bluuebunny/crossref_metadata_2025 huggingface dataset:
The Physiologus and the Greek Papyri
Authors: Stroppa Marco
Published: December 2018

In Greek literary papyri coming from Egypt we can find only a few evidences of works about animals, for example fragments of Aristotelian works or works linked to the scientific production. Only in recent years two papyri were published that contained a “bestiary” in a broad sense.

The first papyrus is a fragment of the Physiologus, one of the most important ancient Greek treatises devoted to the animals: it is a fragment small in size, but of great importance since it testifies the spreading of this work.

The second papyrus full of animal figures is the so-called Artemidorus Papyrus, which on one side bears the drawings of many animals. In some cases it is possible to trace them back to the animals described in the chapters of the Physiologus, and determine connections between such different products, an illustrated scroll belonging to the first century AD and a Christian essay of the third century AD.
Parental sport achievement and the development of athlete expertise
Authors: Wilson Stuart G. , Wilson Melissa J. , Baker Joseph
Published: December 2018

This study sought to examine how parental sport involvement and attainment were related to the eventual level of competitive sport attained by their children. Athletes (n = 229) were divided into three skill level groups (elite: n = 139; pre‐elite: n = 33; non‐elite: n = 57), based on the peak competition level achieved in their career, which were compared using chi‐squares tests of independence and analyses of variance according to parents sport characteristics provided through the Developmental History of Athletes Questionnaire. Parental recreational and competitive sport participation was overrepresented among elite athletes, as were parents who reached an elite level of sport themselves. Results were found to differ according to parent sex, with athlete skill level significantly related to the sport participation and skill level of fathers, but not mothers. Results suggest parental sport experiences at different levels of competition influence the development of athletes, although these relationships are subject to many factors.
ANPELA: analysis and performance assessment of the label-free quantification workflow for metaproteomic studies
Authors: Tang Jing , Fu Jianbo , Wang Yunxia , Li Bo , Li Yinghong , Yang Qingxia , Cui Xuejiao , Hong Jiajun , Li Xiaofeng , Chen Yuzong , Xue Weiwei , Zhu Feng
Published: December 2018

Label-free quantification (LFQ) with a specific and sequentially integrated workflow of acquisition technique, quantification tool and processing method has emerged as the popular technique employed in metaproteomic research to provide a comprehensive landscape of the adaptive response of microbes to external stimuli and their interactions with other organisms or host cells. The performance of a specific LFQ workflow is highly dependent on the studied data. Hence, it is essential to discover the most appropriate one for a specific data set. However, it is challenging to perform such discovery due to the large number of possible workflows and the multifaceted nature of the evaluation criteria. Herein, a web server ANPELA (https://idrblab.org/anpela/) was developed and validated as the first tool enabling performance assessment of whole LFQ workflow (collective assessment by five well-established criteria with distinct underlying theories), and it enabled the identification of the optimal LFQ workflow(s) by a comprehensive performance ranking. ANPELA not only automatically detects the diverse formats of data generated by all quantification tools but also provides the most complete set of processing methods among the available web servers and stand-alone tools. Systematic validation using metaproteomic benchmarks revealed ANPELA’s capabilities in 1 discovering well-performing workflow(s), (2) enabling assessment from multiple perspectives and (3) validating LFQ accuracy using spiked proteins. ANPELA has a unique ability to evaluate the performance of whole LFQ workflow and enables the discovery of the optimal LFQs by the comprehensive performance ranking of all 560 workflows. Therefore, it has great potential for applications in metaproteomic and other studies requiring LFQ techniques, as many features are shared among proteomic studies.
1258. The Eyes Have It: Investigating a Cluster of Non-lactose Fermenting Gram-Negative Bacilli From Donor Corneal Rim Tissue
Authors: Olson Christopher , Schomer Kathleen , Pisney Larissa , Barron Michelle
Published: December 2018

Background

Following corneal transplant, donor corneal rim tissue are sometimes cultured to help predict the risk of post-keratoplasty endophthalmitis. In July 2016, the Infection Control (IC) team was notified by the microbiology laboratory of three donor corneal rim cultures growing non-lactose fermenting (NLF) Gram-negative bacilli, which was unusual for this type of specimen. The IC team initiated an epidemiological outbreak investigation to determine the source of the NLF Gram-negative bacilli.

Methods

A 12-month retrospective review of donor corneal rim cultures was performed from July 2015 to July 2016, with continual prospective monitoring of donor corneal rim cultures. The protocols used to prepare corneal donor tissues were reviewed. The standard protocol included flooding the tissue with povidone iodine followed by rinsing with a sterile saline solution and then placement in a sterile container with Opitsol GS (a preservative solution with gentamycin and streptomycin). The sterile saline rinse that was normally used for processing had been on back order and had been replaced with an alternative brand from March 2016 to July 2016. Unopened bottles of the alternative brand of sterile saline fluid and Optisol GS were sent to an outside laboratory for bacterial culture and remaining product was temporarily quarantined.

Results

Microbiology review revealed seven donor corneal rim cultures positive for NLF Gram-negative bacilli from May to July 2016. Organisms isolated from the donor corneal rim tissue included Achromobacter xylosoxidans (4), Burkholderia cepacia (3), Stenotrophomonas maltophilia (2), and Elizabethkingia meningoseptica (1). Sterility cultures of Opitsol GS demonstrated no growth. Sterility cultures of the sterile saline rinse grew Gram-positive and -negative bacteria from all samples. A FDA MedWatch was submitted in July 2016, and on September 6, 2016 an FDA recall notice was published. The quarantined saline was permanently removed. No clinical infections associated with the positive donor corneal rim cultures were identified.

