bluuebunny/crossref_metadata_2025 huggingface dataset:
Electoral Accountability, Responsibility Attributions, and the Democratic Deficit in Devolved Wales
Authors: Dafydd Einion , Badanjak Sanja
Published: August 2018

This study explores electoral accountability at the devolved level in Wales. The retrospective voting model assumes that electoral accountability requires that citizens assign responsibility accurately and vote on the basis of their evaluation of government performance. Drawing on data from the 2016 Welsh Election Study, we examine whether citizens in Wales can identify devolved policy competences and office holders, and identify factors that are linked to accurate attributions. We then examine whether voters seek to use devolved elections as a sanctioning tool, even if they do not have the information required to do so accurately. The findings indicate that there is an acute accountability deficit at the devolved level in Wales: few have the knowledge or the inclination to hold those in power to account. The conclusion discusses the implications of these findings for democracy in Wales and in other multi-level settings.
Noncontact Measurement of the Deformation of Sternal Skin During Shoulder Movements and Upper Extremity Activities Restricted by Sternal Precautions
Authors: Ge Weiqing , Hians Brittany , Sfara Alison
Published: August 2018

Background

Existing variation has been identified in the rehabilitation programs for patients following cardiac surgery. Sternal precautions are believed to be overly restrictive and detrimental to patient recovery both physically and psychologically.

Objective

The objective of this study was to determine the deformation of sternal skin during shoulder movements and upper extremity activities using a noncontact approach.

Design

This was a cross-sectional, nonexperimental observational study.

Methods

Two black dots were marked on participants’ skin overlying sternoclavicular joints using an erasable marker. The coordinates of the dots were recorded using a digital camera and obtained using ImageJ, a public domain image processing program. Skin deformation between the 2 dots was quantified as biomechanical strain.

Results

The sternal skin strain was − 15.3% (SD = 5.6) and − 12.0% (SD = 7.0) at 90 and 180 degrees of flexion; 0.0% (SD=0.0) and−12.8% (SD=5.8) at 90 and 180 degrees of abduction; and − 6.4% (SD=2.8), − 8.9% (SD=3.8), and − 9.8% (SD=4.6) when lifting the 0-, 5-, and 10-lb weights, respectively. The sternal skin strain was 7.9% (SD=3.9) for extension to the end range and−2.5% (SD=5.8) for pushing up from a chair. There is a trend of strain magnitude decrease with the increase of rhomboid strength, but no statistically significant association was found between them (R=0.12).

Limitations

Limitations included convenience sampling, small sample size, and using skin deformation as a proxy for mechanical loading of the bony structures.

Conclusions

The data do not support the restriction on most of the shoulder movements and upper extremity activities following cardiac surgery. The approach has the advantage of measuring skin deformation in the entire sternal region.
Maternal protein restriction induces gastrointestinal dysfunction and enteric nervous system remodeling in rat offspring
Authors: Aubert Philippe , Oleynikova Elena , Rizvi Hina , Ndjim Marième , Le Berre-Scoul Catherine , Grohard Pierre Antoine , Chevalier Julien , Segain Jean-Pierre , Le Drean Gwenola , Neunlist Michel , Boudin Helene
Published: August 2018

Early‐life adversity is a major risk factor for the development of diseases later in life. Maternal protein restriction (MPR) is associated with morbidities in offspring affecting multiple organs, but its impact on the gastrointestinal (GI) tract remains poorly studied. Using a rat model, we examined the consequences of MPR on GI function and on the enteric nervous system (ENS) in the offspring at postnatal d 35 under basal state and following a water avoidance stress (WAS). Compared with control rats, MPR rats exhibited greater colonic motility, permeability, and corticosteronemia. In contrast to controls, MPR rats presented a blunted functional and corticosteronemic response to WAS. Furthermore, MPR rats showed an increased proportion of choline acetyltransferase–immunoreactive (ChAT‐IR) neurons and a reduced level of autophagy in colonic myenteric neurons. In ENS cultures, corticosterone treatment increased the proportion of ChAT‐IR neurons and reduced autophagy level in enteric neurons. Inhibition of autophagy in ENS cultures resulted in a higher vulnerability of enteric neurons to a cellular stress. Altogether, this study suggests that MPR induced GI dysfunction and ENS alterations in offspring rats and that MPR‐induced increased corticosteronemia might be involved in ENS remodeling and altered responsiveness of the gut to stressors later in life.—Aubert, P., Oleynikova, E., Rizvi, H., Ndjim, M., Le Berre‐Scoul, C., Grohard, P. A., Chevalier, J., Segain, J.‐P., Le Drean, G., Neunlist, M., Boudin, H. Maternal protein restriction induces gastrointestinal dysfunction and enteric nervous system remodeling in rat offspring. FASEB J. 33, 770–781 (2019). www.fasebj.org
Development of a Rubric for Evaluation of the DNP Portfolio
Authors: Melander Sheila , Hampton Debra , Hardin-Pierce Melanie , Ossege Julie
Published: August 2018

