bluuebunny/crossref_metadata_2025 huggingface dataset:
Mutations in BRCA2 and taxane resistance in prostate cancer
Authors: Nientiedt Cathleen , Heller Martina , Endris Volker , Volckmar Anna-Lena , Zschäbitz Stefanie , Tapia-Laliena María A. , Duensing Anette , Jäger Dirk , Schirmacher Peter , Sültmann Holger , Stenzinger Albrecht , Hohenfellner Markus , Grüllich Carsten , Duensing Stefan
Published: June 2017

Mutations in BRCA1 or BRCA2 define a subset of prostate cancer patients. Herein, we address the question whether BRCA1/2 mutations have a predictive impact on chemotherapy with docetaxel, a widely used drug in patients with metastatic castration resistant prostate cancer (mCRPC). Fifty-three men treated with docetaxel for mCRPC were tested for somatic BRCA1/2 mutations of the primary tumor. In a subgroup of patients, BRCA1/2 protein expression was tested as a potential surrogate marker for BRCA1/2 inactivation. Eight of 53 patients (15.1%) harbored a deleterious BRCA2 mutation. No BRCA1 mutation was found. Patients with a BRCA2 mutation showed a response rate of 25% to docetaxel in comparison to 71.1% in men with wildtype BRCA2 (p = 0.019). While the time to develop castration resistance was similar in both subgroups, the overall survival was significantly shorter in patients harboring a BRCA2 mutation. No correlation between the BRCA1/2 protein expression and the response to docetaxel was found. While the presence of a BRCA2 mutation does not preclude a response to docetaxel, there is overall a significant correlation between BRCA2 inactivation and a poor response rate. Our results suggest that a close oncological monitoring of patients with BRCA2 mutations for taxane resistance is warranted.
Influence of pore topology on synthesis and reactivity of Sn-modified zeolite catalysts for carbohydrate conversions
Authors: van der Graaff William N. P. , Tempelman Christiaan H. L. , Pidko Evgeny A. , Hensen Emiel J. M.
Published: June 2017

A range of Sn-modified MWW, MFI, MOR and Beta zeolites were prepared by a post-synthetic Sn functionalization method and their catalytic properties for sugar conversions were evaluated.
Activation of antioxidant and detoxification gene expression in cucumber plants exposed to a Cu(OH)2nanopesticide
Authors: Zhao Lijuan , Hu Qirui , Huang Yuxiong , Fulton Aaron N. , Hannah-Bick Cameron , Adeleye Adeyemi S. , Keller Arturo A.
Published: June 2017

A Cu(OH)2nanopesticide induced oxidative stress and activated the antioxidant defense system in cucumber plants.
Residual weakly bound ligands influence biological compatibility of mixed ligand shell, thiol-stabilized gold nanoparticles
Authors: Truong Lisa , Zaikova Tatiana , Schaeublin Nicole M. , Kim Ki-Tae , Hussain Saber M. , Hutchison James E. , Tanguay Robert L.
Published: June 2017

Mixed ligand shells are frequently employed to impart multiple and new functions to inorganic nanoparticles.
Extraction of antioxidant and antiproliferative ingredients from fruits of Rubus chingii Hu by active tracking guidance
Authors: Zhang Tian-Tian , Liu Ya-Jun , Yang Li , Jiang Jian-Guo , Zhao Jing-Wen , Zhu Wei
Published: June 2017

Rubus chingii Hu, namely “Fu-pen-zi” in Chinese, has been used as a functional food in China for a long time.
Recent structural insights into the function of copper nitrite reductases
Authors: Horrell Sam , Kekilli Demet , Strange Richard W. , Hough Michael A.
Published: June 2017

Copper nitrite reductases (CuNiRs) catalyse the reduction of nitrite to nitric oxide as part of the denitrification pathway. In this review, we describe insights into CuNiR function from structural studies.
Porphyra polysaccharide-derived carbon dots for non-viral co-delivery of different gene combinations and neuronal differentiation of ectodermal mesenchymal stem cells
Authors: Chen Jiaxin , Wang Qiang , Zhou Jie , Deng Wenwen , Yu Qingtong , Cao Xia , Wang Jianping , Shao Fengxia , Li Yang , Ma Ping , Spector Myron , Yu Jiangnan , Xu Ximing
Published: June 2017

Multifunctional CDs co-deliver transcription factors for neuronal differentiation of EMSCs for the first time.
Distinguishing relaxation dynamics in transiently crosslinked polymeric networks
Authors: Tan Cindy Soo Yun , Agmon Gillie , Liu Ji , Hoogland Dominique , Janeček Emma-Rose , Appel Eric A. , Scherman Oren A.
Published: June 2017

Polymeric materials based on reversible non-covalent associations possess diverse mechanical behaviour, which can be orthogonally accessed through polymer molecular weight and control over physical crosslinks.
Structural and magnetic properties and DFT analysis of ZnO:(Al,Er) nanoparticles
Authors: Bououdina M. , Azzaza S. , Ghomri R. , Shaikh M. Nasiruzzaman , Dai J. H. , Song Y. , Song W. , Cai W. , Ghers M.
Published: June 2017

The structural and magnetic properties of the investigated ZnO : (Al, Er) nanoparticle powders synthesized by hydrothermal method.
Authentication of shrimp muscle in complex foodstuff by in-solution digestion and high-resolution mass spectrometry
Authors: Chen Qing , Pan Xiao-Dong , Huang Bai-Fen
Published: June 2017

