bluuebunny/crossref_metadata_2025 huggingface dataset:
Family-centered Care Improved Neonatal Medical and Neurobehavioral Outcomes in Preterm Infants: Randomized Controlled Trial
Authors: Yu Yen-Ting , Hsieh Wu-Shiun , Hsu Chyong-Hsin , Lin Yuh-Jyh , Lin Chyi-Her , Hsieh Shulan , Lu Lu , Cherng Rong-Ju , Chang Ying-Ju , Fan Pi-Chuan , Yao Nai-Jia , Chen Wei J. , Jeng Suh-Fang
Published: August 2017

Background

Family-centered care for preterm infants in Western societies has yielded short- to medium-term benefits. However, the intervention effects have rarely been validated in Eastern societies.

Objective

The aim of this study was to examine whether a family-centered intervention program (FCIP) could improve the short-term medical and neurobehavioral outcomes in preterm infants with very low birth weight (VLBW; a birth weight of <1,500 g) in Taiwan over the outcomes seen with a usual care program (UCP).

Design

This was a multicenter, single-blind, randomized controlled trial study.

Setting

Three medical centers in northern and southern Taiwan were the locations for the study.

Participants

The participants were 251 VLBW preterm infants without severe perinatal complications.

Intervention

The infants were randomly assigned to receive the FCIP or the UCP during hospitalization.

Measurements

Infant morbidities, feeding, growth, and neurobehavioral performance were evaluated during the neonatal period. Parental adherence to interventions was measured in the FCIP group.

Results

The FCIP promoted earlier full enteral feeding (β = –1.1 weeks; 95% CI = –1.9 to –0.2 weeks) and hospital discharge (β = –0.6 week; 95% CI = –1.1 to –0.1 weeks), greater weight gain (β = 3.3 g/d; 95% CI = 0.1 to 6.6 g/d), and better neurobehavioral performance than the UCP (β = 1.2 points; 95% CI = 0.2 to 2.3 points). Furthermore, a higher degree of parental motivation in interventions, goal attainment, and comprehensiveness of home activities was significantly associated with greater effects in infants’ neurobehavioral performance and weight gain (r = .20–.31; all Ps < .05).

Limitations

The findings may not be generalized to preterm infants with severe perinatal diseases and parents with a low level of interest in interventions.

Conclusions

Family-centered care facilitated short-term medical and neurobehavioral outcomes in VLBW preterm infants in Taiwan; the effects were likely achieved through parental adherence to interventions. The designated strategies may be considered in a future launch of family-centered care in Taiwan.
Absolute Quantification ofTomato leaf curl New Delhi virusSpain strain, ToLCNDV-ES: Virus Accumulation in a Host-Specific Manner
Authors: Simón Almudena , Ruiz Leticia , Velasco Leonardo , Janssen Dirk
Published: August 2017

Tomato leaf curl New Delhi virus (ToLCNDV) (family Geminiviridae, genus Begomovirus) has recently been introduced in western Mediterranean countries. Isolates in Spain constitute a new strain, denominated ToLCNDV-ES, that is causing losses in commercial zucchini and melon crops; however, it is also, although less often, detected in commercial tomato crops. We developed a tissue-print hybridization test to detect the two genomic components of the virus and a TaqMan quantitative polymerase chain reaction (qPCR) test to estimate the number of genome copies in plants. qPCR was approximately 104to 106times more sensitive than tissue-print hybridization to detect viral genomic DNA-A and DNA-B, respectively. It also detected the virus in more experimentally and naturally ToLCNDV-ES-infected zucchini squash and tomato plants. ToLCNDV-ES DNA-A titers were significantly lower in tomato than in zucchini plants, often falling below the detection limits in the hybridization test. In addition, the DNA-B accumulation was impaired in tomato when compared with zucchini. According to the data obtained in this study, the differences in viral titers of both plant species contribute to explain the dissimilarities in symptom expression, capability of detection, and transmission of the virus.
PAs in primary care
Authors: Coplan Bettie , Smith Noel , Cawley James F.
Published: August 2017

Objectives:

Understanding the PA primary care workforce is an initial step toward greater use of primary care PAs in new healthcare delivery models. This study sought to describe primary care PA practice as it compares with PA practice in other specialties.

Methods:

Data from two 2015 national American Academy of Physician Assistants surveys were analyzed using descriptive statistics. Statistically significant differences between primary care and specialty PAs were assessed using tests of column proportions and tests of column means.

Results:

Compared with PAs in specialties, primary care PAs were older, saw more patients per week, and spent less time consulting with physicians. In addition, higher percentages were Hispanic, had a record of military service, and had plans to leave their specialty or retire.

