bluuebunny/crossref_metadata_2025 huggingface dataset:
Propagating ice front induces gas bursts and ultrasonic acoustic emissions from freezing xylem
Authors: Lintunen Anna , Losso Adriano , Aalto Juho , Chan Tommy , Hölttä Teemu , Mayr Stefan
Published: December 2019

Ice formation and propagation in the xylem of plants is a complex process. During freezing of xylem sap, gases dissolved in liquid sap are forced out of the ice lattice due to their low solubility in ice, and supersaturation of xylem sap as well as low water potential (Ѱ) are induced at the ice–liquid interface. Supersaturation of gases near the ice front may lead to bubble formation and potentially to cavitation and/or to burst of gases driven out from the branch. In this study, we investigated the origin and dynamics of freezing-related gas bursts and ultrasonic acoustic emissions (AEs), which are suggested to indicate cavitation. Picea abies (L.) H. Karst. and Salix caprea L. branch segments were exposed to frost cycles in a temperature test chamber, and CO2 efflux (indicating gas bursts) and AEs were recorded. On freezing, two-thirds of the observed gas bursts originated from the xylem and only one-third from the bark. Simultaneously with gas bursts, AEs were detected. Branch Ѱ affected both gas bursts and AEs, with high gas burst in saturated and dry samples but relevant AEs only in the latter. Repeated frost cycles led to decreasing gas burst volumes and AE activity. Experiments revealed that the expanding ice front in freezing xylem was responsible for observed gas bursts and AEs, and that branch Ѱ influenced both processes. Results also indicated that gas bursts and cavitation are independently induced by ice formation, though both may be relevant for bubble dynamics during freezing.
Megacode Simulation Training in Undergraduate Nursing Education
Authors: Duprey Melissa D. , Dunker Kimberly Silver
Published: December 2019

The use of simulation to prepare new graduates to enter a dynamic workforce is an effective strategy to improve skill acquisition, critical thinking, and the training needed to care for complex patients. Megacode simulation was implemented in the undergraduate curriculum during the last semester prior to graduation. Students (n = 52) completed the Clinical Decision-Making Self-Confidence Scale; 95 percent were satisfied with the megacode experience and perceived the simulation training as beneficial in content knowledge and skill acquisition. Megacode simulation provided senior-level nursing students the opportunity to develop in their new role as graduate nurse.
Progressive Application of the Lasater Clinical Judgment Rubric in an Accelerated Undergraduate Program
Authors: Cason Melanie , Reibel Melody
Published: December 2019

Clinical judgment is at the forefront for safe nursing practice and quality patient care and an increasing focus for success on the NCLEX-RN licensure exam. The ability to think critically and make sound clinical decisions is not intuitive for new graduates. This article describes the progressive application of an established tool, the Lasater Clinical Judgment Rubric, in a 16-month accelerated undergraduate program with simulation experiences. Student evaluations indicate the tool is valuable for helping students develop awareness of their progression in using clinical judgment skills and understanding the essential attributes of clinical judgment.
A rare case of non-small cell lung cancer choroidal metastasis responding to ALK tyrosine kinase inhibitors
Authors: Scotti Vieri , Perna Marco , Meacci Fiammetta , Maragna Virginia , Garlatti Pietro , Vicini Giulio , Pieretti Giulia , Agresti Benedetta , Mazzini Cinzia , Livi Lorenzo
Published: December 2019

Choroidal localization from non-small cell lung cancer is rare and when it occurs may cause visual alterations. Targeted therapy against actionable gene mutations represents the standard of care in advanced non-small cell lung cancer. We report the case of a 53-year-old woman affected by metastatic anaplastic lymphoma kinase (ALK)-rearranged non-small cell lung cancer who received ALK tyrosine kinase inhibitors, from January 2017. The patient had a complete response of choroidal metastasis after therapy with ALK tyrosine kinase inhibitors. She recovered a complete visus and actually she still continue therapy with alectinib. The patient had a complete recovery of visus in addiction to a long response on treatment.
The Epidemiology of Sepsis in Chinese ICUs: A National Cross-Sectional Survey
Authors: Xie Jianfeng , Wang Hongliang , Kang Yan , Zhou Lixin , Liu Zhongmin , Qin Bingyu , Ma Xiaochun , Cao Xiangyuan , Chen Dechang , Lu Weihua , Yao Chen , Yu Kaijiang , Yao Xiaoqing , Shang Hongcai , Qiu Haibo , Yang Yi
Published: December 2019

Objectives:

We performed a national cross-sectional survey to determine the epidemiologic characteristics of patients with sepsis in ICU in China.

Design:

A cross-section survey study.

Setting:

Forty-four hospitals in mainland China from December 1, 2015, to January 31, 2016.

Patients:

All septic patients diagnosed according sepsis-1 criteria admitted to participating ICU.

Interventions:

None.

Measurements and Main Results:

We recorded demographic, physiologic, and microbiological data with follow-up for 90 days or death, if sooner. The frequency of sepsis and 90-day mortality rate were computed, and the relationship with gross domestic product determined. Multivariate logistic regression analysis was used to determine risk factors for 90-day mortality in patients with sepsis. Two-thousand three-hundred twenty-two patients with sepsis were included in the analysis, of whom 786 patients (33.9%) had hospital-acquired sepsis. The most common infection site was the lung (68.2%), followed by abdomen (26.6%) and bloodstream (7.8%). The frequency of sepsis in the ICU was 20.6 cases per 100 ICU admissions (95% CI, 15.8–25.4) with a 90-day mortality of 35.5%. The proportion of sepsis, severe sepsis, and septic shock were 3.10%, 43.6%, and 53.3% with a 90-day mortality of 2.78%, 17.69%, and 51.94%, respectively. Older age, low body weight, higher Sequential Organ Failure Assessment score, the number of systemic inflammatory response syndrome criteria, comorbid with heart failure, hematologic cancer, immunosuppression, higher level of lactate, infection site (pneumonia and bloodstream) were associated with 90-day mortality.

