bluuebunny/crossref_metadata_2025 huggingface dataset:
Hindernisse und Voraussetzungen für die Vermittlung älterer, depressiv erkrankter Menschen in Psychotherapie aus Sicht von HausärztInnen
Authors: Kammerer K. , Falk K. , Heintze C. , Döpfmer S. , Heusinger J.
Published: November 2016

Zielsetzung Ältere Menschen mit depressiven Erkrankungen nehmen seltener Psychotherapie in Anspruch als jüngere Menschen. HausärztInnen sind für die Vermittlung in psychotherapeutische Behandlung insbesondere für ältere Menschen von großer Bedeutung. Dieser Beitrag präsentiert Ergebnisse zur hausärztlichen Sicht auf die Hindernisse und Voraussetzungen für eine Vermittlung älterer, depressiv erkrankter Menschen in Psychotherapie.

Methodik Hausärztliche LehrärztInnen wurden mit einem Fragebogen zur Versorgung älterer Menschen (60+) mit depressiven Erkrankungen befragt. In 2 offenen Fragen wurde die Sicht auf Hindernisse und Voraussetzungen für die Vermittlung älterer, depressiv erkrankter Menschen in psychotherapeutische Behandlung erfragt.

Ergebnisse Die meisten Aussagen betreffen Hindernisse, die auf PatientInnen-Seite wahrgenommen werden, gefolgt von Barrieren, die auf Seiten des Versorgungssystems gesehen werden. Vor allem hinderliche Einstellungen und Emotionen, aber auch funktionale Einschränkungen auf Seiten der PatientInnen wurden als Barriere genannt. Hinsichtlich des Versorgungssystems wurden strukturelle Aspekte, wie fehlende Psychotherapieplätze, aber auch das Handeln der Versorgungsakteure sowie eine ungenügende Kooperation aufgeführt. Als Voraussetzungen wurden spezielle Therapieangebote für ältere Menschen genannt.

Schlussfolgerungen Der Umgang mit Vorbehalten gegenüber Psychotherapie auf Seiten älterer Menschen erfordert Zeit, die in der hausärztlichen Praxis in der Regel nicht vergütet wird. Kooperationen mit PsychotherapeutInnen werden als wichtige Voraussetzung für eine Vermittlung gesehen, wobei hier unterschiedliche Professionsbilder aufeinandertreffen. Insbesondere für Menschen mit Mehrfacherkrankungen wird der Zugang als schwierig angesehen.
Tracking the decoy: maximizing the decoy effect through sequential experimentation
Authors: Kaptein Maurits C , Van Emden Robin , Iannuzzi Davide
Published: November 2016

The decoy effect is one of the best known human biases violating rational choice theory. According to a large body of literature, people may be persuaded to switch from one offer to another by the presence of a third option (the decoy) that, rationally, should have no influence on the decision-making process. For example, when asked to choose between a laptop with a good battery but a poor memory and a laptop with a poor battery but a good memory, customers may be induced to shift their preference if the offer is accompanied by a third laptop that has a battery as good as the latter but even worse memory—an effect that has clear applications in marketing practice. Surprisingly, renowned decoy studies have resisted replication, inducing scholars to challenge the scientific validity of the phenomenon and question its practical relevance. Using a treatment allocation scheme that takes inspiration from the lock-in amplification schemes used in experimental physics, we were able to explore the entire range of decoy attribute values and demonstrate that some of the reproducibility issues reported in the literature result from a suboptimal initial conditions. Furthermore, we demonstrate that our approach is able to sequentially identify the features of the decoy that maximize choice reversal. We thus reinstate the scientific validity and practical relevance of the decoy effect and demonstrate the use of lock-in amplification to optimize treatments.
Is there a prescription for strategic IT decisions?
Authors: Kurnia Sherah , Constantinidis Dora , Parkes Alison Jane , Seddon Peter B.
Published: November 2016

Strategic IT decisions are complex and critical since they significantly influence an organisation's growth and long-term survival. The large number of strategic IT failures reported in the media and academic literature indicate we have limited understanding of how to make optimal IT strategic decisions. More work is needed to understand the factors influencing strategic IT decision processes and outcomes. By exploring the key influence factors presented in this case study, students will be more informed about how senior decision makers can better manage strategic IT decision-making processes. This improved understanding will help reduce project cost overruns and enable organisations to realise the expected benefits of large-scale IT investments. This teaching case study provides insights into the key factors that influenced the strategic IT decision-making process at a major Australian pharmaceutical company (PHARMA). A decision was made under pressure to upgrade the existing enterprise resource planning system at PHARMA in order to meet an increased need for demand forecasting and planning. The implications of strategic IT decision-making theory and practice are discussed in relation to this case study.
Epipolymorphisms associated with the clinical outcome of autoimmune arthritis affect CD4+T cell activation pathways
Authors: Spreafico Roberto , Rossetti Maura , Whitaker John W. , Wang Wei , Lovell Daniel J. , Albani Salvatore
Published: November 2016

Significance

Juvenile idiopathic arthritis, a common chronic childhood rheumatic disease, is characterized by joint inflammation and synovial accumulation of activated autoreactive T cells. Although current therapies induce high rates of disease remission, 50–80% patients flare upon treatment withdrawal, thus requiring continued exposure to the safety risks and costs of an immunosuppressive biologic. Unfortunately, at the time of therapy withdrawal, patients who will maintain inactive disease are clinically indistinguishable from those who will not. We identified differences in the DNA methylation status of T-cell activation genes—detectable at a protein level and established at the time of therapy withdrawal—that were specifically associated with clinical outcome, demonstrating the mechanistic and diagnostic relevance of epigenetic features in autoimmune arthritis.
Wind speed reductions by large-scale wind turbine deployments lower turbine efficiencies and set low generation limits
Authors: Miller Lee M. , Kleidon Axel
Published: November 2016

