bluuebunny/crossref_metadata_2025 huggingface dataset:
Serial Procalcitonin as a Predictor of Bacteremia and Need for Intensive Care Unit Care in Adults With Pneumonia, Including Those With Highest Severity: A Prospective Cohort Study
Authors: McCluskey Suzanne M. , Schuetz Philipp , Abers Michael S. , Bearnot Benjamin , Morales Maria E. , Hoffman Debora , Patel Shreya , Rosario Lauren , Chiappa Victor , Parry Blair A. , Callahan Ryan T. , Bond Sheila A. , Lewandrowski Kent , Binder William , Filbin Michael R. , Vyas Jatin M. , Mansour Michael K.
Published: December 2016

Background

Procalcitonin (PCT) is a prohormone that rises in bacterial pneumonia and has promise in reducing antibiotic use. Despite these attributes, there are inconclusive data on its use for clinical prognostication. We hypothesize that serial PCT measurements can predict mortality, intensive care unit (ICU) admission, and bacteremia.

Methods

A prospective cohort study of inpatients diagnosed with pneumonia was performed at a large tertiary care center in Boston, Massachusetts. Procalcitonin was measured on days 1 through 4. The primary endpoint was a composite adverse outcome defined as all-cause mortality, ICU admission, and bacteremia. Regression models were calculated with area under the receiver operating characteristic curve (AUC) as a measure of discrimination.

Results

Of 505 patients, 317 patients had a final diagnosis of community-acquired pneumonia (CAP) or healthcare-associated pneumonia (HCAP). Procalcitonin was significantly higher for CAP and HCAP patients meeting the composite primary endpoint, bacteremia, and ICU admission, but not mortality. Incorporation of serial PCT levels into a statistical model including the Pneumonia Severity Index (PSI) improved the prognostic performance of the PSI with respect to the primary composite endpoint (AUC from 0.61 to 0.66), bacteremia (AUC from 0.67 to 0.85), and need for ICU-level care (AUC from 0.58 to 0.64). For patients in the highest risk class PSI >130, PCT was capable of further risk stratification for prediction of adverse outcomes.

Conclusion

Serial PCT measurement in patients with pneumonia shows promise for predicting adverse clinical outcomes, including in those at highest mortality risk.
Toasting Time and Cooking Formulation Affect Browning Reaction Products Development in Corn Flakes
Authors: Cueto Mario , Perez Burillo Sergio , Rufián‐Henares José Ángel , Farroni Abel Eduardo , Buera María del Pilar
Published: December 2016

During toasting, the last stage of corn flake production, Maillard reaction takes place, favored by the high temperature and low water content. The cooking formulation ingredients influence color and flavor of the final product and, therefore, consumer acceptance. However, some undesirable components are also formed. The impact of cooking formulation and toasting time on color development and on the formation of chemical markers was investigated. Samples (flakes) were equilibrated at water activity (aw) 0.8 and toasted at 230°C. After extraction of fluorescent pigments with pronase, fluorescence, absorbance at 420 nm, and furfurals analysis was performed. Sucrose showed a synergistic interaction with malt and salt. Formulation highly affected the amount of 5‐hydroxymethylfurfural and furfural formed. L* and a* were sensitive variables to measure overall browning reaction. These results allow for further understanding of the influence of formulation used during cooking and would help to mitigate the formation of undesirable compounds.
Treating skin and soft tissue infections
Authors: Mospan Geoffrey , Hulisz Darrell
Published: December 2016

New guidelines have been released for the treatment of skin and soft tissue infections. The updates include recommendations on when to prescribe antibiotics and which antibiotics are effective for each infection. This article will highlight the important changes to practice and provide additional antibiotic clinical pearls.
Cold Thermal Irrigation Decreases the Ipsilateral Gain of the Vestibulo-Ocular Reflex
Authors: Tamás Laszlo T. , Weber Konrad P. , Bockisch Christopher J. , Straumann Dominik , Lasker David M. , Büki Béla , Tarnutzer Alexander A.
Published: December 2016

Objectives:

During head rotations, neuronal firing rates increase in ipsilateral and decrease in contralateral vestibular afferents. At low accelerations, this “push-pull mechanism” is linear. At high accelerations, however, the change of firing rates is nonlinear in that the ipsilateral increase of firing rate is larger than the contralateral decrease. This mechanism of stronger ipsilateral excitation than contralateral inhibition during high-acceleration head rotation, known as Ewald’s second law, is implemented within the nonlinear pathways. The authors asked whether caloric stimulation could provide an acceleration signal high enough to influence the contribution of the nonlinear pathway to the rotational vestibulo-ocular reflex gain (rVOR gain) during head impulses.

Design:

Caloric warm (44°C) and cold (24, 27, and 30°C) water irrigations of the left ear were performed in 7 healthy human subjects with the lateral semicircular canals oriented approximately earth-vertical (head inclined 30° from supine) and earth-horizontal (head inclined 30° from upright).

Results:

With the lateral semicircular canal oriented earth-vertical, the strongest cold caloric stimulus (24°C) significantly decreased the rVOR gain during ipsilateral head impulses, while all other irrigations, irrespective of head position, had no significant effect on rVOR gains during head impulses to either side.

