bluuebunny/crossref_metadata_2025 huggingface dataset:
Effective properties of a porous medium with aligned cracks containing compressible fluid
Authors: Song Yongjia , Hu Hengshan , Han Bo
Published: December 2019

Understanding the wave propagation in fluid-saturated cracked rocks is important for detecting and characterizing cracked reservoirs and fault zones with applications in geomechanics, hydrogeology, exploration geophysics and reservoir engineering. In sedimentary rocks, microscopic-scale pores are usually filled with fluid. One logical means of modelling the essential features of such rocks is to use poroelasticity theory. But previous models of wave propagation in cracked porous medium are either restricted to low frequencies at which effects of the elastic scattering (scattering into fast-P and S waves via mode conversion at the crack faces) are negligible or to the case that the crack-filling fluid is assumed to be incompressible. To overcome these restrictions, we consider the effects of crack fluid compressibility by extending spring condition into poroelasticity and derive exact solutions of the scattering problem of an incident P wave by a circular crack containing compressible fluid in a porous medium. Based on the solutions, we develop two different effective medium models to estimate frequency-dependent effective velocity and attenuation in a fluid-saturated porous rock with a set of aligned cracks. The mixed-boundary value problem reveals that both the wave-induced fluid flow (WIFF) and elastic wave scattering can cause important velocity dispersion and attenuation. The diffusion-type WIFF dominates the velocity change and attenuation for the low frequency range, while the elastic scattering dominates them for the relatively higher frequency range. The dependences of the P-wave velocity on the crack fluid compressibility are different at different frequencies. For the WIFF-dominated frequency range and Rayleigh-scattering frequency range, the P-wave velocity decreases with the crack fluid compressibility. In contrast, for the Mie scattering frequency range, the opposite occurs (the P-wave velocity increases with the crack fluid compressibility).
Mimicking of splicing-related retinitis pigmentosa mutations in C. elegans allow drug screens and identification of disease modifiers
Authors: Kukhtar Dmytro , Rubio-Peña Karinna , Serrat Xènia , Cerón Julián
Published: December 2019

CRISPR/Cas and the high conservation of the spliceosome components facilitate the mimicking of human pathological mutations in splicing factors of model organisms. The degenerative retinal disease retinitis pigmentosa (RP) is caused by mutations in distinct types of genes, including missense mutations in splicing factors that provoke RP in an autosomal dominant form (s-adRP). Using CRISPR in Caenorhabditis elegans, we generated mutant strains to mimic s-adRP mutations reported in PRPF8 and SNRNP200. Whereas these inherited mutations are present in heterozygosis in patients, C. elegans allows the maintenance of these mutations as homozygotes, which is advantageous for genetic and drug screens. We found that snrp-200(cer23[V676L]) and prp-8(cer14[H2302del]) display pleiotropic phenotypes, including reduced fertility. However, snrp-200(cer24[S1080L]) and prp-8(cer22[R2303G]) are weak alleles suitable for RNAi screens for identifying genetic interactions, which could uncover potential disease modifiers. We screened a collection of RNAi clones for splicing-related genes and identified three splicing factors: isy-1/ISY1, cyn-15/PPWD1 and mog-2/SNRPA1, whose partial inactivation may modify the course of the disease. Interestingly, these three genes act as modifiers of prp-8(cer22) but not of snrp-200(cer24). Finally, a screen of the strong allele prp-8(cer14) with FDA-approved drugs did not identify molecules capable of alleviating the temperature-sensitive sterility. Instead, we detected drugs, such as dequalinium chloride, which exacerbated the phenotype, and therefore, are potentially harmful to s-adRP patients since they may accelerate the progression of the disease.
Conditional switching of KIF2A mutation provides new insights into cortical malformation pathogeny
Authors: Gilet Johan G , Ivanova Ekaterina L , Trofimova Daria , Rudolf Gabrielle , Meziane Hamid , Broix Loic , Drouot Nathalie , Courraud Jeremie , Skory Valerie , Voulleminot Paul , Osipenko Maria , Bahi-Buisson Nadia , Yalcin Binnaz , Birling Marie-Christine , Hinckelmann Maria-Victoria , Kwok Benjamin H , Allingham John S , Chelly Jamel
Published: December 2019

By using the Cre-mediated genetic switch technology, we were able to successfully generate a conditional knock-in mouse, bearing the KIF2A p.His321Asp missense point variant, identified in a subject with malformations of cortical development. These mice present with neuroanatomical anomalies and microcephaly associated with behavioral deficiencies and susceptibility to epilepsy, correlating with the described human phenotype. Using the flexibility of this model, we investigated RosaCre-, NestinCre- and NexCre-driven expression of the mutation to dissect the pathophysiological mechanisms underlying neurodevelopmental cortical abnormalities. We show that the expression of the p.His321Asp pathogenic variant increases apoptosis and causes abnormal multipolar to bipolar transition in newborn neurons, providing therefore insights to better understand cortical organization and brain growth defects that characterize KIF2A-related human disorders. We further demonstrate that the observed cellular phenotypes are likely to be linked to deficiency in the microtubule depolymerizing function of KIF2A.
The 6-min walk test in the functional evaluation of patients with lung cancer qualified for lobectomy
Authors: Wesolowski Stefan , Orlowski Tadeusz M , Kram Marek
Published: December 2019

OBJECTIVES

The American College of Chest Physicians guidelines recommend low-technology exercise tests in the functional evaluation of patients with lung cancer considered for resectional surgery. However, the 6-min walk test (6MWT) is not included, because the data on its clinical value are inconsistent. Our goal was to evaluate the 6MWT in assessing the risk of cardiopulmonary complications in candidates for lung resection.