Significance

Understanding the limits of electricity generation from winds is a requirement for planning a renewable energy future. A difficulty in estimating such limits is that wind turbines remove kinetic energy from the atmosphere, so that many turbines should reduce wind speeds, ultimately setting a limit to how much kinetic energy can be taken out of the atmosphere. We show that this slowdown effect can be accounted for by detailed climate model simulations and a relatively simple method that does not directly simulate atmospheric dynamics. This slowdown effect is critical to consider, as it makes each turbine less productive and shows that few land areas can yield more than 1.0 W
e
m
−2
of electricity at large scales.
Late Archaic–Early Formative period microbotanical evidence for potato at Jiskairumoko in the Titicaca Basin of southern Peru
Authors: Rumold Claudia Ursula , Aldenderfer Mark S.
Published: November 2016

Significance

The potato is perhaps the most important of the high Andean crops. Cultivated the length of the Andean cordillera and across disparate ecological zones, it is now also a principal global staple. For this study, we analyzed starch microremains recovered from 14 groundstone tools from Late Archaic to Early Formative period contexts at Jiskairumoko, an early village site in the Titicaca Basin of the south-central Andes of Peru. A total of 50 starches were identified as consistent with cultivated potato. These data are significant because they contribute to the empirical foundation for understanding the development of food production in the study area and underscore the utility of starch analysis in addressing questions relating to geophyte domestication and cultivation.
Circadian rhythms identified in
Caenorhabditis elegans
by in vivo long-term monitoring of a bioluminescent reporter
Authors: Goya María Eugenia , Romanowski Andrés , Caldart Carlos S. , Bénard Claire Y. , Golombek Diego A.
Published: November 2016

Significance

Endogenous circadian rhythms have been demonstrated in several model systems, including mammals, insects, and fungi, among many others. Cycles in behavior, physiology and gene expression have also been reported in the nematode
Caenorhabditis elegans
, although limited by experimental conditions. Here we report the application of a luciferase-based reporter to investigate circadian regulation in
C
.
elegans
. Our study demonstrates entrainable, endogenous, and temperature-dependent circadian rhythms in gene expression as well as part of the pathway for synchronization. Our results represent an innovative approach for the study of long-term gene expression in real time in this system, opening the way for novel research in neuroscience and molecular pathways in general, including the precise determination of its elusive circadian clock.
RNA modification enzyme TruB is a tRNA chaperone
Authors: Keffer-Wilkes Laura Carole , Veerareddygari Govardhan Reddy , Kothe Ute
Published: November 2016

Significance

RNAs are intimately involved in numerous cellular functions such as gene expression. Typically, RNAs adopt a 3D fold, and their sequences may be chemically altered to contain modified nucleotides such as pseudouridines. There are many RNA modification enzymes, but often their cellular functions remain unknown. In this proof-of-principle study, we show that the tRNA pseudouridine synthase TruB is a tRNA chaperone. In contrast to its modification activity, the ability of TruB to fold tRNA is critical for cellular fitness. It is likely that other modification enzymes and RNA-binding proteins act as RNA chaperones increasing the efficiency of RNA maturation. This connection of RNA modification with RNA folding may have arisen during the evolution from an RNA to a ribonucleoprotein world.
Cortical networks involved in visual awareness independent of visual attention
Authors: Webb Taylor W. , Igelström Kajsa M. , Schurger Aaron , Graziano Michael S. A.
Published: November 2016

Significance

Do specific areas of the brain participate in subjective visual experience? We measured brain activity in humans using fMRI. Participants were aware of a visual stimulus in one condition and unaware of it in another condition. The two conditions were balanced for their effect on visual attention. Specific brain areas were more active in the aware than in the unaware condition, suggesting they were involved in subjective awareness independent of attention. The largest cluster of activity was found in the temporoparietal junction (TPJ), supporting a recent suggestion that the TPJ plays a role in computations concerning awareness.
Evolution of directional hearing in moths via conversion of bat detection devices to asymmetric pressure gradient receivers
Authors: Reid Andrew , Marin-Cudraz Thibaut , Windmill James F. C. , Greenfield Michael D.
Published: November 2016

Significance

In most acoustic animals, directional hearing evolved alongside basic ear structure. Pyraloid moths differ because their ears generally function as simple bat detectors with little directional ability. Those pyraloid moths that broadcast mating calls represent a yet more special case, as these species localize sound but the ability evolved well after hearing and may be constrained by fundamental auditory features. Analyzing a species with male calling songs, we report a localization mechanism wherein the membrane structure of each ear affords sharp sensitivity to sound arriving from a distinct angle. Females can thereby track male calls but only via an indirect, curvilinear trajectory. Such inefficiency may characterize specialized perceptual traits that rely on general ones having already undergone extensive prior evolution.
Persistent sulfate formation from London Fog to Chinese haze
Authors: Wang Gehui , Zhang Renyi , Gomez Mario E. , Yang Lingxiao , Levy Zamora Misti , Hu Min , Lin Yun , Peng Jianfei , Guo Song , Meng Jingjing , Li Jianjun , Cheng Chunlei , Hu Tafeng , Ren Yanqin , Wang Yuesi , Gao Jian , Cao Junji , An Zhisheng , Zhou Weijian , Li Guohui , Wang Jiayuan , Tian Pengfei , Marrero-Ortiz Wilmarie , Secrest Jeremiah , Du Zhuofei , Zheng Jing , Shang Dongjie , Zeng Limin , Shao Min , Wang Weigang , Huang Yao , Wang Yuan , Zhu Yujiao , Li Yixin , Hu Jiaxi , Pan Bowen , Cai Li , Cheng Yuting , Ji Yuemeng , Zhang Fang , Rosenfeld Daniel , Liss Peter S. , Duce Robert A. , Kolb Charles E. , Molina Mario J.
Published: November 2016

