bluuebunny/crossref_metadata_2025 huggingface dataset:
The Gene Messenger Impact Project: An Innovative Genetics Continuing Education Strategy for Primary Care Providers
Authors: Carroll June C. , Grad Roland , Allanson Judith E. , Pluye Pierre , Permaul Joanne A. , Pimlott Nicholas , Wilson Brenda J.
Published: August 2016

Introduction:

Primary care providers (PCP) will need to be integrally involved in the delivery of genomic medicine. The GenetiKit trial demonstrated effectiveness of a knowledge translation intervention on family physicians' (FP) genetics referral decision-making. Most wanted to continue receiving Gene Messengers (GM), evidence-based summaries of new genetic tests with primary care recommendations. Our objective was to determine the value of GMs as a continuing education (CE) strategy in genomic medicine for FPs.

Methods:

Using a “push” model, we invited 19,060 members of the College of Family Physicians of Canada to participate. Participants read GMs online, receiving 12 emailed topics over 6 months. Participants completed an online Information Assessment Method questionnaire evaluating GMs on four constructs: cognitive impact, relevance, intended use of information for a patient, and expected health benefits.

Results:

One thousand four hundred two FPs participated, 55% rated at least one GM. Most (73%) indicated their practice would be improved after reading GMs, with referral to genetics ranked highly. Of those who rated a GM relevant, 94% would apply it to at least one patient and 79% would expect health benefits. This method of CE was found useful for genetics by 88% and 94% wanted to continue receiving GMs.

Discussion:

FPs found this novel CE strategy, brief individual reflective e-learning, to be valuable for learning about genetics. This method of information delivery may be an especially effective method for CE in genomic medicine where discoveries occur at a rapid pace and lack of knowledge is a barrier to integration of genetic services.
Factors Influencing Participation in Continuing Professional Development: A Focus on Motivation Among Pharmacists
Authors: Tjin A Tsoi Sharon L. N. M. , de Boer Anthonius , Croiset Gerda , Koster Andries S. , Kusurkar Rashmi A.
Published: August 2016

Introduction:

The interest in continuing education (CE) for pharmacists has increased because of patient safety issues, advancing science and the quick changes in the profession. Therefore, contemporary pharmaceutical care requires an effective and sustainable system for pharmacists to maintain and improve competencies. Although motivation plays an important role both as a facilitator (desire to learn) and a barrier (lack of motivation), there is little investigated about this specific factor. The aim of the study was to explore what factors influence pharmacists' participation in CE with a focus on motivation.

Methods:

The theoretical framework was self-determination theory (SDT), which describes autonomous motivation (AM) representing motivation from an internal locus of causality, controlled motivation (CM) originating from an external locus of causality, and relative autonomous motivation (RAM) that measures the AM in an individual after correcting for the CM. The relationship between pharmacists' characteristics, especially their motivation (AM, CM and RAM) in CE, and their participation in CE activities was explored using the AMS-questionnaire and the Dutch online portfolio system.

Results:

RAM was positively correlated with CE participation of pharmacists and explained 7.8% of the variance. The correlations between the independent variables AM and CM and CE hours were negative (−0.301 and −0.476, respectively). Other factors influencing CE participation were pharmacy school (6.8%), traineeship (10.9%), and work experience (7.8%). Pharmacists participated for 27.0 hours on average in CE during 11 months and preferred face-to-face-learning (85.5%) above e-learning (13.8%).

Discussion:

Our findings show a positive relationship between RAM and CE participation. The current CE system is probably not conducive to stimulation of AM. Further research is needed to understand the factors that stimulate pharmacists' motivation and participation in CE.
Exploring the Top-Cited and Most Influential Articles in Medical Education
Authors: Azer Samy A.
Published: August 2016

Introduction:

The citations received by a scientific publication have been used as a proxy measurement of scientific quality and in ranking researchers. Although these practices have been observed in several institutes, careful assessment of top-cited articles may provide more insight into exploring their characteristics. The aim of this study was to analyze the top-cited articles in medical education identified by Azer 2015 and explore the characteristics of these articles that can provide insight into their assessment.

Methods:

The most frequently cited articles identified by searching the Web of Science under the category “Education, Scientific Discipline” were included in the analysis. The following issues were further analyzed: 1) comparing the mean yearly citations received by articles published before the year 2000 and those published after, 2) assessing whether there was a correlation between the number of grants, number of authors, number of institutes, or number of countries involved and the number of citations received, 3) assessing the number of female representation in authorship, 4) assessing the representation of none-medical staff in the authorship, and 5) exploring any association between top authors identified and those who were awarded the Karolinska Institutet Prize for research in medical education.

