bluuebunny/crossref_metadata_2025 huggingface dataset:
Hydrogeological Landscapes framework: a biophysical approach to landscape characterisation and salinity hazard assessment
Authors: Moore C. L. , Jenkins B. R. , Cowood A. L. , Nicholson A. , Muller R. , Wooldridge A. , Cook W. , Wilford J. R. , Littleboy M. , Winkler M. , Harvey K.
Published: June 2017

In Australia, salinity has the potential to affect up to 17million hectares of agricultural and pastoral land. For many degraded sites, biophysical hazards are often poorly understood and consequently poorly managed. Attempts to remediate areas affected by salinity have met with varying degrees of success. The New South Wales (NSW) Office of Environment and Heritage, NSW Department of Primary Industries, University of Canberra and Geoscience Australia have collaborated to develop a biophysical expert-based approach for the assessment and management of salinity within landscapes. The Hydrogeological Landscape (HGL) framework provides a structure for understanding how salinity manifests in the landscape, how differences in salinity are expressed across the landscape and how salinity may best be managed. The HGL framework merges the flow dynamics of the groundwater flow system with the landscape elements of the soil landscape or regolith landform approaches. This is the first approach to specifically address all three manifestations of salinity: land salinity, in-stream salt load and in-stream salt concentration. The HGL framework methodology recognises the interplay between surface and subsurface flow systems, as well as the capacity for water to interact with salt stores in the landscape, and identifies biophysical landscape characteristics (e.g. amount and type of vegetation cover, typical land use practice) that affect these interactions. The HGL framework is an expert system that integrates the spatial variability of landscape characteristics and salinity processes to produce a salinity hazard assessment for any given area.
Force generation by groups of migrating bacteria
Authors: Sabass Benedikt , Koch Matthias D. , Liu Guannan , Stone Howard A. , Shaevitz Joshua W.
Published: June 2017

Significance

Bacterial migration, aggregation, and even host infection depend on the generation of mechanical force. Despite their biomedical importance, forces between bacteria and surfaces have not yet been measured during migration. We present a first study of bacterial cell–substrate traction using
Myxococcus xanthus
as a model organism.
M. xanthus
exhibits two common mechanisms of motility, namely, twitching and gliding. We find that these mechanisms lead to distinct patterns of traction during motion as an individual or in groups. Twitching leads to local, uncoordinated traction, and gliding in groups allows for collective emergence of directional traction. The forces produced by twitching or gliding of individual cells are significantly amplified when cells move in groups.
Poor caregiver mental health predicts mortality of patients with neurodegenerative disease
Authors: Lwi Sandy J. , Ford Brett Q. , Casey James J. , Miller Bruce L. , Levenson Robert W.
Published: June 2017

Significance

In this study, we investigated the role that caregiver mental health plays in patient mortality. In 176 patient–caregiver dyads, we found that worse caregiver mental health predicted greater patient mortality even when accounting for key risk factors in patients (i.e., diagnosis, age, sex, dementia severity, and patient mental health). Thus, although providing the best possible care for the large and growing number of individuals with neurodegenerative disease is an important public health priority, our findings suggest that these efforts should also consider caregiver mental health as an important intervention target. These findings represent research at the intersection of psychology, neuroscience, and medical science, and highlight the importance of caring for caregivers as well as patients when attempting to improve patients’ lives.
Traces of surfactants can severely limit the drag reduction of superhydrophobic surfaces
Authors: Peaudecerf François J. , Landel Julien R. , Goldstein Raymond E. , Luzzatto-Fegiz Paolo
Published: June 2017

Significance

Whereas superhydrophobic surfaces (SHSs) have long promised large drag reductions, experiments have provided inconsistent results, with many textures yielding little or no benefit. Given the vast potential impact of SHSs on energy utilization, finding an explanation and mitigating strategies is crucially important. A recent hypothesis suggests surfactant-induced Marangoni stresses may be to blame. However, paradoxically, adding surfactants has a barely measurable effect, casting doubt on this hypothesis. By performing surfactant-laden simulations and unsteady experiments we demonstrate the impact of surfactants and how extremely low concentrations, unavoidable in practice, can increase drag up to complete immobilization of the air–liquid interface. Our approach can be used to test other SHS textures for sensitivity to surfactant-induced stresses.
Local thermal energy as a structural indicator in glasses
Authors: Zylberg Jacques , Lerner Edan , Bar-Sinai Yohai , Bouchbinder Eran
Published: June 2017

Significance

When liquids are cooled sufficiently fast, they fail to crystalize and form disordered solids—glasses. Understanding the physical properties of glasses remains a major challenge, in large part because of the lack of tools to characterize the emerging disordered structures and well-established structure–properties relations. In this work, we propose that fluctuational thermal energy reveals highly localized and soft structures in glasses. We show that the degree of softness of these “soft spots” follows a universal fat-tailed statistical distribution and relate it to the density of noncrystalline vibrational states. The softest spots are shown to predict the loci of irreversible plastic rearrangements in sheared glasses, thus offering a generic structure–properties approach to glassy materials.
System-wide organization of actin cytoskeleton determines organelle transport in hypocotyl plant cells
Authors: Breuer David , Nowak Jacqueline , Ivakov Alexander , Somssich Marc , Persson Staffan , Nikoloski Zoran
Published: June 2017