METHODS

We performed a retrospective assessment of clinical data and pulmonary function test results in 947 patients, mean age 65.3 (standard deviation 9.5) years, who underwent a single lobectomy for lung cancer. In 555 patients with predicted postoperative values ≤60%, the 6MWT was performed. The 6-min walking distance (6MWD) and the distance-saturation product (DSP), which is the product of the 6MWD in metres, and the lowest oxygen saturation registered during the test were assessed.

RESULTS

A total of 363 patients with predicted postoperative values <60% and a 6MWT distance (6MWD) ≥400 m or DSP ≥ 350 m% had a lower rate of cardiopulmonary complications than patients with shorter 6MWD or lower DSP values [odds ratio (OR) 0.53, 95% confidence interval (CI) 0.35–0.81] and 0.47 (95% CI 0.30–0.73), respectively. This result was also true for patients with predicted postoperative values <40%, ORs 0.33 (95% CI 0.14–0.79) and 0.25 (95% CI 0.10–0.61), respectively.

CONCLUSIONS

The 6MWT is useful in the assessment of operative risk in patients undergoing a single lobectomy for lung cancer. It helps to stratify the operative risk, which is lower in patients with 6MWD ≥400 m or DSP ≥350 m% than in patients with a shorter 6MWD or lower DSP values.
Self-Similar Dynamics for the Modified Korteweg–de Vries Equation
Authors: Correia Simão , Côte Raphaël , Vega Luis
Published: December 2019

We prove a local well-posedness result for the modified Korteweg–de Vries equation in a critical space designed so that is contains self-similar solutions. As a consequence, we can study the flow of this equation around self-similar solutions: in particular, we give an asymptotic description of small solutions as $t \to +\infty $.
Occurrence of cross-resistance and β-lactam seesaw effect in glycopeptide-, lipopeptide- and lipoglycopeptide-resistant MRSA correlates with membrane phosphatidylglycerol levels
Authors: Hines Kelly M , Shen Tianwei , Ashford Nathaniel K , Waalkes Adam , Penewit Kelsi , Holmes Elizabeth A , McLean Kathryn , Salipante Stephen J , Werth Brian J , Xu Libin
Published: December 2019

Background

Glycopeptides (GPs), lipopeptides (LPs) and lipoglycopeptides (LGPs) are related antimicrobials important for the management of invasive MRSA infections. Cross-resistance among these antibiotics in MRSA is well documented, as is the observation that susceptibility of MRSA to β-lactams increases as susceptibility to GPs and LPs decreases (i.e. the seesaw effect). Efforts to understand the relationship between GP/LP/LGP cross-resistance and the seesaw effect have focused on the PBPs, but the role of lipid metabolism has not been investigated.

Objectives

Since the cell membrane is structurally and metabolically integrated with the cell wall and anchors associated proteins, including PBPs, we examined the relationship between membrane lipid composition and the phenomena of cross-resistance among GPs/LPs/LGPs and the β-lactam seesaw effect.

Methods

We selected for daptomycin, vancomycin and dalbavancin resistance using the USA300 strain JE2 and evaluated the resulting mutants by WGS, MS-based lipidomics and antimicrobial susceptibility testing to assess the relationship between membrane composition, cross-resistance, and the seesaw effect.

Results

We observed cross-resistance to GPs/LPs/LGPs among the selected strains and the seesaw effect against various β-lactams, depending on the PBP targets of the particular β-lactam. We found that modification of membrane composition occurs not only in daptomycin-selected strains, but also vancomycin- and dalbavancin-selected strains. Significantly, we observed that the abundance of most phosphatidylglycerols positively correlates with MICs of GPs/LPs/LGPs and negatively correlates with the MICs of β-lactams.

Conclusions

These studies demonstrate a major association between membrane remodelling, cross-resistance and the seesaw effect.
Design and analytic considerations for using patient-reported health data in pragmatic clinical trials: report from an NIH Collaboratory roundtable
Authors: Rockhold Frank W , Tenenbaum Jessica D , Richesson Rachel , Marsolo Keith A , O’Brien Emily C
Published: December 2019

Pragmatic clinical trials often entail the use of electronic health record (EHR) and claims data, but bias and quality issues associated with these data can limit their fitness for research purposes particularly for study end points. Patient-reported health (PRH) data can be used to confirm or supplement EHR and claims data in pragmatic trials, but these data can bring their own biases. Moreover, PRH data can complicate analyses if they are discordant with other sources. Using experience in the design and conduct of multi-site pragmatic trials, we itemize the strengths and limitations of PRH data and identify situational criteria for determining when PRH data are appropriate or ideal to fill gaps in the evidence collected from EHRs. To provide guidance for the scientific rationale and appropriate use of patient-reported data in pragmatic clinical trials, we describe approaches for ascertaining and classifying study end points and addressing issues of incomplete data, data alignment, and concordance. We conclude by identifying areas that require more research.
Can we constrain the dark energy equation of state parameters using configuration entropy?
Authors: Das Biswajit , Pandey Biswajit
Published: December 2019

