bluuebunny/crossref_metadata_2025 huggingface dataset:
Experiences of Burnout among Drug Counselors in A Large Opioid Treatment Program: A Qualitative Investigation
Authors: Beitel Mark , Oberleitner Lindsay , Muthulingam Dharushana , Oberleitner David , Madden Lynn M. , Marcus Ruthanne , Eller Anthony , Bono Madeline H. , Barry Declan T.
Published: March 2018

Background

Little is known about possible experiences of burnout among drug counselors in opioid treatment programs that are scaling up capacity to address the current opioid treatment gap.

Methods

Participants in this quality improvement study were 31 drug counselors employed by large opioid treatment programs whose treatment capacities were expanding. Experiences of burnout and approaches for managing and/or preventing burnout were examined using individual semi-structured interviews, which were audiotaped, transcribed, and systematically coded by a multidisciplinary team using grounded theory.

Results

Rates of reported burnout (in response to an open-ended question) were lower than expected, with approximately 26% of participants reporting burnout. Counselor descriptions of burnout included cognitive, affective, behavioral, and physiological symptoms; and job-related demands were identified as a frequent cause. Participants described both self-initiated (e.g., engaging in pleasurable activities, exercising, taking breaks during workday) and system-supported strategies for managing or preventing burnout (e.g., availing of supervision and paid time off). Counselors provided recommendations for system-level changes to attenuate counselor risk of burnout (e.g., increased staff-wide encounters, improved communication, accessible paid time off, and increased clinical supervision).

Conclusions

Findings suggest that drug counselor burnout is not inevitable, even in opioid treatment program settings whose treatment capacities are expanding. Organizations might benefit from routinely assessing counselor feedback about burnout and implementing feasible recommendations to attenuate burnout and promote work engagement.
Pteris multifida, Cortex phellodendri, and probiotics attenuated inflammatory status and immunity in mice with a Salmonella enterica serovar Typhimurium infection
Authors: Yin Mei-Chin , Chang Chiung-Hung , Su Chiu-Hsian , Yu Bi , Hsu Yuan-Man
Published: March 2018

Pteris multifida (PM) and Cortex phellodendri (CP) are medicinal foods used for gastrointestinal protection. Lactic-acid bacteria are probiotics. Salmonella Typhimurium strain ST21-infected mice were used to examine the alleviative effects of two lactic-acid bacteria (LAB) as well as aqueous extracts of PM and CP for a 4-day treatment. CP and LAB decreased fecal ST counts. CP and PM reduced the ST21 count in the blood, intestine, and liver. LAB lowered the ST21 count in the intestine and spleen. CP and LAB decreased the IFN-gamma level; PM lowered the TNF-alpha level; and both LAB and PM reduced the IL-1beta level in serum. PM and CP lowered the IgG level in serum. The data in a macrophage infection model indicate that TNF-alpha was partial involved in this alleviative effects, other mechanisms might be involved. In sum, these novel findings suggest that PM, CP, and LAB probiotics are potential anti-Salmonellae agents.
‘You Think You Know a Story…’: Reframing the Tudors on Television in the Twenty-First Century
Authors: Mullin Romano
Published: March 2018

Over the past 10 years, there has been an explosion in the number of television dramas about Tudor England. These programmes have been engaged in a re-visioning of history that prioritizes a heterogeneous approach to the past, adapting historical themes, figures, and events in order to challenge existing conceptions about the nature of history. By using Showtime’s The Tudors (2007–2010) and the BBC’s Wolf Hall 2015 as examples, this paper explores how both series reimagine the Tudor era by destabilising traditional modes of historical engagement and emphasizing the shared narrative lineage of historiography and history as entertainment. Ultimately, the paper argues that these programmes are responding not only to new ways of accessing the past, but also by adapting a period which is central to an Anglocentric cultural identity, they are responding to the crises and political faultlines that have marked the twenty-first century.
Repeat-aware evaluation of scaffolding tools
Authors: Mandric Igor , Knyazev Sergey , Zelikovsky Alex
Published: March 2018

Genomic sequences are assembled into a variable, but large number of contigs that should be scaffolded (ordered and oriented) for facilitating comparative or functional analysis. Finding scaffolding is computationally challenging due to misassemblies, inconsistent coverage across the genome and long repeats. An accurate assessment of scaffolding tools should take into account multiple locations of the same contig on the reference scaffolding rather than matching a repeat to a single best location. This makes mapping of inferred scaffoldings onto the reference a computationally challenging problem. This paper formulates the repeat-aware scaffolding evaluation problem, which is to find a mapping of the inferred scaffolding onto the reference maximizing number of correct links and proposes a scalable algorithm capable of handling large whole-genome datasets. Our novel scaffolding validation framework has been applied to assess the most of state-of-the-art scaffolding tools on the representative subset of Genome Assembly Golden-Standard Evaluations (GAGE) datasets and some novel simulated datasets.

Availability and implementation

The source code of this evaluation framework is available at https://github.com/mandricigor/repeat-aware. The documentation is hosted at https://mandricigor.github.io/repeat-aware.

