bluuebunny/crossref_metadata_2025 huggingface dataset:
The American Society of Retina Specialists 2016 Founders Award Lecture
Authors: Shields Carol L. , Shields Jerry A.
Published: January 2017

Purpose:

To review the current state of the art of retinal tumors with respect to clinical features, imaging, and management.

Methods:

Review of published literature and personal experience from an ocular oncology service.

Results:

There are several tumors that arise from the sensory retina including those of glial origin (astrocytic hamartoma, acquired astrocytoma, and solitary circumscribed retinal astrocytic proliferation), neural origin (retinoblastoma), and vascular origin (hemangioblastoma, cavernous hemangioma, racemose hemangioma, and vasoproliferative tumor). Most retinal tumors are benign with the exception of retinoblastoma and retinal metastasis. Some retinal tumors are associated with systemic oculoneurocutaneous syndromes such as tuberous sclerosis complex (TSC), 13q deletion syndrome, Von Hippel–Lindau disease, and systemic cavernous and racemose hemangioma syndromes with ocular, cutaneous, neurologic, and other findings. Regarding management, recent data indicate that retinal astrocytic hamartoma and retinal achromic patch are key to the diagnosis of TSC and imply greater risk for brain and kidney tumors. Some children with TSC respond to mammalian target of rapamycin inhibitors, controlling brain, kidney, and eye tumors. Children with retinoblastoma are all screened genetically, and systemic evaluation is provided for detection of metastasis and secondary-related tumors. Newer chemotherapy regimens by intravenous or intra-arterial routes have revolutionized retinoblastoma control. Retinal vascular tumors are uncommon but can have serious systemic implications. Therefore, imaging of the brain for related cerebellar hemangioblastoma, midbrain racemose hemangioma, or multifocal cavernomas is performed. Genetic testing for each disease can be revealing.

Conclusions:

Retinal tumors are often benign, can be recognized by clinical and imaging features, and can be associated with important systemic syndromes.
Progression From No AMD to Intermediate AMD as Influenced by Antioxidant Treatment and Genetic Risk
Authors: Awh Carl C. , Zanke Brent , Kustra Rafal
Published: January 2017

Purpose:

To investigate the impact of antioxidant treatment and genetic risk on the development of intermediate age-related macular degeneration (AMD) in patients without baseline AMD, using data from the Age-Related Eye Disease Study (AREDS) Cataract Trial.

Methods:

Genetic risk and antioxidant treatment were analyzed as independent and interacting risk factors for the development of intermediate AMD in 554 AREDS individuals for whom genotyping was available. Genetic risk was determined using an allele dosage model based on the total number of complement factor H and age-related maculopathy sensitivity 2 risk alleles.

Results:

Overall, 14% of patients developed intermediate AMD over approximately 8 years. The risk of developing intermediate AMD varied from 6.5% for patients with 0 risk alleles to 39% for those with 3 or 4 risk alleles ( P < .0001). Antioxidants had no impact on the development of intermediate AMD overall. However, antioxidant treatment had a significant impact on progression to intermediate AMD for patients with low or high genetic risk. Patients with 0 or 1 risk alleles had increased risk of progression to intermediate AMD (hazard ratio [HR] = 2.31, P = .017) if treated with antioxidants compared to placebo. Patients with 3 or 4 risk alleles had decreased risk of progression to intermediate AMD (HR = 0.27, P = .0008) if treated with antioxidants compared to placebo.

Conclusion:

On average, antioxidant treatment has no impact on the development of intermediate AMD in patients without AMD. However, antioxidant treatment may increase the risk of developing intermediate AMD in patients with low genetic risk and may reduce the risk of developing intermediate AMD in patients with high genetic risk. Since patients with high genetic risk have the greatest risk of progressing from intermediate to advanced AMD, genotype-directed antioxidant treatment of patients without AMD may ultimately lead to fewer cases of advanced AMD.
Does Internal Limiting Membrane Peeling Size Matter?
Authors: Steel David H. W. , Chen Yunzi , Latimer James , White Kathryn , Avery Peter J.
Published: January 2017

Purpose:

A variety of retinal topographical changes occur after internal limiting membrane (ILM) peeling for macular holes including a movement of the fovea toward the optic nerve. This study was carried out to assess the effect of the extent of ILM-peeled area on these changes and postoperative visual acuity.

Methods:

Prospective single-center study of a consecutive series of patients undergoing macular hole surgery. Preoperative and postoperative optical coherence tomography images were used to assess a variety of measures of retinal morphology. Transmission electron microscopy of the peeled ILM was used to assess residual retinal and vitreous side debris. The area of the ILM peeled was calculated from intraoperative images.

Results:

Fifty-six eyes of 56 patients were included. The mean area of ILM peeled was 9.5 mm2 (2.4-28.3 mm2). The mean disc-to-fovea distance (DFD) preoperatively was 3703 μm with a mean reduction of 52 μm postoperatively, representing a change of −1.29% with a wide range of −7.04% to 1.36%. Using stepwise linear regression, ILM-peeled area was significantly associated with a change in DFD ( P < .001), extent of a dissociated optic nerve fiber layer appearance ( P < .001), and postoperative visual acuity ( P = .025). Nasotemporal retinal thickness asymmetry was associated with the minimum linear diameter ( P < .001).

