bluuebunny/crossref_metadata_2025 huggingface dataset:
Drawing up plans
Authors: Lankester Ted
Published: April 2019

This chapter describes how to draw up a community plan and how to use planning tools within the community, for example, problem trees, a SWOT analysis, and SMART objectives. It describes how to write and use a logical framework (logframe) and provides examples. It covers the importance of establishing village health committees and community action groups, and how using these can assist with engaging the target communities, It also discusses other alternatives to assist in writing proposals, for example, using findings from the participatory appraisal (PA) or a community survey, but also as working programme tools. Finally, it gives practical examples.
Making a programme sustainable
Authors: Lankester Ted
Published: April 2019

This chapter describes a wide variety of ways to help programmes become financially sustainable. It begins by defining sustainability, and discusses way to encourage community involvement in making the programme sustainable. It also discusses reducing costs, accessing free supplies, co-financing, utilizing revolving drug funds (RDFs), health insurance schemes, and other methods of cost recovery. It provides some background information about funding health development, and briefly covers the 1978 Alma-Ata Declaration. It mentions partnerships with donors and emphasizes the needs of communities to develop their own funds through entrepreneurship and micro-enterprise. It also emphasizes the need to employ, train, educate, and retain team members, and how dedicated team members also contribute to programme sustainability.
Fitness for work after surgery or critical illness
Authors: Williams Tony , Pearce Neil
Published: April 2019

Occupational health professionals frequently advise about return to work after surgery. Providing advice can be challenging, and considerable misunderstanding exists among patients and clinicians. One patient may return to work 1 week after a hysterectomy while another is absent for 5 months. Advice on returning to work after surgery should be based on knowledge of tissue healing processes, along with adverse effects of smoking and obesity, perioperative infection, and co-morbidity. Medical issues are often confounded by inconsistent advice, inappropriate beliefs, and unhelpful motivators. There is a recognized limitation in the evidence base. However, consensus is available from a number of guidelines drawn up by various expert bodies, which are covered in this chapter.
Surveillance and outbreak management
Authors: Damani Nizam
Published: April 2019

This chapter describes the surveillance of healthcare-associated infections (HAIs) and outlines the management of an outbreak. The chapter on surveillance describes the objectives and advantages and disadvantages of various surveillance strategies. It describes how to collect and validate surveillance data and calculate various HAI rates. It also summarizes the advantages and disadvantages of both outcome and process surveillance. It provides a list of alert infectious conditions and alert organisms which need to be monitored by healthcare facilities. Advice is also given on how to recognize and manage an outbreak, and the role of the microbiology laboratory. It provides advice on how to develop an epidemic curve and summarizes what steps should be taken on an investigation of an outbreak.
Overview of IDEAL schedule and how to use it
Authors: Semrau Maya , Burns Alistair , Lobo Antonio , Rikkert Marcel Olde , Robert Philippe , Schepens Mirjam , Stoppe Gabriela , Sartorius Norman
Published: April 2019

This chapter gives a detailed description of the International Schedule for the Integrated Assessment and Staging of Care for Dementia (IDEAL schedule), as well as of the glossary that accompanies the schedule. It provides information necessary to decide who may use the schedule, what purposes the assessments may serve, and how the schedule should be used. The chapter describes the IDEAL schedule’s structure, as well as its seven dimensions and the anchor points that the schedule has for each of those dimensions, and the schedule’s rating system. It also describes how to train staff in the use of the IDEAL schedule, how to conduct a clinical interview with the IDEAL schedule, and what to take into account in finalizing the assessment after the IDEAL interview.
Glossary for the IDEAL schedule
Authors: Semrau Maya , Burns Alistair , Lobo Antonio , Rikkert Marcel Olde , Robert Philippe , Schepens Mirjam , Stoppe Gabriela , Sartorius Norman
Published: April 2019

This chapter provides a definition of the terms used in the International Schedule for the Integrated Assessment and Staging of Care for Dementia (IDEAL schedule) and provides further details for each of the schedule’s seven dimensions and how these should be rated. It also gives examples for each anchor point of the IDEAL schedule’s dimensions to help healthcare professionals who have experience working with people living with dementia in the correct application of the schedule in clinical practice and research. The glossary is a key component of the IDEAL schedule and should be used alongside the schedule, including within training.
Epidemic of Cardiovascular Disease and Diabetes
Authors: Bhopal Raj S.
Published: April 2019

