bluuebunny/crossref_metadata_2025 huggingface dataset:
Narrative performances of user involvement among service users in mental health care
Authors: Klausen Rita K. , Karlsson Marie , Haugsgjerd Svein , Lorem Geir Fagerjord
Published: July 2017

This article deals with user involvement in mental health care and emerges from interviews with four service users at a community mental health center in northern Norway. The stories told by the participants were related to an impending closure of the center following a new health care reform. The aim of this article is to take a closer look at how user involvement was performed by the participants in the storytelling context. We explore the stories told using narrative contextualization analysis. Through our analysis, we find that narrative environments demands our attention to turn to storytelling as stories play out in the here and now of everyday life in mental health care.
Restructuring structural narrative analysis using Campbell’s monomyth to understand participant narratives
Authors: Cruz Joshua , Kellam Nadia
Published: July 2017

In this paper, we describe a method for performing structural narrative analysis that draws on narratology and literary studies, moving structural narrative analysis from a focus on examining linguistic parts of narratives to understanding thematic structures that make up the whole narrative. We explore the possibility of constructing participant narratives using Campbell’s monomyth as a coding and structuralizing scheme. The method we describe is the response to the question, “How might we find a reliable way to construct ‘smooth’ stories (with attention to the structures of stories) so that we might compare trajectories of student experiences?” To answer this question, we use narrative interviews from a larger study to show how this method can make sense of interviews and construct accessible and useful participant narratives. We close by providing an example narrative constructed using the monomyth coding scheme and discussing benefits and difficulties associated with this method.
Stylistic fronting in corpora
Authors: Sigurðsson Halldór Ármann
Published: July 2017

Stylistic Fronting (SF) fronts various types of non-subjects to preverbal position in subjectless clauses. With the exception of Icelandic and Faroese, SF has disappeared from Scandinavian. It is commonly assumed that even in Icelandic it is formal and old fashioned, indicating that it might be on its way out. However, this assumption has not been supported by frequency surveys. This paper studies the distribution and frequency of Stylistic Fronting in two large language corpora, Timarit.is and the Internet. The results support the common assumption that SF is on the retreat. Nevertheless, the survey also highlights that this change is proceeding slowly. The study also shows that Google Search can be used as a research tool in linguistics – no small advantage.
How can fruit production be made more sustainable?
Authors: Jemrić T. , Vuković M. , Milošević T.
Published: July 2017

The world population is expected to be doubled by the next few decades that will increase the food demand in future. The fruit production is no doubt has of great importance in agricultural sector due to the economic importance and as well as their beneficial effect on human health. Adopting the sustainable ways of fruit production is the need of the day to cope with upcoming future problems. Today's fruit production approaches the goals of sustainability in some respects, but it is seriously lacking in others, such as the narrow genetic base of existing cultivars and the need for soil treatment with broad-spectrum biocides to maintain production in continuous monocultures. Demanding task of keeping competitiveness in global market and in same time enhancing biodiversity, decreasing energy inputs and reducing environmental impact is accompanied with pressure from consumers for selectivity, quality, safety and transparency of products. Logical question arises than, if sustainable development of fruit production sector is possible in the future or not. The purpose of this review is to examine sustainability of today's fruit production and point out possible future trends. This review summarizes the use of resistant cultivars, rootstocks, the use of wild fruits, the changes in soil management fruit nutrition and, light manipulation, pesticides, the use of bioregulators and biostimulants, irrigation, improvements in machinery, advancements in postharvest technology and socioeconomic aspects as tools for achieving sustainability of fruit production. If used together, these tools will enable technological change from a yield-focused model to a system that will be focused on crop quality and conservation of natural resources, as well to benefits of producers, workers, consumers and a society as a whole which is the fundamental characteristic of sustainability. This is not simple task and it will take long time, but with the long-term commitment of all role-players (producers, traders, consumers, government bodies, regulatory agencies, etc.) it can be achieved. The role of science and education has not to be neglected in this process since only innovation and knowledge driven technologies will enable faster improvement of sustainability of fruit production.
Overview of steam oxidation behaviour of Al protective oxide precursor coatings on P92
Authors: Agüero A. , Gutiérrez M. , Muelas R. , Spiradek-Hahn K.
Published: July 2017

Future designs for steam power plants are expected to operate at 625–750°C, at which the candidate ferritic/martensitic steels exhibit insufficient steam oxidation resistance. Al-based coatings constitute an alternative to prevent or reduce oxidation. For over 50 years this type of coating has been applied on blades and vanes made of Ni- and Co-based alloys used in the hot section gas of turbines which operate at temperatures higher than 900°C. For these coatings, the mechanism of protection from high-temperature oxidation, is based on the formation and maintenance of a thin layer of dense α-Al2O3. Many articles have been written about the nature, formation and failure mechanism of oxide precursor coatings, under air, at over 900°C. [1–6] However, very little is known regarding alumina scales formed under pure steam at lower temperatures, which is the expected scenario for new steam power plants. This paper covers a recapitulation of the behaviour of Al-based protective oxides formed on coatings with various compositions under steam at 650°C, including new data relative to the formation of said oxides under steam and the microstructure of samples exposed to steam for 70 000 h. It has been shown that on Al containing coatings, such as diffusion Fe aluminides and FeCrAls, alumina forms under steam at 650°C. Provided that a critical content of Al is maintained underneath the scale, Al2O3 is very stable, surpassing 70 000 h under steam at 650°C, without evidence of spallation (testing is still ongoing). The industry target for coatings in this cases is 100 000 h. In turn, the critical Al content depends on the coating's Cr content, and if the oxidation takes place at temperatures of 900°C or higher, under air. However, under steam, alumina phases formation and transformations are different: at 650°C χ-Al2O3 forms initially, and appears to slowly transform unto α-Al2O3. General considerations regarding the stability of protective oxides formed under steam as a function of the composition of the subjacent material will be provided.
Simplicial Abel-Jacobi maps and reciprocity laws
Authors: Kerr Matt , Lewis James , Lopatto Patrick
Published: July 2017

