bluuebunny/crossref_metadata_2025 huggingface dataset:
Regionale Zitratantikoagulation
Authors: Forster Christian , Schley Gunnar , Willam Carsten
Published: August 2017

Die regionale Zitratantikoagulation ist inzwischen zum oftmals bevorzugten Antikoagulationsverfahren in der chirurgischen und anästhesiologischen Intensivmedizin geworden. Dem Nachteil des höheren Aufwandes und der Bedenken wegen Nebenwirkungen stehen die Vorteile gegenüber, weniger Blutverlust zu erleiden, höhere Filterlaufzeiten und konsekutiv höhere Dialysedosen zu erreichen und auch blutungsgefährdete Patienten behandeln zu können. Für die intermittierenden Verfahren gibt es mittlerweile ebenfalls zahlreiche Protokolle, die jedoch als weniger validiert gelten können. Die Weiterentwicklung der Zitratantikoagulation verspricht auch vorteilhaft für den intermittierenden Dialysebereich und der Therapie chronischer Dialysepatienten zu sein.
Qualitätssicherung
Authors: Meusel Timo
Published: August 2017

Wie in der letzten Ausgabe beschrieben, umfasst unsere Aufgabe, die qualitativ gute Betreuung unserer Patienten zu gewährleisten, nicht nur die Strukturierung der dialysespezifischen Tätigkeit, sondern alle Aspekte der Pflege. Um dieser ganzheitlichen Sicht Rechnung zu tragen, ist es empfehlenswert, sich für ein Pflegemodell zu entscheiden und danach die Pflegetätigkeiten zu kategorisieren und zu standardisieren (z. B. das „Modell der Lebensaktivitäten (LA)“ nach Nancy Roper).
Neues Service-Angebot
Authors: Großmann Anne , Schrooten Charlotte
Published: August 2017

Der Verband Deutsche Nierenzentren (DN) e. V. möchte seine Mitglieder bei der Suche nach ausgebildetem Personal für die nephrologische Praxis und Dialyse unterstützen. Daher wurde kürzlich als neuer Service für ordentliche DN-Mitglieder eine Stellenbörse für Praxispersonal auf der Homepage des Verbands eingerichtet.
Die Förderung der Adhärenz durch eine psychoedukative Intervention für psychodynamische Psychotherapien
Authors: Hoffmann Knut , Hollenberg Stefan , Juckel Georg
Published: August 2017

Anliegen Es wird die Förderung der Adhärenz durch ein psychoedukatives Programm für eine psychodynamisch orientierte stationäre Therapie mittels einer randomisierten Experimentalstudie untersucht.

Methode Ein vollständiger Aufnahmejahrgang einer Maßregelvollzugsklinik wurde randomisiert einer Frühgruppe zugeordnet, die nach einer sechswöchigen Eingangsphase an einem psychoedukativen Programm parallel zu einer psychodynamisch orientierten Therapie teilnahm bzw. einer Spätgruppe, die 3 Monate später an dem gleichen Programm teilnahm.

Ergebnisse Von den Teilnehmern der Frühgruppe sind nach 7 Monaten signifikant mehr in psychodynamischer Behandlung.

Schlussfolgerungen Die Adhärenz für eine psychodynamisch orientierte stationäre Therapie kann bei Maßregelvollzugspatienten durch ein psychoedukatives Programm verbessert werden.
Forschen für uns! Welche Forschungsthemen interessieren von Depression Betroffene?
Authors: Bernges Tabea , Iden Laura , Gielen Reinhard , Scholl Michael , Brütt Anna
Published: August 2017

Ziel der Studie Identifikation und Priorisierung von Forschungsfragen zu Depressionen durch Betroffene und Angehörige.

Methodik In einer Onlineumfrage konnten Betroffene und Angehörige Forschungsthemen benennen, die von den Autoren zu Forschungsfragen zusammengefasst wurden. Diese wurden auf einer Likert-Skala online bewertet.

Ergebnisse Die Befragten schätzen Forschungsfragen zum Zugang und zur Gestaltung von Versorgung als besonders relevant ein.

Schlussfolgerung Themen aus dem Bereich Selbsthilfe und Zugang zur Versorgung sollten stärker beforscht werden.
Investigating performance of microchannel evaporators for automobile air conditioning with different port structures
Authors: Zhou Guoliang , Su Lin , Cheng Qia , Wu Longbing
Published: August 2017

Microchannel evaporator has been widely applied in automobile air conditioning, while it faces the problem of refrigerant maldistribution which deteriorates the thermal performance of evaporator. In this study, the performances of microchannel evaporators with different port structures are experimentally investigated for purpose of reducing evaporator pressure drop. Four evaporator samples with different port number and hydraulic diameter are made for this study. The performances of the evaporator samples are tested on a psychometric calorimeter test bench with the refrigerant R-134A at a real automobile air conditioning. The results on the variations of the evaporator pressure drop and evaporator surface temperature distribution are presented and analyzed. By studying the performance of an evaporator, seeking proper port structure is an approach to reduce refrigerant pressure drop as well as improve refrigerant distribution.
Electrostatic double layers and solitary structures in non-Maxwellian unmagnetized plasmas
Authors: Shan S. Ali , Saleem H.
Published: August 2017