Conclusions:

Primary care PAs appear to possess unique strengths; however, challenges to maintaining a primary care PA workforce are substantial.
Is there a role for inhaled anticholinergic therapy in asthma management?
Authors: Parkey Shannon M. , Mospan Cortney M.
Published: August 2017

Anticholinergic therapy has long been a cornerstone of management of chronic obstructive pulmonary disease (COPD) but has not been included in treatment guidelines for asthma. In September 2015, tiotropium bromide was approved for use in adults with asthma; the indication has since been expanded to children ages 6 years and older. This article discusses appropriate patient selection and dosing, and the role of tiotropium bromide in asthma management.
Dual-Task Walking Performance in Older Persons With Hearing Impairment: Implications for Interventions From a Preliminary Observational Study
Authors: Wollesen Bettina , Scrivener Katharine , Soles Kirsty , Billy Yaw , Leung Angela , Martin Felicity , Iconomou Nicholas , McMahon Catherine , Dean Catherine
Published: August 2017

Objectives:

Adults with “hearing loss” have an increased falls risks. There may be an association between hearing impairment and walking performance under dual-task (DT) and triple-task (TT) conditions. The aim of this study was to identify DT and TT effects on walking speed, step length, and cadence in adults with hearing impairment, previous falls, and physical limitations.

Design:

The observational study included 73 community-dwelling older people seeking audiology services. Data were collected on sociodemographic characteristics, previous falls, fear of falling, physical limitations, and walking performance under three task conditions. Differences between the task conditions (single task [ST], DT, and TT) and the hearing groups were analyzed with a two-way ANOVA with repeated measures. The influence of fall risks and limited physical functioning on walking under ST, DT, and TT conditions was analyzed with ANOVAs, with ST, DT, and TT performance as repeated measurement factor (i.e., walking speed, step length and Cadence × Previous falls, or short physical performance battery <12 × Hearing Groups).

Results:

Walking speed was reduced accompanied by decreased step length and increased cadence in people with more severe hearing loss. Larger negative effects on DT and TT walking were found with increasing hearing loss (speed and cadence decreased with higher DT costs). Highest DT costs were found for the walking-manual conditions. These results were accompanied by small effects of older age and more comorbidities.

Conclusions:

This first screening data of walking performance under different conditions for people with hearing loss warrants the need for development and investigation of training interventions to improve walking abilities. DT training may be beneficial to enhance motor and cognitive flexibility and to reduce fall risks.
Correlation Between Original Biopsy Pathology and Mohs Intraoperative Pathology
Authors: Stiegel Evan , Lam Charlene , Schowalter Michael , Somani Ally-Khan , Lucas Jennifer , Poblete-Lopez Christine
Published: August 2017

BACKGROUND

The pathology observed on initial biopsy specimens for nonmelanoma skin cancer (NMSC), specifically the tumor subtype, weighs heavily into the selection of the treatment modality. Recognizing aggressive features on intraoperative Mohs micrographic surgery (MMS) frozen sections that were not indicated on initial biopsy reports is not uncommon. To date, there is limited data describing this discrepancy.

OBJECTIVE

To investigate the frequency and nature of incongruity between the pathology seen in initial biopsies and intraoperative Mohs sections, providing information that will potentially impact skin cancer treatment and biopsy recommendations.

METHODS

Retrospective chart review of cases of NMSC referred for MMS at the authors' institution over a 1-year period, recording changes between tumor subtypes observed at biopsy and those observed during MMS.

RESULTS

Cases (50.5%) (n = 163) changed aggressiveness. Of these, 33% (n = 108) were more aggressive, whereas 17% (n = 55) were less aggressive.

CONCLUSION

A substantial discrepancy was observed between preoperative biopsy and intraoperative pathology, including a significant portion tumors that became more aggressive. These results suggest that treatment modalities without margin control may not provide adequate treatment for a considerable number of NMSC based on preoperative tumor type alone.
Nucleoligands-repurposing G Protein–coupled Receptor Ligands to Modulate Nuclear-localized G Protein–coupled Receptors in the Cardiovascular System
Authors: Audet Nicolas , Dabouz Rabah , Allen Bruce G. , Hébert Terence E.
Published: August 2017

There is significant evidence that internal pools of G protein–coupled receptors (GPCRs) exist and may be affected by both endogenous signaling molecules and hydrophobic pharmaceutical ligands, once assumed to only affect cell surface versions of these receptors. Here, we discuss evidence that the biology of nuclear GPCRs in particular is complex, rich, and highly interactive with GPCR signaling from the cell surface. Caging existing GPCR ligands may be an excellent means of further stratifying the phenotypic effects of known pharmacophores such as β-adrenergic, angiotensin II, and type B endothelin receptor ligands in the cardiovascular system. We describe some synthetic strategies we have used to design ligands to go from in cellulo to in vivo experiments. We also consider how surface and intracellular GPCR signaling might be integrated and ways to dissect this. If they could be selectively targeted, nuclear GPCRs and their associated nucleoligands would represent a completely novel area for exploration by Pharma.
Drug-induced Myopia and Bilateral Angle Closure Secondary to Zolmitriptan
Authors: Lee Jonathan Tak Loong , Skalicky Simon Edward , Lin Ming-Lee
Published: August 2017

Purpose:

To describe a unique case of drug-induced transient myopia with angle-closure glaucoma in a patient being treated with zolmitriptan for migraines.

Methods:

A 42-year-old woman who had been using increasing amounts of zolmitriptan over the previous 12 months presented with an acute myopic shift and raised intraocular pressures (IOP) with anterior chamber shallowing. Clinical examination findings at presentation and at follow-up visits were reviewed.