We describe an explicit morphism of complexes that induces the cycle-class maps from (simplicially described) higher Chow groups to rational Deligne cohomology. The reciprocity laws satisfied by the currents we introduce for this purpose are shown to provide a clarifying perspective on functional equations satisfied by complex-valued di- and trilogarithms.
The Impact of Farm Animal Housing Restrictions on Egg Prices, Consumer Welfare, and Production in California
Authors: Mullally Conner , Lusk Jayson. L.
Published: July 2017

New animal welfare policies on the horizon in many U.S. states have prompted debates about the cost of achieving happier hens and hogs. A recent policy change in California offers a unique opportunity to measure the economic repercussions of minimum space requirements for egg‐laying hens. Using forecasting methods and structural break tests as applied to sixteen years of monthly data on egg production and input prices, we find that by July 2016, both egg production and the number of egg‐laying hens were about 35% lower than they would have been in the absence of the new regulations. Out‐of‐state eggs were able to compensate for falling California production until around the time the new rules were implemented, at which point imports of eggs into California fell. For consumers, we estimate price impacts using panel structural break tests and difference‐in‐differences models as applied to five years of scanner data from the retail market for shell eggs in three California markets and three control markets. We find that the average price paid per dozen eggs was about 22% higher from December 2014 through September 2016 than it would have been in the absence of the hen housing restrictions. The price impact fell over time, from an initial impact of about 33% per dozen to about 9% over the last six months of the observed time horizon. These price increases correspond to welfare losses of at least $117 million for the three California markets over the observed time horizon. Our results suggest that because of the policy change, California consumers can expect to experience annual welfare losses of at least $25 million in future years from higher retail egg prices alone.
wft4galaxy: a workflow testing tool for galaxy
Authors: Piras Marco Enrico , Pireddu Luca , Zanetti Gianluigi
Published: July 2017

Motivation

Workflow managers for scientific analysis provide a high-level programming platform facilitating standardization, automation, collaboration and access to sophisticated computing resources. The Galaxy workflow manager provides a prime example of this type of platform. As compositions of simpler tools, workflows effectively comprise specialized computer programs implementing often very complex analysis procedures. To date, no simple way to automatically test Galaxy workflows and ensure their correctness has appeared in the literature.

Results

With wft4galaxy we offer a tool to bring automated testing to Galaxy workflows, making it feasible to bring continuous integration to their development and ensuring that defects are detected promptly. wft4galaxy can be easily installed as a regular Python program or launched directly as a Docker container—the latter reducing installation effort to a minimum.

Availability and implementation

Available at https://github.com/phnmnl/wft4galaxy under the Academic Free License v3.0.
SPRINT: an SNP-free toolkit for identifying RNA editing sites
Authors: Zhang Feng , Lu Yulan , Yan Sijia , Xing Qinghe , Tian Weidong
Published: July 2017

Motivation

RNA editing generates post-transcriptional sequence alterations. Detection of RNA editing sites (RESs) typically requires the filtering of SNVs called from RNA-seq data using an SNP database, an obstacle that is difficult to overcome for most organisms.

Results

Here, we present a novel method named SPRINT that identifies RESs without the need to filter out SNPs. SPRINT also integrates the detection of hyper RESs from remapped reads, and has been fully automated to any RNA-seq data with reference genome sequence available. We have rigorously validated SPRINT’s effectiveness in detecting RESs using RNA-seq data of samples in which genes encoding RNA editing enzymes are knock down or over-expressed, and have also demonstrated its superiority over current methods. We have applied SPRINT to investigate RNA editing across tissues and species, and also in the development of mouse embryonic central nervous system. A web resource (http://sprint.tianlab.cn) of RESs identified by SPRINT has been constructed.

Availability and implementation

The software and related data are available at http://sprint.tianlab.cn.