Significance

Exceedingly high levels of fine particulate matter (PM) occur frequently in China, but the mechanism of severe haze formation remains unclear. From atmospheric measurements in two Chinese megacities and laboratory experiments, we show that the oxidation of SO
2
by NO
2
occurs efficiently in aqueous media under two polluted conditions: first, during the formation of the 1952 London Fog via in-cloud oxidation; and second, on fine PM with NH
3
neutralization during severe haze in China. We suggest that effective haze mitigation is achievable by intervening in the sulfate formation process with NH
3
and NO
2
emission control measures. Hence, our results explain the outstanding sulfur problem during the historic London Fog formation and elucidate the chemical mechanism of severe haze in China.
Duplication of chicken
defensin7
gene generated by gene conversion and homologous recombination
Authors: Lee Mi Ok , Bornelöv Susanne , Andersson Leif , Lamont Susan J. , Chen Junfeng , Womack James E.
Published: November 2016

Significance

Copy number variation is an important source of genetic variation in animal genomes and an evolutionary intermediate in gene family expansion. In this study, we report the presence of a tandem duplication of β-defensin
7
(
BD7
) among multiple breeds of chickens and a resulting chimeric promoter that appears to result from gene conversion followed by nonallelic homologous recombination. These findings contribute to the understanding of gene family expansion in animals and the role of large gene families in host-defense mechanisms.
Pseudo-relatives and their left-periphery
Authors: Casalicchio Jan
Published: November 2016

In this article I propose a new analysis of Pseudo-Relative clauses (‘PRs’) within the Cartographic model (Rizzi 1997 a.o.). Heretofore, the apparently contradictory behavior of PRs in the syntactic tests used to determine their structure has been very problematic. Based on new data from Italian, I show that PRs are Small Clauses with a ForceP projection. Moreover, I explain the inconsistent results of the syntactic tests by claiming that PRs can be embedded in different syntactic environments. More specifically, they can be inserted as ‘bare’ Small Clauses into the matrix clause or be part of a bigger structure: i.e., a Complex-DP, a locative adjunction or a ‘Larsonian’ structure.
The status of subject pronouns in Modern Standard French revisited
Authors: Zimmermann Michael
Published: November 2016

This paper readdresses the long-standing debate on the morpho-syntactic status of subject pronouns in the contemporary formal variety of French by reinvestigating this issue along with those of the number of their paradigms and the null subject property. On the basis of the discussion of proposals challenging what has emerged as the received view on these issues, the paper essentially argues that a structural differentiation of prosodically weak subject pronouns as a function of their occurrence regarding the finite verb is unwarranted. From this and various other evidence which underpin the fundamental plausibility of the received view the paper concludes that Modern Standard French has two paradigms of prosodically strong and, respectively, phonologically clitic subject pronouns and represents a non null subject language.
Czechoslovak Ruthenia's 1925 Latinization campaign as the heritage of nineteenth-century Slavism
Authors: Brown Geoffrey , Maxwell Alexander
Published: November 2016

In 1925, two newspapers, both published in Uzhhorod, advocated using the Latin alphabet in the Czechoslovak province of Ruthenia. Efforts by the Czech Agrarian party to consolidate the Republic played some role, but the plans mostly emerged from a longer tradition of Slavic thought which imagined literacy in more than one alphabet, conforming to more than one literary standardization. We trace the nineteenth-century history of Slavic linguistic ideologies from the original Panslavism of Jan Herkel, the “Slavic Reciprocity” of Jan Kollár and his successors, to the Kollárian Czechoslovakism used to legitimate the first Czechoslovak Republic. We survey Ruthenia's status within Czechoslovakia and then contrast two 1925 Latinization schemes: a proposal from Czech chauvinist František Svojše and a proposal from Rusyn journalist Viktor Barany. While Rusyns mostly remained with the Cyrillic alphabet, arguments made for and against Latinization show that nineteenth century Slavic ideals endured far into the twentieth century.
Effects of heat input on welding buckling distortion by experimental measurement method
Authors: Guo N. , Yin X.-Q. , Liang J. , Ma N.
Published: November 2016

An experimental method based on digital image correlation technology is proposed to measure welding buckling distortion for bead-on-plane with tungsten inert gas welding. This study focuses on the effect of welding heat input for dynamic buckling and full-field distribution. The experimental results demonstrate that heat input has a great influence on welding buckling distortion. The longitudinal shrinkage of the weld bead is in direct proportion to the heat input. In the weld bead, the longitudinal plastic strain is small, while the transverse strain is large. The key points on the line, that is perpendicular to the bisector of the weld bead, experience a distorted trend of positive increase, constant displacement, negative increase and stable displacement, although the heat inputs are different.
Effects of shielding gas composition on arc characteristics and droplet transfer in tandem narrow gap GMA welding
Authors: Cai Xiaoyu , Fan Chenglei , Lin Sanbao , Yang Chunli , Ji Xiangru , Hu Li
Published: November 2016