Results:

Initial examination revealed unaided visual acuities of 20/100 in the right eye and 20/125 in the left, with IOP measuring 34 mm Hg bilaterally. Zolmitriptan was ceased and the patient was commenced on topical antiglaucoma medication. Within 2 weeks, IOP had normalized, with deepening of the anterior chambers and complete resolution of her myopia. Her final recorded unaided visual acuities were 20/12.5 in the right eye and 20/16 in the left. When topical antiglaucoma medication was ceased the patient developed pressure-related headaches and selective laser trabeculoplasty was performed to minimize the need for long-term topical medication use.

Conclusion:

Idiosyncratic drug reactions resulting in ciliochoroidal effusion, secondary angle closure, and transient myopia are well described, but they have not been previously reported with zolmitriptan use. An awareness of the various potential causative agents is important, as findings are generally reversible if recognized early and if the offending drug is discontinued.
Analysis of Invasive Community-Acquired Methicillin-Susceptible Staphylococcus aureus Infections During a Period of Declining Community Acquired Methicillin-Resistant Staphylococcus aureus Infections at a Large Children’s Hospital
Authors: Hultén Kristina G. , Mason Edward O. , Lamberth Linda B. , Forbes Andrea R. , Revell Paula A. , Kaplan Sheldon L.
Published: August 2017

Background:

The epidemiology of community acquired (CA) Staphylococcus aureus infections is changing in the United States. We investigated the current epidemiology of S. aureus infections at Texas Children’s Hospital.

Methods:

Patients with CA-S. aureus skin and soft tissue and invasive infections were retrospectively identified from January 1, 2007 to December 31, 2014. Invasive CA-MSSA isolates were characterized by pulsed field gel electrophoresis, Spa typing, agr type and presence of lukSF-PV (pvl) genes. Medical records were reviewed. Statistical analyses included Fisher exact, χ2 for trend and Wilcoxon tests.

Results:

CA-MRSA infections decreased by 60.4% (1461–578 infections) from 2007 to 2014 (P < 0.0001), while CA-MSSA infections averaged 550 infections annually. Invasive CA-MRSA infections decreased by 67.2% from 61 to 20 infections (P < 0.0001); invasive CA-MSSA averaged 44 infections annually. Among 296 invasive CA-MSSA isolates, 74 (25%) isolates were USA300 and 88 (30%) were pvl+. USA300 declined among invasive CA-MSSA over time (P < 0.008). Musculoskeletal infections were most common (242/296, 82%); 52/242 (21.5%) isolates were USA300 and 62/242 (25.6%) pvl+. All 18 isolates from musculoskeletal infections with deep venous thrombosis and/or septic shock were pvl+ and 16/18 (88.9%) were USA300. Pneumonia isolates were mainly USA300 (8, 66.7%) and pvl+ (11, 91.7%).

Conclusions:

MSSA now cause the majority of invasive CA-S. aureus infections at our institution. Molecular analysis of invasive CA-MSSA isolates suggests strain diversity with USA300 on the decline and that disease presentations are to some extent strain specific. Changes in the CA-S. aureus epidemiology may, in part, be related to changes in immunity to the USA300 clone in the general population.
Enhancing Infant Mental Health Using a Capacity-Building Model
Authors: O'Farrelly Christine , Lovett Judy , Guerin Suzanne , Doyle Orla , Victory Gerard
Published: August 2017

Infant mental health (IMH) is best promoted through a continuum of services underpinned by strong service capacity. However, service providers often lack fundamental IMH knowledge and skills. Using the Ready, Steady, Grow (RSG) initiative as a case study of a capacity-building model (P., Hawe, L., King, M., Noort, C., Jordens, & B., Llyod, 2000), this article contributes to the field by investigating the facilitators and challenges to IMH promotion in a disadvantaged community in Ireland. A mixed-methods study assessed the degree to which RSG has developed the local service community capacity. Data included semistructured interviews (n = 23) and a survey with service stakeholders from nursing, speech and language, early childhood care and education, social work, family support, physiotherapy, and youth work (n = 40). The findings indicated that RSG has enhanced IMH capacity among service stakeholders by establishing a strong groundwork and enthusiasm for IMH, in addition to building preliminary IMH skills, although scope remains for further engagement and training. Ongoing barriers to capacity building include a dearth of resources and concern about sustainability. This case study offers theoretical and practical insights to those interested in promoting child health using a capacity-building model.
Online Parent Training to Support Children With Complex Communication Needs
Authors: Douglas Sarah N. , Nordquist Erica , Kammes Rebecca , Gerde Hope
Published: August 2017

Parent training can help support the development of communication skills for young children with complex communication needs (CCN). Online delivery of such training may alleviate some of the burden on families, thereby increasing participation and outcomes. To determine the effectiveness of online parent training in communication partner strategies, a single-subject, multiple-probe design study was conducted with four parents and their children with developmental disabilities and CCN. Parents completed an interactive online training and then participated in live sessions to demonstrate trained skills. Results indicate that online parent training resulted in higher levels of communication opportunities provided by parents to their children with CCN. Increases were also noted for child communication and responses provided by parents to child communication. Results varied for participants. Parent evaluations of the training, limitations, and future research directions are discussed.
Early Childhood Inclusion in Taiwan
Authors: Liao Hua-Fang , Wu Pei-Fang
Published: August 2017