Supplementary information

Supplementary data are available at Bioinformatics online.
Enhanced gamma radiation towards the rotation axis from the immediate vicinity of extremely rotating black holes
Authors: Song Yoogeun , Pu Hung-Yi , Hirotani Kouichi , Matsushita Satoki , Kong Albert K. H. , Chang Hsiang-Kuang
Published: July 2017

We investigate the acceleration of electrons and positrons by magnetic-field-aligned electric fields in the polar funnel of an accreting black hole (BH). Applying the pulsar outer-gap theory to BH magnetospheres, we find that such a lepton accelerator arises in the immediate vicinity of the event horizon due to frame-dragging, and that their gamma-ray luminosity increases with decreasing accretion rate. Furthermore, we demonstrate that the gamma-ray flux is enhanced along the rotation axis by more than an order of magnitude if the BH spin increases from a = 0.90M to a = 0.9999M. As a result, if a ten-solar-mass, almost-maximally rotating BH is located within 3 kpc, when its accretion rate is between 0.005 and 0.01 per cent of the Eddington rate, its high-energy flare becomes detectable with the Fermi/Large Area Telescope, provided that the flare lasts longer than 1.2 months and that we view the source nearly along the rotation axis. In addition, its very high energy flux is marginally detectable with the Cherenkov Telescope Array, provided that the flare lasts longer than a night and that our viewing angle is about 45 deg with respect to the rotation axis.
Diabetes Is Not Associated With Increased 90-Day Mortality Risk in Critically Ill Patients With Sepsis
Authors: van Vught Lonneke A. , Holman Rebecca , de Jonge Evert , de Keizer Nicolette F. , van der Poll Tom
Published: July 2017

Objectives:

To determine the association of pre-existing diabetes, hyperglycemia, and hypoglycemia during the first 24 hours of ICU admissions with 90-day mortality in patients with sepsis admitted to the ICU.

Design:

We used mixed effects logistic regression to analyze the association of diabetes, hyperglycemia, and hypoglycemia with 90-day mortality (n = 128,222).

Setting:

All ICUs in the Netherlands between January 2009 and 2014 that participated in the Dutch National Intensive Care Evaluation registry.

Patients:

All unplanned ICU admissions in patients with sepsis.

Interventions:

The association between 90-day mortality and pre-existing diabetes, hyperglycemia, and hypoglycemia, corrected for other factors, was analyzed using a generalized linear mixed effect model.

Measurements and Main Results:

In a multivariable analysis, diabetes was not associated with increased 90-day mortality. In diabetes patients, only severe hypoglycemia in the absence of hyperglycemia was associated with increased 90-day mortality (odds ratio, 2.95; 95% CI, 1.19–7.32), whereas in patients without pre-existing diabetes, several combinations of abnormal glucose levels were associated with increased 90-day mortality.

Conclusions:

In the current retrospective large database review, diabetes was not associated with adjusted 90-day mortality risk in critically ill patients admitted with sepsis.
Sensitive Troponin I and Stress Testing in the Emergency Department for the Early Management of Chest Pain Using 2-Hour Protocol
Authors: Dadkhah Shahriar , Almuwaqqat Zakaria , Sulaiman Samian , Husein Husein , Nguyen Quang , Ali Saad , Taskesen Tuncay
Published: July 2017

Background:

Despite improvements in identifying high-risk patients with non-ST segment ACS (acute coronary syndrome), low risk patients presenting with atypical chest pain and non-diagnostic Electrocardiogram (ECG) continued to undergo unnecessary admissions and testing. Since 1992, our chest pain protocol included using 4-hour serial biomarkers from ED admission in combination with stress testing to evaluate these patients. Our study aimed at determining whether a new accelerated diagnostic protocol using sensitive cardiac troponin I (cTnI) 2 hours after admission to the ED followed by stress testing is safe and effective in emergency settings, allowing for appropriate triage, earlier discharge and reducing costs.

Methods:

We conducted a single center randomized trial at Presence St. Francis Hospital Chest pain center in Evanston, Illinois enrolling sixty-four consecutive patients with atypical chest pain and non-diagnostic ECG, participants were randomized to accelerated 2 hrs protocol or our pre-existing 4-hrs protocol. Sixty patients completed the protocol and were randomized to either a 2-hour (29 patients) or 4-hour protocol using both I-STAT and PATHFAST cTnI (31 Patients). Troponin I was evaluated at 0 and at 2 hours from ED presentation with and additional draw for patients in the 4-hour rule out-group. Patients with normal serial biomarkers were then evaluated with stress testing and qualified for earlier discharge if the stress test was negative, while those with a positive biomarker at any time were admitted. Thirty-six patients had exercise treadmill stress test and 24 patients had either nuclear or Echo stress test.

Results:

Fifty-three patients had a normal stress test and were discharged home. One patient in the 4-hour group with normal serial troponins developed ventricular tachycardia/fibrillation during the recovery period of a regular stress test. Six patients had a positive PATHFAST cTnI and a normal I-STAT cTnI at 2-hours. Two out of these six patients evaluated by coronary angiography. One patient had severe tortuous coronaries but no significant obstructive lesion and one had a severe CAD who needed Coronary artery bypass grafting (CABG). Three of the six patients had a normal stress test and one patient decided to leave without further testing. None of the patients with a normal stress test had a major cardiac event or adverse cardiac outcome at six-month follow up.

