bluuebunny/crossref_metadata_2025 huggingface dataset:
FDA Approval of PARP Inhibitors and the Impact on Genetic Counseling and Genetic Testing Practices
Authors: Buchtel Kathryn M. , Vogel Postula Kristen J. , Weiss Shelly , Williams Carmen , Pineda Mario , Weissman Scott M.
Published: August 2017

In December 2014, the FDA approved olaparib, a poly(ADP‐ribose) polymerase inhibitor (PARPi) for ovarian cancer patients who have failed three or more lines of chemotherapy and have a germline BRCA1/2 mutation identified through a companion diagnostic test (BRACAnalysis CDx™ (CDx™)) offered exclusively by Myriad Genetic Laboratories. This study explored the impact of PARPi/CDx™ on genetic counselors’ (GCs) counseling and testing practices. One hundred twenty three GCs responded to an online survey regarding pre‐ and post‐FDA approval referral patterns, testing strategies/influences, and anecdotal experiences with insurance coverage of PARPi for BRCA1/2 positive patients through a non‐CDx™ platform. Following PARPi approval, 40% of respondents reported an increase in overall referrals of ovarian cancer patients and 20% had an increase in post‐test counseling only referrals. The majority (61.9%) of respondents reported no change in genetic testing strategy, and there was no change in factors influencing choice of testing laboratory. Nearly all (98.1%) respondents who had experience with insurance covering PARPi indicated approval with mutations identified via non‐CDx™ testing. Respondents indicated an increase in referral volume following FDA approval of PARPi/CDx™, but did not report changes in testing practices. Respondents were not aware of PARPi insurance coverage denial in the absence of CDx™.
The outcomes of glucose abnormalities in chronic hepatitis C patients receiving interferon‐free direct antiviral agents
Authors: Huang Jee‐Fu , Huang Chung‐Feng , Yeh Ming‐Lun , Dai Chia‐Yen , Hsieh Meng‐Hsuan , Yang Jeng‐Fu , Huang Ching‐I. , Lin Yi‐Hung , Liang Po‐Cheng , Lin Zu‐Yau , Chen Shinn‐Chern , Yu Ming‐Lung , Chuang Wan‐Long
Published: August 2017

Direct‐acting antiviral agents (DAAs) have been widely used for chronic hepatitis C (CHC) treatment recently. The characteristics of glucose abnormalities after DAAs therapy however, remain elusive. We aimed to elucidate the mutual impact between treatment response and parameters of glucose abnormalities after DAAs therapy in CHC patients. CHC patients who received DAAs therapy were recruited. The primary outcome measurements were their insulin resistance (IR) and beta‐cell function assessed by the homeostasis model assessment (HOMA) method before treatment and at end‐of‐follow‐up (EOF). Sixty‐five CHC patients (19 males, mean age = 59.8 ± 10.3 years) were consecutively enrolled. They included 47 (72.3%) patients of genotype‐1 infection. The treatment regimens among patients were sofosbuvir in 30 patients, paritaprevir‐ritonavir/ombitasvir/dasabuvir in 23 patients, and asunaprevir/daclatasvir in 12 patients respectively. The overall sustained virological response rate was 98.5%. The mean IR at EOF was 2.6 ± 1.8, which was not significantly different from baseline level (2.7 ± 2.9, P = 0.75). There was a significant improvement of beta‐cell function at EOF compared to baseline (107.7 ± 86.8 to 86.7 ± 44.5, P = 0.05). The amelioration of beta‐cell function at EOF was significantly observed among 23 patients of high baseline IR (166.7 ± 111.3 of baseline vs 105.7 ± 48.2 of EOF, P = 0.04). Six (60%) of the 10 pre‐diabetic patients at baseline achieved a normoglycemic state at EOF. Successful eradication of HCV by DAAs might improve glucose abnormalities in CHC patients, particularly among those who had high IR.
Vonoprazan treatment improves gastrointestinal symptoms in patients with gastroesophageal reflux disease
Authors: Shinozaki Satoshi , Osawa Hiroyuki , Hayashi Yoshikazu , Sakamoto Hirotsugu , Miura Yoshimasa , Lefor Alan Kawarai , Yamamoto Hironori
Published: August 2017

The effects of vonoprazan, a new potassium‐competitive acid blocker, on gastroesophageal reflux disease (GERD) symptom are not fully elucidated. The aim of this study is to determine the effect of vonoprazan on GERD and associated gastrointestinal symptoms. We retrospectively reviewed 88 Helicobacter pylori negative patients with GERD treated with vonoprazan 10 mg daily. Symptoms were evaluated using the Izumo scale, which reflects quality of life related to various abdominal symptoms. The rates of improvement and resolution of GERD symptoms were 86% (76/88) and 57% (50/88), respectively. Improvement and resolution in patients with erosive esophagitis was higher than in those with non‐erosive reflux disease (91% vs 83%, p = 0.260 and 71% vs 47%, p = 0.025, respectively). We attempted to identify factors which predict the effects of vonoprazan. Multivariate analysis identified advanced age (≥60‐year‐old) (odds ratio [OR] 7.281, 95% confidence interval [CI] 2.056–25.776, p = 0.002), obesity (BMI ≥ 24) (OR 3.342, 95%CI 1.124–9.940, p = 0.030) and erosive esophagitis (OR 4.368, 95%CI 1.281–14.895, p = 0.018) as positive predictors of resolution of GERD symptoms. Alcohol use (OR 0.131, 95%CI 0.027–0.632, p = 0.011) and history of H. pylori eradication (OR 0.171, 95%CI 0.041–0.718, p = 0.015) were identified as negative predictors. Vonoprazan also improved epigastric pain (73%), postprandial distress (60%), constipation (58%) and diarrhea (52%) in patients with GERD. In conclusion, vonoprazan 10 mg daily is effective in improving GERD symptoms. Advanced age, obesity, erosive esophagitis, alcohol use and history of H. pylori eradication influence the resolution of GERD symptoms. Treatment with vonoprazan favorably affects gastrointestinal symptoms in patients with GERD.
Opportunities for producing dimensionally enhanced powder-injection-molded parts
Authors: Piotter Volker , Klein Alexander , Mueller Tobias , Plewa Klaus
Published: August 2017

