bluuebunny/crossref_metadata_2025 huggingface dataset:
Cryptic bracts facilitate herbivore avoidance in the mycoheterotrophic plant Monotropsis odorata (Ericaceae)
Authors: Klooster Matthew R. , Clark David L. , Culley Theresa M.
Published: November 2009

Plant coloration, shown to play a dynamic role in animal attraction, has been proposed as a means of defense, although these reports lack experimental evidence. This study empirically assesses defensive coloration in the mycoheterotrophic plant, Monotropsis odorata, which produces stems and flowers covered by dried vegetative bracts. Field studies were conducted using an experimental group of plants with bracts removed and a control group to evaluate the frequency of and fitness impacts associated with herbivory. Additionally, we quantitatively assessed the reflectance spectra of bracts, stems, and flowers of M. odorata relative to an ambient leaf litter substrate. Across the 2‐yr study, the experimental group experienced a 20–27% higher mean herbivory rate and 7–20% lower mean fruit production relative to the control group. Bracts were shown to strongly resemble ambient leaf litter in spectral analyses, with stems and flowers having more conspicuous coloration. Results show that the presence of dried bracts effectively camouflages conspicuous stem and floral tissues, significantly reducing the frequency of floral and stem herbivory, and thereby increasing fruit set, a component of plant fitness. This study supports the principal hypothesis that coloration can play a fundamental role in plant defense.
New insights into the phylogenetic relationships, character evolution, and phytogeographic patterns of Calceolaria (Calceolariaceae)
Authors: Cosacov Andrea , Sérsic Alicia N. , Sosa Victoria , De‐Nova J. Arturo , Nylinder Stephan , Cocucci Andrea A.
Published: November 2009

Biogeographical patterns and diversification processes in Andean and Patagonian flora are not yet well understood. Calceolaria is a highly diversified genus of these areas, representing one of the most specialized plant–pollinator systems because flowers produce nonvolatile oils, a very unusual floral reward. Phylogenetic analyses with molecular (ITS and matK) and morphological characters from 103 Calceolaria species were conducted to examine relationships, to understand biogeographic patterns, and to detect evolutionary patterns of floral and ecological characters. Total evidence analysis retrieved three major clades, which strongly correspond to the three previously recognized subgenera, although only subgenus Rosula was retrieved as a monophyletic group. A single historical event explains the expansion from the southern to central Andes, while different parallel evolutionary lines show a northward expansion from the central to northern Andes across the Huancabamba Deflection, an important geographical barrier in northern Peru. Polyploidy, acquisition of elaiophores, and a nototribic pollination mechanism are key aspects of the evolutionary history of Calceolaria. Pollination interactions were more frequently established with Centris than with Chalepogenus oil‐collecting bee species. The repeated loss of the oil gland and shifts to pollen as the only reward suggest an evolutionary tendency from highly to moderately specialized pollination systems.
Pd/C-mediated synthesis of α-pyrone fused with a five-membered nitrogen heteroaryl ring: A new route to pyrano[4,3-c]pyrazol-4(1H)-ones
Authors: Gorja Dhilli Rao , Batchu Venkateswara Rao , Ettam Ashok , Pal Manojit
Published: November 2009

Pd/C-mediated alkynylation of 5-iodo-pyrazole-4-carboxylic acid, involving the first regioselective construction of α-pyrone ring on a pyrazol moiety via tandem coupling–cyclization process, has been developed to afford pyrano[4,3-c]pyrazol-4(1H)-one in a single pot.
The Incidence Rate of HIV Type-1 drug Resistance in Patients on Antiretroviral Therapy: A Nationwide Population-Based Danish Cohort Study 1999–2005
Authors: Audelin Anne Margrethe , Lohse Nicolai , Obel Niels , Gerstoft Jan , Jørgensen Louise Bruun
Published: November 2009

Background

Newer antiretroviral treatment regimens for HIV carry a lower risk of inducing drug resistance mutations. We estimated changes in incidence rates (IRs) of new mutations in HIV-infected individuals receiving highly active antiretroviral therapy (HAART).

Methods

Population-based data were obtained from the Danish HIV Cohort Study and the Danish HIV Sequence Database. We included treatment-naive patients initiating HAART after December 1997 and computed time to first drug resistance mutation, identified as new mutations detected within 1 year after a 60-day period of treatment failure (HIV RNA>1,000 copies/ml). We estimated annual IRs of new resistance mutations towards nucleoside reverse transcriptase inhibitors (NRTIs), non-NRTIs (NNRTIs) and protease inhibitors (PI), and of new specific resistance mutations.

Results

A total of 1,829 individuals were observed for 7,294 person-years at risk (PYR). The IR of NRTI resistance decreased from 13.1 per 1,000 PYR (95% confidence interval [CI] 4.9–35.0) in 1999 to 3.7 (1.9–7.2) in 2004–2005 (test for trend P=0.024). The IR of NNRTI resistance decreased from 15.4 (2.2–109.6) in 1999 to 7.9 (4.6–13.6) in 2004–2005 ( P=0.077). The IR of PI resistance decreased from 7.5 (1.4–21.8) in 1999 to 2.9 (0.7–11.4) in 2002–2003 ( P=0.148). The IRs were low for specific resistance mutations, except for M184V (IR 5.6 [4.0–7.9]) and K103N (IR 8.2 [5.6–12.0]).