In accordance with the Special Education Act that indicates that young children with special needs must have individualized educational plans and receive education with their typically developing peers in the general education setting, Taiwan implemented an experimental preschool inclusion program in 1989. Subsequently, during the 1990s, there was an emphasis on the importance of early intervention for children with special needs from birth to 6 years of age. The use of the International Classification of Functioning, Disability, and Health (ICF) and its Children and Youth version (ICF-CY) has also influenced views on early childhood inclusion in educational settings. This article describes the relevant legislation, current early childhood inclusion practices in different forms, relevant research, challenges, and future directions of early childhood inclusion at the governmental, community, institutional, and individual levels in Taiwan.
The Effects of the Newborn Behavioral Observations (NBO) System on Sensitivity in Mother–Infant Interactions
Authors: Nugent J. Kevin , Bartlett Jessica Dym , Von Ende Adam , Valim Clarissa
Published: August 2017

The Newborn Behavioral Observations (NBO) system is a neurobehavioral observation tool designed to sensitize parents to infants' capacities and individuality and to enhance the parent–infant relationship by strengthening parents' confidence and practical skills in caring for their children. The NBO's focus on relationship building is intended for infant mental health professionals who strive for a relational, family-centered model of care versus a pathology-based model. This study assessed the impact of the NBO on the sensitivity of mother–infant interaction in the first 4 months of life. Primiparous mothers and their full-term infants were randomized into experimental and control groups. The intervention group participated in the NBO in the hospital within 2 days of birth and again at home at 1 month postpartum. At 4 months, dyads (n = 35) were videotaped during semistructured play episodes, which were coded to assess parent–child sensitivity in interactions with one another. Intervention infants were 2.8 times more likely to be classified as “cooperative” (sensitive) than control group infants. Intervention mothers were 2.5 times more likely to be classified as sensitive than control mothers. These findings highlight the potential of the NBO to promote positive maternal–infant relations by influencing newborn behavior and suggest that the NBO is an effective, time-limited intervention for strengthening relationships between parents and infants.
Sensory phenotype and risk factors for painful diabetic neuropathy: a cross-sectional observational study
Authors: Raputova Jana , Srotova Iva , Vlckova Eva , Sommer Claudia , Üçeyler Nurcan , Birklein Frank , Rittner Heike L. , Rebhorn Cora , Adamova Blanka , Kovalova Ivana , Kralickova Nekvapilova Eva , Forer Lucas , Belobradkova Jana , Olsovsky Jindrich , Weber Pavel , Dusek Ladislav , Jarkovsky Jiri , Bednarik Josef
Published: August 2017

Different sensory profiles in diabetic distal symmetrical sensory-motor polyneuropathy (DSPN) may be associated with pain and the responsiveness to analgesia. We aimed to characterize sensory phenotypes of patients with painful and painless diabetic neuropathy and to assess demographic, clinical, metabolic, and electrophysiological parameters related to the presence of neuropathic pain in a large cohort of well-defined DSPN subjects. This observational cross-sectional multi-center cohort study (performed as part of the ncRNAPain EU consortium) of 232 subjects with nonpainful (n = 74) and painful (n = 158) DSPN associated with diabetes mellitus of type 1 and 2 (median age 63 years, range 21-87 years; 92 women) comprised detailed history taking, laboratory tests, neurological examination, quantitative sensory testing, nerve conduction studies, and neuropathy severity scores. All parameters were analyzed with regard to the presence and severity of neuropathic pain. Neuropathic pain was positively correlated with the severity of neuropathy and thermal hyposensitivity (P < 0.001). A minority of patients with painful DSPN (14.6%) had a sensory profile, indicating thermal hypersensitivity that was associated with less severe neuropathy. Neuropathic pain was further linked to female sex and higher cognitive appraisal of pain as assessed by the pain catastrophizing scale (P < 0.001), while parameters related to diabetes showed no influence on neuropathic pain with the exception of laboratory signs of nephropathy. This study confirms the value of comprehensive DSPN phenotyping and underlines the importance of the severity of neuropathy for the presence of pain. Different sensory phenotypes might be useful for stratification of patients with painful DSPN for analgesic treatment and drug trials.
Stepping Back to Move Forward: Evaluating the Effectiveness of a Diabetes Prevention Program Within a Large Integrated Healthcare Delivery System
Authors: Brunisholz Kimberly D. , Joy Elizabeth A. , Hashibe Mia , Gren Lisa H. , Savitz Lucy A. , Hamilton Sharon , Cannon Wayne , Huynh Kelly , Schafer Tonya A. N. , Newman Laurel M. , Parker Jodi , Musselman Joilynne , Kim Jaewhan
Published: August 2017

Objective:

To evaluate the short-term effectiveness of the Intermountain Healthcare (IH) Diabetes Prevention Program (DPP) for patients with prediabetes (preDM) deployed within primary care clinics.

Study Design:

A quasi-experimental study design was used to deploy the DPP within the IH system to identify patients with preDM and target a primary goal of a 5% weight loss within 6–12 months of enrollment.

Study Population:

Adults (aged 18–75 years) who met the American Diabetes Association criteria for preDM were included for study. Patients who attended DPP counseling between August 2013 and July 2014 were considered as the intervention (or DPP) group. The DPP group was matched using propensity scores at a 1:4 ratio with a control group of patients with preDM who did not participate in DPP.