Significance

In the crowded interior of a cell, diffusion alone is insufficient to master varying transport requirements for cell sustenance and growth. The dynamic actin cytoskeleton is an essential cellular component that provides transport and cytoplasmic streaming in plant cells, but little is known about its system-level organization. Here, we resolve key challenges in understanding system-level actin-based transport. We present an automated image-based, network-driven framework that accurately incorporates both actin cytoskeleton and organelle trafficking. We demonstrate that actin cytoskeleton network properties support efficient transport in both growing and elongated hypocotyl cells. We show that organelle transport can be predicted from the system-wide cellular organization of the actin cytoskeleton. Our framework can be readily applied to investigate cytoskeleton-based transport in other organisms.
Overview of ASDEX Upgrade results
Authors: Kallenbach A.
Published: June 2017

The ASDEX Upgrade (AUG) programme is directed towards physics input to critical elements of the ITER design and the preparation of ITER operation, as well as addressing physics issues for a future DEMO design. Since 2015, AUG is equipped with a new pair of 3-strap ICRF antennas, which were designed for a reduction of tungsten release during ICRF operation. As predicted, a factor two reduction on the ICRF-induced W plasma content could be achieved by the reduction of the sheath voltage at the antenna limiters via the compensation of the image currents of the central and side straps in the antenna frame. There are two main operational scenario lines in AUG. Experiments with low collisionality, which comprise current drive, ELM mitigation/suppression and fast ion physics, are mainly done with freshly boronized walls to reduce the tungsten influx at these high edge temperature conditions. Full ELM suppression and non-inductive operation up to a plasma current of

I

p

=
0.8

MA could be obtained at low plasma density. Plasma exhaust is studied under conditions of high neutral divertor pressure and separatrix electron density, where a fresh boronization is not required. Substantial progress could be achieved for the understanding of the confinement degradation by strong D puffing and the improvement with nitrogen or carbon seeding. Inward/outward shifts of the electron density profile relative to the temperature profile effect the edge stability via the pressure profile changes and lead to improved/decreased pedestal performance. Seeding and D gas puffing are found to effect the core fueling via changes in a region of high density on the high field side (HFSHD).

The integration of all above mentioned operational scenarios will be feasible and naturally obtained in a large device where the edge is more opaque for neutrals and higher plasma temperatures provide a lower collisionality. The combination of exhaust control with pellet fueling has been successfully demonstrated. High divertor enrichment values of nitrogen

E

N

⩾
10

have been obtained during pellet injection, which is a prerequisite for the simultaneous achievement of good core plasma purity and high divertor radiation levels. Impurity accumulation observed in the all-metal AUG device caused by the strong neoclassical inward transport of tungsten in the pedestal is expected to be relieved by the higher neoclassical temperature screening in larger devices.
Bayesian local extremum splines
Authors: Wheeler M W , Dunson D B , Herring A H
Published: June 2017

We consider shape-restricted nonparametric regression on a closed set $\mathcal{X} \subset \mathbb{R},$ where it is reasonable to assume that the function has no more than $H$ local extrema interior to $\mathcal{X}$. Following a Bayesian approach we develop a nonparametric prior over a novel class of local extremum splines. This approach is shown to be consistent when modelling any continuously differentiable function within the class considered, and we use itto develop methods for testing hypotheses on the shape of the curve. Sampling algorithms are developed, and the method is applied in simulation studies and data examples where the shape of the curve is of interest.
A New Score to Predict the Risk of Hearing Impairment After Microvascular Decompression for Hemifacial Spasm
Authors: El Damaty Ahmed , Rosenstengel Christian , Matthes Marc , Baldauf Joerg , Dziemba Oliver , Hosemann Werner , Schroeder Henry W S
Published: June 2017

BACKGROUND

Intraoperative monitoring of brainstem auditory evoked potentials (BAEPs) has been implemented to reduce the risk of hearing impairment during microvascular decompression for hemifacial spasm.

OBJECTIVE

To evaluate intraoperative monitoring of BAEPs during microvascular decompression in patients with hemifacial spasm for predicting the risk of hearing impairment after surgery.

METHODS

This prospective study included 100 patients. BAEPs were recorded for all patients. We established a scoring system for the changes in wave I amplitude, I-III interpeak latency, and wave V amplitude and latency. For each change, total points were calculated, and a score out of 6 was assigned to every patient. We classified the patients based on the points scored into 3 risk groups: low-risk (0-3), medium-risk (4-5), and high-risk (6). Further, the correlation between the score and the hearing outcome was evaluated to detect the incidence and degree of hearing impairment.

RESULTS

Eighty-seven patients scored 0 to 3, 10 scored 4 to 5, and 3 scored 6. The degree of hearing impairment was proportionate to the score recorded at the end of surgery, and patients in the low-risk group showed no impairment; medium-risk group, deterioration of maximum 2 grades according to World Health Organization classification of hearing impairment; and high-risk group, deterioration of 3 to 4 grades.