Conclusions

The incidence of acquired drug resistance has decreased among HIV-infected patients treated with HAART in Denmark during 1999–2005.
Prophylactic and therapeutic efficacy of a chimeric monoclonal antibody specific for H5 haemagglutinin against lethal H5N1 influenza
Authors: Prabhu Nayana , Prabakaran Mookkan , Hongliang Qian , He Fang , Ho Hui-Ting , Qiang Jia , Goutama Michael , Lim Angeline Pei-Chiew , Hanson Brendon J , Kwang Jimmy
Published: November 2009

Background

Recent outbreaks of highly pathogenic H5N1 viruses in humans indicate that no endogenous protection exists in the general population. Vaccination programmes against this new pathogen require synthesis of endogenous antibodies and cannot provide any immediate protection in the event of a pandemic. Passive immunization with humanized neutralizing monoclonal antibodies can prove to be promising in preventing a catastrophic pandemic.

Methods

A murine monoclonal antibody (mAb) 3B1 of immunoglobulin M isotype was switched to a chimeric immunoglobulin G1. BALB/c mice were used to study the protective efficacy of the chimeric mAbs against a lethal H5N1 virus challenge with strains from clades 1 and 2.1. Kinetics of the viral load were determined during the course of the treatment.

Results

The chimeric mAb, in passive administration, was able to protect 100% of the mice when challenged with H5N1 strains from clades 1 or 2.1. Prophylaxis at 1 day prior to challenge and treatment at 1 day after challenge with this mAb resulted in the clearance of the virus from the lungs of the infected mice within 6 days post-viral challenge.

Conclusions

Passive immunotherapy using chimeric mAb 3B1 can be an effective tool in both the prophylaxis and treatment of highly pathogenic H5N1 infection, providing the immediate immunity needed to contain a future influenza pandemic.
A population analysis of weight-related differences in lopinavir pharmacokinetics and possible consequences for protease inhibitor-naive and -experienced patients
Authors: Bouillon-Pichault Marion , Jullien Vincent , Piketty Christophe , Viard Jean-Paul , Morini Jean-Pierre , Chhun Stéphanie , Krivine Anne , Salmon Dominique , Dupin Nicolas , Weiss Laurence , Lortholary Olivier , Pons Gérard , Launay Odile , Treluyer Jean-Marc
Published: November 2009

Background

Lopinavir is a potent protease inhibitor (PI) used for the treatment of HIV infection. Different lopinavir target trough concentrations (Ctroughs) were previously determined according to patient treatment histories: 1 mg/l for PI-naive patients, and 4 and 5.7 mg/l for PI-experienced patients. However, the probability to achieve these target Ctroughs with the current 400 mg twice-daily or 800 mg once-daily doses of the new tablet form, and the influence of body weight on this probability are unknown.

Methods

A population pharmacokinetic model for lopinavir was developed using data from 424 HIV type-1-infected patients, and the final model was used to estimate the probability to achieve target Ctroughs via Monte Carlo simulations.

Results

A one-compartment model adequately described the data. Mean population estimates (percentage inter-individual variability) were 4.61 l/h (36%) for apparent clearance (CL/F) and 63.2 l (70%) for apparent distribution volume. Body weight was found to explain the interindividual variability of lopinavir CL/F. Probability to achieve the 1 mg/l target Ctrough was >96% for the twice-daily dose and comprised between 80% and 90% for the once-daily dose. The probability to achieve the 4 and 5.7 mg/l target Ctroughs with the twice-daily dose significantly decreased when body weight increased (from 76% to 61% and from 56% to 37% respectively, for body weights increasing from 50 to 90 kg).

Conclusions

These results support lopinavir therapeutic drug monitoring and the use of higher lopinavir doses for PI-pretreated patients.
Prevalence of HIV type-1 drug-associated mutations in pre-therapy patients in the Free State, South Africa
Authors: Huang Kuan-Hsiang Gary , Goedhals Dominique , Fryer Helen , van Vuuren Cloete , Katzourakis Aris , Oliveira Tulio De , Brown Helen , Cassol Sharon , Seebregts Chris , McLean Angela , Klenerman Paul , Phillips Rodney , Frater John ,   the Bloemfontein-Oxford Collaborative Group
Published: November 2009

Background

We aimed to characterize the molecular epidemiology of HIV type-1 (HIV-1) and the prevalence of drug- associated mutations prior to initiating highly active antiretroviral therapy (HAART) in the Free State province, South Africa. The Free State has a population of 3 million, an antenatal HIV prevalence of approximately 34% and a well established infrastucture for antiretroviral (ARV) provision.

Methods

HIV-1 polymerase genes were sequenced from 425 HAART-naive HIV-1-positive patients at voluntary primary healthcare HIV testing centres, who were subsequently attending district centres for assessment for commencing ARVs. Patients (>18 years) were sampled randomly with no exclusion for gender or clinical criteria. Sequences were analysed according to phylogeny and drug resistance.

Results

Phylogenetic clustering within the cohort was suggestive of multiple introductions of subtype C virus into the region. Drug resistance mutations (according to the International AIDS Society-USA classification) were distributed randomly across the cohort phylogeny with an overall prevalence of 2.3% in the sampled patients. When stratified according to CD4+ T-cell count, the prevalence of resistance was 3.6%, 0.9% and 1.2% for CD4+ T-cell counts <100, 200-350 and >500 cells/μ l, respectively, and was most common for non-nucleoside reverse transcriptase inhibitor resistance (3.1% in patients with CD4+ T-cell count <100 cells/μ l). We surveyed all drug-selected mutations and found further significant clustering among patients with low CD4+ T-cell counts ( P=0.003), suggesting unrecognized exposure to ARVs.