Conclusions:

Strong caloric irrigation, which can only be achieved with cold water, reduces the rVOR gain during ipsilateral head impulses and thus demonstrates Ewald’s second law in healthy subjects. This unilateral gain reduction suggests that cold-water caloric irritation shifts the set point of the nonlinear relation between head acceleration and the vestibular firing rate toward a less acceleration-sensitive zone.
Effects of Web-Based Instruction on Nursing Students' Arithmetical and Drug Dosage Calculation Skills
Authors: Karabağ Aydin Arzu , Dinç Leyla
Published: December 2016

Drug dosage calculation skill is critical for all nursing students to ensure patient safety, particularly during clinical practice. The study purpose was to evaluate the effectiveness of Web-based instruction on improving nursing students' arithmetical and drug dosage calculation skills using a pretest-posttest design. A total of 63 nursing students participated. Data were collected through the Demographic Information Form, and the Arithmetic Skill Test and Drug Dosage Calculation Skill Test were used as pre and posttests. The pretest was conducted in the classroom. A Web site was then constructed, which included audio presentations of lectures, quizzes, and online posttests. Students had Web-based training for 8 weeks and then they completed the posttest. Pretest and posttest scores were compared using the Wilcoxon test and correlation coefficients were used to identify the relationship between arithmetic and calculation skills scores. The results demonstrated that Web-based teaching improves students' arithmetic and drug dosage calculation skills. There was a positive correlation between the arithmetic skill and drug dosage calculation skill scores of students. Web-based teaching programs can be used to improve knowledge and skills at a cognitive level in nursing students.
Patient-Centered Personal Health Record and Portal Implementation Toolkit for Ambulatory Clinics
Authors: Nahm Eun-Shim , Diblasi Catherine , Gonzales Eva , Silver Kristi , Zhu Shijun , Sagherian Knar , Kongs Katherine
Published: December 2016

Personal health records and patient portals have been shown to be effective in managing chronic illnesses. Despite recent nationwide implementation efforts, the personal health record and patient portal adoption rates among patients are low, and the lack of support for patients using the programs remains a critical gap in most implementation processes. In this study, we implemented the Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit in a large diabetes/endocrinology center and assessed its preliminary impact on personal health record and patient portal knowledge, self-efficacy, patient-provider communication, and adherence to treatment plans. Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit is composed of Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit—General, clinic-level resources for clinicians, staff, and patients, and Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit Plus, an optional 4-week online resource program for patients (“MyHealthPortal”). First, Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit—General was implemented, and all clinicians and staff were educated about the center’s personal health record and patient portal. Then general patient education was initiated, while a randomized controlled trial was conducted to test the preliminary effects of “MyHealthPortal” using a small sample (n = 74) with three observations (baseline and 4 and 12 weeks). The intervention group showed significantly greater improvement than the control group in patient-provider communication at 4 weeks (t
56 = 3.00, P = .004). For other variables, the intervention group tended to show greater improvement; however, the differences were not significant. In this preliminary study, Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit showed potential for filling the gap in the current personal health record and patient portal implementation process. Further studies are needed using larger samples in other settings to ascertain if these results are generalizable to other populations.
Design and Evaluation of a Web-Based Symptom Monitoring Tool for Heart Failure
Authors: Wakefield Bonnie J. , Alexander Gregory , Dohrmann Mary , Richardson James
Published: December 2016

Heart failure is a chronic condition where symptom recognition and between-visit communication with providers are critical. Patients are encouraged to track disease-specific data, such as weight and shortness of breath. Use of a Web-based tool that facilitates data display in graph form may help patients recognize exacerbations and more easily communicate out-of-range data to clinicians. The purposes of this study were to (1) design a Web-based tool to facilitate symptom monitoring and symptom recognition in patients with chronic heart failure and (2) conduct a usability evaluation of the Web site. Patient participants generally had a positive view of the Web site and indicated it would support recording their health status and communicating with their doctors. Clinician participants generally had a positive view of the Web site and indicated it would be a potentially useful adjunct to electronic health delivery systems. Participants expressed a need to incorporate decision support within the site and wanted to add other data, for example, blood pressure, and have the ability to adjust font size. A few expressed concerns about data privacy and security. Technologies require careful design and testing to ensure they are useful, usable, and safe for patients and do not add to the burden of busy providers.
Histologic Assessment of Lichenoid Dermatitis Observed in Patients With Advanced Malignancies on Antiprogramed Cell Death–1 (anti–PD-1) Therapy With or Without Ipilimumab
Authors: Chou Shaun , Hwang Shelley Ji Eun , Carlos Giuliana , Wakade Deepal , Fernandez-Penas Pablo
Published: December 2016

Lichenoid drug reaction is a common adverse reaction in patients taking immune-modulatory agents such as antiprogramed cell death (PD-1) and cytotoxic T lymphocyte antigen–4 agents. The authors describe the clinical and histologic features of lichenoid drug reaction in 20 biopsies from 15 patients on anti–PD-1 agents and 9 biopsies from 7 patients on anti–PD-1 plus ipilimumab therapy. Clinically, all except 2 patients presented with discrete, violaceous exanthematous papules to plaques. The lichenoid inflammation in the majority (18 of 29 biopsies) was florid although histology was quite heterogeneous. Nevertheless, there was frequent involvement of the superficial follicular epithelium and acrosyringium, and also a propensity to blister that occurred in approximately 20% of the biopsies. Occasional patients had disease closely resembling lichen planus, although all of these biopsies had some atypical features for lichen planus such as parakeratosis. Dermal eosinophils were common particularly in those with mild inflammation. The lichenoid reaction was responsive to topical steroid or oral systemic treatment in general, and the anti–PD-1 agent had to be ceased in only one patient.
The Selective Late Sodium Current Inhibitor Eleclazine, Unlike Amiodarone, Does Not Alter Defibrillation Threshold or Dominant Frequency of Ventricular Fibrillation
Authors: Silva Ana F. G. , Bonatti Rodolfo , Batatinha Julio A. P. , Nearing Bruce D. , Zeng Dewan , Belardinelli Luiz , Verrier Richard L.
Published: December 2016

Introduction:

We examined the effects of the selective late INa inhibitor eleclazine on the 50% probability of successful defibrillation (DFT50) before and after administration of amiodarone to determine its suitability for use in patients with implantable cardioverter defibrillators (ICDs).