During the recent decades, powder injection molding has achieved a significant position as a manufacturing technique for high value-add products. For further progress, the improved dimensional accuracy of the sintered parts is of considerable importance. Investigations into meeting this demand through an enhanced process conduct comprising an additional compression step after cavity filling were performed. To achieve improved cavity filling and investigate influencing parameters, a demonstrator design was developed which enabled the generation of thin membranes by controlled piston movements. The combined injection and embossing process reached replication accuracies of ±0.15 to ±0.4%. An interaction between membrane quality and the compression parameters could be asserted. Moreover, the additional compaction step allowed for reduction of the minimum membrane values to about half of the thicknesses feasible by unmodified PIM processes.
Neuropsychiatric signs and symptoms of Alzheimer's disease: New treatment paradigms
Authors: Lanctôt Krista L. , Amatniek Joan , Ancoli‐Israel Sonia , Arnold Steven E. , Ballard Clive , Cohen‐Mansfield Jiska , Ismail Zahinoor , Lyketsos Constantine , Miller David S. , Musiek Erik , Osorio Ricardo S. , Rosenberg Paul B. , Satlin Andrew , Steffens David , Tariot Pierre , Bain Lisa J. , Carrillo Maria C. , Hendrix James A. , Jurgens Heidi , Boot Brendon
Published: August 2017

Neuropsychiatric symptoms (NPSs) are hallmarks of Alzheimer's disease (AD), causing substantial distress for both people with dementia and their caregivers, and contributing to early institutionalization. They are among the earliest signs and symptoms of neurocognitive disorders and incipient cognitive decline, yet are under‐recognized and often challenging to treat. With this in mind, the Alzheimer's Association convened a Research Roundtable in May 2016, bringing together experts from academia, industry, and regulatory agencies to discuss the latest understanding of NPSs and review the development of therapeutics and biomarkers of NPSs in AD. This review will explore the neurobiology of NPSs in AD and specific symptoms common in AD such as psychosis, agitation, apathy, depression, and sleep disturbances. In addition, clinical trial designs for NPSs in AD and regulatory considerations will be discussed.
Ginsenoside Rg3 attenuates sepsis-induced injury and mitochondrial dysfunction in liver via AMPK-mediated autophagy flux
Authors: Xing Wei , Yang Lei , Peng Yue , Wang Qianlu , Gao Min , Yang Mingshi , Xiao Xianzhong
Published: August 2017

Sepsis-led mitochondrial dysfunction has become a critical pathophysiological procedure in sepsis. Since ginsenosides have been applied in the treatment of mitochondrial dysfunction, ginsenoside Rg3 was employed to study its effects on the mitochondrial dysfunction induced by sepsis. The apoptosis rate, oxygen consumption rate (OCR), reactive oxygen species (ROS), antioxidant glutathione (GSH) pools, and mitochondrial transmembrane potential (MTP) were determined in LPS-induced sepsis hepatocytes treated with different concentrations of Rg3. Then, the protein expression levels of mitochondrial biogenesis related transcription factors, autophagy-related proteins, and AMP-activated protein kinase (AMPK) signal pathway related proteins were determined by Western blotting in both in vitro and in vivo sepsis models. Rg3 shows functions of promotion of OCR, attenuation of ROS, and maintenance of GSH pools, and its conjugating activity in the in vitro sepsis models. Rg3-treated cells were observed to have a higher MTP value compared with the LPS only induced cells. Moreover, Rg3 treatment can inhibit mitochondrial dysfunction via increasing the protein expression levels of mitochondrial biogenesis related transcription factors. Rg3 treatment has the function of inhibitor of apoptosis of human primary hepatocytes, and Rg3 can up-regulate the autophagy-related proteins and activate AMPK signal pathway in sepsis models. Meanwhile, the mitochondrial protective function exerted by Rg3 decreased after the autophagy inhibitors or AMPK inhibitor treatment in LPS-induced human primary hepatocytes. Rg3 can improve mitochondrial dysfunction by regulating autophagy in mitochondria via activating the AMPK signal pathway, thus protecting cell and organ injuries caused by sepsis.
Consequences of RNA oxidation on protein synthesis rate and fidelity: implications for the pathophysiology of neuropsychiatric disorders
Authors: Nunomura Akihiko , Lee Hyoung-gon , Zhu Xiongwei , Perry George
Published: August 2017