We propose a new scheme for constraining the dark energy equation of state parameter/parameters based on the study of the evolution of the configuration entropy. We analyse a set of one-parameter and two-parameter dynamical dark energy models and find that the derivative of the configuration entropy in all the dynamical dark energy models exhibits a minimum. The magnitude of the minimum of the entropy rate is decided by both the parametrization of the equation of state and the associated parameters. The location of the minimum of the entropy rate is less sensitive to the form of the parametrization but depends on the associated parameters. We determine the best-fitting equations for the location and magnitude of the minimum of the entropy rate in terms of the parameter/parameters of the dark energy equation of state. These relations would allow us to constrain the dark energy equation of state parameter/parameters for any given parametrization provided the evolution of the configuration entropy in the Universe is known from observations.
The Pristine survey – IX. CFHT ESPaDOnS spectroscopic analysis of 115 bright metal-poor candidate stars
Authors: Venn Kim A , Kielty Collin L , Sestito Federico , Starkenburg Else , Martin Nicolas , Aguado David S , Arentsen Anke , Bonifacio Piercarlo , Caffau Elisabetta , Hill Vanessa , Jablonka Pascale , Lardo Carmela , Mashonkina Lyudmilla , Navarro Julio F , Sneden Chris , Thomas Guillaume , Youakim Kris , González-Hernández Jonay I , Sánchez Janssen Rubén , Carlberg Ray , Malhan Khyati
Published: December 2019

A chemo-dynamical analysis of 115 metal-poor candidate stars selected from the narrow-band Pristine photometric survey is presented based on CFHT high-resolution ESPaDOnS spectroscopy. We have discovered 28 new bright (V < 15) stars with [Fe/H] < −2.5 and 5 with [Fe/H] < −3.0 for success rates of 40 (28/70) and 19 per cent (5/27), respectively. A detailed model atmosphere analysis is carried out for the 28 new metal-poor stars. Stellar parameters were determined from SDSS photometric colours, Gaia DR2 parallaxes, MESA/MIST stellar isochrones, and the initial Pristine survey metallicities, following a Bayesian inference method. Chemical abundances are determined for 10 elements (Na, Mg, Ca, Sc, Ti, Cr, Fe, Ni, Y, and Ba). Most stars show chemical abundance patterns that are similar to the normal metal-poor stars in the Galactic halo; however, we also report the discoveries of a new r-process-rich star, a new CEMP-s candidate with [Y/Ba] > 0, and a metal-poor star with very low [Mg/Fe]. The kinematics and orbits for all of the highly probable metal-poor candidates are determined by combining our precision radial velocities with Gaia DR2 proper motions. Some stars show unusual kinematics for their chemistries, including planar orbits, unbound orbits, and highly elliptical orbits that plunge deeply into the Galactic bulge (Rperi < 0.5 kpc); also, eight stars have orbital energies and actions consistent with the Gaia-Enceladus accretion event. This paper contributes to our understanding of the complex chemo-dynamics of the metal-poor Galaxy, and increases the number of known bright metal-poor stars available for detailed nucleosynthetic studies.
The large amplitude X-ray variability in NGC 7589: possible evidence for accretion mode transition
Authors: Liu Zhu , Liu He-Yang , Cheng Huaqing , Qiao Erlin , Yuan Weimin
Published: December 2019

We report the discovery of large amplitude X-ray variability in the low-luminosity active galactic nucleus NGC 7589, and present possible observational evidence for accretion mode transition in this source. Long-term X-ray flux variations by a factor of more than 50 are found using X-ray data obtained by Swift/X-Ray Telescope and XMM–Newton over 17 yr. Results of long-term monitoring data in the UV, optical, and infrared bands over ∼20 yr are also presented. The Eddington ratio λEdd increased from 10−3 to ∼0.13, suggesting a transition of the accretion flow from an advection dominated accretion flow to a standard thin accretion disc. Further evidence supporting the thin disc in the high-luminosity state is found by the detection of a significant soft X-ray component in the X-ray spectrum. The temperature of this component ($\sim 19^{+15}_{-7}$ eV, fitted with a blackbody model) is in agreement with the predicted temperature of the inner region for a thin disc around a black hole (BH) with mass of ∼107M⊙. These results may indicate that NGC 7589 had experienced accretion mode transition over a time-scale of a few years, suggesting the idea that similar accretion processes are at work for massive BH and BH X-ray binaries.
HSF2BP negatively regulates homologous recombination in DNA interstrand crosslink repair
Authors: Sato Koichi , Brandsma Inger , van Rossum-Fikkert Sari E , Verkaik Nicole , Oostra Anneke B , Dorsman Josephine C , van Gent Dik C , Knipscheer Puck , Kanaar Roland , Zelensky Alex N
Published: December 2019

The tumor suppressor BRCA2 is essential for homologous recombination (HR), replication fork stability and DNA interstrand crosslink (ICL) repair in vertebrates. We show that ectopic production of HSF2BP, a BRCA2-interacting protein required for meiotic HR during mouse spermatogenesis, in non-germline human cells acutely sensitize them to ICL-inducing agents (mitomycin C and cisplatin) and PARP inhibitors, resulting in a phenotype characteristic of cells from Fanconi anemia (FA) patients. We biochemically recapitulate the suppression of ICL repair and establish that excess HSF2BP compromises HR by triggering the removal of BRCA2 from the ICL site and thereby preventing the loading of RAD51. This establishes ectopic expression of a wild-type meiotic protein in the absence of any other protein-coding mutations as a new mechanism that can lead to an FA-like cellular phenotype. Naturally occurring elevated production of HSF2BP in tumors may be a source of cancer-promoting genomic instability and also a targetable vulnerability.
DNA targeting by Clostridium cellulolyticum CRISPR–Cas9 Type II-C system
Authors: Fedorova Iana , Arseniev Anatolii , Selkova Polina , Pobegalov Georgii , Goryanin Ignatiy , Vasileva Aleksandra , Musharova Olga , Abramova Marina , Kazalov Maksim , Zyubko Tatyana , Artamonova Tatyana , Artamonova Daria , Shmakov Sergey , Khodorkovskii Mikhail , Severinov Konstantin
Published: December 2019