Conclusion:

The ILM-peeled area has a significant effect on changes in retinal topography and postoperative visual acuity separate from macular hole size. Further study is needed to assess the effect of ILM peeled size on visual function and to guide clinical practice.
Simultaneous Dexamethasone Intravitreal Implant and Anti-VEGF Therapy for Neovascular Age-Related Macular Degeneration Resistant to Anti-VEGF Monotherapy
Authors: Todorich Bozho , Thanos Aristomenis , Yonekawa Yoshihiro , Mane Gerta , Hasbrook Madeleine , Thomas Benjamin J. , Woodward Maria A. , Williams George A. , Capone Antonio , Wolfe Jeremy D. , Faia Lisa J. , Hassan Tarek S.
Published: January 2017

Purpose:

To evaluate the efficacy of a dexamethasone intravitreal implant in combination with intravitreal anti-vascular endothelial growth factor (VEGF) agents for treatment-resistant neovascular age-related macular degeneration (nvAMD).

Methods:

This study was designed as a single-center, retrospective interventional case series. Consecutive patients with treatment-resistant nvAMD underwent simultaneous combined injection of anti-VEGF agent and dexamethasone intravitreal implant. Eighteen patients with mean age of 81.5 years were included. Patients received an average of 26.3 anti-VEGF injections before dual therapy, with a mean follow-up of 8.2 months after dual therapy.

Results:

Dual therapy produced a significant mean decrease in central foveal thickness (126.3 μm), compared to a mean increase in 29.9 μm when treated with anti-VEGF monotherapy ( P = .0017). Patients also had a mean decrease in macular cube volume of −0.85 mm3 with dual therapy compared to anti-VEGF monotherapy ( P = .0014). There was a moderate correlation between the number of prior anti-VEGF injections and the magnitude of anatomic response, suggesting that shorter disease duration may positively influence response to combined treatment. Although there was a slight trend toward improved mean visual acuity after dual therapy, these differences did not reach statistical significance. Nevertheless, with combination treatment, 33% of patients gained 1 or more lines of vision. Dual therapy resulted in a significantly lower number of required anti-VEGF injections (4.25 vs 5.33) and an increase in the anti-VEGF injection-free interval to 1.41 months from 1.12 months during the 6 months following dual therapy compared to the same interval before dual therapy. Dual therapy was well tolerated; 2 eyes developed mild intraocular pressure elevation effectively managed with topical therapy and 1 patient developed worsening cataract.

Conclusions:

Combined treatment of anti-VEGF with dexamethasone intravitreal implant is a viable alternative for treatment-resistant nvAMD and may reduce treatment burden. Earlier treatment with dual therapy may be beneficial to maximize anatomic and visual outcomes in these patients.
Obeticholic Acid
Authors: Smith Susan M. , Pegram Angela H.
Published: January 2017

Objective: To review the pharmacology, efficacy, and safety of obeticholic acid (OCA) and determine its clinical role relative to other agents in the treatment of patients with primary biliary cholangitis (PBC). Data Sources: A PubMed search (1946 to November 2016) was conducted using the terms INT-747, obeticholic acid, OCA, farnesoid X receptor agonists, FXR agonists, primary biliary cirrhosis, and primary biliary cholangitis. Study Selection and Data Extraction: Phase II and III studies evaluating the use of OCA in PBC patients were included in this review. Data Synthesis: OCA, a farnesoid X receptor (FXR) agonist, is indicated for adult patients with PBC in combination with ursodeoxycholic acid (UDCA) or as monotherapy if unable to tolerate UDCA. Two clinical trials were identified evaluating OCA for the treatment of PBC. Study end points utilized biochemical markers (alkaline phosphatase [ALP] and bilirubin). A phase II study (n = 165) to determine efficacy and safety of OCA at 3 different doses (10 mg, 25 mg, 50 mg) demonstrated statistically significant reductions in ALP ( P < .0001 for all OCA groups versus placebo) after 12 weeks. A phase III trial (n = 217) assessed lower OCA doses (5 mg and 10 mg) with a longer study duration (12 months). Statistically significant differences ( P < .001) between the 5 to 10 mg group (46%) and the 10 mg group (47%) compared to the placebo group (10%) were found. The primary adverse effect reported in both trials was pruritus. Conclusions: OCA is the first FXR agonist approved for the treatment of PBC. Ongoing research to evaluate clinical outcomes with OCA is currently underway.
Patient Treatment Adherence
Authors: Allan Elizabeth L. , Suchanek-Hudmon Karen L. , Berger Bruce A. , Eiland Sallie A.
Published: January 2017

Objective:

To describe the essential facility characteristics for a model patient counseling area: (1) activities that should be accommodated by the facility; (2) special environmental and interior design features, with a discussion of their impact on the healthcare provider-patient interaction; (3) storage and equipment requirements; and (4) determination of space requirements for the counseling area. A second objective is to suggest a strategy to follow when justifying an adherence clinic.