A simpler method is used to obtain differential equations producing ion acoustic solitary waves and double layers (DLs) in a an unmagnetized plasma. The electrons are assumed to follow Cairns-Tsallis and Kappa distribution functions while the ions are assumed to be cold. The results are applied to F-region ionosphere where such electrostatic structures have been observed by many satellites.
Coupled dust drift acoustic shock and soliton in collisional four component magnetized dusty plasmas
Authors: Farooq M. , Ahmad Mushtaq , Jan Qasim
Published: August 2017

Low frequency electrostatic coupled dust drift dust acoustic waves are studied in an inhomogeneous, collisional four component dust magnetoplasma composed of dust components of opposite polarity, along with Boltzmannian ions and electrons. The nonlinear evolution equation in the form of an ordinary differential equation and its limiting cases are derived and solved using the Tanh-method. The numerical analysis of the obtained solutions is studied for both laboratory and cosmic plasma systems. It is observed that, depending on the values of the plasma parameters like ion and electron temperatures, and charge number, both rarefactive and compressive shock and solitary waves may exist. It is shown that the concepts of a critical ion and electron temperatures/density in the nonlinear equations treatment, and of a changeover from compressive to rarefactive shock and soliton characters, correspond to the formation of rarefactive regimes, at which the electric stresses maximize and density minimizes.
An actively controlled silicon ring resonator with a fully tunable Fano resonance
Authors: Li A. , Bogaerts W.
Published: August 2017

We demonstrate a novel way to generate Fano resonance with tunable wavelength, extinction ratio, and slope rate. The device is a silicon add-drop microring with two integrated tunable reflectors inside, which form an embedded Fabry-Perot cavity. The fabrication is executed at a commercial CMOS foundry. Fano resonance at the drop port is generated from the interference between the Fabry-Perot cavity mode and the ring resonance mode. By tuning the reflectivities of these two reflectors with integrated heaters, various Fano resonance shapes can be achieved with a maximum extinction ratio over 40 dB and a slope rate more than 700 dB/nm.
Amphibian reproductive success as a gauge of functional equivalency of created wetlands in the Central Appalachians
Authors: Strain Gabriel F. , Turk Philip J. , Helmick Jordan , Anderson James T.
Published: August 2017

Context Evaluating the adequacy of created wetlands to replace the functions of lost natural wetlands is important because wetland mitigation is a major tool used to offset wetland losses. However, measurements such as vegetative cover and presence of wildlife may not provide sufficient evidence that created wetlands are functioning properly. Thus, examining the ecology of wetland biota such as that of amphibians may be a more useful surrogate for function. Aims The objectives of this study were to compare the abundance of amphibian metamorphs and survival and growth of larval amphibians in created wetlands, relative to natural wetlands. Methods Amphibian metamorphs were trapped in created and natural wetlands during the spring (April–May) and summer (June–August) of 2009 and 2010, and 165 green frog (Lithobates clamitans) larvae were raised during the spring of 2010 in laboratory aquaria containing water from created or natural wetlands. Key results Abundance of spring peeper (Pseudacris crucifer) metamorphs decreased significantly from 2009 to 2010 and abundance of green frog metamorphs increased with habitat complexity, but both were unaffected by wetland type. Detection probability of metamorphs of both species was low, increased with water temperature and declined with month of observation. Survival, growth curves and mass were similar among green frog larvae raised in created and natural wetland aquaria. Conclusions Our results suggest that the created and natural wetlands we examined function similarly with respect to providing adequate breeding habitat for green frogs and spring peepers. Implications Wetlands created to offset the loss of natural wetlands, although generally not designed for the purpose of wildlife habitat, can function as adequate breeding habitat for generalist amphibians such as green frogs and spring peepers.
Identifying key denning habitat to conserve brown bear (Ursus arctos) in Croatia
Authors: Whiteman A. , Passoni G. , Rowcliffe J. M. , Ugarković D. , Kusak J. , Reljić S. , Huber D.
Published: August 2017

Context The preservation of denning habitat is paramount to the recovery of threatened bear populations because of the effect that den site disturbance can have on cub mortality. Understanding habitat suitability for denning can allow management efforts to be directed towards the regions where conservation interventions would be most effective. Aim We sought to identify the environmental and anthropogenic habitat variables associated with the presence of Eurasian brown bear (Ursus arctos) den sites in Croatia. Based on these associations, in order to inform future conservation decisions, we also sought to identify regions of high suitability for denning across Croatia. Methods Using the locations of 91 dens inhabited by bears between 1982 and 2011, we opted for the presence-only modelling option in software Maxent to determine the most important predictors of den presence, and thus predict the distribution of high-value denning habitat across Croatia. Key results We found that structural elements were the most important predictors, with ruggedness and elevation both relating positively to den presence. However, distance to nearest settlement was also positively associated with den presence. Conclusion We determine that there is considerable denning habitat value in areas with high and rugged terrain as well as areas with limited human activity. We suspect that high and rugged terrain contains a greater concentration of the karstic formations used for denning than lower-lying regions. Implications Our study presents the first habitat suitability model for brown bears in Croatia, and identifies core areas suitable for denning both within and outside the species’ current range. As such, it provides useful evidence for conservation decision making and the development of scientifically-based management plans. Our results also support the need for finer spatial scale studies that can reveal specific denning preferences of subpopulations.
Null effects of boot camps and short-format training for PhD students in life sciences
Authors: Feldon David F. , Jeong Soojeong , Peugh James , Roksa Josipa , Maahs-Fladung Cathy , Shenoy Alok , Oliva Michael
Published: August 2017