Coronary heart disease (CHD) and stroke, collectively cardiovascular disease (CVD), are caused by narrowing and blockage of the arteries supplying the heart and brain, respectively. In type 2 diabetes (DM2) insulin is insufficient to maintain normal blood glucose. South Asians have high susceptibility to these diseases. Drawing upon the scientific literature and discussions with 22 internationally recognized scholars, this book focuses on causal explanations and their implications for prevention and research. Genetically based hypotheses are considered together with the developmental origins of health and disease (DOHAD) family of hypotheses. The book then considers how CHD, stroke, and DM2 are closely linked to rising affluence and the accompanying changes in life-expectancy and lifestyles. The established causal factors are shown to be insufficient, though necessary, parts of a convincing explanation for the excess of DM2 and CVD in South Asians. In identifying new explanations, this book emphasizes glycation of tissues, possibly leading to arterial stiffness and microcirculatory damage. In addition to endothelial pathways to atherosclerosis an external (adventitial) one is proposed, i.e. microcirculatory damage to the network of arterioles that nourish the coronary arteries. In addition to the ectopic fat in their liver and pancreas as the cause of beta cell dysfunction leading to DM2, additional ideas are proposed, i.e. microcirculatory damage. The high risk of CVD and DM2 in urbanizing South Asians is not inevitable, innate or genetic, or acquired in early life and programmed in a fixed way. Rather, exposure to risk factors in childhood, adolescence, and most particularly in adulthood is the key. The challenge to produce focused, low cost, effective actions, underpinned by clear, simple, and accurate explanations of the causes of the phenomenon is addressed.
Genetic explanations 3: neurobehavioural explanations
Authors: Bhopal Raj S.
Published: April 2019

These hypotheses propose brain and behavioural evolution as the driver of the adaptations that are now leading to CVD and DM2. Of these, the behavioural switch, also known as the soldier-to-diplomat, hypothesis is best developed. The concept is that as humans moved from hunter-gatherer to settled agricultural lives, complex changes occurred to support this lifestyle, e.g. reduced aggression, more resources to nurture fewer children, and preferential use of glucose by the brain rather than by muscle. Insulin resistance is seen as a secondary—once beneficial—adaptation underlying this change. This hypothesis implies insulin resistance is valuable and it also provides an explanation for South Asians’ reduced muscle mass. Similar ideas have been proposed on longer evolutionary timescales, e.g. the aggression control hypothesis. At present the evidence from these hypotheses does not explain South Asians’ particular susceptibility to CVD and DM2. The hypotheses do, valuably, point to the brain’s central role in glucose metabolism.
Established CVD and DM2 risk factors: reappraisal in relation to South Asians
Authors: Bhopal Raj S.
Published: April 2019

The causal basis of the established CVD and type 2 diabetes risk factors rests mainly on cohort studies, sometimes with supplementary data from trials, Mendelian randomization studies, and experiments in animals. In South Asian populations, specifically, the direct evidence is limited but the associations between risk factors and disease outcomes are generally as expected. The lifestyle-related risk factors can be grouped into those where an excess is a problem (e.g. diets leading to adiposity or a high glycaemic load) and those where a deficit is a problem (e.g. insufficient physical activity). These kinds of risk factors, particularly in the context of adverse socio-economic circumstances, provide an excellent basis for causal thinking. So far, even combined with a wide range of biochemical and physiological risk factors, however, such factors are insufficient, though necessary, parts of a convincing explanation for the excess of DM2 and CVD in South Asians.
A causal synthesis and models
Authors: Bhopal Raj S.
Published: April 2019

This chapter synthesizes explanations that are relevant to each of diabetes, CHD, and stroke, and all three collectively. This synthesis emphasizes glycation of tissues, possibly leading to arterial stiffness and microcirculatory damage. In addition to endothelial pathways to atherosclerosis an external (adventitial) one is proposed, i.e. microcirculatory damage to the vasa vasorum, the network of arterioles that supplies nutrients to the larger arteries themselves. DM2 plays into this pathway through glycosylation and dyslipidaemia. The cause of the high prevalence of DM2 in South Asians may lie in protective factors in Europeans not just detrimental ones in South Asians. The high glucose level is considered as an allostatic mechanism controlled by the brain. In addition to the ectopic fat in their liver and pancreas as the cause of beta cell dysfunction, two additional ideas are proposed, i.e. firstly, microcirculatory damage and secondly, glycation, possibly compounded by dietary factors including neoformed contaminants, e.g. AGEs.
Burn prevention
Authors: Peck Michael
Published: April 2019

The impact of burn injuries can be minimized by attention to known risk factors, including those related to the persons involved, the mechanism and object of injury, and the physical and socioeconomic environments. Interventions can take place at three stages-to prevent the injury from occurring, to minimizing the damage caused by the burn, and to optimize chances for a successful recovery. There are a variety of strategies by which burns can be controlled, modified, or interrupted. The choice of strategies depends on factors related to values and preferences, costs, and the balance of benefits and harms. Ongoing monitoring and evaluation of programs is vital to their success. Examples of successful strategies are described, including child-resistant lighters, fire-safe cigarettes, regulation of hot water heaters, and smoke alarms.
Burns first aid
Authors: Leon-Villapolas Jorge
Published: April 2019

In the UK alone there are approximately 175,000 acute burn injuries /year. There is a great variation in the way these injuries are managed. Advances in our understanding of the pathophysiology and natural history of burn injuries have highlighted the importance of early intervention in minimizing later functional and cosmetic morbidity. Differences in beliefs and ethnic background have a large impact on the way that burns are initially dealt with, as we know that only a minority of patients presenting with burns are optimally managed pre-hospital. Lack of education and conflicting information about burns first aid is believed to be a major factor in the common occurrence of burnt patients presenting with a variety of domestic remedies being applied to their burns as first aid. Judicious application of simple burns first aid is the first step for soft tissue preservation, improvement of outcomes and a decrease in the need for operative management.
Burn wound dressings
Authors: Hardwicke Joseph , Moiemen Naiem
Published: April 2019