CONCLUSION

Intraoperative monitoring of BAEPs evaluated through our scoring system was valuable in predicting hearing impairment after surgery.
Motor Evoked Potentials Correlate With Magnetic Resonance Imaging and Early Recovery After Acute Spinal Cord Injury
Authors: Dhall Sanjay S , Haefeli Jenny , Talbott Jason F , Ferguson Adam R , Readdy William J , Bresnahan Jacqueline C , Beattie Michael S , Pan Jonathan Z , Manley Geoffrey T , Whetstone William D
Published: June 2017

BACKGROUND

While the utilization of neurophysiologic intraoperative monitoring with motor evoked potentials (MEPs) has become widespread in surgery for traumatic spine fractures and spinal cord injury (SCI), clinical validation of its diagnostic and therapeutic benefit has been limited.

OBJECTIVE

To describe the use of intraoperative MEP at a large level I trauma center and assess the prognostic capability of this technology.

METHODS

The SCI REDCap database at our institution, a level I trauma center, was queried for acute cervical SCI patients who underwent surgery with intraoperative monitoring between 2005 and 2011, yielding 32 patients. Of these, 23 patients had severe SCI (association impairment scale [AIS] A, B, C). We assessed preoperative and postoperative SCI severity (AIS grade), surgical data, use of steroids, and early magnetic resonance imaging (MRI) findings (preoperatively in 27 patients), including axial T2 MRI grade (Brain and Spinal Injury Center score).

RESULTS

The presence of MEPs significantly predicted AIS at discharge (P< .001). In the group of severe SCI (ie, AIS A, B, C) patients with elicitable MEPs, AIS improved by an average of 1.5 grades (median = 1), as compared to the patients without elicitable MEP who improved on average 0.5 grades (median = 0, P< .05). In addition, axial MRI grade significantly correlated with MEP status. Patients without MEPs had a significantly higher axial MRI grade in comparison to the patients with MEPs (P< .001).

CONCLUSION

In patients with severe SCI, MEPs predicted neurological improvement and correlated with axial MRI grade. These significant findings warrant future prospective studies of MEPs as a prognostic tool in SCI.
Phylogeny of the Neotropical genus Gephyrocharax (Characiformes: Characidae: Stevardiinae), with remarks on the tribe Stevardiini
Authors: Vanegas-Ríos James A
Published: June 2017

Stevardiinae, which consists of 326 species and 44 genera, is a monophyletic subfamily within the family Characidae. In a recent classification of the subfamily, the tribe Stevardiini was expanded from three (Corynopoma, Gephyrocharax and Pterobrycon) to six genera by the addition of Chrysobrycon, Hysteronotus and Pseudocorynopoma. However, no morphological evidence has supported this definition of the tribe and the monophyly of Gephyrocharax. To address these issues, a phylogenetic study of most stevardiins focusing on Gephyrocharax was conducted. A data matrix including 532 characters and 213 taxa (73 stevardiines, 19 of which were stevardiins) was processed using maximum parsimony in TNT 1.5. All characters were analysed under extended implied weighting, exploring 21 k values. A strict consensus (comprising the most stables trees obtained) was used as the final topology. The results support the current definition of Stevardiini, as well as the monophyly of Chrysobrycon, Gephyrocharax and Pterobrycon. Corynopoma was obtained as the sister group of Gephyrocharax, the latter being phylogenetically diagnosed by two synapomorphies associated with caudal-fin morphology of adult males. The following interspecific relationships within Gephyrocharax are hypothesised: (G. martae ((G. chocoensis (G. major (G. atracaudatus, G. intermedius))) (G. venezuelae (G. sinuensis (G. valencia (G. caucanus (G. melanocheir, G. torresi)))))))).
PAs
Authors: Carter Reginald D. , Ballweg Ruth
Published: June 2017

From the very beginning, popular media has played an essential role in driving public awareness and recognition of physician assistants (PAs) as major contributors to healthcare. But for PAs, popular media can be a double-edged sword. Over time, the roles of PAs have evolved from bit players to leading characters on television medical dramas. Even so, on some occasions, the roles of PAs have been marginalized and misrepresented. In the future, the PA profession will need to remain vigilant about how PAs are portrayed in the popular media and must learn how to use the full benefit of the media to promote the profession's diversity, flexibility, collegiality, and civic-mindedness.
The Modified Low Back Pain Disability Questionnaire
Authors: Denteneer Lenie , Van Daele Ulrike , Truijen Steven , De Hertogh Willem , Meirte Jill , Deckers Kristiaan , Stassijns Gaetane
Published: June 2017

Study design.

Cross-sectional study.

Objective.

The goal of this study is to translate the English version of the Modified Low Back Pain Disability Questionnaire (MDQ) into a Dutch version and investigate its clinimetric properties for patients with nonspecific chronic low back pain (CLBP).

Summary of Background Data.

Fritz et al (2001) developed a modified version of the Oswestry Disability Questionnaire (ODI) to assess functional status and named it the MDQ. In this version, a question regarding employment and homemaking ability was substituted for the question related to sex life. Good clinimetric properties for the MDQ were identified but up until now it is not clear whether the clinimetric properties of the MDQ would change if it was translated into a Dutch version.

Methods.

Translation of the MDQ into Dutch was done in 4 steps. Test-retest reliability was investigated using the intraclass correlation coefficient (ICC) model. Validity was calculated using Pearson correlations and a 2-way analysis of variance for repeated measures. Finally, responsiveness was calculated with the area under the curve (AUC), minimal detectable change (MDC), and the standardized response mean (SRM).

Results.