Significance

To increase the effectiveness of graduate research training, many universities have introduced boot camps and bridge programs lasting several days to several weeks. National Science Foundation and National Institutes of Health currently support such interventions with nearly $28 million in active awards. Previous evidence for the efficacy of this format exists primarily in the form of anecdotes and end-of-course surveys. Here we show that participation in such short-format interventions is not associated with observable benefits related to skill development, scholarly productivity, or socialization into the academic community. Analyzing data from 294 PhD students in life sciences from 53 US institutions, we found no evidence of effectiveness across 115 variables. We conclude that boot camps and other short formats may not durably impact student outcomes.
Replication and refinement of a vaginal microbial signature of preterm birth in two racially distinct cohorts of US women
Authors: Callahan Benjamin J. , DiGiulio Daniel B. , Goltsman Daniela S. Aliaga , Sun Christine L. , Costello Elizabeth K. , Jeganathan Pratheepa , Biggio Joseph R. , Wong Ronald J. , Druzin Maurice L. , Shaw Gary M. , Stevenson David K. , Holmes Susan P. , Relman David A.
Published: August 2017

Significance

Premature birth (PTB) is a major global public health burden. Previous studies have suggested an association between altered vaginal microbiota composition and PTB, although findings across studies have been inconsistent. To address these inconsistencies, improve upon our previous signature, and better understand the vaginal microbiota’s role in PTB, we conducted a case-control study in two cohorts of pregnant women: one predominantly Caucasian at low risk of PTB, the second predominantly African American at high risk. With the results, we were able to replicate our signature in the first cohort and refine our signature of PTB for both cohorts. Our findings elucidate the ecology of the vaginal microbiota and advance our ability to predict and understand the causes of PTB.
Rome’s urban history inferred from Pb-contaminated waters trapped in its ancient harbor basins
Authors: Delile Hugo , Keenan-Jones Duncan , Blichert-Toft Janne , Goiran Jean-Philippe , Arnaud-Godet Florent , Albarède Francis
Published: August 2017

Significance

Isotopic evidence showing that Rome’s lead water pipes were the primary source of lead pollution in the city’s runoff reveals the sedimentary profile of lead pollution in the harbor at Ostia to be a sensitive record of the growth of Rome’s water distribution system and hence, of the city itself. The introduction of this lead pipe network can now be dated to around the second century BC, testifying to a delay of about a century and a half between the introduction of Rome’s aqueduct system and the installation of a piped grid. The diachronic evolution of anthropogenic lead contamination is able to capture the main stages of ancient Rome's urbanization until its peak during the early high empire.
Stabilizing a different cyclooctatetraene stereoisomer
Authors: Li Longfei , Lei Ming , Xie Yaoming , Schaefer Henry F. , Chen Bo , Hoffmann Roald
Published: August 2017

Significance

Cyclooctatetraene (COT) is a poster child for nonaromatic molecules. An isomer of tub-shaped COT, with one of the ring double bonds changed from the usual cis form to a trans one, lies some 23 kcal/mol higher in energy. Devising a substitution strategy for turning the tables, making the
trans
isomer the stable point of the system, is the challenge. Simple bonding ideas, of the bulk of substituents, of clamping and turning aromaticity on and off, of pushing electrons in and out of the system, guide us in devising several realistic candidates. Along the way, a set of molecules that might easily split hydrogen reversibly emerges.
Differential HspBP1 expression accounts for the greater vulnerability of neurons than astrocytes to misfolded proteins
Authors: Zhao Ting , Hong Yan , Yin Peng , Li Shihua , Li Xiao-Jiang
Published: August 2017

Significance

It remains unclear why astrocytes are affected to a lesser extent than neurons in a variety of neurodegenerative diseases. We report the higher activity of C terminus of Hsp70-interacting protein (CHIP), cochaperone of Hsp70, in astrocytes than in neurons, which not only promotes the degradation of misfolded proteins, but also upregulates levels of basal and stress-induced Hsp70 in astrocytes. Furthermore, the low activity of CHIP in neurons is caused by the abundant expression of HspBP1, an inhibitor of CHIP. Knocking down HspBP1 in neurons prevents the accumulation and aggregation of the Huntington’s disease (HD) protein and ameliorates neuropathology in a HD knockin mouse model. These findings suggest that HspBP1 accounts for differential vulnerabilities of neurons and glia to misfolded proteins.
From coseismic offsets to fault-block mountains
Authors: Thompson George A. , Parsons Tom
Published: August 2017

Significance

Observations at different times during extensional faulting cycles show dramatically different deformation. Available coseismic and postseismic observations bear little resemblance to the topography of rifted zones, yet this topography is the end result of repeated earthquakes. During earthquakes, and during periods decades later, there is little evidence of rift flank, or range-front deformation, yet strong bending and uplift of these features ultimately define extended terranes. Numerical modeling incorporating gravity and the principle of isostatic balance predicts strong vertical forces during the first decade after a significant earthquake that are preferentially focused beneath range fronts. We conclude these forces are responsible for characteristic rift topography. This hypothesis is testable with intermediate period geodetic observations that are rare for extensional earthquakes.
Top-down modulation of sensory cortex gates perceptual learning
Authors: Caras Melissa L. , Sanes Dan H.
Published: August 2017