Results:

Although there was no correlation between the number of citations and the number of years since publications, the mean number of citations received by articles published before the year 2000 varied from zero to 18.2 ± 16.6, whereas for those published after the year 2000 the mean varied from 2.0 ± 2.1 to 35.3 ± 26.8. No correlation was found between the number of citations obtained and number of grants, number of authors, number of institutes, or number of countries involved. Females comprised 50% of the total number of authors. However, no correlation was found between the number of females in authorship and the number of citations obtained. Similarly, the number of authors with non-medical degrees did not correlate with the number of citations obtained. An association was found between authoring more than one article in the list and receiving the Karolinska Institutet Prize for research in medical education.

Discussion:

The analysis shows that the higher number of citations received are not necessarily related to funding, working collaboratively with a big team from several institutes or from several countries. The finding that authors of more than one top-cited article received the Karolinska Institutet Prize for research in medical education indicates that this could be a parameter in selecting the candidates for the award.
Learn to Change: Teaching Toward a Shifting Health Care Horizon
Authors: Hart Laura C.
Published: August 2016

Changes in health care—including a growing emphasis on quality, outcomes, and lower costs—are transforming the delivery of care and creating a knowledge gap that continuing education must bridge. As clinicians and health leaders spend less time in hospital settings, educational activities are likely to extend their reach, for instance through online education distributed on laptops, tablets, or smartphones. Ezekiel J. Emanuel, MD, PhD, explored this shift in his 2016 keynote to the World Congress for Continuing Professional Development: “Learn to Change: Teaching Toward a Shifting Health Care Horizon.” This article describes some of the main trends in health care that Dr. Emanuel foresees, focusing on the implications of the changing role of hospitals for innovation in continuing education.
More Than Reducing Complexity: Canadian Specialists' Views of the Royal College's Maintenance of Certification Framework and Program
Authors: Horsley Tanya , Moreau Katherine , Lockyer Jocelyn , Zeiter Jeanie , Varpio Lara , Campbell Craig
Published: August 2016

Introduction:

Maintenance of Certification (MOC) programs are facing competing pressures from physicians and regulators to design and deliver systems that ensure physicians sustain or maintain competence postcertification. Adding to these pressures is an emerging discourse of dissatisfaction by physicians participating in MOC programs suggesting physicians themselves are seeking programs that are relevant to their scope of practice. The object was to determine Canadian specialists' views of a redesigned Royal College of Physician and Surgeons of Canada's MOC program in five priority areas: complexity, motivation, impact, credit sufficiency, and enhancement.

Methods:

A national, cross-specialty, survey of Royal College of Physician and Surgeons of Canada's MOC program users who had participated for at least 1 year.

Results:

Five thousand two hundred fifty nine respondents were included in the analysis. A majority of participates either “agreed” (2258, 43%) or “strongly agreed” (631, 12%) that the new framework was simpler to understand and the redesigned submission templates were simpler to use (“agree” 2297 [43.7%], “strongly agree” 701 [13.3%]). A total of 64.5% had a good understanding of the program purposes; however, some respondents believe the program does not yet deliver intended outcomes. Maintaining Fellowship designation, regulatory requirements, and a desire to remain up-to-date were indicated as the primary motivators for engaging in MOC. The program has had a modest influence on users' approach to lifelong learning (“neither agree nor disagree”).

Discussion:

The program redesign reduced the perceived complexity of the MOC framework however it is described by some, as additional work (an add-on) by necessitating the documentation of participation in learning activities. An important “disconnect” between the program purposes and how physicians operationalize engagement was also illuminated by our study. Further attention needs to be paid to shifting the culture of continuing professional development to one that enables physicians to sufficiently demonstrate their continuing competence and enhanced performance meaningfully through participation in MOC programs.
Virtual Knowledge Brokering: Describing the Roles and Strategies Used by Knowledge Brokers in a Pediatric Physiotherapy Virtual Community of Practice
Authors: Hurtubise Karen , Rivard Lisa , Héguy Léa , Berbari Jade , Camden Chantal
Published: August 2016

Introduction:

Knowledge transfer in pediatric rehabilitation is challenging and requires active, multifaceted strategies. The use of knowledge brokers (KBs) is one such strategy noted to promote clinician behavior change. The success of using KBs to transfer knowledge relies on their ability to adapt to ever-changing clinical contexts. In addition, with the rapid growth of online platforms as knowledge transfer forums, KBs must become effective in virtual environments. Although the role of KBs has been studied in various clinical contexts, their emerging role in specific online environments designed to support evidence-based behavior change has not yet been described. Our objective is to describe the roles of, and strategies used by, four KBs involved in a virtual community of practice to guide and inform future online KB interventions.

