bluuebunny/crossref_metadata_2025 huggingface dataset:
Stress Resiliency Practices in Neonatal Nurses
Authors: Pannell Lisa M. , Rowe Lynn , Tully Salena
Published: December 2016

Background:

Multiple environmental changes were experienced in a large level III neonatal intensive care unit (NICU) causing a perception of work-related stress leading to high nurse turnover, decreased engagement, and decreased satisfaction.

Purpose:

To identify a preintervention measure of perceived stress resiliency and ranking of interpretive styles in a population of neonatal, bedside registered nurses faced with a change in the physical practice environment.

Methods:

A descriptive, cross-sectional, correlational design was used to measure stress resiliency. The Stress Resiliency Profile (SRP) questionnaire was administered to a convenience sample of 48 neonatal bedside nurses. The SRP identifies 3 distinct interpretive styles as constructs of stress resiliency including deficiency focusing (negative thinking), necessitating (managing forced change), and skill recognition. Statistical analysis was used to describe associations between ages, years of experience, and resiliency.

Results:

Results showed skill recognition to be significantly lower than expected in participants 40 years and older. Also, participants with greater than 5 years of NICU experience revealed low to moderate levels of resiliency.

Implications for Practice:

Although skill is critical in nursing, it may not be the key factor in reducing the perception of work-related stress. Implementation of interventions targeting interpretative styles known to enhance resiliency may promote positive coping and quality change management.

Implications for Research:

Baseline resiliency data are necessary to guide unit leaders to manage future challenges found in evolving NICU nurse practice environments. More research is warranted to determine the generalizability of study results as healthcare organizations strive to implement best practices, control costs, and deliver safe, quality care.
The novel interleukin-1 cytokine family members in inflammatory diseases
Authors: Hahn Madelaine , Frey Silke , Hueber Axel J.
Published: December 2016

Purpose of review

This review provides an update on the new interleukin-1 (IL-1) cytokine family members in inflammatory diseases with focus on recent findings concerning the family members IL-36, IL-37, and IL-38 and their different expression patterns.

Recent findings

The IL-1 cytokines are known to be involved in many different inflammatory and autoimmune diseases. The latest IL-1 family members, IL-36, IL-37, and IL-38 have been shown to be differently regulated during course of disease. Studies of patients suffering from inflammatory diseases revealed that those cytokines are upregulated in the serum as well as in inflamed tissue. Both, epithelial cells and infiltrating peripheral mononuclear blood cells serve as source of the cytokines IL-36, IL-37, and IL-38 triggering different outcomes. These results could be confirmed in different mouse models and in-vitro and ex-vivo studies.

IL-36, IL-37, and IL-38 are involved in the pathogenesis of the inflammatory diseases psoriasis, rheumatoid arthritis, gout, systemic lupus erythematosus as well as Crohn's disease. Thereby IL-36 acts proinflammatory triggering further inflammatory mediators. In contrast, IL-37 and IL-38 are upregulated to counteract. Understanding the imbalance of the IL-1 family is crucial for future therapeutics.
Enhancing memory self-efficacy during menopause through a group memory strategies program
Authors: Unkenstein Anne E. , Bei Bei , Bryant Christina A.
Published: December 2016

Objective:

Anxiety about memory during menopause can affect quality of life. We aimed to improve memory self-efficacy during menopause using a group memory strategies program.

Methods:

The program was run five times for a total of 32 peri- and postmenopausal women, age between 47 and 60 years, recruited from hospital menopause and gynecology clinics. The 4-week intervention consisted of weekly 2-hour sessions, and covered how memory works, memory changes related to ageing, health and lifestyle factors, and specific memory strategies. Memory contentment (CT), reported frequency of forgetting (FF), use of memory strategies, psychological distress, and attitude toward menopause were measured. A double-baseline design was applied, with outcomes measured on two baseline occasions (1-month prior [T1] and in the first session [T2]), immediately postintervention (T3), and 3-month postintervention (T4). To describe changes in each variable between time points paired sample t tests were conducted. Mixed-effects models comparing the means of random slopes from T2 to T3 with those from T1 to T2 were conducted for each variable to test for treatment effects.

Results:

Examination of the naturalistic changes in outcome measures from T1 to T2 revealed no significant changes (all Ps > 0.05). CT, reported FF, and use of memory strategies improved significantly more from T2 to T3, than from T1 to T2 (all Ps < 0.05). Neither attitude toward menopause nor psychological distress improved significantly more postintervention than during the double-baseline (all Ps > 0.05). Improvements in reported CT and FF were maintained after 3 months.