Methods and Results:

In 20 anesthetized pigs, transvenous active-fixation cardiac defibrillation leads were fluoroscopically positioned into right ventricular apex through jugular vein. ICDs were implanted subcutaneously. Dominant frequency of ventricular fibrillation was analyzed by fast Fourier transform. The measurements were made before drug administration (control), and at 40 minutes after vehicle, eleclazine (2 mg/kg, i.v., bolus over 15 minutes), or subsequent/single amiodarone administration (10 mg/kg, i.v., bolus over 10 minutes). Eleclazine did not alter DFT50, dominant frequency, heart rate, or mean arterial pressure (MAP). Subsequent amiodarone increased DFT50 (P = 0.006), decreased dominant frequency (P = 0.022), and reduced heart rate (P = 0.031) with no change in MAP. Amiodarone alone increased DFT50 (P = 0.005; NS compared to following eleclazine) and decreased dominant frequency (P = 0.003; NS compared to following eleclazine).

Conclusion:

Selective late INa inhibition with eleclazine does not alter DFT50 or dominant frequency of ventricular fibrillation when administered alone or in combination with amiodarone. Accordingly, eleclazine would not be anticipated to affect the margin of defibrillation safety in patients with ICDs.
Fast and Adequate Liquid Chromatography–Tandem Mass Spectrometric Determination of Z-endoxifen Serum Levels for Therapeutic Drug Monitoring
Authors: de Krou Sven , Rosing Hilde , Nuijen Bastiaan , Schellens Jan H. M. , Beijnen Jos H.
Published: December 2016

Background:

Z-endoxifen (further referred to as endoxifen, unless stated otherwise) is proposed as the most important metabolite of tamoxifen. Patients receiving adjuvant tamoxifen treatment with endoxifen levels below the threshold of 5.9 ng/mL may have an increased risk of breast cancer recurrence. Several factors, such as genetic polymorphisms, drug interactions, and (non)adherence, lead to large interpatient variability in endoxifen exposure, resulting in a substantial number of patients showing subtherapeutic levels. As genotyping and phenotyping are not able to adequately predict endoxifen exposure, therapeutic drug monitoring (TDM) seems to be the best approach for tailored tamoxifen therapy.

Methods:

To support TDM services, a rapid and sensitive high-performance liquid chromatography–tandem mass spectrometry assay for the quantification of endoxifen in human serum was developed and validated. Validation was performed according to the latest US FDA and EMA guidelines on bioanalytical method validation.

Results:

The successfully validated serum assay quantifies endoxifen with a linear regression calibration model (weighted 1/x2) in the concentration range from 1.00 to 25.0 ng/mL. The assay was validated with an inaccuracy of ±7.7% and an imprecision of ≤3.9%, obtained with an IS normalized matrix factor of 0.925 and a signal-to-noise ratio of >66.

Conclusions:

All validation parameters fulfilled their acceptance criteria, and the developed assay is now successfully being used to support TDM services. Thus far, 32.7% of the more than 500 determined endoxifen serum levels were below the threshold of 5.9 ng/mL.
Near-complete Humerus Reconstruction in the Pediatric Patient with Vascularized Free Fibula Transfer
Authors: Shuck John , Wood Benjamin C. , Zarella Christopher , Oh Albert K. , Henshaw Robert M. , Rogers Gary F.
Published: December 2016

Vascularized free fibula transfer remains the gold standard for reconstruction of large segmental diaphyseal defects of the upper extremity. In the pediatric patient, before skeletal maturity, free fibula transfer with the fibular head provides an active physis for growth and an articular interface for glenohumeral joint reconstruction. Clinical and cadaveric studies have demonstrated that the vascular supply to the fibular head originates, in most cases, from the anterior tibial system. However, anatomical variation exists, and we report a case in which a vascularized fibula autograft including the physis was transferred on the peroneal artery in a 5-year-old patient with Ewing’s sarcoma. At 15-month follow-up, the patient has functional range of motion of the shoulder.
Anatomical Regional Targeted (ART) BOTOX Injection Technique: A Novel Paradigm for Migraines and Chronic Headaches
Authors: Amirlak Bardia , Sanniec Kyle , Pezeshk Ronnie , Chung Michael
Published: December 2016