Conclusion:

This study demonstrates that the 2 hours accelerated protocol using high sensitivity Troponin assay at 0 and 2 hours with comprehensive clinical evaluation and ECG followed by stress testing might be successful in identifying low-risk patient population who may benefit from early discharge from ED reducing associated costs and length of stay.
The Association of Cognitive Reserve in Chronic-Phase Functional and Neuropsychological Outcomes Following Traumatic Brain Injury
Authors: Leary Jacob B. , Kim Grace Y. , Bradley Catherine L. , Hussain Uzma Z. , Sacco Maryanne , Bernad Martha , Collins John , Dsurney John , Chan Leighton
Published: July 2017

Objective:

Examine the association of cognitive reserve (CR) factors (estimated premorbid intelligence quotient [IQ], years of education, and occupational attainment) and traumatic brain injury (TBI) severity with functional and neuropsychological outcomes 1 to 5 years following TBI.

Participants:

Patients with mild (N = 58), moderate (N = 25), or severe (N = 17) TBI.

Main Measures:

Cognitive reserve factors (estimated premorbid IQ, years of education, and occupational attainment); neuropsychological test battery; Glasgow Outcome Scale—Extended; Short Form-36 Health Survey.

Analyses:

Spearman-Brown correlations, linear regression models, and analyses of covariance were used to analyze the relation between CR factors and outcome measures.

Results:

Analyses revealed significant relations between estimated premorbid IQ and neuropsychological outcomes (P < .004): California Verbal Learning Test, Wechsler Adult Intelligence Scale—Fourth Edition working memory, Booklet Category Test, Trail Making Test B, and Grooved Pegboard Test. There was also a significant correlation between estimated premorbid IQ and Wechsler Adult Intelligence Scale—Fourth Edition processing speed. Years of education had significant relations with California Verbal Learning Test and Wechsler Adult Intelligence Scale—Fourth Edition working memory and processing speed scores. There were significant differences between TBI severity groups and performance on the Trail Making Test A, Grooved Pegboard Test, and Finger Tapping Test.

Conclusions:

Cognitive reserve factors may be associated with outcomes following TBI. Additional alternatives to TBI severity are needed to help guide rehabilitative planning postinjury.
Use of Resuscitative Endovascular Balloon Occlusion of the Aorta in a Multidisciplinary Approach
Authors: Nilsson Carolina , Bilos Linda , Hörer Tal , Pirouzram Artai
Published: July 2017

The usage of resuscitative endovascular balloon occlusion of the aorta, also known as aortic balloon occlusion, is an emerging method for bleeding control as a bridge to definitive treatment in trauma management. We describe a trauma case where resuscitative endovascular balloon occlusion of the aorta was used as part of the EndoVascular hybrid Trauma and bleeding Management concept to facilitate transient hemorrhage control and thereby to permit damage control surgery. The case is an illustration of the adoption of a multidisciplinary approach.
Direct and Indirect Effectiveness of the 10-Valent Pneumococcal Conjugate Vaccine Against Carriage in a Cluster Randomized Trial
Authors: Palmu Arto A. , Toropainen Maija , Kaijalainen Tarja , Siira Lotta , Lahdenkari Mika , Nieminen Heta , Syrjänen Ritva K. , Kilpi Terhi M. , Jokinen Jukka
Published: July 2017

Finnish invasive pneumococcal disease (FinIP) vaccine trial was designed to evaluate effectiveness of 10-valent pneumococcal conjugate vaccine (PHiD-CV10; GSK; Rixensart, Belgium). We conducted 2 satellite studies to evaluate ten-valent Pneumococcal Haemophilus influenzae protein D conjugate vaccine (PHiD-CV10) effectiveness against pneumococcal carriage in FinIP-vaccinated children (long-term direct and indirect effectiveness combined) and in their unvaccinated siblings (indirect effectiveness within the family). FinIP was a cluster randomized trial, where >47,000 children <19 months of age were recruited in 2009–2010. Children received PHiD-CV10 in 2/3, and control vaccine in 1/3 of clusters according to age-specific infant and catch-up schedules. We obtained nasopharyngeal samples from subgroups of FinIP-vaccinated children at 3–5 years of age in 2013 and their unvaccinated older siblings in 2011 and 2013, and compared carriage in PHiD-CV10 clusters to control clusters in parallel. National Vaccination Programme with PHiD-CV10 for all 3-month-old children started in 2010 resulting in 92% vaccination coverage. To investigate indirect effects, over 2200 nasopharyngeal swabs were obtained during each round from unvaccinated older siblings. In 2011, we observed a 29% (95% confidence interval: 6–47) reduction in vaccine-type carriage in siblings of PHiD-CV10 participants vaccinated according to infant schedules. Vaccine-type carriage prevalences were low with no differences observed in 2013, 3 years after PHiD-CV10 introduction. For estimation of combined direct and indirect effectiveness, 1550 swabs from FinIP-vaccinated children were obtained in 2013. We observed a reduction of 54% (95% confidence interval: 34–68) in vaccine-type carriage in PHiD-CV10–vaccinated children. This study was the first randomized trial to show the indirect effect of extended valency pneumococcal conjugate vaccination on carriage. Also, long-term effectiveness against vaccine-type carriage was demonstrated in vaccinated children.
An Observational Study of Severe Pertussis in 100 Infants ≤120 Days of Age
Authors: Cherry James D. , Wendorf Kristen , Bregman Brooke , Lehman Deborah , Nieves Delma , Bradley John S. , Mason Wilbert H. , Sande-Lopez Linette , Lopez Merrick , Federman Myke , Chen Tempe , Blumberg Dean , Johnston Samantha , Schwenk Hayden T. , Weintrub Peggy , Quinn Kevin K. , Winter Kathleen , Harriman Kathleen
Published: July 2017

Background:

Pertussis in young infants is a unique, severe, afebrile, cough illness that is frequently fatal.