Unlike DNA, oxidative damage to RNA has received little attention presumably due to the assumed transient nature of RNA. However, RNAs including mRNA can persist for several hours to days in certain tissues and are demonstrated to sustain greater oxidative damage than DNA. Because neuronal cells in the brain are continuously exposed to reactive oxygen species due to a high oxygen consumption rate, it is not surprising that neuronal RNA oxidation is observed as a common feature at an early stage in a series of neurodegenerative disorders. A recent study on a well-defined bacterial translation system has revealed that mRNA containing 8-oxo-guanosine (8-oxoGuo) has little effect on fidelity despite the anticipated miscoding. Indeed, 8-oxoGuo-containing mRNA leads to ribosomal stalling with a reduced rate of peptide-bond formation by 3–4 orders of magnitude and is subject to no-go decay, a ribosome-based mRNA surveillance mechanism. Another study demonstrates that transfer RNA oxidation catalyzed by cytochrome c (cyt c) leads to its depurination and cross-linking, which may facilitate cyt c release from mitochondria and subsequently induce apoptosis. Even more importantly, a discovery of oxidized microRNA has been recently reported. The oxidized microRNA causes misrecognizing the target mRNAs and subsequent down-regulation in the protein synthesis. It is noteworthy that oxidative modification to RNA not only interferes with the translational machinery but also with regulatory mechanisms of noncoding RNAs that contribute toward the biological complexity of the mammalian brain. Oxidative RNA damage might be a promising therapeutic target potentially useful for an early intervention of diverse neuropsychiatric disorders.
Hardware‐efficient multi‐channel digital sigma‐delta modulator
Authors: Cho J.‐K. , Jeong M.
Published: August 2017

A method for implementing a hardware‐efficient multi‐channel digital sigma‐delta modulator is presented for processing field sequential multiple inputs. Compared to a conventional one, which processes the inputs in a time‐multiplexed manner without sharing integrator memory for the multiple sequential inputs, the proposed method significantly reduces the number of storage bits in the integrator memory by partially sharing the integrator memory for the inputs. Simulation results on modulator noise power spectral density and overall signal‐to‐noise ratio match well with those based on quantitative noise analysis.
Sensing period adaptation for multiobjective optimisation in cognitive radio using Jaya algorithm
Authors: Kaur A. , Sharma S. , Mishra A.
Published: August 2017

Adaptation of sensing period for licensed channel is one of the key requirements to maximise the utilisation of transmission opportunities by a secondary user. A novel objective function evaluation method for sensing period optimisation in cognitive radio network is formulated. A recently introduced optimisation technique, namely Jaya algorithm has been used for achieving the optimum value of sensing period in order to maximise the discovery of spectrum opportunities while maintaining the sensing overhead and interference time within user defined value. This multiobjective optimisation problem involving different constraints is solved using an objective function that introduces penalty for violation of constraints. Results show that the proposed scheme leads to quick adaptation and efficient discovery of spectrum opportunities while satisfying the different QoS constraints, thus making it a better choice for real‐time applications.
Near‐field and far‐field shared structure for NFC and CNSS applications
Authors: Wang Meng‐Shuang , Guo Yong‐Xin , Wu Wen
Published: August 2017

This study presents a shared structure for both near‐ and far‐field operations using magnetic resonance coupling and electromagnetic radiation. The proposed structure is composed of a rectangular loop and two monopoles. A duplexer is designed to route the near‐ and far‐field signals. For far‐field operation, both dual‐band resonance and dual‐sense circular polarisation required by the compass navigation satellite system (CNSS) are achieved. For near‐field operation, a wireless communication link operating at 13.56 MHz is established. The effect of matching distance on the transmission performances is studied and the optimal matching network is obtained. The proposed design is fabricated and verified experimentally. In the far‐field regime, it can achieve 10 dB impedance bandwidths of 17.2 and 15.8% and 3 dB axial ratio bandwidths of 4.6 and 12.8% and the two CNSS bands are fully covered. In the near‐field regime, an average transmission coefficient of 0.59 is achieved within the operation range of 5–30 mm by the proposed design. The obtained good performance reveals that the proposed shared structure is suitable to be applied in handheld devices for near‐field communication and CNSS applications.
Improved ant colony algorithm for adaptive frequency‐tracking control in WPT system
Authors: Li Yang , Zhang Cheng , Yang Qingxin , Li Jianxiong , Zhang Yaxi , Zhang Xian , Xue Ming
Published: August 2017

When the distance between resonators is low enough for the coupling condition to be greater than the critical coupling, the single resonant peak at the load splits to form double peaks. This frequency‐splitting phenomenon results in a reduction in the power transferred. In this study, an adaptive frequency‐tracking control (AFTC) approach based on a closed‐loop control scheme is implemented to overcome this problem. An improved ant colony algorithm (IACA) was proposed in AFTC to track the maximum power point in real time. Then, simulations were performed to test the real‐time characteristics of IACA. Finally, a wireless power transfer system with AFTC is demonstrated experimentally to validate the IACA results and the tracking of the optimal frequency.
Soft‐switching bidirectional DC–DC converter with high voltage conversion ratio
Authors: Molavi Navid , Adib Ehsan , Farzanehfard Hosein
Published: August 2017

This study introduces a soft‐switching non‐isolated bidirectional DC–DC converter with high voltage conversion ratio and low voltage stress across semiconductor devices. The presented topology is well suited for high step‐up/step‐down applications. By integrating coupled inductors and switched capacitors techniques, a high step‐up/step‐down voltage gain is achieved. Active clamp circuits are employed in both high step‐up and high step‐down operating states to recycle the leakage inductance energy and realise zero‐voltage‐switching condition for all switches to mitigate the switching losses and improve efficiency. Also, the reverse recovery problem of the body diodes is completely alleviated owing to zero‐current‐switching performance. The operation principles and theoretical analysis of proposed converter are presented in details. Finally, the experimental results of a 200 W prototype circuit are provided to confirm the validity of the proposed topology.
A position and orientation independent drone charging system
Authors: Dominique David , Dominique Faith
Published: August 2017