Methods:

A descriptive design guided this study and a thematic content analysis process was used to analyze online KB postings. The Promoting Action on Research in Health Sciences knowledge transfer framework and online andragogical learning theories assisted in the coding. A thematic map was created illustrating the links between KBs' strategies and emerging roles in the virtual environment.

Results:

We analyzed 95 posts and identified three roles: 1) context architect: promoting a respectful learning environment, 2) knowledge sharing promoter: building capacity, and 3) linkage creator: connecting research-to-practice. Strategies used by KBs reflected invitational, constructivism, and connectivism approaches, with roles and strategies changing over time.

Discussion:

This study increases our understanding of the actions of KBs in virtual contexts to foster uptake of research evidence in pediatric physiotherapy. Our results provide valuable information about the knowledge and skills required by individuals to fulfill this role in virtual environments.
Continuing Professional Development in the Twenty-First Century
Authors: Sachdeva Ajit K.
Published: August 2016

The critical role of continuing professional development (CPD) in supporting delivery of patient care of the highest quality and safety is receiving significant attention in the current era of monumental change. CPD is essential in efforts to ensure effectiveness of new models of health care delivery, improve outcomes and value in health care, address external regulations, and foster patient engagement. The unique features of CPD; the use of special mastery-based teaching, learning, and assessment methods, and other special interventions to promote excellence; and direct involvement of a variety of key stakeholders differentiate CPD from undergraduate medical education and graduate medical education. The needs of procedural specialties relating to CPD are different from those of primary care disciplines and require special attention for the greatest impact. Simulation-based education and training can be very useful in CPD aimed at improving outcomes and promoting patient safety. Preceptoring, proctoring, mentoring, and coaching should be used routinely to address specific needs in CPD. Distinct CPD strategies are necessary for retraining, reentry, and remediation. Participation in CPD programs can be encouraged by leveraging the joy of learning, which should drive physicians and surgeons to strive continually to be the best in their professional work.
Combating Opioid Overdose With Public Access to Naloxone
Authors: Mitchell Kathryn Dambrino , Higgins Leslie J.
Published: August 2016

Purpose

Opioid overdose deaths have become an escalating epidemic in the United States. To combat this complex issue, naloxone distribution to the public has been initiated in many states as a harm reduction strategy. While supportive legislation develops and community programs expand, research- and policy-focused literature surrounding this timely topic require exploration, compilation, and analysis. The purpose of this systematic review is to identify trends in the current literature, gaps in the findings, nursing implications, and opportunities for further exploration.

Methods

Following a systematic approach, the keywords “naloxone” and “opioid overdose” were used to retrieve articles through the search engines Academic Search Premier, CINAHL Complete, MEDLINE Complete, PubMed, and Psychology and Behavior Sciences Collection.

Findings

In the 38 articles selected for the final review, six categories were discussed: global trends, U.S. overdose education programs with naloxone distribution, barriers to public access of naloxone, political opposition and support, financial impact, and recommendations. After reviewing the findings, gaps in the literature were examined, and nursing implications were acknowledged.

Originality and Value

Although many authors have researched and discussed public naloxone distribution, a comprehensive review of the current evidence is useful and necessary to enhance future research, practice, and policy efforts. By discovering significant gaps in the literature and by recognizing opportunities for nursing practice, this literature review provides valuable input for healthcare professionals, public health officials, policymakers, and laypersons to better understand an ethically, politically, and socially complicated public health initiative.
Women and Alcohol Use Disorders
Authors: Brighton Renee , Moxham Lorna , Traynor Victoria
Published: August 2016

Women, alcohol, and alcohol use disorders are underresearched topics when compared with the plethora of literature exploring male alcohol consumption and its related harms. It is time to change the fact that women are underrepresented in research and programs targeting alcohol use disorders. Given the changing patterns of alcohol consumption by women, coupled with the fact that women experience a telescoping effect in alcohol-related harms, it is time that increasing attention be paid to the way gender influences the experience of alcohol-related harms, including the development of alcohol use disorders. Recovery-orientated systems are not possible without the voices of the consumers being heard. With this in mind, the purposes of this article are to explore factors that lead to alcohol-related harm in women and to highlight the gender-specific barriers to service engagement.
How Quality Improvement Practice Evidence Can Advance the Knowledge Base
Authors: O'Rourke Hannah M. , Fraser Kimberly D.
Published: August 2016