A method for shrimp muscle identification in complex foods is required to safeguard the shrimp-allergic population.
Enhancing the stability of organolead halide perovskite films through polymer encapsulation
Authors: McKenna Barry , Troughton Joel R. , Watson Trystan M. , Evans Rachel C.
Published: June 2017

The ability of different polymer encapsulants to enhance the thermal stability of organolead halide perovskite films has been investigated. Epifluorescence microscopy provides crucial insight into early onset thermal degradation.
Utilizing light-triggered plasmon-driven catalysis reactions as a template for molecular delivery and release
Authors: Gu Xin , Wang Huan , Camden Jon P.
Published: June 2017

A template for molecular delivery and release by utilizing a plasmon-driven reaction.
Drastic improvement in the photocatalytic activity of Ga2O3 modified with Mg–Al layered double hydroxide for the conversion of CO2 in water
Authors: Iguchi Shoji , Hasegawa Yudai , Teramura Kentaro , Kidera Shotaro , Kikkawa Soichi , Hosokawa Saburo , Asakura Hiroyuki , Tanaka Tsunehiro
Published: June 2017

Modification of Ga2O3 photocatalyst with a Mg–Al layered double hydroxide (LDH) considerably enhanced not only the amount of CO evolved but also the selectivity toward CO evolution in the photocatalytic conversion of CO2 in water.
Facile fabrication of a resveratrol loaded phospholipid@reduced graphene oxide nanoassembly for targeted and near-infrared laser-triggered chemo/photothermal synergistic therapy of cancer in vivo
Authors: Hai Luo , He Dinggeng , He Xiaoxiao , Wang Kemin , Yang Xue , Liu Jinquan , Cheng Hong , Huang Xiaoqin , Shangguan Jingfang
Published: June 2017

A resveratrol-loaded phospholipid coated reduced graphene oxide was prepared using a sonication method.
Rapamycin alleviates inflammation and muscle weakness, while altering the Treg/Th17 balance in a rat model of myasthenia gravis
Authors: Jing Feng , Yang Fei , Cui Fang , Chen Zhaohui , Ling Li , Huang Xusheng
Published: June 2017

Myasthenia gravis (MG) is an autoimmune disease commonly treated with immunosuppressants. We evaluated the novel immunosuppressant, rapamycin (RAPA), in a rat model of experimental autoimmune MG (EAMG). Mortality rates in the RAPA (12%) were significantly down compared with the EAMG (88%) or cyclophosphamide (CTX) (68%) intervention groups. Muscular weakness decreased after both RAPA and CTX treatment. However, Lennon scores were lower (1.74 ± 0.49, 3.39 ± 0.21, and 3.81 ± 0.22 in RAPA, CTX, and EAMG groups, respectively), and body weights (203.12 ± 4.13 g, 179.23 ± 2.13 g, and 180.13 ± 5.13 g in RAPA, CTX, and EAMG groups, respectively) were significantly higher, only in the RAPA group. The proportion of regulatory T cells (Treg) significantly increased, while that of Th17 cells significantly decreased in the RAPA group compared with the EAMG group. In comparison, CTX intervention resulted in increased Th17 but significantly decreased Tregs. Hence, RAPA can be more effectively used in comparison with CTX to treat MG, with an efficacy higher than that of CTX. In addition, our results suggest RAPA’s efficacy in alleviating symptoms of MG stems from its ability to correct the Treg/Th17 imbalance observed in MG.
Review of recent research towards power cable life cycle management
Authors: Zhou Chengke , Yi Huajie , Dong Xiang
Published: June 2017

Power cables are integral to modern urban power transmission and distribution systems. For power cable asset managers worldwide, a major challenge is how to manage effectively the expensive and vast network of cables, many of which are approaching, or have past, their design life. This study provides an in‐depth review of recent research and development in cable failure analysis, condition monitoring and diagnosis, life assessment methods, fault location, and optimisation of maintenance and replacement strategies. These topics are essential to cable life cycle management (LCM), which aims to maximise the operational value of cable assets and is now being implemented in many power utility companies. The review expands on material presented at the 2015 JiCable conference and incorporates other recent publications. The review concludes that the full potential of cable condition monitoring, condition and life assessment has not fully realised. It is proposed that a combination of physics‐based life modelling and statistical approaches, giving consideration to practical condition monitoring results and insulation response to in‐service stress factors and short term stresses, such as water ingress, mechanical damage and imperfections left from manufacturing and installation processes, will be key to success in improved LCM of the vast amount of cable assets around the world.
Boron nitride microsphere/epoxy composites with enhanced thermal conductivity
Authors: Sun Jiajia , Wang De , Yao Yimin , Zeng Xiaoliang , Pan Guiran , Huang Yun , Hu Jiantao , Sun Rong , Xu Jian‐Bin , Wong Ching‐Ping
Published: June 2017