Conclusions

In the Free State population, there was a statistical association between low CD4+ T-cell counts and drug-associated viral polymorphisms. Our data advocate the benefit of detailed history taking from patients starting HAART at low CD4+ T-cell counts with close follow-up of the virological response.
Evolution of hepatitis B virus mutation during entecavir rescue therapy in patients with antiviral resistance to lamivudine and adefovir
Authors: Choe Won Hyeok , Hong Sun Pyo , Kim Byung Kook , Ko Soon Young , Jung Young Kul , Kim Ji Hoon , Yeon Jong Eun , Byun Kwan Soo , Kim Kyun-Hwan , Ji Seung Il , Kim Soo-Ok , Lee Chang Hong , Kwon So Young
Published: November 2009

Background

The efficacy of entecavir (ETV) monotherapy in treatment-experienced patients with chronic hepatitis B (CHB) is debatable.

Methods

A total of 22 hepatitis B e antigen (HBeAg)-positive CHB patients who had shown viral breakthrough or suboptimal response with lamivudine (3TC) and adefovir disoproxil (ADV) therapy were treated with 1.0 mg of ETV. Clinical and virological parameters were monitored every 3 months. Restriction fragment mass polymorphism assays were used to detect antiviral resistance.

Results

During 3TC and ADV therapy, 11 patients had rtM204V/I mutations, 2 had rtA181V/T or rtN236T, 7 had both and 2 had no 3TC- or ADV-related mutations. After switching to ETV monotherapy, the median change in serum hepatitis B virus (HBV) DNA level was -2.1 log10 copies/ml. Virological response (HBV DNA<300 copies/ml) was achieved in 1 of 18 patients with pre-existing rt204 mutations, whereas it was achieved in all 4 patients without pre-existing rt204 mutations regardless of the presence of rt181 or rt236 mutations. Changes in mutational patterns during ETV therapy showed that rt204 mutations persisted or re-emerged. Relative abundances of rtM204V/I mutations in total viral populations gradually increased under ETV rescue, whereas those with rtA181V/T and rtN236T mutations decreased. ETV resistance mutations (rtL180M+rtT184I/L[rtS202G]+rtM204V) were detected in five patients with pre-existing rt204 mutations.

Conclusions

ETV monotherapy resulted in a limited virological response in patients who had previously failed 3TC and ADV rescue therapy. The limited efficacy might be associated with residual or reselected rtM204V/I mutations leading to ETV resistance. Combination treatment including potent antiviral agents should be recommended for patients with pre-existing rtM204V/I mutations.
Safety and Efficacy of Once-Daily Nevirapine Dosing: A Multicohort Study
Authors: Calmy Alexandra , Vallier Nathalie , Nguyen Alain , Lange Joep MA , Battegay Manuel , de Wolf Frank , Reiss Peter , Lima Viviane D , Hirschel Bernard , Hogg Robert S , Yip Benita , Montaner Julio SG , Wit Ferdinand W
Published: November 2009

Background

Nevirapine (NVP) is often prescribed once daily in clinical practice in combination with a once daily nucleoside backbone. We investigated the relationship of NVP dosing with safety and efficacy.

Methods

Patients from the Dutch AIDS Therapy Evaluation in the Netherlands (ATHENA) cohort study, Canadian HAART Observational Medical Evaluation and Research (HOMER) cohort and Swiss HIV Cohort Study (SHCS) using NVP-based combination therapy either once daily or twice daily were included. Risk factors for discontinuing NVP because of hypersensitivity reactions (HSRs) were investigated using multivariate logistic regression. Risk factors for virological failure 96 weeks after NVP initiation were identified using logistic regression and Cox models.

Results

Of 5,636 patients (774 once daily and 4,862 twice daily), 268 (4.8%) discontinued NVP because of HSR between 2 and 18 weeks. Logistic regression showed that, compared with patients with detectable HIV type-1 (HIV-1) RNA starting twice-daily NVP, there was a significantly higher risk of discontinuation of once-daily NVP because of HSR in patients with detectable HIV-1 RNA at the start of NVP (odds ratio [OR] 1.52; P=0.04), whereas the risk was actually significantly lower in patients starting once-daily NVP with undetectable HIV-1 RNA (OR 0.44; P=0.04). Cox models showed that risk of virological failure was not different for twice- versus once-daily NVP in treatment-naive patients (twice-daily versus once-daily hazard ratio [HR] 1.01; P=0.95), treatment- experienced patients experiencing treatment failure (twice-daily versus once-daily HR 1.22; P=0.30) or patients with undetectable HIV-1 RNA simplifying treatment with NVP (twice-daily versus once-daily HR 1.29; P=0.30).

Conclusions

Initiation of a once-daily NVP-based regimen in patients with suppressed viraemia carries a low risk of treatment-limiting HSR. Once- or twice-daily NVP-based regimens appear to have similar antiretroviral efficacy.
Effects of HIV type-1 immune selection on susceptability to integrase inhibitor resistance
Authors: Tschochner Monika , Chopra Abha , Maiden Tanya M , Ahmad Imran F , James Ian , Furrer Hansjakob , Günthard Huldrych F , Mallal Simon , Rauch Andri , John Mina
Published: November 2009

Background

All site-specific interactions between HIV type-1 (HIV-1) subtype, human leukocyte antigen (HLA)-associated immune selection and integrase inhibitor resistance are not completely understood. We examined naturally occurring polymorphisms in HIV-1-integrase sequences from 342 antiretroviral-naive individuals from the Western Australian HIV Cohort Study and the Swiss HIV Cohort Study.