Significance

With training, stimulus detection or discrimination abilities can improve dramatically. This process, called perceptual learning, supports language acquisition, musical expertise, and professional judgments, such as the identification of abnormalities in X-rays. To explore neural mechanisms that support perceptual learning, we measured and manipulated auditory cortex activity as animals trained on an auditory task. We found improvements in neural sensitivity that correlated tightly with perceptual learning, both in absolute magnitude and time course, and depended strongly on task engagement. Disrupting auditory cortical function impaired learning while leaving perception largely intact. Our findings indicate that improvements in cortical sensitivity could plausibly explain perceptual learning, and suggest that plasticity within top-down networks may be a general mechanism for perceptual improvement.
Initial training with difficult items does not facilitate category learning
Authors: Edmunds CER , Wills Andy J , Milton Fraser
Published: August 2017

In the phenomenon of transfer along a continuum (TAC), initial training on easy items facilitates later learning of a harder discrimination. TAC is a widely replicated cross-species phenomenon that is well predicted by certain kinds of associative theory. A recent report of an approximately opposite phenomenon (i.e., facilitation by initial training on hard items) poses a puzzle for such theories, but is predicted by a dual-system model (COVIS). However, across four experiments, we present substantial evidence that this counterintuitive finding was in error. Rather, the result appears to be a false positive and, as such, should not form part of the evidence base for COVIS nor be considered as a counter-example to the pervasive TAC phenomenon.
Spatiotemporal Variability of Benthic Communities on Weathervane Scallop Beds off Alaska
Authors: Glass Jessica R. , Kruse Gordon H.
Published: August 2017

Marine benthic communities are critical biotic components of habitat due to their roles in ecosystem function and health and as indicators of ecosystem change. Benthic communities are receiving increasing attention as institutions adopt ecosystem-oriented research approaches. We conducted a multidecadal analysis of benthic communities in areas targeted by a commercial weathervane scallop Patinopecten caurinus fishery on the continental shelf off Alaska. Using bycatch data collected by onboard observers during 1996–2012, we analyzed spatiotemporal patterns in community composition on weathervane scallop beds. We also explored whether spatiotemporal differences were related to environmental (sediment and depth) and anthropogenic (dredging effort) variables. Statistically significant (P < 0.05) temporal changes in community composition occurred during 1996–2012, with a split between 1996 and 1999 and subsequent years. Taxa contributing to temporal changes were not consistent across fishery registration areas. Significant spatial differences in community structure were detected both at the scale of registration areas (200–2,000 km) and individual scallop beds (<50 km). We also found significant correlations between benthic species composition and environmental and anthropogenic variables over space and time. Although the relationships were generally weak, the ecological associations were consistent with expected depth and sediment relationships in this region. Our results are directly relevant to the habitat objective of the scallop fishery management plan, inform essential fish habitat designations for weathervane scallops and other commercially important species, and serve as a baseline against which to compare future changes associated with fishing and climate change. Ensuing research should include the collection of environmental data at the spatial scale of individual scallop beds as well as controlled experiments on the impacts of fishing on benthic communities and their recovery.
Gpr158 mediates osteocalcin’s regulation of cognition
Authors: Khrimian Lori , Obri Arnaud , Ramos-Brossier Mariana , Rousseaud Audrey , Moriceau Stéphanie , Nicot Anne-Sophie , Mera Paula , Kosmidis Stylianos , Karnavas Theodoros , Saudou Frederic , Gao Xiao-Bing , Oury Franck , Kandel Eric , Karsenty Gerard
Published: August 2017

That osteocalcin (OCN) is necessary for hippocampal-dependent memory and to prevent anxiety-like behaviors raises novel questions. One question is to determine whether OCN is also sufficient to improve these behaviors in wild-type mice, when circulating levels of OCN decline as they do with age. Here we show that the presence of OCN is necessary for the beneficial influence of plasma from young mice when injected into older mice on memory and that peripheral delivery of OCN is sufficient to improve memory and decrease anxiety-like behaviors in 16-mo-old mice. A second question is to identify a receptor transducing OCN signal in neurons. Genetic, electrophysiological, molecular, and behavioral assays identify Gpr158, an orphan G protein–coupled receptor expressed in neurons of the CA3 region of the hippocampus, as transducing OCN’s regulation of hippocampal-dependent memory in part through inositol 1,4,5-trisphosphate and brain-derived neurotrophic factor. These results indicate that exogenous OCN can improve hippocampal-dependent memory in mice and identify molecular tools to harness this pathway for therapeutic purposes.
Evacuating People and Their Pets: Older Floridians’ Need for and Proximity to Pet-Friendly Shelters
Authors: Douglas Rachel , Kocatepe Ayberk , Barrett Anne E , Ozguven Eren Erman , Gumber Clayton
Published: August 2017

Objectives

Pets influence evacuation decisions, but little is known about pet-friendly emergency shelters’ availability or older adults’ need for them. Our study addresses this issue, focusing on the most densely populated area of Florida (Miami-Dade)—the state with the oldest population and greatest hurricane susceptibility.