As modern electronics are developed towards miniaturisation, high‐degree integration and intelligentisation, a large amount of heat will be generated during the operation of devices. How to efficiently remove needless heat is becoming more and more crucial for the lifetime and performance of electronic devices. Many efforts have been made to improve the thermal conductivity of polymer composites, which is an important component of electronics. Herein, the authors report on preparation of boron nitride micosphere/epoxy composites. The cross‐plane thermal conductivity of the resultant composites is up to 1.03 Wm‒1K‒1. This is attributed to the thermally conductive network formed by the peeled hexagonal boron nitride flakes. Thanks to the superior thermal stability of boron nitride micosphere, the boron nitride micosphere/epoxy composite shows a decreased coefficient of thermal expansion (53.47 ppm/K) and an increased glass transition temperature (147.2°C) compared with the pure epoxy resin. In addition, the boron nitride micosphere/epoxy composite exhibits a lower dielectric constant compared with that of the hexagonal boron nitride/epoxy composite. This strategy can potentially pave the way for the design and fabrication of materials with high cross‐plane thermal conductivity and lower dielectric properties.
Micro‐movement magnification in video signals using complex wavelet analysis
Authors: Fahmy Gamal , Fahmy Mamdouh F. , Fahmy Omar M.
Published: June 2017

Magnifying micro‐movements from natural video has recently been investigated by several computer vision researchers, due to its impact in numerous applications. In this study, the authors analyse video signals and try to magnify micro‐movements/vibrations to make them visible. These micro‐movements are typically undetectable and cannot be seen by basic human vision. They utilise complex wavelets to analyse sequential frames and detect any minor change in object's spatial position. They magnify some specific complex wavelet frequency bands by a multiplication factor and reconstruct back the video signal after some manipulation and modification to make these micro‐movements seen and observable. They compare their work with recent techniques in micro‐motion magnification (Freeman et al.) and try to show the merits of each technique. These micro‐movements can later be utilised in different applications such as medical imaging, structural engineering, mechanical engineering, physical feature analysis and industrial engineering, as will be seen in their experiments.
Single coupled‐inductor dual output soft‐switching DC–DC converters with improvedcross‐regulation and reduced components
Authors: Chen Guipeng , Chen Luan , Deng Yan , He Xiangning , Wang Yousheng , Zhang Jiangfeng
Published: June 2017

Single inductor dual‐output (SIDO) DC–DC converters are attractive in diverse applications such as renewable energy systems and electric vehicles, due to its favourable advantages of reduced magnetic core and high‐power density. However, in conventional SIDO converters, severe cross‐regulation problem is caused by the multiplex of inductor current, resulting in deteriorated dynamic performance. To alleviate the cross‐regulation problem, a new family of dual‐output DC–DC converters is proposed in this paper, which employs a coupled inductor to substitute the inductor in SIDO converters. The proposed converters can achieve improved dynamic performance while keeping the advantage of reduced magnetic core. Moreover, the number of semiconductor devices is also reduced in comparison with conventional SIDO converters, and soft‐switching operation of switches is also achieved. Therefore, lower cost and higher power density are obtained. Topology derivation of proposed converters from conventional SIDO converters is firstly demonstrated in detail. After that, the operation principle, steady‐state characteristics and small‐signal model are provided. Finally, design example and experiment results are given to validate the merits of the proposed topology.
Controllability and observability analysis of basal ganglia model and feedback linearisation control
Authors: Rouhollahi Korosh , Emadi Andani Mehran , Izadi Iman , Karbassi Seyed Mahdi
Published: June 2017

Deep brain stimulation (DBS) is a clinical remedy to control tremor in Parkinson's disease. In DBS, one of the two main areas of basal ganglia (BG) is stimulated. This stimulation is produced with no feedback of the tremor and often causes a wide range of unpleasant side effects. Using a feedback signal from tremor, the stimulatory signal can be reduced or terminated to avoid extra stimulation and as a result decrease the side effects. To design a closed‐loop controller for the non‐linear BG model, a complete study of controllability and observability of this system is presented in this study. This study shows that the BG model is controllable and observable. The authors also propose the idea of stimulating the two BG areas simultaneously. A two‐part controller is then designed: a feedback linearisation controller for subthalamic nucleus stimulation and a partial state feedback controller for globus pallidus internal stimulation. The controllers are designed to decrease three indicators: the hand tremor, the level of delivered stimulation signal in disease condition, and the ratio of the level of delivered stimulation signal in health condition to disease condition. Considering these three indicators, the simulation results show satisfactory performance.
Synthesis, optical and magnetic properties of a new nanocomposite HAp/CoFe2O4/RGO
Authors: Sakhaei Fatemeh , Salahi Esmaeil , Olya Mohammad Ebrahim , Mobasherpour Iman
Published: June 2017

Magnetically separable CoFe2O4/reduced graphene oxide (CoFe2O4/RGO) and a new of magnetic hydroxyapatite/CoFe2O4/RGO nanocomposites (HAp/CoFe2O4/RGO) were prepared via co‐precipitation along with hydrothermal methods. The characterisation and properties of the synthesised nanocomposite were analysed using Fourier transform infrared, X‐ray powder diffraction, vibrating sample magnetometer, field emission scanning electron microscopy, transmission electron microscopy (TEM) and UV‐visible spectroscopy. TEM images show that the synthetic RGO layers are decorated with 10 nm CoFe2O4 particles and HAp nanorods of about 10 nm diameter and 100 nm average length are well separated and uniformly distributed. In addition, separation of the layers from one another and approximately uniform distribution on nanosheets is completely visible. Due to the magnetic properties of HAp/CoFe2O4/RGO nanocomposite, it can be separated from the environment by an external magnetic field. In addition, the energy gap measurements represent the effective role of CoFe2O4/RGO inremarkable decreasing of the energy gap of the nano‐HAp.
Nanoscale static voltage generation and its surface potential decay using scanning probe microscopy
Authors: Rajeev Sreenidhi Prabha , Cherumannil Karumuthil Subash , Valiyaneerilakkal Uvais , Varghese Soney
Published: June 2017