Supplementary information

Supplementary data are available at Bioinformatics online.
The Uniformed Services University of the Health Sciences, F. Edward Hébert School of Medicine: Status of the Federal Medical School after 25 Years
Authors: Gardner John W. , Harmon Susan , Stavish Peter J.
Published: March 2018

In its first 25 years, the Uniformed Services University of the Health Sciences (USUHS) has become a quality institution of medical education that provides a steady flow of career physicians for the military. It compares favorably with U.S. medical school averages in all aspects of undergraduate medical education: faculty, teaching facilities, matriculants, curriculum, student performance, and cost. USUHS provides excellent medical education and adds unique preparation for uniformed public service. It also provides military-specific graduate education, graduate medical education, continuing health education, medical research, clinical services, consultation, public service, and ties with international military, medical, and research institutions.
Generalizability in Pregnancy and Work Research
Authors: Evans Mary Ann
Published: March 2018

Generalizability of findings is a critical issue in research on pregnancy and work. The characteristics of a sample of 350 pregnant military women were compared with those of the populations of active duty women and active duty pregnant women. The sample was fairly representative in terms of minority status and age. The sample differed somewhat in terms of branch of service, rank, and marital status. Comparisons of demographics and pregnancy planning between military and civilian pregnant women supported generalizability. Unique aspects of military service and different access to health care among civilian pregnant women warrant caution in generalizing of findings.
Safety and Efficacy of DEET and Permethrin in the Prevention of Arthropod Attack
Authors: Young G. David , Evans Sandra
Published: March 2018

Many preventable diseases affecting troop strength are directly attributed to disease-carrying insects. The first line of defense against arthropod vectors is the use of personal protective measures. The concurrent application of DEET (N,N-diethyl-m-toluamide) repellent on the skin and permethrin [(3-phenoxy-phenyl)methyl(±)cis,trans-3-(2,2-dichloroethenyl)-2,2-dimethylcyclopropane-carboxylate] insecticide on the battle dress uniform, while the uniform is worn properly, is a personal protective strategy officially known as the DOD Insect Repellent System. It is important for troop commanders and field leaders to enforce the use of personal protective measures to prevent insect-borne infectious diseases and to ensure troop and soldier readiness. DEET is a safe and effective repellent. Permethrin is a synthetic pyrethroid insecticide and repellent. Used in conjunction with proper clothing and other personal protective equipment, these repellents provide the best known protection available and are critical in minimizing the occupational health threat of arthropod-borne diseases to troops in the field.
Acute Necrotizing Ulcerative Gingivitis-Periodontitis: A Literature Review
Authors: Wade Douglas N. , Kerns David G.
Published: March 2018

Acute necrotizing ulcerative gingivitis-periodontitis (ANUG/ NUP) is a relatively uncommon periodontal disease characterized by gingival necrosis and ulceration, pain, and bleeding. The purpose of this paper is to provide a review of current knowledge on ANUG/NUP. Current literature on the epidemiology, pathogenesis, immunology, predisposing factors, and treatment of ANUG/NUP is reviewed.
Ejection of rocky and icy material from binary star systems: implications for the origin and composition of 1I/‘Oumuamua
Authors: Jackson Alan P , Tamayo Daniel , Hammond Noah , Ali-Dib Mohamad , Rein Hanno
Published: March 2018

In single-star systems like our own Solar system, comets dominate the mass budget of bodies ejected into interstellar space, since they form further away and are less tightly bound. However, 1I/‘Oumuamua, the first interstellar object detected, appears asteroidal in its spectra and lack of detectable activity. We argue that the galactic budget of interstellar objects like 1I/‘Oumuamua should be dominated by planetesimal material ejected during planet formation in circumbinary systems, rather than in single-star systems or widely separated binaries. We further show that in circumbinary systems, rocky bodies should be ejected in comparable numbers to icy ones. This suggests that a substantial fraction of interstellar objects discovered in future should display an active coma. We find that the rocky population, of which 1I/‘Oumuamua seems to be a member, should be predominantly sourced from A-type and late B-star binaries.
Intraoperative Traction May Be a Viable Alternative to Anterior Surgery in Cerebral Palsy Scoliosis ≥100 Degrees
Authors: Jackson Taylor J. , Yaszay Burt , Pahys Joshua M. , Singla Anuj , Miyanji Firoz , Shah Suken A. , Sponseller Paul D. , Newton Peter O. , Flynn John M. , Cahill Patrick J.
Published: March 2018

Background:

For large scoliosis, 2 strategies to maximize correction include intraoperative traction and/or anterior release. It is unclear which patients will benefit the most form either approach. The purpose of our study is to compare the radiographic, perioperative clinical outcomes, and health-related quality of life (HRQoL) outcomes of 2 approaches when used in severe neuromuscular scoliosis in the setting of cerebral palsy (CP).

Methods:

In total, 23 patients with minimum 2-year follow-up, major curves ≥100 degrees, and in whom treatment included posterior spinal fusion were evaluated. Eighteen were treated with posterior spinal fusion with intraoperative traction and 5 with anterior/posterior spinal fusion (APSF). The baseline characteristics, perioperative outcomes, and preoperative and 2-year follow-up data for HRQoL and radiographic measures were compared.

Results:

The groups had similar age, sex, nutritional and seizure status, GMFCS level, and change in CPCHILD scores. The groups had similar curve magnitude (120 vs. 105 degrees, P=0.330) and flexibility (28% vs. 40%, P=0.090), but the APSF group had less pelvic obliquity (POB) (24 vs. 42 degrees, P=0.009). There were similar postoperative major curves (37 vs. 40 degrees, P=0.350), but greater correction in POB (33.5 vs. 14 degrees of correction, P=0.007) in the traction group. The APSF group had longer anesthesia times (669 vs. 415 min, P=0.005), but similar hospital stays, intensive care unit and days intubated, estimated blood loss, cell saver, and red blood cells used. Although the APSF group had twice the rate of complications (22% vs. 40%) during the first 90 days postoperatively, this did not reach statistical significance.

