bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinicoradiological changes of brain NK/T cell lymphoma manifesting pure akinesia: a case report
Authors: Ishihara Susumu , Kano Osamu , Ikeda Ken , Shimokawa Reiko , Kawabe Kiyokazu , Iwasaki Yasuo
Published: November 2011

Background

Pure akinesia (PA) is a distinct form of parkinsonism characterized by freezing phenomena. Little is known about brain tumor-associated PA. We highlight the clinicoradiological changes in a patient with PA and central nervous system (CNS) metastases of natural killer/T-cell lymphoma (NKTL).

Case presentation

A 68-year-old man with stage IVB extranodal NKTL developed a gait disturbance. Neurological examination of his gait revealed freezing, start hesitation, short step, forward flexion posture, festination and postural instability. Mild facial hypomimia and micrographia were observed. There was no rigidity or tremor in any of the four extremities. Brain magnetic resonance imaging (MRI) displayed T2-hyperintense lesions in the dorsal brainstem, cerebellum and periventricular white matter. Diffusion-weighted imaging (DWI) and the apparent diffusion coefficient (ADC) revealed hyperintensity in these regions. Cerebrospinal fluid cytology revealed CD56-positive cells on immunohistochemical staining. The patient's neurological deficits did not respond to L-dopa treatment and intrathecal administration of methotrexate (MTX). Two weeks later, he displayed confusion and generalized convulsions. T2-hyperintense lesions spread to the basal ganglia and the infratentorial regions. Gadolinium enhancement was observed in the cerebellum and frontal subcortex. DWI and the ADC revealed diffusion-restricted lesions in the middle cerebellar peduncles, left internal capsules and cerebral white matter. MTX pulse therapy and intrathecal administration of cytosine arabinoside and MTX were performed. Two months later, his ambulatory state was normalized. Brain MRI also revealed marked alleviation of the infratentorial and supratentorial lesions.

Conclusions

The clinicoradiological profile of our patient suggested that dorsal ponto-mesencephalic lesions could contribute to the pathogenesis of PA. Physicians should pay more attention to striking CNS seeding of metastatic NKTL. MTX pulse therapy had an excellent effect in improving serious symptoms and brain lesions in our patient.
Prevalence of BRCA1 and BRCA2 mutations in unselected breast cancer patients from Greece
Authors: Koumpis Chrissovaladis , Dimitrakakis Constantine , Antsaklis Aris , Royer Robert , Zhang Shiyu , Narod Steven A , Kotsopoulos Joanne
Published: November 2011

Background

Inheritance of a mutation in either BRCA1 or BRCA2 accounts for approximately 5% of all breast cancer cases, but varies by country. Investigations into the contribution of BRCA mutations to breast cancer incidence in Greece have been, for the most part, limited by small sample sizes and by the use of cases selected for their family history of cancer. The aim of the current study was to estimate BRCA mutation frequencies in breast cancer patients unselected for family history.

Methods

To do so, we enrolled 127 unselected women with breast cancer from the Alexandra Hospital in Athens, Greece, a large public hospital in the city. Mutations in BRCA1 and BRCA2 were detected using a combination of techniques and were confirmed by direct sequencing. Two large genomic deletions were sought using mutation-specific assays. A detailed family history of cancer was obtained from each patient.

Results

We were able to successfully complete testing on samples from 127 women. Among these, six mutations were identified (four in BRCA1 and two in BRCA2) representing 4.7% of the total or 9.5% of cases diagnosed before age forty. None of the mutation carriers had a family history of breast or ovarian cancer. Three of the four BRCA1 mutations were in exon 20: two were a G5331A mutation and the third was a 3.2 kb deletion. The fourth BRCA1 mutation was the 3819delGTAAA in exon 11. The two BRCA2 mutations were in exon 11 (3782del10 and 4512insT).

Conclusions

The G5331A mutation in BRCA1 appears to be a founder mutation in the Greek population.
Attenuation of prostaglandin E2 elimination across the mouse blood-brain barrier in lipopolysaccharide-induced inflammation and additive inhibitory effect of cefmetazole
Authors: Akanuma Shin-ichi , Uchida Yasuo , Ohtsuki Sumio , Tachikawa Masanori , Terasaki Tetsuya , Hosoya Ken-ichi
Published: November 2011

Background

Peripheral administration of lipopolysaccharide (LPS) induces inflammation and increases cerebral prostaglandin E2 (PGE2) concentration. PGE2 is eliminated from brain across the blood-brain barrier (BBB) in mice, and this process is inhibited by intracerebral or intravenous pre-administration of anti-inflammatory drugs and antibiotics such as cefmetazole and cefazolin that inhibit multidrug resistance-associated protein 4 (Mrp4/Abcc4)-mediated PGE2 transport. The purpose of this study was to examine the effect of LPS-induced inflammation on PGE2 elimination from brain, and whether antibiotics further inhibit PGE2 elimination in LPS-treated mice.

Methods

[3H]PGE2 elimination across the BBB of intraperitoneally LPS-treated mice was assessed by the brain efflux index (BEI) method. Transporter protein amounts in brain capillaries were quantified by liquid chromatography-tandem mass spectrometry.