The effects of shielding gas composition in tandem narrow gap gas metal arc welding were studied. The shielding gas included argon, carbon dioxide and helium. The arc characteristics and droplet transfer process were analysed. The results show that in the same welding parameters, the trail wire welding current is higher than the lead wire welding current. With the increase of carbon dioxide content, the welding currents of two wires decrease, and the trail wire droplet transfer mode transforms from spray transfer to projected transfer. With the increase of helium content, the welding currents increase and the lead wire droplet transfer mode transforms from projected transfer to spray transfer. The weld width is the largest when the shielding gas mixture is 80%Ar10%CO210%He.
Quasicircles and the conformal group
Authors: Benoist Yves , Hulin Dominique
Published: November 2016

We prove that a Jordan curve in the 2-sphere is a quasicircle if and only if the closure of its orbit under the action of the conformal group contains only points and Jordan curves.
Cesarean Delivery Rates Revisiting a 3-Decades-Old Dogma
Authors: D’Alton Mary E. , Hehir Mark P.
Published: November 2016

(JAMA 2015;314(21):2238–2240)

Cesarean delivery rates have become a major public health concern. Because of some studies showing that higher rates could be associated with negative outcomes, including increased maternal morbidity and mortality and neonatal intensive care unit admission along with unnecessary consumption of health care resources, there have been efforts in some developed countries to decrease national cesarean delivery rates. A cross-sectional, geographical study was conducted by Molina and colleagues estimating annual cesarean delivery rates in World Health Organization (WHO) member countries from data collected during the period 2005 to 2012. The research estimated that, in 2012, there were 22.9 million cesarean deliveries worldwide. The combined data were then analyzed in association with maternal and neonatal mortality rates from those countries where these rates were available. The study concluded that a cesarean delivery rate of 19% resulted in the best outcomes in terms of optimal levels of maternal and neonatal mortality.
Does Preprocedural Ultrasound Increase the First-Pass Success Rate of Epidural Catheterization Before Cesarean Delivery? A Randomized Controlled Trial
Authors: Tawfik Mohamed M. , Atallah Magdy M. , Elkharboutly Walaa S. , Allakkany Nasser S. , Abdelkhalek Mostafa
Published: November 2016

(Anesth Analg 2016) [Epub ahead of print].

Many obstetric studies have compared preprocedural ultrasound for epidural catheterization with the landmark palpation technique and found the former to be safe and efficacious. However, several of these studies were unblinded and had inconsistent designs regarding patient characteristics, single or multiple operator involvement, and operator expertise. The authors of the present study addressed these issues in this double-blind, randomized controlled trial, which compared preprocedural ultrasound with conventional palpation for epidural catheterization performed by a single, experienced anesthesiologist as a component of double-interspace combined spinal-epidural (CSE) anesthesia for cesarean delivery. The primary outcome was the success rate of epidural catheterization at the first needle pass. Secondary outcomes included the success rate of epidural catheterization at the first skin puncture, number of performed needle passes and skin punctures, duration of the epidural procedure, patient satisfaction, and complications.
Anesthetic Considerations for the Parturient After Solid Organ Transplantation
Authors: Moaveni D.M. , Cohn J.H. , Hoctor K.G. , Longman R.E. , Ranasinghe J.S.
Published: November 2016

(Anesth Analg 2016;123:402–410)

There are an increasing number of women conceiving after organ transplant. According to the 2014 National Transplantation Pregnancy Registry report, a total of 1396 female organ transplant recipients reported 2463 pregnancies. In the present review, authors discuss concerns important to the obstetric anesthesia management of pregnant solid organ transplant recipients.
Placental Implantation Abnormalities and Risk of Preterm Delivery: A Systematic Review and Meta-Analysis
Authors: Vahanian S.A. , Lavery J.A. , Ananth C.V. , Vintzileos A.
Published: November 2016

(Am J Obstet Gynecol 2015;213(suppl):S78–S90)

A rise in placental implantation abnormalities (PIAs) such as placenta previa, placenta accreta, vasa previa, and velamentous cord insertion have led to an increase in cesarean delivery rates in the past 2 decades. PIAs account for 5.6% to 8.7% of indicated preterm deliveries at <35 weeks’ gestation. This study presented a metaanalysis of PIAs in relation to preterm delivery and other adverse perinatal outcomes.
Cerebral Palsy: Causes, Pathways, and the Role of Genetic Variants
Authors: MacLennan A.H. , Thompson S.C. , Gecz J.
Published: November 2016

(Am J Obstet Gynecol 2015;213(6):779–788)

Cerebral palsy (CP) is a neurological disorder of permanent nature. It has multiple clinical types; patterns of neuropathology as seen on brain imaging, associated developmental pathologies (intellectual disability, autism, epilepsy, and visual impairment) and also rare pathogenic genetic variations (mutations). This review addresses causes, pathways and genetic variants associated with CP.
Global, Regional, and National Levels and Trends in Maternal Mortality Between 1990 and 2015, With Scenario-based Projections to 2030: A Systematic Analysis by the UN Maternal Mortality Estimation Inter-Agency Group
Authors: Alkema Leontine , Chou Doris , Hogan Daniel , Zhang Sanqian , Moller Ann-Beth , Gemmill Alison , Fat Doris Ma , Boerma Ties , Temmerman Marleen , Mathers Colin , Say Lale
Published: November 2016

(Lancet 2016;387: 462–674)