The ultimate goal for all burns is to allow the wound to heal with the least amount of scarring, and this is directly related to the depth of burn injury. Superficial partial thickness burns and deeper burns of small area can be treated by suitable dressings alone and this is probably the most widely applied form of treatment for burns. Burns that are selected for treatment by dressings alone, or in combination with surgical debridement and skin grafting, require regular monitoring, both clinically and microbiologically. Modern dressings may allow a longer interval between dressing changes, but this should not be sacrificed in favour of regular review. If wound healing progresses at the expected rate, then the comfort afforded by fewer changes of dressings is advantageous, but the poorly progressing wound should be treated aggressively with a custom-designed dressing which can be tailored for the individual needs of the patient.
Management of burn wound infection
Authors: Azzopardi Ernest , Barbara Christopher Henry
Published: April 2019

Sepsis and resultant organ failure is the leading cause of death for patients with major burns. A detailed account of infection in burned patients is provided from types of organisms to prevention and treatment.
Outcome measures for burns
Authors: Mabvuure Nigel Tapiwa , Arham Ali , Herndon David N. , Finnerty Celeste C.
Published: April 2019

Advances in burn care have greatly reduced mortality, necessitating standardized outcome measures for function and quality of life. This chapter discusses outcome measures that are most commonly used or that have been validated. Outcome measures are presented according to time after burn injury (short- and long term). Measures are also presented for biological/physical outcomes, psychosocial outcomes, paediatric-specific outcomes, and limb-related outcomes. The chapter concludes with a description of common single variable outcomes such as mortality rate, pain, and length of hospitalization.
Burn contracture surgery
Authors: Watson Stuart B.
Published: April 2019

Principles of timing, assessment and management of burn contractures by surgery are discussed. Techniques appropriate to release and reconstruction of different types of contracture are presented in the chapter.
Burns itch
Authors: Brooks Peter
Published: April 2019

Post-burns itch, or pruritus, is one of the most common and distressing complications of burn injury. It typically begins in the first two weeks after the injury, and may last for several years. Post-burn pruritus can interfere with daily activities, and also complicate healing when scratched. This chapter outlines the causes, epidemiology, and biology of itching then provides an overview of therapies available. Assessment scales and the classification of types of pruritus are also outlined.
Hair restoration
Authors: Darhouse Nagham , Williams Greg
Published: April 2019

Scalp and facial hair are essential components of what is perceived to be a normal appearance. This chapter examines options for both surgical and non-surgical management. Surgical options are further discussed by location and size, and possible complications or issues are outlined. It is important for the multi-disciplinary team to be aware of the possible therapeutic modalities and to develop established links with practitioners who offer those services that are not available locally.
Inner Ear Genes Underwent Positive Selection and Adaptation in the Mammalian Lineage
Authors: Pisciottano Francisco , Cinalli Alejandro R , Stopiello Juan Matías , Castagna Valeria C , Elgoyhen Ana Belén , Rubinstein Marcelo , Gómez-Casati María Eugenia , Franchini Lucía F
Published: April 2019

The mammalian inner ear possesses functional and morphological innovations that contribute to its unique hearing capacities. The genetic bases underlying the evolution of this mammalian landmark are poorly understood. We propose that the emergence of morphological and functional innovations in the mammalian inner ear could have been driven by adaptive molecular evolution.

In this work, we performed a meta-analysis of available inner ear gene expression data sets in order to identify genes that show signatures of adaptive evolution in the mammalian lineage. We analyzed ∼1,300 inner ear expressed genes and found that 13% show signatures of positive selection in the mammalian lineage. Several of these genes are known to play an important function in the inner ear. In addition, we identified that a significant proportion of genes showing signatures of adaptive evolution in mammals have not been previously reported to participate in inner ear development and/or physiology. We focused our analysis in two of these genes: STRIP2 and ABLIM2 by generating null mutant mice and analyzed their auditory function. We found that mice lacking Strip2 displayed a decrease in neural response amplitudes. In addition, we observed a reduction in the number of afferent synapses, suggesting a potential cochlear neuropathy.

Thus, this study shows the usefulness of pursuing a high-throughput evolutionary approach followed by functional studies to track down genes that are important for inner ear function. Moreover, this approach sheds light on the genetic bases underlying the evolution of the mammalian inner ear.
Gene therapy with apoptosis-associated speck-like protein, a newly described schwannoma tumor suppressor, inhibits schwannoma growth in vivo
Authors: Ahmed Sherif G , Abdelnabi Ahmed , Maguire Casey A , Doha Mohamed , Sagers Jessica E , Lewis Rebecca M , Muzikansky Alona , Giovannini Marco , Stemmer-Rachamimov Anat , Stankovic Konstantina M , Fulci Giulia , Brenner Gary J
Published: April 2019

Background

We evaluated apoptosis-associated speck-like protein containing a caspase recruitment domain (ASC) as a schwannoma tumor suppressor and explored its utilization in a schwannoma gene therapy strategy that may be translated to clinical use.

