bluuebunny/crossref_metadata_2025 huggingface dataset:
Seven Versus 14 Days of Antibiotic Therapy for Uncomplicated Gram-negative Bacteremia: A Noninferiority Randomized Controlled Trial
Authors: Yahav Dafna , Franceschini Erica , Koppel Fidi , Turjeman Adi , Babich Tanya , Bitterman Roni , Neuberger Ami , Ghanem-Zoubi Nesrin , Santoro Antonella , Eliakim-Raz Noa , Pertzov Barak , Steinmetz Tali , Stern Anat , Dickstein Yaakov , Maroun Elias , Zayyad Hiba , Bishara Jihad , Alon Danny , Edel Yonatan , Goldberg Elad , Venturelli Claudia , Mussini Cristina , Leibovici Leonard , Paul Mical ,   Bacteremia Duration Study Group
Published: December 2018

Background

Gram-negative bacteremia is a major cause of morbidity and mortality in hospitalized patients. Data to guide the duration of antibiotic therapy are limited.

Methods

This was a randomized, multicenter, open-label, noninferiority trial. Inpatients with gram-negative bacteremia, who were afebrile and hemodynamically stable for at least 48 hours, were randomized to receive 7 days (intervention) or 14 days (control) of covering antibiotic therapy. Patients with uncontrolled focus of infection were excluded. The primary outcome at 90 days was a composite of all-cause mortality; relapse, suppurative, or distant complications; and readmission or extended hospitalization (>14 days). The noninferiority margin was set at 10%.

Results

We included 604 patients (306 intervention, 298 control) between January 2013 and August 2017 in 3 centers in Israel and Italy. The source of the infection was urinary in 411 of 604 patients (68%); causative pathogens were mainly Enterobacteriaceae (543/604 [90%]). A 7-day difference in the median duration of covering antibiotics was achieved. The primary outcome occurred in 140 of 306 patients (45.8%) in the 7-day group vs 144 of 298 (48.3%) in the 14-day group (risk difference, –2.6% [95% confidence interval, –10.5% to 5.3%]). No significant differences were observed in all other outcomes and adverse events, except for a shorter time to return to baseline functional status in the short-course therapy arm.

Conclusions

In patients hospitalized with gram-negative bacteremia achieving clinical stability before day 7, an antibiotic course of 7 days was noninferior to 14 days. Reducing antibiotic treatment for uncomplicated gram-negative bacteremia to 7 days is an important antibiotic stewardship intervention.

Clinical Trials Registration

NCT01737320.
Detection of Immunoglobulin G1 Against rK39 Improves Monitoring of Treatment Outcomes in Visceral Leishmaniasis
Authors: Mollett Guy , Bremer Hinckel Bruno C , Bhattacharyya Tapan , Marlais Tegwen , Singh Om Prakash , Mertens Pascal , Falconar Andrew K , El-Safi Sayda , Sundar Shyam , Miles Michael A
Published: December 2018

Background

Visceral leishmaniasis (VL), caused by the Leishmania donovani complex, is a fatal, neglected tropical disease that is targeted for elimination in India, Nepal, and Bangladesh. Improved diagnostic tests are required for early case detection and for monitoring the outcomes of treatments. Previous investigations using Leishmania lysate antigen demonstrated that the immunoglobulin (Ig) G1 response is a potential indicator of a patient’s clinical status after chemotherapy.

Methods

IgG1 or IgG enzyme-linked immunosorbent assays (ELISAs) with rK39 or lysate antigens and novel IgG1 rK39 rapid diagnostic tests (RDTs) were assessed with Indian VL serum samples from the following clinical groups: paired pre- and postchemotherapy (deemed cured); relapsed; other infectious diseases; and endemic, healthy controls.

Results

With paired pre- and post-treatment samples (n = 37 pairs), ELISAs with rK39- and IgG1-specific conjugates gave a far more discriminative decrease in post-treatment antibody responses when compared to IgG (P < .0001). Novel IgG1 rK39 RDTs provided strong evidence for decreased IgG1 responses in patients who had successful treatment (P < .0001). Furthermore, both IgG1 rK39 RDTs (n = 38) and ELISAs showed a highly significant difference in test outcomes between cured patients and those who relapsed (n = 23; P < .0001). RDTs were more sensitive than corresponding ELISAs.

Conclusions

We present strong evidence for the use of IgG1 in monitoring treatment outcomes in VL, and the first use of an IgG1-based RDT using the rK39 antigen for the discrimination of post-treatment cure versus relapse in VL. Such an RDT may have a significant role in monitoring patients and in targeted control and elimination of this devastating disease.
Genome of the small hive beetle (Aethina tumida, Coleoptera: Nitidulidae), a worldwide parasite of social bee colonies, provides insights into detoxification and herbivory
Authors: Evans Jay D , McKenna Duane , Scully Erin , Cook Steven C , Dainat Benjamin , Egekwu Noble , Grubbs Nathaniel , Lopez Dawn , Lorenzen Marcé D , Reyna Steven M , Rinkevich Frank D , Neumann Peter , Huang Qiang
Published: December 2018

Background

The small hive beetle (Aethina tumida; ATUMI) is an invasive parasite of bee colonies. ATUMI feeds on both fruits and bee nest products, facilitating its spread and increasing its impact on honey bees and other pollinators. We have sequenced and annotated the ATUMI genome, providing the first genomic resources for this species and for the Nitidulidae, a beetle family that is closely related to the extraordinarily species-rich clade of beetles known as the Phytophaga. ATUMI thus provides a contrasting view as a neighbor for one of the most successful known animal groups.

