient Digital Twin in healthcare using smart contracts.

Modern healthcare has a sharp focus on data aggregation and processing technologies. Consequently, from a data perspective, a patient may be regarded as a timestamped list of medical conditions and their corresponding corrective interventions. Technologies to securely aggregate and access data for individual patients in the quest for precision medicine have led to the adoption of Digital Twins in healthcare. Digital Twins are used in manufacturing and engineering to produce digital models of physical objects that capture the essence of device operation to enable and drive optimization. Thus, a patient's Digital Twin can significantly improve health data sharing. However, creating the Digital Twin from multiple data sources, such as the patient's electronic medical records (EMR) and personal health records (PHR) from wearable devices, presents some risks to the security of the model and the patient. The constituent data for the Digital Twin should be accessible only with permission from relevant entities and thus requires authentication, privacy, and provable provenance. This paper proposes a blockchain-secure patient Digital Twin that relies on smart contracts to automate the updating and communication processes that maintain the Digital Twin. The smart contracts govern the response the Digital Twin provides when queried, based on policies created for each patient. We highlight four research points: access control, interaction, privacy, and security of the Digital Twin and we evaluate the Digital Twin in terms of latency in the network, smart contract execution times, and data storage costs.

Selecting Medical Conditions Relevant to Exploration Spaceflight to Create the IMPACT 1.0 Medical Condition List.

INTRODUCTION: Medical conditions occurring in spaceflight pose risks to the crew and the mission and these risks will be exacerbated during exploration-class missions. Probabilistic risk assessment is a method used at NASA to quantify this risk for low-Earth orbit operations. Informing Mission Planning via Analysis of Complex Tradespaces (IMPACT) is a next-generation tool suite that will perform these assessments for exploration-class missions. It will require a robust list of medical conditions of significant likelihood and/or consequence to exploration-class missions to accurately inform the tool suite.METHODS: The IMPACT 1.0 Medical Condition List (ICL 1.0) contains 120 conditions selected in the context of a 210-d cis-lunar, Mars analog design reference mission. The conditions were selected via a systematic process that preserved institutional knowledge from nine prior condition lists. Conditions were prioritized for inclusion in the ICL 1.0 based on history of occurrence in spaceflight, concurrence among the nine source lists, and concurrence among subject matter experts.DISCUSSION: The ICL 1.0 has notable advantages over its predecessor lists in that it is more specific to exploration-class missions, contains a greater number, breadth, and depth of conditions, and was derived via consensus across multiple medical specialties.Kreykes AJ, Suresh R, Levin D, Hilmers DC. Selecting medical conditions relevant to exploration spaceflight to create the IMPACT 1.0 Medical Condition List. Aerosp Med Hum Perform. 2023; 94(7):550-557.

Developing Consensus on Priority Pediatric Otolaryngology-Head and Neck Surgery Conditions and Procedures.

The aim of this study was to develop an international expert consensus on priority pediatric otolaryngology-head and necksurgery (OHNS) conditions and procedures for which all national health systems globally should be capable of managing. The Delphi method is a multiround online questionnaire and was administered internationally to otolaryngologists with a focus on pediatric populations. This study was administered in parallel to a Delphi survey focusing on adult OHNS conditions amongst adult otolaryngology experts. International online survey. In round 1, participants listed the top 15 pediatric otolaryngological conditions and top 15 pediatric otolaryngology procedures for their World Bank region. In round 2, participants ranked round 1 responses in order of global importance on a 5-point Likert scale. In round 3, participants reranked conditions and procedures that did not achieve consensus, defined as at least 70% of the round 2 Likert responses being ranked as either "important" or "very important." Descriptive statistics were calculated for each round. The survey was distributed to 35 experts globally, with a 40% (n = 14) response rate. Fifty percent (n = 7) of participants were from low- and middle-income countries, with at least 1 participant from each World Bank region. A list of 28 consensus surgical procedures and 11 consensus conditions were identified. This Delphi survey method of world experts in pediatric otolaryngology identified a core list of medical conditions and surgical procedures that should be a part of every national health system's clinical goals of treatment, research, and capacity building.

Identification of Preanesthetic History Elements by a Natural Language Processing Engine.