Methods

ASC protein expression and mRNA level were assessed in human schwannoma by immunohistochemistry and quantitative PCR, respectively. Methylation- specific PCR was used to assess ASC promoter methylation. The effect of ASC overexpression in schwannoma cells was evaluated through ATP-based viability, lactate dehydrogenase release, and apoptosis staining. Western blotting and colorimetric assay were used to test the effect of ASC overexpression on endogenous pro-apoptotic pathways. Bioluminescence imaging, behavioral testing, and immunohistochemistry in human xenograft and murine allograft schwannoma models were used to examine the efficacy and toxicity of intratumoral injection of adeno-associated virus (AAV) vector encoding ASC.

Results

ASC expression was suppressed via promoter methylation in over 80% of the human schwannomas tested. ASC overexpression in schwannoma cells results in cell death and is associated with activation of endogenous caspase-9, caspase-3, and upregulation of BH3 interacting-domain death agonist. In a human xenograft schwannoma model, AAV1-mediated ASC delivery reduced tumor growth and resolved tumor-associated pain without detectable toxicity, and tumor control was associated with reduced Ki67 mitotic index and increased tumor-cell apoptosis. Efficacy of this schwannoma gene therapy strategy was confirmed in a murine schwannoma model.

Conclusion

We have identified ASC as a putative schwannoma tumor suppressor with high potential clinical utility for schwannoma gene therapy and generated a vector that treats schwannomas via a novel mechanism that does not overlap with current treatments.
Outpatient Antibiotic Prescribing in Massachusetts, 2011–2015
Authors: Klevens R Monina , Caten Evan , Olesen Scott W , DeMaria Alfred , Troppy Scott , Grad Yonatan H
Published: April 2019

Background

The objectives of this study were to develop methods to measure population-based outpatient antibiotic prescribing in Massachusetts and to describe the findings as a first step toward institution of ongoing surveillance.

Methods

We analyzed outpatient prescription claims from the Massachusetts All-Payers Claims Database from 2011 to 2015. We grouped claims for antibiotics according to the World Health Organization’s Anatomical Therapeutic Chemical Classification System using the National Library of Medicine’s RXNorm database. We grouped prescribers into 17 specialties. Antibiotic use rates were calculated, and simple frequencies were used to describe patterns.

Results

The overall annual rate of outpatient antibiotic use for individuals aged 0–64 years was 696 prescriptions per 1000 people. During 2015, 68% of people in Massachusetts had no antibiotic prescription, and 17% had only 1 prescription. There was dramatic variability in antibiotic use rates by census tract within the state (rates of penicillin use ranged from 31 to 265 prescriptions per 1000 people, macrolides from 28 to 333, cephalosporins from 8 to 89, quinolones from 13 to 118). Antibiotic use rates were generally lower in urban census tracts. From 2011 to 2015, there was a 17% decline in antibiotic prescribing, with the greatest decline for macrolides (28%).

Conclusions

There was variability in antibiotic prescribing within Massachusetts by age, sex, and antibiotic class. Variation in antibiotic use across census tracts within the state was similar to the variation in use across US states. Continued measurement and detailed local population rates of antibiotic use in Massachusetts will provide feedback for local prescribers.
Reconceptualizing Canadian Federal Political Culture: Examining Differences between Quebec and the Rest of Canada
Authors: McGrane David , Berdahl Loleen
Published: April 2019

While the concept of federal political culture has been attractive to federalism scholars, Canada has proved to be a puzzling case and generated contradictory results across studies. We test a new definition of Canadian federal political culture using original survey data and find that Canadians have moderate levels of federal political culture driven by a utopian view of federalism in which the promotion of diversity should be achieved without any negative consequences for the unity of the polity. We also find that Quebecers and other Canadians have similar levels of federal political culture and that the results are consistent when survey questions are altered to take out country-specific references.
Sound Words: Hymns in Twentieth-Century Literature
Authors: Masud Noreen
Published: April 2019

Why, in the twentieth century, do atheist or agnostic authors write so many hymns into their poems and novels? This essay contends that attending to the frequent but overlooked hymn episodes in early to mid-twentieth-century literature, and to their historical contexts, can complicate our understanding of literary postures of faith, and of everyday sounds as ‘filler’ in modernist literature. Focusing on Stevie Smith and D. H. Lawrence, with reference to a range of other writers, it draws on unpublished archival material to argue that hymn-history reveals an alternative narrative to that of religious writing as conservative, and literary writing as radical. Hymn-compilers often sought modernity, while poets and novelists tended to privilege older, more dated hymns. This ideological clash led to a literary approach which defiantly accommodated ‘bad old hymns’ through nostalgic reminiscence and extensive quotation. Used in this way, hymn oscillates between a status as textual padding and as focal point: an embarrassingly excessive and solid substance which nevertheless enables embarrassment to be discharged. Ultimately, the muffling, ostensibly authoritative substance of hymn, in twentieth-century literature, fills up gaps in which too much might resound or be revealed: it offers literary writing an opportunity to accommodate and neutralize awkwardness, failure and error.
Nontuberculous Mycobacterial Infections After Cosmetic Procedures: A Systematic Review and Management Algorithm
Authors: Jabbour Samer F. , Malek Alexandre E. , Kechichian Elio G. , Tomb Roland R. , Nasr Marwan W.
Published: April 2019

BACKGROUND

Nontuberculous mycobacterium (NTM) infection following cosmetic procedures usually results from inadequate sterile techniques and contamination from nonsterile water. These infections are difficult to diagnose and treat.