Data Sources:

Primary and secondary sources of literature were reviewed in the areas of pharmacy, psychology, and architecture to identify design specifications for the patient counseling area.

Conclusions:

The design of a counseling area can indirectly affect the quality of the interaction between the patient and healthcare provider, primarily in terms of its effect on communication. The key features that should be included in the design of the area are different levels of privacy (visual and auditory), “soft” interior decoration, and accommodation of people with disabilities. There are several design-related barriers to communication that should be avoided in the facility. The space required for a counseling area is dependent upon the scope of services provided—approximately 100–130 square feet may be necessary.
Atovaquone: A Review with Emphasis on its Role in the Treatment of Pneumocystis Carinii Pneumonia
Authors: Maddix Daniel S.
Published: January 2017

Objective:

To discuss the mechanism of action, in vitro and in vivo activity, pharmacokinetics, clinical trials, adverse effects, drug interactions, and dosage guidelines of atovaquone.

Data Sources:

Pertinent literature published since 1988 was identified via a MEDLINE search. Published proceedings of selected conferences were also used.

Study Selection:

All basic science, microbiologic, and pharmacokinetic articles were evaluated. Since only limited data regarding atovaquone are available in the literature, all clinical trials involving the use of atovaquone in the treatment of Pneumocystis carinii pneumonia were reviewed.

Data Synthesis:

Atovaquone is an antiprotozoal agent that was recently approved for the treatment of mild to moderate P. carinii pneumonia (PCP) in patients who are intolerant of trimethoprim/sulfamethoxazole (TMP/SMX). The exact mechanism of action of atovaquone against P. carinii has not been determined. The drug has in vitro and in vivo activity against P. carinii, Toxoplasma gondii, and Plasmodium species. The bioavailability of oral atovaquone is highly variable. The drug must be administered with food to enhance absorption. In a double-blind comparative trial in AIDS patients with mild to moderate PCP, those who were treated with atovaquone had a significantly higher mortality rate than those treated with TMP/SMX. More patients who received TMP/SMX experienced adverse effects that resulted in discontinuation of therapy.

Conclusions:

Because of concerns of increased mortality in atovaquone recipients, the drug should be reserved for the treatment of mild to moderate PCP in patients who are unable to tolerate TMP/SMX and trimethoprim-dapsone.
Use of Angiotensin-Converting Enzyme Inhibitors in Heart Failure
Authors: Hailemeskel Bisrat , Mauro Vlncent F.
Published: January 2017

Objective:

To review the literature discussing the use of angiotensin-converting enzyme (ACE) inhibitors in the treatment of heart failure.

Data Sources:

English-language journal articles.

Study Selection:

Representative articles discussing the effects of ACE inhibitors on hemodynamics, symptoms, and survival.

Data Extraction:

Studies selected for review in the text were based on study design and clinical endpoints.

Data Synthesis:

Heart failure results in a series of compensatory responses that, although effective acutely, are ultimately maladaptive. A major mediator in this process is angiotensin II. The production of angiotensin II is dependent on the ACE. Inhibition of this enzyme by ACE inhibitors results in fewer symptoms, improved hemodynamic function, and prolonged survival in patients with heart failure.

Conclusions:

ACE inhibitors are beneficial in improving the survival of patients with symptomatic heart failure and of patients who have recently had an acute myocardial infarction (MI) and subsequently have a reduced ejection fraction. There appears to be no advantage for immediately initiating ACE-inhibitor therapy within the first few hours of an MI episode. With respect to patients with a reduced ejection fraction without symptoms of heart failure, current data suggest that ACE inhibitors delay the onset of symptoms of heart failure, reduce the need for hospitalization, and may possibly improve survival.
Psychopharmacists' Role in Neuroleptic Therapy a Pharmaceutical Care Approach
Authors: Lacro Jonathan P. , Kodsi Angela B. , Gilbert Patricia L.
Published: January 2017

Objective:

To describe the roles of the psychopharmacist in the use of neuroleptic therapy.

Setting:

A geriatric psychiatry ambulatory care clinic in a 400-bed Department of Veterans Affairs Medical Center, San Diego, California.