Recommendations for the evaluation of quality improvement interventions have been made in order to improve the evidence base of whether, to what extent, and why quality improvement interventions affect chosen outcomes. The purpose of this article is to articulate why these recommendations are appropriate to improve the rigor of quality improvement intervention evaluation as a research endeavor, but inappropriate for the purposes of everyday quality improvement practice. To support our claim, we describe the differences between quality improvement interventions that occur for the purpose of practice as compared to research. We then carefully consider how feasibility, ethics, and the aims of evaluation each impact how quality improvement interventions that occur in practice, as opposed to research, can or should be evaluated. Recommendations that fit the evaluative goals of practice-based quality improvement interventions are needed to support fair appraisal of the distinct evidence they produce. We describe a current debate on the nature of evidence to assist in reenvisioning how quality improvement evidence generated from practice might complement that generated from research, and contribute in a value-added way to the knowledge base.
Developing Governance Structures in Health Care System Consolidation
Authors: Swartz Colleen H. , Bentley Sarah
Published: August 2016

Given the acceleration and increasing complexity of integrative care models across health systems, the question how governance and management structure(s) should be operationalized and evolved to achieve peak system performance is paramount. In a recent evaluation of partnerships with the University of Kentucky HealthCare (UK HealthCare), the conceptualization of the integration management model was explored. It was recognized that nursing leadership, governance structure, and relationships are vital for successful movement and migration of appropriate care models. In this case, the evolving governance models and the forecasted impact on models of care delivery were carefully considered. This included the potential impact on nursing practice. As the model was developed, a conceptual framework was utilized to examine potential variant relationship arrangements and to provide organization to key constructs. Utilization of a blueprint to optimize decision making and provide a replicable approach was essential to management of the integration philosophy.
Health Care Evolution Is Driving Staffing Industry Transformation
Authors: Faller Marcia , Gogek Jim
Published: August 2016

The powerful transformation in the health care industry is reshaping not only patient care delivery and the business of health care but also demanding new strategies from vendors who support the health care system. These new strategies may be most evident in workforce solutions and health care staffing services. Consolidation of the health care industry has created increased demand for these types of services. Accommodating a changing workforce and related pressures resulting from health care industry transformation has produced major change within the workforce solutions and staffing services sector. The effect of the growth strategy of mergers, acquisitions, and organic development has revealed organizational opportunities such as expanding capacity for placing physicians, nurses, and allied professionals, among other workforce solutions. This article shares insights into workforce challenges and solutions throughout the health care industry.
Frontline Nurse Engagement and Empowerment
Authors: Riley Bettina H. , Dearmon Valorie , Mestas Lisa , Buckner Ellen B.
Published: August 2016

Improving health care quality is the responsibility of nurses at all levels of the organization. This article describes a study that examined frontline staff nurses' professional practice characteristics to advance leadership through the understanding of relationships among practice environment, quality improvement, and outcomes. The study design was a descriptive quantitative design at 2 time points. Findings support the use of research and quality processes to build leadership capacity required for positive resolution of interdisciplinary operational failures.
Two Essential Roles
Authors: Schneider Maureen
Published: August 2016

American health care organizations are experiencing increasing change driven by emerging partnerships, market demographics, population health initiatives, and merger and acquisition trends. The health care business environment necessitates alterations in how companies operate on a larger scale. New regional leadership roles are being created to provide leadership to systematize networks, build market share, and strengthen market needs. It is important and necessary to explore, review, and contrast the roles, skills, and behaviors of regional leader's roles and the solo organization leaders. It is also imperative to review the benefits of new affiliations for the community and hospital entity.
On-Boarding a New Chief Nursing Officer to Lead a Magnet Redesignation Visit
Authors: Cantu Kathy , Batcheller Joyce A.
Published: August 2016

The chief nursing officer (CNO) is a critical senior executive in a hospital and serves as the architect of patient care. Recruiting, hiring, and on-boarding a new CNO present a challenge for any facility. Stakes are higher when the facility is replacing a CNO in the midst of its Magnet redesignation. How does a facility ensure success under these circumstances? This case study demonstrates how one organization was successful in meeting this challenge.
Executing on Integration
Authors: Bradley Carol
Published: August 2016