Conclusions:

Sepsis affects a fifth of patients admitted to ICUs in mainland China with a 90-day mortality rate of 35.5%. Our findings indicate that a large burden of sepsis, and we need to focus on sepsis as a quality improvement target in China given the high mortality. In addition, further studies are needed to delineate the epidemiology of sepsis outside the ICU.
Initial Psychometric Testing of the Knowledge About Atrial Fibrillation and Self-Management Survey
Authors: McCabe Pamela J. , Sendin Mary Janette , Stuart-Mullen Lynette , Kronebusch Beckie , Fowler Susan , Krecke Catherine , Kopecky Stephen
Published: December 2019

Background

Guidelines endorse educating patients to self-manage atrial fibrillation (AF) to mitigate AF-related adverse events contributing to personal and societal burden. Published interventions to improve patients' knowledge about AF and self-management are emerging, but evaluations of interventions are limited by lack of a psychometrically sound instrument to measure learning outcomes.

Objective

We report results of initial psychometric testing of the Knowledge about Atrial Fibrillation and Self-Management (KAFSM) survey.

Methods

Participants (N = 383), from midwest and southeast medical centers, completed the KAFSM survey. Content validity was evaluated by expert review. Construct validity was evaluated using the Pearson correlation procedure for convergent validity with the Knowledge about Atrial Fibrillation test and independent t test for known groups. Factor analysis using principal axis factoring was performed with a tetrachoric matrix. The Kuder-Richardson procedure was used to determine internal consistency reliability.

Results

A content validity index of 0.86 resulted from expert review. A positive (r = 0.60) correlation between the KAFSM survey and Knowledge about Atrial Fibrillation test demonstrated convergent validity. Higher KAFSM scores (difference, 3.28; t = 6.44, P < .001) observed in participants who underwent AF ablation compared with those with an AF diagnosis of less than or equal to 6 months supported known groups validity. Factor analysis revealed a single-factor structure explaining 35% of the variance. The Kuder-Richardson coefficient was 0.86.

Conclusions

The KAFSM survey demonstrates content and construct validity and internal consistency reliability. Implementation of the KAFSM in the clinical setting will permit evaluation of the feasibility of its use and value to assess learning outcomes of AF education.
Rare clinical findings in three sporadic cases of Beckwith-Wiedemann syndrome due to novel mutations in the CDKN1C gene
Authors: Jurkiewicz Dorota , Skórka Agata , Ciara Elżbieta , Kugaudo Monika , Pelc Magdalena , Chrzanowska Krystyna , Krajewska-Walasek Małgorzata
Published: December 2019

Beckwith-Wiedemann syndrome (BWS) is a rare congenital overgrowth disorder characterised by macroglossia, abdominal wall defects, neonatal hypoglycaemia, lateralised overgrowth and predisposition to embryonal tumours. BWS results mainly from epigenetic changes at chromosome 11p15.5; however, heterozygous pathogenic variants on the maternalCDKN1Callele are observed in 5–8% of sporadic BWS cases. In this study, we report three sporadic BWS patients with novel pathogenic variants in theCDKN1Cgene, including one missense (c.181T>C) and two frameshift (c.415_416dup, c.804delC). Detailed clinical evaluation of the patients showed variable manifestation of the disease and underlined the diagnostic challenge for BWS patients at various age of life. The child with the c.415_416dup variant presented with two rare features observed so far in only a few BWS patients withCDKN1Cpathogenic variants: supernumerary flexion creases and agenesis of corpus callosum. Confirmation of these findings in another BWS patient adds to the broad clinical spectrum of the disease and suggests that presence of these features may be associated withCDKN1Cpathogenic variants.
Predictive value of Tpeak-Tend interval for ventricular arrhythmia and mortality in heart failure patients with an implantable cardioverter-defibrillator
Authors: Xue Cong , Hua Wei , Cai Chi , Ding Li-Gang , Niu Hong-Xia , Fan Xiao-Han , Liu Zhi-Min , Gu Min , Zhao Yun-Zi , Zhang Shu
Published: December 2019

Background:

Tpeak-Tend interval (TpTe), a measurement of transmural dispersion of repolarization (TDR), has been shown to predict ventricular tachyarrhythmia in cardiac resynchronization therapy with defibrillator (CRT-D) patients. However, the ability of TpTe to predict ventricular tachyarrhythmia and mortality for heart failure patients with a cardioverter-defibrillator (ICD) is not clear. The purpose of this study was to assess the predictive ability of TpTe in heart failure patients with ICD.

Methods and results:

We enrolled 318 heart failure patients treated after ICD. Patients were divided into 3 groups according to their post-implantation TpTe values and were evaluated every 6 months. The primary endpoint was appropriate ICD therapy. The secondary endpoint was all-cause mortality. During long-term follow-up, the TpTe > 110 ms group (n = 111) experienced more VT/VF episodes (45%) and all-cause mortality (25.2%) than the TpTe 90–110 ms group (n = 109) (26.4%, 14.5%) and TpTe < 90 ms group (n = 98) (11.3%, 11.3%) (overall P < .05, respectively). In Cox regression, longer post-implantation TpTe was associated with an increased number of VT/VF episodes [HR: 1.017; 95% CI: 1.008-1.026; P < .001], all-cause mortality [HR: 1.015; 95% CI: 1.004-1.027; P = .010] and the combined endpoint [HR: 1.018; 95%CI: 1.010-1.026; P < .001].