Results

We present a robust genome assembly and a gene set possessing 97.5% of the core proteins known from the holometabolous insects. The ATUMI genome encodes fewer enzymes for plant digestion than the genomes of wood-feeding beetles but nonetheless shows signs of broad metabolic plasticity. Gustatory receptors are few in number compared to other beetles, especially receptors with known sensitivity (in other beetles) to bitter substances. In contrast, several gene families implicated in detoxification of insecticides and adaptation to diverse dietary resources show increased copy numbers. The presence and diversity of homologs involved in detoxification differ substantially from the bee hosts of ATUMI.

Conclusions

Our results provide new insights into the genomic basis for local adaption and invasiveness in ATUMI and a blueprint for control strategies that target this pest without harming their honey bee hosts. A minimal set of gustatory receptors is consistent with the observation that, once a host colony is invaded, food resources are predictable. Unique detoxification pathways and pathway members can help identify which treatments might control this species even in the presence of honey bees, which are notoriously sensitive to pesticides.
The draft genomes of five agriculturally important African orphan crops
Authors: Chang Yue , Liu Huan , Liu Min , Liao Xuezhu , Sahu Sunil Kumar , Fu Yuan , Song Bo , Cheng Shifeng , Kariba Robert , Muthemba Samuel , Hendre Prasad S , Mayes Sean , Ho Wai Kuan , Yssel Anna E J , Kendabie Presidor , Wang Sibo , Li Linzhou , Muchugi Alice , Jamnadass Ramni , Lu Haorong , Peng Shufeng , Van Deynze Allen , Simons Anthony , Yana-Shapiro Howard , Van de Peer Yves , Xu Xun , Yang Huanming , Wang Jian , Liu Xin
Published: December 2018

Background

The expanding world population is expected to double the worldwide demand for food by 2050. Eighty-eight percent of countries currently face a serious burden of malnutrition, especially in Africa and south and southeast Asia. About 95% of the food energy needs of humans are fulfilled by just 30 species, of which wheat, maize, and rice provide the majority of calories. Therefore, to diversify and stabilize the global food supply, enhance agricultural productivity, and tackle malnutrition, greater use of neglected or underutilized local plants (so-called orphan crops, but also including a few plants of special significance to agriculture, agroforestry, and nutrition) could be a partial solution.

Results

Here, we present draft genome information for five agriculturally, biologically, medicinally, and economically important underutilized plants native to Africa: Vigna subterranea, Lablab purpureus, Faidherbia albida, Sclerocarya birrea, and Moringa oleifera. Assembled genomes range in size from 217 to 654 Mb. In V. subterranea, L. purpureus, F. albida, S. birrea, and M. oleifera, we have predicted 31,707, 20,946, 28,979, 18,937, and 18,451 protein-coding genes, respectively. By further analyzing the expansion and contraction of selected gene families, we have characterized root nodule symbiosis genes, transcription factors, and starch biosynthesis-related genes in these genomes.

Conclusions

These genome data will be useful to identify and characterize agronomically important genes and understand their modes of action, enabling genomics-based, evolutionary studies, and breeding strategies to design faster, more focused, and predictable crop improvement programs.
Establishing and implementing a health promoting school in rural Cambodia
Authors: Heesch Kristiann C , Hepple Erika , Dingle Kaeleen , Freeman Natasha
Published: December 2018

Few studies have used a whole-of-school approach in implementing a health promoting schools (HPS) framework. Descriptions of how HPS is being implemented, particularly in low-resourced, developing countries, are limited. This study used an exploratory case study design to examine the planning and implementation of a HPS in a rural Cambodian village. Data were collected via observations of the school, school documentation, and interviews with stakeholders (n = 9). The data were analysed inductively as an iterative process, from initial coding, through to categorizing, leading to concept mapping and then identifying the emergent themes within the stages of school development and implementation of educational and health programming. The case study demonstrated how all six components of the HPS framework can be used to plan and implement a school in a rural village in a developing country. The key elements of implementation were building local and international partnerships, local leadership, and a culture of change and participation. These elements were used to establish a non-profit school that aimed to address the stated health and educational needs of local villagers. This case study adds to the limited evidence on the HPS components and implementation methods that are being applied in low-resourced, developing countries.
The Impact of Universal Infant Hepatitis B Immunization on Reducing the Hepatitis B Carrier Rate in Pregnant Women
Authors: Su Wei-Ju , Chen Shu-Fong , Yang Chin-Hui , Chuang Pei-Hung , Chang Hsiu-Fang , Chang Mei-Hwei
Published: December 2018

Background

The hepatitis B virus (HBV) status of pregnant women affects HBV vaccine failure in their offspring. This study is aimed to investigate the impact of the universal infant HBV vaccination program on the long-term hepatitis B surface antigen (HBsAg) rate in pregnant women.

Methods

Using the National Immunization Information System, we examined a 32-year period of cross-sectional data on a maternal HBsAg and hepatitis B e antigen (HBeAg) screening program launched in July 1984. An age-period-cohort model analysis of 940 180 pregnant women screened for July 1996–June 1997 and the years 2001, 2006, 2011, and 2016 was applied.