OBJECTIVE

This study aimed to describe the characteristics of NTM infections acquired after an aesthetic procedure, identify high-risk patients and high-risk cosmetic procedures, and provide a diagnostic and management algorithm for NTM infections occurring after cosmetic procedures.

METHODS

On December 20, 2017 an online search of the Medline database was done. All articles describing NTM infection in cosmetic procedures were included in this review.

RESULTS

In total, 92 patients with a mean age of 38.35 years were included in this review. Cosmetic procedures performed in the Dominican Republic were the most common source of infection and were noted in 33 patients. The procedure that resulted in the highest proportion of the infections was mesotherapy (34%). In most of the cases, the diagnosis was missed at the initial presentation and a short course of inadequate antibiotics was unsuccessful.

CONCLUSION

Nontuberculous mycobacterium infections are hard to diagnose and difficult to treat, sometimes leading to severe irreversible sequalae. Aesthetic practitioners should know when to suspect and how to prevent, diagnose, and treat NTM infections.
REVERSE SUTURE TECHNIQUE FOR INTRAOCULAR LENS REFIXATION
Authors: Patel Shriji N. , Snyder Laura L.
Published: April 2019

Purpose:

To describe a novel reverse suture approach to safely and securely refixate dislocated intraocular lenses (IOLs).

Methods:

We describe two cases herein where we use a reverse suture technique to refixate dislocated IOLs. By reversing the needle-holder grasp on a Gore-Tex suture needle, we can safely insert the base of the needle through the pars plana. This allows for looping of the suture around the haptic of subluxated or dislocated IOL. We use the technique in a case with a subluxed plate haptic IOL and a subluxed three-piece IOL with an encircling capsular tension ring.

Results:

The reverse suture technique allows for safe and effective looping of a subluxed IOL haptic or capsular tension ring. This technique can be performed without an assistant and prevents excessive manipulation and unnecessary explantation of dislocated IOL.

Conclusion:

The reverse suture technique is a safe, effective, and easily reproducible maneuver to refixate dislocated IOLs.
SPONTANEOUS CLOSURE OF A MACULAR HOLE RESULTING FROM YAG LASER CAPSULOTOMY IN A 13-YEAR-OLD GIRL
Authors: Parikh Pooja , Day Ghafoori Shelley , Dixit Lena , Harper Clio Armitage
Published: April 2019

Purpose:

To describe the novel finding of spontaneous resolution of a full-thickness macular hole resulting from YAG laser capsulotomy in a 13-year-old girl with previous history of retinal detachment repair and cataract surgery.

Methods:

A 13-year-old girl who had developed a macular hole after YAG laser was noted to have spontaneous resolution of the macular hole at 2-week follow-up visit with concurrent increase in visual acuity. Institutional review board was not applicable for this case.

Results:

Spontaneous resolution of a YAG laser–induced macular hole in a pediatric patient.

Conclusion:

This is a novel report in a pediatric patient of spontaneous resolution of a full-thickness macular hole induced by YAG laser capsulotomy. If a macular hole is noted after YAG capsulotomy, consideration should be given to initial close observation rather than surgical intervention as spontaneous resolution may occur.
Effect of Riboflavin Solution With Hydroxypropyl Methylcellulose and Eyelid Speculum on Pachymetry Changes During Accelerated Collagen Crosslinking
Authors: Akkaya Turhan Semra , Aydin Fahri Onur , Toker Ebru
Published: April 2019

Purpose:

To assess corneal thickness changes with isotonic riboflavin (RF) solution with hydroxylpropyl methylcellulose in patients undergoing accelerated corneal collagen crosslinking (CXL) with and without an eyelid speculum.

Methods:

Fifty-two eyes of 48 patients with progressive keratoconus were enrolled in this study. The patients in this study were divided into 2 groups: in group 1 an eyelid speculum was removed during 20-minute RF (0.1%) + hydroxylpropyl methylcellulose (Mediocross M; Avedro Inc, Waltham, MA) instillation, and in group 2 the eyelid speculum was retained in place during the entire CXL procedure. All patients underwent accelerated CXL using continuous ultraviolet-A (UVA) light exposure at 9 mW/cm2 for 10 minutes; total energy dose was 5.4 J/cm2. Intraoperative ultrasound pachymetry measurements were obtained before and after epithelial removal, after RF loading, and after UVA light exposure at 5 and 10 minutes.

Results:

The preoperative pachymetric measurements decreased in both groups after the removal of epithelium [group 1 (n = 26): −25 μm, group 2 (n = 26): −31 μm, P = 0.234]. Although the thinnest pachymetry significantly increased after soaking in both group 1 (52.26 μm) and group 2 (27.88 μm, P < 0.001), closure of the eyelids during RF instillation further increased the pachymetry readings (P < 0.0001). The corneal thickness remained stable in both groups during UVA irradiation at 5 and 10 minutes (P > 0.05).