Conclusions:

Post-implantation TpTe was an independent predictor of both ventricular arrhythmias and all-cause mortality in heart failure patients with an implanted ICD.
Pancreatic cancer treatment costs, including patient liability, by phase of care and treatment modality, 2000–2013
Authors: Tramontano Angela C. , Chen Yufan , Watson Tina R. , Eckel Andrew , Sheehan Deirdre F. , Peters Mary Linton B. , Pandharipande Pari V. , Hur Chin , Kong Chung Yin
Published: December 2019

Objectives:

Our study provides phase-specific cost estimates for pancreatic cancer based on stage and treatment. We compare treatment costs between the different phases and within the stage and treatment modality subgroups.

Methods:

Our cohort included 20,917 pancreatic cancer patients from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database diagnosed between 2000 and 2011. We allocated costs into four phases of care-staging (or surgery), initial, continuing, and terminal– and calculated the total, cancer-attributable, and patient-liability costs in 2018 US dollars. We fit linear regression models using log transformation to determine whether costs were predicted by age and calendar year.

Results:

Monthly cost estimates were high during the staging and surgery phases, decreased over the initial and continuing phases, and increased during the three-month terminal phase. Overall, the linear regression models showed that cancer-attributable costs either remained stable or increased by year, and either were unaffected by age or decreased with older age; continuing phase costs for stage II patients increased with age.

Conclusions:

Our estimates demonstrate that pancreatic cancer costs can vary widely by stage and treatment received. These cost estimates can serve as an important baseline foundation to guide resource allocation for cancer care and research in the future.
Age is not a barrier to good outcomes following ambulatory high ligation and stripping for varicose veins
Authors: Chen ChuWen , Cai YuTing , Long XiaoQing , Fan Xiang , Yuan Ding , Yang Yi , Huang Bin , Zhao JiChun , Ma YuKui
Published: December 2019

This was a prospective cohort study with a short-term follow-up. To explore whether age is a factor in the prognosis following high ligation and stripping (HLS) performed in an ambulatory care center. This study included 170 patients who underwent their first HLS for varicose veins in an ambulatory center from November 2016 to October 2017 at West China Hospital. The patients were categorized as two groups: the ≤60 years old group and the >60 years old group. We collected the two age groups data included Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) classification, Venous Clinical Severity Score (VCSS), Visual Analogue Score (VAS), Aberdeen Varicose Veins Questionnaire (AVVQ), Quality of Recovery (QoR-15), and postoperative complications at predetermined time points. The clinical correlation between age and prognosis following HLS in an ambulatory care center was prospectively studied after adjusting for potential confounders. The distribution of age and prognosis were also compared in the AVVQ improvement and VCSS improvement of patients at 6 weeks and 6 months after surgery. Our research comprised a total of 170 patients (236 limbs), of which 86 (50.6%) patients were female and 66 (38.8%) patients received bilateral procedures. After multivariable risk adjustment for potential confounding factors, we observed that age was not associated with the improvement of AVVQ (OR 0.3, 95%CI (1.3, 0.7), P = .54) and VCSS (OR 0.2, 95%CI (0.2, 0.6) P = .38) at 6 months after HLS, as well as AVVQ (OR 0.5,95%CI (1.2, 2.2), P = .57) at 6 weeks after HLS. However, at 6 weeks after HLS, age was related to the improvement of VCSS (OR −0.6, 95%CI (1.2, 0.1), P = .03), with the >60 years old group having a lower VCSS improvement compared to the 60 years old group. In postoperative complications, there were no significant differences in terms of complications between the two age groups (all P value >.05). Therefore, in our opinion, age is not a barrier for good outcomes following HLS in an ambulatory care center.
A PRISMA assessment of the reporting quality of systematic reviews of nursing published in the Cochrane Library and paper-based journals
Authors: Zhang Juxia , Han Lin , Shields Linda , Tian Jinhui , Wang Jiancheng
Published: December 2019

Objective:

The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) was released as a standard of reporting systematic reviewers (SRs). However, not all SRs adhere completely to this standard. This study aimed to evaluate the reporting quality of SRs published in the Cochrane Library and paper-based journals.

Methods:

The SRs which evaluate the effectiveness of nursing interventions in 2016 were identified via PubMed. The reporting quality of selected articles was evaluated using the PRISMA checklist. For comparison, we divided these articles into Cochrane review (CR) and non-Cochrane review (NCR). Based on the satisfaction of the applicable criteria, each article is assigned an accumulated score and a total percentage score.

Results:

Overall, 41.7% articles were concentrated in 19.0 to 22.5 points which represent the moderate quality, 22% articles were high quality. There were still 36.5% articles with low quality. The mean PRISMA score was 20.54 ± 2.367 for CRs, and 18.81 ± 2.536 for NCRs. Although no significant difference was exit between overall CR and NCR scores, there were differences between items 1, 5, 8, 16, 23. Analysis indicated that CR was significantly associated with the overall PRISMA score.

Conclusion:

Compliance of CR and NCR with PRISMA checklist exhibited different strengths and weaknesses. Our study underscores that nursing researchers should pay more attention to comprehensive reporting of SRs in nursing to follow the PRISMA statement.