Conclusion

Microbiologists are the front line for IC surveillance. Close partnership between the IC team and the microbiology laboratory can help identify potential outbreaks by alerting them of the growth of atypical organisms or clusters.

Disclosures

All authors: No reported disclosures.
1041. How Do Healthcare Providers Approach Empiric β-Lactam (BL) Treatment of Bloodstream Infections (BSI) Caused by Gram-Negative Rods (GNRs)? Analysis of Escherichia coli and Klebsiella pneumoniae BSI From the Veterans Health Administration (VHA)
Authors: Viau Roberto , Wilson Brigid , Evans Scott R , Perez Federico , Chambers Henry F , Fowler Vance G , Kreiswirth Barry N , Bonomo Robert A ,   ARLG
Published: December 2018

Background

Physicians make decisions regarding antimicrobial chemotherapy based on clinical and demographic factors, choosing initial empiric therapy without knowing the pathogen or its susceptibilities. Given the various treatment options and resistance mechanisms, treatment of GNR BSI is challenging with 30 day mortality approaching 30%. Using a large cohort of Escherichia coli and Klebsiella pneumoniae BSI, we aimed to characterize empiric antibiotic therapy, comparing treatment before and after Gram stain (GS) results, and summarize clinical outcomes.

Methods

Using a cohort of patients hospitalized within VHA, we used the Corporate Data Warehouse to identify blood cultures positive for E. coli or K. pneumoniae from 2006 to 2015. We extracted inpatient antimicrobial regimens, demographics, and antibiotic susceptibility testing (AST) results. We excluded cases with missing GS result dates and those not treated with BLs. We defined “initial” empiric treatment as agents received between specimen collection and GS results; and “modified” empiric treatment as agents received after GS but before AST results. Patient characteristics, treatments, and outcomes were summarized overall and by organism.

Results

Of 36,531 BSI identified, we analyzed a subset of 21,597 that met our inclusion criteria (figure). Within this subset of patients, the mean age was 70.3 and all-cause 30-day mortality was 13.9% (2,054 out of 14,735) for E. coli and 17.8% (1,220 out of 6,862) for K. pneumoniae. Initial empiric treatment included an effective agent in 90.4% (91.2% in E. coli, 88.7% in K. pneumoniae) of cases. This rate increased to 95.3% (96.0% in E. coli, 93.8% in K. pneumoniae) for modified empiric treatment. The most commonly prescribed initial empiric BL was piperacillin/tazobactam, observed in 55% of treated patients, followed by ceftriaxone and cefepime in 14% and 11% of treated patients, respectively. Carbapenems were included in 8% of initial and 13% of modified empiric treatments.

Conclusion

In this cohort of older patients with E. coli and K. pneumoniae BSI, higher rates of effective BL empiric treatment were achieved after GS results. BL empiric regimens consisted mostly of broad-spectrum agents. These observations highlight the potential utility of a diagnostic tool available shortly after specimen collection to inform treatment and improve patient outcomes.

Disclosures

All authors: No reported disclosures.
Replicating Anomalies
Authors: Hou Kewei , Xue Chen , Zhang Lu
Published: December 2018

Most anomalies fail to hold up to currently acceptable standards for empirical finance. With microcaps mitigated via NYSE breakpoints and value-weighted returns, 65% of the 452 anomalies in our extensive data library, including 96% of the trading frictions category, cannot clear the single test hurdle of the absolute $t$-value of 1.96. Imposing the higher multiple test hurdle of 2.78 at the 5% significance level raises the failure rate to 82%. Even for replicated anomalies, their economic magnitudes are much smaller than originally reported. In all, capital markets are more efficient than previously recognized.

Received June 12, 2017; editorial decision October 29, 2018 by Editor Stijn Van Nieuwerburgh. Authors have furnished an Internet Appendix, which is available on the Oxford University Press Web site next to the link to the final published paper online.
How Do You Deal With Uncertainty? Cochlear Implant Users Differ in the Dynamics of Lexical Processing of Noncanonical Inputs
Authors: McMurray Bob , Ellis Tyler P. , Apfelbaum Keith S.
Published: December 2018

Objectives:

Work in normal-hearing (NH) adults suggests that spoken language processing involves coping with ambiguity. Even a clearly spoken word contains brief periods of ambiguity as it unfolds over time, and early portions will not be sufficient to uniquely identify the word. However, beyond this temporary ambiguity, NH listeners must also cope with the loss of information due to reduced forms, dialect, and other factors. A recent study suggests that NH listeners may adapt to increased ambiguity by changing the dynamics of how they commit to candidates at a lexical level. Cochlear implant (CI) users must also frequently deal with highly degraded input, in which there is less information available in the input to recover a target word. The authors asked here whether their frequent experience with this leads to lexical dynamics that are better suited for coping with uncertainty.