Method

We use Geographic Information Systems (GIS)–based methodology to identify the shortest paths to pet-friendly shelters, based on distance and congested and uncongested travel times—taking into account the older population’s spatial distribution. Logistic regression models using the 2013 American Housing Survey’s Disaster Planning Module examine anticipated shelter use as a function of pet ownership and requiring pet evacuation assistance.

Results

Thirty-four percent of older adults in the Miami-Dade area have pets—35% of whom report needing pet evacuation assistance. However, GIS accessibility measures show that travel time factors are likely to impede older adults’ use of the area’s few pet-friendly shelters. Logistic regression results reveal that pet owners are less likely to report anticipating shelter use; however, the opposite holds for pet owners reporting they would need help evacuating their pets—they anticipate using shelters.

Discussion

High pet shelter need coupled with low availability exacerbates older adults’ heightened vulnerability during Florida’s hurricane season.
Quality in Spine Surgery
Authors: Graves Christopher , Meyer Scott , Knightly John , Glassman Steven
Published: August 2017

Health care is expensive in the United States. There is an increasing focus on value rather than volume. Accurately measuring quality is a critically important step in determining value of care delivered. This article discusses the trials and techniques of measuring quality in spine surgery. A detailed analysis of advantages and disadvantages of various measures of quality, including process measurements, patient-reported outcome measurements, and safety measurements is included—from a historical perspective through modern practice.
Critical Thoughts About the Core Entrustable Professional Activities in Undergraduate Medical Education
Authors: Krupat Edward
Published: August 2017

The Core Entrustable Professional Activities for Entering Residency (Core EPAs) have taken a strong hold on undergraduate medical education (UME). This Perspective questions their value added and considers the utility of the Core EPAs along two separate dimensions: (1) the ways they change the content and focus of the goals of UME; and (2) the extent to which entrustable professional activity (EPA)–based assessment conforms to basic principles of measurement theory as practiced in the social sciences. Concerning content and focus, the author asks whether the 13 Core EPAs frame UME too narrowly, putting competencies into the background and overlooking certain aspirational, but important and measurable, objectives of UME. The author also discusses the unevenness of EPAs in terms of their breadth and their developmental status as core activities. Regarding measurement and assessment, the author raises concerns that the EPA metric introduces layers of inference that may cause distortions and hinder accuracy and rater agreement. In addition, the use of weak anchors and multidimensional scales is also of concern. The author concludes with a proposal for reframing the Core EPAs and Accreditation Council for Graduate Medical Education competencies into broadly defined sets of behaviors, referred to as “Tasks of Medicine,” and calls for the development of a systematic and longitudinal research agenda. The author asserts that “slowing down when you should” applies to medical education as well as patient care, and calls for a reevaluation of the Core EPAs before further commitment to them.
Competency-Based Medical Education and the Ghost of Kuhn: Reflections on the Messy and Meaningful Work of Transformation
Authors: Holmboe Eric S.
Published: August 2017

The transition, if not transformation, to outcomes-based medical education likely represents a paradigm shift struggling to be realized. Paradigm shifts are messy and difficult but ultimately meaningful if done successfully. This struggle has engen dered tension and disagreements, with many of these disagreements cast as either–or polarities. There is little disagreement, however, that the health care system is not effectively achieving the triple aim for all patients. Much of the tension and polarity revolve around how more effectively to prepare students and residents to work in and help change a complex health care system.

Competencies were an initial attempt to facilitate this shift by creating frameworks of essential abilities needed by physicians. However, implementation of competencies has proven to be difficult. Entrustable professional activities (EPAs) in undergraduate and graduate medical education and Milestones in graduate medical education are recent concepts being tried and studied as approaches to guide the shift to outcomes. Their primary purpose is to help facilitate implementation of an outcomes-based approach by creating shared mental models of the competencies, which in turn can help to improve curricula and assessment. Understanding whether and how EPAs and Milestones effectively facilitate the shift to outcomes has been and will continue to be an iterative and ongoing reflective process across the entire medical education community using lessons from implementation and complexity science. In this Invited Commentary, the author reflects on what got the community to this point and some sources of tension involved in the struggle to move to outcomes-based education.
The High-Value Care Rounding Tool: Development and Validity Evidence
Authors: McDaniel Corrie E. , White Andrew A. , Bradford Miranda C. , Sy Carolyn D. , Chen Tiffany , Brock Doug , Foti Jeffrey , Beck Jimmy B.
Published: August 2017

Little is known about current practices in high-value care (HVC) bedside teaching. A lack of instruments for measuring bedside HVC behaviors confounds efforts to assess the impact of curricular interventions. The authors aimed to define observable HVC concepts by developing an instrument to measure the content and frequency of HVC discussions.