Results:

Of the 17,142 patients who met the inclusion criteria for preDM, 40% had an in-person office visit with their provider. On average, patients were 58 years old, and greater than 60% were women. Based on multivariate logistic regression, the DPP group was more likely to achieve a 5% weight loss within 6–12 months after enrollment (OR = 1.70; 95% CI = 1.29–2.25; p < .001) when compared with the no-DPP group.

Conclusions:

Diabetes Prevention Program–based lifestyle interventions demonstrated significant reduction in body weight and incident Type 2 diabetes mellitus when compared with nonenrollees.
Using Technology to Support Data Analytics: A Chief Nursing Officer Accountability Scorecard
Authors: Polancich Shea , Poe Terri , Hackney Natalie , Williamson Jason
Published: August 2017

Accountability for health system improvement is a requirement for nursing leadership in practice. However, to be accountable for organizational goals, nurse leaders need the tools to identify gaps in their microsystems of care. The purpose of this article was to provide a case study example of chief nursing officer (CNO) leadership in using a technology solution to develop a CNO accountability scorecard. This project highlights the HQ Essential for data analytics using an innovative technological approach to drive improvement at the front line of clinical care.
Increased Risk of Mortality Associated With Pancreatic Exocrine Insufficiency in Patients With Chronic Pancreatitis
Authors: de la Iglesia-Garcia Daniel , Vallejo-Senra Nicolau , Iglesias-Garcia Julio , López-López Andrea , Nieto Laura , Domínguez-Muñoz J. Enrique
Published: August 2017

Background:

Pancreatic exocrine insufficiency (PEI) is a common serious complication in chronic pancreatitis (CP); however, little is known about its effect on mortality in these patients. In this study, we assessed the mortality risk of PEI in patients with CP.

Study:

A prospective, longitudinal cohort study conducted in patients with CP under long-term follow-up. CP and PEI were diagnosed using pancreatic imaging and the 13C-labeled mixed triglyceride breath test, respectively. Multivariate analysis was performed to evaluate the impact of PEI and other clinical features on mortality risk.

Results:

Patients (N=430) were analyzed (79.1% male; mean age, 47.8 y) during a mean follow-up of 8.6±4.6 years. PEI prevalence was 29.3% and mortality was 10.9%. Most frequent causes of death were cancer (40.4%), infection (21.3%), and acute cardiovascular event (14.9%). Multivariate analyses showed associations between increased mortality and presence of PEI [hazard ratio (HR), 2.59; 95% confidence interval (CI), 1.42-4.71; P<0.003], liver cirrhosis (HR, 3.87; 95% CI, 1.95-7.69; P<0.001), age at diagnosis (HR, 1.05; 95% CI, 1.03-1.09; P<0.001), toxic etiology of CP (HR, 3.11; 95% CI, 1.11-8.70; P<0.05) and respiratory comorbidity (HR, 2.19; 95% CI, 1.12-4.31; P<0.03). Nutritional markers were significantly lower in patients with PEI versus those without PEI (P<0.001) and in those who died versus survivors (P<0.001).

Conclusions:

PEI was a significant independent risk factor for mortality in patients with CP. These results support further research into the optimal treatment of PEI to reduce mortality in this population.
Facts and Fantasies on Extraesophageal Reflux
Authors: Zerbib Frank , Dulery Charlotte
Published: August 2017

Gastroesophageal reflux disease encompasses a wide spectrum of disorders related to the reflux of gastric contents into the esophagus. Extraesophageal reflux (EER) may be suspected in patients with unexplained chronic cough, pharyngolaryngeal symptoms, and asthma. For physicians, suspected EER is challenging as there is currently no tool that can reliably make a definitive diagnosis. Endoscopic signs are not specific, pharyngeal and proximal reflux monitoring are not reliable, and if distal pH or pH-impedance monitoring can identify patients with abnormal reflux, they cannot predict the response to therapy. Controlled randomized trials have failed to reliably demonstrate any benefit of high-dose proton-pump inhibitors over placebo in patients with laryngeal symptoms, chronic cough, and asthma. Overall, the role of gastroesophageal reflux has been largely overestimated in patients with suspected EER. Especially when proton-pump inhibitors failed to improve symptoms, other diagnosis should be considered, such as functional laryngeal disorders which are probably much more prevalent in these patients than pathologic gastroesophageal reflux.
Beyond Abdominal Pain
Authors: Keller Craig E. , Wilcox Charles Mel , Gudleski Gregory D. , Branham Stacey , Lackner Jeffrey M.
Published: August 2017

Goals:

To assess the relationship between pain, psychological processes, and quality of life (QOL) in chronic pancreatitis (CP).

Background:

CP is a progressive inflammatory disorder of the pancreas characteristically resulting in abdominal pain and impairing QOL. Pain due to CP is poorly understood and frequently difficult to treat. This pain has historically been understood as a peripheral process originating from the pancreas itself, but a growing body of literature is revealing an important role offered by central influences. Viewed through the perspective of the biopsychosocial model of illness, cognitive variables strongly influence QOL. However, there is little understanding of variables that influence QOL in CP.

Study:

Patients with CP from the University of Alabama at Birmingham were administered a 165-question test battery which was comprised of questionnaires evaluating pain beliefs, disease-specific QOL, psychological distress, pain sensation, pain affect, and long-term suffering.