Type II CRISPR–Cas9 RNA-guided nucleases are widely used for genome engineering. Type II-A SpCas9 protein from Streptococcus pyogenes is the most investigated and highly used enzyme of its class. Nevertheless, it has some drawbacks, including a relatively big size, imperfect specificity and restriction to DNA targets flanked by an NGG PAM sequence. Cas9 orthologs from other bacterial species may provide a rich and largely untapped source of biochemical diversity, which can help to overcome the limitations of SpCas9. Here, we characterize CcCas9, a Type II-C CRISPR nuclease from Clostridium cellulolyticum H10. We show that CcCas9 is an active endonuclease of comparatively small size that recognizes a novel two-nucleotide PAM sequence. The CcCas9 can potentially broaden the existing scope of biotechnological applications of Cas9 nucleases and may be particularly advantageous for genome editing of C. cellulolyticum H10, a bacterium considered to be a promising biofuel producer.
Biplanar X-Ray Methods for Stereotactic Intraoperative Localization in Deep Brain Stimulation Surgery
Authors: Sedrak Mark , Sabelman Eric , Pezeshkian Patrick , Duncan John , Bernstein Ivan , Bruce Diana , Tse Victor , Khandhar Suketu , Call Elena , Heit Gary , Alaminos-Bouza Armando
Published: December 2019

BACKGROUND

Efficacy in deep brain stimulation (DBS) is dependent on precise positioning of electrodes within the brain. Intraoperative fluoroscopy, computed tomography (CT), or magnetic resonance imaging are used for stereotactic intraoperative localization (StIL), but the utility of biplanar X-ray has not been evaluated in detail.

OBJECTIVE

To determine if analysis of orthogonal biplanar X-rays using graphical analysis (GA), ray tracing (RT), and/or perspective projection (PP) can be utilized for StIL.

METHODS

A review of electrode tip positions comparing postoperative CT to X-ray methods was performed for DBS operations containing orthogonal biplanar X-ray with referential spheres and pins.

RESULTS

Euclidean (Re) errors for final DBS electrode position on intraoperative X-rays vs postoperative CT using GA, RT, and PP methods averaged 1.58 mm (±0.75), 0.74 mm (±0.45), and 1.07 mm (±0.64), respectively (n = 56). GA was more accurate with a ventriculogram. RT and PP predicted positions that correlated with third ventricular structures on ventriculogram cases. RT was the most stable but required knowledge of the geometric setup. PP was more flexible than RT but required well-distributed reference points. A single case using the O-arm demonstrated Re errors of 0.43 mm and 0.28 mm for RT and PP, respectively. In addition, these techniques could also be used to calculate directional electrode rotation.

CONCLUSION

GA, RT, and PP can be employed for precise StIL during DBS using orthogonal biplanar X-ray. These methods may be generalized to other stereotactic procedures or instances of biplanar imaging such as angiograms, radiosurgery, or injection therapeutics.
Shock Transmission Through Cross-Border Bank Lending: Credit and Real Effects
Authors: Hale Galina , Kapan Tümer , Minoiu Camelia
Published: December 2019

We study the transmission of financial shocks across borders through international bank connections. Using data on cross-border interbank loans among 6,000 banks during 1997–2012, we estimate the effect of asset-side exposures to banks in countries experiencing systemic banking crises on profitability, credit, and the performance of borrower firms. Crisis exposures reduce bank returns and tighten credit conditions for borrowers, constraining investment and growth. The effects are larger for foreign borrowers, including in countries not experiencing banking crises. Our results document the extent of cross-border crisis transmission, but also highlight the resilience of financial networks to idiosyncratic shocks.
Systematic genetic analysis of early-onset gout: ABCG2 is the only associated locus
Authors: Zaidi Faseeh , Narang Ravi K , Phipps-Green Amanda , Gamble Greg G , Tausche Anne-Katherin , So Alexander , Riches Philip , Andres Mariano , Perez-Ruiz Fernando , Doherty Michael , Janssen Matthijs , Joosten Leo A B , Jansen Tim L , Kurreeman Fina , Torres Rosa J , McCarthy Geraldine M , Miner Jeffrey N , Stamp Lisa K , Merriman Tony R , Dalbeth Nicola
Published: December 2019

Objective

The aim of this study was to examine whether serum urate-associated genetic variants are associated with early-onset gout.

Methods

Participants with gout in the Genetics of Gout in Aotearoa study with available genotyping were included (n = 1648). Early-onset gout was defined as the first presentation of gout <40 years of age. Single nucleotide polymorphisms (SNPs) for the 10 loci most strongly associated with serum urate were genotyped. Allelic association of the SNPs with early-onset gout was tested using logistic regression in an unadjusted model and in a model adjusted for sex, body mass index, tophus presence, flare frequency, serum creatinine and highest serum urate. The analysis was also done in two replication cohorts: Eurogout (n = 704) and Ardea (n = 755), and data were meta-analysed.