World leaders at the landmark Millennium Summit in September 2000 agreed to adopt the Millennium Development Goals (MDGs) with the goal of improving the lives of the world’s poor. Countries and international agencies agreed to monitor progress on these goals that addressed development and health outcomes between 1990 and 2015. One of the goals, MDG 5, strived for a reduction of 75% in the world-wide maternal mortality ratio over these 25 years. The objective of this current study was to project the levels and trends in maternal mortality for 183 countries for the period 2016 to 2030 based on the data obtained for MDG 5.
Mortality in Mothers After Perinatal Loss: A Population-based Follow-up Study
Authors: Hvidtjørn D. , Wu C. , Schendel D. , Thorlund Parner E. , Brink Henriksen T.
Published: November 2016

(BJOG 2016;123:393–398)

Parents who have suffered a perinatal loss experience a mourning process. Research has shown that traumatic or untimely death increases the risk of poor physical and mental health in those affected by the loss. Certainly the loss of a fetus or neonate would fit into this category. The aim of this study was to analyze mortality in mothers who have experienced a perinatal loss and explore possible underlying mechanisms.
Prolonged Second Stage of Labor, Maternal Infectious Disease, Urinary Retention and Other Complications in the Early Postpartum Period
Authors: Stephansson O. , SandstrÖm A. , Petersson G. , WikstrÖm A.-K. , Cnattingius S.
Published: November 2016

(BJOG 2016;123:608–616)

A prolonged second stage of labor is known to be associated with increased risk of certain maternal complications, such as infection, urinary retention, hematoma, and ruptured sutures in the early postpartum period. Urinary retention can lead to other adverse consequences for the affected woman, including bladder denervation, detrusor atony, and long-term voiding problems. This current population-based cohort study was undertaken to study the association between prolonged second stage of labor and these early postpartum complications.
Prediction of Escape Red Blood Cell Transfusion in Expectantly Managed Women With Acute Anaemia After Postpartum Haemorrhage
Authors: Prick B.W. , Schuit E. , Mignini L. , Jansen A.J.G. , van Rhenen D.J. , Steegers E.A.P. , Mol B.W. , Duvekot J.J.
Published: November 2016

(BJOG. 2015;122(13):1789–1797)

Severe postpartum hemorrhage (blood loss of at least 1000 mL) remains a relatively common obstetric complication. In fact, the incidence has been increasing in some developed countries, and the worldwide prevalence has been reported at 1.9%. The purpose of this study was to determine clinical predictors of the need for escape red blood cell (RBC) transfusion (a transfusion administered beyond the acute blood loss phase) in postpartum anemic women who were initially managed expectantly. In addition, the study evaluated whether health-related quality of life (HRQoL) scores provided additional predictive value beyond the clinical predictors determined.
Intraobserver and Interobserver Agreement Among Obstetric Experts in Court Regarding the Review of Abnormal Fetal Heart Rate Tracings and Obstetrical Management
Authors: Sabiani L. , Le Dû R. , Loundou A. , d’Ercole C. , Bretelle F. , Boubli L. , Carcopino X.
Published: November 2016

(Am J Obstet Gynecol. 2015;213:856.e1–e.8)

It has been noted that the fear of litigation has an impact on obstetricians and institutions, and obstetricians pay some of the highest premiums among physicians for malpractice insurance. The objective of this study was to evaluate the intraobserver and interobserver agreement among obstetric experts in court (OECs) regarding the retrospective review of abnormal fetal heart rate tracings (AFHRTs) and obstetrical management of patients with AFHRT during labor.
The Risks of Planned Vaginal Breech Delivery Versus Planned Caesarean Section for Term Breech Birth: A Meta-Analysis Including Observational Studies
Authors: Berhan Y. , Haileamlak A.
Published: November 2016

(BJOG. 2016;123:49–57)

The optimal route of delivery for a term singleton breech presentation has been debated for >50 years with several randomized and observational studies performed to address the question. The Term Breech Trial was a large, international study that showed decreased perinatal morbidity and mortality with cesarean section (CS). Following publication of this article in 2000, the American College of Obstetricians and Gynecologists and the Royal College of Obstetricians and Gynaecologists both recommended CS for term breech deliveries. A few years later, however, both organizations revised their recommendations to suggest a trial of labor in certain situations. Regardless, the vast majority of term breech presentations are now delivered by CS in high resource countries. The aim of this current meta-analysis was to establish the absolute and relative risks of planned vaginal breech delivery for term pregnancies.
A Prospective Observational Study of Maternal Oxygenation During Remifentanil Patient-controlled Analgesia Use in Labour
Authors: Messmer A. , Potts J. M , Orlikowski C.E.
Published: November 2016

(Anaesthesia 2016;71:171–176)

Remifentanil patient-controlled analgesia (PCA) has been used for labor analgesia for many years at some institutions. However, its use has not gained widespread acceptance. Studies have shown high levels of maternal satisfaction with remifentanil PCA for labor, but safety concerns, especially the adverse effects of sedation and respiratory depression, seem to be contributing to the reluctance of many anesthesiologists to adopt this analgesic technique. The objective of this study was to evaluate maternal oxygen desaturation during remifentanil PCA for labor.
Use of an Intrathecal Catheter for Analgesia, Anesthesia, and Therapy in an Obstetric Patient With Pseudotumor Cerebri Syndrome
Authors: Gragasin F.S. , Chiarella A.B.
Published: November 2016

(A A Case Rep. 2016;6:160–162)