Conclusions:

The use of group interventions to improve memory self-efficacy during menopause warrants continued evaluation.
Totally Endoscopic Robotic Correction of Cor Triatriatum Sinister Coexisting with Atrial Septal Defect
Authors: Gao Changqing , Yang Ming , Xiao Cangsong , Zhang Huajun , Wang Gang
Published: December 2016

Cor triatriatum sinister (CTS) is a rare congenital cardiac anomaly and is mainly corrected through conventional surgery through sternotomy. We described our successful novel surgical technique of totally robotic correction of CTS in one case of CTS with concomitant repair of atrial septal defect using da Vinci SI Surgical System (Intuitive Surgical, Inc, Sunnyvale, CA USA) with excellent surgical outcome. We conclude that robotic correction of CTS is a feasible and safe alternative to conventional surgical technique.
Extracorporeal Membrane Oxygenation in Dengue, Malaria, and Acute Chagas Disease
Authors: Salazar Leonardo A. , Schreuder Cornelis M. , Eslava Jhonathan A. , Murcia Adriana S. , Forero Mario J. , Orozco-Levi Mauricio A. , Echeverría Luis E. , Figueredo Anton io
Published: December 2016

Extracorporeal membrane oxygenation (ECMO) is widely used in acute respiratory distress syndrome (ARDS) and myocarditis. Severe vector-mediated diseases may be complicated by ARDS or myocarditis, which are both associated with a high mortality rate. We present six cases of severe dengue, malaria, and acute Chagas disease that were treated with ECMO from September 2007 to September 2015. Patients included two pediatric and four adults (aged 12–48). Survival to decannulation was 83% and to discharge was 66%. Overall, the mean duration on ECMO was 25.4 days. We conclude that ECMO treatment can be beneficial in patients with severe dengue, malaria, and acute Chagas disease, if complicated by pulmonary or cardiac complications.
Safety and Outcomes of Mobile ECMO Using a Bicaval Dual-Stage Venous Catheter
Authors: Kanji Hussein D. , Chouldechova Alexandra , Harvey Chris , O’dea Ephraim , Faulkner Gail , Peek Giles
Published: December 2016

There is little published data on the safety and effectiveness of mobile (inter-hospital) extracorporeal membrane oxygenation (ECMO) in adults, particularly focusing on the cannulation strategy. We sought to study the outcomes of patients cannulated with a bicaval dual lumen catheter needing mobile compared with conventional ECMO. Specifically, we evaluated the safety of using this cannulation strategy during initiation, in transport and overall performance. Multivariate adjustment was performed to report on adjusted 6 month survival as well as complications and performance from cannulation and the ECMO run. A total of 170 consecutive patients (44 mobile ECMO, 126 conventional ECMO) with severe hypoxemic respiratory failure were included in our cohort from 2010 to 2014. Improved in-hospital survival and adjusted lower 6 month mortality favored the mobile ECMO group (86% vs. 79%; odds ratio [OR] 0.24 [0.07–0.69]). Performance of ECMO and complications were similar between the two groups. There were no serious ECMO cannulation-related complications reported during cannulation and on transport. We conclude that the use of bicaval dual lumen catheters instituted with fluoroscopy guidance at referral sites is safe and should be considered in mobile ECMO patients. Furthermore, mobile ECMO is associated with an unexpected mortality benefit in severely hypoxemic patients. Further prospective study is needed to elucidate this finding.
Ventricular Assist Device Implantation Configurations Impact Overall Mechanical Circulatory Support System Thrombogenic Potential
Authors: Chiu Wei-Che , Alemu Yared , McLarty Allison J. , Einav Shmuel , Slepian Marvin J. , Bluestein Danny
Published: December 2016

Ventricular assist devices (VADs) became in recent years the standard of care therapy for advanced heart failure with hemodynamic compromise. With the steadily growing population of device recipients, various postimplant complications have been reported, mostly associated with the hypershear generated by VADs that enhance their thrombogenicity by activating platelets. Although VAD design optimization can significantly improve its thromboresistance, the implanted VAD need to be evaluated as part of a system. Several clinical studies indicated that variability in implantation configurations may contribute to the overall system thrombogenicity. Numerical simulations were conducted in the HeartAssist 5 (HA5) and HeartMate II (HMII) VADs in the following implantation configurations: 1) inflow cannula angles: 115° and 140° (HA5); 2) three VAD circumferential orientations: 0°, 30°, and 60° (HA5 and HMII); and 3) 60° and 90° outflow graft anastomotic angles with respect to the ascending aorta (HA5). The stress accumulation of the platelets was calculated along flow trajectories and collapsed into a probability density function, representing the “thrombogenic footprint” of each configuration—a proxy to its thrombogenic potential (TP). The 140° HA5 cannula generated lower TP independent of the circumferential orientation of the VAD. Sixty-degree orientation generated the lowest TP for the HA5 versus 0° for the HMII. An anastomotic angle of 60° resulted in lower TP for HA5. These results demonstrate that optimizing the implantation configuration reduces the overall system TP. Thromboresistance can be enhanced by combining VAD design optimization with the surgical implantation configurations for achieving better clinical outcomes of implanted VADs.
Exercise Hemodynamics as a Predictor of Myocardial Recovery in LVAD Patients
Authors: Segan Louise A. , Nanayakkara Shane S. , Leet Angeline S. , Vizi Donna , Kaye David M.
Published: December 2016

Mechanical circulatory support using left ventricular assist devices (LVADs) has been demonstrated to improve survival in patients with advanced heart failure. Left ventricular assist device therapy also promotes reverse ventricular remodeling, which in some cases has led to sufficient myocardial recovery to allow LVAD removal. Identification of suitable patients for LVAD removal however remains challenging. We investigated the hypothesis that invasive assessment of exercise hemodynamics may provide additional information in relation to the assessment of contractile reserve in potential candidates for LVAD explant.
Caregiver Sleep and Patient Neutrophil Engraftment in Allogeneic Hematopoietic Stem Cell Transplant
Authors: Sannes Timothy S. , Mikulich-Gilbertson Susan K. , Natvig Crystal L. , Brewer Benjamin W. , Simoneau Teresa L. , Laudenslager Mark L.
Published: December 2016

Background:

Caregiving for allogeneic hematopoietic stem cell transplant (Allo-HSCT) patients can be significantly burdensome. Caregiver well-being often mirrors patients' suffering. However, to our knowledge, this dyadic relationship has not been linked to patient outcome.