Design:

Listeners heard words either correctly pronounced (dog) or mispronounced at onset (gog) or offset (dob). Listeners selected the corresponding picture from a screen containing pictures of the target and three unrelated items. While they did this, fixations to each object were tracked as a measure of the time course of identifying the target. The authors tested 44 postlingually deafened adult CI users in 2 groups (23 used standard electric only configurations, and 21 supplemented the CI with a hearing aid), along with 28 age-matched age-typical hearing (ATH) controls.

Results:

All three groups recognized the target word accurately, though each showed a small decrement for mispronounced forms (larger in both types of CI users). Analysis of fixations showed a close time locking to the timing of the mispronunciation. Onset mispronunciations delayed initial fixations to the target, but fixations to the target showed partial recovery by the end of the trial. Offset mispronunciations showed no effect early, but suppressed looking later. This pattern was attested in all three groups, though both types of CI users were slower and did not commit fully to the target. When the authors quantified the degree of disruption (by the mispronounced forms), they found that both groups of CI users showed less disruption than ATH listeners during the first 900 msec of processing. Finally, an individual differences analysis showed that within the CI users, the dynamics of fixations predicted speech perception outcomes over and above accuracy in this task and that CI users with the more rapid fixation patterns of ATH listeners showed better outcomes.

Conclusions:

Postlingually deafened CI users process speech incrementally (as do ATH listeners), though they commit more slowly and less strongly to a single item than do ATH listeners. This may allow them to cope more flexible with mispronunciations.
Therapeutic Plasma Exchange in Children With Thrombocytopenia-Associated Multiple Organ Failure: The Thrombocytopenia-Associated Multiple Organ Failure Network Prospective Experience
Authors: Fortenberry James D. , Nguyen Trung , Grunwell Jocelyn R. , Aneja Rajesh K. , Wheeler Derek , Hall Mark , Fleming Geoffrey , Tarrago Rod , Buttram Sandra , Dalton Heidi , Han Yong , Easley Kirk A. , Knezevic Andrea , Dai Tian , Paden Matthew , Carcillo Joseph A.
Published: December 2018

Objective:

The objective was to compare the resolution of organ dysfunction, 28-day mortality, and biochemical markers in children with thrombocytopenia-associated multiple organ failure who received therapeutic plasma exchange versus no therapeutic plasma exchange.

Design:

Observational longitudinal cohort study.

Setting:

Nine U.S. PICUs.

Patients:

Eighty-one children with sepsis-induced thrombocytopenia-associated multiple organ failure.

Interventions:

Therapeutic plasma exchange.

Measurements and Main Results:

Adjusted relative risk for 28-day mortality was modeled using standard multivariate regression with propensity score weighting to reduce covariate confounding. Change from baseline Pediatric Logistic Organ Dysfunction scores between therapeutic plasma exchange and no therapeutic plasma exchange differed in temporal pattern during the first week (p = 0.009). By day 4, mean Pediatric Logistic Organ Dysfunction score declined by 7.9 points (95% CI, –10.8 to –5.1) in the therapeutic plasma exchange–treated group compared with no change with no therapeutic plasma exchange. Use of therapeutic plasma exchange was associated with reduced 28-day mortality by multivariate analysis (adjusted relative risk, 0.45; 95% CI, 0.23–0.90; p = 0.02) and by propensity score weighting (adjusted relative risk, 0.46; 95% CI, 0.22–0.97; p = 0.04).

Conclusions:

Therapeutic plasma exchange use in thrombocytopenia-associated multiple organ failure was associated with a decrease in organ dysfunction. After accounting for several risk factors, 28-day all-cause mortality was lower in children treated with therapeutic plasma exchange compared with those receiving no therapeutic plasma exchange. A multicenter randomized clinical trial is necessary to determine a causal relationship.
Plant-based Diet and Adiposity Over Time in a Middle-aged and Elderly Population
Authors: Chen Zhangling , Schoufour Josje D. , Rivadeneira Fernando , Lamballais Sander , Ikram M. Arfan , Franco Oscar H. , Voortman Trudy
Published: December 2018

Background:

We aimed to explore whether adhering to a more plant-based diet, beyond strict vegan or vegetarian diets, may help prevent adiposity in a middle-aged and elderly population.

Methods:

We included 9,633 participants from the Rotterdam Study, a prospective cohort in the Netherlands. Dietary data were collected using food-frequency questionnaires at baseline of three subcohorts of the Rotterdam Study (1989–1993, 2000–2001, 2006–2008). We created a plant-based diet index by giving plant-based foods positive scores and animal-based foods reverse scores. A higher score on the index reflected an overall more plant-based and less animal-based diet. Data on anthropometrics and body composition (using dual energy X-ray absorptiometry) were collected every 3–5 years from 1989 to 2016. We used multivariable linear mixed models to analyze the associations.

Results:

In the 9,633 participants, baseline plant-based diet score ranged from 21.0 to 73.0 with a mean ± SD of 49.0 ± 7.0. In multivariable-adjusted analyses, higher adherence to a plant-based diet was associated with lower BMI, waist circumference, fat mass index, and body fat percentage across a median follow-up period of 7.1 years (per 10 points higher score, BMI: β = −0.70 kg/m2 [95% CI = −0.81, −0.59]; waist circumference: −2.0 cm [−2.3, −1.7]; fat mass index: −0.66 kg/m2 [−0.80, −0.52]; body fat percentage: −1.1 points [−1.3, −0.84]).