Migraine headaches are a debilitating disease that causes significant socioeconomic problems. One of the speculated etiologies of the generation of migraines is peripheral nerve irritation at different trigger points. The use of Onabotulinum toxin A (BOTOX), although initially a novel approach, has now been determined to be a valid treatment for chronic headaches and migraines as described in the Phase III Research Evaluating Migraine Prophylaxis Therapy trials that prompted the approval by the Food and Drug Administration for treatment of chronic migraines. The injection paradigm established by this trial was one of a broad injection pattern across large muscle groups that did not always correspond to the anatomical locations of nerves. The senior author developed the Anatomical Regional Targeted BOTOX injection paradigm as an alternative to the current injection model. This technique targets both the anatomical location of nerves known to have causal effects with migraines and the region where the pain localizes, to provide relief across a wide distribution of the peripheral nerve. This article serves as a guide to the Anatomical Regional Targeted injection technique, which, to our knowledge, is the first comprehensive BOTOX injection paradigm described in the literature for treatment of migraines that targets nerves and nerve areas rather than purely muscle groups. This technique is based on the most up-to-date anatomical and scientific studies and large-volume migraine surgery experience.
Developing an Organizational Model for Improvement: From Translation to Practice
Authors: Polancich Shea
Published: December 2016

This department column highlights translation of research into healthcare quality practice. Achieving the highest quality in healthcare is a goal that requires focused attention and accountability. Standardization in practice through translation and application of evidence-informed practice promotes excellence in outcomes. To meet the goal of achieving the highest quality of care through evidence-informed translation and application in practice, organizations should outline a plan for developing, organizing, implementing, and evaluating evidence-informed improvement interventions. The purpose of this article is to provide an example for developing an organizational model for improvement from concept to application.
Psychometric Testing of a Religious Belief Scale
Authors: Chiang Yi-Chien , Lee Hsiang-Chun , Chu Tsung-Lan , Han Chin-Yen , Hsiao Ya-Chu
Published: December 2016

Background:

Nurses account for a significant percentage of staff in the healthcare system. The religious beliefs of nurses may affect their competence to provide spiritual care to patients. No reliable and valid instruments are currently available to measure the religious beliefs of nurses in Taiwan.

Purposes:

The aims of this study were to develop a religious belief scale (RBS) for Taiwanese nurses and to evaluate the psychometric properties of this scale.

Methods:

A cross-sectional study design was used, and 24 RBS items were generated from in-depth interviews, a literature review, and expert recommendations. The RBS self-administered questionnaire was provided to 619 clinical nurses, who were recruited from two medical centers and one local hospital in Taiwan during 2011–2012. A calibration sample was used to explore the factor structure, whereas a validation sample was used to validate the factor structure that was constructed by the calibration sample. Known-group validity and criterion-related validity were also assessed.

Results:

An exploratory factor analysis resulted in an 18-item RBS with four factors, including “religious effects,” “divine,” “religious query,” and “religious stress.” A confirmatory factor analysis recommended the deletion of one item, resulting in a final RBS of 17 items. The convergent validity and discriminate validity of the RBS were acceptable. The RBS correlated positively with spiritual health and supported concurrent validity. The known-group validity was supported by showing that the mean RBS between nurses with or without religious affiliation was significant.

Conclusions/Implications for Practice:

The 17-item RBS developed in this study is a reliable, valid, and useful scale for measuring the religious beliefs of nurses in Taiwan. This scale may help measure the religious beliefs of nurses and elicit the relationship between these beliefs and spirituality.
The Management of Extensor Mechanism Disruption After Total Knee Arthroplasty: A Systematic Review
Authors: Maffulli Nicola , Spiezia Filippo , La Verde Luca , Rosa Michele Attilio , Franceschi Francesco
Published: December 2016

We performed a literature search on PubMed, Web of Science, Science Direct/Scopus, Google Scholar, and Google to evaluate results of several techniques to manage disruption of the extensor mechanism after total knee arthroplasty. Different methods to manage extensor mechanism disruption are available at present, with no level I studies informing surgeons in an evidence-based fashion. Primary repair is not indicated. Allograft reconstruction could be effective, providing that appropriate surgical technique and allograft tensioning are implemented.
Clinical Variability After Partial External Biliary Diversion in Familial Intrahepatic Cholestasis 1 Deficiency
Authors: Squires James E. , Celik Neslihan , Morris Amy , Soltys Kyle , Mazariegos George , Shneider Benjamin , Squires Robert H.
Published: December 2016

Objectives:

Familial intrahepatic cholestasis 1 (FIC1) **deficiency is caused by a mutation in the ATP8B1 gene. Partial external biliary diversion (PEBD) is pursued to improve pruritus and arrest disease progression. Our aim is to describe clinical variability after PEBD in FIC1 disease.

Methods:

We performed a single‐center, retrospective review of genetically confirmed FIC1 deficient patients who received PEBD. Clinical outcomes after PEBD were cholestasis, pruritus, fat‐soluble vitamin supplementation, growth, and markers of disease progression that included splenomegaly and aspartate aminotransferase‐to‐platelet ratio index.

Results:

Eight patients with FIC1 disease and PEBD were included. Mean follow‐up was 32 months (range 15–65 months). After PEBD, total bilirubin was <2 mg/dL in all patients at 8 months after surgery, but 7 of 8 subsequently experienced a total of 15 recurrent cholestatic events. Subjective assessments of pruritus demonstrated improvement, but itching exacerbation occurred during cholestatic episodes. High‐dose fat‐soluble vitamin supplementation persisted, with increases needed during cholestatic episodes. Weight z scores improved (−3.4 to −1.65, P < 0.01). Splenomegaly did not worsen or develop and 1 patient developed an aminotransferase‐to‐platelet ratio index score of >0.7 suggesting development of fibrosis 24 months after PEBD.