Results

The annual HBsAg- and HBeAg-seropositive rates decreased from 13.4% and 6.4%, respectively, for the period 1984–1985 to 5.9% and 1.0% in 2016 (P for both trends < .0001). Pregnant women with birth years after July 1986 (the HBV vaccination cohort) had the lowest relative risk (0.27 [95% confidence interval, .26–.28]) of HBsAg positivity compared with birth years before June 1984.

Conclusions

The birth cohort effect in relation to the universal infant HBV immunization program has effectively reduced the HBV carrier rate in pregnant women and the burden of perinatal HBV infection on the next generation.
ADP-ribosylation factor-like 8b is required for the development of mouse models of systemic lupus erythematosus
Authors: Saitoh Shin-Ichiroh , Saitoh Yoshiko Mori , Kontani Kenji , Sato Katsuaki , Miyake Kensuke
Published: December 2018

Toll-like receptor 7 (TLR7) and type I interferons (IFN-1) are essential for the development of systemic lupus erythematosus (SLE) models such as BXSB.Yaa and 2,6,10,14-tetramethyl-pentadecane (TMPD)-induced experimental lupus. However, the mechanism underlying the development of SLE remains undefined. We report a requirement for ADP-ribosylation factor-like 8b (Arl8b) for TLR7-dependent IFN-1 production in plasmacytoid dendritic cells (pDCs). We analyzed whether Arl8b plays a role in two SLE models by comparing wild-type and Arl8b-deficient Arl8b GeneTrap (Arl8bGt/Gt) mice. We found that BXSB.Yaa Arl8bGt/Gt mice showed none of the abnormalities characterized in BXSB.Yaa mice. TMPD treatment of Arl8bGt/Gt mice significantly inhibited the development of SLE. pDCs were required for TMPD-induced peritonitis. Our data demonstrate that Arl8b contributes to disease pathogenesis in two SLE models via IFN-1-dependent and -independent mechanisms and suggest that Arl8b is an attractive new target for therapeutic intervention in SLE.
Withdrawal Symptom, Treatment Mechanism, and/or Side Effect? Developing an Explicit Measurement Model for Smoking Cessation Research
Authors: Tonkin Sarah S , Williams Trevor F , Simms Leonard J , Tiffany Stephen T , Mahoney Martin C , Schnoll Robert A , Cinciripini Paul M , Hawk Larry W
Published: December 2018

Introduction

Assessment of withdrawal symptoms, treatment mechanisms, and side effects is central to understanding and improving smoking cessation interventions. Though each domain is typically assessed separately with widely used questionnaires to separately assess each domain (eg, Minnesota Nicotine Withdrawal Scale = withdrawal; Questionnaire of Smoking Urges-Brief = craving; Positive and Negative Affect Schedule = affect; symptom checklist = side effects), there are substantial problems with this implicit “one questionnaire equals one construct” measurement model, including item overlap across questionnaires. This study sought to clarify the number and nature of constructs assessed during smoking cessation by developing an explicit measurement model.

Methods

Two subsamples were randomly created from 1246 smokers in a clinical trial. Exploratory and confirmatory factor analyses were conducted to identify and select a model that best represented the data. Measurement invariance was assessed to determine if the factors and their content were consistent prior to and during the quit. Improvement in construct overlap within this model was compared against the implicit measurement model using correlational analyses.

Results

A 5-factor measurement model composed of negative affect, somatic symptoms, sleep problems, positive affect, and craving fits the data well prior to and during quitting. All factor content except somatic symptoms was consistent over time. Correlational analyses indicated that the 5-factor model attenuated construct overlap compared to the implicit model.

Conclusions

The models generated from data-driven approaches (eg, the 5-factor model) reduced overlap and better represented the constructs underlying these measures. This approach created distinct, stable constructs that span over measures of side effects and potential treatment mechanisms.

Implications

This study demonstrated that measures assessing treatment mechanisms, withdrawal symptoms, and side effects contain problematic overlap that reduces the clarity of these key constructs. The use of data-driven approaches showed that these measures do not map on to their posited latent constructs (eg, the Minnesota Nicotine Withdrawal Scale does not yield a withdrawal factor). Rather, these measures form distinct, basic processes that may represent more meaningful constructs for future research on cessation and treatment. Assessments designed to individually examine these processes may improve the study of treatment mechanisms.
Evaluation of the Impact of an Online Opioid Education Program for Acute Pain Management
Authors: Langford Dale J , Gross Jacob B , Doorenbos Ardith Z , Tauben David J , Loeser John D , Gordon Debra B
Published: December 2018

Objective

The University of Washington instituted a policy requiring all credentialed clinicians who prescribe opioids to complete a one-time education activity about safe and responsible opioid prescribing. A scenario-based, interactive online learning module was developed for opioid management of acute pain in hospitalized adults. This study examined the impact of the education module on learners’ knowledge, perceived competence, and use of guideline-adherent practices.

Methods

Clinicians who completed the education module participated in a voluntary de-identified online survey approximately six months after the learning activity. Survey questions were related to 1) the perception of improved knowledge; 2) impact on learner’s use of three guideline-adherent practices; and 3) perceived competence in managing opioids for acute pain. Descriptive statistics were generated, and multiple linear regression models were used for analysis.

Results

Clinicians (N = 167) reported improvement in knowledge and perceived competence. Controlling for other aspects of knowledge evaluated, learning to construct a safe opioid taper plan for acute pain, distinguishing between short- and long-acting opioids, and safely initiating opioids for acute pain were significantly associated with increased self-reported likelihood of incorporating the Washington state Prescription Monitoring Program (P = 0.003), using multimodal analgesia (P = 0.022), and reducing the duration of opioids prescribed (P = 0.016). Only improvement in knowledge of how to construct a safe opioid taper plan was significantly associated with increased perceived competence (P = 0.002).