A doctor of nursing practice (DNP) portfolio rubric for faculty to use when evaluating student portfolios and for students to use to critique their work is described. No rubrics or tools were found in the literature that provided guidelines to evaluate the extent to which portfolio exemplars meet American Association of Colleges of Nursing Essentials of Doctoral Education for Advanced Nursing Practice. The rubric provides criteria to evaluate whether portfolio documents demonstrate achievement of the DNP Essentials at a “developing, proficient, or exceptional” level. It is valuable tool to illustrate how the competencies outlined in the essentials are met within a DNP program.
Walk patients through total hip arthroplasty
Authors: Hohler Sharon E.
Published: August 2018

Osteoarthritis is the most common cause for hip pain. Total hip arthroplasty (THA) can relieve pain and enhance mobility and quality of life for patients with arthritic hip pain. The focus of this article is THA in patients with osteoarthritis using Mr. H's case as an illustration. It reviews indications and contraindications for THA and other treatment options as well as nursing care for patients undergoing THA.
The Effect of Positive and Negative Affect on Early Treatment Milestones in the Context of Integrated Smoking Treatment
Authors: Garey Lorra , Kauffman Brooke Y. , Manning Kara F. , Taha Samar A. , Schmidt Norman B. , Neighbors Clayton , Zvolensky Michael J.
Published: August 2018

Smoking is the leading cause of preventable death in the United States. Efforts have been made to develop effective, integrated smoking-cessation treatments for individuals with greater difficulty quitting, including individuals with elevated anxiety sensitivity (AS). Despite initial evidence for the efficacy of these treatments, little is understood about pretreatment predictors of early treatment milestones, including treatment initiation and response. Positive affectivity (PA) and negative affectivity (NA) are unique mood traits that may be related to early treatment milestones. Indeed, PA and NA are related to smoking and mood outcomes generally. Yet, it is presently unknown if pretreatment PA or NA predict early treatment milestones within the context of an integrated smoking-cessation treatment. The current study sought to evaluate the independent effect of PA and NA on early treatment milestones within the context of an integrated smoking–AS treatment protocol. Smoking and AS outcomes were evaluated independently. Participants included 288 (50% female; M
age = 38.66, SD = 13.67) treatment-seeking adult daily cigarette users. Results indicated that higher pretreatment NA was associated with an increased likelihood of early dropout versus responding to treatment across both outcomes (smoking: odds ratio [OR] 0.93, 95% confidence interval [CI] 0.88–0.99; AS: OR 0.92, 95% CI 0.88–0.98). Pretreatment PA did not significantly differentiate any of the groups. Overall, the present study serves as an initial investigation of the role of pretreatment NA in identifying those at greatest risk for dropping out of treatment (cf. responding to treatment).
Health-Related Quality of Life in Mandarin-Speaking Children With Cochlear Implants
Authors: Zhao Yawen , Li Ying , Zheng Zhipeng , Li Jing , Nie Xiaolu , Jin Xin , Zheng Jun , Zhang Jie , Chen Min , Hao Jinsheng , Yang Yang , Liu Wei , Liu Haihong , Ni Xin
Published: August 2018

Objectives:

The primary aim of this study was to evaluate the health-related quality of life (HRQoL) of children with cochlear implants (CIs) from the parental perspective. The secondary objective was to explore possible relationships between demographic variables (such as age at assessment, gender, age at implantation, and duration of language rehabilitation) and the HRQoL. The third objective was to determine the developmental trajectories of HRQoL.

Design:

This study included parents of 123 children with CIs (mean age, 40.45 months; mean age of CI implantation, 24.74 months; mean device experience, 16.34 months). The time periods for follow-up were at 0, 1, 2, 3, 6, and 12-month intervals of CI use. The Mandarin Children with Cochlear Implants: Parental Perspectives questionnaire was employed to assess HRQoL.

Results:

Parents were satisfied with HRQoL, especially with the domain of social relations; however, education received a less positive rating. The duration of CI use was positively correlated with 5 domains, suggesting that children who used CIs for a longer time had higher HRQoL ratings. Children with longer language rehabilitation received more positive ratings in the domains of social relations and education (p < 0.05); children whose mothers had higher education levels received more positive ratings in the domain of general functioning (p < 0.05); children living in cities received more positive ratings in the domains of communication, general functioning and self-reliance (p < 0.05). Girls received more positive rating than boys in the domain of well-being (p < 0.05). No significant correlation was found between age at implantation, age at assessment, only child status, and HRQoL. All domains showed clear increases in the duration of CI use; the majority of the domains showed steeper progress over the first 3 months of CI use. Communication exhibited the most rapid progress, with education progressing at a slower rate.

Conclusions:

Parents were satisfied with all domains of HRQoL. Almost all domains exhibited rapid progress over the first 3 months of CI use, with education progressing at a slower rate. This research underscores the importance of language rehabilitation by revealing that strengthening language rehabilitation could be an effective means of improving the HRQoL of children with CIs.
The Role of the Basement Plate in Physeal Bar Formation
Authors: Wattenbarger John Michael , Marshall Amanda , Cox Michael D. , Gruber Helen
Published: August 2018

Background:

Physeal fractures and resultant physeal bars can pose significant problems in skeletal development for the injured growing child. Although now well-recognized, only a small body of experimental literature covering this problem is available. The goal of this study was to help further develop an understanding of the different regions of the physis and the way in which each region responds to injury/fracture.