Conclusions:

Clinical variability is evident among genetically defined FIC1 deficient patients after PEBD, even among those with identical mutations. Recurrent, self‐limited episodes of cholestasis and pruritus are reminiscent of the benign recurrent intrahepatic cholestasis phenotype. Despite diversion of bile from the intestinal lumen, weight gain improved while fat‐soluble vitamin requirements persisted. Significant progression of liver disease was not evident during follow‐up.
Capillary Flow Rates in the Duodenum of Pediatric Ulcerative Colitis Patients Are Increased and Unrelated to Inflammation
Authors: Zaidi Deenaz , Churchill Lucas , Huynh Hien Q. , Carroll Matthew W. , Persad Rabin , Wine Eytan
Published: December 2016

Background and Aim:

Inflammatory bowel diseases (IBD), including Crohn disease (CD) and ulcerative colitis (UC), are chronic pediatric disorders. Changes in vasculature are described in IBD, but these could be secondary to inflammation and the role in pathogenesis is poorly understood. Assessing circulatory changes in typically unaffected sites in IBD (eg, duodenum), when inflammation is absent, can identify vascular changes associated with pathogenesis. The aim of the study is to measure capillary flow rates in duodenal mucosa using probe‐based confocal laser endomicroscopy (pCLE) during endoscopy in children with IBD.

Methods:

Images of villi with visible blood vessels obtained using pCLE were captured as video sequences. Capillary flow rate (mm/s) was calculated by dividing the distance travelled by blood cells by the duration of the sequence. Flow rates were correlated with various clinical parameters.

Results:

Forty‐five patients (22 non‐IBD, 14 CD, 9 UC) were included in the study. Duodenal capillary flow rates were significantly higher in UC patients (0.75 ± 0.07 mm/s) as compared to non‐IBD (0.57 ± 0.03) and CD (0.65 ± 0.04). There was no correlation between serum hemoglobin and albumin, disease activity indices, serum inflammatory markers, and capillary flow rates in patients.

Conclusions:

This pilot study shows, for the first time, increased capillary blood flow in the duodenum of UC patients that was unrelated to inflammatory markers or disease activity. Thus, early vascular changes can be assessed using pCLE during endoscopy.
Diverting Ileostomy for the Treatment of Severe, Refractory, Pediatric Inflammatory Bowel Disease
Authors: Maxwell Elizabeth C. , Dawany Noor , Baldassano Robert N. , Mamula Petar , Mattei Peter , Albenberg Lindsey , Kelsen Judith R.
Published: December 2016

Objectives:

Diverting ileostomy is used as a temporizing therapy in patients with perianal Crohn disease; however, little data exist regarding its use for colonic disease. The primary aim of the present study was to determine the role of diversion in severe refractory colonic inflammatory bowel disease (IBD) in a pediatric population.

Methods:

Retrospective study of patients who underwent diverting ileostomy at The Children's Hospital of Philadelphia from 2000 to 2014 for the management of severe, refractory colonic IBD. Clinical variables were compared in the 1 year before ileostomy and 1 year after diversion. Surgical and disease outcomes including changes in diagnosis were reviewed through 2015.

Results:

Twenty‐four patients underwent diverting ileostomy for refractory colonic disease. Initial diagnoses were Crohn disease in 10 (42%), ulcerative colitis in 1 (4%), and IBD‐unclassified in 13 patients (54%). Comparing data before and after surgery, there were statistically significant improvements in height and weight velocities, height velocity z score, blood transfusion requirement, hemoglobin, and hospitalization rates. Chronic steroid use decreased from 71% to 22%. At the conclusion of the study, 10 patients had undergone subsequent colectomy, 7 had successful bowel reanastomosis, and 7 remain diverted. Seven patients (29%) had a change in diagnosis. There were 13 surgical complications in 7 subjects, including prolapse reduction, stoma revision, and resection of ischemic bowel.

Conclusions:

In pediatric patients with refractory colonic IBD, diverting ileostomy can be a successful intervention to induce clinical stability. Importantly, diversion is a steroid‐sparing therapy and allows additional time to clarify the diagnosis.
Nutritional Practices and Growth in Premature Infants After Surgical Necrotizing Enterocolitis
Authors: Lin Grace C. , Robinson Daniel T. , Olsen Steven , Reber Kristina M. , Moallem Mohannad , DiGeronimo Robert , Mulroy Cecilia , Datta Ankur , Murthy Karna
Published: December 2016

Objective:

The aim of the study was to describe the nutritional provisions received by infants with surgical necrotizing enterocolitis (NEC) and the associated effects on short‐term growth.

Methods:

Through the Children's Hospitals Neonatal Database, we identified infants born ⩽32 weeks’ gestation with surgical NEC from 5 regional neonatal intensive care units for 4 years. Excluded infants had isolated intestinal perforation and died <14 days postoperatively. Infants were stratified by their median parenteral protein dose (low [LP] or high [HP] protein) for the first postoperative week. The primary outcome was postoperative weight growth velocity. Growth (weight, length, and head circumference [HC]) was measured and the effects related to protein dose were estimated using multivariable analyses.