Conclusions:

Closure of the eyelids further induces corneal swelling that may offer an advantage to improve safety of the procedure particularly in thin corneas.
Randomized Controlled Trial of Oropharyngeal Colostrum Administration in Very‐low‐birth‐weight Preterm Infants
Authors: Ferreira Daniela M.L.M. , Oliveira Angela M.M. , de Leves Débora V. , de Bem Érica B. , Fatureto Giovana G. , Navarro Natássia F. , Afonso Nathália G. , Santiago Fernanda M. , Mineo José R. , Sopelete Mônica C. , Martinez Francisco E. , Bernardino Neto Morun , Abdallah Vânia O.S.
Published: April 2019

Objective:

The purpose of this study was to evaluate the effects of oropharyngeal colostrum administration in the incidence of late‐onset clinical and proven sepsis and in concentrations of immunoglobulin A (IgA) in very‐low‐birth‐weight (VLBW) infants.

Methods:

We conducted a double‐blinded, randomized, placebo‐controlled trial and assigned 113 VLBW infants to receive 0.2 mL of maternal colostrum or sterile water (placebo) via oropharyngeal route every 2 hours for 48 hours, beginning in the first 48 to 72 hours of life. Neonates of both groups were fed breast milk from the first 3 days of life until a volume of at least 100 mL · kg−1 · day−1. IgA was measured in serum and urine before and after treatment. Clinical data during hospitalization were collected.

Results:

We found no statistically significant differences between colostrum and placebo groups in the incidence of late‐onset clinical sepsis (odds ratio 0.7602; CI 95% 0.3–1.6) and proven sepsis (odds ratio 0.7028; CI 95% 0.3–1.6). The measurement of IgA was similar in serum before (P value 0.87) and after treatment (P value 0.26 day 4 and 0.77 day 18). No differences were also observed in IgA in urine before (P value 0.8) and after treatment (P value 0.73 day 4 and 0.52).

Conclusions:

This study could not confirm the hypothesis that oropharyngeal administration of maternal colostrum to VLBW could reduce the incidence of late‐onset sepsis and increase the levels of IgA. We believe that this finding can be justified by the practice of feeding VLBW infants exclusively with breast milk in the first days of life and reinforces the prior knowledge of the importance of early nutrition, especially, with human milk. It also suggests that oropharyngeal administration of colostrum should be reserved for neonates who cannot be fed in first few days of life.
Live Discharge From Hospice
Authors: Wu Serena , Volker Deborah L.
Published: April 2019

Live discharges from hospice may occur because of patient choice or provider choice. However, when discharges occur before death, patients and families may feel abandoned and left to manage care needs previously provided by hospice. The purpose of this systematic review was to better understand the nature of live discharges, including frequency, patient characteristics, and hospice characteristics. Of 44 studies identified for review, 13 met inclusion criteria and were published between 2008 and 2018. Live discharge rates varied from 5% to 23%. Patients’ prehospice characteristics varied widely based on diagnosis, comorbidities, gender, race, and ethnicity. Hospice characteristics indicated that the likelihood of a live discharge was increased for patients enrolled in for-profit hospices and in rural areas. Only 2 studies captured the patient/family perspective of the live discharge experience, finding that the loss of hospice support was fraught with difficulties. A need for further study of the live discharge experience and the practices of hospices with high live discharge rates was identified.
Transforming Nursing Students’ Attitudes Toward End-of-Life Care
Authors: Mahan Pamela , Taggart Helen , Knofczynski Greg , Warnock Sherry
Published: April 2019

End-of-life care is an important nursing competency and must be incorporated into the baccalaureate nursing curriculum. The purpose of this research was to examine the outcomes of an actual hospice compared with a simulated hospice clinical experience. This pretest and posttest nonequivalent 2-group design consisted of a sample of 65 undergraduate nursing students enrolled in a community health course. All students enrolled in the community health course have 1 day for hospice experience and a 2-hour orientation from the nurse educator at a local hospice agency. Students enrolled in the first 7 weeks were paired with a hospice nurse and conducted home visits. Students enrolled in the second 7-week session participated in 2 simulated hospice clinical experiences on campus. Thirty-two students were in the simulated hospice group and 33 were in the home hospice group. Attitudes toward end-of-life care were measured before and after the intervention with the Frommelt Attitudes Toward Care of the Dying. The findings indicated positive attitude changes toward end-of-life care. After the hospice clinical experience, both groups seemed to show increases in their mean Frommelt Attitudes Toward Care of the Dying scores, possibly indicating a greater comfort with caring for dying patients.
Work Satisfaction Among Hospice and Palliative Nurses
Authors: Head Barbara , Middleton Alyssa , Zeigler Craig
Published: April 2019