This work aims at the manipulation of nanoscopic voltage produced through uniform and non‐uniform rubbing in neat unpolarised polymer polyvinylidene fluoride. A metal–insulator configuration is considered for the analysis. The decay of surface potential in such a configuration is also addressed in this work. The polarity of the voltage observed on the film depends on the work function of the metal electrode in contact as well as the electronegativity of polymeric material under study. Scanning probe microscopic techniques such as dynamic contact mode electrostatic force microscopy, scanning tunnelling microscopy are used for the investigation of specific electrostatic potential variation on polymer films. Effect of contact electrification leads to nanoscopic domains of voltage generation on the surface of the tribolayers. Electrostatic potential developed on the surface of unrubbed polymer film using modulated tip is in the range of 20–40 mV. The range of voltage generated increased from 20 to 125 mV in the case of rubbed polymer films. Charge retention is discussed through obtaining surface potential decay trend at various intervals. This also plays an important role in the generation of the voltage as well as the current. The above scenario has been demonstrated in both rubbed and unrubbed scenarios. Charge decay is observed to be gradually decreasing from 40 to 29.5 mV in unrubbed surface and 125 to 14 mV in rubbed surface for various time intervals. The obtained results suggest insignificance of triboelectric series on contact electrification between similar tribolayers.
Perinatal and Childhood Outcomes Associated with Infertility
Authors: Zore Temeka , Wang Erica
Published: June 2017

Infertility affects 11% of reproductive-age women in the United States and the number of live births from infertility treatment, both in vitro fertilization (IVF) and non-IVF fertility treatment (NIFT), continues to rise. Given this trend, the perinatal and childhood outcomes of children conceived with assisted reproduction are of critical importance. We provide a comprehensive overview of the current literature, consisting primarily of observational cohort studies focused on IVF children. The outcomes of interest include (1) perinatal outcomes of low birth weight and prematurity; (2) congenital birth defects; (3) childhood development to encompass autism spectrum disorders, development, and school functioning; (4) growth and puberty: and (5) childhood cancer. Overall, these data appear to be reassuring; however, further studies are needed to clarify the role of underlying parental infertility and to focus on NIFT conceptions. There remains a paucity of long-term data for these children as they progress to adulthood and long-term prospective registries will be the key to answering these questions.
Stellenwert der selektiven Lasertrabekuloplastik (SLT)
Authors: Schlote Torsten
Published: June 2017

Hintergrund Die selektive Lasertrabekuloplastik (SLT) hat sich in den letzten Jahren zu einer sehr erfolgreichen Behandlungsform des Glaukoms entwickelt.

Material und Methoden Aktuelle Literaturrecherche in PubMed. Eigene klinische Erfahrungen flossen in die Bewertung von Zusammenhängen ein.

Ergebnisse Die SLT kann mit vergleichbarer Effektivität wie eine Argonlasertrabekuloplastik (ALT) oder eine medikamentöse Ersttherapie bei allen häufigen Formen des Offenwinkelglaukoms und der okulären Hypertension eingesetzt werden. Im Vergleich zur ALT zeigt die SLT Vorteile: Es wird wesentlich weniger Energie benötigt und die SLT kann wiederholt werden. Die SLT hat auch Anwendung in einigen selteneren Indikationsbereichen gefunden. Sie beeinflusst andere Formen der Glaukombehandlung nicht negativ. Die Risiken sind gering und beinhalten Druckspitzen und sehr selten Hornhautveränderungen (Endothelzellversagen, Hornhauttrübung und -vernarbung) oder ein zystoides Makulaödem. Aufgrund ihres Potenzials als Ersttherapie wird die SLT auch aktuell intensiv beforscht.

Schlussfolgerung Die SLT ist eine risikoarme Behandlungsmethode des Glaukoms mit sehr breitem Indikationsbereich. Aufgrund der Vorteile der SLT ist eine weitere Verbreitung als Ersttherapie denkbar. Die SLT ist deshalb Gegenstand der aktuellen Forschung.
Vernetzung in der medizinischen Versorgung
Authors: Dinges Martin
Published: June 2017

Patientennetzwerke werden weniger als die Netzwerke der Ärzte beachtet. Sie sind aber ebenfalls wichtig: Das gilt vor allem hinsichtlich der Entscheidung für die Homöopathie als therapeutisches System, die oft auf Laienempfehlungen hin erfolgt. Hier wird vor allem rekonstruiert, welche Motive Bettine und Achim von Arnim von der Homöopathie – unterschiedlich stark – überzeugten und welche familiären und gesellschaftlichen Beziehungen Bettine während der ersten Jahre ihres Engagements nutzte, um für die Homöopathie zu werben.
The doublesex-related Dmrta2 safeguards neural progenitor maintenance involving transcriptional regulation of Hes1
Authors: Young Fraser I. , Keruzore Marc , Nan Xinsheng , Gennet Nicole , Bellefroid Eric J. , Li Meng
Published: June 2017