The authors developed the HVC Rounding Tool in four iterative phases, using Messick’s validity framework. Phases 1 and 2 were designed to collect evidence of content validity, Phases 3 and 4 to collect evidence of response process and internal structure. Phase 1 identified HVC topics within the literature. Phase 2 used a modified Delphi approach for construct definition and tool development. Through two rounds, the Delphi panel narrowed 16 HVC topics to 11 observable items, categorized into three domains (quality, cost, and patient values). Phase 3 involved rater training and creation of a codebook. Phase 4 involved three iterations of instrument piloting. Six trained raters, in pairs, observed bedside rounds during 148 patient encounters in 2016. Weighted kappas for each domain demonstrated improvement from the first to third iteration: Quality increased from 0.65 (95% CI 0.55–0.79) to 1.00, cost from 0.58 (95% CI 0.4–0.75) to 0.96 (95% CI 0.80–1.00), and patient values from 0.41 (95% CI 0.19–0.68) to 1.00. Percent positive agreement for all domains improved from 65.3% to 98.1%. This tool, the first with established validity evidence, addresses an important educational gap for measuring the translation of HVC from theoretical knowledge to bedside practice.
Competitive Antagonism of Anesthetic Action at the γ-Aminobutyric Acid Type A Receptor by a Novel Etomidate Analog with Low Intrinsic Efficacy
Authors: Ma Celena , Pejo Ervin , McGrath Megan , Jayakar Selwyn S. , Zhou Xiaojuan , Miller Keith W. , Cohen Jonathan B. , Raines Douglas E.
Published: August 2017

Background

The authors characterized the γ-aminobutyric acid type A receptor pharmacology of the novel etomidate analog naphthalene–etomidate, a potential lead compound for the development of anesthetic-selective competitive antagonists.

Methods

The positive modulatory potencies and efficacies of etomidate and naphthalene–etomidate were defined in oocyte-expressed α1β3γ2L γ-aminobutyric acid type A receptors using voltage clamp electrophysiology. Using the same technique, the ability of naphthalene–etomidate to reduce currents evoked by γ-aminobutyric acid alone or γ-aminobutyric acid potentiated by etomidate, propofol, pentobarbital, and diazepam was quantified. The binding affinity of naphthalene–etomidate to the transmembrane anesthetic binding sites of the γ-aminobutyric acid type A receptor was determined from its ability to inhibit receptor photoaffinity labeling by the site-selective photolabels [3H]azi-etomidate and R-[3H]5-allyl-1-methyl-5-(m-trifluoromethyl-diazirynylphenyl) barbituric acid.

Results

In contrast to etomidate, naphthalene–etomidate only weakly potentiated γ-aminobutyric acid–evoked currents and induced little direct activation even at a near-saturating aqueous concentration. It inhibited labeling of γ-aminobutyric acid type A receptors by [3H]azi-etomidate and R-[3H]5-allyl-1-methyl-5-(m-trifluoromethyl-diazirynylphenyl) barbituric acid with similar half-maximal inhibitory concentrations of 48 μM (95% CI, 28 to 81 μM) and 33 μM (95% CI, 20 to 54 μM). It also reduced the positive modulatory actions of anesthetics (propofol > etomidate ~ pentobarbital) but not those of γ-aminobutyric acid or diazepam. At 300 μM, naphthalene–etomidate increased the half-maximal potentiating propofol concentration from 6.0 μM (95% CI, 4.4 to 8.0 μM) to 36 μM (95% CI, 17 to 78 μM) without affecting the maximal response obtained at high propofol concentrations.

Conclusions

Naphthalene–etomidate is a very low-efficacy etomidate analog that exhibits the pharmacology of an anesthetic competitive antagonist at the γ-aminobutyric acid type A receptor.
Lumbar Spine Fusion Surgery in Solid Organ Transplant Recipients Is Associated With Increased Medical Complications and Mortality
Authors: Amin Raj , Puvanesarajah Varun , Qureshi Rabia , Jain Amit , Kebaish Khaled , Shen Frank H. , Hassanzadeh Hamid
Published: August 2017

Study Design.

Retrospective database review.

Objective.

To characterize the outcomes of solid organ transplant (SOT) patients after one- or two-level lumbar fusion surgery.

Summary of Background Data.

Over the past decade advances in SOT patients have improved graft survival. As such, this patient population is increasingly eligible for elective surgery such as lumbar fusion procedures to improve mobility and quality of life. However, the outcomes of spine surgery in this population are not well defined.

Methods.

Data from the full 100% Medicare sample between 2005 and 2014 were used for the study. Patients were included if they had an elective one- or two-level lumbar spine fusion and previous history of renal, heart, liver, or lung SOT patients during this period. SOT patients were compared to non-SOT patients with respect to baseline characteristics, 90-day medical complications, 1-year rate of revision surgery, and 1-year mortality.

Results.

There were 961 patients in the transplant cohort and 258,342 in the non-SOT cohort. Seventy-seven percent of the SOT patients had prior renal transplant. SOT patients had a longer length of stay (P < 0.001), and a higher 30-day readmission rate compared to non-SOT patients (P =  < 0.001). In addition, SOT patients experienced a 23.8% rate of 90-day postoperative major medical complications and 3.0%, 1-year mortality, significantly larger than respective rates in the control population (P < 0.001). One-year infection, revision surgery rates, and wound dehiscence were not significantly different between the two cohorts.

Conclusion.

Spine surgery is associated with significant medical complications and 1-year mortality in the SOT population. Although there may be a substantial benefit from lumbar fusion in the SOT population, judicious patient selection is of paramount importance.

Level of Evidence: 3
Metabolic Syndrome and 30-Day Outcomes in Elective Lumbar Spinal Fusion
Authors: Chung Andrew S. , Campbell David , Waldrop Robert , Crandall Dennis
Published: August 2017

Study Design.