Methods:

This Institutional Animal Care and Use Committee (IACUC)-approved study assessed bar formation using radiologic and histologic methods and measured leg lengths of skeletally immature rats. The right tibia was used as the control to measure leg length discrepancy (LLD), and the left tibia received either a fracture only (F), an epiphyseal scrape (ES), an epiphyseal drilling procedure (ED), or metaphyseal drilling (MD). Radiographs and LLD measurements were obtained at postoperative days 0, 21, and 56.

Results:

A significant LLD was present at day 56 in the ED group (P=0.01). Radiographic identification of bars showed significant evidence of bar formation for the ES and ED groups at 21 days and the ED group at 56 days (P<0.05). Histologic examination showed a high incidence of histologic physeal bar formation in the ES, ED, and MD groups at 21 and 56 days.

Conclusions:

Findings showed that the physis was able to continue to grow following an injury to the physis’ hypertrophic region. MD produced little effects with few physeal bars and little LLD. By postoperative day 56, ED animals showed greater LLD than ES animals. Penetration of the basement plate was more likely to lead to bar formation/growth retardation than was ablation of the epiphyseal region of the physis (including resting cells).

Clinical Relevance:

Data presented here provides insight into the importance of different regions of the physis and its repair/continued growth after physeal fracture. We suggest that a better understanding of the physiological cause of physeal arrest after physeal fracture will be important for the development of treatments to prevent physeal arrest or to treat physeal arrest after it occurs.
Consequences Following Distal Femoral Growth Plate Violation in an Ovine Model With an Intramedullary Implant: A Pilot Study
Authors: Knapik Derrick M. , Zirkle Lewis G. , Liu Raymond W.
Published: August 2018

Background:

Retrograde femoral nailing in skeletal immature patients would broaden the surgical options for fracture care and reconstructive procedures but involves violation of the open, active distal femoral physis with the potential for growth disturbance. The tolerance for putting a large diameter metal implant across the physis is largely unknown. The purpose of this pilot investigation was to define the upper limit of cross-sectional violation with a metal implant before causing premature growth arrest or inhibition using a sheep model.

Methods:

Eighteen sheep underwent placement of a retrograde, intramedullary implant at 3-months of age through an open distal femoral physis. The cross-sectional area of the physis was measured preoperatively and implants were selected that violated 3% to 8% of the cross-sectional area of the physis. Growth across the distal femoral physis was examined radiographically following surgery. Following euthanasia, both operative and no operative femurs were removed to compare differences in maximal lengths.

Results:

The distal femora grew an average of 10.6±2.2 mm radio graphically after implantation. When compared with control specimens, only operative specimens with 8% of physeal violation demonstrated significant growth discrepancy with operative femurs measuring <2.1 mm in length compared with the contralateral control femur. Histologic analysis did not demonstrate any significant physeal bars formation.

Conclusion:

Distal femoral growth continues across the physis when 3% to 7% of the cross-sectional area of the physis is violated using a retrograde intramedullary implant. Specimens with 8% of growth violation demonstrated significant growth inhibition. As such, retrograde nailing through the distal femoral physis appears safe up to 7%. On the basis of previous anatomic data in humans and average nail sizes, violations of >6% of the physis with pediatric retrograde nailing would be uncommon. These findings suggest that retrograde nailing may be a viable option and merits further study.

Level of Evidence:

Level IV—case series.
Using Quick Response Codes to Increase Students' Participation in Case-Based Learning Courses
Authors: Lin Kai-Yin , Teng Daniel Chia-En
Published: August 2018

The purpose of this study was to use Quick Response codes to increase engagement in a case-based learning course. A quasi-experiment was conducted, and 103 students enrolled in a pharmacology course participated. The students were divided into high-, medium-, and low-scoring groups, based on their previous semester grades in the pharmacology course. A Chinese-version questionnaire of the Nursing Students' Attitude Toward Quick Response Codes in Case-Based Learning Scale was used. The major findings were as follows: (1) Most participants held positive attitudes toward the use of Quick Response codes in case-based learning courses. It was suggested that participants perceived the use of Quick Response codes to be easy and useful in learning activities. They also demonstrated positive attitudes toward the Quick Response codes and expressed their intention to use this application in the future. (2) After applying Quick Response codes in classroom teaching, students performed better in asking questions and discussions than they did before. The performance of the medium-level students improved significantly.
Creative Teaching Methods for Educators
Authors: Aldridge Michael D.
Published: August 2018

In order to gain expertise, intensive care unit nurses must have a good understanding of the pathophysiology and complicated disease processes seen in their units. Nurse educators and critical-care preceptors must be able to explain these complex concepts to a wide variety of audiences including nursing students, graduate nurses, and experienced critical-care nurses. Many times, demonstrations, analogies, visual aids, games, and creative teaching methods can help communicate these complicated ideas. The purpose of this article is to provide ideas for nurse educators and preceptors to use when explaining concepts that may be encountered with patients in a critical-care setting. In addition, general tips for using creative ideas when teaching are discussed.
Nurses' Perceptions of Barriers to Rapid Response System Activation
Authors: Padilla Ricardo M. , Urden Linda D. , Stacy Kathleen M.
Published: August 2018

Background

The rapid response system (RRS) was designed to identify and intervene on patients exhibiting clinical deterioration in the non–critical-care setting but is not always effectively activated by nurses, leading to adverse patient outcomes.