Methods that can automate, support, and streamline the preanesthesia evaluation process may improve resource utilization and efficiency. Natural language processing (NLP) involves the extraction of relevant information from unstructured text data. We describe the utilization of a clinical NLP pipeline intended to identify elements relevant to preoperative medical history by analyzing clinical notes. We hypothesize that the NLP pipeline would identify a significant portion of pertinent history captured by a perioperative provider. For each patient, we collected all pertinent notes from the institution's electronic medical record that were available no later than 1 day before their preoperative anesthesia clinic appointment. Pertinent notes included free-text notes consisting of history and physical, consultation, outpatient, inpatient progress, and previous preanesthetic evaluation notes. The free-text notes were processed by a Named Entity Recognition pipeline, an NLP machine learning model trained to recognize and label spans of text that corresponded to medical concepts. These medical concepts were then mapped to a list of medical conditions that were of interest for a preanesthesia evaluation. For each condition, we calculated the percentage of time across all patients in which (1) the NLP pipeline and the anesthesiologist both captured the condition; (2) the NLP pipeline captured the condition but the anesthesiologist did not; and (3) the NLP pipeline did not capture the condition but the anesthesiologist did. A total of 93 patients were included in the NLP pipeline input. Free-text notes were extracted from the electronic medical record of these patients for a total of 9765 notes. The NLP pipeline and anesthesiologist agreed in 81.24% of instances on the presence or absence of a specific condition. The NLP pipeline identified information that was not noted by the anesthesiologist in 16.57% of instances and did not identify a condition that was noted by the anesthesiologist's review in 2.19% of instances. In this proof-of-concept study, we demonstrated that utilization of NLP produced an output that identified medical conditions relevant to preanesthetic evaluation from unstructured free-text input. Automation of risk stratification tools may provide clinical decision support or recommend additional preoperative testing or evaluation. Future studies are needed to integrate these tools into clinical workflows and validate its efficacy.

The Importance of Vitamin D in Long-Term Care Residents

The Importance of Vitamin D in Long-Term Care Residents

A Quick and Comprehensive Guide to Differential Diagnosis of Neck and Back Pain: a Narrative Review.

The list of diagnostic options when approaching a patient with axial pain is impressively complex. Many offer limited diagnostic workups, but we could not find a truly comprehensive diagnostic guide to assist in the diagnostic evaluation. In this short paper, we briefly described a long list of medical conditions, each of which can manifest as back or neck pain, and whose prevalence ranges from common to very rare. We then proposed an algorithm for classifying them into subgroups. Further referral to diagnostic tests and specialist consultations, after assignment to one of those subgroups, could save time and unnecessary tests. We believe that this review and the proposed diagnostic algorithm can be valuable for medical education and for use in the primary care setting for the diagnostic evaluation of any type of back or neck pain in all patient groups.

Aurimatrix: Software-as-a-Service Solution for Clinical Work and Research in Auriculotherapy.

Objective: Auriculotherapy practitioners need a digital record-keeping method to track their cases that provides different ear maps and methodologies from different schools of auriculotherapy in one place. Materials and Methods: Main requirement were as followed: to be run whatever the platform; to manage different representations of the ear and to allow data analysis from multiple users. Results: Aurimatrix® is a software-as-a-service solution developed to help the practitioner enter all data pertaining to an auriculotherapy session. Although the software was originally designed for the two schools of French auriculotherapy, this software is highly configurable and can support the use of any ear chart in any language. Moreover, the ear charts are divided in several layers, allowing use of a representation of the ear of one school with the set of auricular points in use in another school. Because the list of medical conditions is limited and the modalities of variables used to evaluate the effectiveness of auriculotherapy are unchangeable, Aurimatrix enables comparison between different sessions, different patients, and different practitioners. Conclusions: Doing so, the software helps pave the way to improve auriculotherapy protocols.

When years of many different diagnosis may turn into one – a case of munchausen syndrome