Implications for nursing and/or health policy:

Nursing researchers who participate in SRs should follow the latest Cochrane Handbook to prepare such study. Meanwhile, the PRISMA statement should be followed strictly to report SRs, so as to improve the quality of SRs.
Association of MRI-defined lumbar paraspinal muscle mass and slip percentage in degenerative and isthmic spondylolisthesis
Authors: Park Jae-Hyun , Kim Koh-Woon , Youn Yousuk , Kim Hyungsuk , Chung Won-Seok , Song Mi-Yeon , Cho Jae-Heung
Published: December 2019

The objective of this study is to investigate the role of paraspinal muscles in the progression of different types of spondylolisthesis by examining the correlation between cross-sectional area (CSA) of lumbar paraspinal muscle and slip percentage (SP) in degenerative spondylolisthesis and isthmic spondylolisthesis.

A multicenter retrospective analysis was carried out including 219 subjects diagnosed with lumbar spondylolisthesis. Using T2-weighted axial magnetic resonance imgaging, CSAs of the psoas major (PM), multifidus (MU), and erector spinae were measured and divided by L5 vertebral body (VB) CSA. SP was measured using sagittal T2-weighted images. Correlations between muscle CSA ratio and SP were calculated in each group. Regression analysis was performed to predict the influence of each muscle CSA/VB CSA ratio on SP.

No significant correlation was found in the degenerative spondylolisthesis group between any of the muscle CSA ratios and SP. Both PM/VB ratio (r = −0.24, P = .021) and MU/VB ratio (r = −0.26, P = .012) were negatively correlated with SP in the isthmic spondylolisthesis group. MU had more influence on SP than PM in the isthmic spondylolisthesis group (regression coefficient MU/VB: −8.08, PM/VB: −4.34).

Both PM and MU muscle CSA ratios were negatively correlated with SP in the isthmic group. MU had more influence on SP than PM. No muscles had any correlations with SP in the degenerative group. This discrepancy between the two groups suggests that exercise programs or interventions regarding the segmental stability of isthmic spondylolisthesis and degenerative spondylolisthesis should be distinguished in clinical practice.

Clinical Research Information Service of Korea Centers for Disease control and Prevention, KCT0002588. Registered on 12 December 2017, https://cris.nih.go.kr/cris/search/search_result_st01.jsp?seq=10702
Severe polycystic liver diseases: hepatectomy or waiting for liver transplantation?
Authors: Zhang Zeyu , Hu Kuan , Yang Jiajin , Zhou Yufan , Wang Zhiming , Huang Yun
Published: December 2019

Introduction:

Choice of treatment in patients with symptomatic polycystic liver diseases (PLD) remains controversial. Various surgical procedures aiming at eliminating symptomatic cysts are widely used in mild and advanced PLD patients, but liver transplantation is currently recommended as the only curative treatment especially in severe cases.

Patient concerns:

Case 1: A 51-year-old male was admitted for severe eating disorder and dyspnea for 2 months. He had been diagnosed as PLD, PKD, and hypertension for 9 years, with only antihypertensive drug therapy. No significant family history could be traced.

Case 2: A 54-year-old female was admitted to our hospital for ventosity during nearly 5 years. She had been diagnosed as PLD and hypertension for 22 years, for which only aspiration-sclerotherapy therapy was performed for multiple times. Both her mother and sister were diagnosed with PLD previously.

Diagnosis:

They were diagnosed as PLD by medical history, family history, and computed tomography scan (multiple cysts dispersively presenting in the liver).

Interventions:

The 2 patients underwent hepatectomy with fenestration, and were well recovered with no mortality.

Outcomes:

While case 1 only experienced relief of symptoms, case 2 experienced massive growth of hepatic parenchyma, which indicated positive prognosis and showed the possibility to avoid or at least postpone liver transplantation for a long time, considering the lack of liver parenchyma is one of the main reason for urgency of liver transplantation.

Conclusion:

Here we described subradical polycystic hepatectomy, a special form of hepatectomy with fenestration modified by us, as a safe and effective treatment to potentially achieve long-term effects in PLD patients.
Management of delayed encephalopathy after CO poisoning
Authors: Xu Xiao-Min , Luo Hua , Rong Ben-bing , Zheng Xiao-Mei , Wang Feng-tao , Zhang Shu-Jiang , Li Zuo-Xiao
Published: December 2019

Background:

Approximately 10% to 30% patients develop delayed encephalopathy after acute CO poisoning (DEACMP). No specific treatment is available and poor prognosis is a characteristic of this disease. We aimed to evaluate the efficacy and safety of all therapies that have been tried in randomized controlled trial (RCT) for DEACMP.

Methods:

We conducted a systematic search of the Cochrane, Embase, PubMed, and Web of Science databases.

Results:

Overall, 4 RCTs were identified in our study. Both hyperbaric oxygen (HBO) and mesenchymal stem cell (MSC) transplantation were effective in DEACMP, and MSC seemed to be superior to HBO. The addition of dexamethasone, N-butylphthalide, or XingZhi-YiNao granules into HBO, or butylphthalide into MSC could achieve better neurological recovery in DEACMP patients but did not significantly increase the incidence of adverse events.