Results

The apparent elimination rate of [3H]PGE2 from brain was lower by 87%, in LPS-treated mice compared with saline-treated mice. The Mrp4 protein amount was unchanged in brain capillaries of LPS-treated mice compared with saline-treated mice, while the protein amounts of organic anion transporter 3 (Oat3/Slc22a8) and organic anion transporting polypeptide 1a4 (Oatp1a4/Slco1a4) were decreased by 26% and 39%, respectively. Either intracerebral or intravenous pre-administration of cefmetazole further inhibited PGE2 elimination in LPS-treated mice. However, intracerebral or intravenous pre-administration of cefazolin had little effect on PGE2 elimination in LPS-treated mice, or in LPS-untreated mice given Oat3 and Oatp1a4 inhibitors. These results indicate that peripheral administration of cefmetazole inhibits PGE2 elimination across the BBB in LPS-treated mice.

Conclusion

PGE2 elimination across the BBB is attenuated in an LPS-induced mouse model of inflammation. Peripheral administration of cefmetazole further inhibits PGE2 elimination in LPS-treated mice.
Chronic angiotensin receptor blockade suppresses intracardiac angiotensin II in angiotensin II-infused rats
Authors: Conte Debra , Viscarra Jose , Nishiyama Akira , Ortiz Rudy M
Published: November 2011

Accumulation of angiotensin II (Ang II) in tissues is an Ang II-receptor-mediated process. In pigs, acute angiotensin receptor blockade (ARB) reduced the heart-to-plasma ratio of Ang II following acute infusion. However in rats, chronic ARB treatment increased heart Ang II levels, suggesting that a differential response to ARB treatment may exist in the mammalian heart. Furthermore, the changes in heart aldosterone following chronic ARB treatment are not well described. To address the discrepancy in heart Ang II concentrations following ARB treatment, three groups ( n = 6) of rats were chronically studied: (1) control; (2) angiotensin II (Ang II; 80 ng/min for 28 d); and (3) angiotensin II + olmesartan (ARB; 10 mg/kg/d for 21 d). Ang II-infusion increased intracardiac Ang II by 40% (53 ± 2 versus 74 ± 6 fmol/g) and intrarenal Ang II over 2-fold (96 ± 6 versus 207 ± 14 fmol/g), and chronic ARB treatment decreased Ang II by 48% in the heart (50 ± 7 fmol/g) and over two-fold in the kidney (92 ± 7 fmol/g), suggesting that accumulation of Ang II in the heart is receptor-mediated as in the kidney. Ang II increased plasma aldosterone 2.5-fold (1.4 ± 0.1 versus 3.5 ± 1.2 nmol/L) and was exacerbated by ARB treatment (5.6 ± 1.0 nmol/L). Intracardiac aldosterone was exacerbated by ARB treatment (control: 2.2 ± 0.3; Ang II: 2.7 ± 1.1; ARB: 7.8 ± 1.7 pmol/g). Suppression of intracardiac Ang II with ARB is consistent with the existing view of Ang II-receptor-mediated uptake by tissues.
Rating Customers According to Their Promptness to Adopt New Products
Authors: Hochbaum Dorit S. , Moreno-Centeno Erick , Yelland Phillip , Catena Rodolfo A.
Published: November 2011

Databases are a significant source of information in organizations and play a major role in managerial decision-making. This study considers how to process commercial data on customer purchasing timing to provide insights on the rate of new product adoption by the company's consumers. Specifically, we show how to use the separation-deviation model (SD-model) to rate customers according to their proclivity for adopting products for a given line of high-tech products. We provide a novel interpretation of the SD-model as a unidimensional scaling technique and show that, in this context, it outperforms several dimension-reduction and scaling techniques. We analyze the results with respect to various dimensions of the customer base and report on the generated insights.
Wait-Time Predictors for Customer Service Systems with Time-Varying Demand and Capacity
Authors: Ibrahim Rouba , Whitt Ward
Published: November 2011

We develop new, improved real-time delay predictors for many-server service systems with a time-varying arrival rate, a time-varying number of servers, and customer abandonment. We develop four new predictors, two of which exploit an established deterministic fluid approximation for a many-server queueing model with those features. These delay predictors can be used to make delay announcements. We use computer simulation to show that the proposed predictors outperform previous predictors.
TECHNICAL NOTE—A Computational Approach for Optimal Joint Inventory-Pricing Control in an Infinite-Horizon Periodic-Review System
Authors: Feng Youyi , Chen Youhua (Frank)
Published: November 2011

This note considers a joint inventory-pricing control problem in an infinite-horizon periodic-review system. Demand in a period is random and depends on the posted price. Besides the holding and shortage costs, the system incurs inventory-replenishment costs that consist of both variable and fixed components. At the beginning of each period, a joint inventory and pricing decision is made. Under the long-run average profit criterion, we show that an optimal policy exists within the class of so-called (s, S, p) policies. This is established based on our algorithmic development, which also results in an algorithm for finding an optimal (s, S, p) policy.
Optimizing the Societal Benefits of the Annual Influenza Vaccine: A Stochastic Programming Approach
Authors: Özaltın Osman Y. , Prokopyev Oleg A. , Schaefer Andrew J. , Roberts Mark S.
Published: November 2011