IntroductionThe term Munchausen syndrome was first used in 1951 after Baron von Münchhausen, a German nobleman known for his exaggerated storytelling. DSM-5 refers to it as factitious disorder imposed on self: “falsification of physical or psychological signs or symptoms, or induction of injury or disease, (…) in the absence of obvious external rewards”.ObjectivesTo report a case of Munchausen syndrome and highlight the impact on its physical and psychiatric approaches.MethodsDescription of a clinical case based on medical records and a brief review on Munchausen syndrome.ResultsA 57-year-old female, with no previous psychiatric history, was evaluated by Psychiatry for complaints of depression with suicidal ideation. She reported family conflicts and a list of medical conditions and surgical interventions. According to the patient she was waiting for a cardiac transplant and said she had type 1 diabetes, myasthenia gravis, hepatic steatoses, dyslipidemia, hyperuricemia, mitral valve prolapse and was submitted to a thymectomy and cervical herniated disc surgery. She was on many different prescription pills. Even though she had blocked the access to her clinical records in other institutions, at our hospital she had multiple admissions to the emergency room, numerous follow-up appointments of different specialties and several allergies documented. She displayed many incoherencies throughout the interview, had a circumstantial speech and exuberant appearance.ConclusionsMunchausen syndrome remains a challenging diagnosis to physicians. This condition is not only associated with significant morbidity and mortality, but also with unnecessary tests and procedures, iatrogenesis, prolonged hospitalizations and increased health costs.DisclosureNo significant relationships.

Occupational Diseases and Perceived Health in Operating Room Nurses: A Multicenter Cross-Sectional Observational Study

BackgroundThe surgical environment has multiple factors that could affect nurses’ health. The aim was to determine the effects of the working environment of operating room nurses on their health compared to hospitalization nurses.MethodsA sample of operating room nurses and hospitalization nurses were included in the study and participated by filling in a self-report survey containing sociodemographic data items, the validated Nordic and SF12 scales and a list of medical conditions.ResultsThree hundred and thirty-one nurses participated in the study. Statistically significant results had obtained for diagnoses of musculoskeletal disorders and contact dermatitis among the operating room nurses.Conclusion/Application to PracticeContinuous training in ergonomics is essential. Moreover, surgical protocols for preventing infection should be revised, optimizing the chlorhexidine content of soaps to reduce the risk of lesions among the surgical staff.

The measurement of multimorbidity.

The presence of multiple concurrent medical conditions (also known as multimorbidity) is now a common phenomenon, hence the importance of its measurement. The purpose of this paper is to review the multimorbidity measures that have been published in the literature to date and that are available for use in future research studies. Two main groups of measures of multimorbidity could be distinguished. The first group of measures is constituted by a simple count from various lists of chronic conditions. The second group of measures introduces a weighting for included chronic conditions thus creating a "weighted index" of multimorbidity. These groups are not mutually exclusive as the list of medical conditions in some weighted indices can be used as a list of conditions without weighting. This article includes a review of the multimorbidity literature to date that has reported these groups of measurements, showing the variety of existing measurements and highlighting their differences to provide an overview of the possibilities that are available to a researcher intending to measure multimorbidity. Finally, we outline some guidelines for the choice of a measurement of multimorbidity for research studies. We hope that this review of the existing literature will help inform the careful use of these tools by researchers moving forward. In addition to this review, it is advised that readers attempt to keep updated on the ever-increasing multimorbidity literature. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Drug-related deaths in hospital inpatients: A retrospective cohort study.

To determine the incidence of drug-related deaths (DRD) in a university hospital in 2015, to describe their characteristics, and to discover risk factors of DRD. An analytic and retrospective cohort study. Patients with a death diagnosed predefined from a list of medical conditions potentially caused by drugs were the selected cases for further review. Causality assessment was evaluated by a local drug safety committee. Out of 1135 inpatient deaths, 73 DRD were included (six were hospital-acquired). The incidence of DRD of all hospital admissions was 0.34%, and the incidence of all deaths cases was 7%. Drugs were the cause of death in 38 patients (52%) and a contributive role in 35 (48%). The median age of DRD patients was 72years (range 19-94) and 72.6% were men. The median hospital stay, Charlson score and number of drugs were 5days, 2 points and seven drugs respectively. The most frequent DRD were cerebral haemorrhages and infections in drug-immunosuppressed patients (32, 43.8%, each group). The most frequently involved drugs were antineoplastics and glucocorticosteroids (40% and 18%), and antithrombotics (33%); drug-drug interactions were present in 44% DRD. Sex, age and number of drugs were risk factors of DRD. Adverse drug reactions were a significant cause of death in hospitalized patients, mainly haemorrhages and infections precipitated by drug-drug interactions. Risk factors for DRD were sex, age and number of drugs. Preventable DRD and measures to avoid them should be accurately assessed in further studies.

Perspective on Broad-Acting Clinical Physiological Effects of Photobiomodulation.