Conclusion:

Several therapies have shown positive results in treating DEACMP and need to be proven by further studies.
Effects of SGLT2 inhibitors on cardiovascular outcomes and mortality in type 2 diabetes
Authors: Zou Cai-Yan , Liu Xue-Kui , Sang Yi-Quan , Wang Ben , Liang Jun
Published: December 2019

Background:

Optimal glycemic control is required to restrain the increase of cardiovascular events in patients with type 2 diabetes. The effects of sodium-glucose cotransporter-2 (SGLT-2) inhibitors on cardiovascular events and mortality in those patients are not well established. This meta-analysis was conducted to assess the effects of SGLT2 inhibitors on cardiovascular events and mortality in patients with type 2 diabetes.

Methods:

We conducted a systematic literature search of Medline, Embase and Cochrane Library and included randomized controlled trials (RCTs) of 3 different SGLT2 inhibitors (canagliflozin, dapagliflozin and empagliflozin) that evaluated the effects on cardiovascular outcomes and mortality in the final meta-analysis. The intervention arm was defined either as SGLT2 inhibitor monotherapy or as SGLT2 inhibitor add-on to other non-SGLT2 inhibitor antidiabetic agents (ADAs).

Results:

Forty-two trials with a total of 61,076 patients with type 2 diabetes were included in the meta-analysis. Compared with the control, SGLT2 inhibitor treatment was associated with a reduction in the incidence of major adverse cardiovascular events (MACEs) (OR = 0.86, 95% CI 0.80–0.93, P < .0001), myocardial infarction (OR = 0.86, 95% CI 0.79–0.94, P = .001), cardiovascular mortality (OR = 0.74, 95% CI 0.67–0.81, P < .0001) and all cause mortality (OR = 0.85, 95% CI 0.79–0.92, P < .0001). However, the risk of ischemic stroke was not reduced after SGLT2 inhibitor treatment in patients with type 2 diabetes (OR = 0.95, 95% CI 0.85–1.07, P = .42).

Conclusion:

These data suggest a decreased risk of harm with SGLT2 inhibitor as a class with respect to cardiovascular events and mortality.
Implant-assisted removable prosthetic rehabilitation after distraction osteogenesis in a patient with ameloblastoma recurrence
Authors: Lee Jae-Hyun , Kim Sung-Hun , Yoon Hyung-In , Yeo In-Sung Luke , Han Jung-Suk
Published: December 2019

Introduction:

A resected mandibular edentulous ridge resulting from an ameloblastoma and marginal mandibulectomy is a restorative challenge. To maintain oral hygiene, recurrent examinations, and for long-term maintenance, a removable dental prosthesis is preferred to an implant-supported fixed dental prosthesis.

Patient concerns:

A 28-year-old Asian man was referred for evaluation of a radiolucent area on the right side of the mandible. The right mandibular area had increasingly enlarged over a period of ≥5 months. Marginal resection and inferior alveolar nerve repositioning of the mandible were performed by oral surgeons, followed by reconstruction of the resected mandible with distraction osteogenesis. After 6 years, the patient presented with swelling of the same area.

Diagnosis:

Histopathological examination revealed recurrence of benign ameloblastoma in the mandible. After mass excision of the recurrent benign tumor, dental implants were installed. To aid with recurrent examinations and oral hygiene maintenance, a treatment plan using implant-assisted removable dental prosthesis, instead of a fixed prosthesis, was formulated.

Interventions:

The edentulous area was rehabilitated with a tooth- and implant-assisted removable partial denture. Due to the insufficient intermaxillary clearance, the removable prosthesis was designed in such a manner that retention, support, and stability could be ensured by separate components.

Outcomes:

The tooth- and implant-assisted removable partial denture showed satisfactory function and esthetics. No complications were observed in the dental prosthesis and supporting tissues during the 3-year follow-up period.

Conclusion:

In recurrent ameloblastoma cases, a removable dental prosthesis may be an effective treatment option for oral rehabilitation. The type of denture design used in this study is novel for implant-assisted removable partial denture rehabilitation.
On Best Interests
Authors: Moss Karen O. , Guerin Robert , Dwyer Olubukunola Mary , Wills Celia E. , Daly Barbara
Published: December 2019

Surrogate health care decision making is often a challenge for everyone involved. In the case of incapacitated patients, family members, nurses, health care providers, and other members of the health care team often grapple with determining the most appropriate clinical course of action. For these difficult patient scenarios, the expertise of clinical ethics consultants is sought to assist with complex health care decision making. Clinical ethics consultation is designed to provide a more objective “outside” opinion and offer advice to the patient, family, and entire care team to support and guide decisions. Nurses are well positioned to initiate assistance from Clinical Ethics Consult Services in support of patient and family advocacy. This article presents a case analysis based on the Stakeholder, Facts, Norms, and Options Framework to analyze the best interest course of action for Mr K., a patient diagnosed with abdominal pain due to end-stage liver cirrhosis and who lacks decisional capacity in regard to his own treatment decision making. The case analysis highlights specific examples of how nurses can provide information, facilitate discussion, and otherwise support patients and families to achieve best interest outcomes.
Elisabeth Kübler-Ross and the 5 Stages Model in a Sampling of Recent North American Nursing Textbooks
Authors: Corr Donna M. , Corr Charles A.
Published: December 2019

Nursing education programs and nursing textbooks often present accounts of the work of Dr Elisabeth Kübler-Ross and her “5 stages” model. In this article, we examine a sampling of recent North American nursing textbooks to illustrate the different ways those subjects are discussed. Unfortunately, the information provided is not always accurate or helpful in guiding readers. We describe why that is so and suggest some ways in which better guidance could be delivered. It is particularly timely to undertake this examination since 2019 is the 50th anniversary of the publication of On Death and Dying, the well-known book in which Dr Kübler-Ross first published her theory and descriptions of the work that led to it.
Maternity Nurses' Knowledge about Sudden Unexpected Postnatal Collapse and Safe Newborn Positioning
Authors: Addison Camilla , Ludington-Hoe Susan
Published: December 2019

Purpose:

Sudden unexpected postnatal collapse (SUPC) of healthy newborns in the first 2 days of life is increasing. These types of adverse events are known to be associated with unsafe positioning during skin-to-skin contact and breastfeeding. The purpose of the study was to determine maternity nurses' knowledge about SUPC and safe newborn positioning.