Results

In the Genetics of Gout in Aotearoa study, there were 638 (42.4%) participants with early-onset gout. The ABCG2 rs2231142 gout risk T-allele was present more frequently in participants with early-onset gout compared with the later-onset group. For the other SNPs tested, no differences in risk allele number were observed. In the allelic association analysis, the ABCG2 rs2231142 T-allele was associated with early-onset gout in unadjusted and adjusted models. Analysis of the replication cohorts confirmed the association of early-onset gout with the ABCG2 rs2231142 T-allele, but not with other serum urate-associated SNPs. In the meta-analysis, the odds ratio (95% CI) for early-onset gout for the ABCG2 rs2231142 T-allele was 1.60 (1.41, 1.83).

Conclusion

In contrast to other serum urate-raising variants, the ABCG2 rs2231142 T-allele is strongly associated with early-onset gout.
Surgical Management of Multiple Rib Fractures Reduces the Hospital Length of Stay and the Mortality Rate in Major Trauma Patients: A Comparative Study in a UK Major Trauma Center
Authors: Gerakopoulos Efstratios , Walker Leonie , Melling David , Scott Sharon , Scott Simon
Published: December 2019

Objectives:

To investigate and assess the effectiveness of surgical fixation of rib fractures in complex traumatic chest injuries compared with traditional nonoperative management.

Design:

Retrospective observational comparative study.

Setting:

Level 1 Major Trauma Centre in North West England.

Patients/Participants:

A total of 83 patients who were admitted urgently to our hospital after major trauma, between August 2012 and March 2015, and fulfilled the criteria for surgical fixation of their multiple rib fractures. Patients who had concomitant nonsurvivable injuries or did not consent for surgery were excluded.

Intervention:

Open reduction and internal fixation (ORIF) of multiple rib fractures and flail chest segments versus traditional nonoperative management.

Main Outcome Measurements:

The primary outcome of interest was the total hospital length of stay (LOS). Secondary outcomes included the incidence of intensive care unit (ICU) admission and the incidence of respiratory complications such as hospital-acquired pneumonia, need for mechanical ventilation, and/or tracheotomy. The mortality rate was also investigated.

Results:

A total of 83 patients were included, 47 of these in the ORIF group and 36 in the non-ORIF group. The mean hospital LOS for patients in the non-ORIF group was 30.41 days (SD 30.1). This was markedly reduced in the ORIF group to a mean of 14.53 days (SD 11.7), with the difference being statistically significant (P < 0.01). Twenty-eight patients (77.7%) in the nonoperatively managed group required admission to the ICU compared with a significantly lower 48.9% (23 patients) in the ORIF group (P < 0.01). The incidence of respiratory complications was lower in the ORIF group but this difference was not statistically significant. The mortality rate was 2.1% for the group that was treated surgically compared with 13.9% for the conservative group (P < 0.05).

Conclusions:

Surgical fixation of multiple displaced rib fractures reduced the total hospital LOS and the overall mortality in our major trauma patients and decreased the incidence of ICU admission.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Management of Opioid and Sedative Weaning in Pediatric Congenital Heart Disease Patients
Authors: O’Connell Caitlin , Ziniel Sonja , Hartwell Lauren , Connor Jean
Published: December 2019

Background:

Opioid and sedative medications are commonly used to treat pediatric patients with congenital heart disease; however, their use is not without adverse effects. Symptoms of withdrawal can occur if the medications are discontinued abruptly or weaned too quickly.

Objective:

The aim of this study was to understand and describe the current management of opioid and sedative weaning in pediatric congenital heart disease patients in freestanding children’s hospitals across the United States.

Methods:

A Web-based survey of pediatric congenital heart centers was conducted. Survey participants were recruited from the Consortium of Congenital Cardiac Care–Measurement of Nursing Practice. Quantitative data were summarized using frequency and proportions. Qualitative data were summarized using content analysis.

Results:

Twelve sites participated in the survey (44% response rate). Methadone was used as a weaning medication at 100% of participating sites, lorazepam at 83% of sites, and clonidine at 75% of sites. Seventy-five percent of sites reported using a clinical assessment tool to monitor withdrawal symptoms. Twenty-five percent of sites used a standardized clinical pathway when weaning opioid and sedative medications. Eighty-three percent of sites will consider discharging a patient to complete the medication wean at home.

Discussion:

Weaning practices varied across sites. While some similarities were observed among sites, substantial practice variation exists. The majority of sites used a clinical assessment tool to assess for withdrawal symptoms. Few sites reported using a standardized approach to weaning patients. Discharging patients to complete an opioid or sedative wean at home was common practice. Opportunities exist for the development of weaning practice guidelines.
Palliative Care Triggers in the Intensive Care Unit
Authors: Jones Brian W. , Bernstein Charles
Published: December 2019

There is growing recognition that electronic medical record triggers in the intensive care unit (ICU) have led to an increase in palliative care consultations. One suburban health care system adopted triggers unique to their culture and setting in a pilot study and saw an increase in palliative consultations in the ICU. Implementing triggers is often a complex and multifaceted process to adopt. This review shares the steps from concept to implementation of establishing palliative prompts in 1 ICU within an integrated health care system.
Organizational Learning in a Cardiac Intensive Care Unit
Authors: Lyman Bret , Ethington Kalene M. , King Carly , Jacobs Jonathan D. , Lundeen Hayley
Published: December 2019

Introduction:

Providing high-quality care to every patient is challenging, particularly in critical care units (CCUs). However, this standard can be achieved through organizational learning. Unfortunately, the process of organizational learning in CCUs is not well understood.