Methods

Standard bulk sequencing and sequence-based typing were used to generate integrase sequences and high-resolution HLA genotypes, respectively. Viral residues were examined with respect to drug resistance mutations and CD8+ T-cell escape mutations.

Results

In both predominantly subtype B cohorts, 12 of 38 sites that mediate integrase inhibitor resistance mutations were absolutely conserved, and these included the primary resistance mutations. There were 18 codons with non-primary drug resistance-associated substitutions at rates of up to 58.8% and eight sites with alternative polymorphisms. Five viral residues were potentially subject to dual-drug and HLA-associated immune selection in which both selective pressures either drove the same amino acid substitution (codons 72, 157 and 163) or HLA alleles were associated with an alternative polymorphism that would alter the genetic barrier to resistance (codons 125 and 193). The common polymorphism T125A, which was characteristic of non-subtype B and was also associated with carriage of HLA-B*57/*5801, increased the mutational barrier to the resistance mutation T125K.

Conclusions

Primary integrase inhibitor resistance mutations were not detected in the absence of drug exposure in keeping with sites of high constraint. Viral polymorphisms caused by immune selection and/or associated with non-subtype B might alter the genetic barrier to some non-primary resistance-associated mutations.
Efficacy of the novel parainfluenza virus haemagglutinin-neuraminidase inhibitor BCX 2798 in mice – further evaluation
Authors: Alymova Irina V , Watanabe Makiko , Boyd Kelli L , Chand Pooran , Babu Y Sudhakara , Portner Allen
Published: November 2009

Background

Human parainfluenza virus type 1 (hPIV-1) causes serious respiratory tract infections, especially in children. This study investigated the efficacy of the novel haemagglutinin-neuraminidase (HN) inhibitor BCX 2798 in the prophylaxis of lethal and the treatment of non-lethal parainfluenza virus infection in mice.

Methods

In the prophylaxis model, 129x1/SvJ mice were inoculated with a 90% lethal dose of a recombinant Sendai virus, in which the HN gene was replaced with that of hPIV-1 (rSeV[hPIV-1HN]). The mice were intranasally treated either once or for 5 days with 1 or 10 mg/kg/ day of BCX 2798, starting 4 h before infection. In the therapeutic model, mice were infected with 100 plaque-forming units of rSeV(hPIV-1HN) per mouse and treated intranasally with 0.1, 1 or 10 mg/kg/day of BCX 2798 for 5 days, starting 24 or 48 h after infection, or for 4 days starting 72 h after infection.

Results

Similar to multiple dosing, a single intranasal prophylaxis with 1 or 10 mg/kg of BCX 2798 protected approximately 40% or 90%, respectively, of mice from death by rSeV(hPIV-1HN) infection. BCX 2798 also significantly reduced virus lung titres (in a dose- and time- dependent manner) and reduced histopathological changes in the airways of non-lethally infected mice at multiple intranasal dosages in the therapeutic model, with the lowest effective dosage being 0.1 mg/kg/day administered 24 h after infection.

Conclusions

BCX 2798 was effective in the prophylaxis of lethal and in the therapy of non-lethal parainfluenza virus infection in mice, suggesting further consideration of BCX 2798 for clinical trials.
Potential risk factors associated with the use of cidofovir to treat benign human papillomavirus-related disease
Authors: Donne Adam J , Hampson Lynne , He Xiaotong T , Day Philip JR , Salway Fiona , Rothera Michael P , Homer Jarrod J , Hampson Ian N
Published: November 2009

Background

Cidofovir is currently being used off-licence to treat different viral infections, such as benign low-risk human papillomavirus (HPV)-related recurrent respiratory papillomatosis (RRP). There are concerns over the safety of this practice as rat studies demonstrated a high malignant transformation rate. As yet, there are no clinical reports of cidofovir-induced malignant changes in humans.

Methods

Telomerase immortalised human keratinocytes (hTert) stably expressing E6 proteins from either low-risk HPV6b or high-risk HPV16 and vector control cells were treated with either low-dose (5 μg/ml) or higher dose (30 μg/ml) cidofovir for 2 days and the effects evaluated by clonogenic survival assays. Based on these results, gene expression microarray analysis was performed on cidofovirtreated low-risk E6 and vector cells before, during and after drug treatment, and the results verified by real-time PCR.

Results

Both low-risk and high-risk E6-expressing cells show significantly improved long-term survival compared with vector control cells when exposed to 5 μg/ml cidofovir for 2 days, (hTert T6E6 P=0.0007, hTert T16E6 P=0.00023 and hTert vector control P=0.62). Microarray and real-time PCR analyses of low-dose cidofovir-treated low-risk E6-expressing cells revealed changes in gene expression that are known to be associated with malignant progression, which were not observed in drug-treated vector control cells.