Seasonal influenza is a major public health concern, and the first line of defense is the flu shot. Antigenic drifts and the high rate of influenza transmission require annual updates to the flu shot composition. The World Health Organization recommends which flu strains to include in the annual vaccine, based on surveillance and epidemiological analysis. There are two critical decisions regarding the flu shot design. One is its composition; currently, three strains constitute the flu shot, and they influence vaccine effectiveness. Another critical decision is the timing of the composition decisions, which affects the flu shot production. Both of these decisions have to be made under uncertainty many months before the flu season starts. We quantify the trade-offs involved through a multistage stochastic mixed-integer program that determines the optimal flu shot composition and its timing in a stochastic and dynamic environment.We incorporate risk sensitivity through mean-risk models. Our results provide valuable insights for pressing policy issues.
‘Earthly, sensual, devilish’
Authors: Hogan Eileen
Published: November 2011

This article examines racialized and sexualized constructions of jazz in Ireland in the post-independence era. Drawing on newspaper coverage and Government debate from 1920 to 1938, I argue that the broadcasting service and the dance halls represented key sites of formation of Irish national identity, which was based upon gendered productions of space and place. The nation-building project was premised upon the idealization of a rural, sanitized moral landscape. In this period, fears of foreign cultural corruption and the liberalization of sexual mores were articulated through intensive campaigning, led by the Catholic elite and largely supported by the state, against jazz music which was seen as a cultural import that threatened Irish cultural identity and the nation.
Response of Dry Bulb Onion, Sugar Beet, and Pinto Beans to Imazosulfuron Soil Residues
Authors: Felix Joel
Published: November 2011

Field studies were conducted in 2010 in Ontario, OR, to evaluate the response of direct-seeded dry bulb onion, sugar beet, and pinto beans to imazosulfuron soil residues 12 mo after application to control weeds in potato. The studies were organized as randomized complete block designs with three replications each. Imazosulfuron was applied alone PRE at 224 and 450 g ai ha−1, sequentially at 224 g ha−1PRE and POST, or in tank mixture withS-metolachlor 1,060 g ha−1. Very few onion plants emerged in plots previously treated with imazosulfuron at 224 g ha−1, regardless of timing. Emerged onion plants were severely injured and never matured. No onions emerged from residues of imazosulfuron applied at 450 g ha−1. A few sugar beet plants emerged from 224 g ha−1but were severely stunted and never grew beyond the first set of leaves. There was no sugar beet emergence from imazosulfuron sequential applications, regardless of the rate and application timing. However, imazosulfuron residues did not affect pinto beans, which emerged and produced marketable yield, similar to grower standard and nontreated plots. The results suggest sensitivity of direct-seeded dry bulb onion and sugar beet, but not pinto beans, to imazosulfuron residues 12 mo after application.
Effectiveness of Sulfosulfuron and Quinclorac for Weed Control during Switchgrass Establishment
Authors: Curran William S. , Ryan Matthew R. , Myers Matthew W. , Adler Paul R.
Published: November 2011

We conducted a field experiment in 2007 and 2008 and repeated it in a separate field in 2008 and 2009 to test the effectiveness of two herbicides applied at two different times on weed control during switchgrass establishment. At 4 and 6 wk after switchgrass planting (WAP), sulfosulfuron was applied at 0.04 and 0.07 kg ai ha−1with nonionic surfactant and quinclorac was applied at 0.28, 0.42, and 0.56 kg ai ha−1with methylated seed oil. Herbicides applied at 4 WAP tended to be more effective than at 6 WAP. Sulfosulfuron provided greater control of smooth pigweed; however, quinclorac provided greater control of yellow foxtail, a grass weed that has traditionally been difficult to control with herbicides in switchgrass. Average yellow foxtail control was 73, 87, and 93% for quinclorac at 0.28, 0.42, and 0.56 kg ha−1, respectively, compared to 62 and 60% for sulfosulfuron at 0.04 and 0.07 kg ha−1, respectively. Switchgrass injury (chlorosis and height reduction relative to the untreated control) was observed, but most symptoms were not detectable by 8 wk after treatment (WAT) for most treatments. Plots that received quinclorac at 0.56 kg ha−1at 6 WAP tended to have relatively low weed biomass and high total aboveground yield in the establishment year and relatively high total aboveground yield in the year after establishment.
Western Snowberry (Symphoricarpos occidentalis) Control with Aminopyralid and Metsulfuron
Authors: Sbatella Gustavo M. , Wilson Robert G. , Sleugh Byron
Published: November 2011

The use of aminopyralid combined with metsulfuron for western snowberry control was evaluated with field trials conducted near Rushville, NE. Herbicides treatments consisted of aminopyralid plus metsulfuron, aminopyralid plus metsulfuron plus 2,4-D, 2,4-D alone, and metsulfuron plus chlorsulfuron plus 2,4-D plus dicamba. All treatments were applied in May and June. Sixty days after treatment (DAT) western snowberry control with aminopyralid plus metsulfuron at 0.073 + 0.012 kg ai ha−1 applied in May was 64%, whereas when applied in June, control was 97%. Meanwhile control with 2,4-D was 99 and 78% for the May and June applications, respectively. No major differences between application timings were observed 60 DAT for the rest of the treatments, with control levels ranging from 85 to 99%. One year after application, differences in control between application timings only persisted for 2,4-D. At 365 DAT, western snowberry control with aminopyralid plus metsulfuron at 0.073 + 0.012 kg ai ha−1 was 76 and 78% for May and June applications, respectively. The addition of 2,4-D at 1.1 kg ai ha−1 to aminopyralid plus metsulfuron provided excellent control and was similar to the combination of metsulfuron, chlorsulfuron, 2,4-D, and dicamba for both May and June applications. Grass production and animal carrying capacity were higher after western snowberry control with the majority of the treatments. Aminopyralid plus metsulfuron applied at the lower rate was the exception. The increase in the carrying capacity after western snowberry control ranged from 2.2 to 4.5 animal unit month (AUM). The control of western snowberry resulted in an increase in net income per hectare when compared with the untreated checks, ranging from $4 to $47.9 ha−1. Several options are available for effective western snowberry control during a broader time of application with increased grass production.
Texasweed (Caperonia palustris) Can Survive and Reproduce in 30-cm Flood
Authors: Godara Rakesh K. , Williams Billy J. , Webster Eric P.
Published: November 2011