Design:

Nurses who participate in a hosted listserv were solicited to complete a questionnaire.

Methods:

An email with an embedded link to a 20-item questionnaire, the SUPC and Safe Positioning Knowledge Assessment Tool, and 16 demographic questions was sent to 605 maternity nurses in the United States who are part of a Perinatal Listserv for members of the Association of Women's Health, Obstetric and Neonatal Nurses. Scores were analyzed by mean, standard deviation, and percent correct answers.

Results:

Fifty questionnaires were initiated (response rate of 8.2%), and 36 completed questionnaires (response rate of 5.9%) were analyzed. Maternity nurses' knowledge of SUPC was less than their knowledge of safe newborn positioning (61% correct vs. 72% correct; p < 0.001).

Clinical Implications:

Maternity nurses need more information about SUPC and safe newborn positioning, including risk factors, and effective strategies to reduce risk of preventable newborn harm.
Use of a Transfusion Checklist by Student Nurses to Improve Patient Safety
Authors: Scott Sue S. , Henneman Elizabeth A. , Nathanson Brian H. , Andrzejewski Chester , Gonzalez Megan , Walker Rachel , Martinez Vanessa I.
Published: December 2019

Better education around the recognition of transfusion-associated adverse events is warranted. It is unknown if checklist use improves recognition by student nurses. This study examined whether using a checklist could improve transfusion-associated adverse event recognition behaviors. There was an increased frequency of transfusion-associated adverse event management behaviors in the checklist group, but overall recognition was no greater than other groups. A transfusion-associated adverse event checklist may increase patient safety by promoting identification behaviors.
Recruitment Strategies for Nurse Enrollment in an Online Study
Authors: Surdam Jessica , Daly Barbara , Fulton Sarah , Margevicius Seunghee , Schluchter Mark , Flocke Susan , Manne Sharon , Meropol Neal J.
Published: December 2019

Background

Although there is a great deal of literature regarding effective recruitment and challenges of recruiting specific patient populations, there is less known about best practices for recruitment of nurses as study subjects.

Objectives

The purpose of this article is to report our experience with recruitment and retention for a randomized trial of an online educational program to prepare oncology nurses to discuss oncology clinical trials with patients.

Methods

The study population included currently employed oncology nurses with direct patient interaction. There were three phases of this study: (1) qualitative interviews, (2) a pilot test, and (3) the randomized trial. Phase 3 was rolled out in five waves of recruitment. The distinct phases of the study—and the gradual roll out of recruitment during Phase 3—allowed us to test and refine our recruitment and retention methods for the randomized trial. Upon analysis of our response rate and attrition after the first wave of recruitment in Phase 3, we made several changes to improve recruitment and retention, including adding incentives, shortening the survey, and increasing the number of reminders to complete the program.

Results

The response rate was higher when we used both e-mail and U.S. postal mail solicitations. After the first wave of recruitment in the final phase, changes in our strategies did not increase our overall response rate significantly; however, the rate of attrition following baseline declined.

Discussion

Recruitment planning is an important component of successful clinical research. The use of the Internet for both recruitment of subjects and testing of interventions remains a cost-effective and potentially high yield methodology. Our research demonstrated several successful approaches to yield increased participation and retention of subjects, including seeking formal relationships with professional organizations as sponsors or supporters, providing meaningful incentives to participants, keeping surveys or questionnaires as short as possible, and planning multiple follow-up contacts from the outset.
A Simulation Suture Compared With a Clinical Suture for Training on Laparoscopic Simulators
Authors: Aljamal Yazan , Johnson Daniel E. , Summerson Todd J. , Belda Thomas E. , Thoreson Andrew R. , Farley David R.
Published: December 2019

Objective

Simulation sutures are a low-cost option for training purposes, but they may not perform as well as the more expensive clinical suture. Trainees at our institution have raised concerns about their quality and integrity compared with clinical suture. The objective was to determine whether significant differences in strength of the sutures and knot holding capabilities between low and high-cost sutures existed.

Methods

Two sutures were compared: 3-0 braided silk simulation suture (Sim*Vivo LLC, Willsboro, NY) and 3-0 Perma-Hand silk braided clinical suture (Ethicon, Somerville, NJ). The diameter of the suture was assessed with light microscopy. Tensile strength of the suture and knotted suture were assessed. Both sutures were tested dry and wet.

Results

Tensile strength of the sutures, knotted or unknotted, were not significantly different. Knot type did not change this comparison. Soaking in saline did not change the tensile strength but did introduce a substantial difference in knot failure mode between sutures. The mean diameter of the Ethicon suture was larger than that of the Sim*Vivo suture, which could influence suture behavior.