Results:

Sixty-eight subjects completed the question battery between February 28, 2011 and January 16, 2014. Almost all (91.2%) reported taking pain medication. QOL was significantly associated with reported levels of pain intensity (r=−0.52, P<0.01) as well as perceived self-blame.

Conclusions:

The significant predictors of QOL impairment in CP are pain intensity and perceived self-blame for pain. Further research is needed to elucidate this relationship while also evaluating the effectiveness of systematic modification of these variables in an attempt to improve pain and QOL in CP.
Treatment of Refractory Infantile Hemangiomas and Pulmonary Hypertension With Sirolimus in a Pediatric Patient
Authors: Hutchins Kelley K. , Ross Robert D. , Kobayashi Daisuke , Martin Alissa , Rajpurkar Madhvi
Published: August 2017

Infantile hemangioma is a benign vascular neoplasm that spontaneously involutes over time. Management, when needed, consists of medications, laser treatment and surgical excision. We describe a 3-year-old girl who presented shortly after birth with diffuse cutaneous hemangiomas, hepatosplenomegaly with liver lesions, anemia, and acute heart failure. She was diagnosed with hepatic and cutaneous infantile hemangioma based on skin biopsy. She developed progressive pulmonary hypertension with numerous pulmonary nodules suspicious for pulmonary arteriovenous malformations. She was started on sirolimus and had significant improvement in her pulmonary hypertension and liver lesions. This report supports prior studies that sirolimus is effective for vascular anomalies including IH refractory to conventional therapy.
Effects of the Nurse Athlete Program on the Healthy Lifestyle Behaviors, Physical Health, and Mental Well-being of New Graduate Nurses
Authors: Hrabe David P. , Melnyk Bernadette Mazurek , Buck Jacalyn , Sinnott Loraine T.
Published: August 2017

Recognizing that transition from nursing student to point-of-care nurse can be a stressful time period in one's career. A pilot study at a large Midwestern medical center tested the preliminary effects of a health-oriented workshop, the Nurse Athlete, on new graduate nurses' healthy lifestyle beliefs, healthy lifestyle behaviors, depressive and anxiety symptoms, as well as health outcomes. The Nurse Athlete workshop, provided in partnership with Johnson & Johnson's Human Performance Institute (HPI), used materials from HPI's Corporate Athlete program. The 2-day workshop focuses on energy management through a comprehensive examination of goals and values in relation to one's spiritual, mental, emotional, and physical development and provides practical strategies to improve self-care. Eighty-eight new graduate nurses hired at the university's medical center were offered the opportunity to participate in the Nurse Athlete program and associated study. Sixty-nine percent of these new graduate nurses (n = 61) consented and participated in the program. There was a statistically significant decrease in the participants' weight and body mass index from baseline to the 6-month follow-up assessment, which resulted in small to medium positive effects for the Nurse Athlete program. There was also a significant decrease in body fat percentage across time, resulting in a large positive intervention effect. Statistically significant reductions in depressive symptoms were measured between baseline and 6 months.
Misconceptions About Genomics Among Nursing Faculty and Students
Authors: Read Catherine Y. , Ward Linda D.
Published: August 2017

A comparison of 2 research studies revealed that nursing faculty and students share limited understanding and specific misconceptions about foundational genomic concepts. Mean scores on the Genomic Nursing Concept Inventory were 48% for faculty and 42% for students. Identifying misconceptions is important when designing educational strategies for students who will inevitably care for patients with genomic concerns. Common clinical scenarios requiring accurate interpretation of genomic terminology, gene function and expression, and genetic counseling principles are presented.
The Clinical Instructor Program
Authors: Weston Jeannie
Published: August 2017

The purpose of this study was to determine whether an online program, the Clinical Instructor Program (CIP), was helpful in improving feelings of efficacy for nurse clinicians in the role of clinical instructor. In addition, understanding of the clinical instructor role, knowledge of instructional content, and understanding of instructional strategies were evaluated before and after CIP participation. A primary finding of the study was that overall self-efficacy significantly improved.
Evaluation of 2-stage Treatment for Cervical Dorsal Rami Entrapment Syndrome
Authors: Li Qi , Wang Jing-Wu , Zeng Bing-Fang , Cai Yi-Ming , Zhang Chang-Qing
Published: August 2017

Objectives:

To evaluate the effectiveness of a 2-stage nonoperative treatment for patients with cervical dorsal rami entrapment syndrome.

Materials and Methods:

The study included 66 patients diagnosed with cervical dorsal rami entrapment syndrome randomized to an experimental group (n=33) and control group (n=33). The experimental group was treated with additional diagnostic block if regular 2 weeks medication was not effective. The control group only received nonsteroidal anti-inflammatory drugs for 2 weeks. A visual analog scale (VAS) and pain treatment satisfaction scale (PTSS) were used to assess pain. Muscle power in the upper limbs was also assessed. The registration number of this study is ChiCTR-IIR-15007565.

Results:

The VAS scores of the experimental group were significantly lower at 2, 4, and 6 months after treatment compared with baseline and the VAS scores of the control group (all P<0.001). The PTSS scores of the experimental group were significantly higher at 2, 4, and 6 months after treatment compared with baseline and the PTSS scores of the control group (all P<0.001). Maximal muscle power after treatment was significantly greater in the experimental group compared with the control group for shoulder abduction (P<0.001), thumb pinch force (P=0.001), and grasp (P<0.001).