Texasweed is an annual broadleaf plant belonging to the Euphorbiaceae family and is an emerging problem in southern U.S. rice fields. Field studies were conducted in 2008 and 2009 to study the effect of flood depth on Texasweed survival and growth. The trearments were five flood depths: 0, 10, 15, 20, and 30 cm and two Texasweed growth stages: two- to three-leaf stage and four- to five-leaf stage. The experiment was conducted in a completely randomized split-plot design with three replications. Flooding conditions were created by placing potted plants in 1.3 m by 0.7 m by 0.7 m polyvinyl chloride troughs. The effect of flood depth on Texasweed growth and fruit production was evaluated using ANOVA and regression analysis. Texasweed plants were able to survive in floods up to 30 cm; however, growth and fruit production were reduced. Increasing flood depths resulted in increased plant height and greater biomass allocation to stem. Texasweed plants produced adventitious roots and a thick spongy tissue, secondary aerenchyma, in the submerged roots and stem, which may play a role in its survival under flooded conditions. The recommended flood depth for rice in Louisiana is 5 to 10 cm. A 10-cm flood in the present study caused about 30 and 15% biomass reduction in two- to three-leaf and four- to five-leaf stage Texasweed, respectively. The results, thus, suggest that flooding alone may not be a viable option for Texasweed management in drill-seeded rice. However, appropriate manipulation of flooding could enhance the effectiveness of POST herbicides. This aspect needs further investigation.
Validity and Reliability: Part I
Authors: Davis Deborah Winders
Published: November 2011

IN THE FIRST COLUMN OF THIS series, I discussed different types of research study designs (see September/October 2003 issue). In this column, I review the concepts of validity and reliability. Validity is a measure of accuracy and generalizability; reliability has to do with whether results can be repeated. Often these terms are used in reference to measurements or instruments. They can also be used to describe a study itself, however.1 The overall validity of a study depends generally on the validity and reliability of the measurement tools, but other factors also contribute. This column focuses on overall study validity and reliability. Measurement validity and reliability will be the topic for a future column.
Perinatal Corticosteroids: A Review of Research Part I: Antenatal Administration
Authors: Purdy Isabell , Wiley Dorothy
Published: November 2011

The premature infant may receive therapeutic glucocorticoid drugs whilein uteroor in the postnatal period. This article (part I of a two-part series) discusses the benefits and risks ofin utero,or antenatal, corticosteroids (ACS) for the premature infant. Part II addresses the benefits and risks of postnatal corticosteroid (PCS) use. There are numerous clinical studies on the therapeutic use of these steroids for the prevention of respiratory distress syndrome and chronic lung disease in the premature infant, although research results on the efficacy of repeated steroid exposure among premature infants vary. Premature infants who are exposed to repeated courses of ACS and/or highcumulative- dose PCS may show no neurologic side effects until later in life. Research in newborn animal models focused on the timing, duration, and amounts of ACS and PCS. Current clinical research includes examination of the neurodevelopment of infants who are therapeutically exposed to perinatal corticosteroids, to identify safer minimal dose protocols. Over the past 30 years, corticosteroids have been increasingly prescribed before and after birth. Understanding the potential treatment benefits and risks to human fetuses and neonates is vital to clinical practice. This review presents historic and pharmacokinetic information about prenatal use of corticosteroids. It also offers scientific evidence of the benefits and risks identified in animal models and clinical trials, to stimulate thought that guides neonatal clinical practice.
The Discovery of Retrolental Fibroplasia and the Role of Oxygen: A Historical Review, 1942–1956
Authors: Reedy Elizabeth
Published: November 2011

Nearly 50 years after it was thought to be conquered, retinopathy of prematurity (ROP) continues to cause vision disturbances and blindness among prematurely born infants. During the 1940s and early 1950s, researchers and caregivers first identified and struggled to eliminate this problem, which seemed to come from nowhere and was concentrated among the most advanced premature nurseries in the U.S. Research studies initially identified many potential causes, none of which could be proved conclusively. By the mid-1950s, oxygen was identified as the culprit, and its use was immediately restricted. The rate of blindness among premature infants decreased significantly. ROP was not cured, however. By the 1960s, it had reappeared. The history of ROP serves to remind us that, despite our best intentions, the care and treatment of premature newborns will always carry with it the possibility of iatrogenic disease. This caution is worth remembering as we work to expand the quality and quantity of clinical research.
Saying Good-Bye
Authors: Burkes Chaplain Norris
Published: November 2011

ONE OF THE MOST COMMON questions asked by NICU families is “when is it time to stop praying for healing and start saying good-bye?”
End-Tidal CO2 Verification of Endotracheal Tube Placement in Neonates
Authors: DeBoer Scott , Seaver Michael
Published: November 2011