Conclusions

Our findings suggest that this online education module about safe opioid prescribing for acute pain management was effective at improving knowledge, increasing the likelihood of using guideline-adherent clinical practices, and increasing perceived competence.
Managing dyslipidemia for CVD prevention
Authors: Ciffone Nicole A. , Copple Tina
Published: December 2018

The American Association of Clinical Endocrinology and the American College of Endocrinology Clinical Practice Guideline is a comprehensive, practical tool that can be used to diagnose and manage dyslipidemia, a major risk for the development and progression of atherosclerotic cardiovascular disease. Effective therapies are available to improve lipid profiles and reduce cardiovascular events.
Report on the Sixth Pediatric Anesthesia Neurodevelopmental Assessment (PANDA) Symposium, “Anesthesia and Neurodevelopment in Children”
Authors: Lee Jennifer J. , Sun Lena S. , Levy Richard J.
Published: December 2018

On April 14 and 15, 2018, the Sixth Biennial Pediatric Anesthesia Neurodevelopmental Assessment (PANDA) Symposium convened at Columbia University Medical Center and New York Presbyterian/Morgan Stanley Children’s Hospital of New York. Since its inception over 10 years ago, the PANDA Symposium has served as a key forum for clinicians, researchers, and other major stakeholders to gather and review the current state of preclinical and clinical research related to anesthetic neurotoxicity in the developing brain. It has also served as an important venue for participants to gain insight and leverage support from various public and private regulatory bodies. Goals of this year’s meeting included assessments of how current knowledge has evolved, endeavors to develop common outcome measures, and formulations of future directions for research and policy. The Symposium program highlighted a diverse body of cutting-edge work, from results of preclinical and clinical studies to updates in clinical practice and policymaking.
Prolonged Anesthetic Exposure in Children and Factors Associated With Exposure Duration
Authors: Ing Caleb , Ma Xiaoyue , Klausner Anna J. , Dutton Richard P. , Li Guohua
Published: December 2018

Introduction:

Anesthetic exposure duration has come under scrutiny because of a Food and Drug Administration warning against prolonged use of anesthesia in children, defined as exposures longer than 3 hours.

Methods:

Data for 2,613,344 pediatric anesthetic records from the American Society of Anesthesiologist’s National Anesthesia Clinical Outcomes Registry from 2010 to 2015 were analyzed to describe anesthetic duration and the prevalence of prolonged exposures in children. Common pediatric inpatient procedures were independently assessed to determine factors associated with exposure duration.

Results:

The overall mean pediatric anesthetic duration was 83.3±107.4 minutes (median, 57 min). Prolonged exposures comprised 7% of pediatric anesthetic records, and 15% of anesthetic records in infants. After restricting to common pediatric inpatient procedures (n=96,603) and adjusting for procedure type using a Poisson model, compared with children 10 years or older, exposures in infants were 20.5% longer (anesthetic duration ratio [ADR], 1.205; 95% confidence interval [CI], 1.202–1.208). Longer exposures were also seen with a variety of other patient and hospital factors including ASA 4 patients versus ASA 1 patients, (ADR, 1.381; 95% CI, 1.376-1.386), and university hospitals versus surgery centers (ADR, 1.241; 95% CI, 1.236-1.246).

Conclusions:

Most pediatric anesthetic exposures last <1 hour with a small percentage lasting over 3 hours. Anesthetic duration for inpatient pediatric procedures, however, is associated with specific patient and hospital characteristics. These results may help identify children potentially at risk for prolonged anesthetic exposure and inform procedure time prediction and operating room scheduling.
Early Developmental Exposure to Repetitive Long Duration of Midazolam Sedation Causes Behavioral and Synaptic Alterations in a Rodent Model of Neurodevelopment
Authors: Xu Jing , Mathena Reilley Paige , Singh Shreya , Kim Jieun , Long Jane J. , Li Qun , Junn Sue , Blaize Ebony , Mintz Cyrus David
Published: December 2018

There is a large body of preclinical literature suggesting that exposure to general anesthetic agents during early life may have harmful effects on brain development. Patients in intensive care settings are often treated for prolonged periods with sedative medications, many of which have mechanisms of action that are similar to general anesthetics. Using in vivo studies of the mouse hippocampus and an in vitro rat cortical neuron model we asked whether there is evidence that repeated, long duration exposure to midazolam, a commonly used sedative in pediatric intensive care practice, has the potential to cause lasting harm to the developing brain. We found that mice that underwent midazolam sedation in early postnatal life exhibited deficits in the performance on Y-maze and fear-conditioning testing at young adult ages. Labeling with a nucleoside analog revealed a reduction in the rate of adult neurogenesis in the hippocampal dentate gyrus, a brain region that has been shown to be vulnerable to developmental anesthetic neurotoxicity. In addition, using immunohistochemistry for synaptic markers we found that the number of presynaptic terminals in the dentate gyrus was reduced, while the number of excitatory postsynaptic terminals was increased. These findings were replicated in a midazolam sedation exposure model in neurons in culture. We conclude that repeated, long duration exposure to midazolam during early development has the potential to result in persistent alterations in the structure and function of the brain.
A Summary of Preclinical Poster Presentations at the Sixth Biennial Pediatric Anesthesia Neurodevelopment Assessment (PANDA) Symposium
Authors: Griffiths Keren K. , Morgan Philip G. , Johnson Simon C. , Nambyiah Pratheeban , Soriano Sulpicio G. , Johnson Kenneth , Xu Jing , Garber Carol , Maxwell Lynne , Saraiya Neeta
Published: December 2018