Conclusions

This is the first report that cidofovir can both increase cell survival and induce alterations in gene expression that are known to be associated with malignant transformation in cells transduced only with the E6 gene from low-risk HPV. It is our belief that these data provide cause for concern over the off-license use of this drug to treat RRP.
Progress in Basic and Clinical Research on HIV Resistance: Report on the XVIII International HIV Drug Resistance Workshop
Authors: Mascolini Mark , Boucher Charles AB , Mellors John W , Larder Brendan A , Richman Douglas D
Published: November 2009

Over nearly two decades, the International HIV Drug Resistance Workshop has become the leading forum for new research on viral resistance to agents developed to treat infection with HIV. The XVIII workshop featured work on HIV type-1 (HIV-1) persistence, reservoirs and elimination strategies; resistance to HIV-1 entry inhibitors (including a comparison of genotyping versus phenotyping to determine HIV-1 coreceptor use before treatment with CCR5 antagonists); polymerase domain resistance to reverse transcriptase inhibitors (including hepatitis B virus and HIV-1 resistance to lamivudine, and emergence of the K65R mutation in HIV-1 subtypes B and C); connection and RNase H domain resistance to reverse transcriptase inhibitors (including the effect of mutations in those domains on response to efavirenz and etravirine); resistance to hepatitis C virus and HIV-1 protease inhibitors; resistance to the integrase inhibitor raltegravir; global resistance epidemiology (including models to predict response to second-line antiretrovirals in resource-poor settings); and the role of minority resistant variants (including the effect of such variants on prevention of mother-to-child transmission of HIV-1). This report summarizes data from the oral abstract presentations at the workshop.
Does RNA interference provide new hope for control of chronic hepatitis B infection?
Authors: Wilson Rachel , Purcell Damian , Netter Hans J , Revill Peter A
Published: November 2009

Hepatitis B virus (HBV) infection is a global human health problem, with an estimated 350 million people having chronic hepatitis B (CHB) infection worldwide. The majority of infections acquired during adulthood are resolved without intervention; however, infections acquired at birth or during early childhood have a 90% chance of progressing to CHB, leading to a host of adverse effects on the liver, including cirrhosis and cancer. CHB is currently treated with a combination of cytokines and/or nucleoside/nucleotide analogues; however, adverse side effects to cytokine therapy and the selection of resistance mutations to nucleoside analogues often abrogate the efficacy of treatment. The recent discovery that small interfering RNA and microRNA are active in mammalian cells suggests it might be possible to supplement existing HBV therapies with small RNA-based therapeutic(s).
Our Journey From a Modular to a Multimillion Dollar Education Center: A Rural Hospital Clinical Education Department's Road to Excellence
Authors: Strong Sherri , DeBord Dina , Butler Allison
Published: November 2009

This column discusses how a Midwest rural hospital's education department made the journey from a staff of four individuals located in a modular unit outside of the hospital to a multidisciplinary team reaching the hospital and the community from one of the most highly technologically advanced education centers in the nation.

J Contin Educ Nurs
2009;40(11):485–486.
The EMPOWER Project: An Initiative to Educate and Mentor Paraprofessional Staff
Authors: Donahue Moreen , Smith Lisa , Dykes Patricia , Fitzpatrick Joyce J.
Published: November 2009

This column describes a new program designed to enhance patient safety by teaching paraprofessional staff (PPS) how to communicate changes in patient status to professional staff. Phase 1 of the project included assessment of PPS perceptions of the patient safety culture at the hospital through survey and focus group discussions. Results from Phase 1 and plans for Phase 2 are described.

J Contin Educ Nurs
2009;40(11):487–488.
Teaching and Learning in Virtual Worlds
Authors: Billings Diane M.
Published: November 2009

This column explores virtual worlds and their use in nursing.

J Contin Educ Nurs
2009;40(11):489–490.
The Effect of High-Fidelity Simulation Training on Medical-Surgical Graduate Nurses' Perceived Ability to Respond to Patient Clinical Emergencies
Authors: Gordon Christopher James , Buckley Tom
Published: November 2009

Background:

Recognition of and early intervention for patients with acutely deteriorating conditions is often the responsibility of medical-surgical nurses. This study examined the effect of simulation on medical-surgical graduate nurses' perceived ability and confidence in responding to patient clinical emergencies.

Method:

Fifty medical-surgical graduate students participated in high-fidelity immersive simulations. Questionnaires completed before and after simulation asked participants to rate their perceived ability and confidence.

Results:

After simulation, participants reported increased confidence in their ability to perform both technical and nontechnical aspects of responding to patient clinical emergencies. Ninety-four percent of participants identified formal debriefing as the most useful aspect of the simulation experience.

Conclusion:

Medical-surgical graduate nurses' confidence and perceived technical and nontechnical skills during patient clinical emergencies are enhanced following simulation. The ability of graduates to transfer the increased confidence and perceived advanced resuscitation skills following simulation to the clinical environment needs to be investigated.

J Contin Educ Nurs
2009;40(11):491–498.
Creating a Culture of Professional Development: A Milestone Pathway Tool for Registered Nurses
Authors: Cooper Elizabeth
Published: November 2009

The nursing shortage continues to be a significant threat to health care. Creating a culture of professional development in health care institutions is one way to combat this shortage. Professional development refers to a constant commitment to maintain one's knowledge and skill base. Increasing professional development opportunities in the health care setting has been shown to affect nurse retention and satisfaction. Several approaches have been developed to increase professional development among nurses. However, for the most part, these are “one size fits all” approaches that direct nurses to progress in lock step fashion in skill and knowledge acquisition within a specialty. This article introduces a milestone pathway tool for registered nurses designed to enhance professional development that is unique to the individual nurse and the specific nursing unit. This tool provides a unit-specific concept map, a milestone pathway template, and a personal professional development plan.