Significance

Maintaining an intricate balance between continued progenitor proliferation and cell cycle exit/differentiation is pivotal for proper brain development. Disruption of this delicate process can lead to brain malformations, such as microlissencephaly. In this paper, we identify Dmrta2 (doublesex- and mab-3–related transcription factor a2, also known as Dmrt5) as an important transcription factor that helps regulate the fine tuning between cell cycle progression and neuronal differentiation. Mechanistically, this function of Dmrta2 involves direct transcriptional regulation of a known repressor of neurogenesis Hes1. Our findings thus add Dmrta2 to the complex regulatory machinery controlling cortical NPC maintenance, and provide an explanation for the microlissencephaly caused by Dmrta2 deficiency in model organisms and humans.
Reducedness of affine Grassmannian slices in type A
Authors: Kamnitzer Joel , Muthiah Dinakar , Weekes Alex , Yacobi Oded
Published: June 2017

We prove in type A a conjecture which describes the ideal of transversal slices to spherical Schubert varieties in the affine Grassmannian. As a corollary, we prove a modular description (due to Finkelberg-Mirković) of the spherical Schubert varieties.
How PAs became licensed to practice in the United States
Authors: Sadler Alfred M. , Davis Ann
Published: June 2017

The history of how PAs in the United States were first granted practice authority under the medical practice acts of the various states and territories begins in the 1960s with an imaginative way to circumvent the moratorium on licensure of new healthcare occupations in place at the time, while allowing the requisite flexibility for the new profession to take hold and thrive. In the subsequent decades, separate licensure for PAs was required and adopted. Despite the enormous success of the PA profession over its first 50 years, challenges remain.
History and Outcomes of 50 Years of Physician–Scientist Training in Medical Scientist Training Programs
Authors: Harding Clifford V. , Akabas Myles H. , Andersen Olaf S.
Published: June 2017

Physician-scientists are needed to continue the great pace of recent biomedical research and translate scientific findings to clinical applications. MD–PhD programs represent one approach to train physician–scientists. MD–PhD training started in the 1950s and expanded greatly with the Medical Scientist Training Program (MSTP), launched in 1964 by the National Institute of General Medical Sciences (NIGMS) at the National Institutes of Health. MD–PhD training has been influenced by substantial changes in medical education, science, and clinical fields since its inception. In 2014, NIGMS held a 50th Anniversary MSTP Symposium highlighting the program and assessing its outcomes. In 2016, there were over 90 active MD–PhD programs in the United States, of which 45 were MSTP supported, with a total of 988 trainee slots. Over 10,000 students have received MSTP support since 1964. The authors present data for the demographic characteristics and outcomes for 9,683 MSTP trainees from 1975–2014. The integration of MD and PhD training has allowed trainees to develop a rigorous foundation in research in concert with clinical training. MSTP graduates have had relative success in obtaining research grants and have become prominent leaders in many biomedical research fields. Many challenges remain, however, including the need to maintain rigorous scientific components in evolving medical curricula, to enhance research-oriented residency and fellowship opportunities in a widening scope of fields targeted by MSTP graduates, to achieve greater racial diversity and gender balance in the physician–scientist workforce, and to sustain subsequent research activities of physician–scientists.
Leadership Development Programs at Academic Health Centers: Results of a National Survey
Authors: Lucas Raymond , Goldman Ellen F. , Scott Andrea R. , Dandar Valerie
Published: June 2017

Purpose

To identify the prevalence and characteristics of faculty leadership development programs (LDPs) offered by North American academic health centers (AHCs) and to uncover gaps in leadership training.

Method

Faculty development/affairs deans of the 161 Association of American Medical Colleges member schools were surveyed in 2015 on their approach to faculty leadership training. For AHCs delivering their own training, the survey included questions about LDP participants, objectives, curriculum, delivery, resources, and evaluation. The literature on leadership and leadership development was used to develop a taxonomy of leadership competencies, which formed the basis of the survey questions related to program content. Survey results were analyzed with descriptive statistics and chi-square analysis for categorical data.

Results

Of the 94 respondents (response rate 58%), 93 provided some form of leadership training and 61 provided a formal internal faculty LDP. Content was variable and rarely based on a specific leadership competency model. Although programs described innovative approaches to learning, lectures and case discussions were the predominant approaches. Evaluation beyond participant satisfaction was uncommon.

Conclusions

Faculty LDPs were common, with some programs describing elements informed by the leadership literature. However, nationally programs can improve by basing content on a leadership competency model, incorporating multiple approaches to teaching, and implementing more rigorous program evaluation.
Tablet-Based Intervention for Reducing Children's Preoperative Anxiety: A Pilot Study
Authors: Chow Cheryl H. T. , Van Lieshout Ryan J. , Schmidt Louis A. , Buckley Norman
Published: June 2017

Objectives:

To examine the feasibility, acceptability, and effects of a novel tablet-based application, Story-Telling Medicine (STM), in reducing children's preoperative anxiety.

Methods:

Children (N = 100) aged 7 to 13 years who were undergoing outpatient surgery were recruited from a local children's hospital. This study comprised 3 waves: Waves 1 (n = 30) and 2 (n = 30) examined feasibility, and Wave 3 (n = 40) examined the acceptability of STM and compared its effect on preoperative anxiety to Usual Care (UC). In Wave 3, children were randomly allocated to receive STM+UC or UC. A change in preoperative anxiety was measured using the Children's Perioperative Multidimensional Anxiety Scale (CPMAS) 7 to 14 days before surgery (T1), on the day of surgery (T2), and 1 month postoperatively (T3).

Results:

Wave 1 demonstrated the feasibility of participant recruitment and data collection procedures but identified challenges with attrition at T2 and T3. Wave 2 piloted a modified protocol that addressed attrition and increased the feasibility of follow-up. In Wave 3, children in the STM+UC demonstrated greater reductions in CPMAS compared with the UC group (ΔM = 119.90, SE = 46.36, t(27) = 2.59, p = .015; 95% confidence interval = 24.78–215.02).