A retrospective cohort study.

Objective.

The aim of this study was to evaluate the effect of metabolic syndrome (MetS) on 30-day morbidity and mortality following elective lumbar spinal fusion.

Summary of Background Data.

MetS is a variable combination of hypertension, obesity, elevated fasting plasma glucose, and dyslipidemia.

MetS has been associated with an increased risk of postoperative morbidity and mortality in multiple surgical settings. To our knowledge, the effect of MetS on 30-day outcomes following elective lumbar spinal fusion has not been well studied.

Methods.

An analysis of ACS-NSQIP data was performed between 2006 and 2013. Patients undergoing elective posterior lumbar fusion were identified. Emergency procedures, infections, tumor cases, and revision surgeries were excluded. Patients were defined as having MetS if they had a history of hypertension requiring medication, diabetes, and a body mass index (BMI) ≥30 kg/m2.

Results.

One thousand five hundred ninety (10.2%) patients with MetS were identified. A mild increase in major (P = 0.040) and minor complications (P = 0.003) in patients with MetS was noted. MetS was associated with increased rates of pulmonary complications (1.9% compared with 1.0%; P = 0.001), sepsis (1.7% compared with 0.9%; P = 0.005), and acute post-op renal failure (0.4% compared with 0%; P < 0.001). Multivariate analysis confirmed MetS to be an independent predictor of pulmonary complications [odds ratio (OR) 1.51; 95% confidence interval (95% CI 1.00–2.27); P = 0.048], sepsis (OR 1.56; 95% CI 1.01–2.42; P = 0.039), and acute postoperative renal failure (OR 6.95; 95% CI 2.23–21.67; P = 0.001). MetS status was associated with a mild increase in total hospital length of stay (4.38 compared with 3.81 days; P < 0.001).

Conclusion.

While MetS is a predictor of postoperative acute renal failure, it only slightly increases the risk of overall complications and is not associated with increased rates of 30-day reoperations or readmissions following elective lumbar fusion.

Level of Evidence: 3
Advanced Percutaneous Mechanical Circulatory Support Devices for Cardiogenic Shock
Authors: Miller P. Elliott , Solomon Michael A. , McAreavey Dorothea
Published: August 2017

Objectives:

To review temporary percutaneous mechanical circulatory support devices for the treatment of cardiogenic shock, including current evidence, contraindications, complications, and future directions.

Data Sources:

A MEDLINE search was conducted with MeSH terms: cardiogenic shock, percutaneous mechanical circulatory support, extracorporeal membrane oxygenation, Impella, and TandemHeart.

Study Selection:

Selected publications included randomized controlled trial data and observational studies describing experience with percutaneous mechanical circulatory support in cardiogenic shock.

Data Extraction:

Studies were chosen based on strength of association with and relevance to cardiogenic shock.

Data Synthesis:

Until recently, there were few options if cardiogenic shock was refractory to vasopressors or intra-aortic balloon pump counterpulsation. Now, several percutaneous mechanical circulatory support devices, including Impella (Abiomed, Danvers, MA), TandemHeart (CardiacAssist, Pittsburgh, PA), and extracorporeal membrane oxygenation, are more accessible. Compared with intra-aortic balloon pump, Impella provides greater hemodynamic support but no reduction in mortality. Similarly, TandemHeart improves hemodynamic variables but not survival. Comparative studies have been underpowered for mortality because of small sample size. Veno-arterial extracorporeal membrane oxygenation offers the advantage of biventricular circulatory support and oxygenation, but there are significant vascular complications. Comparative studies with extracorporeal membrane oxygenation have not been completed. Despite lack of randomized controlled data, there has been a substantial increase in use of percutaneous mechanical circulatory support. Several ongoing prospective studies with larger sample sizes may provide answers, and newer devices may become smaller, easier to insert, and more effective.

Conclusions:

Mortality from cardiogenic shock remains unacceptably high despite early coronary revascularization or other therapies. Although evidence is lacking and complications rates are high, improvements and experience with percutaneous mechanical circulatory support may offer the prospect of better outcomes.
“It Was the Only Thing I Could Hold Onto, But…”: Receiving a Letter of Condolence After Loss of a Loved One in the ICU: A Qualitative Study of Bereaved Relatives’ Experience*
Authors: Kentish-Barnes Nancy , Cohen-Solal Zoé , Souppart Virginie , Galon Marion , Champigneulle Benoît , Thirion Marina , Gilbert Marion , Lesieur Olivier , Renault Anne , Garrouste-Orgeas Maïté , Argaud Laurent , Venot Marion , Demoule Alexandre , Guisset Olivier , Vinatier Isabelle , Troché Gilles , Massot Julien , Jaber Samir , Bornstain Caroline , Gaday Véronique , Robert René , Rigaud Jean-Philippe , Cinotti Raphaël , Adda Mélanie , Thomas François , Azoulay Elie
Published: August 2017

Objectives:

Family members of patients who die in the ICU often remain with unanswered questions and suffer from lack of closure. A letter of condolence may help bereaved relatives, but little is known about their experience of receiving such a letter. The objective of the study was to understand bereaved family members’ experience of receiving a letter of condolence.