Methods:

All pertussis cases ≤120 days of age admitted to a pediatric intensive care unit in California between October 1, 2013, and April 25, 2015, were evaluated.

Results:

Of 100 pertussis patients ≤120 days of age admitted to pediatric intensive care unit, there were 5 deaths. The white blood cell counts in the fatal cases were significantly higher than in the nonfatal cases. Thirty-four percent of patients were intubated, 18% received inotropic and/or vasoactive support, 22% received steroid, 4% received extracorporal membrane oxygenation, and 3% underwent exchange blood transfusion. The median age at the time of illness onset in the patients who died was 23 days.

Conclusions:

These data, as well as data from previous California studies, suggest updated strategies for the management of severe pertussis. These include perform serial white blood cell counts, treat all presumptive cases with azithromycin, evaluate for pulmonary hypertension, intubate and administer oxygen for apneic episodes and administer inotropic/vasoactive agents for cardiogenic shock. Do not administer steroids or nitric oxide. Criteria for exchange blood transfusion therapy for leukocytosis with lymphocytosis are suggested.
Audiologic Gain of Incus Short Process Vibroplasty With Conventional Incus Long Process Vibroplasty: A Retrospective Analysis of 36 Patients
Authors: Lee Jeon Mi , Lee Young Ho , Jung Jinsei , Kim Sung Huhn , Moon In Seok , Choi Jae Young
Published: July 2017

Objective:

To compare the audiological and non-audiological benefits of incus short process (SP) vibroplasty with those of conventional incus long process (LP) vibroplasty.

Study Design:

Retrospective analysis.

Setting:

Tertiary referral center.

Patients:

Thirty-six patients with sensorineural hearing loss were treated with the semi-implantable middle ear hearing device. Of these, 22 were treated with conventional LP vibroplasty, and 14 were treated with SP vibroplasty using SP couplers.

Interventions:

Implantation with the semi-implantable middle ear hearing device by different methods.

Main Outcome Measures:

Pre- and postoperative hearing level, word recognition score, operation time, and duration of hospital stay were compared. We also surveyed a questionnaire to assess postoperative complications.

Results:

The improvement in hearing gain was comparable between SP vibroplasty and conventional LP vibroplasty, except at 8 kHz, at which LP vibroplasty showed better hearing gain (p < 0.05). Patients undergoing SP vibroplasty had shorter operation time (p < 0.01) and duration of hospital stay (p < 0.01). While four patients who underwent incus LP vibroplasty experienced taste changes, none who underwent incus SP vibroplasty experienced any complications.

Conclusions:

SP vibroplasty with the newly invented SP coupler could be a good alternative to conventional LP vibroplasty for treating patients with sensorineural hearing loss. Although both SP vibroplasty and LP vibroplasty produce good results, the former is associated with a shorter operation time and duration of hospital stay as well as fewer complications.
The Relationship Between Environmental Sound Awareness and Speech Recognition Skills in Experienced Cochlear Implant Users
Authors: Harris Michael S. , Boyce Lauren , Pisoni David B. , Shafiro Valeriy , Moberly Aaron C.
Published: July 2017

Hypothesis:

1) Environmental sound awareness (ESA) and speech recognition skills in experienced, adult cochlear implant (CI) users will be highly correlated, and, 2) ESA skills of CI users will be significantly lower than those of age-matched adults with normal hearing.

Background:

Enhancement of ESA is often discussed with patients with sensorineural hearing loss as a potential benefit of implantation and, in some cases, ESA may be a major motivating factor. Despite its ecological validity and patients’ expectations, ESA remains largely a presumed skill. The relationship between ESA and speech recognition is not well-understood.

Methods:

ESA was assessed in 35 postlingually deaf, experienced CI users and a control group of 41 age-matched, normal hearing listeners using the validated, computerized familiar environmental sounds test—identification (FEST-I) and a diverse speech recognition battery. Demographic and audiological factors as well as nonverbal intelligence quotient (IQ)/nonverbal reasoning and spectral resolution were assessed.

Results:

Six of the 35 experienced CI users (17%) demonstrated FEST-I accuracy within the range of the NH controls. Among CI users all correlations between FEST-I accuracy and speech recognition scores were strong. Chronological age at the time of testing, duration of deafness, spectral resolution, and nonverbal IQ/nonverbal reasoning were strongly correlated with FEST-I accuracy. Partial correlation analysis showed that correlations between FEST-I and speech recognition measures remained significant when controlling for the demographic and audiological factors.