A total of 80 completed questionnaires were collected in 3 different hospitals and a total of 43 patients finished a 9 weeks intervention period, completing the retest. Test-retest reliability was excellent with an ICC of 0.89 (95% confidence interval [CI], 0.74–0.95). To confirm the convergent validity, the MDQ answered all predefined hypothesises (r = −0.65–0.69/P = 0.01–0.00) and good results for construct validity were found (P = 0.02). The MDQ had an AUC of 0.64 (95% confidence interval [CI], 0.47–0.81), an MDC of 8.80 points, and a SRM of 0.65.

Conclusion.

The Dutch version of the MDQ shows good clinimetric properties and is shown to be usable in the assessment of the functional status of Dutch-speaking patients with nonspecific CLBP.

Level of Evidence: 3
Performance Indicators in Spine Surgery
Authors: St-Pierre Godefroy Hardy , Yang Michael H. , Bourget-Murray Jonathan , Thomas Ken C. , Hurlbert Robin John , Matthes Nikolas
Published: June 2017

Study Design.

Systematic review.

Objective.

To elucidate how performance indicators are currently used in spine surgery.

Summary of Background Data.

The Patient Protection and Affordable Care Act has given significant traction to the idea that healthcare must provide value to the patient through the introduction of hospital value-based purchasing. The key to implementing this new paradigm is to measure this value notably through performance indicators.

Methods.

MEDLINE, CINAHL Plus, EMBASE, and Google Scholar were searched for studies reporting the use of performance indicators specific to spine surgery. We followed the Prisma-P methodology for a systematic review for entries from January 1980 to July 2016. All full text articles were then reviewed to identify any measure of performance published within the article. This measure was then examined as per the three criteria of established standard, exclusion/risk adjustment, and benchmarking to determine if it constituted a performance indicator.

Results.

The initial search yielded 85 results among which two relevant studies were identified. The extended search gave a total of 865 citations across databases among which 15 new articles were identified. The grey literature search provided five additional reports which in turn led to six additional articles. A total of 27 full text articles and reports were retrieved and reviewed. We were unable to identify performance indicators. The articles presenting a measure of performance were organized based on how many criteria they lacked. We further examined the next steps to be taken to craft the first performance indicator in spine surgery.

Conclusion.

The science of performance measurement applied to spine surgery is still in its infancy. Current outcome metrics used in clinical settings require refinement to become performance indicators. Current registry work is providing the necessary foundation, but requires benchmarking to truly measure performance.

Level of Evidence: 1
Preadmission Use of Calcium Channel Blocking Agents Is Associated With Improved Outcomes in Patients With Sepsis: A Population-Based Propensity Score–Matched Cohort Study
Authors: Lee Chien-Chang , Lee Meng-tse Gabriel , Lee Wan-Chien , Lai Chih-Cheng , Chao Christin Chih-Ting , Hsu Wan-Ting Hsu , Chang Shy-Shin , Lee Matthew
Published: June 2017

Objectives:

Use of calcium channel blockers has been found to improve sepsis outcomes in animal studies and one clinical study. This study determines whether the use of calcium channel blockers is associated with a decreased risk of mortality in patients with sepsis.

Design:

Population-based matched cohort study.

Setting:

National Health Insurance Research Database of Taiwan.

Patients:

Hospitalized severe sepsis patients identified from National Health Insurance Research Database by International Classification of Diseases, Ninth Revision, Clinical Modification codes.

Interventions:

None.

Measurements and Main Results:

The association between calcium channel blocker use and sepsis outcome was determined by multivariate-adjusted Cox proportional hazard models and propensity score analysis. To examine the influence of healthy user bias, beta-blocker was used as an active comparator. Our study identified 51,078 patients with sepsis, of which, 19,742 received calcium channel blocker treatments prior to the admission. Use of calcium channel blocker was associated with a reduced 30-day mortality after propensity score adjustment (hazard ratio, 0.94; 95% CI, 0.89–0.99), and the beneficial effect could extend to 90-day mortality (hazard ratio, 0.95; 95% CI, 0.89–1.00). In contrast, use of beta-blocker was not associated with an improved 30-day (hazard ratio, 1.06; 95% CI, 0.97–1.15) or 90-day mortality (hazard ratio, 1.00; 95% CI, 0.90–1.11). On subgroup analysis, calcium channel blockers tend to be more beneficial to patients with male gender, between 40 and 79 years old, with a low comorbidity burden, and to patients with cardiovascular diseases, diabetes, or renal diseases.

Conclusions:

In this national cohort study, preadmission calcium channel blocker therapy before sepsis development was associated with a 6% reduction in mortality when compared with patients who have never received calcium channel blockers.
Victimization by Siblings in Children with Disability or Weight Problems
Authors: Tucker Corinna J. , Finkelhor David , Turner Heather
Published: June 2017

Objective:

Children with a physical disability, psychological disorder, or of nonnormative weight are often targets of peer victimization. Sibling victimization, however, is more common than peer victimization, but rarely explored. We investigated linkages between sibling victimization and whether children had a physical disability, psychological disorder (i.e., internalizing disorder, attention deficit disorder/attention-deficit hyperactivity disorder), and were perceived by parents as being thinner than average or overweight. Also, we explored how the extent and kinds of sibling victimization experiences were related to these characteristics in childhood.