Conclusions:

In this population-based cohort of middle-aged and elderly participants, a higher adherence to a more plant-based, less animal-based diet was associated with less adiposity over time, irrespective of general healthfulness of the specific plant- and animal-based foods.
Prenatal Metal Concentrations and Childhood Cardiometabolic Risk Using Bayesian Kernel Machine Regression to Assess Mixture and Interaction Effects
Authors: Kupsco Allison , Kioumourtzoglou Marianthi-Anna , Just Allan C. , Amarasiriwardena Chitra , Estrada-Gutierrez Guadalupe , Cantoral Alejandra , Sanders Alison P. , Braun Joseph M. , Svensson Katherine , Brennan Kasey J. M. , Oken Emily , Wright Robert O. , Baccarelli Andrea A. , Téllez-Rojo Maria M.
Published: December 2018

Background:

Trace metal concentrations may affect cardiometabolic risk, but the role of prenatal exposure is unclear. We examined (1) the relation between blood metal concentrations during pregnancy and child cardiometabolic risk factors; (2) overall effects of metals mixture (essential vs. nonessential); and (3) interactions between metals.

Methods:

We measured 11 metals in maternal second-trimester whole blood in a prospective birth cohort in Mexico City. In children 4–6 years old, we measured body mass index (BMI), percent body fat, and blood pressure (N = 609); and plasma hemoglobin A1C (HbA1c), non–high-density lipoprotein (HDL) cholesterol, triglycerides, leptin, and adiponectin (N = 411). We constructed cardiometabolic component scores using age- and sex-adjusted z scores and averaged five scores to create a global risk score. We estimated linear associations of each metal with individual z scores and used Bayesian Kernel Machine Regression to assess metal mixtures and interactions.

Results:

Higher total metals were associated with lower HbA1c, leptin, and systolic blood pressure, and with higher adiponectin and non-HDL cholesterol. We observed no interactions between metals. Higher selenium was associated with lower triglycerides in linear (β = −1.01 z score units per 1 unit ln(Se), 95% CI = −1.84, −0.18) and Bayesian Kernel Machine Regression models. Manganese was associated with decreased HbA1c in linear models (β = −0.32 and 95% CI = −0.61, −0.03). Antimony and arsenic were associated with lower leptin in Bayesian Kernel Machine Regression models. Essential metals were more strongly associated with cardiometabolic risk than were nonessential metals.

Conclusions:

Low essential metals during pregnancy were associated with increased cardiometabolic risk factors in childhood.
Panax Notoginseng Saponins Attenuate Myocardial Ischemia-Reperfusion Injury Through the HIF-1α/BNIP3 Pathway of Autophagy
Authors: Liu Xin-Wen , Lu Meng-Kai , Zhong Hui-Ting , Wang Li-Hong , Fu Yong-Ping
Published: December 2018

Background and Objective:

Panax Notoginseng Saponins (PNS) is a formula of Chinese medicine commonly used for treating ischemia myocardial in China. However, its mechanism of action is yet unclear. This study investigated the effect and the mechanism of PNS on myocardial ischemia-reperfusion injury (MIRI) through the hypoxia-inducible factor 1α (HIF-1α)/bcl-2/adenovirus E1B19kDa-interacting protein3 (BNIP3) pathway of autophagy.

Methods:

We constructed a rat model of myocardial injury and compared among 4 groups (n = 10, each): the sham-operated group (Sham), the ischemia-reperfusion group (IR), the PNS low-dose group, and the PNS high-dose group were pretreated with PNS (30 and 60 mg/kg, respectively). Serum creatine kinase, malonaldehyde (MDA), lactate dehydrogenase, myocardial tissue superoxide dismutase, and reactive oxygen species were detected in rats with myocardial ischemia-reperfusion after the intervention of PNS. The rat myocardial tissue was examined using hematoxylin and eosin (H&E) staining, and the mitochondria of myocardial cells were observed using transmission electron microscopy. The expressions of microtubule-associated protein light chain 3 (LC3), HIF-1α, BNIP3, Beclin-1, and autophagy-related gene-5 (Atg5) in rat myocardial tissue were detected using Western blotting.

Results:

The results showed that PNS was significantly protected against MIRI, as evidenced by the decreasing in the concentration of serum CK, MDA, lactate dehydrogenase, and myocardial tissue superoxide dismutase, reactive oxygen species, the attenuation of myocardial tissue histopathological changes and the mitochondrial damages of myocardial cells, and the increase of mitochondria autophagosome in myocardial cells. In addition, PNS significantly increased the expression of LC3 and the ratio of LC3II/LC3I in rat myocardial tissue. Moreover, PNS significantly increased the expression of HIF-1α, BNIP3, Atg5, and Beclin-1 in rat myocardial tissue.

Conclusions:

The protective effect of PNS on MIRI was mainly due to its ability to enhance the mitochondrial autophagy of myocardial tissue through the HIF-1α/BNIP3 pathway.
CYP1B1 Gene and Phenotypic Correlation in Patients From Northeastern Brazil With Primary Congenital Glaucoma
Authors: Coêlho Rodrigo E.A. , Sena Dayse R. , Santa Cruz Fernando , Moura Bárbara C.F.S. , Han Cristal C. , Andrade Flaviano N. , Lira Rodrigo P.C.
Published: December 2018

Purpose:

To identify variants in the CYP1B1 gene in northeastern Brazilian patients with primary congenital glaucoma (PCG) and possible genotype-phenotype correlations.