J Contin Educ Nurs2009;40(11):501–508.
Supporting Preceptors: A Three-Pronged Approach for Success
Authors: Burns Helen K. , Northcutt Terry
Published: November 2009

This article describes the development and implementation of the Nursing Preceptor Program (NPP), an innovative program that provides training and support to preceptors working with undergraduate nursing students. The main objective of the NPP is to support the learning outcomes of students by preparing and supporting preceptors for their roles. The University of Pittsburgh School of Nursing created a three-pronged program: a self-paced, modular, online preceptor course; a dedicated web page for both preceptors and students; and a relational database that can be queried for information on clinical sites and preceptors, catalogued by semester and year. A task force, consisting of local academic and clinical experts, was created to help with program development. To date, 25 preceptors have participated in the online course. Evaluations have been positive. Preceptors believe the included information is applicable and the modules, as a whole, are well planned and written.

J Contin Educ Nurs
2009;40(11):509–513.
Fostering a Smooth Transition to the Faculty Role
Authors: Suplee Patricia Dunphy , Gardner Marcia
Published: November 2009

Both new and experienced nursing faculty across the United States are struggling to meet the individual needs of an increasingly diverse and growing population of nursing students, while simultaneously attempting to balance the research, scholarship, and stewardship requirements of their institutions. Faculty development is part of the professional career journey, and involves mentorship, guidance, and more formal educational experiences. One university's faculty development program is described and addresses the role of mentors and administrators in the faculty development process, the recognized need for continued development and partnering opportunities, and outcome data from two cohorts of new nursing faculty.

J Contin Educ Nurs
2009;40(11):514–520.
Structured Group Reminiscence: An Intervention for Older Adults
Authors: Stinson Cynthia Kellam
Published: November 2009

Group reminiscence is an intervention recommended for care of older adults in structured and unstructured settings. One problem experienced by nurses is how to organize, facilitate, and evaluate reminiscence groups for older people. Hence, there is a need for further research on reminiscence to determine how to use this as an intervention to improve the well-being of older adults. There is also a need for continuing education to provide nurses with education on this intervention for older persons. This article provides an overview of qualitative and quantitative research on group reminiscence and offers a suggested evidence-based protocol for a 6-week group intervention based on this research.

J Contin Educ Nurs
2009;40(11):521–528.
The New Adult Orphan: Issues and Considerations for Health Care Professionals
Authors: McDaniel J. Goodlett , Clark Paul G.
Published: November 2009

The death of the last parent has a profound effect on survivors. Health care workers are often the first source of anticipatory guidance for newly orphaned adults as they cope with grief, loss, and awareness that their lives are forever changed. It is estimated that more than 80 million Americans were born between 1946 and 1964. As this Baby Boomer generation, often defined as seeing themselves as culturally special, becomes “orphaned,” they may be less aware, less prepared, and less supported than any previous group of Americans regarding this life event. For a number of adults, the loss creates many unexpected results that can destabilize life in profound ways. This article describes the unique new realities of helping adult orphans as they relate to health care providers and discusses the problems associated with prolonged and complicated grief. Implications for geriatric caregivers, mental health providers, health educators, and others are proposed.
Palliative Care for Advanced Dementia: Approaches that Work
Authors: Long Carol O.
Published: November 2009

Advanced dementia is a terminal condition; however, research has revealed that affected individuals are subjected to multiple intrusive and burdensome interventions. Individuals with advance dementia require palliative care long before their death. This article reviews selected approaches that support personhood, explain behavior management principles, assure meaningful connections for activities of daily living, minimize weight loss, and explain advance directives and medical management best practices in palliative care for advanced dementia.
Clearing the Err: Reporting Serious Adverse Events and “Never Events” in Today's Health Care System
Authors: Plawecki Lawrence H. , Amrhein David W.
Published: November 2009

Absent an infinitesimal percentage, most Americans seek health care services due to a legitimate health issue. Fundamental within this relationship is the understanding that health care professionals will do everything within their power and expertise to alleviate the suffering of each patient they treat. Unfortunately, preventable medical errors do occur, and the innocent patient is left to suffer. In 1999, the Institute of Medicine released
to err Is human: building A safer health system
, the first mainstream publication calling for a change in the culture of health care and the eradication of preventable medical errors. In the 10 years since its publication, federal and state governments and agencies have been proactive in attempting to meet the recommendations originally proposed in
to err Is human
. This article will review what has been accomplished in this time frame.
The Effects of Postoperative Ketorolac on Wound Healing in a Rat Model
Authors: Eck Jason C. , Gomez Ben A. , Yaszemski Michael J.
Published: November 2009

Ketorolac is a nonopioid, anti-inflammatory drug commonly used for postoperative analgesia. Its effectiveness has been previously documented in various orthopedic procedures and more recently in spinal surgery. It remains uncertain if ketorolac has an effect on wound healing. The purpose of this study was to determine if the use of postoperative ketorolac induced deleterious effects on wound healing in a simulated spinal surgery incision using a rat model.

A 4-cm dorsal midline incision was made and closed in 36 rats. Rats were divided into 3 groups: (1) 5 mg/kg ketorolac given every 6 hours for 24 hours; (2) 5 mg/kg ketorolac given every 6 hours for 48 hours; and (3) control group given dextrose 5% in water every 6 hours for 48 hours. On postoperative day 14, sutures were removed. Wounds were removed and loaded to failure in tension. The mean±SD loads to failure were 9.8±1.8 N for group 1, 9.0±2.4 N for group 2, and 9.5±4.5 N for group 3. The differences among the 3 groups were not statistically significant (
P
>.05).