Design:

Qualitative study using interviews with bereaved family members who received a letter of condolence and letters written by these family members to the ICU team. This study was designed to provide insight into the results of a larger randomized, controlled, multicenter study.

Setting:

Twenty-two ICUs in France.

Subjects:

Family members who lost a loved one in the ICU and who received a letter of condolence.

Measurements and Main Results:

Thematic analysis was used and was based on 52 interviews and 26 letters. Six themes emerged: 1) a feeling of support, 2) humanization of the medical system, 3) an opportunity for reflection, 4) an opportunity to describe their loved one, 5) continuity and closure, and 6) doubts and ambivalence. Possible difficulties emerged, notably the re-experience of the trauma, highlighting the absence of further support.

Conclusions:

This study describes the benefits of receiving a letter of condolence; mainly, it humanizes the medical institution (feeling of support, confirmation of the role played by the relative, supplemental information). However, this study also shows a common ambivalence about the letter of condolence’s benefit. Healthcare workers must strive to adapt bereavement follow-up to each individual situation.
Toll-Like Receptor 7 Staining in Malignant Epithelial Tumors
Authors: Franz Regina , Ritter Nathalie , Hein Rüdiger , Biedermann Tilo , Al-Sisi Mohammed , Eyerich Kilian , Garzorz-Stark Natalie , Andres Christian
Published: August 2017

Background:

As important players of the innate immune system, Toll-like receptors (TLRs) and their role for tumorigenesis have been in the focus of research. In particular TLR7 is an interesting candidate, as TLR7 agonists are broadly used for the treatment of cutaneous tumors. However, data addressing the baseline expression of TLR7 in both basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) on the protein level are lacking, while on the genomic level significantly elevated expression of TLR7 in SCC but not in BCC has been demonstrated.

Aim:

Our aim was to characterize the immunohistochemical staining pattern of TLR7 in SCC and BCC. Besides, we aimed to clarify if, in case of different TLR7 expression between SCC and BCC, TLR7 expression would help to define basosquamous carcinoma (BSC), a tumor entity sharing characteristics of both SCC and BCC.

Methods:

We examined histopathological samples from 23 BCC, 4 BSC, and 24 SCC and characterized the expression of TLR7 by immunohistochemistry and immunofluorescence.

Results:

We found that TLR7 was not expressed by the tumor tissue of SCC, BCC, and BSC, but by inflammatory cells located within the tumoral and/or peritumoral tissue. Whereas the overall expression of TLR7 did not differ between BCC and SCC (30.4% vs. 45.8%, respectively), we found that within the group of SCC, the well-differentiated SCC showed strong tumoral and/or peritumoral immunocellular TLR7 reactivity in contrast to the poorly differentiated SCC (73.33% vs. 11.1%, respectively). Besides, immunofluorescence double staining revealed the expression of TLR7 in immune cells closely interacting with T cells and natural killer cells.

Conclusions:

In contrast to genomic data, we did not find a general difference between baseline TLR7 expression of SCC and BCC on the protein level. Nevertheless, the expression of TLR7 by the inflammatory infiltrate associated with SCC may correlate with the degree of differentiation of SCC possibly indicating better outcome.
Coccidioidomycosis Involving Lungs and Skin: A Mimicker of Metastatic Disease
Authors: Saenz-Ibarra Barbara , Prieto Victor G. , Torres-Cabala Carlos A. , Huen Auris , Nagarajan Priyadharsini , Tetzlaff Michael T. , Curry Jonathan L. , Ivan Doina , Aung Phyu P.
Published: August 2017

Coccidioidomycosis is the major systemic mycoses, considered to be 1 of the most infectious fungal diseases. In symptomatic patients, the most common manifestation is pulmonary disease, but many other organs can be affected. Disseminated disease occurs in 1%–5% of all patients affected by coccidioidomycosis and can affect any organ, with the skin, central nervous system, and musculoskeletal system being reported as the most prevalent. Here, we report a 42-year-old male farmer from the west Texas who presented with an approximately 2-month history of progressive shortness of breath and dyspnea on exertion, weight loss, and night sweats. He was treated with various antibiotics for possible upper respiratory tract infection without symptomatic improvement. Computed tomography of the chest revealed numerous subcentimeter noncalcified pulmonary nodules scattered throughout both lungs with extensive mediastinal and bilateral hilar lymphadenopathy. The patient was referred to our hospital for further evaluation of suspected metastatic lung disease. Physical examination revealed an erythematous 1.2 cm nodule on his left medial eyebrow. Skin biopsy of the lesion revealed prominent squamous epithelial hyperplasia with basal keratinocytic atypia and associated mixed inflammatory infiltrate and scattered large thick-walled spherules containing variable-sized endospores, predominantly within the multinucleated giant cells. Special stain Periodic acid–Schiff tissue culture studies confirmed these to be Coccidioides immitis. After appropriate treatment with antifungal therapy for 5.5 months, his symptoms have improved with complete disappearance of lung nodules and a partially cavitated (1.1 × 1.1 cm) lesion in the left upper lung confirmed by follow-up chest computed tomography. With this report, the authors highlight disseminated coccidioidomycosis, a great mimicker of metastatic lung disease, which was diagnosed by skin biopsy, to ensure its prompt recognition and appropriate antifungal therapy.