Conclusions:

Both intraoperative traction and anterior surgery were used to aid correction in severe CP scoliosis. Anterior surgery did not offer superior correction or better HRQoL, and was associated with increased operative times, whereas intraoperative traction was associated with greater correction of POB. Intraoperative traction may be a viable alternative to an anterior release in severe CP scoliosis.

Level of Evidence:

Level II.
Management of Infected Nonunited Femoral Fracture With Large Bone Defects: A Technique
Authors: Ghaffar Khalid Abd El , Diab Ramy , Kotb Ahmed
Published: March 2018

Background:

Segmental defects created after debridement for infected nonunion of long bones can be managed by external fixation and bone grafting, bone transport, or microvascular free-tissue flaps. Distorted local anatomy with a cumbersome Ilizarov frame, recipient site complications, thrombosis, and graft failure are possible complications of trending treatment modalities. Our 2-staged novel technique offers a simpler, easier, lesser money and time-consuming procedure to combat one of the most difficult orthopedic problems.

Patients and Methods:

Between January 2012 and January 2014, 12 patients, all were male individuals, enrolled in a prospective study underwent a 2-staged operation for infected nonunited femoral fracture with large bone defects. The first stage included radical debridement and sequestrectomy with rush pin fixation to maintain alignment and medullary patency supported by biplanar or limb reconstruction fixator; the second stage included 4 corticocancellous bone graftings. Follow-up was for a duration of a mean of 24±3.4 months; the mean duration for full union was 9.36±1.6 months. Complications included knee flexion deformity managed by flexion deformity graft and pain at site by iliac crest graft.

Conclusions:

Our method of treatment presents a new approach for management of one of the most complicated orthopedic problems ever. Our method is economic, and cost and time saving, consuming less time and materials needed for the operation.
Guided Pelvic Resections in Tumor Surgery
Authors: Alexander John H. , Mayerson Joel L. , Scharschmidt Thomas J.
Published: March 2018

Primary bone sarcoma of the pelvis is one of the more challenging pathologies treated by orthopedic oncologists. In particular, their anatomic complexity contributes to delays in diagnosis and high rates of positive margins with associated high rates of local recurrence, all contributing to poor outcomes in this patient population. Computer-assisted surgery in the form of navigation and patient-specific instrumentation has shown promise in other fields of orthopedics. Intuitively, in an effort to improve tumor resections and improve oncologic outcomes, surgeons have been working to apply these advances to orthopedic oncology. Early studies have demonstrated benefits from guided pelvic resections, with studies demonstrating improved resection accuracy, fewer positive margins and decreased rates of local recurrence. Although these techniques are promising and will likely become an essential tool for orthopedic oncologist, surgeons must understand the limitations and costs associated with each technology before blind adoption.
Treatment and Spiritual Care in Mental Health
Authors: Neathery Melissa
Published: March 2018

Recovery in mental illness is a person-oriented process that involves self-determination/choice, and growth potential. This article discusses eight components of recovery-oriented treatment, and how nurses in any setting can facilitate recovery and encourage the healthy role of spirituality in clients' lives during the recovery process. Biblical references relating to each component of the recovery-oriented process are offered.
Authentic Leadership
Authors: Hughes Vickie
Published: March 2018

Integrity is a highly desired leadership trait. Authentic leaders reflect on their behavior and seek feedback about how their actions affect others. How can a nurse develop as an authentic leader who consistently demonstrates integrity? The following are discussed: Reflection; Connection to Christ and others; Social and Emotional Intelligence providing perceptive competency and social awareness; Aesthetic Qualities whereby leaders apply experiential knowing in leadership situations; and effective expression of Gratitude as a meaningful act of valuing others.
Journeys to Jamaica
Authors: Whelan Margaret , Ulrich Ethel , Ginty Joan , Walsh Denise
Published: March 2018

Nurse practitioner and doctor of nursing practice students gain cultural awareness and primary care experience on biannual medical mission trips to Jamaica. Faith-based Molloy College's partnership with professional medical volunteers enables students to apply clinical skills, express compassion, and gain interprofessional experience. Volunteers provide care and education for the high prevalence of noncommunicable conditions found in Jamaica. The program enjoys a positive relationship with Jamaica's Ministry of Health; a research study will assess impact on students and patients.
CLINICAL AND GENETIC CHARACTERISTICS OF MALE PATIENTS WITH RPGR-ASSOCIATED RETINAL DYSTROPHIES
Authors: Talib Mays , van Schooneveld Mary J. , Thiadens Alberta A. , Fiocco Marta , Wijnholds Jan , Florijn Ralph J. , Schalij-Delfos Nicoline E. , van Genderen Maria M. , Putter Hein , Cremers Frans P. M. , Dagnelie Gislin , ten Brink Jacoline B. , Klaver Caroline C. W. , van den Born L. Ingeborgh , Hoyng Carel B. , Bergen Arthur A. , Boon Camiel J. F.
Published: March 2018

Purpose:

To describe the phenotype and clinical course of patients with RPGR-associated retinal dystrophies, and to identify genotype–phenotype correlations.

Methods:

A multicenter medical records review of 74 male patients with RPGR-associated retinal dystrophies.