Methods:

A US probability sample of adult caregivers of a child aged 0 to 9 (N = 780; 50% women; mean age 4.58) in 2-child households who completed a telephone interview.

Results:

Controlling for other forms of maltreatment and individual and family characteristics, children with a physical disability and parent-perceived children who are thinner than average and children who are overweight experienced more sibling victimization. Children with an internalizing disorder experienced less sibling victimization. Sibling victimization did not differ for children with and without ADHD. Children perceived to be overweight by parents and children with a physical disability were at increased risk of experiencing more types of sibling victimization. Children with a physical disability had greater odds of being victims of property victimization by a sibling.

Conclusion:

Children with a physical disability or perceived as different from average weight are at risk for sibling victimization. Using a nationally representative sample, this is the first study to highlight the importance of screening for sibling victimization in families of children with a disability and/or nonnormative weight status.
Substance Use Among Adolescents with Attention-Deficit/Hyperactivity Disorder: Reasons for Use, Knowledge of Risks, and Provider Messaging/Education
Authors: Harstad Elizabeth , Wisk Lauren E. , Ziemnik Rosemary , Huang Qian , Salimian Parissa , Weitzman Elissa R. , Levy Sharon
Published: June 2017

Objective:

Adolescents with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for alcohol and marijuana use. This study's objective is to describe adolescents' ADHD-specific reasons for marijuana use, knowledge of ADHD-specific alcohol risks, and reported subspecialty provider messaging/education regarding alcohol use among adolescents with ADHD.

Methods:

Youths with ADHD aged 12 to 18 years completed a survey about alcohol and marijuana use, ADHD-specific reasons for marijuana use, knowledge of ADHD-specific alcohol risks, and reported provider messaging/education regarding alcohol use. We assessed knowledge toward substance use using descriptive statistics. We used χ2 and t tests to determine whether knowledge or provider messaging/education differed by sociodemographic characteristics.

Results:

Of the 96 participants, 61.5% were male, average age was 15.7 years; 31.3% reported past-year alcohol use and 20.8% reported past-year marijuana use. The majority (65.2%) said “no/don't know” to both “Can alcohol make ADHD symptoms worse?” and “Can alcohol interfere or get in the way of the medications you take?” Older participants were more likely to correctly answer the medication question “yes.” Despite most (74%) participants reporting that their provider asked about alcohol use, few youth reported that their providers gave specific messages/education that alcohol could make ADHD symptoms worse (9.4%) or interfere with ADHD medications (14.6%); older participants and past-year alcohol users were more likely to have received these alcohol-specific messages.

Conclusion:

Many youth with ADHD are unaware of the risks of alcohol use in relation to ADHD and providers are not consistently discussing these risks in the context of clinical ADHD care.
Assessing Estimates of Patient Safety Derived From Coded Data
Authors: Narain Wazim
Published: June 2017

The Agency for Healthcare Research and Quality (AHRQ) developed Patient Safety Indicators (PSI) with the goal of detecting and preventing adverse events using administrative data. Use of PSIs to measure safety and quality of care raises questions since they rely heavily on coded data. The goal of this paper is to review literature on AHRQ PSIs, specifically their accuracy in detecting adverse events, and how recent coding changes affect the accuracy of these estimates. The Healthcare Utilization Project (HCUP) National Inpatient Sample (NIS) contains data on more than seven million hospital stays yearly. Trending these estimates over time indicate there has been a decrease in rates for the majority of PSIs, with Accidental Puncture or Laceration, Central Venous Catheter Blood Stream Infections, Iatrogenic Pneumothorax, and Deaths from complications decreasing significantly each year from 2008–2012. Birth Trauma, Retained Foreign Bodies, Post-op Sepsis and Post-Op Respiratory Failure PSIs show no improvement from 2008–2012. A literature review on accuracy of PSIs and the affect of the Present on Admission (POA) indicator on PSI estimates reveals mixed results. PSIs serve as a useful tool in identifying problem areas in quality of care but should be used cautiously in determining hospital performance.
Using Kotter's Change Framework to Implement and Sustain Multiple Complementary ICU Initiatives
Authors: Mørk Anne , Krupp Anna , Hankwitz Jennifer , Malec Ann
Published: June 2017

This article describes the planning, implementation, and outcomes of 2 complementary quality initiatives, bedside handoff and nurse-initiated interdisciplinary bedside rounds, in a 24-bed medical/surgical intensive care unit. Systematic approaches such as Kotter's change model and unit-based champions were used to redesign care processes and standardize daily communication and workflows. Active partnership with the patient and the family during these changes promoted a strong intensive care unit culture of patient- and family-centered care.
Chasing Zero
Authors: Johnson Samantha , McNeal Mallory , Mermis Joel , Polineni Deepika , Burger Stephanie
Published: June 2017

Patients with cystic fibrosis have increased risk of pulmonary infections, and reducing spread of microorganisms is critical. To improve hospital-staff adherence to infection control guidelines, we implemented brightly colored Safe Zone floor decals, staff compliance contracts, and an infection control in-service video. Audits of staff adherence conducted pre and postintervention demonstrated an increased and sustainable improvement among each group (P < .05). These effective measures may be implemented to improve infection control compliance elsewhere.
Using Local Data to Improve Care and Collaborative Practice
Authors: Jeffs Lianne , McShane Julie , Indar Alyssa , Maione Maria
Published: June 2017