Objective:

Caregiver's objective and subjective sleep and overall distress before transplantation were hypothesized to be related to patient's time to engraftment in secondary analyses.

Methods:

Dyads (N = 124) were Allo-HSCT patients (mean [SD] age, 49.2 [12.7] years) and their caregivers (mean [SD] age, 52.7 [12.3] years). Caregiver's subjective sleep quality was measured via the Pittsburgh Sleep Quality Index, objective sleep was measured by actigraphy, and distress was measured by combining validated psychological measures.

Results:

Both caregiver reports of worse sleep (β = .22; P < .05) and objective measurement of caregiver sleep patterns (higher sleep efficiency; less time awake after sleep onset) collected before engraftment significantly predicted shorter time to patient engraftment (β values = −.34 and .29, respectively; P values < .05). Caregiver distress was unrelated to engraftment (β = .14; P = .22).

Conclusions:

Despite limitations in available patient data, these findings appear to link caregiver well-being to patient outcome. This underscores the interrelatedness of the patient-caregiver dyad in Allo-HSCT. Future research should examine psychological and biomedical mediators.

Implications for Practice:

Given that caregiver well-being during the peritransplantation period was associated with patient outcome in this study, such findings highlight the need to address caregiver and patient well-being during Allo-HSCT. There may be potential to improve patient outcome by focusing on the caregiver, which nursing staff is well positioned to monitor.
Association Between Sarcopenia and Metabolic Syndrome in Cancer Survivors
Authors: Lee Su Jung , Kim Nam Cho
Published: December 2016

Background:

Advanced cancer treatments have improved survival from cancer, but the incidence of cardiovascular disease in survivors has recently increased. Sarcopenia and metabolic syndrome (MetS) are related to cancer survival, and sarcopenia is an emerging risk factor for cardiovascular disease. However, evidence of a relationship between sarcopenia and MetS in cancer survivors is lacking.

Objectives:

The aims of this study were to determine the prevalence of sarcopenia and MetS in cancer survivors and to investigate independent predictors of MetS in cancer survivors.

Methods:

From the fourth and fifth Korea National Health and Nutritional Exam Survey (2008–2011), 798 consecutive cancer survivors were analyzed. Sarcopenia was defined as the appendicular skeletal muscle mass divided by weight less than 1 SD below the sex-specific healthy population aged 20 to 39 years. Metabolic syndrome was defined using the National Cholesterol Education Program definition.

Results:

Among 798 cancer survivors, the prevalence rates of sarcopenia and MetS were 23.1% and 30.0%, respectively. Survivors with sarcopenia were more likely to have a higher waist circumference, body mass index, triglyceride level, and blood pressure and to have a lower high-density lipoprotein cholesterol level compared with those without sarcopenia. In multivariable analysis, sarcopenia was an independent predictor of MetS (odds ratio, 2.76; 95% confidence interval, 1.92–3.97). In addition, age and type of cancer were independent predictors of MetS.

Conclusion:

Sarcopenia was associated with an increased prevalence of MetS in cancer survivors.

Implications for Practice:

Interventions to prevent sarcopenia may be necessary to improve cardiovascular outcome in cancer survivors.
The Effects of Muscle Relaxation and Therapeutic Walking on Depression, Suicidal Ideation, and Quality of Life in Breast Cancer Patients Receiving Chemotherapy
Authors: Sun Fan-Ko , Hung Chao-Ming , Yao YuChun , Lu Chu-Yun , Chiang Chun-Ying
Published: December 2016

Background:

The suicide rate of cancer patients is high in Taiwan. Breast cancer has a high incidence rate and is the leading cause of cancer in women. There is a lack of research examining breast cancer–related depression, suicidal ideation, and quality of life.

Objectives:

This study evaluated the effects of muscle relaxation and therapeutic walking on depression, suicidal ideation, and quality of life in breast cancer patients receiving chemotherapy.

Methods:

An experimental approach was adopted. A group of 87 breast cancer patients receiving chemotherapy were randomly assigned into an experimental group (n = 44) or a control group (n = 43). The subjects in the experimental group received 2 interventions for 3 months. This study used 3 instruments, including (1) the Center for Epidemiological Studies Depression Scale, (2) the Beck Scale for Suicidal Ideation, and (3) the World Health Organization Questionnaire on Quality of Life.

Results:

The results showed no significant difference in any outcome variable in the pretest. The results of the posttest indicated that the 2 groups scored significantly differently only on the Center for Epidemiological Studies Depression Scale (U = 638.00, P < .05). The breast cancer patients who participated in the 3 month muscle relaxation and therapeutic walking interventions had a lower level of depression (RE
¯ = 37.00) than those who did not (RC
¯ = 51.16).