Results:

Patients had retinitis pigmentosa (RP; n = 52; 70%), cone dystrophy (COD; n = 5; 7%), or cone-rod dystrophy (CORD; n = 17; 23%). The median follow-up time was 11.6 years (range 0–57.1). The median age at symptom onset was 5.0 years (range 0–14 years) for patients with RP and 23.0 years (range 0–60 years) for patients with COD/CORD. The probability of being blind (best-corrected visual acuity <0.05) at the age of 40 was 20% and 55% in patients with RP and COD/CORD, respectively. RPGR-ORF15 mutations were associated with high myopia (P = 0.01), which led to a faster best-corrected visual acuity decline in patients with RP (P < 0.001) and COD/CORD (P = 0.03). Patients with RP with RPGR-ORF15 mutations had a faster visual field decline (P = 0.01) and thinner central retina (P = 0.03) than patients with mutations in exon 1 to 14.

Conclusion:

Based on best-corrected visual acuity survival probabilities, the intervention window for gene therapy for RPGR-associated retinal dystrophies is relatively broad in patients with RP. RPGR-ORF15 mutations were associated with COD/CORD and with a more severe phenotype in RP. High myopia is a risk factor for faster best-corrected visual acuity decline.
LARGE UVEAL MELANOMA (≥10 MM THICKNESS)
Authors: Shields Carol L. , Sioufi Kareem , Robbins Justin S. , Barna Laura E. , Harley Maxwell R. , Lally Sara E. , Say Emil Anthony T. , Mashayekhi Arman , Shields Jerry A.
Published: March 2018

Purpose:

To analyze the clinical features and rate of metastatic disease in eyes with large (≥10 mm thickness) uveal melanoma.

Design:

Retrospective noncomparative case series.

Participants:

There were 1,311 consecutive patients.

Methods:

Retrospective medical chart review.

Main outcome measures:

Clinical features and rate of metastatic melanoma.

Results:

Of 1,311 patients with large melanoma, the mean age was 59 years (median 60, range 6–98 years) and 95% were white. Mean tumor basal dimension was 17 mm (median 17, range 7–25 mm), and mean tumor thickness was 12 mm (median 12, range 10–24 mm). Mean distance to the foveola was 6 mm (median 6, range 0–19 mm) and to optic nerve was 6 mm (median 5, range 0–19 mm). Of all eyes, using Kaplan–Meier analysis, metastasis occurred in 11, 30, 45, and 52% at 1, 3, 5, and 7 years, respectively. According to tumor thickness (10.0–11.0, 11.1–12.0, 12.1–13.0, 13.1–14.0, 14.1–15.0, 15.1–16.0, and >16.0 mm), metastasis at 1 year was found in 7, 12, 13, 15, 18, 22, and 20%; metastasis at 3 years was 24, 27, 37, 35, 51, 69, and 57%; metastasis at 5 years was 38%, 42%, 56%, 48%, 61%, not available, and 66%; and metastasis at 7 years was 47%, 47%, 61%, 57%, 61%, not available, and 66%. Clinical features associated with fewer metastatic events included Bruch membrane rupture (7-year metastasis at 48%, P = 0.018) and macular location (7-year metastasis at 32%, P = 0.014), whereas those with worse outcome included extraocular extension (7-year metastasis at 79%, P < 0.001). There was no significant difference in rate of melanoma-related metastasis for patients treated with plaque radiotherapy versus enucleation.

Conclusion:

Large uveal melanoma demonstrates 7-year rate of metastasis at 52%, with generalized increasing risk per 1-mm or 2-mm thickness increments. Extraocular extension was associated with greater metastatic rate, whereas Bruch membrane rupture and macular location demonstrated lower rate.
Long-term Clinical Outcomes of Pars Plana Versus Anterior Chamber Placement of Glaucoma Implant Tubes
Authors: Qin Vivian L. , Kaleem Mona , Conti Felipe F. , Rockwood Edward J. , Singh Annapurna , Sood-Mendiratta Shalini , Sears Jonathan E. , Silva Fabiana Q. , Eisengart Jonathan , Singh Rishi P.
Published: March 2018

Purpose:

To compare long-term surgical outcomes and complications of pars plana (PP) tube implantation with conventional anterior chamber (AC) tube implantation.

Materials and Methods:

Records of patients undergoing glaucoma tube implant surgery at a single institution between 2007 and 2015 were retrospectively reviewed. Eyes were matched for glaucoma diagnosis and patient age. Demographics, baseline characteristics, and treatment outcomes were recorded. Surgical success was defined as intraocular pressure (IOP) between 6 and 21 mm Hg, no subsequent glaucoma surgeries performed, and at least light perception vision.

Results:

Fifty-seven eyes that underwent Ahmed or Baerveldt glaucoma drainage device surgery with PP tube placement were compared with 57 eyes with AC tube placement. Mean follow-up was 43.5 months in the PP group and 35.3 months in the AC group (P=0.02). Forty-nine (86.0%) PP eyes and 46 (80.7%) AC eyes achieved surgical success (P=0.45). At last follow-up, mean IOP decreased from 29.0 to 15.1 mm Hg in the PP group (P<0.01) and from 32.7 to 15.6 mm Hg in the AC group (P<0.01). Mean number of medications decreased from 2.9 to 1.1 in the PP group (P<0.01) and from 2.8 to 1.3 in the AC group (P<0.01). Mean IOP and number of medications were similar between PP and AC groups at baseline, last follow-up, and all interim time points (P>0.05 for all). There were 16 complications in the PP group and 14 in the AC group (P=0.67).