The potential for long-term neurotoxic effects of anesthetics on the developing human brain has led to intensified research in this area. To date, the human evidence has been inconclusive, but a large body of animal evidence continues to demonstrate cause for concern. On April 14 and 15, 2018 the sixth biennial Pediatric Anesthesia and Neurodevelopmental Assessment (PANDA) study symposium was held at Morgan Stanley Children’s Hospital of New York. This symposium brought together clinicians and researchers and served as a platform to review preclinical and clinical data related to anesthesia and neurotoxicity in developing brains. The program participants included many active investigators in the field of anesthesia neurotoxicity as well as stakeholders from different backgrounds with the common interest of potential anesthetic neurotoxicity in children. The moderated poster session included presentations of preclinical animal research studies. These studies focused on defining the anesthetic-induced neurotoxicity phenotype, understanding the mechanism of injury and discovering potential inhibitors of neurotoxic effects.
Retrospective Analysis of Perioperative Variables Associated With Postoperative Delirium and Other Adverse Outcomes in Older Patients After Spine Surgery
Authors: Susano Maria J. , Scheetz Seth D. , Grasfield Rachel H. , Cheung Dominique , Xu Xinling , Kang James D. , Smith Timothy R. , Lu Yi , Groff Michael W. , Chi John H. , Crosby Gregory , Culley Deborah J.
Published: December 2018

Background:

The aim of this retrospective study was to identify perioperative variables predictive of the development of delirium in older surgical patients after spine surgery.

Materials and Methods:

We collected preoperative, intraoperative, and postoperative data on patients 65 years of age and above having spine surgery between July 1, 2015 and March 15, 2017. The primary outcome was the development of postoperative delirium. Data were analyzed using univariate and multivariable analysis.

Results:

Among the 716 patients included in this study 127 (18%) developed postoperative delirium. On multivariable analysis, independent predictors of postoperative delirium included older age (odds ratio [OR]=1.04; 95% confidence interval [CI], 1.00-1.09; P=0.048), American Society of Anesthesiologists physical status >2 (OR=1.89 [95% CI, 1.04-3.59]; P=0.042), metabolic equivalents of task <4 (OR=1.84 [95% CI, 1.10-3.07]; P=0.019), depression (OR=2.01 [95% CI, 1.21-3.32]; P=0.006), nonelective surgery (OR=4.81 [95% CI, 1.75-12.79]; P=0.002), invasive surgical procedures (OR=1.97 [95% CI, 1.10-3.69]; P=0.028) and higher mean pain scores on postoperative day 1 (OR=1.28 [95% CI, 1.11-1.48]; P<0.001).

Conclusions:

Postoperative delirium is a common complication in older patients after spine surgery, and there are several perioperative risk factors associated with its development.
Independent Locking Screws for Articular Fragment Fixation in the Elbow
Authors: Felstead Alisdair J. , Phadnis Joideep
Published: December 2018

Articular fractures of the elbow require direct reduction and interfragmentary fixation to restore anatomic stability. The fragments are often small, with limited bone stock, hence implants are often placed through the articular surface to gain maximal purchase. Traditional techniques involve the use of countersunk cortical screws or cannulated headless compression screws. We describe a technique in which small locking screws are used independently from a plate as a substitute for headless or other traditional screws. This method of fixation negates the need for countersinking the screw head, or over drilling a guide wire, and enables the use of smaller diameter screws which provide excellent purchase in very small fragments. Independent locking screws can be considered for any fracture that previously would have been amenable to cortical or headless compression screw fixation. Locking screws from several manufacturers have been used with equal success. Screws can be used in a unicortical manner if necessary, as the grip comes from engaging the subchondral bone with the locking thread. This technique has been used on 35 consecutive articular elbow fractures with a minimum 6-month follow-up. All fractures have achieved bony union within this period, and there have been no loss of fixations or requirement for further surgeries to remove prominent metalwork.
What Is Faith-Based Health Promotion? A Working Definition
Authors: Patestos Chrysanthe
Published: December 2018

Faith-based health promotion (FBHP) is a concept utilized across multiple disciplines, including nursing, public health, government, social work, and medicine. This article presents a hybrid concept analysis of FBHP and construction of a working definition for further investigative study. Defining FBHP is especially valuable for faith community nurses (FCNs), public health nurses, and other healthcare professionals who seek to study and offer FBHP. The relationship and application of FBHP to FCN practice is explored.
Treating Chronic Nonmalignant Pain
Authors: Snell Sarah , Hughes Tia , Fore Carolyn , Lukman Roy , Morgan Brett
Published: December 2018

A significant portion of the world's population is impacted by chronic pain; in the United States, chronic pain costs billions annually in treatment and lost productivity. A needs assessment was conducted to evaluate the prevalence of chronic nonmalignant pain (CNMP) at a university occupational therapy clinic over a 3-month period; recommendations were made to improve pain management at the clinic and referring hospital system. Graded Chronic Pain Scale 2.0 results indicated the prevalence of CNMP was a significant problem. Three evidence-based interventions based on the biblically based CREATION Health Model were developed.
Ready to Care? Student Nurse Perceptions of Spiritual Care Education
Authors: Brown Kimberly , Humphreys Heather , Whorley Elizabeth , Bridge Diane
Published: December 2018