Conclusions:

In the pharmaceutical care model, the pharmacist is involved in several important roles in the provision of neuroleptic therapy. In the ambulatory care program, psychopharmacists provide important drug-related information to patients and consultation regarding potential neuroleptic-induced adverse effects. In addition, psychopharmacists serve as consultants to other clinicians concerning the risks associated with the use of neuroleptics and participate in neuroleptic-discontinuation clinics. Morbidity associated with neuroleptic-induced tardive dyskinesia has exposed healthcare providers to legal repercussions; therefore, pharmacy intervention may aid in the reduction of legal liability.
Barrier and biodegradable properties of corn starch-derived biopolymer film filled with nanoclay fillers
Authors: Mohan TP , Devchand Kay , Kanny K
Published: January 2017

The objective of this work is to study the effect of nanoclay fillers on the biodegradation and barrier properties of corn starch polymer-based biofilm. Starch derived from corn plant source was used to prepare a biofilm by plasticization method. The barrier properties, namely, water absorption, moisture permeation, oxygen permeation and swelling of unfilled and nanoclay-filled corn starch biofilms were examined. The results indicate: ∼22% reduced water absorption, 40% reduced moisture uptake, 30% reduced oxygen permeation and 31% reduced swelling for 2–3 wt.% nanoclay-filled biofilm, when compared with unfilled biopolymer. The biodegradation result of unfilled and nanoclay-filled film series indicates that the nanoclay addition delays the biodegradation and is a function of nanoclay content in the film. The tensile, dynamic mechanical analysis and biodegradable studies were conducted on the biopolymers before and after water absorption, and the result shows that the nanoclay-filled biopolymer increased these properties when compared with unfilled biopolymer even after water absorption and is dependent on the nanocomposite structure and morphology as examined by X-ray diffraction and transmission electron microscopy analysis.
Numerous niches for hematopoietic stem cells remain empty during homeostasis
Authors: Shimoto Manabu , Sugiyama Tatsuki , Nagasawa Takashi
Published: January 2017

Key Points

Numerous empty HSC niches, located distantly from filled niches, are available for engraftment and proliferation in bone marrow. Presumptive niches for granulocyte/macrophage progenitors appear to be filled in bone marrow.
Antenatal management in fetal and neonatal alloimmune thrombocytopenia: a systematic review
Authors: Winkelhorst Dian , Murphy Michael F. , Greinacher Andreas , Shehata Nadine , Bakchoul Taman , Massey Edwin , Baker Jillian , Lieberman Lani , Tanael Susano , Hume Heather , Arnold Donald M. , Baidya Shoma , Bertrand Gerald , Bussel James , Kjaer Mette , Kaplan Cécile , Kjeldsen-Kragh Jens , Oepkes Dick , Ryan Greg
Published: January 2017

Key Points

The systematic review suggests that first-line antenatal management in FNAIT is weekly IVIG administration. Noninvasive management is effective without the relatively high rate of adverse outcomes seen in invasive strategies.
Effect of a short course of iron polymaltose on acquisition of malarial parasitaemia in anaemic Indonesian schoolchildren: a randomized trial
Authors: Prasetyani Margaretta A. , de Mast Quirijn , Afeworki Robel , Kaisar Maria M. M. , Stefanie Difa , Sartono Erliyani , Supali Taniawati , van der Ven André J.
Published: January 2017

Background

Concern exists about the safety of iron supplementation given to individuals in malarious areas. The possible unfavourable impact of iron supplementation on malaria might be less when slow-release iron compounds are used instead of ferrous salts, because no toxic non-transferrin bound iron is formed. The aim of this study was to determine the effect of iron supplementation using the slow-release iron compound iron polymaltose (IPM) on the acquisition of malarial parasitaemia.

Methods

A randomized, placebo-controlled trial was performed in schoolchildren aged 5–18 years with mild or moderate anaemia on the Indonesian island Flores. Microscopic malaria-negative children were randomized to receive 8 weeks of IPM (6 mg elemental iron/kg/day) or placebo . The primary outcomes were the occurrence of microscopically detectable malarial parasitaemia at week 4, 8, 12 and 16 after start of treatment and the proportion of participants with real-time (RT) PCR positive malarial parasitaemia at week 16.

Results

294 Children were assigned to the IPM group and 297 to the placebo group. Whereas IPM supplementation failed to increased haemoglobin or ferritin concentrations, the IPM group had a significantly higher rate of occurrence of microscopically detectable parasitaemia [hazard ratio 2.2, 95% C.I. 1.2–4.0; P = 0.01]. This higher rate was confined to iron-replete children. At the end of the study, 89% of the children in the IPM group had remained free from microscopically detectable parasitaemia vs 95% of children in the placebo group. The proportion of plasmodial RT-PCR positive children was similar in both groups at week 16 (IPM group 16.6% vs placebo group 14.3%; P = 0.47). When analysis was restricted to iron-replete children (serum ferritin ≥30 µg/l), there was a trend for a higher proportion being RT-PCR positive at week 16 in the IPM group compared with the placebo group (20 vs 13.3%; P = 0.07). Erythrocyte microcytosis was an independent risk factor for microscopically detectable malarial parasitaemia.

Conclusions

A short course of IPM should be used cautiously in anaemic children in malaria endemic areas, as it has limited efficacy in treating iron deficiency, while it increases the rate of microscopic malarial parasitaemia in those with replete iron stores.