Conclusion:

This pilot study provides preliminary evidence that STM is a feasible and acceptable intervention for reducing children's preoperative anxiety in a busy pediatric operative setting and supports the investigation of a full-scale randomized controlled trial.
Ablative Fractional Laser Resurfacing With Laser-Assisted Delivery of 5-Fluorouracil for the Treatment of Cicatricial Ectropion and Periocular Scarring
Authors: Lee Bradford W. , Levitt Alexandra E. , Erickson Benjamin P. , Ko Audrey C. , Nikpoor Neda , Ezuddin Nisreen , Lee Wendy W.
Published: June 2017

Purpose:

Cicatricial ectropion and periocular scarring can cause significant functional and cosmetic deficits. Surgical treatments can be associated with recicatrization, donor site morbidity, and textural and pigmentary abnormalities. This case series reports on efficacy and safety of a novel nonsurgical approach to treating cicatricial ectropion using ablative fractional laser resurfacing and laser-assisted delivery of 5-fluorouracil.

Methods:

A retrospective review was conducted of all patients at a single institution who received ≥3 rounds of ablative fractional laser resurfacing with laser-assisted delivery of 5-fluorouracil. Six patients with cicatricial ectropion and periocular scarring secondary to reconstructive surgery, traumatic lacerations, and facial burns were included. Aesthetic and functional improvement were evaluated via fluorescein staining, tear breakup time, external photography, questionnaires gauging dry eye symptoms, and scar appearance.

Results:

All patients showed functional improvement based on fluorescein staining (mean improvement 6.0 ± 1.4; p = 0.0007) and other indicators of dry eye. All 4 patients with lagophthalmos improved and 2 showed complete resolution. All patients demonstrated significant cosmetic improvement based on a validated scar assessment questionnaire (mean improvement 37.5 ± 18.9; p = 0.004), and 5 of 6 patients reported improved satisfaction with scar appearance (mean improvement 19.3 ± 12.8; p = 0.014). There were no adverse effects reported.

Conclusions:

Ablative fractional laser resurfacing with laser-assisted delivery of 5-fluorouracil appears to be a safe and effective modality for treating the functional and aesthetic abnormalities associated with periocular scarring, yielding results that are difficult to attain through surgery alone. Optimal management of cicatricial ectropion and periocular scarring often requires multimodality treatment, and ablative fractional laser resurfacing with laser-assisted delivery of 5-fluorouracil may be considered as part of a comprehensive approach to managing periocular scars.
Predictors of Second Medical Emergency Team Activation Within 24 Hours of Index Event
Authors: Still Mary , Vanderlaan Jennifer , Brown Courtenay , Gordon Melissa , Graham Kimberly , Holder Carolyn , McMurtry James P. , Meyer Ellen , Morelock Vicki , Shapiro Susan
Published: June 2017

This study explored the trajectory of patients who remained on a general unit after medical emergency team activation. Of those who had a second activation within 24 hours, 80% occurred within 12 hours of the baseline activation. Chest pain and recent intensive care unit discharge were associated with having a second activation. There were statistically, not clinically, significant associations between mean vital signs and second activations; however, the patterns of change may be clinically useful.
Impact of a Restraint Management Bundle on Restraint Use in an Intensive Care Unit
Authors: Hall Debra K. , Zimbro Kathie S. , Maduro Ralitsa S. , Petrovitch Deborah , Ver Schneider Patricia , Morgan Merri
Published: June 2017

Restraint use has been linked to longer lengths of stay and other undesirable outcomes. This evidence-based project explored the impact of a restraint management bundle on restraint use, quality, and safety outcomes. Results indicated that the proportion of intensive care unit patients restrained decreased significantly (24.3% vs 20.9%) following program implementation. Project results suggest that the restraint management bundle may provide a framework for guiding the process to reduce restraint use, minimize harm, and improve patient safety.
Competency Milestones
Authors: Reville Barbara , Foxwell Anessa M.
Published: June 2017

Advanced practice nurses with specialty-level skills in hospice and palliative care are urgently needed to optimize care delivery for Americans with advanced serious illness. Leaders in the healthcare and nursing communities encourage new nurses to pursue higher education pathways, to enroll in postgraduate training programs, and to pursue career-long learning. An integral part of the learning process is evaluating competence in the knowledge, skills, and attitudes defined for the discipline. However, there are currently no established methods to track achievement of clinical competence for either trainees or practicing palliative nurses. In this article, the authors present the Advanced Practice Palliative Nurse Competency Milestones, a tool to assess and document emerging competency of palliative nurses across the career trajectory from novice to specialist. It is derived from the evidence-based Hospice and Palliative Nurses Association competencies for advanced practice palliative nurses and mapped across a developmental continuum using Benner’s novice-to-expert framework. The authors describe the tool’s development and application over a 2-year period.
Factors Influencing Chinese Nursing Students’ Attitudes Toward the Care of Dying Patients
Authors: Wang Liping , Chen Jing , Du Yanli , Wang Zhenzhen , Li Zhifang , Dong Zhaoyang
Published: June 2017