Health care mergers and acquisitions require a clearly stated vision and exquisite planning of integration activities to provide the best possible conditions for a successful transaction. During the due diligence process, key steps can be taken to create a shared vision and a plan to inspire confidence and build enthusiasm for all stakeholders. Integration planning should include a defined structure, roles and responsibilities, as well as a method for evaluation.
Unpacking MACRA
Authors: Haycock Camille , Edwards Michelle L. , Stanley Christopher S.
Published: August 2016

The Centers for Medicare & Medicaid Services (CMS) has released a proposed rule that details a consolidated pay-for-performance provider payment system within the Medicare Access and CHIP Reauthorization Act. This proposed rule establishes policy for the new provider Merit-Based Incentive System and Alternative Payment Models. While the rule is extremely complex, and not yet finalized, there are significant implications for nursing and advanced practice providers. This proposed rule intends to drastically change the current provider payment system and reward providers who demonstrate better quality outcomes at a lower cost. It also aligns with the current administration's intention to reform the payment and delivery system to a value-based methodology. Within the proposed rule, there is much at stake and will likely transform the way in which providers are reimbursed for Medicare beneficiaries. There are many strategies that can be deployed to help drive success within this new legislation. Among them are a renewed focus on quality outcomes, knowledge of clinical performance, care coordination, and deploying new models of care that address a lower cost structure. It is imperative that nurses and advanced practice providers are aware of this new legislation and how their practice will be implicated by payment reform.
Validation of the Critical-Care Pain Observation Tool With Seriously Ill Patients
Authors: Ross Melody , Boitor Madalina , Gélinas Céline
Published: August 2016

The Critical-Care Pain Observation Tool is a behavioral scale recommended for pain assessment in nonverbal critically ill adults. Although the use of this tool was validated in various critical care patient groups, little is known about its validity of use in seriously ill patients at high risk of dying in the intensive care unit, which is the purpose of this study. A prospective cohort study with repeated-measure within-subject design was conducted in a Canadian intensive care unit. Two trained raters assessed the pain of 22 participants with the Critical-Care Pain Observation Tool before, during, and 15 minutes after a nonnociceptive procedure (gentle touch) and a nociceptive procedure (turning). Interrater reliability and discriminant validation were examined. Intraclass correlation coefficients greater than 0.75 between the raters’ scores supported interrater reliability. Higher Critical-Care Pain Observation Tool scores were found during turning compared with gentle touch (P < 0.01), demonstrating discriminant validation. The Critical-Care Pain Observation Tool seems to be valid, can be used consistently, and is able to discriminate painful from nonpainful conditions in the nonverbal critically ill adults at high risk of dying.
Tales: A Tool to Address Death With Children
Authors: Ortego Carmen , Aparicio Mar , Paz María , Torres Blanca , Sarabia Raquel , Sevilla Lourdes , Álvarez Lourdes , Agudo M. Jesús
Published: August 2016

Children are curious about death, but it is also one of their biggest fears and a primary cause of sadness. Several authors argue that tales are an appropriate tool for addressing concepts of death. This article summarizes and evaluates 23 tales dealing with death in terms of their usefulness in helping 3- to 9-year-old children understand and cope with the concept of death. On a Likert scale of 1 to 10 points, the 23 tales received an average score of 6.62 points (SD, 0.72) points (range, 5.32–7.53 points). There was no significant correlation between the average score and selection frequency (r
Spearman = −0.26; P = .3). Only 2 of the tales analyzed indicated the recommended reading age. Nurses can recommend that families use tales that deal with death as a teaching tool because death themes are presented in a positive and realistic way that promotes understanding and coping with the concept of death.
Journeys of Hope
Authors: Coats Heather , Rishel Cindy J.
Published: August 2016

In pediatric malignancies, when a parent(s) and a child are faced with a life-threatening illness, the decision-making process can be quite complex. The purpose of this study was to describe parents’ experiences and their perspectives of transitions that occurred along the trajectory of their child’s illness. A thematic content analysis was performed to identify patterns in the parents’ experiences through their children’s illness. The sample included seven parents, two fathers and five mothers, whose children had died within the previous 2 years. Three overarching themes emerged: parents’ development of multidimensional trust and parents’ transitional knowing, which both occurred along the parents’ journeys of hope. In healthcare, the knowledge gained from these parents’ experiences is beneficial to practitioners to facilitate the best journey possible.
Burdens Versus Benefits
Authors: Plakovic Kathy
Published: August 2016