Conclusion:

The muscle relaxation and therapeutic walking program was effective in the reduction of breast cancer patients’ depression.

Implications for Practice:

Nursing staff could teach muscle relaxation and therapeutic walking to breast cancer patients to reduce their depression.
Research on Experiences Related to the Possibility of Consciousness Beyond the Brain
Authors: Daher Jorge Cecílio , Damiano Rodolfo Furlan , Lucchetti Alessandra Lamas Granero , Moreira-Almeida Alexander , Lucchetti Giancarlo
Published: December 2016

This study aims to conduct a search of publications investigating experiences commonly associated with the possibility of the existence of a consciousness independent of the brain held on the main scientific databases (Pubmed, Web of Knowledge, PsycINFO, Science Direct, and Scopus). Of the 9065 articles retrieved, 1954 were included (598 near-death experiences, 223 out-of-body experiences, 56 end-of-life experiences, 224 possession, 244 memories suggestive of past lives, 565 mediumship, 44 others). Over the decades, there was an evident increase in the number of articles on all the areas of the field, with the exception of studies on mediumship that showed a decline during the late 20th century and subsequent rise in the early 21st century. Regarding the types of articles found, with the exception of past-life memories and end-of-life experiences (mostly original studies), publications were predominantly review articles. The articles were published in journals with an impact factor similar to other areas of science.
Clinical Hours in Nurse Practitioner Programs Equals Clinical Competence
Authors: Fulton Cathy R. , Clark Carol , Dickinson Stephanie
Published: December 2016

An assumption in nursing education is that clinical experience equals competent practice. Knowing the extent of learning acquired during these experiences is important, and in graduate education, this is not always known. This study examined the nature of clinical hours that nurse practitioner students complete during practicum courses and explored activities of students when not engaged in direct patient care.
Patient Outcomes After Early Versus Late Tracheostomy in the Puerto Rico Trauma Hospital
Authors: Romero Vázquez Ana M. , García Rodríguez Omar , Ramos Meléndez Ediel , Rodríguez Ortiz Pablo
Published: December 2016

Objective

This study aimed to evaluate the impact of early tracheostomy (ET, ≤7 days) versus that of late tracheostomy (LT, >7 days) on outcomes such as hospital length of stay (LOS), intensive care unit (ICU) days, mechanical ventilation (MV) days, and mortality ratio.

Methods

A historical cohort study was undertaken using charts of patients admitted to the Puerto Rico Trauma Hospital who required MV and underwent tracheostomies, from 2000 to 2013. A logistic regression was performed to evaluate the association between timing of tracheostomy and complications and mortality. To estimate the relationship between ET and outcomes related to hospital stay, a binomial-negative regression was performed. A P < 0.05 was considered statistically significant.

Results

A total of 1134 patients were evaluated, 313 of whom underwent ET and 821 underwent LT. Early tracheostomy patients had a lower Injury Severity Score compared with their counterparts (P = 0.004) and showed lower complications (respiratory failure: odds ratio [OR], 0.61; 95% confidence interval [CI], 0.45–0.84; acute respiratory distress syndrome: OR, 0.44; 95% CI, 0.30–0.64; pneumonia: OR, 0.53; 95% CI, 0.40–0.71; septicemia: OR, 0.48; 95% CI, 0.33–0.70; bacteremia: OR, 0.59; 95% CI, 0.40–0.86) than LT patients. Those with ET had lower MV days (RRadj, 0.74; 95% CI, 0.68–0.82), ICU days (RRadj, 0.66; 95% CI, 0.59–0.73), and LOS (RRadj, 0.74; 95% CI, 0.69–0.80) compared with those with LT, after adjusting for age, Injury Severity Score, and complications. However, there were no differences in mortality ratio (ORadj, 0.66; 95% CI, 0.44–1.01) among ET and LT patients, after adjusting for confounders.

Conclusions

Our results suggested that ET reduced complications, MV days, ICU days, and LOS, having an indirect effect on mortality ratio. Standardized protocols for ET are recommended to enhance health outcomes in trauma patients.
Using mHealth for HIV/TB Treatment Support in Lesotho: Enhancing Patient–Provider Communication in the START Study
Authors: Hirsch-Moverman Yael , Daftary Amrita , Yuengling Katharine A. , Saito Suzue , Ntoane Moeketsi , Frederix Koen , Maama Llang B. , Howard Andrea A.
Published: December 2016

Background:

mHealth is a promising means of supporting adherence to treatment. The Start TB patients on ART and Retain on Treatment (START) study included real-time adherence support using short-text messaging service (SMS) text messaging and trained village health workers (VHWs). We describe the use and acceptability of mHealth by patients with HIV/tuberculosis and health care providers.

Methods:

Patients and treatment supporters received automated, coded medication and appointment reminders at their preferred time and frequency, using their own phones, and $3.70 in monthly airtime. Facility-based VHWs were trained to log patient information and text message preferences into a mobile application and were given a password-protected mobile phone and airtime to communicate with community-based VHWs. The use of mHealth tools was analyzed from process data over the study course. Acceptability was evaluated during monthly follow-up interviews with all participants and during qualitative interviews with a subset of 30 patients and 30 health care providers at intervention sites. Use and acceptability were contextualized by monthly adherence data.