Endotracheal tubes are misplaced more often than one may think, and the consequences of not quickly detecting and correcting the error can be catastrophic. In the pediatric and adult populations, end-tidal CO2verification of endotracheal tube placement is considered to be the standard of care. An understanding and use of the technology available are essential for all health care professionals to allow them to provide optimum care for their patients.
The Latest in the Literature
Authors: Rasmussen Lynn
Published: November 2011

This column presents abstracts of recently published research studies and evidence-based practice guidelines of interest to those who care for neonates. These abstracts, printed as written by the authors, have been chosen from peer-reviewed journals in order to provide readers of Neonatal Network:® The Journal of Neonatal Nursing with a timely glimpse at the state of the science. A short commentary regarding the studies and topics is provided.
Why Are We Trimming Peripherally Inserted Central Venous Catheters?
Authors: Trotter Carol
Published: November 2011

PERIPHERALLY INSERTED CENTRAL venous catheters (PICCs) are used as the standard of care for longterm intravenous access in neonates treated in neonatal intensive care units. Little evidence supports many of the practices associated with PICC lines, however. Some practices needing more evidence include catheter tip placement in very low birth weight neonates, the catheter insertion site, the catheter material, insertion site dressings, and mechanisms to prevent catheter-related sepsis. Of particular concern is the practice of trimming the excess length off the distal end of the catheter prior to insertion.
Treatment of Neonatal Pain without a Gold Standard: The Case for Caregiving Interventions and Sucrose Administration
Authors: Prince Wende , Horns Kimberly , Latta Teresa , Gerstmann Dale
Published: November 2011

Although many different neonatal pain assessment scales are used in clinical research, no gold-standard instrument exists. The multitude of pain assessment scales used has, in fact, threatened the validity of many studies and confused the construct of pain. This integrative review of the neonatal pain literature provides the recommendations from practice guidelines and the current evidence for modifying the pain response prior to and during common painful procedures.
News of The Academy of Neonatal Nursing
Authors: Davis Deborah Winders
Published: November 2011

Yesterday, I went out with my wife for some coffee. The cost was nearly ten dollars as we ordered one regular coffee, one tall mocha and two scones. (If you know what a “tall mocha” is, you too are spending anywhere from $1.35 for a regular coffee to $2.50 for a mocha [the cost of a tall mocha at my local coffee hangout is much less expensive than the cost of the exact same cup of coffee in a major city, an airport, or hotel].) If you buy a magazine when you are waiting in line at the grocery store, it will cost you three or four dollars (O: The Oprah Magazine costs $3.95 and Martha Stewart Living costs $4.75 for a single issue). If you drink one tall mocha a day and buy one magazine such as O, you will spend at least $21.45 per week or about $3.00 a day.
Supine Sleep Positioning, EMLA for Lumbar Puncture, and Home Gavage for Preterm Infants
Authors: McCain Gail
Published: November 2011

This column highlights selected research abstracts from published studies and systematic reviews about neonatal care. The original abstracts, from peer-reviewed journals, are followed with a commentary by the column editor. The goal of this column is to inform the readers of Neonatal Network:® The Journal of Neonatal Nursing about the most up-to-date research evidence for use in neonatal nursing practice. If you would like to see a particular research publication, research review, or research-based guideline in this column, please advise the column editor (E-mail: gmccain.com).
Extralobar Sequestration with Congenital Diaphragmatic Hernia: A Complicated Case Study
Authors: Harris Kathryn
Published: November 2011

This article presents a case study of an infant (JG) with an antenatal diagnosis of a left diaphragmatic hernia and an extralobar sequestration of his right lung, which was noted postnatally. JG’s course was complicated by persistent pulmonary hypertension of the newborn (PPHN) and suspected pulmonary hypoplasia, and he required support with extracorporeal life support (ECLS). JG’s case was unusual in his presentation of extreme PPHN that was unresponsive to inhaled nitric oxide and ECLS. His PPHN was nearly intractable, requiring treatment with vasodilators combined with intravenous sildenafil, which had never been tried in our institution before this case. The article concludes with a discussion of the etiology, diagnosis, and management of congenital diaphragmatic hernia and extralobar sequestration, singly and in combination.
Mongolian Spots in the Newborn: Do They Mean Anything?
Authors: Snow Timothy
Published: November 2011

Mongolian spots are the most frequently seen birthmarks in infants. They have almost universally been regarded as benign cutaneous manifestations that have no clinical significance. Recently, however, there have been studies suggesting that Mongolian spots manifest more often in children with certain inborn errors of metabolism, including mucopolysaccharidosis and GM1 gangliosidosis.
Point-of-Care Testing: All Good?
Authors: Thomas Patricia
Published: November 2011

ONE OF THE TECHNOLOGIES that many of us have incorporated into our practice is point- of-care testing (POCT). Any diagnostic blood test performed physically close to the patient versus in a centralized laboratory is POCT. Whole-blood home glucose monitoring for diabetics is probably the most widely used and accepted form of POCT. This technology easily translates to our world of the NICU. Many neonates— including preterm infants, those who are small for gestational age, large for gestational age, born to diabetic mothers, on intravenous fluids, receiving steroids, or requiring surgery— need frequent glucose monitoring.
Getting High on Performance!
Authors: Simons Sherri Lee
Published: November 2011