Results:

There were 103 infants included; the median parenteral protein dose received was 3.27 g · kg−1 · day−1 (LP: 2.80 g · kg−1 · day−1; HP: 3.87 g · kg−1 · day−1). Postoperative weight (11.5 ± 6.5 g · kg−1 · day−1) and linear growth (0.9 ± 0.2 cm/wk) were similar regardless of dose (P > 0.3 between groups for weight and length). Unadjusted and independent associations were identified with HC changes and HP dose (β = 0.1 cm/wk, P = 0.03) after adjusting for gestational age, the presence of severe bronchopulmonary dysplasia, short bowel syndrome, blood stream infection, severe intraventricular hemorrhage, small for gestational age, and calorie intake. Eventual nonsurvivors received 18% less protein and 14% fewer calories over the first postoperative month.

Conclusions:

Postoperative protein doses in infants with surgical NEC appear related to increases in HC. The influence of postoperative nutritional support on risk of adverse outcomes deserves further attention.
Autophagy in Hepatocytes in Infants With Alpha‐1 ATD and Different Liver Disease Outcomes
Authors: Czarnowska Elżbieta , Bakuła Agnieszka , Bierła Joanna B. , Niderla‐Bielińska Justyna , Sowińska Agnieszka , Cukrowska Bożena , Cielecka‐Kuszyk Joanna , Socha Piotr
Published: December 2016

Objectives:

It is unclear whether a distinct activity of pathways removing the antitrypsin (AT) protein in Alpha‐1‐Antitrypsin Deficiency (α1ATD) are associated with an unfavorable predisposition to liver disease in the future. The aim of this study was to determine whether liverspecific activity of AT protein disposal occurs at infancy in α1ATD with PiZZ phenotype (ATZ).

Methods:

Liver samples of 17 infants with unfavorable ATZ outcome (Group I, n = 8, median age = 0.35 year) and good outcome (Group II, n = 9, 0.17 year), and 9 with biliary atresia (BA, median age = 0.17 year) as control, were enrolled. For each subject were investigated autophagy activity by mRNA, protein expression (Calnexin, Beclin‐1, p62, and Parkin), and hepatocyte ultrastructure with morphometric analyses.

Results:

No significant differences in gene expression in the liver of infants were found between the 2 ATZ groups. Although a correlation between patients’ age and protein expression was observed, the ATZ groups differed Parkin immunohistochemical expression. Moreover, the hepatocytes in ATZ infants with unfavorable outcome were characterized by low Parkin expression and the presence of isolated mitophagosoms and numerous enlarged mitochondria. The mentioned findings differed in patients with BA.

Conclusions:

Thus, mentioned specific features occurring at infancy may suggest association with poor liver outcome. Parkin low expression could have a potential for disease prognosis and treatment; however, further studies in a greater number of patients are needed.
Study of Carnitine/Acylcarnitine and Amino Acid Profile in Children and Adults With Acute Liver Failure
Authors: Sood Vikrant , Rawat Dinesh , Khanna Rajeev , Sharma Shvetank , Gupta Prem K. , Alam Seema , Sarin Shiv Kumar
Published: December 2016

Objectives:

Fatty acid oxidation defects (FAODs) may underlie or modify the course of acute liver failure (ALF). Overall significance of carnitine/acylcarnitine and amino acid profile in ALF is similarly undetermined. Thus, this study was undertaken to study the abnormalities in carnitine/acylcarnitine and amino acid profile in ALF.

Methods:

A prospective study was performed including all patients with ALF, and detailed evaluation including metabolic testing was done.

Results:

A total of 55 patients (33 pediatric and 22 adult patients) were included in the study. Three patients (a 1‐year 6‐month‐old child, a 13‐year‐old adolescent, and a 21‐year‐old adult, ie, 5.5% of all) were identified for the study with underlying metabolic etiology, that is, carnitine palmitoyl transferase‐1 deficiency, based on the abnormal carnitine/acylcarnitine profile. Almost three‐fourths of patients (78%) had evidence of serum hyperaminoacidemia. Thirty‐one patients (56%) had evidence of abnormal carnitine/acylcarnitine profile with predominant abnormality being low free carnitine (C0). Higher levels of serum tyrosine (P = 0.002) and lower levels of serum C0 (P = 0.032) in children and higher levels of serum phenyalanine (P = 0.047) in adults predicted poor outcome (death/liver transplant) on univariate analysis.

Conclusions:

FAODs are not uncommon in ALF with a suggested prevalence of approximately 5.5%. FAODs can cause ALF or modify the natural course of ALF caused by other etiologies. Serum hyperaminoacidemia and low serum free carnitine may predict poor outcome in patients with acute liver failure.
Employment outcomes following spinal cord injury in Taiwan
Authors: Huang I-C.
Published: December 2016

It is important to maximize vocational achievement following spinal cord injury. Despite this recognition, unemployment remains a prevalent problem and continues to challenge rehabilitation professionals. This study aimed to examine the employment status and determinants of employability for individuals with spinal cord injury in Taiwan. A cross-sectional survey was conducted. A total of 353 participants aged 18–65 years were recruited from four branches of the Association of People with Spinal Cord Injury. The results showed that, of the participants, 107 were employed at the time of the survey, with an employment rate of 30.3%. Logistic regression analyses indicated that individuals with a college degree or higher [odds ratio (OR)=3.03; 95% confidence intervals (CI): 1.30–7.07], aged 26–40 years (OR=8.51; 95% CI: 3.14–23.02) and 41–55 years (OR=3.06; 95% CI: 1.31–7.18), sustaining injury longer than 10 years (OR=9.89; 95% CI: 2.61–37.46), experiencing less functional limitations (OR=0.90; 95% CI: 0.86–0.95), and perceiving greater social support (OR=1.04; 95% CI: 1.01–10.7) were associated with higher likelihood of employment. Vocational rehabilitation services can use the results to target efforts toward those at risk of unemployment.
Longitudinal Study of Posttraumatic Stress Disorder in the Community
Authors: Pejuskovic Bojana , Lecic-Tosevski Dusica , Toskovic Oliver
Published: December 2016