Trial registration ISRCTN 83091970. Registered 16 May 2012 (retrospectively registered)
Metformin promotes the survival of transplanted cardiosphere-derived cells thereby enhancing their therapeutic effect against myocardial infarction
Authors: Yue Rongchuan , Fu Wenbin , Liao Xiang , Lan Cong , Liao Qiao , Li Liangpeng , Yang Dezhong , Xia Xuewei , Chen Xiongwen , Zeng Chunyu , Wang Wei Eric
Published: January 2017

Background

Transplantation of cardiosphere-derived cells (CDCs) has been shown to exert a therapeutic effect in patients with myocardial infarction (MI). However, poor survival of transplanted CDCs limits their beneficial effect. Metformin (MET) activates AMP-activated protein kinase (AMPK) which is associated with cell survival. The aim of this study is to determine whether MET improves CDC survival in the transplantation microenvironment and enhances the therapeutic effect of CDC transplantation against MI.

Methods

CDCs were isolated and expanded from transgenic β-actin-GFP mice. CDCs were pretreated with MET and intramyocardially injected into wild-type C57 mouse heart with MI injury. The survival of CDCs was quantified, and the infarct size and cardiac function of treated hearts were evaluated.

Results

CDC transplantation modestly reduced infarct size and improved cardiac function in the post-MI heart, which was further improved by MET treatment. MET pretreatment significantly increased the survival of CDCs transplanted into the myocardium. MET also reduced CDC apoptosis induced by oxidative stress in vitro. The anti-apoptotic effect of MET was blocked by the AMPK inhibitor compound C. MET increased AMPK phosphorylation and upregulated endothelial nitric oxide synthase (eNOS) in CDCs under oxidative stress, which might be associated with the anti-apoptotic effect of MET.

Conclusions

MET improves the survival of transplanted CDCs in the myocardium, thereby enhancing their therapeutic effect against MI injury. The pro-survival function of MET on CDCs might be associated with an AMPK-eNOS-dependent mechanism.
An exploratory study of ESL writing by junior secondary students in China: text type, register and textual features
Authors: Xuan Winfred Wenhui
Published: January 2017

While interest in L2 writing research has increased exponentially in recent years, research on adolescent L2 writing remains relatively scarce. Drawing on the framework of functional text analysis, namely context-based text typology and register theory, the present study aimed to explore Chinese adolescent L2 writing from the perspective of writing as meaning making. Ten instances of writing tasks written by a class of 50 junior secondary students from Guangzhou, China were collected. Context-based text typology and field, mode tenor from register theory were used to analyze the participants’ writing. The findings revealed that recommending was the dominant text type in the students’ writing because of the influence of the exam-driven culture. Moreover, tenor awareness was lacking in the students’ writing. Relevant Chinese secondary L2 writing curriculum design and pedagogy recommendations are provided.
Optimization of machining parameters and wire vibration in wire electrical discharge machining process
Authors: Habib Sameh
Published: January 2017

Background

Wire Electrical discharge machining (WEDM) has higher capability for cutting complex shapes with high precision for very hard materials without using high cost of cutting tools. During the WEDM process, the wire behaves like a metal string, straightened by two axial pulling forces and deformed laterally by a sum of forces from the discharge process. Major forces acting on the wire can be classified into three categories. The first is a tensile force, pulling the wire from both sides in axial direction and keeping it straight. The second is the dielectric flushing force that comes from circulation of the dielectric fluid in the machining area. The third category consists of forces of different kinds resulting from sparking and discharging. Large amplitude of wire vibration leads to large kerf widths, low shape accuracies, rough machined surfaces, low cutting speeds and high risk of wire breakage. Such tendencies for poor machining performance due to wire instability behavior appear with thinner wires.

Methods

The present work investigates a mathematical modeling solution for correlating the interactive and higher order influences of various parameters affecting wire vibration during the WEDM process through response surface methodology (RSM). The adequacy of the above proposed model has been tested using analysis of variance (ANOVA).

Results

Optimal combination of machining parameters such as wire tension, wire running speed, flow rate and servo voltage parameters has been obtained to minimize wire vibration.

Conclusions

The analysis of the experimental observations highlights that the wire tension, wire running speed, flow rate and servo voltage in WEDM greatly affect average wire vibration and kerf width.
Weekly Formative Exams and Creative Grading Enhance Student Learning in an Introductory Biology Course
Authors: Bailey E. G. , Jensen J. , Nelson J. , Wiberg H. K. , Bell J. D.
Published: January 2017

First-year students often become discouraged during introductory biology courses when repeated attempts to understand concepts nevertheless result in poor test scores. This challenge is exacerbated by traditional course structures that impose premature judgments on students’ achievements. Repeated testing has been shown to benefit student ability to recognize and recall information, but an effective means to similarly facilitate skill with higher-order problems in introductory courses is needed. Here, we show that an innovative format that uses a creative grading scheme together with weekly formative midterm exams produced significant gains in student success with difficult items requiring analysis and interpretation. This format is designed to promote tenacity and avoid discouragement by providing multiple opportunities to attempt demanding problems on exams, detailed immediate feedback, and strong incentives to retain hope and improve. Analysis of individual performance trajectories with heat maps reveals the diversity of learning patterns and provides rational means for advising students.
Lighten the Load: Scaffolding Visual Literacy in Biochemistry and Molecular Biology
Authors: Offerdahl Erika G. , Arneson Jessie B. , Byrne Nicholas
Published: January 2017