Materials and Methods:

This is a cross-sectional observational study of 17 nonrelated patients with PCG, performed at the Altino Ventura Foundation, Recife, Brazil, between December 2017 and February 2018. All patients underwent an examination, including gathering information from their medical records, slit-lamp examination, fundoscopy, tonography, and measuring corneal diameter and thickness.

Results:

The mean age at the time of the examination was 27.7 years; 52.9% (n=9) were male, 29.4% (n=5) had history of parental consanguinity. The mean age when the diagnosis was confirmed was 0.53±2.18 years. Horizontal corneal diameter ranged from 12 to 16 mm (mean: 14.05±1.42 mm) and the IOP mean value was 17.31±9.84 mm Hg. Predicted pathogenic variants of the CYP1B1 gene were identified in 4 patients (23.5%). The differences among all clinical parameters did not reach statistical significance between individuals with and without CYP1B1 variants (P-values >0.05).

Conclusions:

Two variants which had not been previously related to PCG in Brazil (c.182G>A, c.241T>A) were identified. No statistically significant genotype-phenotype correlations were found.
Predictors of Poor Outcomes Among Infants With Respiratory Syncytial Virus–associated Acute Lower Respiratory Infection in Botswana
Authors: Patel Sweta M. , Spees Lisa , Smieja Marek , Luinstra Kathy , Steenhoff Andrew P. , Feemster Kristen A. , Arscott-Mills Tonya , Boiditswe Sefelani , Patel Mohamed Z. , Shah Samir S. , Cunningham Coleen K. , Kelly Matthew S.
Published: December 2018

Among children 1–23 months of age with respiratory syncytial virus–associated acute lower respiratory infection in Botswana, young age (<6 months), household use of wood as a cooking fuel, moderate or severe malnutrition and oxygen saturation <90% on room air were independent predictors of clinical nonresponse at 48 hours. Among HIV-uninfected infants less than six months of age, HIV exposure was associated with a higher risk of in-hospital mortality.
Distance Versus On-Site Educational Strategies for Competency-Based Screening, Brief Intervention, and Referral to Treatment Education
Authors: Kelly Patricia , Gotham Heather J. , Knopf-Amelung Sarah , Kohnle Kendall , Kuofie Araba
Published: December 2018

Background:

Although the individual and public health consequences of alcohol and drug use are substantial, nursing education programs generally lack content on addiction. The goal of this evaluation was to compare the initial outcomes of on-site versus distance methods for training graduate nurse practitioner students in Screening, Brief Intervention, and Referral to Treatment (SBIRT) for substance use.

Method:

A nonrandomized two-group pretest–posttest design was used to compare knowledge, attitudes, and skills learning outcomes between on-site (n = 45) and distance (n = 18) family or adult/geriatric Master of Science in Nursing nurse practitioner students receiving SBIRT training.

Results:

Overall, students increased their knowledge, attitudes, and confidence about screening and intervening with patients who use substances; showed a high level of skills in conducting a brief intervention to motivate patients to reduce their substance use; and were highly satisfied with the education provided. Counseling confidence and gains in knowledge were similar across groups. Compared with distance students, on-site students reported significantly more positive attitudes about their role adequacy, role legitimacy, and role support for intervening with alcohol use and about their role support for intervening with drug use. On-site students had greater training satisfaction, but distance students’ skills assessed through standardized patient interactions were significantly better.

Conclusions:

Both on-site and distance training were effective instructional methods to increase SBIRT knowledge and skills. However, differences in attitudes, training satisfaction, and skills demonstration should be taken into account when designing addiction training using distance technologies.
The Explosion of a New Designer Drug, Flakka
Authors: Salani Deborah , Albuja Laura D. , Zdanowicz Martin M.
Published: December 2018

There are many challenges facing healthcare professionals. One such challenge is the continuous introduction of new synthetic drugs. Synthetic drugs pose many difficulties to providers, including identification of the drug ingested, management of symptoms, ensuring safety of the patient and his or her environment, and continual monitoring after the initial symptoms, because synthetic cathinones have many long-term effects on an individual. One such synthetic drug, flakka, is a potent second-generation synthetic cathinone. Because flakka inhibits the reuptake of norepinephrine and dopamine, which are involved in one’s perception of pleasure, it causes inflated feelings and also causes signs and symptoms of psychosis. Flakka also induces various exaggerated symptoms, such as feelings of incredible strength, disorientation, aggression, and altered thought processes, and also can cause hyperthermia, coma, and death. Healthcare professionals need to understand the nature of flakka ingestion, the various symptoms a user may exhibit, and the long-term symptoms a person may have once the acute recovery phase has ended. Once the initial phase of ingestion is over and the patient is medically stabilized, the patient may experience signs and symptoms of psychosis or other psychiatric disorders. It is paramount that healthcare professionals are able to recognize the signs and symptoms of flakka ingestion, know the steps to take to ensure safety of the patient and those around him or her, and also know how to facilitate the patient’s recovery.
Youth Substance Use Prevention Using Disciplinary Literacy Strategies
Authors: Park Eunhee , Jang Bong Gee
Published: December 2018