Posttraumatic stress disorder (PTSD) is a multicausal phenomenon and a final end point of the combination of a number of potential causes. Our study aimed to examine potential risk and recovery factors of PTSD in general adult population at 1-year follow-up period. The sample consisted of 640 subjects in the initial phase, chosen by random walk technique in five regions of the country, and 100 in the follow-up. The assessment has been carried out by the following instruments: Mini-International Neuropsychiatric Interview, Life Stressor Checklist-Revised, Brief Symptom Inventory, and Manchester Short Assessment of Quality of Life Scale. Older age, low education, and lower monthly income are potential risk factors for current PTSD, as well as decreased quality of life, psychiatric comorbidity, and higher personal distress. Urban population, higher quality of life, smaller number of stressors, and lower personal distress contributed to recovery of PTSD. It is essential to know the risk and resilience factors that contribute to the development and recovery of PTSD, which is important for prevention and treatment of this disorder.
Healing Through Words: Jerome Frank and Psychotherapy at Johns Hopkins
Authors: Jamison Kay Redfield
Published: December 2016

This lecture, given to celebrate the centenary of the founding of the Henry Phipps Psychiatric Service at Johns Hopkins, focuses on the contributions of Jerome Frank to the understanding and practice of psychotherapy. It gives an overview of Professor Frank's ideas and work, puts them into the context of the history of psychotherapy research at Johns Hopkins, and discusses psychotherapy and demoralization in bipolar illness.
Information Technology Strategies for Honor Society and Organization Membership Retention in Online Nursing Programs
Authors: Hopkins Emily E. , Wasco Jennifer J.
Published: December 2016

Membership retention in an honor society or organization is of utmost importance for sustainability. However, retaining members in organizations that serve online education nursing students can be a challenging task. Understanding the importance of creating a sense of community to promote retention within an honor society chapter, nursing faculty at a small private university implemented different online approaches. This article highlights successful information technology strategies to promote membership retention in organizations for online nursing students.
Evaluation of an Intervention to Improve Clinical Nurse Educators’ Knowledge, Perceived Skills, and Confidence Related to Diversity
Authors: Warren Nicole , Baptiste Diana-Lyn , Foronda Cynthia , Mark Hayley D.
Published: December 2016

This article describes the evaluation of a diversity-related video and its impact on clinical nurse educators. Our evaluation suggests that educators’ knowledge, perceived skills, and confidence in creating a diversity-friendly learning environment were positively affected. Their awareness of their own biases did not improve significantly, thus suggesting the need for continued emphasis on self-assessment. The video was considered relevant and was supported by most educators, suggesting that similar videos may be an acceptable strategy for engaging them in diversity-related issues.
Scaffolding and Sequencing Core Concepts to Develop a Simulation-Integrated Nursing Curriculum
Authors: Herrington Alaina , Schneidereith Tonya
Published: December 2016

Integrating simulation in multiple levels of nursing programs remains a challenge for educators. Nurse educators from various degree-granting programs were surveyed to identify placement of multiple nursing concepts. The results of the survey identified concepts that could be incorporated, that is, scaffolded, into various levels of education via concept-based simulations. Categorizing concepts into multiple learner levels provides an efficient, systematic approach to incorporating concepts into simulation throughout any nursing curriculum.
Role of Survival Time and Injury Severity in Fatal Pulmonary Fat Embolism
Authors: Jarmer Juliane , Ampanozi Garyfalia , Thali Michael J. , Bolliger Stephan A.
Published: December 2016

Pulmonary fat embolism (PFE) is frequent in blunt trauma and may occasionally lead to death. A correlation between fracture grade and severity and PFE grade has been described before, but no correlation between PFE and survival time, fat crushing extent, fat crush grade, or number of body regions with fractures could be noted in this small study. To further examine this, we decided to examine the aforementioned points in a far larger study group.

Autopsy protocols of 188 nonresuscitated fatalities with blunt trauma and without right heart injury, which underwent whole body dissection, were retrospectively reviewed concerning the presence and the severity of PFE, injuries, survival time, age, sex, and the body mass index.

The fracture grade, the fracture severity, and the number of the fractured regions correlated very well with the grade of PFE, but the crushed regions, crush grade, and crush severity did not. We observed a time correlation between survival time and PFE only in the sense that very rapid deaths were often PFE negative. High-grade PFE was observed most often in patients having died less than 6 hours after the incident, and PFE grades of 2 or more were occasionally noted even after 48 hours.
Exploring the Experiences of Women and Health Care Workers in the Context of PMTCT Option B Plus in Malawi
Authors: Cataldo Fabian , Chiwaula Levison , Nkhata Misheck , van Lettow Monique , Kasende Florence , Rosenberg Nora E. , Tweya Hannock , Sampathkumar Veena , Hosseinipour Mina , Schouten Erik , Kapito-Tembo Atupele , Eliya Michael , Chimbwandira Frank , Phiri Sam ,   for the PURE Malawi Consortium
Published: December 2016

Introduction:

Malawi has embarked on a “test-and-treat” approach to prevent mother-to-child transmission (PMTCT) of HIV, known as “Option B+,” offering all HIV-infected pregnant and breastfeeding women lifelong antiretroviral therapy (ART) regardless of CD4 count or clinical stage. A cross-sectional qualitative study was conducted to explore early experiences surrounding “Option B+” for patients and health care workers (HCWs) in Malawi.