Objectives

The objective of this systematic review was to explore nurses' perceived barriers to RRS activation in the acute adult inpatient setting.

Method

A systematic review was completed utilizing the Preferred Reporting Items for Systematic Reviews and Meta-analysis checklist. Six different search terms were used in the following electronic databases: Academic Search Premier, the Cumulative Index to Nursing and Allied Health Literature, Healthsource: Nursing/Academic Edition, MEDLINE, and PubMed. Limiters applied to search methods included years 2007 to current, full text, scholarly (peer reviewed), and English language. This review was further limited to quantitative studies in the adult inpatient setting.

Results

The initial electronic database search yielded 149 articles. After duplicate exclusion, 87 article abstracts were reviewed for inclusion and eligibility, and a total of 8 articles were used for this systematic review. Themes to nurses' perceived barriers to RRS activation include RRS activator-responder interaction, physician influence, nurse education, and nurse experience.

Discussion

Nurses play a vital role in patient care by providing continuous surveillance and are the frontline for early detection including prompt intervention should a patient's condition deteriorate. Inconsistent RRS activation has been associated with negative patient outcomes. Exploring nurses' perceived barriers to RRS activation may contribute to interventions that lead to nurses appropriately activating the RRS and potentially decreasing adverse patient outcomes.
STRUCTURAL AND FUNCTIONAL CHARACTERISTICS OF LAMELLAR MACULAR HOLES
Authors: Nguyen Justin H. , Yee Kenneth M.P. , Nguyen-Cuu Jeannie , Sebag J.
Published: August 2018

Purpose:

Lamellar macular holes (LMHs) can been subdivided into tractional and degenerative subtypes. This cross-sectional cohort study compared structural and functional characteristics in these subtypes hypothesizing that tractional LMH has a higher prevalence of vitreopapillary adhesion and tangential traction (macular pucker), whereas degenerative LMH has more ellipsoid zone disruption and worse vision, measured three different ways.

Methods:

Tractional LMH (n = 22) and degenerative LMH (n = 15) were distinguished by optical coherence tomography criteria. Separate spectral domain optical coherence tomography scanning of the macula and optic disk was performed. Visual acuity, contrast sensitivity function (Weber Index, %W), and the degree of visual distortions (3-dimensional threshold Amsler grid; % volume lost [%VL]) were quantified.

Results:

Vitreopapillary adhesion was present in 14/22 (64%) tractional, but in only 3/15 (20%) degenerative LMH (P = 0.006). Macular pucker was present in 19/22 (86%) tractional, but in only 8/15 (53%) degenerative LMH (P = 0.011). Ellipsoid zone disruption was present in 13/15 (87%) degenerative, but in only 2/22 (9%) tractional LMH (P = 0.0001). Visual acuity was better in tractional than degenerative LMH (P = 0.006), as was contrast sensitivity function (tractional = 3.44 ± 1.07 %W, degenerative = 4.66 ± 1.73 %W; P = 0.015). Visual distortions were less in tractional (0.33 ± 0.61 %VL) than in degenerative (0.85 ± 0.68 %VL) LMH (P = 0.014).

Conclusion:

Structure and visual function differ significantly in subtypes of LMH. Tractional LMH has 3-fold higher prevalence of vitreopapillary adhesion and 2-fold higher prevalence of macular pucker. Degenerative LMH has 9-fold more ellipsoid zone disruption, worse visual acuity and contrast sensitivity function, and 3-fold more distortions. Thus, outer retinal integrity seems more closely correlated with vision than anterior structural abnormalities in LMH.
RESPONSE TO INTRAVITREAL AFLIBERCEPT IN A PATIENT WITH PERIPHERAL EXUDATIVE HEMORRHAGIC CHORIORETINOPATHY
Authors: Sax James , Karpa Michael , Reddie Ian
Published: August 2018

Purpose:

To draw attention to a novel treatment agent for vision loss associated with peripheral exudative hemorrhagic chorioretinopathy.

Methods:

The case of an 83-year-old man suffering with loss of left visual acuity vision in the context of vitreous hemorrhage secondary to peripheral exudative hemorrhagic chorioretinopathy is described.

Results:

Resolution of vitreous hemorrhage and subretinal hemorrhage was demonstrated after treatment with aflibercept.

Conclusion:

Peripheral exudative hemorrhagic chorioretinopathy is discussed in terms of its presentation, pathophysiology, and existing treatment methodologies.
OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY IMAGING OF A CONGENITAL SIMPLE HAMARTOMA OF THE RETINAL PIGMENT EPITHELIUM
Authors: Zola Marta , Ambresin Aude , Zografos Leonidas
Published: August 2018

Purpose:

To report the case of a small pigmented tumor in the macular region investigated using optical coherence tomography angiography (OCT-A) in the context of a multimodal approach.