Findings:

From April 2013 to August 2015, the automated SMS system successfully delivered 39,528 messages to 835 individuals, including 633 patients and 202 treatment supporters. Uptake of the SMS intervention was high, with 92.1% of 713 eligible patients choosing to receive SMS messages. Patient and provider interviews yielded insight into barriers and facilitators to mHealth utilization. The intervention improved the quality of health communication between patients, treatment supporters, and providers. HIV-related stigma and technical challenges were identified as potential barriers.

Conclusions:

The mHealth intervention for HIV/tuberculosis treatment support in Lesotho was found to be a low-tech, user-friendly intervention, which was acceptable to patients and health care providers.
Development of a National Campaign Addressing South African Men's Fears About HIV Counseling and Testing and Antiretroviral Treatment
Authors: Orr Neil , Hajiyiannis Helen , Myers Laura , Makhubele Mzamani Benjamin , Matekane Tselisehang , Delate Richard , Mahlasela Lusanda , Goldblatt Brenda
Published: December 2016

Introduction:

South African men are less likely to get tested for HIV than women and are more likely to commence antiretroviral treatment (ART) at later stages of disease, default on treatment, and to die from AIDS compared with women. The purpose of this study was to conduct formative research into the ideational and behavioral factors that enable or create obstacles to mens' uptake of HIV counseling and testing (HCT) and ART. The study consulted men with a goal of developing a communication campaign aimed at improving the uptake of HIV testing and ART initiation among men.

Methods:

Eleven focus groups and 9 in-depth interviews were conducted with 97 male participants in 6 priority districts in 4 South African provinces in rural, peri-urban, and urban localities.

Results:

Fears of compromised masculine pride and reputation, potential community rejection, and fear of loss of emotional control (“the stress of knowing”) dominated men's rationales for avoiding HIV testing and treatment initiation.

Conclusions:

A communication campaign was developed based on the findings. Creative treatments aimed at redefining a ‘strong’ man as someone who faces his fears and knows his HIV status. The resultant campaign concept was: “positive or negative—you are still the same person.”
Effective Interpersonal Health Communication for Linkage to Care After HIV Diagnosis in South Africa
Authors: Mabuto Tonderai , Charalambous Salome , Hoffmann Christopher J.
Published: December 2016

Background:

Early in the global response to HIV, health communication was focused toward HIV prevention. More recently, the role of health communication along the entire HIV care continuum has been highlighted. We sought to describe how a strategy of interpersonal communication allows for precision health communication to influence behavior regarding care engagement.

Methods:

We analyzed 1 to 5 transcripts from clients participating in longitudinal counseling sessions from a communication strategy arm of a randomized trial to accelerate entry into care in South Africa. The counseling arm was selected because it increased verified entry into care by 40% compared with the standard of care. We used thematic analysis to identify key aspects of communication directed specifically toward a client's goals or concerns.

Results:

Of the participants, 18 of 28 were female and 21 entered HIV care within 90 days of diagnosis. Initiating a communication around client-perceived consequences of HIV was at times effective. However, counselors also probed around general topics of life disruption—such as potential for child bearing—as a technique to direct the conversation toward the participant's needs. Once individual concerns and needs were identified, counselors tried to introduce clinical care seeking and collaboratively discuss potential barriers and approaches to overcome to accessing that care.

Conclusions:

Through the use of interpersonal communication messages were focused on immediate needs and concerns of the client. When effectively delivered, it may be an important communication approach to improve care engagement.
Community Mobilization for HIV Testing Uptake: Results From a Community Randomized Trial of a Theory-Based Intervention in Rural South Africa
Authors: Lippman Sheri A. , Neilands Torsten B. , MacPhail Catherine , Peacock Dean , Maman Suzanne , Rebombo Dumisani , Twine Rhian , Selin Amanda , Leslie Hannah H. , Kahn Kathleen , Pettifor Audrey
Published: December 2016

Background:

HIV testing uptake in South Africa is below optimal levels. Community mobilization (CM) may increase and sustain demand for HIV testing, however, little rigorous evidence exists regarding the effect of CM interventions on HIV testing and the mechanisms of action.

Methods:

We implemented a theory-driven CM intervention in 11 of 22 randomly-selected villages in rural Mpumalanga Province. Cross-sectional surveys including a community mobilization measure were conducted before (n = 1181) and after (n = 1175) a 2-year intervention (2012–2014). We assessed community-level intervention effects on reported HIV testing using multilevel logistic models. We used structural equation models to explore individual-level effects, specifically whether intervention assignment and individual intervention exposure were associated with HIV testing through community mobilization.

Results:

Reported testing increased equally in both control and intervention sites: the intervention effect was null in primary analyses. However, the hypothesized pathway, CM, was associated with higher HIV testing in the intervention communities. Every standard deviation increase in village CM score was associated with increased odds of reported HIV testing in intervention village participants (odds ratio: 2.6, P = <0.001) but not control village participants (odds ratio: 1.2, P = 0.53). Structural equation models demonstrate that the intervention affected HIV testing uptake through the individual intervention exposure received and higher personal mobilization scores.