Methods:

Study participants were purposively selected across 6 health facilities in 3 regional health zones in Malawi. Semi-structured interviews were conducted with women enrolled in “Option B+” (n = 24), and focus group discussions were conducted with HCWs providing Option B+ services (n = 6 groups of 8 HCWs). Data were analyzed using a qualitative thematic coding framework.

Results:

Patients and HCWs identified the lack of male involvement as a barrier to retention in care and expressed concerns at the rapidity of the test-and-treat process, which makes it difficult for patients to “digest” a positive diagnosis before starting ART. Fear regarding the breach of privacy and confidentiality were also identified as contributing to loss to follow-up of women initiated under the Option B+. Disclosure remains a difficult process within families and couples. Lifelong ART was also perceived as an opportunity to plan future pregnancies.

Conclusions:

As “Option B+” continues to be rolled out, novel interventions to support and retain women into care must be implemented. These include providing space, time, and support to accept a diagnosis before starting ART, engaging partners and families, and addressing the need for peer support and confidentiality.
Hepatic Histology and Morphometric Measurements in Idiopathic Extrahepatic Portal Vein Thrombosis in Children, Correlated to Clinical Outcome of Meso-Rex Bypass
Authors: Tantemsapya Niramol , Superina Riccardo , Wang Deli , Kronauer Grace , Whitington Peter F. , Melin-Aldana Hector
Published: December 2016

Objective:

The aim of this study was to correlate clinical, histologic, and morphometric features of the liver in children with extrahepatic portal vein thrombosis (EHPVT), with surgical outcome after Meso-Rex bypass (MRB).

Background:

Idiopathic EHPVT, a significant cause of portal hypertension, is surgically corrected by MRB. Correlation of histologic and morphometric features of the liver with outcome has not been reported in children.

Methods:

We retrospectively reviewed clinical and intraoperative data of 45 children with idiopathic EHPVT. Liver samples were obtained at the time of MRB. Morphometric measurements of portal tract structures were performed and correlated with surgical outcome. Median follow-up was 3.65 years after surgery (range 1.5 to 10 years).

Results:

Thirty-seven (82.2%) children had successful MRB. There was no association between age, sex, and suture material with surgical outcome. Average patient age was higher in patients with postoperative complications (P = NS). Portal fibrosis, bridging, parenchymal nodules, portal inflammation, hepatocellular swelling, steatosis, dilatation of portal lymphatics, and periductal fibrosis did not show a significant difference between the 2 groups. Portal vein and bile duct area index were significantly smaller in the unsuccessful group (P = 0.004 and 0.003, respectively). A portal vein area index <0.08 had a lower chance of successful surgical outcome. Hepatic artery area index was not significantly different. Measured intraoperative portal blood inflow was the only significant clinical factor affecting surgical outcome (P = 0.0003).

Conclusions:

Low portal vein area index and intraoperative portal blood inflow may be negative prognostic factors for MRB outcome in children with idiopathic EHPVT. Average patient age was higher, although not statistically significant, in patients with postoperative complications.
Quantitative EEG After Brain Stimulation and Cognitive Training in Alzheimer Disease
Authors: Gandelman-Marton Revital , Aichenbaum Sergio , Dobronevsky Evgenya , Khaigrekht Michael , Rabey Jose M.
Published: December 2016

Purpose:

Medications are the currently accepted symptomatic treatment of Alzheimer disease (AD), but their impact on delaying the progression of cognitive deficits and functional impairment is limited. The authors aimed to explore long-term electrophysiological effects of repetitive transcranial magnetic stimulation interlaced with cognitive training on quantitative electroencephalography (EEG) in patients with AD.

Methods:

Quantitative EEG was assessed on non–repetitive transcranial magnetic stimulation interlaced with cognitive training treatment days before treatment and after each treatment phase in seven patients with mild AD.

Results:

After 4.5 months (54 sessions) of treatment, a significant increase of delta activity over the temporal region was found compared with pretreatment values. Nonsignificant increases of the log EEG power were found for alpha band over the frontal and temporal regions, beta band over the frontal region, theta band over the frontal, temporal, and parieto-occipital regions, and delta band over the frontal and parieto-occipital regions. Nonsignificant decreases were found for alpha over the parieto-occipital region, and for beta over the temporal and parieto-occipital regions. A positive correlation was found between log alpha power over the frontal and temporal regions at 6 weeks and Mini–Mental State Examination (MMSE) scores at 6 weeks and 4.5 months, and between log alpha power over the parieto-occipital regions and MMSE scores at 6 weeks. A negative correlation was found between log alpha power over the frontal and temporal regions at 6 weeks and baseline Alzheimer's Disease Assessment Scale-cognitive subscale scores.

Conclusions:

Repetitive transcranial magnetic stimulation interlaced with cognitive training has long-term effects on quantitative EEG in patients with mild AD. Further research on the quantitative EEG long-term effects of transcranial magnetic stimulation interlaced with cognitive training is required to confirm the authors' data.