In this case report, a 32-year-old primigravida woman with a history of idiopathic intracranial hypertension (IIH) presented to the labor and delivery suite at 40 weeks gestation in active labor and with pseudotumor cerebri syndrome (PTCS). PTCS, which includes IIH, is a rare disorder mainly of obese women of childbearing age, characterized by increased intracranial pressure in the absence of a space-occupying lesion, ventriculomegaly, or abnormal cerebrospinal fluid (CSF) composition. Symptoms include headache, pulsatile tinnitus, back pain, dizziness, photophobia, neck pain, cognitive dysfunction, radicular pain, diplopia, and in some cases, permanent vision loss. This patient was diagnosed with IIH at age 14 and was treated with multiple lumbar punctures and diuretics until age 18 years. She was then asymptomatic until 23 years of age, at which time she had a recurrence and resumed diuretic therapy until her pregnancy.
Sulfonylurea Receptor-1: A Novel Biomarker for Cerebral Edema in Severe Traumatic Brain Injury
Authors: Jha Ruchira M. , Puccio Ava M. , Chou Sherry Hsiang-Yi , Chang Chung-Chou H. , Wallisch Jessica S. , Molyneaux Bradley J. , Zusman Benjamin E. , Shutter Lori A. , Poloyac Samuel M. , Janesko-Feldman Keri L. , Okonkwo David O. , Kochanek Patrick M.
Published: November 2016

Objectives:

Cerebral edema is a key poor prognosticator in traumatic brain injury. There are no biomarkers identifying patients at-risk, or guiding mechanistically-precise therapies. Sulfonylurea receptor-1–transient receptor potential cation channel M4 is upregulated only after brain injury, causing edema in animal studies. We hypothesized that sulfonylurea receptor-1 is measurable in human cerebrospinal fluid after severe traumatic brain injury and is an informative biomarker of edema and outcome.

Design:

A total of 119 cerebrospinal fluid samples were collected from 28 severe traumatic brain injury patients. Samples were retrieved at 12, 24, 48, 72 hours and before external ventricular drain removal. Fifteen control samples were obtained from patients with normal pressure hydrocephalus. Sulfonylurea receptor- 1 was quantified by enzyme-linked immunosorbent assay. Outcomes included CT edema, intracranial pressure measurements, therapies targeting edema, and 3-month Glasgow Outcome Scale score.

Main Results:

Sulfonylurea receptor-1 was present in all severe traumatic brain injury patients (mean = 3.54 ± 3.39 ng/mL, peak = 7.13 ± 6.09 ng/mL) but undetectable in all controls (p < 0.001). Mean and peak sulfonylurea receptor-1 was higher in patients with CT edema (4.96 ± 1.13 ng/mL vs 2.10 ± 0.34 ng/mL; p = 0.023). There was a temporal delay between peak sulfonylurea receptor-1 and peak intracranial pressure in 91.7% of patients with intracranial hypertension. There was no association between mean/peak sulfonylurea receptor-1 and mean/peak intracranial pressure, proportion of intracranial pressure greater than 20 mm Hg, use of edema-directed therapies, decompressive craniotomy, or 3-month Glasgow Outcome Scale. However, decreasing sulfonylurea receptor-1 trajectories between 48 and 72 hours were significantly associated with improved cerebral edema and clinical outcome. Area under the multivariate model receiver operating characteristic curve was 0.881.

Conclusions:

This is the first report quantifying human cerebrospinal fluid sulfonylurea receptor-1. Sulfonylurea receptor-1 was detected in severe traumatic brain injury, absent in controls, correlated with CT-edema and preceded peak intracranial pressure. Sulfonylurea receptor-1 trajectories between 48 and 72 hours were associated with outcome. Because a therapy inhibiting sulfonylurea receptor-1 is available, assessing cerebrospinal fluid sulfonylurea receptor-1 in larger studies is warranted to evaluate our exploratory findings regarding its diagnostic, and monitoring utility, as well as its potential to guide targeted therapies in traumatic brain injury and other diseases involving cerebral edema.
Stimulant pharmacotherapy for adults with attention deficit hyperactivity disorder: cardiovascular effects and risk of sudden cardiac death
Authors: Pucci Mark
Published: November 2016

Drugs for attention deficit hyperactivity disorder are increasingly being used in adults. There have been concerns about the cardiovascular safety of stimulant attention deficit hyperactivity disorder drugs. Overall, studies in adults have shown small but statistically significant increases in heart rate and DBP and SBP, but have been relatively short term. Epidemiological studies have not clearly demonstrated an increased risk of sudden cardiac death, but a small increase in the risk cannot be ruled out.
Nitrite Prevents Right Ventricular Failure and Remodeling Induced by Pulmonary Artery Banding
Authors: Hu Jian , Sharifi-Sanjani Maryam , Tofovic Stevan P.
Published: November 2016

Background:

Nitrite has been shown to reduce right ventricle (RV) remodeling in experimental pulmonary hypertension. However, whether this effect is due to a reduction in RV afterload (ie, reduction in pulmonary artery pressure) or a direct effect on the RV itself remains unanswered. We hypothesize that nitrite has direct effects on RV remodeling and studied its effects in mice with pulmonary artery banding (PAB).

Methods and Results:

PAB decreased exercise tolerance and reduced RV systolic and diastolic function. Nitrite treatment attenuated the decrease in RV systolic function and improved the RV diastolic function. Nitrite-treated mice with PAB had similar exercise tolerance compared with a control group. PAB induced RV hypertrophy and fibrosis which were associated with increased expression of phospho-Akt. Interestingly, nitrite treatment attenuated PAB-induced RV hypertrophy and reduced the expression of phospho-Akt in RV tissue from mice with PAB. In neonatal rat cardiac fibroblast, nitrite also attenuated hypoxia-induced increase in expression of phospho-Akt.