This letter presents a design technique for a contact‐based drone charging system, where the drone can land with any orientation and on any position on the charging pad. Detailed design equations are presented enabling the design of a charging system at any scale.
Genetic background-dependent role of
Egr1
for eyelid development
Authors: Oh Jangsuk , Wang Yujuan , Chen Shida , Li Peng , Du Ning , Yu Zu-Xi , Butcher Donna , Gebregiorgis Tesfay , Strachan Erin , Lehmann Ordan J. , Brooks Brian P. , Chan Chi-Chao , Leonard Warren J.
Published: August 2017

Significance

Eyelid formation begins at approximately day E15.5 in mice. Over the next 24 h, the epidermis of both upper and lower eyelids rapidly grows and merges to cover the cornea. Here, we demonstrate that
Egr1
−/−
mice on the C57BL/6 background have normal eyelid development, but back-crossing to BALB/c background for four or five generations resulted in defective eyelid development by embryonic day E15.5. This defective eyelid formation was then further associated with profound ocular anomalies evident by postnatal days 1-4. The BALB/c albino phenotype associated with the
Tyr

c

tyrosinase mutation also appeared to contribute to the phenotype. Thus EGR1 in a genetic background-dependent manner plays a critical role in mammalian eyelid development, with subsequent impact on ocular integrity.
Short-Term High-Salt Diet Increases Corin Level to Regulate the Salt–Water Balance in Humans and Rodents
Authors: Zhang Jiao , Yin Yanjun , Chen Lili , Chu Chao , Wang Yang , Lv Yongbo , He Ming , Martin Marcy , Huang Po-Hsun , Mu Jian-Jun , Shyy John Y-J , Yuan Zu-Yi
Published: August 2017

BACKGROUND

Dietary sodium and potassium affect the fluctuation in blood pressure (BP) and renal function. Corin, with its enzymatic activity to convert pro-atrial natriuretic peptide (pro-ANP) to biologically active ANP, regulates BP, cardiac, and renal functions. We investigated whether corin expression responds to a high-salt (HS) diet to regulate salt and water balance.

METHODS

Forty-two volunteers followed 3 sequential diets for 7 days each: a low-salt (LS) diet (3.0 g/day NaCl), a HS diet (18.0 g/day NaCl), followed by an HS diet with K+ supplementation (HS + K+) (18.0 g/day NaCl and 4.5 g/day KCl).

RESULTS

Corin level was higher with the HS diet than the LS and HS + K+ diets and was positively correlated with systolic BP (SBP) and 24-hour urinary Na+ and microalbumin (U-mALB) excretion. In rodents, serum and renal levels of corin were transiently increased with the HS diet and were decreased if the HS diet was continued for up to 7 days. HS loading increased SBP, 24-hour urinary Na+, U-mALB excretion, and the expression of proprotein convertase subtilisin/kexin-6 (PCSK6), a corin activator. Knockdown of PCSK6 or corin in high salt-treated M1-cortical collecting duct (M1-CCD) cells increased the expression of aquaporin 2 (AQP2) and β-epithelial Na+ channel (β-ENaC).

CONCLUSIONS

Short-term HS may induce the PCSK6–corin–ANP–AQP2/β-ENaC pathway in the kidney. Enhanced serum corin level in humans and rodents is positively correlated with HS-induced SBP and 24-hour urinary Na+ and U-mALB excretion, which suggests that corin is involved in the salt-water balance in response to HS intake.

CLINICAL TRIALS REGISTRATION

Public Trials Registry Number NCT02915315
A Computerized Microelectrode Recording to Magnetic Resonance Imaging Mapping System for Subthalamic Nucleus Deep Brain Stimulation Surgery
Authors: Dodani Sunjay S , Lu Charles W , Aldridge J Wayne , Chou Kelvin L , Patil Parag G
Published: August 2017

BACKGROUND

Accurate electrode placement is critical to the success of deep brain stimulation (DBS) surgery. Suboptimal targeting may arise from poor initial target localization, frame-based targeting error, or intraoperative brain shift. These uncertainties can make DBS surgery challenging.

OBJECTIVE

To develop a computerized system to guide subthalamic nucleus (STN) DBS electrode localization and to estimate the trajectory of intraoperative microelectrode recording (MER) on magnetic resonance (MR) images algorithmically during DBS surgery.

METHODS

Our method is based upon the relationship between the high-frequency band (HFB; 500-2000 Hz) signal from MER and voxel intensity on MR images. The HFB profile along an MER trajectory recorded during surgery is compared to voxel intensity profiles along many potential trajectories in the region of the surgically planned trajectory. From these comparisons of HFB recordings and potential trajectories, an estimate of the MER trajectory is calculated. This calculated trajectory is then compared to actual trajectory, as estimated by postoperative high-resolution computed tomography.

RESULTS

We compared 20 planned, calculated, and actual trajectories in 13 patients who underwent STN DBS surgery. Targeting errors for our calculated trajectories (2.33 mm ± 0.2 mm) were significantly less than errors for surgically planned trajectories (2.83 mm ± 0.2 mm; P = .01), improving targeting prediction in 70% of individual cases (14/20). Moreover, in 4 of 4 initial MER trajectories that missed the STN, our method correctly indicated the required direction of targeting adjustment for the DBS lead to intersect the STN.

CONCLUSION

A computer-based algorithm simultaneously utilizing MER and MR information potentially eases electrode localization during STN DBS surgery.
The Surgical White Matter Chassis: A Practical 3-Dimensional Atlas for Planning Subcortical Surgical Trajectories
Authors: Jennings Jonathan E , Kassam Amin B , Fukui Melanie B , Monroy-Sosa Alejandro , Chakravarthi Srikant , Kojis Nathan , Rovin Richard A
Published: August 2017

BACKGROUND

The imperative role of white matter preservation in improving surgical functional outcomes is now recognized. Understanding the fundamental white matter framework is essential for translating the anatomic and functional literature into practical strategies for surgical planning and neuronavigation.