Objective:

The objective of this study is to describe the developmental progression of a cardiac intensive care unit (CICU) to reach its current state of reliably excellent clinical performance.

Methods:

The method selected for this study was a learning history. A total of 43 individuals with experience working on the CICU participated in small group interviews. Participants included nurses, surgeons, unit clerks, administrators, nursing assistants, a pharmacist, a respiratory therapist, and an administrative assistant. Relevant artifacts, including unit performance data, were also gathered to complement interview data.

Results:

The CICU progressed through 4 distinct developmental stages to reach its current state. The CICU’s early development involved establishing psychological safety on the unit, which prepared the unit for increased accountability, improved performance, and the pursuit of reliability.

Discussion/Conclusion:

The findings validate the relationship between psychological safety and organizational learning, offer insight into how CCUs become high-reliability organizations, and provide clinical leaders with guidance for achieving high reliability in their organizations. The findings also help validate the American Association of Critical-Care Nurses position that a healthy work environment is essential to achieving clinical excellence. Critical care unit teams should use these findings as a framework for collective reflection and planning to achieve their desired future. Further research is needed to validate the applicability of these findings and to continue building the evidence base for organizational learning in hospital units.
Critical Care Nurses' Perceptions of End-of-Life Care Obstacles
Authors: Beckstrand Renea L. , Lamoreaux Nicole , Luthy Karlen E. , Macintosh Janelle L.B.
Published: December 2019

Background:

Nurses working in intensive care units (ICUs) frequently care for patients and their families at the end of life (EOL). Providing high-quality EOL care is important for both patients and families, yet ICU nurses face many obstacles that hinder EOL care. Researchers have identified various ICU nurse-perceived obstacles, but no studies have been found addressing the progress that has been made for the last 17 years.

Objective:

The aims of this study were to determine the most common and current obstacles in EOL care as perceived by ICU nurses and then to evaluate whether meaningful changes have occurred since data were first gathered in 1998.

Methods:

A quantitative-qualitative mixed methods design was used. A random, geographically dispersed sample of 2000 members of the American Association of Critical-Care Nurses was surveyed.

Results:

Five obstacle items increased in mean score and rank as compared with 1999 data including (1) family not understanding what the phrase “lifesaving measures” really means, (2) providing lifesaving measures at families' requests despite patient's advance directive listing no such care, (3) family not accepting patient's poor prognosis, (4) family members fighting about the use of life support, and (5) not enough time to provide EOL care because the nurse is consumed with lifesaving measures attempting to save the patient's life. Five obstacle items decreased in mean score and rank compared with 1999 data including (1) physicians differing in opinion about care of the patient, (2) family and friends who continually call the nurse rather than calling the designated family member, (3) physicians who are evasive and avoid families, (4) nurses having to deal with angry families, and (5) nurses not knowing their patient's wishes regarding continuing with tests and treatments.

Conclusions:

Obstacles in EOL care, as perceived by critical care nurses, still exist. Family-related obstacles have increased over time. Obstacles related to families may not be easily overcome as each family, dealing with a dying family member in an ICU, likely has not previously experienced a similar situation. On the basis of the current top 5 obstacles, recommendations for possible areas of focus include (1) improved health literacy assessment of families followed by earlier directed, appropriate, and specific EOL information; (2) improved physician/team communication; and (3) ensuring patients' wishes are followed as written. In general, patient- and family-centered care using clear and open EOL communication regarding wishes and desires between patients and families, their physicians, and nurses will help decrease common obstacles, thus improving the quality of EOL care provided to dying patients and families.
Pain and stress: functional evidence that supra-spinal mechanisms involved in pain-induced analgesia mediate stress-induced analgesia
Authors: Tobaldini Glaucia , Andersen Erik O.L. , Polato Jhuliana J. , Guilhen Vinicius A. , Gaspar Jessica C. , Lazzarim Mayla K. , Sardi Natalia F. , Fischer Luana
Published: December 2019

Analgesia induced by stressful and painful stimuli is an adaptive response during life-threatening situations. There is no evidence linking the mechanisms underlying them, while the former depends on the activation of stress-related brain pathways, the second depends on opioidergic mechanisms in the nucleus accumbens and on nicotinic cholinergic mechanisms in the rostral ventromedial medulla. In this study, we hypothesized that stress-induced analgesia is also dependent on opioidergic mechanisms in the nucleus accumbens and on nicotinic cholinergic mechanisms in the rostral ventromedial medulla. We used immobilization, a classical procedure to induce acute stress, and evaluated its ability to decrease the nociceptive responses induced either by carrageenan or by formalin in rats. Immobilization stress significantly decreased either carrageenan-induced hyperalgesia or formalin-induced tonic nociception in a time-dependent manner. This stress-induced analgesia is similar to pain-induced analgesia, as revealed by contrasting the antinociceptive effect induced by immobilization and by a forepaw injection of capsaicin. The administration of a µ-opioid receptor antagonist (CTOP, 0.5 µg) into the nucleus accumbens, as well as that of a nicotinic cholinergic receptor antagonist (mecamylamine, 0.6 µg) into the rostral ventromedial medulla, blocked immobilization stress-induced analgesia in both pain models. These results demonstrate that supraspinal mechanisms which are known to mediate pain-induced analgesia also mediate stress-induced analgesia. Therefore both forms of analgesia have overlapping mechanisms, probably recruited in response to the perception of danger.
Sensor and Survey Measures Associated With Daily Fatigue in HIV: Findings From a Mixed-Method Study
Authors: Makic Mary Beth , Gilbert Danielle , Jankowski Catherine , Reeder Blaine , Al-Salmi Nasser , Starr Whitney , Cook Paul F.
Published: December 2019