Nursing students play a very important role in providing care for dying patients in clinical practice, but little is known about the attitudes of nursing students in China. The aims of this study were to describe Chinese nursing students’ attitudes toward the care of dying patients and to describe the factors influencing these attitudes. A cross-sectional design was used, and the data were obtained from self-administered questionnaires. A convenience sample of 1133 nursing students was recruited from 8 nursing schools. Measurements included the demographic form and the Chinese version of the Frommelt Attitudes Toward Care of the Dying Scale, Form B. The mean score of all Frommelt Attitudes Toward Care of the Dying Scale, Form B items was 95.42 (SD, 6.76). More positive attitudes toward the care of dying patients were associated with willingness to care for dying persons, having religious beliefs, having received education on death and dying, having previous experience caring for dying patients, and currently anticipating the loss of a loved one. Factors predicting nursing students’ attitudes toward the care of dying patients included previous education on death and dying, willingness to care for dying persons, previous experience caring for dying patients, and religious beliefs, with an explanatory power of 20%. This study contributes to a better understanding of the factors that underlie nursing students’ attitudes toward caring for dying patients. Educational programs on end-of-life care for nursing students should be targeted to those nursing students who are unwilling to care for dying persons, those without religious beliefs, those with no previous education on death and dying, or those with no experience caring for dying patients.
Honoring Patient Choices With Advance Care Planning
Authors: Cantillo Michelle , Corliss Amy , Ashton Melinda , Kimata Chieko , Ruiz Jaclynn
Published: June 2017

Patients in Hawai’i are spending their dying days in the hospital and the intensive care unit. In Hawai’i, as of 2014, inpatient spending during the hospitalization in which death occurred was $5518, and US national average was $3802; 18.5% died in the intensive care unit compared with the US national average of 14.4%. Hawai’i has a high elder population who frequently have longer length of stays and are being readmitted to our facilities; 26.7% of deaths occur in Hawai’i hospitals versus the national average of 21.0% from 2003 to 2014. Furthermore, these patients are often not receiving the care that they would choose if informed of their options. The objective of this quality improvement project was to develop, implement, and evaluate the usefulness of an advance care planning (ACP) approach to assist clinicians in identifying and honoring patient choices. A target patient population (“Last Stages”) was identified for the project, and an ACP registry was created. Retrospective chart review showed that, for Last Stages patients, ACP documentation increased from 28.90% to 87.03%, and Provider Orders for Life-Sustaining Treatment completion rates rose from 12.89% to 53.90% after implementation of the ACP approach. Of the patients admitted to the hospital with Provider Orders for Life-Sustaining Treatment, 94% of these patients’ documented wishes were honored. Advance care planning processes did improve clinician adherence to patient choices, reducing the risk of patients receiving unwanted care.
Improved Rates of Immediate Breast Reconstruction at Safety Net Hospitals
Authors: Ballard Tiffany N. S. , Zhong Lin , Momoh Adeyiza O. , Chung Kevin C. , Waljee Jennifer F.
Published: June 2017

Background:

Substantial federal resources have been directed toward ensuring the delivery of high-quality care at safety net hospitals. Although disparities in receipt of breast reconstruction persist at the patient level, the extent to which hospital factors contribute to these differences remains unclear. The rates of immediate breast reconstruction across safety net and non–safety net hospitals were investigated.

Methods:

Women 21 years and older with breast cancer or increased risk of breast cancer undergoing immediate post-mastectomy reconstruction were identified in the Nationwide Inpatient Sample database. Safety net hospitals were defined as hospitals with the highest tertile of Medicaid disproportionate share hospital payment adjustments. Adjusted odds ratios of undergoing reconstruction were calculated.

Results:

Thirty-one percent of patients (n = 10,910) at safety net hospitals underwent immediate reconstruction compared with 46 percent of patients (n = 14,619) at non–safety net hospitals (p < 0.001). Logistic regression revealed that women at non–safety net hospitals were significantly more likely to undergo reconstruction (OR, 1.89; 95 percent CI, 1.65 to 2.16). However, analysis by study year revealed that rates of reconstruction at safety net hospitals increased over time.

Conclusions:

After accounting for sociodemographic factors, women undergoing mastectomies at safety net hospitals remain less likely to undergo immediate breast reconstruction. However, the differences in rates of reconstruction between safety net and non–safety net hospitals have narrowed over time. The availability of immediate reconstruction lessens the psychological trauma of mastectomy, and it is critical to continue redirecting federal efforts toward this valuable component of breast cancer care.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, II.
Oxygen-Sensing Paint-On Bandage: Calibration of a Novel Approach in Tissue Perfusion Assessment
Authors: Koolen Pieter G. L. , Li Zongxi , Roussakis Emmanuel , Paul Marek A. , Ibrahim Ahmed M. S. , Matyal Robina , Huang Thomas , Evans Conor L. , Lin Samuel J.
Published: June 2017

Background:

Knowledge of tissue oxygenation status is fundamental in the prevention of postoperative flap failure. Recently, the authors introduced a novel oxygen-sensing paint-on bandage that incorporated an oxygen-sensing porphyrin with a commercially available liquid bandage matrix. In this study, the authors extend validation of their oxygen-sensing bandage by comparing it to the use of near-infrared tissue oximetry in addition to Clark electrode measurements.

Methods:

The oxygen-sensing paint-on bandage was applied to the left hind limb in a rodent model. Simultaneously, a near-infrared imaging device and Clark electrode were attached to the right and left hind limbs, respectively. Tissue oxygenation was measured under normal, ischemic (aortic ligation), and reperfused conditions.