Methods:

Case report

Results:

A 24-year-old man was referred for evaluation of an asymptomatic unilateral round comma-shaped pigmented tumor located in the macular region of his right eye. Spectral-domain OCT revealed an irregular hyperreflective mass within the retina, with a thickened hyaloid membrane and abrupt margins, and a complete posterior shadowing effect. On fluorescein angiography, early hyperfluorescence without leakage in the middle and late phases and a subtle halo of hyperfluorescence in the late phase were observed. OCT-A revealed the presence of intrinsic vascularization at the level of the inner capillary plexus, with signal intensity present at the level of the outer capillary plexus. In the superficial scans, the retinal vessels were oriented radially to the lesion and were in continuity with the vascular network within the tumor mass. No choroidal vessels could be identified.

Conclusion:

We report the case of a congenital simple hamartoma of the retinal pigment epithelium investigated using OCT-A as part of multimodal imaging. OCT-A provided a new insight in the assessment of the lesion, differential diagnosis, and follow-up of the patient. This imaging modality could be an important non-invasive tool in the management of congenital hamartomas of the retinal pigment epithelium.
TUBERCULOUS CHOROIDITIS IN PATIENT WITH VOGT–KOYANAGI–HARADA DISEASE
Authors: Anderson Erik W. , El Khoury Lara , Schwartzman-Morris Julie S. , Jonisch Jonathan , Goldberg Naomi R.
Published: August 2018

Purpose:

To describe a novel case of intraocular tuberculosis (TB) arising in a patient undergoing treatment for Vogt–Koyanagi–Harada disease, and to highlight the use of spectral domain optical coherence tomography for helping confirm the diagnosis and monitor treatment response.

Methods:

Case report of a patient with Vogt–Koyanagi–Harada disease on prednisone, with acute clinical changes suspicious for bilateral tuberculous choroiditis. Spectral optical coherence tomography, fundus photography, and B-scan ultrasonography were all used to capture the acute lesions, and to monitor their responses after initiation of anti-TB therapy.

Results:

New subretinal lesions arose bilaterally, as characterized by spectral domain optical coherence tomography, and appeared to regress after a first round of anti-TB therapy, thereby helping confirm the presumed diagnosis of intraocular TB. A new peripheral choroidal lesion arose shortly after temporary cessation of antimicrobial treatment, and again regressed once four-drug therapy was instituted, with no recurrent lesions thereafter.

Conclusion:

The use of multimodal imaging was instrumental in the management of a rare case of intraocular TB arising in the setting of underlying Vogt–Koyanagi–Harada disease.
STELLATE NONHEREDITARY IDIOPATHIC FOVEOMACULAR RETINOSCHISIS IN A PATIENT WITH MACULAR TELANGIECTASIA TYPE 2
Authors: Falb Thomas , Malle Eva Maria , Haas Anton , Weger Martin , Wedrich Andreas
Published: August 2018

Purpose:

To present a case of unilateral stellate nonhereditary idiopathic foveomacular retinoschisis in a patient with macular telangiectasia (MacTel) Type 2.

Methods:

Single-patient case report.

Results:

A 61-year-old female white patient was referred to our clinic with metamorphopsia and reduction of visual acuity over a period of 2 months on her right eye. Ocular findings in her right eye included reduced best-corrected visual acuity of 20/63 Snellen, foveomacular retinoschisis with extension to the lower middle periphery, central elevation of the neurosensory retina, and macular telangiectasia (MacTel) Type 2. Other causes of foveomacular retinoschisis, such as glaucoma, myopic degeneration, optic or scleral pit, X-linked juvenile retinoschisis, degenerative retinoschisis, and vitreomacular traction, were ruled out. The patient had no history of niacin or taxane medication, which may cause rather similar appearing cases of cystoid macular edema without leakage in fluorescein angiography. Because of the unilateral presentation, uneventful medical history, female sex, and the absence of known hereditary diseases or retinal pathologies in the patient's family history, hereditary predisposition appears to be highly unlikely.

Conclusion:

To our knowledge, this is the first reported case of stellate nonhereditary idiopathic foveomacular retinoschisis in combination with MacTel Type 2. Whether or not MacTel Type 2 plays a role in the development of stellate nonhereditary idiopathic foveomacular retinoschisis or has an impact on its clinical course requires further investigation. Furthermore, we suggest a significant involvement of Henle fiber layer in the process of intraretinal expansion in optical coherence tomography, in accordance with the most recent published nomenclature.
Tuberculosis Transmission in Danish Children: A Nationwide Register-based Study
Authors: Nordholm Anne Christine , Holm Line Lindebo , Svensson Erik , Andersen Peter H , Johansen Isik Somuncu
Published: August 2018

Background:

Tuberculosis (TB) remains a major public health issue among children worldwide. Data on TB transmission in children living in low-incidence countries is limited.

Methods:

We studied TB transmission in ethnic Danish children younger than 15 years of age between 2000 and 2013. Identification of children with TB disease and information on demographics and TB contacts were retrieved from the national TB surveillance register and the International Reference Laboratory of Mycobacteriology.