Conclusions:

Long-term results of glaucoma tube implant surgery with PP versus AC implantation shows effective IOP control with similar rates of surgical success.
Evaluation of different drug classes on transient sciatic nerve injury–depressed marble burying in mice
Authors: Wilkerson Jenny L. , Curry Zachary A. , Kinlow Pamela D. , Mason Brittany L. , Hsu Ku-Lung , van der Stelt Mario , Cravatt Benjamin F. , Lichtman Aron H.
Published: March 2018

A great need exists for the identification of new effective analgesics to treat sustained pain. However, most preclinical nociceptive assays measure behavioral responses evoked by noxious stimuli (ie, pain-stimulated behavior), which presents a challenge to distinguish between motor impairing and antinociceptive effects of drugs. Here, we demonstrate that chronic constriction injury (CCI) of the sciatic nerve elicits common pain-stimulated responses (ie, mechanical allodynia and thermal hyperalgesia) as well as reduces marble burying/digging behaviors that occur during the early stages of the neuropathy and resolve within 1 week. Although drugs representing distinct classes of analgesics (ie, morphine, valdecoxib, and gabapentin) reversed both CCI-induced and CCI-depressed nociceptive measures, diazepam lacked antinociceptive effects in all assays and the kappa-opioid receptor agonist U69593 reversed pain-stimulated, but not pain-depressed behaviors. In addition, we tested drugs targeting distinct components of the endocannabinoid system, including agonists at cannabinoid receptors type 1 (CB1) and type 2 (CB2), as well as inhibitors of the endocannabinoid-regulating enzymes fatty acid amide hydrolase and monoacylglycerol lipase. Each of these drugs reversed all CCI-induced nociceptive measures, with the exception of the fatty acid amide hydrolase inhibitor that reversed pain-stimulated behaviors, only. These findings support the use of the mouse marble-burying assay as a model of pain-depressed behavior within the first week of sciatic nerve injury to examine candidate analgesics. These data also support existing preclinical research that cannabinoid receptor agonists and inhibitors of endocannabinoid-regulating enzymes merit consideration for the treatment of pain.
Mapping and Assessment of a Threaded Acute Care Curriculum Using Entry-Level Core Competencies Established by Academy of Acute Care Physical Therapy
Authors: Costello Ellen , Maring Joyce R.
Published: March 2018

The Academy of Acute Care Physical Therapy recently established core competencies for entry-level practice in acute care settings. The purpose of this article is to describe and evaluate a model that embeds the competencies throughout an entry-level curriculum, emphasizes active learning strategies, and facilitates student proficiency in clinical decision making in the acute care setting. Faculty-mapped course objectives, learning activities, and assessment methods to the competencies and identified redundancies and gaps. Student learning was assessed using a variety of activities including computerized modules and authentic simulations. The mapping process led to enhanced coordination and documentation of the competencies throughout the curriculum. Course feedback indicated high levels of student satisfaction with active and authentic learning strategies. Learning outcomes substantiated student attainment of the newly established entry-level competencies. Curricular mapping is an effective strategy to ensure that acute care competencies are embedded, reinforced, and integrated. Active and authentic learning assists students to make the transition from the classroom to the demands of acute care settings. Enhanced student self-efficacy and performance in simulated scenarios provided evidence of their attainment of clinical reasoning skills required for the complex and changing demands of the acute care environment.
Examining Injury Among Indigenous Young People: A Narrative Scoping Review
Authors: McLeod Crystal , Helt Amanda , Alilyyani Bayan
Published: March 2018

Indigenous young people of circumpolar developed countries experience a disproportionate incidence of injury compared with non-Indigenous young people. Much has been published about the experience of injury within the general Indigenous population, but literature is limited with regard to Indigenous young people. Trauma nurses, who are important members of the multidisciplinary team that provides injury intervention to Indigenous populations, need to be aware of this literature, as well as subsequent research gaps, to provide effective care to Indigenous young people experiencing injury. The purpose of this study was to provide an updated comprehensive review of the research-based evidence related to all-cause injury for Indigenous young people. An exploratory scoping review was conducted with a narrative synthesis. To locate literature, 7 electronic databases were searched from 2003 to 2017. Criteria were applied to all located articles to determine inclusion and then data were extracted from each study's findings. A total of 15 studies were included in this review that met the inclusion criteria. Themes derived from the knowledge synthesis process are as follows: incidence rates, mechanisms of injury, risk factors, and gaps in research. A strong epidemiological focus has emerged from the research found in this review of injury among Indigenous young people. The results of this review serve as a starting point for trauma nurses to successfully assess, build trusting relationships with, and further research injury among Indigenous young people.
A Descriptive Analysis of EtOH Intoxication in our Latino Trauma Patients: An Indication for a Preventive Program
Authors: Kopatsis Anthony , Wagner Christine , Costello Helen , Morin Nicholas , Kopatsis Katherine Elizabeth , Gomez Mario
Published: March 2018