OBJECTIVE

To present a 3-dimensional (3-D) atlas of the structural and functional scaffolding of human white matter—ie, a “Surgical White Matter Chassis (SWMC)”—that can be used as an organizational tool in designing precise and individualized trajectory-based neurosurgical corridors.

METHODS

Preoperative diffusion tensor imaging magnetic resonance images were obtained prior to each of our last 100 awake subcortical resections, using a clinically available 3.0 Tesla system. Tractography was generated using a semiautomated deterministic global seeding algorithm. Tract data were conceptualized as a 3-D modular chassis based on the 3 major fiber types, organized along median and paramedian planes, with special attention to limbic and neocortical association tracts and their interconnections.

RESULTS

We discuss practical implementation of the SWMC concept, and highlight its use in planning select illustrative cases. Emphasis has been given to developing practical understanding of the arcuate fasciculus, uncinate fasciculus, and vertical rami of the superior longitudinal fasciculus, which are often-neglected fibers in surgical planning.

CONCLUSION

A working knowledge of white matter anatomy, as embodied in the SWMC, is of paramount importance to the planning of parafascicular surgical trajectories, and can serve as a basis for developing reliable safe corridors, or modules, toward the goal of “zero-footprint” transsulcal access to the subcortical space.
Early identification of idiopathic sudden sensorineural hearing loss
Authors: Jensen Elizabeth Ann H. , Harmon Elizabeth D. , Smith Whitney
Published: August 2017

This article discusses the physiology of normal hearing, the pathophysiology and differential diagnoses of sudden sensorineural hearing loss, and an approach for definitive diagnosis and treatment. A focus is placed on idiopathic sudden sensorineural hearing loss in the adult population in a primary care setting.
Infant Resuscitation Practices of Midwives in a Developing Country
Authors: Khriesat Wadah , Kassab Manal , Hamadneh Shereen , Mohammad Khitam , Hamadneh Jehan , Khader Yousef S.
Published: August 2017

Background:

Effective basic newborn resuscitation is an important strategy to reduce the incidence of birth asphyxia and associated newborn outcomes. Outcomes for newborns can be markedly improved if health providers have appropriate newborn resuscitation skills.

Purpose:

To evaluate the skills of midwives in newborn resuscitation in delivery rooms in Jordan.

Methods:

Data were collected from observation of 118 midwives from National Health Service hospitals in the north of Jordan who performed basic newborn resuscitation for full-term neonates. A structured checklist of 14 items of basic skills of resuscitation was used. Descriptive statistics were used to analyze the data.

Results:

The results highlighted the lack of appropriate performance of the 8 necessary skills at birth by midwives. About 17.8% of midwives had performed the core competencies at birth (ie, assessing breathing pattern/crying, cleaning airways) appropriately and met the standard sequence. Less than half of midwives assessed skin color (40.7%) and breathing pattern or crying (41.5%) appropriately with or without minor deviations from standard sequences. Of the 6 skills that had to be performed by midwives at 30 seconds up to 5 minutes after birth, 4 skills were not performed by about one-quarter of midwives.

Implications for Practice and Research:

The midwives' practices at the 2 hospitals of this study were not supported by best practice international guidelines. The study showed that a high proportion of midwives had imperfect basic newborn resuscitation skills despite a mean experience of 8 years. This highlights the critical need for continuing medical education in the area of basic newborn resuscitation. The results highlight the need for formal assessment of midwives' competence in basic newborn resuscitation. National evidence-based policies and quality assurance are needed to reflect contemporary practice.
Healthcare Professionals' Attitudes and Practices in Supporting and Promoting the Breastfeeding of Preterm Infants in NICUs
Authors: Shattnawi Khulood Kayed
Published: August 2017

Background:

Breastfeeding preterm infants is shown to have important health benefits for both infants and mothers. A positive relationship between mothers and healthcare teams and supportive practices tend to facilitate maternal competence and promote early initiation of breastfeeding within neonatal intensive care units (NICUs).

Purpose:

The aim of this study was to understand attitudes and behaviors of healthcare professionals toward breastfeeding practices and supporting mothers of preterm infants.

Methods:

This study adopted an ethnographic research design that involved 135 hours of participant observation over a 6-month period and semistructured interviews of 10 nurses and 5 physicians.

Results:

Data analysis suggests that while staff members agree with the benefits of breastfeeding for preterm infants, the actual implementation of a breastfeeding policy within NICUs is problematic. Three key themes emerged. The first described the contradiction that exists between the staff beliefs and behaviors in relation to breastfeeding and supporting mothers. The second theme was related to staff working conditions, which described the lack of institutional support and barriers to supporting breastfeeding. The final theme of controlling relationships captured the essence of the practitioner to mother association. Together, these elements revealed a situation whereby the staff appeared more preoccupied with addressing the task of caring for the babies than with supporting mothers in feeding and subsequently caring for their preterm children.

Implications for Practice:

The institutional barriers to breastfeeding promotion within NICUs should be addressed by healthcare providers. Actions that provide a supportive environment within NICUs for both mothers and nurses are essential to improve the overall quality of care.

Implications for Research:

Future research may include an examination of hospital policies and practices of promoting breastfeeding for preterm infants.
Cadaveric Analysis of Proximal Humerus Locking Plate Fit: Contour Mismatch May Lead to Malreduction
Authors: Ravindra Amy , Roebke Austin , Goyal Kanu S.
Published: August 2017

Objectives:

To investigate proximal humerus locking plate fit in a large sample of human proximal humeri.