ONE CRITICAL RESPONSIBILITY of the NICU nurse manager is to mentor, evaluate, and improve the performance of the nursing staff. The annual appraisal tool is one method for evaluating performance. Such appraisals have been mandated by regulatory agencies and human resources departments and are very much a part of the hospital setting. But appraisals alone, although a useful tool, don’t necessarily increase morale, promote retention of top performers, or result in much-needed behavioral changes.1
The Integration of Research and Practice: The Importance of Examining the Evidence
Authors: Davis Deborah Winders
Published: November 2011

IN PREVIOUS COLUMNS, I HAVE covered the following topics: types of research design (September/October 2003), study reliability and validity (January/ February 2004), instrument reliability and validity (May/June 2004), selection and use of research instruments (September/ October 2004), and issues and methods related to data collection and study implementation (January/February 2005). This column addresses some issues related to the integration of research and clinical practice across many clinical professions.
A “Moment” in the NICU
Authors: Burkes Norris
Published: November 2011

MOST BABIES WHO COME INTO OUR NICUs stay for weeks or even months. But occasionally a baby will come to stay for only a few minutes, and those few minutes can make a lifelong impact on those involved.
Implementation and Evaluation of a Home Gavage Program for Preterm Infants
Authors: Sturm Lynn
Published: November 2011

Purpose: To describe the implementation and evaluation of a home gavage program for preterm infants.

Design: Retrospective chart reviews were used to assess physiologic progress of infants, and retrospective written questionnaires were administered by mail to families participating in home gavage to assess their experience and solicit advice.

Sample: One hundred forty-three infants born at <37 weeks gestational age with a primary diagnosis of prematurity who met criteria for home gavage, of whom 52 were given home gavage and 91 attained full oral feedings in intensive care before discharge.

Main Outcome Variables: The safety of home gavage was evaluated by weight change and hospital readmission. Parental satisfaction was assessed by the mailed survey. Cost savings also were evaluated.

Results: Infants gained an average of 31 gm/day while receiving home gavage. No hospital readmissions were related to home gavage. Parents expressed satisfaction with the home gavage program. There was an average savings of $12,428 per infant related to shorter hospital stays.
Haddad Syndrome: A Case Study
Authors: Shuman Lisa , Youmans Diane
Published: November 2011

Hirschsprung’s disease (HD), also known as congenital aganglionic megacolon, is a relatively common cause of congenital obstruction of the colon. Congenital central hypoventilation syndrome (CCHS), also known as Ondine’s curse, is a rare condition involving failed autonomic respiration in the absence of cardiorespiratory disease resulting in inadequate alveolar ventilation. Both conditions typically present in the newborn period and belong to a group of disorders referred to as neurocristopathies.

HD and CCHS most commonly exist as discrete entities, but the coexistence of them is now called Haddad syndrome. Although few documented cases of Haddad syndrome exist in the literature, the association of CCHS and HD suggests a common etiology involving neural crest development.
Ventilator-Induced Airway Injury: A Critical Consideration During Mechanical Ventilation of the Infant
Authors: Greenspan Jay , Shaffer Thomas
Published: November 2011

The clinical management of respiratory failure in the newborn often focuses on lung parenchymal stiffness due to immaturity, surfactant deficiency, infiltrates, and other causes. However, health care personnel should also consider the airway, which plays an important role in gas exchange and lung mechanics. The airway can be easily injured, and an injured airway can significantly alter both the acute and chronic course of lung disease in infants. Further, there are developmental changes that affect the susceptibility of the neonatal airway to injury. Recognizing and preventing causes of airway injury can help to ensure optimal outcomes for the critically ill neonate.
News of The Academy of Neonatal Nursing
Authors: Brott Shirley
Published: November 2011

Change is constant of both the NICU and our work here at the Academy. We are always searching to find new ways to improve our educational content and to make our offerings more interesting and useful to you, our members. Now, we take great pleasure in introducing Shirley Brott, RN, BSN, MEd, as the new editor of the “News of the Academy of Neonatal Nursing.”
Pain Assessment and Pharmacologic Management for Infants with NEC: A Retrospective Chart Audit
Authors: Gibbins Sharyn , Maddalena Patricia , Moulsdale Wendy , Garrard Fiona , Mohamed Taslin jan , Nichols Allyson , Asztalos Elizabeth
Published: November 2011

Purpose:To examine (1) the frequency and types of painful procedures, (2) the frequency and types of analgesic/sedative use, and (3) the frequency of documented pain assessments that infants experience during the five days following a diagnosis of necrotizing enterocolitis (NEC).

Design:A retrospective descriptive cohort design.

Sample:Thirty-nine infants from one tertiary care unit diagnosed with stage II NEC.

Main Outcome Variable:Painful procedure data were classified into highly invasive procedures and moderately invasive procedures and were collected for five days following the diagnosis of NEC. Frequency and types of analgesic/sedative administration and frequency of documented pain assessments during each of the five days following the NEC diagnosis were collected.