Research into photobiomodulation reveals beneficial effects of light therapy for a rapidly expanding list of medical conditions and illnesses. Although it has become more widely accepted by the mainstream medicine, the effects and mechanisms of action appear to be poorly understood. The therapeutic benefits of photobiomodulation using low-energy red lasers extend far beyond superficial applications, with a well-described physics allowing an understanding of how red lasers of certain optimum intensities may cross the cranium. We now have a model for explaining potential therapeusis for applications in functional neurology that include stroke, traumatic brain injury, and neurodegenerative conditions in addition to the currently approved functions in lipolysis, in onychomycosis treatment, and in pain management.

Paediatric Anaesthetic Emergency Data Manual

A special challenge for healthcare practitioners is the emergency resuscitation of infants and children. James Armstrong and Hannah King have published the Paediatric Anaesthetic Emergency Data Manual as a guide specifically directed to the treatment of a life-threatening crisis. Its main audience are those involved in anesthetizing pediatric patients; however, the guide would be useful for anyone facing an in-hospital pediatric emergency.The guide is small, light, and composed of water-resistant paper; however, it is not small enough to fit into a pocket. It is sectioned by arrest, trauma, anesthetic, and medical flowcharts, most of which are emergency treatment algorithms, but some are management guidelines. Pain treatment, fluid management, and congenital heart diseases are examples. The information is helpful; however, to be useful it would need to be attached or located at the site of care. It appears that there is only a hard copy of the information available and no electronic version of the flowcharts that come with the book.Much of the information is available as a Pediatric Critical Events Checklist on the Society for Pediatric Anesthesia (SPA) website for printing and through a free iTunes app that is managed by the Children’s Hospital of Philadelphia. The guide, however, provides more detailed information than the SPA checklists in many sections, and the guide starts with age-appropriate charts from neonate to teen, which are especially useful for the infrequent pediatric practitioner.The guide succeeds as a single-source summary for a broad range of pediatric care. It is rare to find a compendium that tackles so many pediatric topics without becoming a textbook. The true utility of this text is that it is an excellent reference, so much so that one need not rely on memory during a life-threatening crisis or during the care of a child with one of the many identified congenital anomalies. The formulary at the end of the guide is also quite valuable.It is especially difficult to choose an organizational format for what is simply a list of medical conditions. The book’s division into four categories works; however, during a true time-critical emergency, a familiarity with the book would be required. There are a few informational boxes spread throughout the guide and attached to flowcharts, such as an informational box on the management of hyperkalemia. Because hyperkalemia may occur as a part of multiple separate emergencies, it might be better served to have a separate section devoted to it. I also had a little difficulty with the guide because the color scheme chosen for some of the backgrounds makes the text difficult to read, especially the dark blues and purples. The color coding seems to follow some of the safety labeling of anesthetic medication syringes, but serves more as a nuisance in this context.Overall, the content of this emergency manual is outstanding, and although the information can be found elsewhere, this book serves as a concise single source. It is definitely a practical, and likely a beneficial, tool for those who want a hard copy at hand in their operating, emergency, or intensive care suite. The authors were clearly thoughtful in including what would be the most effective information for their audience during a pediatric calamity.

Associations between Medical Conditions and Breast Cancer Risk in Asians: A Nationwide Population-Based Study in Taiwan

BackgroundThe breast cancer incidence in Asia is rising. To explore whether the etiology of breast cancer is different from the known risk factors from studies in Western countries, we conducted a nested case-control study using data from the Taiwan National Health Insurance Research Database (NHIRD).MethodsAll medical conditions based on the first three digits of the ICD-9 and a list of medical conditions based on literature review were retrieved for each case and control. The odds ratios (OR) and 95% confidence intervals (CI) of the associations between medical conditions and breast cancer risks were estimated using conditional logistic regression and adjusted for occupation, number of breast cancer screening, and the average number of outpatient visits prior the diagnosis. The associations were also estimated for younger (<50 years old) and older subjects separately.ResultsThe analyses included 4,884 breast cancer cases and 19,536 age-matched controls. Prior breast diseases (OR, 95% CI: 2.47, 2.26–2.71), obesity (1.43, 1.04–1.96), endometriosis (1.44, 1.15–1.80), uterine leiomyoma (1.20, 1.03–1.40), hypertensive diseases (1.14, 1.05–1.25), and disorders in lipid metabolism (1.13, 1.04–1.24) were associated with increased breast cancer risk. No heterogeneity was observed between age groups (<50 and ≥50 years old).ConclusionsIn addition to benign breast diseases, obesity, endometriosis, uterine leiomyoma, hypertensive diseases, and disorders of lipid metabolism were associated with a subsequent breast cancer risk.ImpactsOur results suggest that estrogen related factors may play an important role in breast cancer risks in the Taiwanese female population.