Fatigue is the most common symptom among people living with HIV (PLWH), but may have many causes. This mixed-method study was designed to characterize PLWH's fatigue experiences and associated self-management behaviors, using Two Minds Theory. Fifty-five PLWH completed daily smartphone surveys on psychological states and fatigue at random times for 30 days and used a Fitbit Alta™ wristband. Within-person multilevel models were used to identify univariate correlates of fatigue. The first 25 participants also completed qualitative interviews about their experiences, and results were compared across methods. Participants had significant fatigue despite well-controlled HIV. Fatigue varied between persons and over time. Fatigue was associated with physical activity, sleep, daily psychological states, and barriers to self-care. PLWH reported new insights into fatigue from self-monitoring. There are potential opportunities for PLWH to improve sleep, activity, or stress management to alleviate fatigue. PLWH were interested in reducing fatigue and willing to use self-monitoring technology.
Renal artery wall 18F-NaF activity and glomerular filtration rate: an exploratory analysis in a high cardiovascular risk population
Authors: Oliveira-Santos Manuel , McMahon Gearoid , Castelo-Branco Miguel , Silva Rodolfo , Gomes Andreia , Chichorro Nuno , Abrunhosa Antero , Donato Paulo , de Lima João Pedroso , Pego Mariano , Gonçalves Lino , Ferreira Maria João
Published: December 2019

Objectives

Atherosclerotic plaque molecular imaging with 18F-sodium fluoride (NaF) PET with computed tomography (PET-CT) may identify active unstable microcalcification. We sought to explore renal arteries calcification activity in a group of high cardiovascular (CV) risk subjects without manifest CV disease.

Methods

High CV risk hypertensive individuals from a single centre were prospectively scanned with 18F-NaF-PET-CT in major vascular territories. Renal arterial wall activity was retrospectively analysed and expressed as the ratio between maximum standard uptake value in the lesion and mean blood pool activity in the superior vena cava [tissue-to-background ratio (TBR)]. We explored renal artery wall 18F-NaF activity’s association to CV risk factors and renal function.

Results

Mean age was 64 ± 8.6 years, 56% male, 96% Caucasian and 24% had chronic kidney disease (CKD) (n = 25). Six individuals (24%) showed renal artery wall radiotracer uptake (TBR 1.4 ± 0.4); these subjects were heavier, had higher triglycerides, high-sensitivity C-reactive protein and predicted CV risk (SCORE) compared to the remaining cohort (P < 0.05 for all comparisons). There was a trend toward higher 18F-NaF uptake in other major vessels and increased thoracic fat volume in subjects with renal artery wall uptake. Glomerular filtration rate (GFR) was lower in subjects with positive renal plaques (93.0 ± 29.7 vs. 65.0 ± 19.7 ml/min, P = 0.04). Renal artery radiotracer uptake and eGFR were inversely correlated (r = −0.42, P = 0.04).

Conclusion

In a high CV risk group without manifest CV disease, higher renal artery wall 18F-NaF activity is associated with superior predicted CV risk and lower GFR.
A Quantitative Assessment of Gluten Cross‐contact in the School Environment for Children With Celiac Disease
Authors: Weisbrod Vanessa M. , Silvester Jocelyn A. , Raber Catherine , Suslovic William , Coburn Shayna S. , Raber Blair , McMahon Joyana , Damast Amy , Kramer Zachary , Kerzner Benny
Published: December 2019

Objectives:

A gluten‐free (GF) diet is the primary treatment for celiac disease (CD). Gluten is used in schools, particularly in early childhood, art, and home‐economics classrooms. This study aimed to measure gluten transfer from school supplies to GF foods that a child with CD may eat. Also, to measure efficacy of washing techniques to remove gluten from hands and tables.

Methods:

Five experiments measured potential gluten cross‐contact in classrooms: Play‐Doh (n = 30); baking project (n = 30); paper mâché (n = 10); dry pasta in sensory table (n = 10); cooked pasta in sensory table (n = 10). Thirty participants ages 2 to 18 were enrolled. Following activities, gluten levels were measured on separate slices of GF bread rubbed on participant's hands and table surfaces. Participants were assigned 1 of 3 handwashing methods (soap and water, water alone, or wet wipe). Repeat gluten transfer measurements were taken from hands and tables. Gluten measurements made using R‐Biopharm R7001 R5‐ELISA Sandwich assay.

Results:

Paper mâché, cooked pasta in sensory tables, and baking project resulted in rates of gluten transfer far greater than the 20 ppm threshold set by Codex Alimentarius Commission. Play‐Doh and dry pasta, however, resulted in few gluten transfers to GF bread >20 ppm. Soap and water was consistently the most effective method for removing gluten, although other methods proved as effective in certain scenarios.