The use of ketorolac in the immediate postoperative period produces no increased risk of wound complications in this rat model.
Surgical Planning and Procedures for Difficult Total Knee Arthroplasty
Authors: Feng-Chen Kao , Kuo-Yao Hsu , Yuan-Kun Tu , Ming-Chih Chou
Published: November 2009

Most total knee arthroplasties (TKAs) are performed for minimal knee joint deformities with standard techniques and instrumentation. However, patients with extra-articular deformities, severe varus and valgus deformities, and posttraumatic arthrosis pose unique challenges to surgeons. Each deformity requires different modifications of surgical technique or prosthesis used to successfully perform TKA and optimize postoperative results.

The surrounding tissues connect the femur and the tibia at the anterior, posterior, medial, and lateral walls of the knee joint. The medial soft tissues should be released for varus deformities and lateral soft tissues should be released for valgus deformities. The posterior soft tissue may be released for flexed deformities. The anterior quadriceps and patellar tendon may be adjusted while approaching the knee joint for posttraumatic arthrosis. A more constrained knee prosthesis may be needed for more severe deformities.
Reproducibility and Accuracy of Templating Uncemented THA With Digital Radiographic and Digital TraumaCad Templating Software
Authors: Anil Kumar Panamoottil G. , Kirmani Sayyied J. , Humberg Heike , Kavarthapu Venu , Li Patrick
Published: November 2009

The reproducibility and accuracy of a digital software templating program on digital images was examined for primary uncemented total hip arthroplasty (THA). Forty-five patients waiting for an uncemented THA had templating performed of their digital picture archiving and communication systems (PACS) pelvic images with the TraumaCad software program (Orthocrat Ltd, Petach-Tikva, Israel). Acetabular cup size, femoral stem size, and femoral offset were noted by 2 observers, and again by 1 of the observers a week later. Through correlation coefficients and significance testing, the degree of intraobserver and interobserver variability was evaluated, as well as the level of accuracy for digital templating.

Excellent correlation was found for all data sets, with no significant difference between them in intraobserver reproducibility. Also in terms of interobserver reproducibility, we found good levels of correlation, with no significant difference between the data sets. In terms of accuracy, the correlation was at least acceptable with no significant difference between any of the data sets.

The use of the TraumaCad digital software program provides a reliable method of templating digital images for uncemented THAs. There is little intraobserver and interobserver variability, and the method produces an acceptable level of accuracy.
Noise Characteristics of Surgical Space Suits
Authors: Pearlman Ronald C. , Sandidge Olisa
Published: November 2009

Several studies indicate that the noise generated by performing orthopedic surgery has the potential to cause hearing loss. Noise-induced hearing loss was found in 50% of the orthopedic surgeons studied using audiometric testing, with a greater incidence associated with years of practice.

Noise produced by several orthopedic surgical instruments such as saws, drills, and hammers during surgery exceeds 100 dB, especially during knee replacement procedures. In one study, surgical space suits (personal protection systems) were suggested to help protect against noise-induced hearing loss, although space suit manufacturers do not market them as noise-reduction devices. A research protocol was developed to determine if commercially available surgical space suits help to reduce noise at the surgeon's ear. With the commercially available personal protection systems used in this research, there was no significant extra-helmet noise decrease by wearing the space suit. Sound inside the helmet at the level of the ear averaged 61dBA, approximately the level of conversational speech, which may explain the difficulty the surgical staff may have hearing speech in the operating room when the space suit is worn with the fan on.

If surgical noise is to be decreased, earplugs or muffs must be worn not only by the surgeon, but also by all personnel in the operating theater. At greatest risk may be the anesthesiologist, who may experience several orthopedic surgeries in a single day and is positioned close to the patient.
The Effects of Anterior Cruciate Ligament Lesion on the Articular Cartilage of Growing Goats
Authors: Falciglia Francesco , Mastantuoni Giuseppe , Guzzanti Vincenzo
Published: November 2009

Treatment of anterior cruciate ligament (ACL) injury in skeletally immature patients is controversial. The growth plate could be damaged if treated with the reconstruction techniques used to treat instability in adults. For this reason, many authors postpone surgical treatment until skeletal maturity, but the acceptable length of time that treatment can be postponed without causing irreversible damage to the articular cartilage in children with ACL injury is unknown. Until now, no studies have described the pathological findings and the evolution of the lesions of the articular cartilage during the growing period. For this reason, an experimental study on 16 6-month-old, skeletally immature goats was performed. A complete ACL lesion was achieved by removing the ligament. Two animals per group were sacrificed at intervals of 1, 3, 6, and 9 months postoperatively, and macroscopic and microscopic evaluations were performed. The presence of meniscal injury and articular cartilage lesions with progressive aspects were hystologically underlined. The hystological observations showed that the complete ACL lesion causes irreversible articular cartilage alterations in growing goats 3 months after injury. These experimental data suggest that ACL reconstruction in growing patients with ACL injury and instability should be indicated without waiting until skeletal maturity.
Biologic Response to Orthopedic Sutures: A Histologic Study in a Rabbit Model
Authors: Carr Brian J. , Ochoa Leah , Rankin David , Owens Brett D.
Published: November 2009

Biologic reactivity to suture materials can have an effect on patient outcomes. The goal of this study was to determine the histologic response to 8 commonly used orthopedic sutures—Ethibond (Ethicon, Somerville, New Jersey), Ticron (Tyco, Waltham, Massachusetts), HiFi (Linvatec, Largo, Florida), Ultrabraid (Smith & Nephew, Memphis, Tennessee), MaxBraid (Biomet, Warsaw, Indiana), Orthocord (Mitek, Raynham, Massachusetts), MagnumWire (Opus Medical, San Juan Capistrano, California), and FiberWire (Arthrex, Naples, Florida)—using a rabbit model.