A qualitative study was undertaken to explore the experiences and perceptions of project leaders, clinicians, managers, and mentors associated with the implementation of a strategy aimed at enhancing clinicians' ability to use data to guide quality improvement projects. Our study findings elucidated the value and benefits including (1) using data to understand local context and move forward and (2) improving care and engaging in collaborative professional practice.
Just in KASE
Authors: Max Emma , MacKenzie Meredith Ann
Published: June 2017

Caring for the dying patient can be distressing for nursing students. End-of-life (EoL) care is an essential skill for the professional nurse, and the nursing student must prepare to provide quality care to these patients. The purposes of this study were to describe the knowledge, self-efficacy, and attitudes toward EoL care among nursing students at a northeastern traditional baccalaureate program and examine correlations between student demographics and outcomes. Nursing students from the sophomore to senior levels were sent an online survey consisting of demographic questions, the Frommelt Attitude Toward Care of the Dying (FATCOD) scale, and Knowledge Assessment and Self-Efficacy Assessment instruments. Multivariate modeling was used to identify correlates of student knowledge, self-efficacy, and attitudes. A total of 69 sophomore (22%), junior (52%), and senior (26%) nursing students completed the survey. Class year was the only correlate of knowledge, whereas student’s attitudes and class year affected their self-efficacy. Students’ attitudes toward EOL care were correlated with ethnicity, previous experience with EOL care, age, and self-efficacy. Enhancing student exposure to EOL care in the clinical environment positively affects their attitudes toward caring for the dying patient. Nursing schools should consider actively incorporating EoL care experiences into their clinical rotations.
Communication, Comfort, and Closure for the Patient With Cystic Fibrosis at the End of Life
Authors: Price Deborah M. , Knotts Sharon E.
Published: June 2017

Cystic fibrosis is a life-threatening genetic disease that causes persistent lung infections and progressively limits the ability to breathe. The median predicted survival age of the patient with cystic fibrosis is 40 years. In the terminal care of the patient with cystic fibrosis, the role of the bedside nurse is critical in providing seamless, interdisciplinary care in order to promote a “good death” and ensure that the patient’s and family’s wishes are respected at the end of life (EOL). Key components of the bedside nurse’s role in EOL care for the cystic fibrosis patient include the facilitation of interdisciplinary patient/family–centered communication, the provision of comfort to ease suffering from breathlessness and pain, and the promotion of patient and family closure within the family and among caregivers. This case study depicts the critical role of the bedside nurse in a young female patient with cystic fibrosis at the EOL to honor patient and family wishes and promote a peaceful, dignified death.
Professional Responsibility, Consensus, and Conflict: A Survey of Physician Decisions for the Chronically Critically Ill in Neonatal and Pediatric Intensive Care Units*
Authors: Shapiro Miriam C. , Donohue Pamela K. , Kudchadkar Sapna R. , Hutton Nancy , Boss Renee D.
Published: June 2017

Objective:

To describe neonatologist and pediatric intensivist attitudes and practices relevant to high-stakes decisions for children with chronic critical illness, with particular attention to physician perception of professional duty to seek treatment team consensus and to disclose team conflict.

Design:

Self-administered online survey.

Setting:

U.S. neonatal ICUs and PICUs.

Subjects:

Neonatologists and pediatric intensivists.

Interventions:

None.

Measurements and Main Results:

We received 652 responses (333 neonatologists, denominator unknown; 319 of 1,290 pediatric intensivists). When asked about guiding a decision for tracheostomy in a chronically critically ill infant, only 41.7% of physicians indicated professional responsibility to seek a consensus decision, but 73.3% reported, in practice, that they would seek consensus and make a consensus-based recommendation; the second most common practice (15.5%) was to defer to families without making recommendations. When presented with conflict among the treatment team, 63% of physicians indicated a responsibility to be transparent about the decision-making process and reported matching practices. Neonatologists more frequently reported a responsibility to give decision making fully over to families; intensivists were more likely to seek out consensus among the treatment team.

Conclusions:

ICU physicians do not agree about their responsibilities when approaching difficult decisions for chronically critically ill children. Although most physicians feel a professional responsibility to provide personal recommendations or defer to families, most physicians report offering consensus recommendations. Nearly all physicians embrace a sense of responsibility to disclose disagreement to families. More research is needed to understand physician responsibilities for making recommendations in the care of chronically critically ill children.
Comparison of Steroid and Botulinum Toxin Type A Monotherapy with Combination Therapy for Treating Human Hypertrophic Scars in an Animal Model
Authors: Chen Hung-Chang , Yen Cheng-I , Yang Shih-Yi , Chang Cheng-Jen , Yang Jui-Yung , Chang Shu-Yin , Chuang Shiow-Shuh , Hsiao Yen-Chang
Published: June 2017

Background:

The authors evaluated the efficacy of a combined regimen of botulinum toxin type A (Botox) and a steroid (triamcinolone acetonide) for treating hypertrophic scars in comparison with the treatment with each drug alone.