Conclusion:

Our findings reinforce the hypothesis that ESA and speech perception share common underlying processes rather than reflecting truly separate auditory domains.
An Innovative Transitional Care Program Improves Community Health
Authors: Richardson Barbara M.
Published: July 2017

In this month's Magnet® Perspectives column, Barbara Richardson, MSN, RN-BC, CCRN, clinical nurse specialist at the Southwestern Vermont Medical Center, examines the ways in which a robust transitional care program improves community health, reduces readmissions and emergency department visits, and provides valuable social support for even the most complex patients. Richardson shares critical factors that impacted the program's success, including a Magnet® environment of innovation, a visionary hospital leadership team, strong community alliances, and collaborative solutions to previously intractable problems. Her efforts to build and implement a successful transitional care program earned Richardson the 2016 National Magnet® Nurse of the Year Award for Structural Empowerment.
An Innovative Academic/Service Partnership to Increase BSN-Prepared RNs in a Rural Hospital
Authors: Cheshire Michelle H. , Ford Cassandra D. , Daidone Yvette
Published: July 2017

Developing innovative ways to increase BSN-prepared nurses in hospitals in rural regions is a struggle. A partnership between 1 hospital and a local university to support the associate-degree new graduates to progress toward their BSN is proving to be a success.
Return on Investment
Authors: Astrella Julie A.
Published: July 2017

Workplace wellness programs are expected to reduce employee healthcare costs, increase productivity, and provide a positive return on investment. A review of the literature from 2000 to 2016 was conducted to determine whether workplace wellness programs deliver a positive economic impact. Individual financial metrics and results varied; 6 of 7 studies reported a positive economic impact. Additional study is recommended because of the high-degree variability and lack of longitudinal data.
Utilization of Sexually Transmitted Infection Services at 2 Health Facilities Targeting Men Who Have Sex With Men in South Africa: A Retrospective Analysis of Operational Data
Authors: Rees Kate , Radebe Oscar , Arendse Clarissa , Modibedi Charlotte , Struthers Helen E. , McIntyre James A. , Peters Remco P.H.
Published: July 2017

Background

Men who have sex with men (MSM) are a key population, particularly vulnerable to sexually transmitted infections (STIs) and HIV, but there are limited data on health programs targeting MSM in Africa. This study aims to describe the utilization of nongovernmental organization–supported sexual health services for MSM at 2 public sector health facilities in Johannesburg, South Africa.

Methods

We retrospectively analyzed routine data over the period of January 2014 to June 2016. We report on service utilization for STI syndromes, HIV testing, and the antiretroviral therapy (ART) program.

Results

Some 5796 men visited the facilities. Seven thousand one hundred eighty-eight STI episodes were managed, 68.2% (4903 episodes) of which were classified as male urethritis and 9.8% (704 episodes) as genital ulcers. Positivity yield for first-time HIV tests was 38.0% (205 positive test results) in MSM, compared with 14.1% (471 positive test results) in other men. At the end of the study, there were 1090 clients on ART, and 2-year retention was 82% (95% confidence interval, 78%–85%). There was no difference in retention between MSM and other men (P = 0.49).

Conclusions

This study is the first to show that sexual health services targeting MSM in Africa have managed to attract MSM and other men in need of STI and HIV care. The observed high HIV testing yield among MSM illustrates the relevance of MSM-focused services in the South African public health sector, and the good retention on ART demonstrates that high-quality care can be provided to MSM in our setting.
Mailed Human Papillomavirus Self-Collection With Papanicolaou Test Referral for Infrequently Screened Women in the United States
Authors: Smith Jennifer S. , Des Marais Andrea C. , Deal Allison M. , Richman Alice R. , Perez-Heydrich Carolina , Yen-Lieberman Belinda , Barclay Lynn , Belinson Jerome , Rinas Allen , Brewer Noel T.
Published: July 2017

Background

Testing for high-risk human papillomavirus (HPV) infection using mailed, self-collected samples is a promising approach to increase screening in women who do not attend clinic screening at recommended intervals.

Methods

To assess this intervention among high-risk women in the United States, 429 women without a Papanicolaou (Pap) test in 4 or more years (overdue by US guidelines) were recruited from the general population. Participants aged 30 to 65 years were mailed a kit to self-collect a cervicovaginal sample at home, return the sample by mail, and receive HPV results by telephone, with referral to follow-up cytological Pap testing at a local clinic. Cervicovaginal self-samples were collected with a Viba brush, stored in Scope mouthwash, and tested by Hybrid Capture 2. Data were collected in 2010 to 2011 and analyzed in 2017.

Results

Two-thirds (64%) of participants returned a self-collected sample, of whom 15% tested HPV DNA positive. Human papillomavirus self-test–positive women reported higher rates of follow-up Pap tests (82%) than did those with self-test negative results (51%). No demographic differences were found in self-test return rate or HPV positivity. High acceptability was reported in participant surveys: most women (81%) had “mostly positive” overall thoughts about the self-test, and most reported being comfortable receiving the kit in the mail (99%), returning their self-collected sample by mail (82%), and receiving their test results by telephone (97%).

Conclusions

Conducting HPV self-testing through population-based recruitment, mailed kit delivery and return by mail, and results delivery by telephone has the potential to reach a broad segment of US underscreened women.
Interhospital Transport of Children Undergoing Cardiopulmonary Resuscitation: A Practical and Ethical Dilemma*
Authors: Noje Corina , Fishe Jennifer N. , Costabile Philomena M. , Klein Bruce L. , Hunt Elizabeth A. , Pronovost Peter J.
Published: July 2017

Objectives:

To discuss risks and benefits of interhospital transport of children in cardiac arrest undergoing cardiopulmonary resuscitation.