The development of scientific visual literacy has been identified as critical to the training of tomorrow’s scientists and citizens alike. Within the context of the molecular life sciences in particular, visual representations frequently incorporate various components, such as discipline-specific graphical and diagrammatic features, varied levels of abstraction, and spatial arrangements of visual elements to convey information. Visual literacy is achieved when an individual understands the various ways in which a discipline uses these components to represent a particular way of knowing. Owing to the complex nature of visual representations, the activities through which visual literacy is developed have high cognitive load. Cognitive load can be reduced by first helping students to become fluent with the discrete components of visual representations before asking them to simultaneously integrate these components to extract the intended meaning of a representation. We present a taxonomy for characterizing one component of visual representations—the level of abstraction—as a first step in understanding the opportunities afforded students to develop fluency. Further, we demonstrate how our taxonomy can be used to analyze course assessments and spur discussions regarding the extent to which the development of visual literacy skills is supported by instruction within an undergraduate biochemistry curriculum.
Student Performance along Axes of Scenario Novelty and Complexity in Introductory Biology: Lessons from a Unique Factorial Approach to Assessment
Authors: Deane-Coe Kirsten K. , Sarvary Mark A. , Owens Thomas G.
Published: January 2017

In an undergraduate introductory biology laboratory course, we used a summative assessment to directly test the learning objective that students will be able to apply course material to increasingly novel and complex situations. Using a factorial framework, we developed multiple true–false questions to fall along axes of novelty and complexity, which resulted in four categories of questions: familiar content and low complexity (category A); novel content and low complexity (category B); familiar content and high complexity (category C); and novel content and high complexity (category D). On average, students scored more than 70% on all questions, indicating that the course largely met this learning objective. However, students scored highest on questions in category A, likely because they were most similar to course content, and lowest on questions in categories C and D. While we anticipated students would score equally on questions for which either novelty or complexity was altered (but not both), we observed that student scores in category C were lower than in category B. Furthermore, students performed equally poorly on all questions for which complexity was higher (categories C and D), even those containing familiar content, suggesting that application of course material to increasingly complex situations is particularly challenging to students.
A Comparison of Internal Dispositions and Career Trajectories after Collaborative versus Apprenticed Research Experiences for Undergraduates
Authors: Frantz Kyle J. , Demetrikopoulos Melissa K. , Britner Shari L. , Carruth Laura L. , Williams Brian A. , Pecore John L. , DeHaan Robert L. , Goode Christopher T.
Published: January 2017

Undergraduate research experiences confer benefits on students bound for science, technology, engineering, and mathematics (STEM) careers, but the low number of research professionals available to serve as mentors often limits access to research. Within the context of our summer research program (BRAIN), we tested the hypothesis that a team-based collaborative learning model (CLM) produces student outcomes at least as positive as a traditional apprenticeship model (AM). Through stratified, random assignment to conditions, CLM students were designated to work together in a teaching laboratory to conduct research according to a defined curriculum led by several instructors, whereas AM students were paired with mentors in active research groups. We used pre-, mid-, and postprogram surveys to measure internal dispositions reported to predict progress toward STEM careers, such as scientific research self-efficacy, science identity, science anxiety, and commitment to a science career. We are also tracking long-term retention in science-related career paths. For both short- and longer-term outcomes, the two program formats produced similar benefits, supporting our hypothesis that the CLM provides positive outcomes while conserving resources, such as faculty mentors. We discuss this method in comparison with course-based undergraduate research and recommend its expansion to institutional settings in which mentor resources are scarce.
Student nurse preferences for their first clinical experience: a thematic analysis
Authors: Gillespie Mark
Published: January 2017

Shifts in demographic profiles and in the understanding of how to best deliver health care have seen nurses increasingly caring for non-acute client groups outside traditional clinical settings. Evidence suggests that this does not always sit well with nurses, or with nurses in training. This study sought to investigate the influences on student nurse perceptions of the worth of working with various client groups. Thematic analysis of a focus group discussion led to the identification of several themes suggesting that unhelpful opinions are present in some students on entry to the programme; however, programme-related influences also contribute towards unhelpful attitudes. To create a more positive framing of working within such specialisms will require significant focus across nursing, nurse education and society in general.
Understanding transition to support the journey to registration
Authors: Heywood Wendy
Published: January 2017

As the end of her training approaches, Wendy thinks about the transition from student nurse to registered nurse and the role of mentors during her student nursing career.
The changing profile of our patients
Authors: Foster Sam
Published: January 2017

Sam Foster, Chief Nurse at Heart of England NHS Foundation Trust, considers the impact of increasing life expectancy on healthcare organisations, and looks at how changing care bundles could improve care
The female experience of ISC with a silicone catheter
Authors: Logan Karen
Published: January 2017