Advanced directives allow patients to designate an agent to make decisions for them if they become incapacitated and unable to make their own decisions. Unfortunately, designating an agent does not ensure that that person understands the patient’s preferences for treatment or has the ability to carry out the patient’s wishes. This can leave end-of-life decision making up to individuals who may not be able to understand medically what is happening and may be too emotionally invested to make difficult decisions. Families may request nonbeneficial treatments in these situations that can raise ethical issues such as autonomy and nonmaleficence. Conflict within the family and between the family and health care team regarding the burdens and benefits of further treatment can lead to moral distress. The many dimensions that can influence health care decisions including communication about goals and values, the risks and benefits of proposed treatments, prognostication, and the family’s and clinicians’ response to the situation will be discussed. The palliative care advanced practice registered nurse can play a key role in providing information and supporting family during this difficult time. However, even with this support, family members may continue to have difficulty making end-of-life decisions for their loved ones.
Autonomy and Human Dignity Are Key Features of a Good Death in Finnish Nurses’ Conceptions
Authors: Terkamo-Moisio Anja , Kvist Tarja , Pietilä Anna-Maija
Published: August 2016

In Europe, most individuals die in hospitals or other health care institutions, where nurses care for them at the end of their lives. Despite the nurses’ important role in end-of-life care, their perceptions of death are underrepresented in the literature. This study explores Finnish nurses’ varied conceptions of a good death with a qualitative design. Nurses (n = 82), recruited via social media, completed a Web-based questionnaire about a good death. Data were collected in April 2014 and analyzed inductively with a phenomenographic, 7-step analysis method. The autonomy and human dignity of the dying person were highlighted in the study results as key features of a good death. Four categories of description emerged from the data: respect of one’s autonomy and human dignity, attributes of a good death, preparation for death, and contextual aspects of a good death. The findings demonstrate the broad variation in nurses’ conceptions of a good death. Nurses will be better able to provide individualized and high-quality end-of-life care with knowledge about the various existing conceptions of a good death. Future research should explore the extent to which nurses’ conceptions of a good death are realized during provision of end-of-life care by nurses in different health care settings.
Overcoming Barriers, 1 Child at a Time
Authors: Cormack Carrie , Phillips Shannon M. , McDaniel Christina
Published: August 2016

Children with complex chronic conditions and their families face multiple health issues, including navigating the health care system, which can be improved through palliative care services. Children nearing end of life may qualify for hospice care services, but for other children living with complex chronic conditions, a gap remains in the services being provided. This article provides a case example of a charter school for children with complex needs in the southeastern United States that is collaborating with a pediatric hospice and palliative care provider to incorporate palliative care into comprehensive services. The plan for implementation, anticipated benefits, and potential barriers are discussed.
Immediate Effects of Clock-Turn Strategy on the Pattern and Performance of Narrow Turning in Persons With Parkinson Disease
Authors: Yang Wen-Chieh , Hsu Wei-Li , Wu Ruey-Meei , Lin Kwan-Hwa
Published: August 2016

Background and Purpose:

Turning difficulty is common in people with Parkinson disease (PD). The clock-turn strategy is a cognitive movement strategy to improve turning performance in people with PD despite its effects are unverified. Therefore, this study aimed to investigate the effects of the clock-turn strategy on the pattern of turning steps, turning performance, and freezing of gait during a narrow turning, and how these effects were influenced by concurrent performance of a cognitive task (dual task).

Methods:

Twenty-five people with PD were randomly assigned to the clock-turn or usual-turn group. Participants performed the Timed Up and Go test with and without concurrent cognitive task during the medication OFF period. The clock-turn group performed the Timed Up and Go test using the clock-turn strategy, whereas participants in the usual-turn group performed in their usual manner. Measurements were taken during the 180° turn of the Timed Up and Go test. The pattern of turning steps was evaluated by step time variability and step time asymmetry. Turning performance was evaluated by turning time and number of turning steps. The number and duration of freezing of gait were calculated by video review.

Results:

The clock-turn group had lower step time variability and step time asymmetry than the usual-turn group. Furthermore, the clock-turn group turned faster with fewer freezing of gait episodes than the usual-turn group. Dual task increased the step time variability and step time asymmetry in both groups but did not affect turning performance and freezing severity.

Discussion and Conclusions:

The clock-turn strategy reduces turning time and freezing of gait during turning, probably by lowering step time variability and asymmetry. Dual task compromises the effects of the clock-turn strategy, suggesting a competition for attentional resources.

Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A141).
Neisseria meningitidis Isolated in Postmortem Vitreous Humor in a Death Due to Meningococcal Sepsis
Authors: Garland Jack , Tse Rexson , Cala Allan D
Published: August 2016

Sepsis remains a difficult diagnosis at autopsy. With respect to meningococcal sepsis, a timely and definite diagnosis is critical because it requires public health department notification and the administration of prophylactic antibiotics to potential close contacts. A previous case series, in which both blood and cerebrospinal fluid were unavailable, suggested vitreous humor polymerase chain reaction might be a useful test in diagnosing meningococcal sepsis. We describe a fatal case of meningococcal sepsis where Neisseria meningitidis was detected in both vitreous humor and blood polymerase chain reaction, in addition to positive blood cultures. This gives further support to using microbiology of vitreous humor in suspected meningococcal sepsis, especially when microbiology samples are limited.
Vertebral Artery Dissection Masquerading as Concussion in an Adolescent
Authors: Kumar Gogi , Ludwig Bryan , Patel Vipul V.
Published: August 2016

Objective

Educate providers about the clinical presentation and consequences of delaying diagnosis of traumatic vertebral artery dissection with thromboembolic ischemic strokes in the pediatric population. Vertebral artery dissection is often difficult to diagnose and can be a potentially devastating cause of ischemic stroke.

Methods

Review of the chart, peer review/discussion, and imaging interpretation.

Results

A 16-year-old boy was admitted with confusion after a head and neck trauma was sustained while wrestling. (Glasgow Coma Scale=15, NIHSS = 0). Investigations including computed tomography (CT) head and cervical spine were normal. He then developed severe nausea, vomiting, dizziness, and headaches and was admitted for symptoms of concussion. Ten hours later, patient declined (hypertensive and unresponsive) and was noted to have decerebrate posturing. After emergent intubation, he was transferred to the pediatric intensive care unit. Repeat CT head showed an acute left cerebellar infarct with associated cerebellar edema resulting in effacement of the fourth ventricle/basilar cisterns and acute hydrocephalus. The CT angiography and magnetic resonance imaging of brain confirmed arterial dissection and near occlusion of the left vertebral artery at the C2 level. Extensive infarct was seen in the left cerebellum, brainstem, and right cerebellum. During a prolonged hospital stay, the family opted to continue care, and he was transferred to an inpatient rehabilitation facility because of limited brainstem activity, being nonverbal, and not demonstrating purposeful spontaneous movements.

Conclusions

Detailed history and thorough neurological examination in conjunction with appropriate imaging are necessary to distinguish between brainstem/cerebellar ischemia from vertebral artery dissection and concussion.
Sudden Cardiac Arrest in Pediatrics
Authors: Scheller RoseAnn L. , Johnson Laurie , Lorts Angela , Ryan Thomas D.
Published: August 2016

Sudden cardiac arrest (SCA) in the pediatric population is a rare and potentially devastating occurrence. An understanding of the differential diagnosis for the etiology of the cardiac arrest allows for the most effective emergency care and provides the patient with the best possible outcome. Pediatric SCA can occur with or without prodromal symptoms and may occur during exercise or rest. The most common cause is arrhythmia secondary to an underlying channelopathy, cardiomyopathy, or myocarditis. After stabilization, evaluation should include electrocardiogram, chest radiograph, and echocardiogram. Management should focus on decreasing the potential for recurring arrhythmia, maintaining cardiac preload, and thoughtful medication use to prevent exacerbation of the underlying condition. The purpose of this review was to provide the emergency physician with a concise and current review of the incidence, differential diagnosis, and management of pediatric patients presenting with SCA.
Prediction of Postpartum Weight in Low-Income Mexican-Origin Women From Childhood Experiences of Abuse and Family Conflict
Authors: Luecken Linda J. , Jewell Shannon L. , MacKinnon David P.
Published: August 2016

Objectives

The postpartum period represents a crucial transition period in which weight gain or loss can affect lifetime obesity risk. This study examined the prevalence of obesity and the influence of childhood abuse and family conflict on postpartum weight among low-income Mexican-origin women. Depressive symptoms and partner support were evaluated as mediators.

Methods

At a prenatal assessment, low-income Mexican-origin women (N = 322; mean [SD] age, 27.8 [6.5]) reported on childhood abuse and family conflict. Weight was measured 7 times between 6 weeks and 2 years postpartum and calculated as body mass index. Regression and growth models were used to estimate the impact of childhood abuse, childhood family conflict, partner support, and depressive symptoms on weight and weight change.

Results

Higher family conflict predicted higher weight across the first (β = .12; p = .037) and second (β = .16; p = .012) postpartum years. Family conflict (β = .17; p = .018) and low partner support (β = −.16; p = .028) also predicted increasing weight in the first year. Partner support partially mediated the effect of childhood abuse on weight change in the first year (p = .031). Depressive symptomatology mediated the effects of childhood abuse and family conflict on weight status in the second year (abuse: p = .005; conflict: p = .023).