Design:

Narrative review.

Results:

Not applicable.

Conclusions:

Transporting children in cardiac arrest with ongoing cardiopulmonary resuscitation between hospitals is potentially lifesaving if it enables access to resources such as extracorporeal support, but may risk transport personnel safety. Research is needed to optimize outcomes of patients transported with ongoing cardiopulmonary resuscitation and reduce risks to the staff caring for them.
A Prospective Study of the Association Between Clinically Significant Bleeding in PICU Patients and Thrombocytopenia or Prolonged Coagulation Times*
Authors: Moorehead Paul C. , Barrowman Nicholas J. , Cyr Janelle , Ray Jamie , Klaassen Robert , Menon Kusum
Published: July 2017

Objective:

There are no proven methods to predict the risk of clinically significant bleeding in the PICU. A retrospective study identified platelet count as a risk marker for clinically significant bleeding. We conducted a study to examine any association of platelet count, international normalized ratio, and activated partial thromboplastin time with bleeding risk in PICU patients.

Design:

Prospective observational cohort study.

Setting:

The PICU at the Children’s Hospital of Eastern Ontario, a university-affiliated tertiary care pediatric center.

Patients:

Consecutive patients admitted to the PICU. Exclusion criteria were prior inclusion, admission with bleeding, inherited bleeding disorders, weight less than 3 kg, and age less than 60 days or 18 years or more.

Interventions:

There were no interventions in this observational study.

Measurements and Main Results:

Patients were monitored in real time for clinically significant bleeding, using a broadly inclusive definition of clinically significant bleeding, for up to 72 hours after admission to the PICU, or until death or discharge. All measurements of platelet count, international normalized ratio, and activated partial thromboplastin time obtained during the study period were included as time-varying covariates in Cox proportional hazard models. Two hundred thirty-four patients were eligible, and 25 (11%) had one or more episodes of clinically significant bleeding. Platelet count was associated with increased hazard of clinically significant bleeding (hazard ratio, 0.96 per 10 × 109/L increase in platelet count; 95% CI (0.93–0.997; p = 0.03). Increasing hazard for clinically significant bleeding was seen with decreasing platelet count. Neither international normalized ratio nor activated partial thromboplastin time was significantly associated with clinically significant bleeding.

Conclusions:

There is a statistically significant association in PICU patients between decrease in platelet count and clinically significant bleeding, and this association is stronger with lower platelet counts. Further study is required to determine whether platelet transfusion can reduce bleeding risk. International normalized ratio and activated partial thromboplastin time do not predict clinically significant bleeding, and these tests should not be used for this purpose in a general PICU patient population.
Intravoxel Incoherent Motion
Authors: Ciritsis Alexander , Rossi Cristina , Wurnig Moritz C. , Phi Van Valerie , Boss Andreas
Published: July 2017

Purpose

For diffusion data sets including low and high b-values, the intravoxel incoherent motion model is commonly applied to characterize tissue. The aim of the present study was to show that machine learning allows a model-free approach to determine tissue type without a priori assumptions on the underlying physiology.

Materials and Methods

In 8 healthy volunteers, diffusion data sets were acquired using an echo-planar imaging sequence with 16 b-values in the range between 0 and 1000 s/mm2. Using the k-nearest neighbors technique, the machine learning algorithm was trained to distinguish abdominal organs (liver, kidney, spleen, muscle) using the signal intensities at different b-values as training features. For systematic variation of model complexity (number of neighbors), performance was assessed by calculation of the accuracy and the kappa coefficient (κ). Most important b-values for tissue discrimination were determined by principal component analysis.

Results

The optimal trade-off between model complexity and overfitting was found in the range between K = 11 to 13. On “real-world” data not previously applied to optimize the algorithm, the k-nearest neighbors algorithm was capable to accurately distinguish tissue types with best accuracy of 94.5% and κ = 0.92 reached for intermediate model complexity (K = 11). The principal component analysis showed that most important b-values are (with decreasing importance): b = 1000 s/mm2, b = 970 s/mm2, b = 750 s/mm2, b = 20 s/mm2, b = 620 s/mm2, and b = 40 s/mm2. Applying a reduced set of 6 most important b-values, still a similar accuracy was achieved on the real-world data set with an average accuracy of 93.7% and a κ coefficient of 0.91.

Conclusions

Machine learning allows for a model-free determination of tissue type using intra voxel incoherent motion signal decay curves as features. The technique may be useful for segmentation of abdominal organs or distinction between healthy and pathological tissues.
Kidney Transplantation in Patients With Active Multiple Myeloma: Case Reports
Authors: Lum Erik Lawrence , Kogut Neil , Pham Thu , Danovitch Gabriel M. , Bunnapradist Suphamai
Published: July 2017