Effective health education programs for adolescent substance use prevention need to be developed. However, the evidence supporting the use of specific instructional strategies for youth substance use prevention programs is insufficient. The purpose of this study was to develop and implement a community-based program aiming for smoking, alcohol, and substance use prevention based on multiple disciplinary literacy strategies. A one-group pretest-and-posttest comparison design was used to test the feasibility of the new substance use prevention program. Thirty-two adolescents, most from families with minority and low-socioeconomic status backgrounds, participated. The group met for a 1-hour session once a week for 10 weeks. The program was implemented in a suburban setting in a southeastern state in the United States. Pretests and posttests were administered to assess the program’s effectiveness in improving participants’ knowledge, skills, and assets regarding substance use. Overall, the participants were satisfied with the program and reported significant growth in their knowledge, skills, assets, and perceptions of benefits. These findings suggest that disciplinary literacy strategies may promote adolescents’ perceptions of and knowledge regarding substance use.
Gender Differences in Smartphone Addiction Behaviors Associated With Parent–Child Bonding, Parent–Child Communication, and Parental Mediation Among Korean Elementary School Students
Authors: Lee Eun Jee , Kim Hee Sun
Published: December 2018

Objective:

This study investigated the gender differences in smartphone addiction (SA) behaviors associated with parent–child bonding, parent–child communication, and parental mediation among Korean elementary school students aged 11–13 years.

Method:

A sample of 224 smartphone users (112 boys and 112 girls) was surveyed in a cross-sectional study. Descriptive statistics and multiple regression analysis were conducted to investigate the predictors of SA behaviors based on gender differences using SPSS Win 23.0 software.

Results:

Of the participants, 14.3% (15.18% boys and 13.39% girls) were in the SA behaviors risk group, and the prevalence of SA behaviors was not significantly different between gender groups. In multiple stepwise regression analysis, less active safety mediation; longer duration of smartphone use; more use of smartphones for games, videos, or music; and less restrictive mediation were linked to higher SA behaviors in boys, and these indicators accounted for 22.1% of the variance in SA behaviors. Longer duration of smartphone use, less active use mediation, worse parent–child communication, and more use of smartphones for text, chatting, or social network sites were linked to higher SA behaviors in girls, and these indicators accounted for 38.2% of the variance in SA behaviors.

Conclusion:

The study provides insights into SA behaviors and predictors of SA behaviors among children based on gender differences. Development of SA behavior prevention programs is needed, not only for children but also to teach parents to use active safety mediation and restrictive mediation for boys and better communication and active use mediation for girls.
What Causes LVAD-Associated Ischemic Stroke? Surgery, Pump Thrombosis, Antithrombotics, and Infection
Authors: Cho Sung-Min , Hassett Catherine , Rice Cory J. , Starling Randall , Katzan Irene , Uchino Ken
Published: December 2018

Acute ischemic stroke (AIS) is a major complication in left ventricular assist device (LVAD) population. A better understanding of clinical risk factors associated with AIS may help mitigate risk of stroke. We reviewed prospectively collected data of 477 LVAD patients from a tertiary center from October 1, 2004 to December 31, 2016. Supplemental data abstraction was performed on patients with AIS. Fifty-seven (12%) developed 61 AIS. Of 61, 17 (28%) AIS occurred perioperatively. The median time from implant to perioperative AIS was 5 days (interquartile range: 3–9). Pump thrombosis accounted for 19 (31%) of 61 AIS, and 7 (37%) presented initially with AIS before the pump thrombosis. The median lactate dehydrogenase (LDH) at the time of AIS in the pump thrombosis group (806) was higher than LDH at 1 month (437, P = 0.27) at 3 months (334, P = 0.01), and 6 months (286, P = 0.001) before AIS. Thirty-three (54%) AIS occurred while receiving inadequate antithrombotic therapy. Acute infections were common (31, 51%) in AIS and 12 (20%) were associated with acute bloodstream infection. All AIS were explained by a combination of four clinical risk factors. All LVAD-associated AIS occurred perioperatively or in conjunction with pump thrombosis, subtherapeutic anticoagulation, and bloodstream infection. The common underlying thread is occurrence of a prothrombotic state. The results of this study underscore the potential consequences of disruption of delicate hemostatic balance in patients with LVAD.
Acute In Vivo Evaluation of the Pittsburgh Pediatric Ambulatory Lung
Authors: May Alexandra G. , Orizondo Ryan A. , Frankowski Brian J. , Wearden Peter D. , Federspiel William J.
Published: December 2018

Respiratory failure is a significant problem within the pediatric population. A means of respiratory support that readily allows ambulation could improve treatment. The Pittsburgh Pediatric Ambulatory Lung (P-PAL) is being developed as a wearable pediatric pump-lung for long-term respiratory support and has previously demonstrated positive benchtop results. This study aimed to evaluate acute (4–6 hours) in vivo P-PAL performance, as well as develop an optimal implant strategy for future long-term studies. The P-PAL was connected to healthy sheep (n = 6, 23–32 kg) via cannulation of the right atrium and pulmonary artery. Plasma-free hemoglobin (PfHb) and animal hemodynamics were measured throughout the study. Oxygen transfer rates were measured at blood flows of 1–2.5 L/min. All animals survived the complete study duration with no device exchanges. Flow limitation because of venous cannula occlusion occurred in trial 2 and was remedied via an altered cannulation approach. Blood exiting the P-PAL had 100% oxygen saturation with the exception of trial 4 during which inadequate device priming led to intrabundle clot formation. Plasma-free hemoglobin remained low (<20 mg/dl) for all trials. In conclusion, this study demonstrated successful performance of the P-PAL in an acute setting and established the necessary methods for future long-term evaluation.
Use of Hemodynamic Ramp Study to Optimize Continuous-Flow Ventricular Assist Device in a Fontan Patient
Authors: Chau Peter , Lim Heang M. , Schumacher Kurt R. , Grifka Ronald G. , Peng David M.
Published: December 2018