Methods:

A total of 97 cadaveric human humeri were selected. Humerus length, head diameter, and neck–shaft angle were measured. Three-hole and 5-hole 3.5-mm proximal humerus locking compression plates were affixed. A digital caliper was used to measure the maximum gap distance from the plate to the bone. Analysis of variance and student's t tests were conducted to evaluate differences in plate–bone distance between the 2 plate lengths, gender, race, age, and laterality. Correlation between plate–bone distance and humerus length, head diameter, and neck–shaft angle were determined.

Results:

Mean plate–bone distance for the 3-hole plate was 1.5 ± 0.6 mm (range 0.3–2.9 mm), and for the 5-hole plate was 2.5 ± 0.9 mm (range 0.7–5.0 mm) (P = 0.01). Female and right-sided humeri were shown to have significantly larger plate–bone gap distance when compared with counterparts (P = 0.01). No correlation was found between plate–bone gap distance and humeral length (R2 = 0.03), head diameter (R2 = 0.05), or neck–shaft angle (R2 = 0.08).

Conclusion:

The proximal humerus locking plate was under-contoured and spanned all 97 specimens. Greater plate–bone distance was observed with the 5-hole plate versus the 3-hole plate. Applying the plate flush to bone may lead to medial displacement of the humeral head at the calcar increasing risk of loss of fracture fixation. In fractures with any metaphyseal comminution, malreduction will be more pronounced. Caution should be exercised when using the proximal humerus locking plate as a reduction aide.
PROMIS Physical Function Correlation With NDI and mJOA in the Surgical Cervical Myelopathy Patient Population
Authors: Owen Robert J. , Zebala Lukas P. , Peters Colleen , McAnany Steven
Published: August 2017

Study Design.

Retrospective review.

Objective.

To determine the correlation of Patient-Reported Outcomes Measurement Information System (PROMIS) physical function with Neck Disability Index (NDI) and Modified Japanese Orthopedic Association (mJOA) scores in the surgical cervical myelopathy patient population.

Summary of Background Data.

Outcome measures such as NDI and mJOA are essential for analyzing treatments for cervical myelopathy. Administrative burdens impose limits on completion of these measures. The PROMIS group developed an outcome measure to improve reporting of patient symptoms and function and to reduce administrative burden. Despite early success, NDI and mJOA have not been compared with PROMIS in patients with cervical myelopathy. This study determines the correlation of NDI and mJOA with PROMIS in surgical patients with cervical myelopathy.

Methods.

A total of 60 patients with cervical myelopathy undergoing surgery were included. PROMIS, NDI, and mJOA were collected preoperatively, and in the first 6 months postoperatively. Correlations between NDI, mJOA, and PROMIS were quantified using Pearson correlation coefficients. Students t tests were used to test significance.

Results.

All 60 (100%) of patients completed preoperative questionnaires. Fifty-five (92%) of patients completed initial follow-up questionnaires within the first 6 months. PROMIS physical function and NDI demonstrated a strong negative correlation at baseline and in initial follow-up (R = −0.69, −0.76). PROMIS and mJOA demonstrated a strong positive correlation at baseline and in initial follow-up (R = 0.61, 0.72).

Conclusion.

PROMIS physical function has a strong negative correlation with NDI and a strong positive correlation with mJOA at baseline and in the early postoperative course in patients undergoing surgery for cervical myelopathy. Surgeons may factor these outcomes into the delivery and interpretation of patient-reported outcome measures in this population. Use of PROMIS may improve completion of outcome measures in the office and reduce administrative burden while still providing reliable outcomes data.

Level of Evidence: 3
Worldwide Survey of the “Assessing Pain, Both Spontaneous Awakening and Breathing Trials, Choice of Drugs, Delirium Monitoring/Management, Early Exercise/Mobility, and Family Empowerment” (ABCDEF) Bundle
Authors: Morandi Alessandro , Piva Simone , Ely E. Wesley , Myatra Sheila Nainan , Salluh Jorge I.F. , Amare Dawit , Azoulay Elie , Bellelli Giuseppe , Csomos Akos , Fan Eddy , Fagoni Nazzareno , Girard Timothy D. , Heras La Calle Gabriel , Inoue Shigeaki , Lim Chae-Man , Kaps Rafael , Kotfis Katarzyna , Koh Younsuck , Misango David , Pandharipande Pratik P. , Permpikul Chairat , Cheng Tan Cheng , Wang Dong-Xin , Sharshar Tarek , Shehabi Yahya , Skrobik Yoanna , Singh Jeffrey M. , Slooter Arjen , Smith Martin , Tsuruta Ryosuke , Latronico Nicola
Published: August 2017

Objectives:

To assess the knowledge and use of the Assessment, prevention, and management of pain; spontaneous awakening and breathing trials; Choice of analgesia and sedation; Delirium assessment; Early mobility and exercise; and Family engagement and empowerment (ABCDEF) bundle to implement the Pain, Agitation, Delirium guidelines.

Design:

Worldwide online survey.

Setting:

Intensive care.

Intervention:

A cross-sectional online survey using the Delphi method was administered to intensivists worldwide, to assess the knowledge and use of all aspects of the ABCDEF bundle.

Measurement and Main Results:

There were 1,521 respondents from 47 countries, 57% had implemented the ABCDEF bundle, with varying degrees of compliance across continents. Most of the respondents (83%) used a scale to evaluate pain. Spontaneous awakening trials and spontaneous breathing trials are performed in 66% and 67% of the responder ICUs, respectively. Sedation scale was used in 89% of ICUs. Delirium monitoring was implemented in 70% of ICUs, but only 42% used a validated delirium tool. Likewise, early mobilization was “prescribed” by most, but 69% had no mobility team and 79% used no formal mobility scale. Only 36% of the respondents assessed ICU-acquired weakness. Family members were actively involved in 67% of ICUs; however, only 33% used dedicated staff to support families and only 35% reported that their unit was open 24 hr/d for family visits.