Conclusions:

The potential for gluten exposure at school is high for some materials and low for others. For high‐risk materials, schools should provide GF supplies and have a robust strategy to prevent gluten cross‐contact with food.
Patellofemoral Pain Syndrome and Pain Severity Is Associated With Asymmetry of Gluteus Medius Muscle Activation Measured Via Ultrasound
Authors: Payne Karlie , Payne Justin , Larkin Theresa A.
Published: December 2019

Objective

The aim of the study was to determine whether gluteus medius muscle thickness or activation differed between left and right sides and was associated with patellofemoral pain presence or severity.

Design

Males and females were recruited and screened by a physiotherapist for inclusion in the control or patellofemoral pain syndrome group. Bilateral measures were obtained for Q angle and gluteus medius muscle thickness at rest and on contraction via standing hip external rotation, using ultrasound. Muscle activation was calculated as the percentage change in muscle thickness on contraction relative to at rest. Patellofemoral pain syndrome participants completed the anterior knee pain scale and a visual analog pain scale.

Results

Gluteus medius muscle thickness at rest and on contraction, muscle activation, and Q angle were not different between control (n = 27, 63% female) and patellofemoral pain syndrome (n = 27, 59% female) groups. However, patellofemoral pain syndrome participants had a significantly larger left-right side imbalance in gluteus medius muscle activation than controls (15.9 ± 19.3% vs. 4.4 ± 21.9%, P < 0.05). Among patellofemoral pain syndrome participants, the magnitude of asymmetry of gluteus medius muscle activation was correlated with knee pain score (r = 0.425, P = 0.027).

Conclusions

Asymmetry of gluteus medius muscle activation was associated with patellofemoral pain syndrome and pain severity. This is clinically relevant for patellofemoral pain syndrome prevention and treatment, particularly because this was quantifiable using ultrasound.
Patient and Clinician Perspectives on Quality-of-Care Topics for Users of Custom Ankle-Foot Orthoses
Authors: Heinemann Allen W. , Deutsch Anne , Fatone Stefania , Soltys Nicole , McPherson Vari , Peterson Michelle , Slater Billie C. S. , LaVela Sherri L.
Published: December 2019

Objective

As in all healthcare areas, there is a need to improve quality relevant to orthotic practice, but we lack information as to what aspects of healthcare quality are meaningful to measure. Thus, the objective was to identify issues that are important to the quality-of-care for people who use custom ankle-foot orthoses as identified by ankle-foot orthosis users, orthotists, and physical therapists.

Design

We conducted focus groups with custom ankle-foot orthosis users, orthotists, and physical therapists. A stenographer took verbatim notes and provided transcripts. Research staff members assessed the transcripts using thematic analysis.

Results

Participants included 5 ankle-foot orthosis users (1 focus group), 17 orthotists (2 focus groups), and 7 physical therapists (1 focus group). They discussed domains of quality-of-care relevant for people with ankle-foot orthoses. We identified 28 thematic codes addressing 10 broad themes of quality-of-care. Six of the broad themes (organizational characteristics, patient-clinician communication, care coordination, device fit and comfort, body function, activity, and participation) mapped to the National Quality Forum’s person- and family-centered care concepts. Environment of care, clinician competencies, and device characteristics and usage were important to orthotic practice but do not map to any National Quality Forum concept. Participants did not mention the National Quality Forum concept of shared decision-making.

Conclusions

The quality themes provide information as to what aspects of healthcare quality are meaningful to measure with respect to orthotic care, thus providing guidance on how to measure and improve ankle-foot orthosis service delivery.
Toward Better Reporting Standards of Patients’ Characteristics in Rehabilitation Trials
Authors: Meyer Thorsten , Selb Melissa , Kiekens Carlotte , Grubišić Frane , Arienti Chiara , Stucki Gerold , Negrini Stefano
Published: December 2019

Background and Aim

The reporting of clinical studies in rehabilitation has been criticized in several aspects, including the reporting of patient characteristics. This article aims to contribute to the improvement of the reporting of patient characteristics in rehabilitation trials. Specifically, we want to determine the type of information that should be reported in rehabilitation trials that is specific to rehabilitation patients and how this information is captured by current reporting standards.

Methods

In the first step, we made a conceptual analysis of characteristics of rehabilitation patients by addressing the specifics of the field of medical rehabilitation, including the definition of rehabilitation and a description of its beneficiaries. In the second step, we compared this reference framework to the current reporting standards, especially the Consolidated Standards of Reporting Trials (CONSORT) statement and its extensions, as well as standards for the reporting of clinical guidelines (agree, right).

Results

Patients included in rehabilitation interventions should be distinguished by specific information. From a clinical perspective, patients dealt with in rehabilitation comprise broader diagnostic groups compared with other clinical settings. Information on comorbidities should be added in the description of the patients. In addition, a description of baseline characteristics of patients should always include functioning characteristics of the patients, including information on relevant context factors, ie, environmental and personal factors. The CONSORT statement aims to provide patient characteristic to enable transferability of results to users. It is represented in terms of selection (inclusion/exclusion) criteria and the description of the resulting samples. Extensions of the CONSORT statement specified that information on socioeconomic variables should be added, and the selection of patient characteristics to be reported at baseline should be based on the selection of outcome variables. In addition, all relevant prognostic variables should be reported. Only one CONSORT extension asks explicitly to include comorbid conditions. The reporting standards on guidelines demand a more comprehensive characterization of patients, specific to the rehabilitation area.

Conclusions

Present reporting standards can only partly address relevant issues pertinent to medical rehabilitation. The present analysis provides a conceptual and empirical framework for the development of reporting standards on patient characteristics in rehabilitation trials.