Conclusions:

There was no evidence of community-wide gains in HIV testing due to the intervention. However, a significant intervention effect on HIV testing was noted in residents who were personally exposed to the intervention and who evidenced higher community mobilization. Research is needed to understand whether CM interventions can be diffused within communities over time.
Counseling Framework for HIV-Serodiscordant Couples on the Integrated Use of Antiretroviral Therapy and Pre-exposure Prophylaxis for HIV Prevention
Authors: Morton Jennifer F. , Celum Connie , Njoroge John , Nakyanzi Agnes , Wakhungu Imeldah , Tindimwebwa Edna , Ongachi Snaidah , Sedah Eric , Okwero Emmanuel , Ngure Kenneth , Odoyo Josephine , Bulya Nulu , Haberer Jessica E. , Baeten Jared M. , Heffron Renee ,   for the Partners Demonstration Project Team
Published: December 2016

Background:

For HIV-serodiscordant couples, integrated delivery of antiretroviral therapy (ART) for HIV-positive partners and time-limited pre-exposure prophylaxis (PrEP) for negative partners virtually eliminates HIV transmission. Standardized messaging, sensitive to the barriers and motivators to HIV treatment and prevention, is needed for widespread scale-up of this approach.

Methods:

Within the Partners Demonstration Project, a prospective interventional project among 1013 serodiscordant couples in Kenya and Uganda, we offered ART to eligible HIV-positive partners and PrEP to HIV-negative partners before ART initiation and through the HIV-positive partner's first 6 months of ART use. We conducted individual and group discussions with counseling staff to elicit the health communication framework and key messages about ART and PrEP that were delivered to couples.

Results:

Counseling sessions for serodiscordant couples about PrEP and ART included discussions of HIV serodiscordance, PrEP and ART initiation and integrated use, and PrEP discontinuation. ART messages emphasized daily, lifelong use for treatment and prevention, adherence, viral suppression, resistance, side effects, and safety of ART during pregnancy. PrEP messages emphasized daily dosing, time-limited PrEP use until the HIV-positive partner sustained 6 months of high adherence to ART, adherence, safety during conception, side effects, and other risks for HIV.

Conclusions:

Counseling messages for HIV-serodiscordant couples are integral to the delivery of time-limited PrEP as a “bridge” to ART-driven viral suppression. Their incorporation into programmatic scale-up will maximize intervention impact on the global epidemic.
Training and Validating a Deep Convolutional Neural Network for Computer-Aided Detection and Classification of Abnormalities on Frontal Chest Radiographs
Authors: Cicero Mark , Bilbily Alexander , Colak Errol , Dowdell Tim , Gray Bruce , Perampaladas Kuhan , Barfett Joseph
Published: December 2016

Objectives

Convolutional neural networks (CNNs) are a subtype of artificial neural network that have shown strong performance in computer vision tasks including image classification. To date, there has been limited application of CNNs to chest radiographs, the most frequently performed medical imaging study. We hypothesize CNNs can learn to classify frontal chest radiographs according to common findings from a sufficiently large data set.

Materials and Methods

Our institution's research ethics board approved a single-center retrospective review of 35,038 adult posterior-anterior chest radiographs and final reports performed between 2005 and 2015 (56% men, average age of 56, patient type: 24% inpatient, 39% outpatient, 37% emergency department) with a waiver for informed consent. The GoogLeNet CNN was trained using 3 graphics processing units to automatically classify radiographs as normal (n = 11,702) or into 1 or more of cardiomegaly (n = 9240), consolidation (n = 6788), pleural effusion (n = 7786), pulmonary edema (n = 1286), or pneumothorax (n = 1299). The network's performance was evaluated using receiver operating curve analysis on a test set of 2443 radiographs with the criterion standard being board-certified radiologist interpretation.

Results

Using 256 × 256-pixel images as input, the network achieved an overall sensitivity and specificity of 91% with an area under the curve of 0.964 for classifying a study as normal (n = 1203). For the abnormal categories, the sensitivity, specificity, and area under the curve, respectively, were 91%, 91%, and 0.962 for pleural effusion (n = 782), 82%, 82%, and 0.868 for pulmonary edema (n = 356), 74%, 75%, and 0.850 for consolidation (n = 214), 81%, 80%, and 0.875 for cardiomegaly (n = 482), and 78%, 78%, and 0.861 for pneumothorax (n = 167).

Conclusions

Current deep CNN architectures can be trained with modest-sized medical data sets to achieve clinically useful performance at detecting and excluding common pathology on chest radiographs.
Cognitive impairment following hormone therapy: current opinion of research in breast and prostate cancer patients
Authors: Wu Lisa M. , Amidi Ali
Published: December 2016

Purpose of review

Hormone therapy is a common cancer treatment that may be associated with numerous side and late effects, and in recent years, has been linked to changes in cognition. Here, we present the most important recent findings from empirical studies and reviews that have focused on the effects of hormone therapy on cognitive functioning in breast and prostate cancer populations, underline some general shortcomings, and propose directions for future research.

Recent findings

Recent research indicates that cognitive impairment may occur in breast and prostate cancer patients following onset of hormone therapy. However, because of methodological shortcomings and heterogeneity of current research, conclusions regarding the effects of hormone therapy on cognitive functions remain tentative.