The suture granuloms were evaluated at 30, 60, and 120 days with measurement of the fibrous capsule, the number of giant cells in and near the capsule, and the overall inflammatory grade: 1 (mild), 2 (moderate), and 3 (severe). MagnumWire and Ticron sutures initiated a more intense inflammatory reaction when compared to the other sutures. By 120 days, MagnumWire (
P
=.0297) and Ticron (
P
=.1855) had fewer giant cells at the soft tissue–suture interface, fewer giant cells within the capsule (
P
=.0074 and
P
=.0377, respectively), and the greatest capsular thickness of all suture types (
P
<.0001 and
P
=.1378, respectively).

Differences exist between the biologic reactivity of commonly used orthopedic sutures that may be attributable to their material composition and/or braid characteristics. In comparison to other high-strength sutures, MagnumWire and Ticron stimulated a more intense foreign body inflammatory response.
Multivariate Analysis of Prognostic Factors in Synovial Sarcoma
Authors: Koh Kyoung Hwan , Cho Eun Yoon , Kim Dong Wook , Seo Sung Wook
Published: November 2009

Many studies have described the diversity of synovial sarcoma in terms of its biological characteristics and clinical features. Moreover, much effort has been expended on the identification of prognostic factors because of unpredictable behaviors of synovial sarcomas. However, with the exception of tumor size, published results have been inconsistent.

We attempted to identify independent risk factors using survival analysis. Forty-one consecutive patients with synovial sarcoma were prospectively followed from January 1997 to March 2008. Overall and progression-free survival for age, sex, tumor size, tumor location, metastasis at presentation, histologic subtype, chemotherapy, radiation therapy, and resection margin were analyzed, and standard multivariate Cox proportional hazard regression analysis was used to evaluate potential prognostic factors. Tumor size (>5 cm), nonlimb-based tumors, metastasis at presentation, and a monophasic subtype were associated with poorer overall survival. Multivariate analysis showed metastasis at presentation and monophasic tumor subtype affected overall survival. For the progression-free survival, monophasic subtype was found to be only 1 prognostic factor.

The study confirmed that histologic subtype is the single most important independent prognostic factors of synovial sarcoma regardless of tumor stage.
Range of Flexion After Primary TKA: The Effect of Soft Tissue Release and Implant Design
Authors: Ahmed Issaq , Gray Andrew C. , van der Linden Marietta , Nutton Richard
Published: November 2009

Range of motion following total knee arthroplasty (TKA) is a crucial measure of clinical outcome. The purpose of this randomized, controlled study was to determine which factors are predictive of postoperative range of flexion. Fifty-six patients received either a standard or a high-flexion design NexGen Legacy Posterior-Stabilized TKA (Zimmer, Warsaw, Indiana). The relationship between preoperative flexion, intraoperative flexion, and range of flexion 1 year postoperatively was determined. The influence of soft tissue release and the type of femoral component was also investigated.

A significant correlation existed between preoperative flexion, intraoperative flexion, and maximum flexion 1 year postoperatively. Patients who had a preoperative range of flexion less than the mean range of flexion for the overall group gained flexion, whereas patients with a preoperative range of flexion greater than the mean range of flexion lost flexion. The degree of soft tissue release performed and the type of implant used had no influence on maximum flexion at 1 year.

The principal predictive factor of postoperative range of flexion, regardless of the degree of soft tissue release or implant design, is the preoperative and intraoperative range of flexion.
Arthrodiatasis for the Treatment of Perthes' Disease
Authors: Aly Tarek A. , Amin Osama A.
Published: November 2009

It is hypothesized that the interruption of the blood supply is an important factor causing femoral head osteonecrosis in the early stages of Legg-Calvé-Perthes disease. Currently, treatment by containment is recommended to direct and guide remodeling of the softened femoral head as it evolves from fragmentation through ossification. The goal of this study was to show the results of arthrodiatasis to induce height recovery of the femoral head and to achieve true ambulatory nonweight-bearing containment.

Forty-two patients younger than 8 years with a diagnosis of Perthes' disease were studied. Twenty-three patients (9 class B and 14 class C according to Herring's classification) were treated with an articulated distraction technique and 19 patients (11 class B and 8 class C) were treated conservatively as a control group. Arthrodiatasis or articulated distraction of the hip combines off-loading of muscles and body forces with distraction of the joint space by means of an external fixator that crosses the hip joint. Radiologically, 21 patients (91%) had satisfactory results and 2 (9%) had unsatisfactory results. Clinically, the results were good in 21 patients (92%), fair in 1 (4%), and poor in 1 (4%). In patients treated conservatively, 14 patients (72%) had satisfactory results and 5 (28%) had unsatisfactory results. Clinically, 71% had good results, 17% had fair, and 12% had poor.

We conclude that hip joint containment by articulated arthrodiatasis (plus adductors and psoas minimal tenotomy surgery) is an effective method in the management of Perthes' disease in patients younger than 8 years, classified B and C, and associated with a highly reduced range of abduction. Restoration of clinical abnormalities and satisfactory radiological parameters are achieved in high percentages.