Job satisfaction among hospice and palliative nurses is important as turnover and a dissatisfied workforce impact the work environment and the care provided to seriously ill patients and their families. This article reports the results of a nationwide survey of 633 hospice and palliative nurses evaluating job satisfaction, intent to leave, job stressors, suggested work improvements, and self-care strategies. Statistically significant correlations were found between the Home Healthcare Job Satisfaction Scale and subscales and the individual’s self-rating of overall job satisfaction, likelihood of leaving the job, and thoughts of quitting. Multiple regression revealed a significant positive association between salary and overall job satisfaction, relationship with the organization, professional pride, autonomy, and control. A grounded theory approach was utilized to analyze qualitative data. Top job stressors identified were workload and problems with administration. Physical activities were cited as the most popular for self-care. Results indicate that most participants were highly satisfied with their work, but almost half think of quitting some or all of the time, indicating dissatisfaction with the work environment. Respondents suggested that employers increase recognition and salary, create a more positive work environment, decrease workload, and focus on patient needs rather than profits.
Impact of Environmental Noise Levels on Endotracheal Intubation Performance Among Pediatric Emergency Providers
Authors: Salzman Garrett A. , El Hanan , Chang Todd P.
Published: April 2019

Background

The emergency department is a stressful workplace environment with environmental stimuli and distractions, including noise. This has potential effects on perceived stress for providers and critical procedure performance.

Objective

This study aimed to characterize the impact of environmental noise levels on the time to intubate, the quality of intubation, and physiologic stress response in pediatric emergency department providers.

Methods

This was a randomized control simulation-based study in which experienced pediatric providers intubated an adult manikin 3 times while experiencing 3 different ambient noise levels (60, 75, 80 dB) in random order. Participants' times to intubate were measured, as was the endotracheal tube depth. The quality of each intubation attempt was assessed via video review against a standardized checklist. Lastly, participants' heart rates were monitored in real time to assess for physiologic stress response. Differences in performance were analyzed using a repeated-measures analysis of variance.

Results

No significant difference was found between noise levels and time to intubate (P = 0.19), although each subsequent attempt shortened the time to intubate (P = 0.01). Physiological heart rate changes did not differ by noise level (P = 0.35). Subjectively, “time and economy of motion” and “overall performance” did not differ by noise level but did improve for each subsequent attempt number (P < 0.046).

Conclusions

Intubation performance improved with attempt number, but no differences in performance were seen between noise levels. This suggests that rehearsing and practice impacts performance more than environmental noise levels.
Differences in Measures of Strength and Dynamic Balance Among Individuals With Lower-Limb Loss Classified as Functional Level K3 Versus K4
Authors: Beisheim Emma Haldane , Horne John Robert , Pohlig Ryan Todd , Sions Jaclyn Megan
Published: April 2019

Objective

For individuals with lower-limb loss, functional mobility (ie, K-level) classification can be subjective. Performance-based outcome measures improve the objectivity of K-level assignment; therefore, this study aimed to determine differences in functional strength– and dynamic balance–based outcome measures performance between K3- and K4-classified adults with lower-limb loss.

Design

Prosthetists used subjective information and prosthetic componentry to determine K-levels before outcome measures testing for adults with a unilateral transtibial (n = 50) or transfemoral amputation (n = 17). Outcome measures (ie, 5-Times Sit-to-Stand Test, Figure-of-8 Walk Test, 360-degree Turn Test, and modified Four-Square Step Test) were administered by a blinded examiner. Univariate analyses of variance were used to evaluate between-subgroup differences.

Results

K4-classified participants with a unilateral transfemoral amputation performed better on all outcome measures when compared with K3-classified peers, whereas K4-classified individuals with a transtibial amputation performed better on the modified Four-Square Step Test compared with K3-classified peers (P < 0.050).

Conclusions

K4-classified individuals demonstrated greater lower-limb functional strength and better dynamic balance compared with K3-classified peers. To assist with K-level classification, clinicians should consider selecting outcome measures that objectively differentiate between K-levels (ie, modified Four-Square Step Test for those with a unilateral transtibial or transfemoral amputation; 5-Times Sit-to-Stand Test, Figure-of-8 Walk Test, and 360-degree Turn Test for those with a transfemoral amputation).
Effects of Oxygen During Long-term Hypothermic Machine Perfusion in a Porcine Model of Kidney Donation After Circulatory Death
Authors: Venema Leonie H. , Brat Aukje , Moers Cyril , ‘t Hart Nils A. , Ploeg Rutger J. , Hannaert Patrick , Minor Thomas , Leuvenink and Henri G.D.
Published: April 2019

Background.

Hypothermic machine perfusion (HMP) has become standard care in many center’s to preserve kidneys donated after circulatory death (DCD). Despite a significant reduction in metabolism at low temperatures, the remaining cellular activity requires oxygen. Because of the role and safety of oxygen during HMP has not been fully clarified, its supply during HMP is not standard yet. This study investigates the effect of administering oxygen during HMP on renal function in a porcine DCD model.

Methods.

After 30 minutes of warm ischemia, porcine slaughterhouse kidneys were preserved for 24 hours by means of cold storage (CS), or HMP with Belzer Machine Perfusion Solution supplemented with no oxygen, 21% or 100% oxygen. Next, kidneys were reperfused for 4 hours in a normothermic machine perfusion setup.

Results.

HMP resulted in significantly better kidney function during normothermic machine perfusion. Thiobarbituric acid-reactive substances, markers of oxidative stress, were significantly lower in HMP preserved kidneys. HMP preserved kidneys showed significantly lower aspartate aminotransferase and lactate dehydrogenase levels compared with kidneys preserved by CS. No differences were found between the HMP groups subjected to different oxygen concentrations. Adenosine triphosphate levels significantly improved during HMP when active oxygenation was applied.