Conclusions

The applied mechanical tests identified that clinical and simulation sutures differ some in their inherent mechanical characteristics related to suture handling. However, these differences did not translate to a key measure of performance of a sutured junction, namely, the strength of the knotted suture. Based on the results of the study, any subjective impressions of simulation suture strength and knot holding should not negatively impact its use for medical education.
Blood flow of the venous system during resuscitative endovascular balloon occlusion of the aorta: Noninvasive evaluation using phase contrast magnetic resonance imaging
Authors: Izawa Yoshimitsu , Hishikawa Shuji , Matsumura Yosuke , Nakamura Hiroyasu , Sugimoto Hideharu , Mato Takashi
Published: December 2019

BACKGROUND

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a viable resuscitation approach for a subdiaphragmatic injury that can regulate arterial blood flow. On the other hand, the evaluation of venous or portal venous blood flow during REBOA remains insufficient because invasive cannulation or exposure of the vessel may affect the blood flow, and Doppler echography is highly operator-dependent. However, phase contrast magnetic resonance imaging has enabled accurate evaluation and noninvasive measurement. This study aimed to investigate the change of venous and portal venous blood flow during REBOA in a porcine model.

METHODS

Seven pigs were anesthetized, and a REBOA catheter was placed. The blood flows of the inferior vena cava (IVC), hepatic vein (HV), portal vein (PV), and superior vena cava (SVC) were measured using phase contrast magnetic resonance imaging, in both the balloon deflated (no-REBOA) and fully balloon inflated (REBOA) states. Mean arterial pressure (MAP), central venous pressure, cardiac index, and systemic vascular resistance index were measured.

RESULTS

The blood flows of the suprahepatic, infrahepatic, and distal IVC, HV, and PV in the no-REBOA state were 1.40 ± 0.36 L·min−1, 0.94 ± 0.16 L·min−1, 0.50 ± 0.19 L·min−1, 0.060 ± 0.018 L·min−1, and 0.32 ± 0.091 L·min−1, respectively. The blood flow of each section in the REBOA condition was significantly decreased at 0.41 ± 0.078 (33% of baseline), 0.15 ± 0.13 (15%), 0.043 ± 0.034 (9%), 0.029 ± 0.017 (37%), and 0.070 ± 0.034 L·min−1 (21%), respectively. The blood flow of the SVC increased significantly in the REBOA condition (1.4 ± 0.63 L·min−1 vs. 0.53 ± 0.14 L·min−1 [257%]). Mean arterial pressure, central venous pressure, cardiac index, and systemic vascular resistance index were significantly increased after REBOA inflation.

CONCLUSION

Resuscitative endovascular balloon occlusion of the aorta decreased blood flows of the IVC, HV, and PV and increased blood flow of the SVC. This result could be explained by the collateral flow from the lower body to the SVC. A better understanding of the effect of REBOA on the venous and portal venous systems may help control liver injury.
Novosphingobium umbonatum sp. nov., isolated from a freshwater mesocosm
Authors: Sheu Shih-Yi , Cai Cheng-Ye , Kwon Soon-Wo , Chen Wen-Ming
Published: December 2019

A bacterial strain designated FSY-9Twas isolated from a freshwater mesocosm in Taiwan and characterized to determine its taxonomic affiliation. Phylogenetic analyses based on 16S rRNA gene sequences and coding sequences of 92 protein clusters indicated that strain FSY-9Tformed a phylogenetic lineage in the genusNovosphingobium. Strain FSY-9Twas most closely related toNovosphingobium humiR1-4Twith a 97.2 % 16S rRNA gene sequence similarity. Strain FSY-9Tshowed 71.3–72.6 % average nucleotide identity and 17.7–23.0 % digital DNA–DNA hybridization identity with the strains of otherNovosphingobiumspecies. Cells of strain FSY-9Twere facultatively anaerobic, Gram-negative, rod-shaped, non-motile and formed light yellow coloured colonies. Growth occurred at 15–37 °C and pH 5.5–7, and in the presence of 0–0.5 % NaCl. The major fatty acids (>10 %) of strain FSY-9Twere summed feature 3 (C16 : 1ω7cand/or C16 : 1ω6c), C18 : 1ω7cand C16 : 0. The polar lipid profile consisted of a mixture of phosphatidylethanolamine, phosphatidylglycerol, phosphatidylcholine, phosphatidyldimethylethanolamine, sphingoglycolipid, an uncharacterized aminophospholipid, an uncharacterized glycolipid and an uncharacterized lipid. The major polyamine was spermidine. The major isoprenoid quinone was Q-10. The DNA G+C content was 61.5 mol%. On the basis of phenotypic and genotypic properties and phylogenetic inference, strain FSY-9Tshould be classified as a novel species of the genusNovosphingobium, for which the nameNovosphingobium umbonatumsp. nov. is proposed. The type strain is FSY-9T(=BCRC 81052T=LMG 30054T=KCTC 52813T).
How do interventions impact malaria dynamics between neighboring countries? A case study with Botswana and Zimbabwe
Authors: Agusto Folashade , Goldberg Amy , Ortega Omayra , Ponce Joan , Zaytseva Sofya , Sindi Suzanne , Blower Sally
Published: December 2019