Conclusions:

The current implementation of the ABCDEF bundle varies across individual components and regions. We identified specific targets for quality improvement and adoption of the ABCDEF bundle. Our data reflect a significant but incomplete shift toward patient- and family-centered ICU care in accordance with the Pain, Agitation, Delirium guidelines.
Oxygen Thresholds and Mortality During Extracorporeal Life Support in Adult Patients*
Authors: Munshi Laveena , Kiss Alex , Cypel Marcelo , Keshavjee Shaf , Ferguson Niall D. , Fan Eddy
Published: August 2017

Objectives:

Extracorporeal life support can lead to rapid reversal of hypoxemia and shock; however, it can also result in varying degrees of hyperoxia. Recent data have suggested an association between hyperoxia and mortality; however, this conclusion has not been consistent across the literature. We evaluated the association between oxygenation thresholds and mortality in three cohorts of extracorporeal life support patients.

Design:

We performed a retrospective cohort study using the Extracorporeal Life Support Organization Registry.

Setting:

We evaluated the relationship between oxygenation measured 24 hours after extracorporeal membrane oxygenation onset and mortality (2010–2015).

Patients:

The extracorporeal life support cohorts were as follows: 1) veno-venous extracorporeal membrane oxygenation for respiratory failure, 2) veno-arterial extracorporeal membrane oxygenation for cardiogenic shock, and 3) extracorporeal cardiopulmonary resuscitation.

Interventions:

The relationships between hypoxemia (Pao
2 < 60mm Hg), normoxia (Pao
2 60–100mm Hg), moderate hyperoxia (Pao
2 101–300mm Hg), extreme hyperoxia (Pao
2 > 300 mm Hg), and mortality were evaluated across three extracorporeal life support cohorts.

Measurements and Main Results:

Seven hundred sixty-five patients underwent veno-venous extracorporeal membrane oxygenation, 775 patients underwent veno-arterial extracorporeal membrane oxygenation, and 412 underwent extracorporeal cardiopulmonary resuscitation. During veno-venous extracorporeal membrane oxygenation, hypoxemia (odds ratio, 1.68; 95% CI, 1.09–2.57) and moderate hyperoxia (odds ratio, 1.66; 95% CI, 1.11–2.50) were associated with increased mortality compared with normoxia. There was no association between oxygenation and mortality for veno-arterial extracorporeal membrane oxygenation. Moderate hyperoxia was associated with increased mortality during extracorporeal cardiopulmonary resuscitation compared with normoxia (odds ratio, 1.77; 95% CI, 1.03–3.30). An exploratory analysis did not find more specific Pao
2 thresholds associated with mortality within moderate hyperoxia.

Conclusions:

Moderate hyperoxia was associated with increased mortality in patients undergoing veno-venous extracorporeal membrane oxygenation for respiratory failure and extracorporeal cardiopulmonary resuscitation. Hypoxemia was associated with an increased mortality in veno-venous extracorporeal membrane oxygenation. No association was seen between oxygenation and mortality in veno-arterial extracorporeal membrane oxygenation which may be due to early death driven by the underlying disease.
Prioritization for Plastic Surgery Procedures Aimed to Improve Quality of Life: Moral Considerations
Authors: Selvaggi Gennaro , Kolby Lars , Elander Anna
Published: August 2017

Background:

Different health conditions are treated in a Plastic Surgery unit, including those cases whose main goal is to enable patients to feel and integrate better within society and therefore improving quality of life, rather then physical functions.

Methods:

We discuss moral principles that can be used as a guide for health professionals to revise and create policies for plastic surgery patients presenting with non–life-threatening conditions.

Results:

A specific anatomical feature is not always an indicator of patient’s well-being and quality of life, and therefore it cannot be used as the sole parameter to identify the worst-off and prioritize the provision of health care. A policy should identify who preoperatively are the worst-off and come to some plausible measure of how much they can be expected to benefit from an operation. Policies that do not track these principles in any reliable way can cause discrimination.

Conclusions:

A patient-centered operating system and patient’s informed preferences might be implemented in the process of prioritizing health. In circumstances when the effectiveness of a specific treatment is unproven, professionals should not make assumptions based on their own values.
Cardiac Auscultation for Noncardiologists: Application in Cardiac Rehabilitation Programs
Authors: Compostella Leonida , Compostella Caterina , Russo Nicola , Setzu Tiziana , Iliceto Sabino , Bellotto Fabio
Published: August 2017

During outpatient cardiac rehabilitation after an acute coronary syndrome or after an episode of congestive heart failure, a careful, periodic evaluation of patients' clinical and hemodynamic status is essential. Simple and traditional cardiac auscultation could play a role in providing useful prognostic information.

Reduced intensity of the first heart sound (S1), especially when associated with prolonged apical impulse and the appearance of added sounds, may help identify left ventricular (LV) dysfunction or conduction disturbances, sometimes associated with transient myocardial ischemia. If both S1 and second heart sound (S2) are reduced in intensity, a pericardial effusion may be suspected, whereas an increased intensity of S2 may indicate increased pulmonary artery pressure. The persistence of a protodiastolic sound (S3) after an acute coronary syndrome is an indicator of severe LV dysfunction and a poor prognosis. In patients with congestive heart failure, the association of an S3 and elevated heart rate may indicate impending decompensation. A presystolic sound (S4) is often associated with S3 in patients with LV failure, although it could also be present in hypertensive patients and in patients with an LV aneurysm. Careful evaluation of apical systolic murmurs could help identifying possible LV dysfunction or mitral valve pathology, and differentiate them from a ruptured papillary muscle or ventricular septal rupture. Friction rubs after an acute myocardial infarction, due to reactive pericarditis or Dressler syndrome, are often associated with a complicated clinical course.