Rôle du médecin agréé pour l’évaluation de l’aptitude à la conduite. Aspects pratiques, responsabilité et secret médical

Every candidate for a driving license or any driver who meets a health problem must, on its own initiative, to submit to a medical examination. The list of approved doctors is available in the prefectures. There is a list of medical conditions that are incompatible with the licensing or involve restrictions on the use of the license. The treating physician is not authorized to carry out the assessment of medical fitness to drive for his own patients. This is the prefect who decides after consulting a licensed physician or medical committee composed of licensed doctors. If it deems medically necessary, the medical consultant outside medical commission may request the person to be summoned before the primary medical committee whose jurisdiction is then substituted for his. Possible advice is: fitness, temporary fitness, fitness subject to the license restrictions on use, or the inability of the candidate or driver to drive vehicles of the requested class. We emphasize the absence of shared secret between the attending physician and the medical officer or the Medical Committee.

Reducing the cost and burden of depression: incorporate heart and get an early start.

Article Abstract Because this piece does not have an abstract, we have provided for your benefit the first 3 sentences of the full text. The topic of massive costs and burden of major depressive disorder (MDD) is not new, but it remains timely nonetheless. In recent years, depression has continued to ascend, for lack of a better word, to new heights on the list of medical conditions that encumber individuals, families, health care systems, and society. How do we understand that, despite the growing recognition, treatment, and research in this area, depression seems to carry on seemingly undaunted? See our Focus Collection of J Clin Psychiatry articles on healthcare economics.

Medical test development and implementation: a multistep journey.

Article Abstract Because this piece does not have an abstract, we have provided for your benefit the first 3 sentences of the full text. The topic of massive costs and burden of major depressive disorder (MDD) is not new, but it remains timely nonetheless. In recent years, depression has continued to ascend, for lack of a better word, to new heights on the list of medical conditions that encumber individuals, families, health care systems, and society. How do we understand that, despite the growing recognition, treatment, and research in this area, depression seems to carry on seemingly undaunted?

Abstract 270: The association between medical history and breast cancer risk: A nationwide population-based case-control study using claim data

Abstract Introduction: It is suggested that chronic disease may be associated with increased cancer risk due to common risk factors, treatments to the prior conditions, or other unknown mechanisms. We evaluated the associations between prior medical conditions and subsequent breast cancer risk using the claim data from the Taiwan National Health Insurance (NHI) program. Material and Method: A matched case-control study was conducted using the NHI 1,000,000 random sample dataset. A list of medical conditions based on literature review was retrieved for each case and control. The odds ratios (OR) and 95% confidence intervals (CI) of the association between medical conditions and breast cancer risk were estimated using conditional logistic regression and adjusted for occupation and number of breast cancer screening. The associations were estimated for younger (&amp;lt;50 years old) and older subjects, separately. Results: Prior breast diseases, hypertensive diseases, and endometriosis were associated with increased breast cancer risk in both age groups. Thyroid diseases were associated with breast cancer in the younger (OR=1.32, 95% CI=1.04-1.66) but not in the older group (OR=1.02, 95% CI=0.82-1.27). On the other hand, metabolic syndrome, particularly the disorders involved lipid metabolism, was associated with breast cancer only in the older group (OR=1.24, 95% CI=1.04-1.49). Conclusion: Our analyses support results from previous studies that prior breast diseases and endometriosis were associated with subsequent breast cancer at all ages, thyroid diseases were associated with premenopausal, and metabolic syndrome were associated with postmenopausal breast cancer. Note: This abstract was not presented at the meeting. Citation Format: Shu-Chun Chuang, Guo-Jie Wu, Yen-Shen Lu, Ching-Hung Lin, Chao Agnes Hsiung. The association between medical history and breast cancer risk: A nationwide population-based case-control study using claim data. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 270. doi:10.1158/1538-7445.AM2014-270