Conclusion:

Our study indicates that nitrite treatment has direct beneficial effects on RV and improves function and attenuates remodeling in RV exposed to chronic pressure overload. These beneficial effects, at least in part, could be due to the inhibition of the phospho-Akt (p-Akt) pathway activation.
Clusters of midlife women by physical activity and their racial/ethnic differences
Authors: Im Eun-Ok , Ko Young , Chee Eunice , Chee Wonshik , Mao Jun James
Published: November 2016

Objective:

The purpose of this study was to identify clusters of midlife women by physical activity and to determine racial/ethnic differences in physical activities in each cluster.

Methods:

This was a secondary analysis of the data from 542 women (157 non-Hispanic [NH] Whites, 127 Hispanics, 135 NH African Americans, and 123 NH Asian) in a larger Internet study on midlife women's attitudes toward physical activity. The instruments included the Barriers to Health Activities Scale, the Physical Activity Assessment Inventory, the Questions on Attitudes toward Physical Activity, Subjective Norm, Perceived Behavioral Control, and Behavioral Intention, and the Kaiser Physical Activity Survey. The data were analyzed using hierarchical cluster analyses, analysis of variance, and multinominal logistic analyses.

Results:

A three-cluster solution was adopted: cluster 1 (high active living and sports/exercise activity group; 48%), cluster 2 (high household/caregiving and occupational activity group; 27%), and cluster 3 (low active living and sports/exercise activity group; 26%). There were significant racial/ethnic differences in occupational activities of clusters 1 and 3 (all P < 0.01). Compared with cluster 1, cluster 2 tended to have lower family income, less access to health care, higher unemployment, higher perceived barriers scores, and lower social influences scores (all P < 0.01). Compared with cluster 1, cluster 3 tended to have greater obesity, less access to health care, higher perceived barriers scores, more negative attitudes toward physical activity, and lower self-efficacy scores (all P < 0.01).

Conclusions:

Midlife women's unique patterns of physical activity and their associated factors need to be considered in future intervention development.
The Physical Activity Patterns of Pregnant Taiwanese Women
Authors: Lee Ching-Fang , Hwang Fang-Ming , Lin Hsien-Ming , Chi Li-Kang , Chien Li-Yin
Published: November 2016

Background:

Physical activity reduces the risk of maternal disorders during pregnancy. However, many pregnant women reduce their levels of physical activity while pregnant.

Purpose:

The purpose of this study was to examine and compare the physical activity (total amount, intensity, type) of Taiwanese women during each trimester.

Methods:

This cross-sectional survey used purposive sampling to enroll 581 Taiwanese women as participants. The physical activity of participants was measured using the Mandarin version of the Pregnancy Physical Activity Questionnaire.

Results:

The levels of household/caregiving activity and occupational activity differed significantly across trimesters. Household/caregiving (43.2%–54.5%) and occupational activity (42.0%–54.0%) accounted for the largest percentages of total energy expenditure for all three trimesters. In terms of total and household/caregiving activities, multiparous women had significantly higher mean energy expenditures than their primiparous peers. Moreover, income had a pervasive influence on all types and amounts of physical activity and energy expenditures, respectively, with the exception of sports/exercise.

Conclusions/Implications for Practice:

Further careful assessment of the types and intensities of physical activity that are suitable for pregnant women in different parity and income categories in Taiwan is necessary. Furthermore, healthcare providers should encourage pregnant women to use strategies that promote their more regular participation in enjoyable physical activities. One of these potential strategies is to do activities together with children, family members, or friends.
Comparison of Speech-in-Noise and Localization Benefits in Unilateral Hearing Loss Subjects Using Contralateral Routing of Signal Hearing Aids or Bone-Anchored Implants
Authors: Snapp Hillary A. , Holt Fred D. , Liu Xuezhong , Rajguru Suhrud M.
Published: November 2016

Objective:

To compare the benefit of wireless contralateral routing of signal (CROS) technology to bone-anchored implant (BAI) technology in monaural listeners.

Study Design:

Prospective, single-subject.

Setting:

Tertiary academic referral center.

Patients:

Adult English speaking subjects using either a CROS hearing aid or BAI as treatment for unilateral severe-profound hearing loss.

Interventions:

Aided performance utilizing the subjects BAI or CROS hearing device.

Main Outcome Measures:

Outcome measures included speech-in-noise perception using the QuickSIN™ (Etymotic Research, Elkgrove Village, IL, 2001) speech-in-noise test and localization ability using narrow and broadband stimuli. Performance was measured in the unaided and aided condition and compared with normal hearing controls. Subjective outcomes measures included the Speech Spatial and Qualities hearing scale and the Glasgow Hearing Aid Benefit Profile.

Results:

A significant improvement in speech-in-noise performance for monaural listeners (p < 0.0001) was observed, but there was no improvement in localization ability of either CROS or BAI users. There was no significant difference between CROS and BAI subject groups for either outcome measure. BAI recipients demonstrate higher initial disability and handicap over CROS hearing aid users. No significant difference was observed between treatment groups for subjective measures of post-treatment residual disability or satisfaction.