This research investigated the spiritual care educational preparation that nursing students perceive they have received as they transition to practice. A survey using the Spirituality and Spiritual Care Rating Scale and interviews with senior BSN students at a Christian university demonstrated students' perceptions that their spiritual care education focused primarily on the practice of presence, emphasis on prayer, and the integration of faith in the curricula. Survey results showed a strong perception of readiness to provide spiritual care as graduate nurses.
Attitudes of Iranian Nurses Toward Spirituality and Spiritual Care
Authors: Abdollahyar Asma , Baniasadi Hamidehe , Doustmohammadi Mohammad M. , Sheikhbardesiri Hojjat , Yarmohammadian Mohammad H.
Published: December 2018

Spirituality and spiritual care play a crucial role in providing more effective treatment for patients. The purpose of this study was to determine nurses' attitudes toward spirituality and spiritual care in an educational hospital in Iran. A significant association was found between nurses' spirituality/spiritual care attitudes and age, education level, and type of hospital ward employment (noncritical vs. critical care). Nurses' scores on attitudes toward spirituality and spiritual care suggest the need for more education in this area.
Patient-reported Outcomes in Facial Reconstruction: Assessment of FACE-Q Scales and Predictors of Satisfaction
Authors: Elegbede Adekunle , Mermulla Sara , Diaconu Silviu C. , McNichols Colton , Liang Yuanyuan , Liang Fan , Rasko Yvonne M. , Grant Michael P. , Nam Arthur J.
Published: December 2018

Background:

There is a paucity of patient-reported outcome measures for facial trauma reconstruction. To measure satisfaction and health-related quality of life (HRQOL), following repair of traumatic facial fractures, we used the FACE-Q, a set of patient-reported outcome instruments designed for aesthetic facial surgery. As a step toward validating the scales for facial trauma, we evaluated their reliability.

Methods:

This is a prospective study of patients following primary repair of traumatic facial fractures at a level 1 trauma center from 2016 to 2018. Six FACE-Q scales with relevance to the facial trauma population were completed by patients at their 1-month postoperative visits. Predictors of satisfaction were examined using multiple linear regression models. Reliability of the scales in this population was evaluated using psychometric methods.

Results:

One hundred eighty-five participants fulfilled inclusion criteria. Mean scores for the 6 scales ranged from 59 (SD = 15) for Recovery-Early Life Impact to 94 (SD = 13) for Satisfaction with Medical Team. Predictors of lower satisfaction and/or HRQOL include current tobacco smoking status, mandibulomaxillary fixation, and Le Fort pattern fractures. All scales were found to have good to excellent reliability (Cronbach’s alpha = 0.824–0.969).

Conclusions:

Following repair of facial fractures, patient-reported outcomes can be reliably measured using FACE-Q scales. On average, patients report poor health-related quality of life in the early postoperative period. Predictors of low satisfaction and/or poor HRQOL include current smoking habit, mandibulomaxillary fixation, and Le Fort fractures.
Expanded Utilization of the Digital Atasoy Flap
Authors: Viciana Enrique J. , Lessard Anne-Sophie
Published: December 2018

Background:

The Atasoy, or Kleinert flap, is well-known to hand surgeons. This triangular volar V-Y flap is frequently used for reconstruction of fingertip amputations with exposed bone. It is indicated in transverse amputations or in dorsal oblique amputations, providing replacement of an area of skin and subcutaneous tissues with sensibility. Originally, this flap was not recommended for use in volar oblique amputations (greater volar tissue loss). With the described modifications and recommendations, modest volar oblique amputations can be closed in a single stage, obviating a 2-stage procedure.

Methods:

With the described technical modifications, modest volar oblique amputations can be closed. An injury that previously may have required a 2-stage procedure can be closed in a single stage.

Results:

The elevation of the flap was originally described as a dissection at the volar periosteum from a distal approach. This distal dissection is no longer recommended, as it does not create advancement. Beasley indicated the need for division of the vertical fibrous septa proximally for flap mobilization. This technique description emphasizes the importance of this division of the fibrous septa rather than stretching. Careful treatment of the remaining bone is stressed. Coverage of the nail bed is not recommended.
The impact of anxiety on chronic musculoskeletal pain and the role of astrocyte activation
Authors: Burston James J. , Valdes Ana M. , Woodhams Stephen G. , Mapp Paul I. , Stocks Joanne , Watson David J.G. , Gowler Peter R.W. , Xu Luting , Sagar Devi R. , Fernandes Gwen , Frowd Nadia , Marshall Laura , Zhang Weiya , Doherty Michael , Walsh David A. , Chapman Victoria
Published: December 2018