Conclusions:

The results suggest that the 2-stage treatment is effective for patients with cervical dorsal rami entrapment syndrome.
Fibroepithelial Stromal Polyp of the Vulva: Case Report and Review of Potential Histologic Mimickers
Authors: Pharaon Majed , Warrick Joshua , Lynch Michael C.
Published: August 2017

Vulvar tumors arising from submucosal connective tissue, some of which exhibit hormonal responsiveness, have many clinical and histologic overlapping characteristics. We present a case of a fibroepithelial stromal polyp arising from the vulva of a 22-year-old female. We review the differential diagnosis with an emphasis on distinguishing features of these uncommon neoplasms. Accurate diagnosis is essential as the extent of surgical resection and risk of local recurrence varies for these tumors.
Are You Making an Impact? Evaluating the Population Health Impact of Community Benefit Programs
Authors: Rains Catherine M. , Todd Greta , Kozma Nicole , Goodman Melody S.
Published: August 2017

Context:

The Patient Protection and Affordable Care Act includes a change to the IRS 990 Schedule H, requiring nonprofit hospitals to submit a community health needs assessment every 3 years. Such health care entities are challenged to evaluate the effectiveness of community benefit programs addressing the health needs identified.

Objective:

In an effort to determine the population health impact of community benefit programs in 1 hospital outreach department, researchers and staff conducted an impact evaluation to develop priority areas and overarching goals along with program- and department-level objectives.

Design:

The longitudinal impact evaluation study design consists of retrospective and prospective secondary data analyses.

Setting:

As an urban pediatric hospital, St Louis Children's Hospital provides an array of community benefit programs to the surrounding community.

Participants:

Hospital staff and researchers came together to form an evaluation team. Data from program evaluation and administrative data for analysis were provided by hospital staff.

Main Outcome Measure:

Impact scores were calculated by scoring objectives as met or unmet and averaged across goals to create impact scores that measure how closely programs meet the overarching departmental mission and goals.

Results:

Over the 4-year period, there is an increasing trend in program-specific impact scores across all programs except one, Healthy Kids Express Asthma, which had a slight decrease in year 4 only.

Implications:

Current work in measuring and assessing the population health impact of community benefit programs is mostly focused on quantifying dollars invested into community benefit work rather than measuring the quality and impact of services. This article provides a methodology for measuring population health impact of community benefit programs that can be used to evaluate the effort of hospitals in providing community benefit. This is particularly relevant in our changing health care climate, as hospitals are being asked to justify community benefit and make meaningful contributions to population health. The Patient Protection and Affordable Care Act includes a change to the IRS 990 Schedule H, requiring nonprofit hospitals to submit a community health needs assessment every 3 years, and requires evaluation of program effectiveness; yet, it does not require any quantification of the impact of community benefit programs. The IRS Schedule H 990 policies could be strengthened by requiring an impact evaluation such as outlined in this article.

Conclusion:

As hospitals are being asked to justify community benefit and make meaningful contributions to population health, impact evaluations can be utilized to demonstrate the cumulative community benefit of programs and assess population health impact of community benefit programs.
Patient Recall of Informed Consent at 4 Weeks After Total Hip Replacement With Standardized Versus Procedure-Specific Consent Forms
Authors: Pomeroy Eoghan , Shaarani Shahril , Kenyon Robert , Cashman James
Published: August 2017

Objectives

Informed consent plays a pivotal role in the operative process, and surgeons have an ethical and legal obligation to provide patients with information to allow for shared decision-making. Unfortunately, patient recall after the consent process is frequently poor. This study aims to evaluate the effect of procedure-specific consent forms on patient’s recall four weeks after total hip replacement (THR).

Methods

This is a prospective study using a posttest-only control group design. Sixty adult patients undergoing total hip replacement were allocated to be consented using either the generic or the surgery-specific consent form. Four weeks after surgery, a phone interview was conducted to assess patient’s recall of risk of surgical complications.

Results

Patient demographic characteristics and educational attainment were similar in both groups. There was a statistically significant increase in the mean number of risks recalled in the study group at 1.43 compared with 0.67 in the control group (P = 0.0131).

Conclusions

Consent is a complex process, and obtaining informed consent is far from straightforward. A statistically significant improvement in patient’s recall with the use of procedure-specific consent forms was identified, and based on this, we would advocate their use. However, overall patient recall in both groups was poor. We believe that improving the quality of informed consent may require the sum of small gains, and the use of procedure-specific consent forms may aid in this regard.
Platelet-Derived Microvesicles: A Potential Therapy for Trauma-Induced Coagulopathy
Authors: Lopez Ernesto , Srivastava Amit K. , Pati Shibani , Holcomb John B. , Wade Charles E.
Published: August 2017