Results:The average number of painful procedures was 16.3 per day, with documented PIPP scores performed on 30–60 percent of the infants during each of the days following the diagnosis of NEC. At no time were more than two PIPP scores per infant documented in a 24-hour period. Analgesics were used in 52–76 percent of infants during the first three days following the diagnosis of NEC, but use decreased gradually on the fourth and fifth days. No correlation between painful procedures and analgesic/sedative administration on any day was found. Similarly, no correlation between documented PIPP scores and analgesic/sedative use on any day was found.
Congenital Nephrotic Syndrome
Authors: Jackson Lori Williams
Published: November 2011

THIS COLUMN, ABOUT THE clinical management of congenital nephrotic syndrome (CNS), was prompted by an infant who presented twice within a few months of life with a diagnosis of septic arthritis. During the infant’s second admission, symptoms of acute renal failure were noted. Among the differential diagnoses was congenital nephrotic syndrome. I cared for this patient and his parents during the initial days of his diagnostic tests. In order to learn more about this potential diagnosis, I began a review of the literature. Fortunately, CNS was ruled out. The patient was found to be in failure due to nephrotoxic medications used to treat his septic arthritis. Because CNS was unfamiliar to me, I thought I would share my findings in this column.
Retained Central Venous Lines in the Newborn: Report of One Case and Systematic Review of the Literature
Authors: Serrano Mercedes , García-Alix Alfredo , López Juan-Carlos , Pérez Jesús , Quero José
Published: November 2011

The use of percutaneously inserted central catheters (PICCs) is an established practice in most NICUs. With the widespread use of these catheters, an increasing number of PICC complications has been reported in neonates. We present one case of a PICC retained and tethered in the vein in a very low birth weight infant, as well as a systematic review of PICC retention cases. Ten previous cases of PICC retention in neonates were found. Among those cases, the most common associated factors were coagulase-negative staphylococcus catheter colonization/bacteremia and long duration of catheterization. Occlusion was not a useful sign for predicting catheter retention. Once retention was established, heparin or urokinase instillations were ineffective. Although surgical exploration was sometimes required, firm, continuous traction applied to the catheter over several hours or intermittent, moderately strong pulling maneuvers were successful in 44.4 percent of the cases in which they were performed. Traction did not show major side effects. Our case provides additional support for use of traction as the initial approach in the management of this rare complication.
Evaluation of the Impact of the S.T.A.B.L.E. Program on the Pretransport Care of the Neonate
Authors: O’Neill Nancy , Howlett Alexandra
Published: November 2011

Purpose: To determine whether the S.T.A.B.L.E. Program increases health care providers’ confidence and clinical abilities in pretransport stabilization and to assess the care of transported neonates before and after S.T.A.B.L.E. Program education.

Design: A descriptive design was used to evaluate health care providers’ confidence about pretransport stabilization and to assess infant outcomes before and after S.T.A.B.L.E. education.

Sample: Sixty-four participants in the S.T.A.B.L.E. Program in Nova Scotia participated in this study over a 13-month period. The study evaluated the charts of all neonates transported to the IWK Health Centre over two one-year periods, before and after the S.T.A.B.L.E. Program.

Main Outcome Variable: Perceived confidence and incorporation of S.T.A.B.L.E. Program principles among regional health care providers and neonatal stability at time of transfer were measured.

Results: Ninety-six percent of participants indicated that the course was relevant and useful. Ninety percent indicated that they felt more confident about their ability to provide neonatal pretransport stabilization, and 86.5 percent reported adoption of the S.T.A.B.L.E. Program principles into their practice. There were no differences in infant outcomes between the pre- and post-S.T.A.B.L.E. time periods.
The Therapeutic Use of Honey
Authors: Bell Susan Givens
Published: November 2011

THE ANCIENTS WROTE OF THE healing properties of honey. A Sumerian tablet, possibly dated 3000 BCE, documents the treatment of an infected skin ulcer with honey. An Egyptian papyrus dated around 2000 BCE notes the use of honey to treat a gaping wound penetrating to the bone near the eyebrow. Aristotle (384–322 BCE) wrote about the use of honey to treat wounds and sore eyes. As with those of other natural substances, the healing benefits of honey were passed from generation to generation. Honey continues to be a popular medicine throughout the world, except in the U.S.1
Thyroid Hormone Levels in Term and Preterm Neonates
Authors: Knobel Robin
Published: November 2011

SCREENING THYROID HORMONE levels in the neonate during the first week of life is important because of their valuable link in identifying congenital hypothyroidism (CH), a condition that leads to mental retardation if left untreated. However, if CH is diagnosed early, it can be treated.
An Evidence-Based Review of Hyperbilirubinemia in the Late Preterm Infant, with Implications for Practice: Management, Follow-Up, and Breastfeeding Support
Authors: Smith Joan Renaud , Donze Ann , Schuller Lisa
Published: November 2011

SIX-DAY-OLD BABY DANNY WAS brought to the pediatric Emergency Department (ED) by his parents with chief complaints of persistent sleeping, difficulty arousing for feedings, and a lack of interest in breastfeeding. Danny’s parents reported that he had had only two wet and very yellow diapers within the past 12 hours. Danny’s mother was concerned because he had not had a bowel movement for more than 48 hours.
Designing Medication Safety in the NICU
Authors: Simons Sherri Lee
Published: November 2011

IN SEPTEMBER 2006, A HOSPITAL IN Indianapolis, Indiana, reported that six premature babies had been given adult-size doses of heparin, resulting in the death of three of the infants.1 The adult doses of this blood thinner had inadvertently been placed in a medication cabinet in the NICU. Similar packaging of the adult and neonatal doses contributed to this human error. When used correctly, medications can save neonates’ lives. When incorrectly used, they can cost the lives of the very patients they are intended to help.2
Trisomy 18: A Case Study
Authors: Shaw Jacquelyn
Published: November 2011