We sought to determine patterns of injury in our Latino trauma community targeting alcohol (EtOH) intoxication as an influential variable. With the information gained in our culturally specific and culturally sensitive trauma community, we can use the information to fine-tune our trauma preventive medicine programs. Trauma injuries are the third largest contributor to racial disparities in the United States. Alcohol is involved in approximately half of all trauma admissions to trauma centers around the country. Some investigators have shown that Latinos have higher rates of high-risk drinking, and this factor is independently associated with mortality after trauma. This study is a retrospective review of 524 Latino blunt and penetrating trauma admissions for years (2012–2014). Electronic medical records with the hospital trauma registry charts were evaluated. The trauma registry database included age, gender, EtOH, mechanism of injury, location, insurance, and disposition. Statistical significance was used with chi–square test. Our results show a predominantly male population with falls being the primary mechanism of injury. Intoxicated injuries occurred mostly at bars/clubs, but a substantial amount occurred at the workplace. Despite having a majority of the injuries occurring with patients that have Medicaid or Charity Care insurance, a certain amount of the alcohol-related injuries had private insurance. Many of our Latino trauma patients are still suffering from trauma-related EtOH intoxication. With the information obtained from our project, we will be able to fine-tune and target our trauma preventive medicine program to provide education for our inner-city Latino community of EtOH intoxication-related trauma injuries.
New and emerging therapies in treatment of Clostridium difficile infection
Authors: Goyal Hemant , Perisetti Abhilash , Rehman M. Rubayat , Singla Umesh
Published: March 2018

Clostridium difficile infection (CDI) represents one of the most serious nosocomial infections that have grown dramatically over the past decade. Vancomycin and metronidazole are currently used as a standard therapy for CDI. Metronidazole is recommended as a first-line therapy for mild-to-moderate infections and vancomycin is mainly used for severe and/or refractory cases. However, studies have demonstrated that there are quite high CDI relapse rates with both of these medications, which represents a challenge for clinicians. Over the last decade, a number of newer and novel therapeutic options have emerged as promising alternatives to these standard CDI therapies. The following review provides the updated summaries of these newer therapeutic agents and their status in the treatment of CDI.
The Dutch Pancreas Biobank Within the Parelsnoer Institute
Authors: Strijker Marin , Gerritsen Arja , van Hilst Jony , Bijlsma Maarten F. , Bonsing Bert A. , Brosens Lodewijk A. , Bruno Marco J. , van Dam Ronald M. , Dijk Frederike , van Eijck Casper H. , Farina Sarasqueta Arantza , Fockens Paul , Gerhards Michael F. , Groot Koerkamp Bas , van der Harst Erwin , de Hingh Ignace H. , van Hooft Jeanin E. , Huysentruyt Clément J. , Kazemier Geert , Klaase Joost M. , van Laarhoven Cornelis J. , van Laarhoven Hanneke W. , Liem Mike S. , de Meijer Vincent E. , van Rijssen L. Bengt , van Santvoort Hjalmar C. , Suker Mustafa , Verhagen Judith H. , Verheij Joanne , Verspaget Hein W. , Wennink Roos A. , Wilmink Johanna W. , Molenaar I. Quintus , Boermeester Marja A. , Busch Olivier R. , Besselink Marc G.
Published: March 2018

Objectives

Large biobanks with uniform collection of biomaterials and associated clinical data are essential for translational research. The Netherlands has traditionally been well organized in multicenter clinical research on pancreatic diseases, including the nationwide multidisciplinary Dutch Pancreatic Cancer Group and Dutch Pancreatitis Study Group. To enable high-quality translational research on pancreatic and periampullary diseases, these groups established the Dutch Pancreas Biobank.

Methods

The Dutch Pancreas Biobank is part of the Parelsnoer Institute and involves all 8 Dutch university medical centers and 5 nonacademic hospitals. Adult patients undergoing pancreatic surgery (all indications) are eligible for inclusion. Preoperative blood samples, tumor tissue from resected specimens, pancreatic cyst fluid, and follow-up blood samples are collected. Clinical parameters are collected in conjunction with the mandatory Dutch Pancreatic Cancer Audit.

Results

Between January 2015 and May 2017, 488 patients were included in the first 5 participating centers: 4 university medical centers and 1 nonacademic hospital. Over 2500 samples were collected: 1308 preoperative blood samples, 864 tissue samples, and 366 follow-up blood samples.

Conclusions

Prospective collection of biomaterials and associated clinical data has started in the Dutch Pancreas Biobank. Subsequent translational research will aim to improve treatment decisions based on disease characteristics.
Enhancing Placebo Effects in Somatic Symptoms Through Oxytocin
Authors: Skvortsova Aleksandrina , Veldhuijzen Dieuwke S. , Van Middendorp Henriët , Van den Bergh Omer , Evers Andrea W.M.
Published: March 2018

Objective

Placebo effects relieve various somatic symptoms, but it is unclear how they can be enhanced to maximize positive treatment outcomes. Oxytocin administration may potentially enhance placebo effects, but few studies have been performed, and they have had conflicting findings. The study aim was to investigate the influence of positive verbal suggestions and oxytocin on treatment expectations and placebo effects for pain and itch.

Methods

One hundred eight female participants were allocated to one of the following four groups: (1) oxytocin with positive verbal suggestions, (2) placebo with positive verbal suggestions, (3) oxytocin without suggestions, and (4) placebo without suggestions. The administration of 24 IU oxytocin or a placebo spray was preceded by positive verbal suggestions regarding the pain- and itch-relieving properties of the spray or no suggestions, depending on group allocation. Pain was assessed with a cold pressor test, and itch was assessed with histamine iontophoresis.