Conclusions:

Our data demonstrate that both CROS and BAI systems provide significant benefit for monaural listeners. There is no significant difference between CROS or BAI systems for objective measures of speech-in-noise performance. CROS and BAI hearing devices do not provide any localization benefit in the horizontal plane for monaural listeners and there is no significant difference between systems.
Activation of IGF1 Signaling in the Cochlea Induces the Transcription of Its Mediators During the Protection of Cochlear Hair Cells Against Aminoglycoside
Authors: Hayashi Yushi , Yamamoto Norio , Nakagawa Takayuki , Omori Koichi , Ito Juichi
Published: November 2016

Hypothesis:

Transcription of the Erk and Akt genes and phosphorylation of their products are promoted by insulin-like growth factor 1 (IGF1) during hair cell protection.

Background:

IGF1 protects mammalian hair cells in animal models from various types of damage, including aminoglycoside. Moreover, clinical trials have revealed that IGF1 was effective for idiopathic sudden sensorineural hearing loss. In this process, activation of the downstream of IGF1 signaling, including the phosphorylation of extracellular signal-regulated kinase (ERK) and AKT proteins, is involved. However, the regulation of IGF1 signaling mediators at the transcriptional level has not been studied.

Methods:

We used a neomycin damage model on neonatal mouse cochlear explant culture. Explants established from neonatal mice were treated with either neomycin alone or neomycin and IGF1. The expression levels of IGF1 signaling mediator genes, Akt1, Mapk3, and Mapk1, in the explants were compared using quantitative reverse transcriptase-polymerase chain reaction at several time points. Inhibitors of IGF1 signaling were added to confirm that this observation was dependent on IGF1 signaling.

Results:

The expression levels of all genes tested were significantly upregulated in neomycin+IGF1 treatment samples (p < 0.0001, analysis of variance [ANOVA]). Addition of inhibitors of IGF1 signaling significantly attenuated the upregulation of expression (p < 0.0001, ANOVA).

Conclusions:

IGF1 treatment upregulates the expression of its mediator genes during the protection of hair cells against aminoglycoside. The regulation of mediator gene expression may serve as a novel treatment for sensorineural hearing loss.
Transition to Practice Program
Authors: Porter Valerie , Ham Corey , Grealish Laurie
Published: November 2016

One health service in one Australian jurisdiction introduced a specialist mental health transition to practice program for newly qualified enrolled nurses. A process evaluation with the first cohort (n = 7) was undertaken in 2014. The program increased enrolled nurse confidence in mental health nursing and appears to be a viable solution to address the mental health nursing workforce shortage. Further research to evaluate components that effectively increase confidence and long-term retention is recommended.
The Design and Redesign of a Clinical Ladder Program
Authors: Warman Geri-Anne , Williams Faye , Herrero Ashlea , Fazeli Pariya , White-Williams Connie
Published: November 2016

Clinical Ladder Programs or Clinical Advancement Programs (CAPs) are an essential component of staff nurse professional development, satisfaction, and retention. There is a need for more evidence regarding developing CAPs. CAP initially launched in 2004. Nurses accomplished tasks in four main areas: clinical, education, leadership, and research, which reflected and incorporated the 14 Forces of Magnetism. In February 2012, the newly revised program was launched and renamed Professional Nursing Development Program. The new program was based on the 5 Magnet® model components, the Synergy Professional Practice Model, and a point system which enabled nurses to utilize activities in many areas, thereby allowing them to capitalize on their strengths. The purpose of this article is to discuss the development, revision, implementation, and lessons learned in creating and revising CAP.
Comparison of Reduced Port Totally Laparoscopic-assisted Total Gastrectomy (Duet TLTG) and Conventional Laparoscopic-assisted Total Gastrectomy
Authors: Kim Han Byeol , Kim Su Mi , Ha Man Ho , Seo Jeong Eun , Choi Min-Gew , Sohn Tae Sung , Bae Jae Moon , Kim Sung , Lee Jun Ho
Published: November 2016

Background:

The aim of this study was to compare surgical outcomes of patients with gastric cancer undergoing reduced port totally laparoscopic-assisted total gastrectomy (duet TLTG) with those of patients undergoing conventional laparoscopic-assisted total gastrectomy (LATG).

Materials and Methods:

Between January 2013 and 2015, 54 patients with gastric cancer underwent LATG at the Samsung Medical Center. Duet TLTG using 3 ports was performed in 30 patients, and conventional LATG using 5 ports was performed in 24 patients. Either extracorporeal or intracorporeal anastomosis was used for esophagojejunostomy. Surgical outcomes were compared between the operation methods.

Results:

The operating time was similar for duet TLTG and conventional LATG [222 min (range, 163 to 287 min) vs. 233 min (range, 170 to 310 min), respectively; P=0.807]. Blood loss during surgery was also similar between duet TLTG and conventional LATG groups [100 mL (range, 50 to 400 mL) vs. 175 mL (range, 50 to 400 mL), respectively; P=0.249]. The median number of nodes dissected [duet TLTG vs. conventional LATG, 47 (20 to 67) vs. 41 (22 to 70), P=0.338] was not different between groups. Pain scores were 3.9, 3.3, and 2.9, and 3.9, 3.4, and 2.8, at postoperative days 1, 3, and 5, respectively, in the duet TLTG and the conventional LATG groups (P=0.857, 0.659, and 0.427, respectively). Overall complication rates in the duet TLTG and conventional LATG groups were not significantly different (36.7% vs. 16.7%, P=0.103).

Conclusions:

Duet TLTG is an acceptable procedure with quality of lymph node dissection, including the number of dissected lymph nodes and morbidity.