Trisomy 18 is a devastating genetic disorder that can be characterized by multiple congenital anomalies. Some of these anomalies have no medical significance, but merely provide clues to suggest the diagnosis. The most common form of trisomy 18 is the nondisjunction type, which affects every cell of the body with an extra chromosome 18. Affected infants are typically born with a prominent occiput, short eye fissures with droopy eyelids, micrognathia, external ear variations, clenched fist with index finger overlapping the third finger and fifth finger overlapping the fourth, small fingernails and toenails, underdeveloped or altered thumbs, “rocker-bottom” feet, and redundant skin at the back of the neck. Congenital heart defects are common. The mortality rate among infants with trisomy 18 is high as a result of cardiac and renal malformations, feeding difficulties, sepsis, and central apnea caused by central nervous system defects. A case study is provided.
Mission (IM)Possible? Nurse Civility in the NICU
Authors: Simons Sherri Lee
Published: November 2011

RECRUITING QUALIFIED REGISTERED nurses into the NICU is the first step toward ensuring that adequate numbers of staff are available to meet the needs of NICU patients. Perhaps more crucial, however, is creating healthy work cultures that encourage nurses to stay. The environment in which nurses work is key to job satisfaction and turnover and plays a role in patient outcomes.1–4One factor, a culture of disrespect among nurses, can have a profound impact on teamwork, on the nursing shortage, on patient safety, and on the organization’s bottom line. Even in a profession that has fundamental roots in caring, peer-to-peer abuse among NICU nurses is common.5Each NICU has a unique culture, and the leader’s role is to help create a positive workplace and to monitor the environment.2This column provides an overview of nurse-to-nurse hostility and the role of leaders in establishing and maintaining a culture of civility.
Meconium Aspiration Syndrome
Authors: Wiedemann Jeanne Ray , Saugstad Andrea , Barnes-Powell Laura , Duran Karen
Published: November 2011

Meconium aspiration syndrome (MAS) is one of the most common conditions associated with aspiration during the newborn period. MAS can be defined as respiratory distress in a neonate born through meconium-stained amniotic fluid (MSAF) with symptoms that cannot otherwise be explained. It can be characterized by early onset of respiratory distress in term and near-term infants delivered through MSAF. Early presentation includes respiratory symptoms such as respiratory distress, poor lung compliance, hypoxemia, and radiographic findings of hyperinflation and patchy opacifications. This article discusses the pathophysiology of MAS, historical and current prevention strategies, current management strategies, and prognoses for infants born through MSAF.
News of The Academy of Neonatal Nursing
Authors: Brott Shirley
Published: November 2011

The 8th National Neonatal Nurses Meeting will be held in the nation’s capital October 9–11, 2008. Come early, and participate in our preconference day, Wednesday, October 8, enjoying a full or half-day of educational offerings such as the Cardiopulmonary System Certification Review Course, Pharmacokinetics, PICC Line Management and Complications, and more. On October 9, our keynote speaker, Terry Johnson, ARNP, RNC, MN, will kick off the main conference with “Small is the New BIG: Microtrends and the Small Forces Behind Tomorrow’s Big Changes in Neonatal Nursing.” After the morning general sessions, the afternoons are filled with over 30 workshops with the latest information to keep Academy members up to date on the most current neonatal trends. Hot topics such as “The Dark Side of C-Sections,” “The Neonatal Golden Hour,” “NNP Precepting,” “Proteomics and the Metabolomics,” and “Genetics and Dysmorphology: Evolving Syndromes, New Technologies” are just a sampling of the many great workshops offered.
Celebrating Special People
Authors: Askin Debbie Fraser
Published: November 2011

NICU NURSES ARE A SPECIAL BREED OF PEOPLE. WE CAN talk about intergenerational differences, stressful conditions, staff shortages, and just why there are so few nurses. But when it comes to caring for our patients and their families or our colleagues, we do that really well. I recently had the opportunity to witness the staff of my NICU rally to support a colleague who had a brush with a life-threatening illness. The response was amazing. Before you knew it, there were baked goods and groceries, bubble bath and novels, movies and other goodies being amassed in a series of gift baskets. There were coupons and gift certificates and, most importantly, an outpouring of kind words and supportive messages. This is not the first time I have seen compassion at work among colleagues. Christmas in our NICU finds giant sign-up lists for hamper items for needy families. By the time we are ready to make deliveries there are several enormous hampers making their way to several families that have passed through our doors during the preceding year.
Father Surrogate: Historical Perceptions and Perspectives of Men in Nursing and Their Relationship with Fathers in the NICU
Authors: Peterson Steven
Published: November 2011

Femininity is often associated with the nursing profession, but is not one of its defining characteristics. Men have been providing care to the sick and injured for many centuries, and they continue to do so for many reasons. Male nurses display a wide range of caring practices, which may not always be interpreted as such by their female counterparts. This article presents the male perspective and approach to caring, including the unique relationship that male nurses can have with fathers in the NICU.
News of The Academy of Neonatal Nursing
Authors: Brott Shirley
Published: November 2011

Recruit new members! Renew your membership! The NICU with the highest percentage of ANN members by July 31, 2008, wins a library of books from NICU Ink Books.® The winning unit will be notified by September 1, 2008, and will be recognized at the 8th National Neonatal Nurses Meeting in Washington, DC.