During cardiac rehabilitation, periodic cardiac auscultation may provide useful information about the clinical-hemodynamic status of patients and allow timely detection of signs, heralding possible complications in an efficient and low-cost manner.
Scope, Scale, and Dose of the World’s Largest School-Based Mental Health Programs
Authors: Murphy J. Michael , Abel Madelaine R. , Hoover Sharon , Jellinek Michael , Fazel Mina
Published: August 2017

Untreated mental health problems are among the most disabling, persistent, and costly health conditions. Because they often begin in childhood and continue into adulthood, there has been growing interest in preventive mental health programs for children. In recent years, several such programs have been implemented at regional, state, or national scale, and although many experimental studies have documented positive outcomes of individual programs, this article represents the first attempt to systematically compare the largest programs in terms of scope, scale, and dose. The school-based mental health programs discussed in this review appear to have reached more than 27 million children over the last decade, and many of these programs have collected systematic outcomes data. The role that such programs can play in low- and middle-income countries (LMICs) is a secondary focus of this article. Until recently, wide-scaled, preventive, mental health interventions for children have been studied almost exclusively in high-income countries even though around 80% of the global population of children reside in LMICs. Since a number of programs are now operating on a large scale in LMICs, it has become possible to consider child mental health programs from a more global perspective. With both the increasing diversity of countries represented and the growing scale of programs, data sets of increasing quality and size are opening up new opportunities to assess the degree to which preventive interventions for child mental health, delivered at scale, can play a role in improving health and other life outcomes.
A Double-blind, Randomized, Placebo-controlled Trial of Lactobacillus acidophilus for the Treatment of Acute Watery Diarrhea in Vietnamese Children
Authors: Hong Chau Tran Thi , Minh Chau Nguyen Ngoc , Hoang Le Nhat Thanh , Chung The Hao , Voong Vinh Phat , Nguyen To Nguyen Thi , Ngoc Nguyen Minh , Tuan Ha Manh , Chau Ngoc Tang Le , Kolader Marion-Eliette , Farrar Jeremy J. , Wolbers Marcel , Thwaites Guy E. , Baker Stephen
Published: August 2017

Background:

Probiotics are the most frequently prescribed treatment for children hospitalized with diarrhea in Vietnam. We were uncertain of the benefits of probiotics for the treatment of acute watery diarrhea in Vietnamese children.

Methods:

We conducted a double-blind, placebo-controlled, randomized trial of children hospitalized with acute watery diarrhea in Vietnam. Children meeting the inclusion criteria (acute watery diarrhea) were randomized to receive either 2 daily oral doses of 2 × 108 CFUs of a local probiotic containing Lactobacillus acidophilus or placebo for 5 days as an adjunct to standard of care. The primary end point was time from the first dose of study medication to the start of the first 24-hour period without diarrhea. Secondary outcomes included the total duration of diarrhea and hospitalization, daily stool frequency, treatment failure, daily fecal concentrations of rotavirus and norovirus, and Lactobacillus colonization.

Results:

One hundred and fifty children were randomized into each study group. The median time from the first dose of study medication to the start of the first 24-hour diarrhea-free period was 43 hours (interquartile range, 15–66 hours) in the placebo group and 35 hours (interquartile range, 20–68 hours) in the probiotic group (acceleration factor 1.09 [95% confidence interval, 0.78–1.51]; P = 0.62). There was also no evidence that probiotic treatment was efficacious in any of the predefined subgroups nor significantly associated with any secondary end point.

Conclusions:

This was a large double-blind, placebo-controlled trial in which the probiotic underwent longitudinal quality control. We found under these conditions that L. acidophilus was not beneficial in treating children with acute watery diarrhea.
Parvovirus B19 Infection in a Fatal Case of Acute Liver Failure
Authors: Leon Luciane Almeida Amado , Alves Arthur Daniel Rocha , Garcia Rita de Cássia Nasser Cubel , Melgaço Juliana Gil , de Paula Vanessa Salete , Pinto Marcelo Alves
Published: August 2017

B19V has been proposed as an etiologic agent for hepatitis, mainly in children, but this is a rare clinical occurrence. In this article, we report a case of non-A-E acute liver failure in an immunocompetent child with B19 infection. The clinical findings of severe anemia and pancytopenia combined with the detection of anti-B19 Immunoglobulin G (IgG), B19 DNA and B19 mRNA in liver indicate a persistent infection and suggest a diagnosis of parvovirus B19-associated acute liver failure.
Optimizing Blood Collection and Processing for Quantiferon-TB Gold in-Tube Testing Gives Low Rates of Indeterminate Results: Clinical Implications
Authors: Kordy Faisal , Waters Valerie , Den-Hollander Cathy , Read Stanley , Lam Ray , Kitai Ian
Published: August 2017

The rate of low-mitogen indeterminate interferon-gamma release assay results at a hospital with expert pediatric phlebotomy and rapid incubation of specimens was 0.96%. All low-mitogen indeterminate results were found to be associated with an immunocompromised or anergic state. We describe a child where an unexpected indeterminate interferon-gamma release assay test pointed to an underlying anergic condition and was of diagnostic significance.