Results:

In total, 88 children with TB disease were identified in the study period, corresponding to a mean annual incidence of 6.9 per 1,000,000 children younger than 15 years of age. The male to female ratio was 1.3. Median age was 5 years (interquartile range, 3–8.5). Seventy-three (83%) children had a known TB contact of which 60% was among household contacts with recent TB, predominantly parents. Sixty-six (75%) children were classified as part of epidemiologic clusters. Thirty-five (40%) children had culture verified TB of which information on genotypes was available for 34 (97%). Of these, 35% belonged to cluster C2/1112–15, the most prevalent cluster among adult Danes.

Conclusions:

We found on-going TB transmission in Danish children within the households of a low TB incidence population. These findings emphasize the need for early diagnosis of TB in children, thorough contact tracing and increased focus on risk groups.
Invasive Meningococcal Disease Unraveling a Novel Mutation in the C5 Gene in a Portuguese Family
Authors: Marujo Filipa , Costa Luís Carlos , Duarte Regina , Brito Maria João , Cordeiro Ana , Neves Conceição , Neves João Farela
Published: August 2018

Although bacterial meningitis is a rare presentation of a congenital immunodeficiency, invasive meningococcal disease is classically associated with complement deficiencies. We report a patient from a consanguineous kindred presenting with an invasive meningococcal disease caused by serogroup B meningococcus that revealed an underlying C5 deficiency caused by a novel mutation in the C5 gene.
Staffing Is More Than a Number: Using Workflow to Determine an Appropriate Nurse Staffing Ratio in a Tertiary Care Neurocritical Care Unit
Authors: Hill Michelle , DeWitt Jessica
Published: August 2018

Objective: To enhance nursing staff retention and ensure a consistently high standard of care, a study was conducted to determine an appropriate nurse staffing model for a neurocritical care unit. In addition to being critically ill, these patients often require extensive diagnostic testing to determine treatment. Nurses traveling with patients leave higher nurse-patient ratios remaining on the unit. Methods: Prospective observation was used to assess relationships between neurologic assessment, documentation, and the amount of time spent traveling with patients. Patient acuity and nursing experience were also measured. Results: Over the 30-day study period, more than 226 hours were spent traveling, equivalent to approximately 38% of a single nurse’s shift. There was no correlation between the experience of nurses and the time necessary to perform a neurologic assessment. When controlling for acuity, a relationship was found between nursing experience and the time needed to chart an assessment. Conclusions: Significant time was spent every day off the floor, in addition to the documentation and performance of frequent assessments. These results advocate for a staffing position without a dedicated patient assignment but to assist with traveling and high-acuity patients so that safe and attentive care can be consistently given.
Cervical Cancer Screening Among Women by Birthplace and Percent of Lifetime Living in the United States
Authors: Endeshaw Meheret , Clarke Tainya , Senkomago Virginia , Saraiya Mona
Published: August 2018

Objective

The aim of the study was to provide national estimates of Pap test receipt, by birthplace, and percent of lifetime in the United States (US).

Materials and Methods

Pooled nationally representative data (2005, 2008, 2013, 2015) from the National Health Interview Survey were used to examine differences in Pap test receipt among adult US women by birthplace and percent of lifetime in the US. Descriptive estimates were age-adjusted. Regression models were adjusted for selected sociodemographic and healthcare access and utilization factors and presented as predicted margins.

Results

Foreign-born women 18 years and older were more than twice as likely to have never received a Pap test compared with US-born women (18.6% vs 6.8%). Regression models showed that foreign-born women from Mexico (9.8%), South America (12.6%), Caribbean (14.6%), Southeast Asia (13.7%), Central Asia (20.4%), South Asia (22.9%), Middle East (25.0%), Africa (27.8%), Europe (16.4%), and Former Soviet Union (28.2%) were more likely to be unscreened compared with US-born women (7.6%). Foreign-born women who spent less than 25% of their life in the US had higher prevalence of never having a Pap test (20%) compared with foreign-born who spent more than 25% of their life in the US (12.7%).

Conclusions

Using national survey, we found that where a woman is born and the percent of her lifetime spent residing in the US do impact whether she gets screened at least once in her lifetime.

Impact

These findings may inform cervical cancer screening efforts targeting foreign-born women.
Effect of Bisoprolol on the Level of Dabigatran
Authors: Nehaj Frantisek , Sokol Juraj , Ivankova Jela , Mokan Michal , Mokan Marian
Published: August 2018

Background:

Many patients receiving dabigatran treatment might also require bisoprolol therapy. However, there is a possibility that bisoprolol as significant P-glycoprotein inhibitor might interact with dabigatran.

Study Question:

To investigate the impact of concomitant bisoprolol therapy on dabigatran plasma level in patients with nonvalvular atrial fibrillation.

Study Design:

A pilot drug interaction study in 29 patients with nonvalvular atrial fibrillation on dabigatran therapy. Bisoprolol was administrated in 18 patients. Blood samples were collected at baseline (in the morning, before any medication was administered) and at hour 2 (2 hours after administration of dabigatran and bisoprolol).

Results:

The dabigatran plasma level was significantly higher at baseline and at hour 2 in patients treated with bisoprolol compared with patients without bisoprolol therapy. In addition, we have shown that this increase is affected by dabigatran dosage and concomitant treatment with proton-pump inhibitor and digoxin. The impact of bisoprolol on dabigatran concentration was still significant despite these confounders.