Anxiety and depression are associated with increased pain responses in chronic pain states. The extent to which anxiety drives chronic pain, or vice versa, remains an important question that has implications for analgesic treatment strategies. Here, the effect of existing anxiety on future osteoarthritis (OA) pain was investigated, and potential mechanisms were studied in an animal model. Pressure pain detection thresholds, anxiety, and depression were assessed in people with (n = 130) or without (n = 100) painful knee OA. Separately, knee pain and anxiety scores were also measured twice over 12 months in 4730 individuals recruited from the general population. A preclinical investigation of a model of OA pain in normo-anxiety Sprague-Dawley (SD) and high-anxiety Wistar Kyoto (WKY) rats assessed underlying neurobiological mechanisms. Higher anxiety, independently from depression, was associated with significantly lower pressure pain detection thresholds at sites local to (P< 0.01) and distant from (P< 0.05) the painful knee in patients with OA. Separately, high anxiety scores predicted increased risk of knee pain onset in 3274 originally pain-free people over the 1-year period (odds ratio = 1.71; 95% confidence interval = 1.25-2.34,P< 0.00083). Similarly, WKY rats developed significantly lower ipsilateral and contralateral hind paw withdrawal thresholds in the monosodium iodoacetate model of OA pain, compared with SD rats (P= 0.0005). Linear regressions revealed that baseline anxiety-like behaviour was predictive of lowered paw withdrawal thresholds in WKY rats, mirroring the human data. This augmented pain phenotype was significantly associated with increased glial fibrillary acidic protein immunofluorescence in pain-associated brain regions, identifying supraspinal astrocyte activation as a significant mechanism underlying anxiety-augmented pain behaviour.
Assessment of the Abuse Potential of Cebranopadol in Nondependent Recreational Opioid Users
Authors: Göhler Karin , Sokolowska Marta , Schoedel Kerri A. , Nemeth Robert , Kleideiter Elke , Szeto Isabella , Eerdekens Marie-Henriette
Published: December 2018

Background

Cebranopadol is a nociceptin/orphanin FQ peptide/opioid receptor agonist with central antinociceptive activity. We hypothesize that this novel mechanism of action may lead to a lower risk of abuse compared with pure μ-opioid peptide receptor agonists.

Methods

We conducted a single-dose, nested-randomized, double-blind crossover study in nondependent recreational opioid users to evaluate the abuse potential of single doses of cebranopadol relative to hydromorphone immediate release and placebo. The study consisted of a qualification phase and a 7-period treatment phase (cebranopadol 200, 400, and 800 μg; hydromorphone 8 and 16 mg; and 2 placebos). The primary end point was the peak effect of drug liking at this moment, measured by visual analog scale (VAS). Various secondary end points (eg, VAS rating for good drug effects, high, bad drug effects, take drug again, drug similarity, and pupillometry) were also investigated.

Results

Forty-two subjects completed the study. Cebranopadol 200 and 400 μg did not differentiate from placebo on the abuse potential assessments and generated smaller responses than hydromorphone. Responses observed with cebranopadol 800 μg were similar to hydromorphone 8 mg and smaller than hydromorphone 16 mg. The maximum effect for VAS drug liking at this moment was delayed compared with hydromorphone (3 and 1.5 hours, respectively). Cebranopadol administration was safe; no serious adverse events or study discontinuation due to treatment-emergent adverse events occurred.

Conclusions

These results confirm our hypothesis that cebranopadol, a nociceptin/orphanin FQ peptide/opioid receptor agonist, has lower abuse potential than hydromorphone immediate release, a pure μ-opioid peptide agonist.
An 8-Week, Randomized, Phase 2, Double-Blind, Sequential Parallel-Group Comparison Study of Two Dose Levels of the GABAA Positive Allosteric Modulator PF-06372865 Compared With Placebo as an Adjunctive Treatment in Outpatients With Inadequate Response to Standard of Care for Generalized Anxiety Disorder
Authors: Simen Arthur , Whitlock Mark , Qiu Ruolun , Miceli Jeff , Zumpano Laura , Du Metz Michaele , Dua Pinky , Binneman Brendon
Published: December 2018

Background

Generalized anxiety disorder (GAD) is a common psychiatric disorder, but many patients experience only partial relief of symptoms with existing therapies. Benzodiazepines are effective in many cases but are limited by a number of significant adverse effects. PF-06372865 is a subtype-selective gamma-aminobutyric acid A (GABAA)–positive allosteric modulator lacking in functional activity at alpha 1–containing receptors that are believed to mediate many of these adverse effects.

Methods

PF-06372865 was evaluated as an adjunct to current GAD treatment in a double-blind, placebo-controlled, sequential parallel comparison study in patients with GAD who showed an incomplete response to current standard-of-care pharmacotherapy. A total of 90 subjects (of the planned 384) were randomized into the study before the decision to terminate the study. Two doses of PF-06372865 (2.5 mg twice daily and 7.5 mg twice daily) were compared with placebo.

Results

Neither dose of PF-06372865 differentiated from placebo on week 4 Hamilton Anxiety Inventory total (primary end point) or on the Sheehan Disability Scale total score (secondary end point). Adverse events including dizziness, headache, and somnolence were observed, and the 7.5 mg dose demonstrated some impairment on the Digit Symbol Substitution test and the Epworth Sleepiness Scale relative to placebo and the 2.5 mg dose.

Conclusions

Factors contributing to the negative results include the limited sample size and failure to explore a broader range of doses.
Five-year-term results in cirrhotics without varices, either affected or not by portal hypertensive gastropathy
Authors: Zardi Enrico M. , Pipita Maria E. , Lichinchi Domenico , Dobrina Aldo
Published: December 2018

Objectives

Information is lacking on the appearance of varices in cirrhotics, either affected or not by portal hypertensive gastropathy (PHG). We assessed whether the absence or presence and the grade of PHG influenced the development of varices in cirrhotics without varices over time.

Patients and methods

Forty cirrhotics without varices affected or not by PHG at baseline underwent follow-up endoscopy after 5 years. One-tailed t-test and the χ
2-test were used to evaluate variable comparison and the presence of associations. Multivariate logistic regression analysis and the analysis of variance test were carried out to compare the variables and identify predictors of varices.