The utility of hemodynamic ramp studies in single ventricle patients supported by continuous flow left ventricular assist devices (CF-LVADs) is largely unknown. We report the novel use of the hemodynamic ramp test to optimize a 26 year-old Fontan-palliated single-ventricle patient supported with a continuous-flow ventricular assist device (Heartware HVAD). Modest improvements in Fontan hemodynamics resulted in significant and persistent clinical improvement and symptomatic relief.
An overview of tetracyclines and related resistance mechanisms
Authors: Sheykhsaran Elham , Baghi Hossein B. , Soroush Mohammad H. , Ghotaslou Reza
Published: December 2018

Tetracyclines are one of the most well known antimicrobial agents. These are often prescribed against Gram-negative and Gram-positive organisms. The latest studies indicate that the resistance to tetracyclines is rising throughout the world. The aim of this study was to find out more about the reasons behind bacterial resistance to tetracycline. We performed a selective literature search by studying several articles which mentioned tetracyclines and their resistance mechanisms in various bacteria. We found that a rise in antibiotic resistance to tetracyclines is alarming. The most important mechanisms are ribosomal protection, efflux pumps, modification of the drug target and enzymatic alteration. The resistance mechanism to tigecycline is similar to the tetracycline; however, tigecycline remains partially intact from resistance.
Incidence, Clearance, and Persistence of Anal Human Papillomavirus in Men Who Have Sex With Men Living With Human Immunodeficiency Virus: Implications for Human Papillomavirus Vaccination
Authors: Ong Jason J. , Walker Sandra , Grulich Andrew , Hoy Jennifer , Read Tim R.H. , Bradshaw Catriona , Chen Marcus , Garland Suzanne M. , Cornall Alyssa , Hillman Richard , Templeton David J. , Hocking Jane , Eu Beng , Tee BK , Chow Eric P.F. , Fairley Christopher K.
Published: December 2018

Background

Men who have sex with men living with human immunodeficiency virus have a high risk of anal cancer. We estimate the likely benefit of human papillomavirus (HPV) vaccination among participants of the Anal Cancer Examination study.

Methods

Anal swabs were collected for the detection and genotyping of anal HPV DNA by linear array (Roche Diagnostics) in this 2-year multicenter prospective cohort. We calculated the proportion of men, stratified by age, without detectable vaccine type-specific DNA.

Results

Overall, 255 men, with a median age of 50 years (interquartile range, 44–56 years) contributed 488.9 person-years of follow-up. After 2 years of follow-up, 149 (58%; 95% confidence interval [CI], 52–65) had at least 1 high-risk HPV (HRHPV), and 71 (28%, 95% CI, 22–34) had HPV types 16/18 detected. Assuming that DNA-negative men would receive vaccine protection, vaccination at baseline could potentially prevent HRHPV infection in 10.2% of men (95% CI, 6.8–14.6, 26 of 255) 2 years later from incident HRHPV covered by the bivalent and quadrivalent vaccine, and 29.4% of men (95% CI, 23.9–35.4, 75/255) from incident HRHPV covered by the nonavalent vaccine.

Conclusion

Though there is high prevalence of anal HPV in men who have sex with men living with human immunodeficiency virus, there was also a high incidence of HRHPV vaccine types in the 2-year follow-up, indicating potential for prevention if these men were not previously infected with HPV vaccine types and were vaccinated at their baseline visit.
Comparing Vasoactive-Inotropic Score Reporting Strategies in the PICU Relative to Mortality Risk*
Authors: Musick Matthew A. , Loftis Laura L. , Kennedy Curtis E.
Published: December 2018

Objectives:

High Vasoactive-Inotropic Scores have demonstrated association with poor outcomes in pediatric cardiac ICUs and are being calculated more frequently in studies of critically ill noncardiac patients. Available studies differ in their approach to assigning Vasoactive-Inotropic Scores, making direct comparisons difficult. The goal of this investigation is to compare multiple approaches to Vasoactive-Inotropic Score assignment to determine their strength of association with mortality in a general pediatric intensive care population. In doing so, we aim to help validate the use of the Vasoactive-Inotropic Score in noncardiac patients and to help inform future studies of the relative strength of available approaches in assigning this score.

Design:

Retrospective chart review.

Setting:

PICU at an academic freestanding children’s hospital.

Patients:

Two-thousand seven-hundred fifty-two consecutive patients admitted over a 17-month time period were screened for receiving inotrope or vasopressor therapies regardless of disease process. Four-hundred seventy-four patients met inclusion criteria.

Interventions:

None.