Conclusions:

This study demonstrated the interaction between dabigatran and bisoprolol, which is modulated with dabigatran dosage and concomitant treatment with proton-pump inhibitor and digoxin.
Taking regulatory T-cell therapy one step further
Authors: Sicard Antoine , Boardman Dominic A. , Levings Megan K.
Published: August 2018

Purpose of review

Adoptive cell therapy using CD4+FOXP3+ regulatory T cells (Treg) has emerged as a promising therapeutic strategy to treat autoimmunity and alloimmunity. Preclinical studies suggest that the efficacy of Treg therapy can be improved by modifying the antigen specificity, stability and function of therapeutic Tregs. We review recent innovations that considerably enhance the possibilities of controlling these parameters.

Recent findings

Antigen-specific Tregs can be generated by genetically modifying polyclonal Tregs to express designated T-cell receptors or single-chain chimeric antigen receptors. The benefits of this approach can be further extended by using novel strategies to fine-tune the antigen-specificity and affinity of Treg in vivo. CRISPR/Cas 9 technology now enables the modification of therapeutic Tregs so they are safer, more stable and long lived. The differentiation and homing properties of Tregs can also be modulated by gene editing or modifying ex-vivo stimulation conditions.

A new wave of innovation has considerably increased the number of strategies that could be used to increase the therapeutic potential of Treg therapy. However, the increased complexity of these approaches may limit their wide accessibility. Third-party therapy with off-the-shelf Treg products could be a solution.
Macrophage Markers Are Poorly Associated With Liver Histology in Children With Nonalcoholic Fatty Liver Disease
Authors: Kazankov Konstantin , Alisi Anna , Møller Holger J. , De Vito Rita , Rittig Søren , Mahler Birgitte , Nobili Valerio , Grønbæk Henning
Published: August 2018

Objectives:

We have previously demonstrated associations between the macrophage activation marker soluble (s)CD163 and histology of nonalcoholic fatty liver disease (NAFLD) in adults, and elevated sCD163 levels in children with obesity with NAFLD. Macrophage activation has, however, not been investigated in children with biopsy‐proven NAFLD, which was the objective of the present study.

Methods:

We used in‐house enzyme‐linked immunosorbent assays to measure sCD163 and the novel macrophage marker soluble mannose receptor (sMR) in a cross‐sectional (n = 155) pediatric NAFLD cohort, and a cohort of NAFLD children (n = 36) undergoing a randomized trial by the probiotic VSL#3. We included 56 healthy nonobese children for comparison.

Results:

Levels of sCD163 and sMR were higher in both of the NAFLD cohorts compared with controls (P < 0.001). In the cross‐sectional cohort, sCD163 only showed trends toward association with ballooning (rho = 0.14, P = 0.08) and portal inflammation (rho = 0.17, P = 0.08). sMR showed similar associations with liver histology. In the VSL#3 cohort, sCD163 correlated inversely with steatosis (rho = −0.35, P = 0.04), and lobular (rho = −0.57, P < 0.001) and portal inflammation (rho = −0.38, P = 0.02); sMR was not associated with any histological scores. Neither sCD163 nor sMR changed significantly during intervention, and without association with NAFLD resolution.

Conclusions:

The macrophage activation markers sCD163 and sMR showed poor associations with liver histology in 2 different cohorts of children with biopsy‐proven NAFLD, and none of the markers decreased during successful intervention. These results are in contrast with studies of adult NAFLD and may suggest a possibility of different roles for macrophages in the pathogenesis of adult and pediatric NAFLD.
c-KIT-Positive Fatal Diffuse Cutaneous Mastocytosis With Systemic Manifestations in a Neonate
Authors: Chaudhary Neha , Shapiro Natasha , Bhutada Alok , Rastogi Shantanu
Published: August 2018

Diffuse cutaneous mastocytosis is a rare variant of mastocytosis in the neonatal period. We describe a case of c-KIT (D816V) mutation-positive fatal diffuse cutaneous mastocytosis with systemic involvement of the gastrointestinal tract and associated malabsorption and hepatosplenomegaly associated with mast cell mediator release symptoms.
Silymarin and curcumin effects on virulence and carbapenemase genes among multidrug-resistant Escherichia coli clinical isolates
Authors: Eslami Majid , Ghasemian Abdolmajid , Najafiolya Zahra , Mirforughi S. Ameneh , Nojoomi Farshad
Published: August 2018

Objective

: Silymarin and curcumin antimicrobial properties have been previously described against some infectious agents. The aims of the current study were the investigation of the antibacterial effects of these compounds on the expression of fimA, cdt, bla
IMP1 and bla
OXA-48 and AcrAB-TolC genes among multidrug-resistant Escherichia coli clinical isolates.

Methods

: A total of five carbapenemase-producing E. coli strains were included. All of them carried bla
IMP1 and bla
OXA-48, ACR-AB, cdt, fimA and QepA genes. The antibiotic susceptibility test, imipenem, cefotaxime and ceftazidime minimum inhibitory concentration (MIC) and combine disk and Carba NP-test for carbapenemase production were performed. Silymarin and curcumin minimum inhibitory and bactericidal concentrations [MIC and minimum bactericidal concentration (MBC), respectively] were determined. The effect of 25 μg/ml concentration was also evaluated against gene expression. The quantitative real-time PCR was performed for the evaluation of genes expression.