Intermittent self-catheterisation (ISC) is a safe and effective treatment in the management of neuropathic bladder, voiding dysfunction and urinary incontinence in women. ISC has been shown to improve quality of life when used appropriately. It provides freedom for individuals who require bladder drainage as they can choose where and when to catheterise to empty the bladder. ISC requires minimum equipment, is a more discreet solution than an indwelling catheter and is relatively easy to teach in one patient visit. There are a range of different ISC catheters available on prescription. Many have been designed specifically for women and patient choice regarding product selection is an important consideration. This article describes a UK patient-satisfaction survey evaluating the female patient's perspective of learning ISC using a silicone intermittent catheter called HydroSil Go™ that is manufactured by C.R. Bard, Inc.
Pre-registration clinical skills development and curriculum change
Authors: Rutt Jo
Published: January 2017

This article outlines and offers an overview of the process of curriculum change and the development and integration of clinical skills. The focus on clinical skills in the essential skills clusters annexe set by the Nursing and Midwifery Council requires innovative strategies in theoretical aspects of the nursing programme to be identified. Based on the constructivist philosophy of curriculum design and in light of the ever-changing healthcare environment, a blended-learning approach was developed for the delivery of clinical skills. Key aspects such as learning styles, pedagogical approaches to online learning and facilitation were taken into consideration. A model of e-learning, facilitated sessions (face to face) and reflection was adopted for clinical skills acquisition in the programme. Although positive feedback was given about the online work, sessions and space for reflection, it was clear that further preparation of both lecturers and students for this cultural shift in teaching and learning would have aided this process.
Needle-free devices: keeping the system closed
Authors: Kelly Linda J , Jones Tracey , Kirkham Stephanie
Published: January 2017

Health professionals are under increasing pressure to reduce costs while ensuring patient safety. As the number of vascular access devices (VADs) used in health care continues to increase, there is a need to reduce the complications of infection and occlusion associated with them. Needle-free devices (NFDs), also known as needleless connectors, have been available since the early 1990s and the type and variety of these devices has continued to develop. As well as the original aim of NFDs to maintain a closed system and to reduce the risk of needlestick injuries and blood spillage, NFDs are now designed with the aim of improving clinical outcomes by reducing the common complications of infection and catheter occlusion. As there are a number of NFDs available with specific designs, it is imperative that health professionals have an understanding of the different types and functions. This article provides an explanation of NFD design and functions and guidance and information about their benefits, as well as advice on preventing complications associated with their use.
Management of peripheral neuropathy induced by chemotherapy in adults with cancer: a review
Authors: AL-Atiyyat Nijmeh , Obaid Abdullah
Published: January 2017

Aim:

To identify which of the examined agents or modalities were effective in the management of chemotherapy-induced peripheral neuropathy (CIPN).

Methods:

PubMed, CINAHL, Medline, Science Direct and Ovid databases were used to search keywords. The literature search identified 59 potentially relevant studies; after removing duplicates and reviewing titles a total of 26 articles were examined. In the end, a total of 18 studies met the inclusion criteria.

Findings:

The preliminary data for using lafutidine, acupuncture and sweet bee venom pharmacopuncture indicate that they may be useful in CIPN management. The use of duloxetine was effective and supported as a management of CIPN; likewise the use of scrambler therapy significantly decreased CIPN pain. However, the use of electroacupuncture and topical amitriptyline and ketamine was not supported.

Conclusion:

The use of duloxetine was effective in CIPN management. Further studies with larger sample size are needed.
Including personal development in palliative care education to address death anxiety
Authors: Melo Carol Gouveia , Billings Jenny
Published: January 2017

Background:

Death anxiety may interfere with health care workers' (HCW) relationship with patients and their families.

Aims:

Evaluate an intervention to address death anxiety and improve HCW skills dealing with patients/families in palliative and end-of-life care.

Design:

Quasi-experimental mixed methods approach with a pre-test/post-test design.

Participants:

208 HCWs receiving the intervention and working in end-of-life care, in and out of palliative care units, were invited to answer quantitative and qualitative questionnaires. In the end, 150 returned with quantitative answers and of these, 94 with qualitative answers as well. Additionally, out of the 150 participants, 26 were recruited for interview.

Results:

Pre-and post-test results revealed a significant reduction in levels of death anxiety, an increase in existential wellbeing, and a significant improvement in HCWs' perception of the quality of their helping relationship skills with patients/families. Content analysis provided an understanding of the difficulties experienced by the HCWs and the positive impact of the intervention.