Malaria is a vector-borne disease that is responsible for over 400,000 deaths per year. Although countries around the world have taken measures to decrease the incidence of malaria, many regions remain endemic. Indeed, progress towards elimination has stalled in multiple countries. While control efforts are largely focused at the national level, the movement of individuals between countries may complicate the efficacy of elimination efforts. Here, we consider the case of neighboring countries Botswana and Zimbabwe, connected by human mobility. Both have improved malaria rates in recent years with differing success. We use a two-patch Ross-MacDonald Model with Lagrangian human mobility to examine the coupled disease dynamics between these two countries. In particular, we are interested in the impact that interventions for controlling malaria applied in one country can have on the incidence of malaria in the other country. We find that dynamics and interventions in Zimbabwe can dramatically influence pathways to elimination in Botswana, largely driven by Zimbabwe’s population size and larger basic reproduction number.
The nucleus acts as a ruler tailoring cell responses to spatial constraints
Authors: Lomakin A.J. , Cattin C.J. , Cuvelier D. , Alraies Z. , Molina M. , Nader G. , Srivastava N. , Garcia-Arcos J.M. , Zhitnyak I.Y. , Bhargava A. , Driscoll M.K. , Welf E.S. , Fiolka R. , Petrie R.J. , Manel N. , Lennon-Duménil A.M. , Müller D.J. , Piel M.
Published: December 2019

The microscopic environment inside a metazoan organism is highly crowded. Whether individual cells can tailor their behavior to the limited space remains unclear. Here, we found that cells measure the degree of spatial confinement using their largest and stiffest organelle, the nucleus. Cell confinement below a resting nucleus size deforms the nucleus, which expands and stretches its envelope. This activates signaling to the actomyosin cortexvianuclear envelope stretch-sensitive proteins, upregulating cell contractility. We established that the tailored contractile response constitutes a nuclear ruler-based signaling pathway involved in migratory cell behaviors. Cells rely on the nuclear ruler to modulate the motive force enabling their passage through restrictive pores in complex three-dimensional (3D) environments, a process relevant to cancer cell invasion, immune responses and embryonic development.

One Sentence Summary

Nuclear envelope expansion above a threshold triggers a contractile cell response and thus acts as a ruler for the degree of cell deformation.
A complex IRES at the 5’-UTR of a viral mRNA assembles a functional 48S complex via an uAUG intermediate
Authors: Neupane Ritam , Pisareva Vera P. , Rodríguez Carlos F. , Pisarev Andrey V. , Fernández Israel S.
Published: December 2019

RNA viruses are pervasive entities in the biosphere with significant impact in human health and economically important livestock. As strict cellular parasites, RNA viruses abuse host resources, redirecting them towards viral replication needs. Taking control of the cellular apparatus for protein production is a requirement for virus progression and diverse strategies of cellular mimicry and/or ribosome hijacking evolved to ensure this control. Especially in complex eukaryotes, translation is a sophisticated process, with multiple mechanisms acting on ribosomes and mRNAs. The initiation stage of translation is specially regulated, involving multiple steps and the engagement of numerous initiation factors some of them of high complexity. The use of structured RNA sequences, called Internal Ribosomal Entry Sites (IRES), in viral RNAs is a widespread strategy for the exploitation of eukaryotic initiation. Using a combination of electron cryo-microscopy (cryo-EM) and reconstituted translation initiation assays with native components, we characterized how a novel IRES at the 5’-UTR of a viral RNA assembles a functional translation initiation complex via an uAUG intermediate, redirecting the cellular machinery for protein production towards viral messengers. The IRES features a novel extended, multi-domain architecture, circling the 40S head, leveraging ribosomal sites not previously described to be exploited by any IRES. The structures and accompanying functional data, illustrate the importance of 5’-UTR regions in translation regulation and underline the relevance of the untapped diversity of viral IRESs. Given the large number of new viruses metagenomic studies have uncovered, the quantity and diversity of mechanisms for translation hijacking encrypted in viral sequences may be seriously underestimated. Exploring this diversity could reveal novel avenues in the fight against these molecular pathogens.
MB-GAN: Microbiome Simulation via Generative Adversarial Network
Authors: Rong Ruichen , Jiang Shuang , Xu Lin , Xiao Guanghua , Xie Yang , Liu Dajiang J. , Li Qiwei , Zhan Xiaowei
Published: December 2019

Simulation is a critical component of experimental design and evaluation of analysis methods in microbiome association studies. However, statistically modeling the microbiome data is challenging since that the complex structure in the real data is difficult to be fully represented by statistical models. To address this challenge, we designed a novel simulation framework for microbiome data using a generative adversarial network (GAN), called MB-GAN, by utilizing methodology advancements from the deep learning community. MB-GAN can automatically learn from a given dataset and compute simulated datasets that are indistinguishable from it. When MB-GAN was applied to a case-control microbiome study of 396 samples, we demonstrated that the simulated data and the original data had similar first-order and second-order properties, including sparsity, diversities, and taxa-taxa correlations. These advantages are suitable for further microbiome methodology development where high fidelity microbiome data are needed.
WEDGE: imputation of gene expression values from single-cell RNA-seq datasets using biased matrix decomposition
Authors: Hu Yinlei , Li Bin , Zhang Wen , Liu Nianping , Cai Pengfei , Chen Falai , Qu Kun
Published: December 2019

The low capture rate of expressed RNAs from single-cell sequencing technology is one of the major obstacles to downstream functional genomics analyses. Recently, a number of imputation methods have emerged for single-cell transcriptome data, however, recovering missing values in very sparse expression matrices remains a substantial challenge. Here, we propose a new algorithm, WEDGE (WEighted Decomposition of Gene Expression), to impute gene expression matrices by using a biased low-rank matrix decomposition method (bLRMD). WEDGE successfully recovered expression matrices, reproduced the cell-wise and gene-wise correlations, and improved the clustering of cells, performing impressively for applications with multiple cell type datasets with high dropout rates. Overall, this study demonstrates a potent approach for imputing sparse expression matrix data, and our WEDGE algorithm should help many researchers to more profitably explore the biological meanings embedded in their scRNA-seq datasets.