Results:

On average, the oxygen-sensing paint-on bandage measured a decrease in transdermal oxygenation from 85.2 mmHg to 64.1 mmHg upon aortic ligation. The oxygen-sensing dye restored at 81.2 mmHg after unclamping. Responses in both control groups demonstrated a similar trend. Physiologic changes from normal to ischemic and reperfused conditions were statistically significantly different in all three techniques (p < 0.001).

Conclusions:

The authors’ newly developed oxygen-sensing paint-on bandage exhibits a comparable trend in oxygenation recordings in a rat model similar to conventional oxygenation assessment techniques. This technique could potentially prove to be a valuable tool in the routine clinical management of flaps following free tissue transfer. Incorporating oxygen-sensing capabilities into a simple wound dressing material has the added benefit of providing both wound protection and constant wound oxygenation assessment.
Botulinum Toxin for Neck Rejuvenation: Assessing Efficacy and Redefining Patient Selection
Authors: Jabbour Samer F. , Kechichian Elio G. , Awaida Cyril J. , Tomb Roland R. , Nasr Marwan W.
Published: June 2017

Background:

The “Nefertiti lift” consists of injecting the platysmal bands and the inferior border of the mandible with botulinum toxin. No clinical trial has evaluated its effect on the different lower face and neck aging components, and little is known about the clinical characteristics that predict treatment success.

Methods:

Patients were injected with abobotulinumtoxinA along the inferior border of the mandible and into the platysmal bands. Using standardized preinjection and postinjection photographs, the jowls, marionette lines, oral commissures, neck volume, and platysmal bands at maximal contraction and at rest were assessed with validated photonumeric scales. In addition, the overall appearance of the lower face and neck was evaluated by the Investigators and Subjects Global Aesthetic Improvement Score. Pain and patient satisfaction rates were also evaluated.

Results:

Thirty patients were injected with a mean dose of 124.9 U of abobotulinumtoxinA per patient. Platysmal bands at rest and with maximal tension reached a statistically significant improvement. The other components showed a tendency for improvement but did not reach statistical significance; 93.3 percent of investigators and patients rated the overall results as improved, and 96.6 percent of patients were satisfied with their results. When comparing the patients who improved the most to all the other patients, they had lower preinjection region-specific scores.

Conclusions:

The Nefertiti lift can be used on its own or in conjunction with other rejuvenating procedures. It is particularly helpful in younger patients with platysma muscle hyperactivity and retained skin elasticity.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
The Ideal Buttock Size: A Sociodemographic Morphometric Evaluation
Authors: Heidekrueger Paul I. , Sinno Sammy , Tanna Neil , Szpalski Caroline , Juran Sabrina , Schmauss Daniel , Ehrl Denis , Ng Reuben , Ninkovic Milomir , Broer P. Niclas
Published: June 2017

Background:

Perception of beauty is influenced by geographic, ethnic, cultural, and demographic factors. However, objective measurements remain the foundation for aesthetic evaluations. In the quest to better define the “ideal” female buttock, this study assumes interdependence among variables such as country of residence, sex, age, occupation, and aesthetic perception, yielding a waist-to-hip ratio that appears most pleasing across most cultures and geographic locations.

Methods:

An online survey was designed. Modifiable ranges of buttock sizes were achieved by means of digital alteration, enabling participants to interactively change the size and waist-to-hip ratio of a single model’s buttocks. The questionnaire was translated into multiple languages and sent to more than 9000 plastic surgeons and to the general public worldwide. Demographic data were collected, and analysis of variance was used to elucidate buttock shape preferences.

Results:

A total of 1032 responses were gathered from over 40 different countries. Significant differences regarding preferences for buttock size were identified across the respondents. Overall, 404 of 1032 of survey takers (39 percent) chose the 0.7 waist-to-hip ratio to be their ideal. Significant relationships were distilled between sex, age, self-reported ethnicity, plastic surgeons’ country of residence, and ethnic background. For example, surgeons in Latin America preferred the largest buttocks, followed by surgeons in Asia, North America, and Europe, with non-Caucasians preferring larger buttocks than Caucasians.

Conclusion:

There seems to exist a global consensus regarding the ideal waist-to-hip ratio; however, multiple other factors impact the aesthetic perception of the buttocks significantly.
Evidence-Based Medicine: Wound Management
Authors: Jones Christine M. , Rothermel Alexis T. , Mackay Donald R.
Published: June 2017

Learning Objectives:

After reading this article, the participant should be able to: 1. Describe the basic science of chronic wounds. 2. Discuss the general and local factors that should be considered in any patient with a chronic wound. 3. Discuss the rationale of converting a chronic wound into an acute wound. 4. Describe techniques used to prepare chronic wounds. 5. Discuss the appropriate use of different dressings presented in this article. 6. Discuss the pros and cons of the adjuncts to wound healing discussed in this article.

This is the second Maintenance of Certification article on wound healing. In the first, Buchanan, Kung, and Cederna dealt with the mechanism and reconstructive techniques for closing wounds. In this article, the authors have concentrated on the chronic wound. The authors present a summary of the basic science of chronic wounds and the general and local clinical factors important in assessing any chronic wound. The evidence for interventions of these conditions is presented. The surgical and nonsurgical methods of wound preparation and the evidence supporting the use of the popular wound dressings are presented. The authors then present the evidence for some of the popular adjuncts for wound healing, including hyperbaric oxygen, electrotherapy, and ultrasound. A number of excellent articles on negative-pressure wound therapy have been written, and are not covered in this article.