Results

: Silymarin MIC and MBC were 256 and more than 256 μg/ml, respectively. Moreover, curcumin MIC and MBC concentrations were 128 and 256 μg/ml, respectively. Silymarin down-expressed the ACR-AB, cdt, fimA genes and QepA genes significantly (P < 0.05), but conferred no significant effect on bla
IMP nor bla
OXA-48 genes. Moreover, curcumin down-expressed the ACR-AB, QepA and bla
IMP genes significantly (P < 0.05), but exhibited no significant effect against bla
OXA-48, cdt and fimA genes.

Conclusion

: In this study, curcumin and silymarin sub-MIC concentrations could significantly inhibit the expression of the ACR-AB, cdt, fimA, QepA and bla
IMP genes at 25 μg/ml. Combating bacterial virulence is a proper strategy not only to inhibit the spread of infections, but also to prevent the appearance and spread of antibiotic nonsusceptible strains.
Use of Web-Based Parent–Adolescent Health Promotion Program Among Puerto Ricans
Authors: Villarruel Antonia M. , Varas-Díaz Nelson , Hanlon Alexandra , Betancourt Elba , Lozano Alicia J. , DiNapoli Lucia
Published: August 2018

Background

Despite positive attitudes of Latinos using the Internet and the increased availability of health information resources, few studies have been conducted that examine actual use and barriers to web-based health information.

Objective

The aim of this study was to examine whether select sociodemographic factors and technology factors (e.g., computer and Internet access) predicted use of a web-based, parent–adolescent sexual communication program or a physical activity program, entitled Cuídalos, among Puerto Rican parents.

Methods

This study uses data from a randomized controlled trial designed to examine the long-term effectiveness of Cuídalos. Parents were recruited from community-based and school sites throughout Puerto Rico and randomly assigned to a web-based, parent–adolescent sexual communication (n = 245) or a physical activity (n = 247) program. Parents were instructed to complete the two-session program within 1 week and had access to the program for a period of 3 months. Outcomes in this secondary analysis were the number of log-ins and self-reported access during the 3-month period. Reasons for not accessing the program after the 3-month period were assessed.

Results

Self-reported access after completion of the Cuídalos program and the actual number of log-ins over the intervention period were low. There were no statistically significant differences in the number of log-ins between parents who accessed Cuídalos during the 3-month time frame and those who did not (p = .28). Logistic regression analyses demonstrated that the odds of accessing Cuídalos during the 3-month period was 72% higher (OR = 1.72, 95% CI [1.08, 2.75]) among parents with a high school education or less, as compared to parents with a college education (p = .02). Similarly, Poisson regression model results indicated that, with every year increase in age, the expected number of log-ins increased by 1% (RR = 1.01, 95% CI [1.00, 1.02]); compared to those who accessed the program at home, the expected number of log-ins ranged from 10% to 27% lower for parents accessing elsewhere. Reasons for not accessing the program during the 3-month period included not having easy access to a computer (n = 134, 48.6%), or they did not know how to access the program again (n = 56, 20.3%).

Discussion

Despite the availability of web-based and e-health resources, further research is needed to identify how to facilitate greater access and actual use of digital health resources by Latinos. This is an important effort in order to prevent a widening health equity gap caused by a lack of access and use of digital health resources.
Corneal Nerve Migration Rate in a Healthy Control Population
Authors: Al Rashah Khaled , Pritchard Nicola , Dehghani Cirous , Ruggeri Alfredo , Guimaraes Pedro , Russell Anthony , Malik Rayaz A. , Efron Nathan , Edwards Katie
Published: August 2018

PURPOSE

The purpose of this study was to establish an age-dependent normative range and factors affecting the migration rate of the corneal subbasal nerve plexus in a healthy control population.

METHODS

Corneal nerve migration rate was measured in 60 healthy participants grouped by age: A, aged 20 to 39 years (n = 20); B, 40 to 59 years (n = 20); and C, 60 to 79 years (n = 20). Laser-scanning corneal confocal microscopy was performed on the right eye of all participants at baseline and again after 3 weeks. Fully automated software was used to montage the frames. Distinctive nerve landmarks were manually reidentified between the two montages, and a software program was developed to measure the migration of these landmark points to determine corneal nerve migration rate in micrometers per week (μm/wk).

RESULTS

The mean ± SD age of all participants in the study was 47.5 ± 15.5 years; 62% of participants were male. The average corneal nerve migration rates of groups A, B, and C were 42.0 ± 14.0, 42.3 ± 15.5, and 42.0 ± 10.8 μm/wk, respectively (P = .99). There was no difference in corneal nerve migration rate between male (41.1 ± 13.5 μm/wk) and female (43.7 ± 13.2 μm/wk) participants (P = .47). There was no significant correlation between age (P = .97), smoking (P = .46), alcohol use (P = .61), and body mass index (P = .49, respectively) with corneal nerve migration rate. However, exercise frequency correlated significantly (P = .04) with corneal nerve migration rate.

CONCLUSIONS

Corneal nerve migration rate varies in healthy individuals and is not affected by age, sex, or body mass index but is related to physical activity.