Measurements and Main Results:

For each patient treated with continuous infusions of vasoactive medications, a Vasoactive-Inotropic Score was calculated (and then recalculated) every time they had a documented dose change. Multiple strategies were evaluated to generate receiver operating characteristic curves in relation to mortality. Area under the curve was greatest when evaluating the maximum Vasoactive-Inotropic Score (Max Any) during the initial treatment course (0.788) with an increasing relative risk as the score increased. The Vasoactive-Inotropic Score at 48 hours after treatment initiation had next highest area under the curve (0.736). Primary diagnosis categories were also analyzed, and area under the curve was greatest for the cardiovascular group (0.879).

Conclusions:

Increasing Vasoactive-Inotropic Scores for patients in the PICU are associated with mortality risk. The scoring strategy used can influence the strength of the association, as can the primary diagnosis category.
Moving Toward Excellence in Pediatric Physical Therapy Education: A Scoping Review
Authors: Anderson Deborah K. , Furze Jennifer A. , Moore James G.
Published: December 2018

Purpose:

The purpose of this scoping review was to identify and map current evidence that underpins excellence in pediatric physical therapy education.

Methods:

An extensive review was conducted of literature published over a 27-year period regarding pediatric physical therapy/medical/allied health education.

Results:

Thirty articles were reviewed and analyzed. Articles were classified as levels of evidence 4 to 7. Three major overarching concepts emerged: faculty characteristics, curriculum, and pedagogy.

Conclusions:

Few published studies with methodological rigor exist on this topic. More research and higher quality studies are needed to identify exemplar programs, curriculum, and pedagogy. The key concepts identified in this review will help inform the definition of excellence, as it is perceived through the lens of pediatric physical therapy educators, clinicians, and students.
Early Treadmill Practice in Infants Born With Myelomeningocele: A Pilot Study
Authors: Lee Do Kyeong , Sansom Jennifer K.
Published: December 2018

Purpose:

To determine the feasibility of an early treadmill training program for infants with myelomeningocele (MMC) and to measure changes in overt infant motor development and control, including mechanisms underlying the overt changes.

Methods:

Ten infants with MMC were initially enrolled: 8 infants completed 12 consecutive months of training, and 2 completed 6 months of training. Training consisted primarily of home-based, parent-administered treadmill stepping practice 5 days per week, 10 minutes per day starting within 6 months postbirth. We measured motor milestones, treadmill steps, spinal-level reflexes, and body composition.

Results:

Infants showed earlier acquisition of gross motor skills than previously reported. The number of alternating steps performed increased, indicating more complex neuromotor control and strength. Integrity of monosynaptic pathways and body composition were improved after controlling for chronological age.

Conclusions:

This study demonstrates the feasibility of using early, home-based treadmill training for infants with MMC starting within 6 months postbirth.
Physical Activity Levels of Children With Down Syndrome
Authors: Fox Bianca , Moffett Gwendolyn E. , Kinnison Clara , Brooks Grace , Case Laura E.
Published: December 2018

Purpose:

This systematic review of literature analyzed accelerometer use to measure physical activity (PA) in individuals 21 years and younger with Down syndrome (DS).

Summary of Key Points:

Comprehensive search strategy conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eight articles met inclusion criteria. Six studies reported children with DS are not meeting PA guidelines; 4 studies found intensity levels decline with age. Three studies reported children with DS engage in significantly less vigorous PA than control groups. Determination of intensity levels varied, limiting additional comparisons.

Conclusions:

Children with DS engage in less PA than peers developing typically and are not meeting PA guidelines across age groups, increasing risk for numerous health conditions secondary to decreased activity.

Recommendations for Clinical Practice:

Promotion of more appropriate levels of PA and elimination of barriers to participation in PA are important for individuals with DS.
Effects of High-Intensity Interval Training on Fitness and Health in Youth With Physical Disabilities
Authors: Zwinkels Maremka , Verschuren Olaf , de Groot Janke F. , Backx Frank J. G. , Wittink Harriet , Visser-Meily Anne , Takken Tim
Published: December 2018

Purpose:

To investigate the effects of high-intensity interval training (HIT) on physical fitness and cardiometabolic health in youth with physical disabilities.

Methods:

For this quasi-experimental study 70 participants were recruited from schools for special education and divided into runners and users of wheelchairs. HIT was performed for 8 weeks, twice a week, containing 30 seconds all-out exercises.

Results:

Exercise adherence was 84.5%. Following HIT, there were improvements in anaerobic performance, agility, aerobic performance, and systolic and diastolic blood pressure. There were no changes in peak oxygen uptake (

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O2peak), arterial stiffness, body composition, lipid profile, and fasting glucose.

Conclusions:

Both anaerobic and aerobic performance improved after HIT, with no changes in

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O2peak. There were no effects on cardiometabolic health, except for a decrease in blood pressure.
Maximizing Participation During Walking in Children With Disabilities: Is Response to Unpredictability Important?
Authors: Gosselin Dora , Wright Alexis , Sole Gisela , Girolami Gay , Taylor Jeffrey , Baxter G. David
Published: December 2018

Walking ability is one of the primary components of human motor function, and interventions aimed at improving walking ability are common in physical therapy, particularly in children. One element encountered in a participatory, or natural, environment is unpredictability, defined as the presence of an unexpected obstacle, stimulus, or alteration of the environmental conditions. Little research has assessed the influence of unpredictability on biomechanical adaptations to walking in children who are developing typically or children with motor disabilities. A variety of impairments may result in an inadequate response to unpredictability, and we propose that there may be a relationship between response to an unpredictable visual cue and mobility-based participation.