The review highlights the general findings while also describing the many methodological shortcomings that need to be addressed in future research. It is clear that larger scale neuropsychological studies that also evaluate the impact of impairments on daily life functioning will improve our understanding of the effects of hormone therapy on cognition and inform the development of appropriate interventions.
Domestication impacts on plant–herbivore interactions: a meta-analysis
Authors: Whitehead Susan R. , Turcotte Martin M. , Poveda Katja
Published: December 2016

For millennia, humans have imposed strong selection on domesticated crops, resulting in drastically altered crop phenotypes compared with wild ancestors. Crop yields have increased, but a long-held hypothesis is that domestication has also unintentionally decreased plant defences against herbivores. To test this hypothesis, we conducted a phylogenetically controlled meta-analysis comparing insect herbivore resistance and putative plant defence traits between crops and their wild relatives. Our database included 2098 comparisons made across 73 crops in 89 studies. We found that domestication consistently reduced plant resistance to herbivores, although the magnitude of the effects varied across plant organs and depended on how resistance was measured. However, domestication had no consistent effects on the specific plant defence traits underlying resistance, including secondary metabolites and physical feeding barriers. The values of these traits sometimes increased and sometimes decreased during domestication. Consistent negative effects of domestication were observed only when defence traits were measured in reproductive organs or in the plant organ that was harvested. These results highlight the complexity of evolution under domestication and the need for an improved theoretical understanding of the mechanisms through which agronomic selection can influence the species interactions that impact both the yield and sustainability of our food systems.

This article is part of the themed issue ‘Human influences on evolution, and the ecological and societal consequences’.
Genetic architecture of age at maturity can generate divergent and disruptive harvest-induced evolution
Authors: Kuparinen Anna , Hutchings Jeffrey A.
Published: December 2016

Life-history traits are generally assumed to be inherited quantitatively. Fishing that targets large, old individuals is expected to decrease age at maturity. In Atlantic salmon (
Salmo salar
), it has recently been discovered that sea age at maturity is under strong control by a single locus with sexually dimorphic expression of heterozygotes, which makes it less intuitive to predict how life histories respond to selective fishing. We explore evolutionary responses to fishing in Atlantic salmon, using eco-evolutionary simulations with two alternative scenarios for the genetic architecture of age at maturity: (i) control by multiple loci with additive effects and (ii) control by one locus with sexually dimorphic expression. We show that multi-locus control leads to unidirectional evolution towards earlier maturation, whereas single-locus control causes largely divergent and disruptive evolution of age at maturity without a clear phenotypic trend but a wide range of alternative evolutionary trajectories and greater trait variability within trajectories. Our results indicate that the range of evolutionary responses to selective fishing can be wider than previously thought and that a lack of phenotypic trend need not imply that evolution has not occurred. These findings underscore the role of genetic architecture of life-history traits in understanding how human-induced selection can shape target populations.

This article is part of the themed issue ‘Human influences on evolution, and the ecological and societal consequences’.
Impact of regulatory variation across human iPSCs and differentiated cells
Authors: Banovich Nicholas E. , Li Yang I. , Raj Anil , Ward Michelle C. , Greenside Peyton , Calderon Diego , Tung Po Yuan , Burnett Jonathan E. , Myrthil Marsha , Thomas Samantha M. , Burrows Courtney K. , Gallego Romero Irene , Pavlovic Bryan J. , Kundaje Anshul , Pritchard Jonathan K. , Gilad Yoav
Published: December 2016

Induced pluripotent stem cells (iPSCs) are an essential tool for studying cellular differentiation and cell types that are otherwise difficult to access. We investigated the use of iPSCs and iPSC-derived cells to study the impact of genetic variation across different cell types and as models for studies of complex disease. We established a panel of iPSCs from 58 well-studied Yoruba lymphoblastoid cell lines (LCLs); 14 of these lines were further differentiated into cardiomyocytes. We characterized regulatory variation across individuals and cell types by measuring gene expression, chromatin accessibility and DNA methylation. Regulatory variation between individuals is lower in iPSCs than in the differentiated cell types, consistent with the intuition that developmental processes are generally canalized. While most cell type-specific regulatory quantitative trait loci (QTLs) lie in chromatin that is open only in the affected cell types, we found that 20% of cell type-specific QTLs are in shared open chromatin. Finally, we developed a deep neural network to predict open chromatin regions from DNA sequence alone and were able to use the sequences of segregating haplotypes to predict the effects of common SNPs on cell type-specific chromatin accessibility.
Geographical restructuring ofArabidopsis thaliana’s genetic makeup in the Iberian Peninsula due to climate change based on genetic cluster membership
Authors: Marcer Arnald , Fortin Marie-Josée , Picó F. Xavier
Published: December 2016

Aim

To assess the effects of climate change on genetic lineages ofArabidopsis thalianaat theadmixedpopulation level by directly modelling genetic cluster membership values to predict potential genetic cluster memberships across the Iberian Peninsula.

Location

Iberian Peninsula

Methods

We used a dataset of 274 accessions structured in four genetic clusters as inferred from 250 nuclear single-nucleotide polymorphisms with Bayesian clustering methods. We predicted the change in percentages of genetic cluster membership at a population level and the changes in potential suitability across the study area by combining parametric (Beta regression) and non-parametric (Recursive trees) methods.