Methods:

Twenty excised human hypertrophic scar fragments obtained from surgically treated burn patients were divided into four groups: negative control (group A), triamcinolone alone (group B), Botox alone (group C), and a combination of triamcinolone and Botox (group D). These specimens were implanted into the backs of nude mice after intralesional injection from each group and were observed for 4 weeks. In total, 12 mice and 48 scars were studied. After 4 weeks, the hypertrophic scars were removed from the backs. The authors compared the scar weights, decorin staining, and the Cell Counting Kit-8 assay to evaluate treatment efficacy.

Results:

Significant differences in scar weight reduction were observed among the four groups (group A, 10 percent; group B, 17 percent; group C, 23 percent; and group D, 30 percent; p < 0.05). Treatment groups (groups B, C, and D) showed strong decorin staining. Significant differences in reduction of fibroblast proliferation were observed among the four groups (group A, 0.58; group B, 0.44; group C, 0.21; and group D, 0.08; p < 0.05). Botox or triamcinolone intralesional monotherapy showed significant therapeutic efficacy compared with the control group. The combined therapy further exhibited a significant therapeutic effect compared with monotherapy.

Conclusion:

This study indicates the potential of Botox and triamcinolone when combined for intralesional therapy in treating hypertrophic scars.
Selective Intraoperative Vasopressor Use Is Not Associated with Increased Risk of DIEP Flap Complications
Authors: Szabo Eltorai Ashley , Huang Chuan-Chin , Lu Jeffrey T. , Ogura Asako , Caterson Stephanie A. , Orgill Dennis P.
Published: June 2017

Background:

During deep inferior epigastric perforator (DIEP) flap cases, anesthesiologists commonly avoid intravenous vasopressor administration because of the theoretical concern of inducing vasospasm, thrombosis, or congestion in the vessels of the anastomosis, potentially resulting in poor flap perfusion and ischemia and necessitating revision. In the setting of hypotension, however, vasopressor administration may actually improve outcomes by augmenting flap perfusion by means of increased mean arterial pressure.

Methods:

The authors reviewed 475 consecutive DIEP flap cases in 333 patients at a single large academic medical center over a 3-year period, addressing potential confounders using univariate analyses.

Results:

Ephedrine administration was significantly associated with decreased risk of intraoperative flap complications (OR, 0.88), including vasospasm, thrombosis, and congestion requiring revision, compared with controls, after controlling for the severity and duration of hypotension. Phenylephrine had no significant association with complication rates. Vasopressor administration was not associated with an increased risk of reoperation in the setting of necrosis within 60 days.

Conclusions:

Ephedrine treatment for hypotension during DIEP flap cases is associated with decreased intraoperative flap complication rates compared with controls who did not receive vasopressors, whereas phenylephrine has no significant association. The common clinical practice of complete abstinence from vasopressors out of concern for worsening DIEP flap outcomes is not supported by this study.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Evidence-Based Medicine: Nonsyndromic Craniosynostosis
Authors: Tahiri Youssef , Bartlett Scott P. , Gilardino Mirko S.
Published: June 2017

Learning Objectives:

After reading this article, the participant should be able to: 1. Understand the craniofacial dysmorphology associated with nonsyndromic craniosynostosis. 2. Understand the functional concerns and preoperative considerations when treating patients with nonsyndromic craniosynostosis. 3. Understand the various treatment options available to address patients with nonsyndromic craniosynostosis. 4. Recognize the current debate with regard to timing and type of surgical intervention, and their impact on patient outcome, for patients with nonsyndromic craniosynostosis.

Craniosynostosis is a pathologic condition associated with the premature fusion of one or more cranial sutures. When the cranial sutures fuse prematurely, the skull and the growing brain beneath the suture are restricted, leading to a compensatory expansion into regions of the skull that are not affected. Craniosynostosis can occur in isolation (nonsyndromic) or can be associated with other extracranial anomalies. When anomalies outside the skull are present, craniosynostosis is often part of a syndrome and usually involves multiple sutures (syndromic craniosynostosis). This article focuses on nonsyndromic craniosynostosis, and describes the current state of knowledge regarding its diagnosis, surgical management, and outcomes.
Preventing Soft-Tissue Triangle Collapse in Modern Rhinoplasty
Authors: Campbell Carey F. , Pezeshk Ronnie A. , Basci Deniz S. , Scheuer Jack F. , Sieber David A. , Rohrich Rod J.
Published: June 2017

The unique anatomy of the soft-tissue triangle makes it prone to notching in primary, secondary, and reconstructive rhinoplasty. Understanding the anatomy of the region is critical to appropriate treatment. This article is meant to further clarify the anatomy of the soft-tissue triangle and to present the senior author’s (R.J.R.) approach to proactive correction and prevention of soft-tissue triangle notching through five key steps: (1) precise dissection and incision placement, (2) providing internal support with cartilage grafting if needed, (3) closure of dead space, (4) avoiding undue tension during closure, and (5) providing external support postoperatively.
Polypropylene Mesh Predicts Mesh/Suture Exposure After Sacrocolpopexy Independent of Known Risk Factors: A Retrospective Case-Control Study
Authors: Durst Paula J. , Heit Michael H.
Published: June 2017

Objective(s)

The aim of this study was to determine if ultralightweight polypropylene mesh reduced the risk of mesh/suture exposure after sacrocolpopexy compared with heavier-weighted polypropylene.