Conclusions.

This study showed that preservation of DCD kidneys with HMP is superior to CS. Although the addition of oxygen to HMP did not result in significantly improved renal function, beneficial effects were found in terms of reduced oxidative stress and energy status. Oxygen addition proofed to be safe and did not show detrimental effects.
Brain Death Enhances Activation of the Innate Immune System and Leads to Reduced Renal Metabolic Gene Expression
Authors: Zitur Laura J. , Chlebeck Peter J. , Odorico Scott K. , Danobeitia Juan S. , Zens Tiffany J. , Van Kooten Cees , Eerhart Michael , Reyes Jose A. , Springer Megan L. , Coonen Jennifer M. , Brunner Kevin G. , Capuano Saverio V. , D’Alessandro Anthony M. , Fernandez Luis A.
Published: April 2019

Background.

Brain death (BD)–associated inflammation has been implicated in decreased kidney allograft function and survival, but the underlying mechanisms have not been well distinguished from the conditions of critical care itself. We have developed a clinically translatable model to separate and investigate strategies to improve donor management and critical care.

Methods.

Brain-dead (n = 12) and sham (n = 5) rhesus macaques were maintained for 20 hours under intensive care unit–level conditions. Samples were collected for immunophenotyping, analysis of plasma proteins, coagulation studies, and gene analysis for changes in immune and metabolic profile with comparison to naive samples (n = 10).

Results.

We observed an increase in circulating leukocytes and cytokines, activation of complement and coagulation pathways, and upregulation of genes associated with inflammation in both brain-dead and sham subjects relative to naïve controls. Sham demonstrated an intermediate phenotype of inflammation compared to BD. Analysis of gene expression in kidneys from BD kidneys revealed a similar upregulation of inflammatory profile in both BD and sham subjects, but BD presented a distinct reduction in metabolic and respiratory processes compared to sham and naïve kidneys.

Conclusion.

BD is associated with activation of specific pathways of the innate immune system and changes to metabolic gene expression in renal tissue itself; however, sham donors presented an intermediate inflammatory response attributable to the critical care environment. The early onset and penetrating impact of this inflammatory response underscores the need for early intervention to prevent perioperative tissue injury to transplantable organs.
Modelling human papillomavirus biology in oropharyngeal keratinocytes
Authors: Roberts Sally , Evans Dhananjay , Mehanna Hisham , Parish Joanna L.
Published: April 2019

Most human papillomavirus (HPV) positive head and neck cancers arise in the tonsil crypts; deep invaginations at the tonsil surface that are lined with reticulated epithelium infiltrated by immune cells. As in cervical HPV infections, HPV16 is the most prevalent high-risk type in the oropharyngeal cancers, and a genital-oral route of infection is most likely. However, the natural history of HPV-driven oropharyngeal pathogenesis is an enigma, although there is evidence that it is different to that of cervical disease. It is not known if the virus establishes a productive or abortive infection in keratinocytes of the tonsil crypt, or if viral infections progress to cancer
via
a neoplastic phase, as in cervical HPV infection. The HPV DNA is more frequently found unintegrated in the cancers of the oropharynx compared to those that arise in the cervix, and may include novel HPV-human DNA hybrids episomes. Here, we review current understanding of HPV biology in the oropharynx and discuss the cell-based systems being used to model the HPV life cycle in tonsil keratinocytes and how they can be used to inform on HPV-driven neoplastic progression in the oropharynx.

This article is part of the theme issue ‘Silent cancer agents: multi-disciplinary modelling of human DNA oncoviruses’.
Origin and evolution of papillomavirus (onco)genes and genomes
Authors: Willemsen Anouk , Bravo Ignacio G.
Published: April 2019

Papillomaviruses (PVs) are ancient viruses infecting vertebrates, from fishes to mammals. Although the genomes of PVs are small and show conserved synteny, PVs display large genotypic diversity and ample variation in the phenotypic presentation of the infection. Most PV genomes contain two small early genes
E6
and
E7
. In a bunch of closely related human papillomaviruses (HPVs), the E6 and E7 proteins provide the viruses with oncogenic potential. The recent discoveries of PVs without
E6
and
E7
in different fish species place a new root on the PV tree, and suggest that ancestral PVs consisted of the minimal PV backbone
E1-E2-L2-L1
. Bayesian phylogenetic analyses date the most recent common ancestor of the PV backbone to 424 million years ago (Ma). Common ancestry tests on extant
E6
and
E7
genes indicate that they share a common ancestor dating back to at least 184 Ma. In
AlphaPVs
infecting Old World monkeys and apes, the appearance of the
E5
oncogene 53–58 Ma concurred with (i) a significant increase in substitution rate, (ii) a basal radiation and (iii) key gain of functions in E6 and E7. This series of events was instrumental to construct the extant phenotype of oncogenic HPVs. Our results assemble the current knowledge on PV diversity and present an ancient evolutionary timeline punctuated by evolutionary innovations in the history of this successful viral family.

This article is part of the theme issue ‘Silent cancer agents: multi-disciplinary modelling of human DNA oncoviruses’.