Results

The Child–Pugh score at baseline and after 5 years was significantly different (5.72±0.98 vs. 6.25±1.67, P<0.001). After 5 years, 10 (25%) cirrhotics were affected by varices, whereas 30 (75%) patients remained without varices. PHG was associated significantly with varices (P=0.001), proving to be a significant predictive independent factor for their development over time (F=4.765, significant=0.004; analysis of variance test, P<0.001).

Conclusion

A link between the duration of PHG and the development of varices is likely. An early therapeutic management of PHG might delay the development of varices in cirrhotics.
Spondylolysis 2019 update
Authors: Berger Rachel G. , Doyle Shevaun M.
Published: December 2018

Purpose of review

Provide a comprehensive overview of lumbar spondylolysis, a frequent cause of lower back pain in children and adolescents, from evaluation to management.

Recent findings

With the surge of structured sports participation in the pediatric population, spondylolysis is a common ailment that afflicts many young athletes due to rigorous competition that taxes the growing spine with repetitive extension and rotation.

Spondylolysis is a fracture through the pars interarticularis. When a child presents with lower back pain, spondylolysis should be at the top of the differential. A thorough history and physical examination are essential. In addition, radiographs of the lumbar spine, anterior posterior and lateral views, MRI and, selectively, computed tomography are useful adjuncts to uncover a pars injury. Timely diagnosis facilitates early treatment which includes rest, optimizing bone health, brace treatment, and physical therapy. If delayed or untreated, spondylolysis may result in nonunion or pars defect. If symptomatic, patients may need surgery to fuse the lumbar facet joints or repair the par interarticularis.
Pediatric and adolescent ankle instability: diagnosis and treatment options
Authors: Gruskay Jordan A. , Brusalis Christopher M. , Heath Madison R. , Fabricant Peter D.
Published: December 2018

Purpose of review

The purpose of this review is to discuss the epidemiology, pathoanatomy, diagnosis, and treatment for lateral ankle instability in pediatric patients.

Recent findings

Chronic ankle instability is a common sequela of lateral ankle sprain in young athletes. Incidence is increasing, possibly due in part to inadequate treatment of first-time ankle sprains, as well as increased youth participation in organized and competitive sports. The anterior talofibular ligament (ATFL) is injured in every case, whereas the calcaneofibular ligament (CFL) and syndesmosis may be involved in severe cases. A clinical history, focused physical exam, and appropriate radiographic studies aid in diagnosis, and predisposing factors must be identified. Early treatment of ankle sprains involves bracing or immobilization, followed by a course of physical therapy. Surgery involves anatomic repair of the torn ligaments, and may be required in cases of severe functional and mechanical instability with recurrent sprains refractory to nonsurgical management. Intraarticular disorders should be identified and may be addressed with ankle arthroscopy.

Prompt treatment of lateral ankle instability in young athletes is important to prevent chronic ankle instability. Many patients are successfully treated without surgery, and those requiring operative intervention improve function postoperatively.
Cardioprotective Effects of Spirulina Therapy in Children With Beta-Thalassemia Major
Authors: El-Shanshory Mohammed , Tolba Osama , El-Shafiey Rasha , Mawlana Wegdan , Ibrahim Magda , El-Gamasy Mohamed
Published: December 2018

Introduction:

Cardiac failure in children with Thalassemia major (TM) is the major cause of death due to iron overload. Spirulina is a micro alga with proven anti-inflammatory, antioxidant and may have a cardioprotective effect.

Aim of the Work:

The aim of this study was to evaluate the possible beneficial effect of spirulina supplement in TM children.

Subject and Methods:

It is an interventional study carried out in 60 children with TM and 30 healthy children matched for age and sex as control. Both groups received spirulina supplement at a dose of 250 mg/kg/d for 3 months. 2D Echo, Tissue Doppler, and speckle tracking imaging (STI) were done for all the studied cohort before and after the 3-month duration of spirulina supplement.

Results:

There was significant improvement in hemoglobin level at the end of 3-month period (8.27±1.3 vs. 9.023±1.7; P <0.033) with decrease the frequency of blood transfusion in TM patients (66.6% vs. 40% required transfusion at interval less than 2 wk). Left ventricle global longitudinal strain (LVGLS) significantly improved after 3-month period (−21.7±4.64 vs. −24.67±4.478; P <0.002).

Conclusions:

Spirulina supplement has possible beneficial effect in minimizing the frequency of blood transfusion as well as cardioprotective effect against cardiac damage in TM patients.
How to Build a Positive, Multigenerational Workforce
Authors: Graystone Rebecca
Published: December 2018

Today’s multigenerational nursing workforce presents unique leadership challenges. With an unprecedented 5 generations in the workplace, each with its own attitudes, beliefs, habits, and expectations, chief nursing officers and others must find ways to navigate disparities and leverage strengths. Leaders who effectively manage their age-diverse teams enjoy numerous advantages and give their organizations a competitive edge. This month’s “Magnet Perspectives” column examines how nursing leaders can create a work environment that makes the most of multigenerational differences. What does each generation bring to the table? How can the Magnet® framework help managers capitalize on these traits to build a cohesive, productive nursing team? The column takes an in-depth look at how the principles of Magnet are tailor-made to cultivate a workplace where all generations thrive, enhance quality and productivity, reduce conflict, and maximize the contributions of every team member.