Methods

Bivariate and multivariate analyses were used to interpret data from 133 cases and 261 control subjects to evaluate independent predictors of mesh/suture exposure after sacrocolpopexy from 2003 to 2013.

Results

Multivariate logistic regression revealed that prior surgery for incontinence (odds ratio [OR], 2.87; 95% confidence interval [CI], 1.19–6.96), porcine acellular cross-linked collagen matrix with medium-weight polypropylene mesh (OR, 4.95; 95% CI, 1.70–14.42), other polypropylene mesh (OR, 6.73; 95% CI, 1.12–40.63), nonabsorbable braided suture for vaginal mesh attachment (OR, 4.52; 95% CI, 1.53–15.37), and immediate perioperative complications (OR, 3.64; 95% CI, 1.53–13.37) were independent risk factors for mesh/suture exposure. After multivariate analysis, ultralightweight polypropylene mesh was no longer associated with decreased rates of mesh/suture exposure after controlling for known risk factors identified during bivariate analysis (P = 0.423).

Conclusions

Both mesh choice and suture selection remained independent predictors of mesh/suture exposure, with heavier meshes increasing and monofilament suture decreasing rates of mesh/suture exposure. Based on this study, surgeons may consider use of delayed-absorbable, monofilament suture over nonabsorbable braided suture for attachment of vaginal mesh to reduce the risk of mesh/suture exposure when using mesh.
The Clinical Alliance and Research in Electroconvulsive Therapy Network
Authors: Martin Donel M. , Gálvez Verònica , Lauf Shani , Dong Vanessa , Baily Stephen A. , Cardoner Narcís , Chan Herng N. , Davidson Don , Fam Johnson , De Felice Nick , Martinez-Amoros Erika , Mohan Titus , Ramalingam Jothi , Sarma Shanthi I. , Tor Phern C. , Waite Susan , Loo Colleen K.
Published: June 2017

Objective

There is currently substantial heterogeneity in electroconvulsive therapy (ECT) treatment methods between clinical settings. Understanding how this variation in clinical practice is related to treatment outcomes is essential for optimizing service delivery. The Clinical Alliance and Research in ECT Network is a clinical and research framework with the aims of improving clinical practice, enabling auditing and benchmarking, and facilitating the collection of naturalistic clinical data.

Methods

The network framework and clinical and treatment variables collected and rationale for the use of particular outcome measures are described. Survey results detailing the use of ECT across initial participating clinical centers were examined.

Results

The data are reported from 18 of 22 participating centers, the majority based in Australia. Melancholic unipolar depression was the most common clinical indication (78%). Right unilateral (44%) and bifrontal (39%) were the most commonly used electrode placements. Eighty one percent of the centers used individual seizure titration for initial dosing.

Conclusions

There was substantial heterogeneity in the use of ECT between participating centers, indicating that the Network is representative of modern ECT practice. The Clinical Alliance and Research in ECT Network may therefore offer the opportunity to improve service delivery and facilitate the investigation of unresolved research questions pertaining to modern ECT practice.
Leaping lizards landing on leaves: escape-induced jumps in the rainforest canopy challenge the adhesive limits of geckos
Authors: Higham Timothy E. , Russell Anthony P. , Niklas Karl J.
Published: June 2017

The remarkable adhesive capabilities of geckos have garnered attention from scientists and the public for centuries. Geckos are known to have an adhesive load-bearing capacity far in excess (by 100-fold or more) of that required to support their body mass or accommodate the loading imparted during maximal locomotor acceleration. Few studies, however, have investigated the ecological contexts in which geckos use their adhesive system and how this may influence its properties. Here we develop a modelling framework to assess whether their prodigious adhesive capacity ever comes under selective challenge. Our investigation is based upon observations of escape-induced aerial descents of canopy-dwelling arboreal geckos that are rapidly arrested by clinging to leaf surfaces in mid-fall. We integrate ecological observations, adhesive force measurements, and body size and shape measurements of museum specimens to conduct simulations. Using predicted bending mechanics of petioles and leaf midribs, we find that the drag coefficient of the gecko, the size of the gecko and the size of the leaf determine impact forces. Regardless of the landing surface, safety factors for geckos range from a maximum of just over 10 to a minimum of well under one, which would be the point at which the adhesive system fails. In contrast to previous research that intimates that gecko frictional adhesive capacity is excessive relative to body mass, we demonstrate that realistic conditions in nature may result in frictional capacity being pushed to its limit. The rapid arrest of the lizard from its falling velocity likely results in the maximal loading to which the adhesive system is exposed during normal activities. We suggest that such activities might be primary determinants in driving their high frictional adhesive capacity.
Modelling the spread of innovation in wild birds
Authors: Shultz Thomas R. , Montrey Marcel , Aplin Lucy M.
Published: June 2017

We apply three plausible algorithms in agent-based computer simulations to recent experiments on social learning in wild birds. Although some of the phenomena are simulated by all three learning algorithms, several manifestations of social conformity bias are simulated by only the approximate majority (AM) algorithm, which has roots in chemistry, molecular biology and theoretical computer science. The simulations generate testable predictions and provide several explanatory insights into the diffusion of innovation through a population. The AM algorithm's success raises the possibility of its usefulness in studying group dynamics more generally, in several different scientific domains. Our differential-equation model matches simulation results and provides mathematical insights into the dynamics of these algorithms.