Trauma patients are often affected by a hypocoagulable condition referred to as trauma-induced coagulopathy (TIC) for which few therapeutic options exist. One available treatment is fresh platelets transfusion, although it is not efficacious enough and has a number of limitations. Therefore, we reviewed the literature to propose an alternative therapy based on platelet-derived microvesicles (PMVs), which are cellular fragments surrounded by extracellular membrane and filled with cytoplasmic content. This concept is supported by a large number of studies in which the hypercoagulable role of PMVs has been demonstrated and associated with thrombosis-related conditions. The purpose of this review is to summarize what is currently known about PMVs and discuss whether a transfusion of isolated human PMVs could be used as a therapy for TIC.
Ancient whales did not filter feed with their teeth
Authors: Hocking David P. , Marx Felix G. , Fitzgerald Erich M. G. , Evans Alistair R.
Published: August 2017

The origin of baleen whales (Mysticeti), the largest animals on Earth, is closely tied to their signature filter-feeding strategy. Unlike their modern relatives, archaic whales possessed a well-developed, heterodont adult dentition. How these teeth were used, and what role their function and subsequent loss played in the emergence of filter feeding, is an enduring mystery. In particular, it has been suggested that elaborate tooth crowns may have enabled stem mysticetes to filter with their postcanine teeth in a manner analogous to living crabeater and leopard seals, thereby facilitating the transition to baleen-assisted filtering. Here we show that the teeth of archaic mysticetes are as sharp as those of terrestrial carnivorans, raptorial pinnipeds and archaeocetes, and thus were capable of capturing and processing prey. By contrast, the postcanine teeth of leopard and crabeater seals are markedly blunter, and clearly unsuited to raptorial feeding. Our results suggest that mysticetes never passed through a tooth-based filtration phase, and that the use of teeth and baleen in early whales was not functionally connected. Continued selection for tooth sharpness in archaic mysticetes is best explained by a feeding strategy that included both biting and suction, similar to that of most living pinnipeds and, probably, early toothed whales (Odontoceti).
John Philip Cooper CBE. 16 December 1923—18 November 2011
Authors: Edwards Kenneth
Published: August 2017

John Cooper's innovative research into the genetics of plant growth and development was established with the aim of identifying characters which would guide plant breeders in their selection programmes. Working with certain forage grasses (mainly ryegrass but also cocksfoot and fescue), he analysed growth and development into components, including flowering time, leaf development, photosynthetic efficiency, canopy structure in the crop and nutritional quality. He and his colleagues were able to show, by a combination of selection experiments and comparisons of variance between and within families, that considerable genetic variation existed within all varieties of these outbreeding crops. All the characters were polygenic, with no evidence of individual genes manifesting distinct Mendelian ratios. Cooper obtained information of great value for the plant breeders with whom he worked closely. His research stimulated others to build on his ideas when new molecular techniques became available.

After two decades of creative research at the Welsh Plant Breeding Station, John Cooper became its Director in 1975. This coincided with a turbulent period in government-sponsored agricultural research that involved reductions in funding. Cooper disagreed with the underlying policy changes, but he worked hard to minimize the number of redundancies and the damage to the scientific work of the station. Overall, John Cooper had a distinguished scientific career. His personal achievements from his own research activities and that of his colleagues were unique and innovative. He led by example, by stimulation and by inspiration, and developed a wide international influence for his ideas.
Detection of Allee effects in marine fishes: analytical biases generated by data availability and model selection
Authors: Perälä Tommi , Kuparinen Anna
Published: August 2017

The demographic Allee effect, or depensation, implies positive association between
per capita
population growth rate and population size at low abundances, thereby lowering growth ability of sparse populations. This can have far-reaching consequences on population recovery ability and colonization success. In the context of marine fishes, there is a widespread perception that Allee effects are rare or non-existent. However, studies that have failed to detect Allee effects in marine fishes have suffered from several fundamental methodological and data limitations. In the present study, we challenge the prevailing perception about the rarity of Allee effects by analysing nine populations of Atlantic herring (
Clupea harengus
), using Bayesian statistical methods. We find that populations of the same species can show either strong evidence for Allee effects or compensation. We explicitly demonstrate how the evidence for Allee effects is strongly provisional on observations made at low population abundances. We contrast our statistical approach with previous attempts to detect Allee effects and illustrate methodological issues that can lead to erroneous conclusions about the nature of population dynamics at low abundance. The present study demonstrates that there is no substantive scientific basis to support the perception that Allee effects are rare or non-existent in marine fishes.
BLAST-based validation of metagenomic sequence assignments
Authors: Bazinet Adam L. , Ondov Brian D. , Sommer Daniel D. , Ratnayake Shashikala
Published: August 2017

When performing bioforensic casework, it is important to be able to reliably detect the presence of a particular organism in a metagenomic sample, even if the organism is only present in a trace amount. For this task, it is common to use a sequence classification program that determines the taxonomic affiliation of individual sequence reads by comparing them to reference database sequences. As metagenomic data sets often consist of millions or billions of reads that need to be compared to reference databases containing millions of sequences, such sequence classification programs typically use search heuristics and databases with reduced sequence diversity to speed up the analysis, which can lead to incorrect assignments. Thus, in a bioforensic setting where correct assignments are paramount, assignments of interest made by “first-pass” classifiers should be confirmed using the most precise methods and comprehensive databases available. In this study we present ablast-based method for validating the assignments made by less precise sequence classification programs, with optimal parameters for filtering ofblastresults determined via simulation of sequence reads from genomes of interest, and we apply the method to the detection of four pathogenic organisms. The software implementing the method is open source and freely available.