Results

Climate change will affect genetic lineages ofArabidopsis thalianadifferently. Genetic clusters GC1 and GC2 will suffer a substantive reduction of their respective suitable areas while GC3 and GC4 will expand northward. At the population level, except for GC4, the rest of the lineages will undergo a genetic turnover for many of their populations.

Main conclusions

A. thalianain the Iberian Peninsula will undergo a major internal genetic restructuring and range change due to climate change. Genetic lineages ofArabidopsis thalianain the Iberian Peninsula will be affected differently which reinforce the need for taking into account intraspecific genetic variation when modelling species distribution. Despite limited predictive power of individual statistical models, the combination of distinct models can compensate this shortcoming.
Effect of obesity-linkedFTOrs9939609 variant on physical activity and dietary patterns in physically active men and women
Authors: West Nathan R. , Dorling James , Thackray Alice E. , Decombel Samantha E. , Stensel David J. , Grice Stuart J.
Published: December 2016

Objective

To examine physical activity and dietary patterns in physically active individuals carrying different risk variants of the fat mass and obesity-associated gene (FTO) rs9939609 single nucleotide polymorphism (SNP).

Methods

A total of 528 white men and women (mean (SD): 34.9(9.5) years, 26.6(4.3) kg·m-2) were genotyped forFTOrs9939609 SNP. Sex, age and anthropometric measurements (stature, body mass, waist circumference) were self-reported using an online questionnaire, and body mass index and waist-to-height ratio were calculated. Physical activity level and eating behaviour were assessed using the International Physical Activity Questionnaire and Three-Factor Eating Questionnaire (TFEQ), respectively.

Results

Body mass, body mass index, waist circumference and waist-to-height ratio were not significantly different between individuals carrying differentFTOrs9939609 risk variants (all P≥0.66). The cohort was physically active (4516(3043) total MET min·week-1), although risk allele carriers (AT/AA) reported higher total physical activity (effect size = 0.22, p=0.03), and homozygous risk allele carriers (AA) displayed higher TFEQ cognitive restraint (effect size = 0.33, p=0.03) compared with non-risk allele carriers (TT).

Conclusions

Obesity-related parameters were not different in physically active individuals carrying different risk variants ofFTOrs9939609, but higher physical activity and cognitive restraint in risk allele carriers may reduce genetic predisposition to weight gain.
SUV4-20 activity in the preimplantation mouse embryo controls timely replication
Authors: Eid André , Rodriguez-Terrones Diego , Burton Adam , Torres-Padilla Maria-Elena
Published: December 2016

Extensive chromatin remodeling after fertilization is thought to take place to allow a new developmental program to start. This includes dynamic changes in histone methylation and, in particular, the remodeling of constitutive heterochromatic marks such as histone H4 Lys20 trimethylation (H4K20me3). While the essential function of H4K20me1 in preimplantation mouse embryos is well established, the role of the additional H4K20 methylation states through the action of the SUV4-20 methyltransferases has not been addressed. Here we show that Suv4-20h1/h2 are mostly absent in mouse embryos before implantation, underscoring a rapid decrease of H4K20me3 from the two-cell stage onward. We addressed the functional significance of this remodeling by introducing Suv4-20h1 and Suv4-20h2 in early embryos. Ectopic expression of Suv4-20h2 leads to sustained levels of H4K20me3, developmental arrest, and defects in S-phase progression. The developmental phenotype can be partially overcome through inhibition of the ATR pathway, suggesting that the main function for the remodeling of H4K20me3 after fertilization is to allow the timely and coordinated progression of replication. This is in contrast to the replication program in somatic cells, where H4K20me3 has been shown to promote replication origin licensing, and anticipates a different regulation of replication during this early developmental time window.
A role for mitotic bookmarking of SOX2 in pluripotency and differentiation
Authors: Deluz Cédric , Friman Elias T. , Strebinger Daniel , Benke Alexander , Raccaud Mahé , Callegari Andrea , Leleu Marion , Manley Suliana , Suter David M.
Published: December 2016

Mitotic bookmarking transcription factors remain bound to chromosomes during mitosis and were proposed to regulate phenotypic maintenance of stem and progenitor cells at the mitosis-to-G1 (M–G1) transition. However, mitotic bookmarking remains largely unexplored in most stem cell types, and its functional relevance for cell fate decisions remains unclear. Here we screened for mitotic chromosome binding within the pluripotency network of embryonic stem (ES) cells and show that SOX2 and OCT4 remain bound to mitotic chromatin through their respective DNA-binding domains. Dynamic characterization using photobleaching-based methods and single-molecule imaging revealed quantitatively similar specific DNA interactions, but different nonspecific DNA interactions, of SOX2 and OCT4 with mitotic chromatin. Using ChIP-seq (chromatin immunoprecipitation [ChIP] combined with high-throughput sequencing) to assess the genome-wide distribution of SOX2 on mitotic chromatin, we demonstrate the bookmarking activity of SOX2 on a small set of genes. Finally, we investigated the function of SOX2 mitotic bookmarking in cell fate decisions and show that its absence at the M–G1 transition impairs pluripotency maintenance and abrogates its ability to induce neuroectodermal differentiation but does not affect reprogramming efficiency toward induced pluripotent stem cells. Our study demonstrates the mitotic bookmarking property of SOX2 and reveals its functional importance in pluripotency maintenance and ES cell differentiation.