Kidney disease is a common complication in patients with multiple myeloma. Traditionally, patients with active multiple myeloma and end-stage renal disease have been excluded from kidney transplantation due to the risk of malignancy progression. The introduction of bortezomib-based therapy for patients with multiple myeloma and renal impairment has significantly improved survival in this population. In this report, we present 2 cases of patients with active and controlled multiple myeloma who underwent successful kidney transplantation without progression of their underlying malignancy. In patients with active multiple myeloma controlled with bortezomib, kidney transplantation should be considered a valid option for patients with end-stage kidney disease.
Elemental Accumulation in Kernels of the Maize Nested Association Mapping Panel Reveals Signals of Gene by Environment Interactions
Authors: Ziegler Greg , Kear Philip J. , Wu Di , Ziyomo Catherine , Lipka Alexander E. , Gore Michael , Hoekenga Owen , Baxter Ivan
Published: July 2017

Elemental accumulation in seeds is the product of a combination of environment and a wide variety of genetically controlled physiological processes. We measured the kernel elemental composition of the Nested Association Mapping (NAM) of maize (Zea maysL.) grown in 4 different environments. Analysis of variance revealed strong effects of genotype, environment and genotype by environment interactions. Using Joint-linkage mapping on a set of 7000 markers we identified 354 quantitative trait loci (QTL) across 20 elements, four environments and a combination of the environments. Leveraging 20 M SNPs derived from genome resequencing on the parents of the population, genome-wide association mapping studies (GWAS) detected 8573 loci. While most of the GWAS SNPs were located near genes not previously implicated in elemental regulation, several SNPs were located next to orthologs of well-characterized elemental regulation genes.
Autistic traits and suicidal thoughts, plans and self-harm in late adolescence: population based cohort study
Authors: Culpin Iryna , Mars Becky , Pearson Rebecca M. , Golding Jean , Heron Jon , Bubak Isidora , Carpenter Peter , Magnusson Cecilia , Gunnell David , Rai Dheeraj
Published: July 2017

Importance

There have been recent concerns about a higher incidence of mortality by suicide in people withautism spectrum disorder (ASD). To our knowledge, no large cohort studies have examined which features of autism may lead to suicidal ideation and behaviour, and whether there are any potential modifiable mechanisms.

Objective

To examine the hypothesis that ASD diagnosis and traits in childhood are associated with suicidal thoughts, plans and self-harm at 16 years, and that any of the observed associations are explained by depression in adolescence at 12 years.

Design, setting and participants

Prospective investigation of associations between ASD diagnosis and autistic traits with suicidal ideation and behaviour and a potential risk pathway via depression in early adolescence in 5,031 members of the Avon Longitudinal Study of Parents and Children.

Main outcomes and measures

History of self-harm with and without suicidal intent, suicidal thoughts and plans at 16 years assessed using a detailed self-report questionnaire. Exposures were ASD diagnosis and four measures (the coherence subscale of the Children’s Communication Checklist, the Social and Communication Disorders Checklist, a repetitive behaviour measure, and the sociability temperament subscale of the Emotionality, Activity and Sociability scale) dichotomised to represent the autism trait groups. Depressive symptoms in early adolescence were measured by the Short Moods and Feelings Questionnaire at 12 years.

Results

Children with impaired social communication had a higher risk of self-harm with suicidal intent (RR 2.10, 95% CI 1.28, 3.34), suicidal thoughts (1.42 times (95% CI 1.06, 1.91) and suicidal plans (RR 1.95, 95% CI 1.09, 3.47) by the age of 16 years as compared to those without. There was no evidence for an association between ASD diagnosis and the outcomes although these analyses were imprecise due to small numbers. There was also no evidence of an association between other autism trait measures and the outcomes. Approximately 32% of the total estimated association between social communication impairment and self-harm was explained by depressive symptoms at age 12 years.

Conclusions

Impairments in social communication are important in relation to suicidality. Early identification and management of depression may be a preventative mechanism and future research identifying other modifiable mechanisms may lead to preventative action or interventions against suicidal behaviour in this high-risk group.
Fantastic beasts and how to sequence them: genomic approaches for obscure model organisms
Authors: Matz Mikhail V.
Published: July 2017

Application of genomic approaches to “obscure model organisms” (OMOs), meaning species with little or no genomic resources, enables increasingly sophisticated studies of genomic basis of evolution, acclimatization and adaptation in real ecological contexts. Here, I highlight sequencing solutions and data handling techniques most suited for genomic analysis of OMOs.

Glossary

-Allele Frequency Spectrum, AFS(same as Site Frequency Spectrum, SFS): histogram of the number of segregating variants depending on their frequency in one or more populations.

-Restriction site-Associated DNA (RAD) sequencing: family of diverse genotyping methods that sequence short fragments of the genome adjacent to recognition site(s) for specific restriction endonuclease(s).

-Linkage Disequilibrium (LD): in this review, correlation of genotypes at a pair of markers across individuals.

-LD block: typical distance between markers in the genome across which their genotypes remain correlated.

-Genome scan:profiling of genotypes along the genome looking for unusual patterns. Often used to look for signatures of natural selection or introgression.

-“Denser-than-LD” genotyping: genotyping of several polymorphic markers per LD block.

-Highly contiguous reference: genome or transcriptome reference sequence containing the least amount of fragmentation.

-Phased data: data showing which SNP alleles belong to the same homologous chromosome copy.

-Cross-tissue gene expression analysis: looking for individual-specific shifts in gene expression detectable across multiple tissues. Such shifts are predominantly genetic in nature.