Results

Positive verbal suggestions induced expectations of lower pain (F = 4.77, p = .031) and itch (F = 5.38, p = .022). Moreover, positive verbal suggestions elicited placebo analgesia (F = 5.48, p = .021) but did not decrease itch. No effect of oxytocin on the placebo effect or on expectations was found.

Conclusions

Positive suggestions induced placebo analgesia but oxytocin did not enhance the placebo effect. Study limitations are that we only included a female sample and a failure to induce placebo effect for itch. Future studies should focus on how oxytocin might influence placebo effects, taken into account the role of sex, dose-dependent effects, and various expectation manipulations.

Trial registration: The study was registered as a clinical trial on www.trialregister.nl (number 6376).
Polymethyl Methacrylate Custom-Made Prosthesis: A Novel Three-Dimension Printing-Aided Fabrication Technique for Cranial and/or Orbital Reconstruction
Authors: Martinez-Seijas Pedro , Díaz-Galvis Luis A. , Hernando Josué , Leizaola-Cardesa Ignacio O. , Aguilar-Salvatierra Antonio , Gómez-Moreno Gerardo
Published: March 2018

Background:

Over the years, many materials have been used in orbital reconstruction and cranioplasty. Among the materials in current use, polymethyl methacrylate (PMMA) offers a high degree of compatibility with human tissue.

Objective:

This work describes a new, custom-made, 3D printing-aided, prosthetic fabrication process for orbital and/or cranial reconstruction using PMMA.

Methods:

On the basis of information obtained from computerized tomography scanning processed in Digital Imaging and Communication in Medicine format and exported to treatment planning software, a 3D prosthesis master model was designed and digitally printed. This was then used to create an injection mold from which the prosthesis was cast in PMMA and implanted in the patient. Five patients with cranial and/or orbital defects of tumoral or traumatic etiology were treated by this method. After 5 to 7 years follow-up, no complications occurred to cause the removal of the prostheses.

Conclusion:

This novel method makes it possible to produce customized PMMA prostheses to treat orbital and/or cranial defects that are cost-effective and individualized to each case.
Risk Factors for Pulmonary Complications After Laparoscopic Pylorus-preserving Pancreaticoduodenectomy: A Retrospective Observational Analysis
Authors: Yu Jihion , Seo Hyungseok , Kim Hong-Kyoon , Kim Song Cheol , Kim Young-Kug
Published: March 2018

Laparoscopic pylorus-preserving pancreaticoduodenectomy (LPPPD) is less invasive than open pylorus-preserving pancreaticoduodenectomy. However, LPPPD has a long operation time with pneumoperitoneum, which may affect the postoperative pulmonary complications (PPCs). We retrospectively evaluated the incidence of PPCs and their risk factors in LPPPD. In 191 patients who underwent LPPPD, the incidence of PPCs was 28.8% (n=55). Multivariate logistic regression analysis revealed that the risk factors for PPCs were male sex [odds ratio (OR), 2.518; P=0.008], high body mass index (OR, 1.172; P=0.024), and low preoperative serum albumin level (OR, 0.390; P=0.032). Length of hospital stay was significantly longer in the PPC group than in the no-PPC group [17 (14 to 26) vs. 14 (13 to 18) d, P<0.001]. There was no difference in the incidence of surgical complications between the PPC group and the no-PPC group (14.5% vs. 6.6%, P=0.096). These results provide useful information for perioperative pulmonary management in patients undergoing LPPPD.
When and How to Perform Cultures on Chronic Wounds?
Authors: Stallard Yvonne
Published: March 2018

PURPOSE:

The purpose of this Evidence-Based Report Card was to examine current best evidence related to when and how to perform cultures on chronic wounds to guide clinicians in determining the appropriate treatment.

QUESTION:

(1) When should cultures be performed on chronic wounds? and (2) What is the best method or technique to perform a culture on a chronic wound?

SEARCH STRATEGY:

A search of the literature was performed, resulting in 45 publications relevant to the topic. Following a review of titles and abstracts, 7 studies were identified that met inclusion criteria. Key search terms used were “chronic wound,” “chronic infected wound,” “wound culture,” “specimen collection,” and “wound swab.” Strength of the evidence was rated based on the methodology from Essential Evidence Plus: Levels of Evidence and Oxford Center for Evidence-Based Medicine, adapted by Gray and colleagues.

FINDINGS:

Seven studies were identified as pertinent to the topic on wound culture and meeting inclusion criteria. The study designs included 1 randomized controlled trial, 1 quasi-experimental comparative study, 1 systematic review, 1 scoping literature review, 1 integrative literature review, and 2 professional organization expert panel reviews (consensus statement and position statement). Of the 7 studies, 3 studies suggest that classic signs of infection may not always be present but culturing may be indicated when additional signs such as pain, necrotic tissue, prolonged or delayed healing, and wound bed deterioration occur. Four studies report that a quantitative culture of wound tissue is the gold standard to obtain a wound culture, but the swab method is an acceptable alternative option. Two articles demonstrate the Levine technique is more reliable than the Z-technique to determine microbial load in the wound bed. The strength of the evidence was identified as 2 level A studies, 1 level B study, and 4 level C studies. Using Johns Hopkins methodology, the quality of the studies was deemed either high quality or good quality.