Conclusion:

An intervention to address death anxiety and help relationship skills can reduce the use of avoidance mechanisms and improve HCW self-perceived psycho-existential support to patients/families.
Research Roundup
Authors: Costello John
Published: January 2017

Synopses of a selection of recently published research articles of relevance to palliative care.
Grassland management and helminth control on cattle farms
Authors: Forbe Andrew
Published: January 2017

Farmers manage their pastures and grazing animals primarily to ensure that swards provide adequate, quality nutrients to support animal performance, but it is also possible to provide useful levels of parasite control without compromising production. On cattle only farms the easiest options for the control of parasitic gastroenteritis in young cattle revolve around the avoidance of high risk pastures from July onwards. On many farms, silage/hay aftermaths that have not been grazed by cattle for 12 months or more can provide low risk fields on which cattle can thrive with minimal reliance on anthelmintics.
Reflection and our professional lives
Authors: May Stephen Anthony
Published: January 2017

Despite the concept's lack of familiarity to many veterinary surgeons, reflection should be an important aspect of our professional lives, both during our daily work and when we have opportunities to take stock of what we have achieved. Reflection aids the transfer of existing skills to unfamiliar contexts, informs learning, and supports continued enhancement of the quality of the work we undertake. In contrast to scientific analysis, reflection embraces our actions and ourselves as actors, and both the rational and emotional aspects of our thinking. Importantly, reflection is appreciative as well as critical and, through cognitive reappraisal, it helps us to judge what we can reasonably expect of ourselves. Ultimately, this contributes to reduced stress and enhanced personal wellbeing.
A practical approach to dealing with contagious ovine digital dermatitis (CODD) on farms
Authors: Angell Joe , Grove-White Dai , Duncan Jennifer
Published: January 2017

Contagious ovine digital dermatitis (CODD) is a cause of severe welfare compromise in affected sheep and can cause major problems on some farms. The specific aetiology is still unknown but Treponema spp. are considered as the most likely infectious agents necessary for disease. Recent evidence has shown strong links between footrot and CODD and a holistic approach to treatment and control is likely to be necessary in order to achieve control on affected farms. Together with this, strict biosecurity practices are required including the examination of all feet of all new entrants to a flock with the aim of preventing the introduction of CODD to unaffected flocks.
When is overground endoscopy indicated and what can it tell us?
Authors: Pollock Patrick J
Published: January 2017

The development of overground endoscopy is an exciting addition to the veterinary surgeon's arsenal when investigating dysfunction of the upper portion of the respiratory tract of the horse. The equipment, of which there are a number of versions, allows the operator to acquire real time images of the upper portion of the respiratory tract under normal exercising conditions. To date a large number of horses from all the common equestrian disciplines have been examined and an array of abnormalities have been detected. The equipment is safe, reliable and well tolerated.

In addition to its use for the purpose of investigation and diagnosis of obstructive airway disease, overground endoscopy has allowed the clinician to review the efficacy of therapeutic interventions and take a critical, evidence-based approach to treatment of the many dynamic diseases that affect the equine upper airway.

It would be reasonable to conclude that overground endoscopy is now the gold standard technique for investigation of horses with clinical signs of poor performance or abnormal respiratory noise, and that the knock on positive effect on equine welfare as a result of the introduction of the technique is significant.
Clinical forum: bovine respiratory disease
Authors: Potter Tim , Barrett David , Cutler Keith , Hart Kat , Biggs Andrew
Published: January 2017

Bovine respiratory disease (BRD) remains an important condition of calves that leads to reduced weight gain and productivity as well as incurring significant cost in terms of management, treatment and prevention. The disease is multi-factorial with numerous viruses (bovine herpesvirus 1 (BoHV1); bovine respiratory syncytial virus (BRSV); parainfluenza 3 virus (PI3); and bovine virus diarrhoea virus (BVDV)) and bacteria (Mycoplasma bovis, Pasteurella multocida, Mannheimia haemolytica, Histophilus somni) being implicated in its aetiology. While the economic impact is well documented, and despite in excess of 2900 research publications related to the disease in the last 30 years, BRD continues to be a major concern clinically.
Valorization of Tomato Processing Waste for Lycopene Extraction
Authors: Driouich Rim , Bousselmi Olfa , Cherif Ameur
Published: January 2017

Lycopene is one of the most powerful antioxidants and singlet oxygen quenching agents. It has been found to be of great medical importance with various anti cancer effects, cardiovascular diseases effective agent and with its ability to be an important carotenoid in preventive medicine. In Tunisia, we note a real consumption of tomato paste. With 28 production units for double and triple concentrated tomato, noting a significant production of waste (approximately 30000 Tonne/year) consisting of skins pulp and seeds, which could be an important source of lycopene. Our study is concerned with three solid-phase extraction process: assisted by ultrasonic, by microwave and by homogenizer heating at moderate temperature. Their efficiency for the extraction of lycopene contained in the tomato waste was elaborated. The effect of the main process variables (including solvent polarity, solid-to-liquid ratio, temperature and time) on lycopene recovery have been investigated. The yield of the isolated lycopene was determined using UV-Visible spectrophotometry and UPLC-DAD quantification methods. Lycopene-rich extract was obtained from the dried and milled tomatoes waste using ethanol as a food grade extraction solvent and employing microwave assisted extraction process. The optimum conditions were 30 min total extraction time at 50°C temperature and 1bar pressure. The degradation of extracted lycopene through air oxidation and day light effect were also tested. Lycopene is stable when mixed with olive oil as a natural antioxidant. Up to 80% of lycopene degradated when exposed for one month to day light at 25°C.