CONCLUSION/RECOMMENDATION:

Evidence indicates that identification of potential chronic wound infection should be considered early using clinical signs such as pain, necrotic tissue, delayed healing, and wound deterioration (in addition to classic signs of infection) to determine the need for collecting a culture (Strength of Recommendation Taxonomy [SORT] level 2); and when a culture is deemed necessary, swab culture using the Levine method is a clinically practical alternative if performed correctly (SORT level 1).
Complete genome characterization of a rotavirus B (RVB) strain identified in Alpine goat kids with enteritis reveals inter-species transmission with RVB bovine strains
Authors: Chen Fangzhou , Knutson Todd P. , Ciarlet Max , Sturos Matthew , Marthaler Douglas G.
Published: March 2018

Rotavirus B (RVB) has been associated with enteric disease in many animal species. An RVB strain was identified in pooled intestinal samples from Alpine caprine kids (between 2 and 3 days of age) experiencing high (>90 %) morbidity, and the complete caprine RVB genome was characterized. Histology revealed villus atrophy, the samples tested positive for RVB by real-time RT-PCR and metagenomic next-generation sequencing identified only RVB and orf virus. In the VP4 gene segment, the caprine RVB strain had a higher percentage nucleotide identity to the Indian bovine RVB strains than to the Japanese bovine RVB strains, but the VP7, VP6, VP2, NSP1, NSP2 and NSP5 gene segments of the American caprine RVB strain were genetically related to the Japanese bovine RVB strains. The results indicate a lack of RVB sequences to understand reassortment or the evolutionary relationship of RVB strains from cattle and goats.
Experimentally Induced Metamorphosis in Axolotl (Ambystoma mexicanum) Under Constant Diet Restructures Microbiota Accompanied by Reduced Limb Regenerative Capacity
Authors: Demircan Turan , Ovezmyradov Guvanch , Yıldırım Berna , Keskin İlknur , İlhan Ayse Elif , Fesçioğlu Ece Cana , Öztürk Gürkan , Yıldırım Süleyman
Published: March 2018

Axolotl (Ambystoma mexicanum) is a critically endangered salamander species and a model organism for regenerative and developmental biology. Despite life-long neoteny in nature and in captive-bred colonies, metamorphosis of these animals can be experimentally induced by administering Thyroid hormones (THs). However, biological consequences of this experimental procedure, such as host microbiota response and implications for regenerative capacity, remain largely unknown. Here, we systematically compared host bacterial microbiota associated with skin, stomach, gut tissues and fecal samples based on 16S rRNA gene sequences, along with limb regenerative capacity, between neotenic and metamorphic Axolotls. Our results show that distinct bacterial communities inhabit individual organs of Axolotl and undergo substantial restructuring through metamorphosis. Drastic restructuring was observed for skin microbiota, highlighted by a major transition from Firmicutes-enriched to Proteobacteria-enriched relative abundance and precipitously decreased diversity. Remarkably, shifts in microbiota was accompanied by a steep reduction in limb regenerative capacity. Fecal microbiota of neotenic and metamorphic Axolotl shared relatively higher similarity, suggesting that diet continues to shape microbiota despite fundamental transformations in the host digestive organs. The results provide novel insights into microbiological and regenerative aspects of Axolotl metamorphosis and will establish a baseline for future in-depth studies.
The human leukemia virus HTLV-1 alters the structure and transcription of host chromatin in cis
Authors: Melamed Anat , Yaguchi Hiroko , Miura Michi , Witkover Aviva , Fitzgerald Tomas W , Birney Ewan , Bangham Charles R M
Published: March 2018

Chromatin looping controls gene expression by regulating promoter-enhancer contacts, the spread of epigenetic modifications, and the segregation of the genome into transcriptionally active and inactive compartments. We studied the impact on the structure and expression of host chromatin by the human retrovirus HTLV-1. We show that HTLV-1 disrupts host chromatin structure by forming loops between the provirus and the host genome; certain loops depend on the critical chromatin architectural protein CTCF, which we recently showed binds to the HTLV-1 provirus. Finally, we show that the provirus causes two distinct patterns of abnormal transcription of the host genome in cis: bidirectional transcription in the host genome immediately flanking the provirus, and clone-specific transcription in cis at non-contiguous loci up to >300 kb from the integration site. We conclude that HTLV-1 causes insertional mutagenesis up to the megabase range in the host genome in >104 persistently-maintained HTLV-1+ T-cell clones in vivo.
Integrin β1 optimizes diabetogenic T cell migration and function in the pancreas
Authors: Espinosa-Carrasco Gabriel , Saout Cécile Le , Fontanaud Pierre , Michau Aurélien , Mollard Patrice , Hernandez Javier , Schaeffer Marie
Published: March 2018

T cell search behavior is dictated by their need to encounter their specific antigen to eliminate target cells. However, mechanisms controlling effector T cell motility are highly tissue-dependent. Specifically, how diabetogenic T cells encounter their target beta cells in dispersed islets throughout the pancreas during autoimmune diabetes remains unclear. Using intra-vital 2-photon microscopy in a mouse model of diabetes, we found that CXCR3 chemokine downregulated CD8+ T cell motility specifically within islets, promoting effector cell confinement to their target sites. In contrast, T cell velocity and directionality in the exocrine tissue were enhanced along blood vessels and extra-cellular matrix fibers. This guided migration implicated integrin-dependent interactions, since integrin blockade impaired exocrine T cell motility. In addition, integrin β1 blockade decreased CD4+ T cell effector phenotype specifically in the pancreas. Thus, we unveil an important role for integrins in the pancreas during autoimmune diabetes that may have important implications for the design of new therapies.