Conclusions

For low-income Mexican-origin women with a history of childhood abuse or high family conflict, depression and low partner support may be important targets for obesity prevention efforts in the postpartum period.
Editorial
Authors: Longair Malcolm
Published: August 2016

Welcome to volume 62 of
Biographical Memoirs of Fellows of the Royal Society
, the 2016 edition. It is a particular honour to take over as Editor-in-Chief of
Biographical Memoirs
since I have long valued the excellent biographies written by our colleagues to celebrate the lives of Fellows of the Society. I have had the experience of writing three memoirs and so fully appreciate the effort needed to create a lasting memorial to those commemorated.
Inferring
R
0
in emerging epidemics—the effect of common population structure is small
Authors: Trapman Pieter , Ball Frank , Dhersin Jean-Stéphane , Tran Viet Chi , Wallinga Jacco , Britton Tom
Published: August 2016

When controlling an emerging outbreak of an infectious disease, it is essential to know the key epidemiological parameters, such as the basic reproduction number
R
0
and the control effort required to prevent a large outbreak. These parameters are estimated from the observed incidence of new cases and information about the infectious contact structures of the population in which the disease spreads. However, the relevant infectious contact structures for new, emerging infections are often unknown or hard to obtain. Here, we show that, for many common true underlying heterogeneous contact structures, the simplification to neglect such structures and instead assume that all contacts are made homogeneously in the whole population results in conservative estimates for
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and the required control effort. This means that robust control policies can be planned during the early stages of an outbreak, using such conservative estimates of the required control effort.
Linear models of activation cascades: analytical solutions and coarse-graining of delayed signal transduction
Authors: Beguerisse-Díaz Mariano , Desikan Radhika , Barahona Mauricio
Published: August 2016

Cellular signal transduction usually involves activation cascades, the sequential activation of a series of proteins following the reception of an input signal. Here, we study the classic model of weakly activated cascades and obtain analytical solutions for a variety of inputs. We show that in the special but important case of optimal gain cascades (i.e. when the deactivation rates are identical) the downstream output of the cascade can be represented exactly as a lumped nonlinear module containing an incomplete gamma function with real parameters that depend on the rates and length of the cascade, as well as parameters of the input signal. The expressions obtained can be applied to the non-identical case when the deactivation rates are random to capture the variability in the cascade outputs. We also show that cascades can be rearranged so that blocks with similar rates can be lumped and represented through our nonlinear modules. Our results can be used both to represent cascades in computational models of differential equations and to fit data efficiently, by reducing the number of equations and parameters involved. In particular, the length of the cascade appears as a real-valued parameter and can thus be fitted in the same manner as Hill coefficients. Finally, we show how the obtained nonlinear modules can be used instead of delay differential equations to model delays in signal transduction.
Closing oil palm yield gaps among Indonesian smallholders through industry schemes, pruning, weeding and improved seeds
Authors: Soliman T. , Lim F. K. S. , Lee J. S. H. , Carrasco L. R.
Published: August 2016

Oil palm production has led to large losses of valuable habitats for tropical biodiversity. Sparing of land for nature could in theory be attained if oil palm yields increased. The efficiency of oil palm smallholders is below its potential capacity, but the factors determining efficiency are poorly understood. We employed a two-stage data envelopment analysis approach to assess the influence of agronomic, supply chain and management factors on oil palm production efficiency in 190 smallholders in six villages in Indonesia. The results show that, on average, yield increases of 65% were possible and that fertilizer and herbicide use was excessive and inefficient. Adopting industry-supported scheme management practices, use of high-quality seeds and higher pruning and weeding rates were found to improve efficiency. Smallholder oil palm production intensification in Indonesia has the capacity to increase production by 26%, an equivalent of 1.75 million hectares of land.
Olfactory experience shapes the evaluation of odour similarity in ants: a behavioural and computational analysis
Authors: Perez Margot , Nowotny Thomas , d'Ettorre Patrizia , Giurfa Martin
Published: August 2016

Perceptual similarity between stimuli is often assessed via generalization, the response to stimuli that are similar to the one which was previously conditioned. Although conditioning procedures are variable, studies on how this variation may affect perceptual similarity remain scarce. Here, we use a combination of behavioural and computational analyses to investigate the influence of olfactory conditioning procedures on odour generalization in ants. Insects were trained following either absolute conditioning, in which a single odour (an aldehyde) was rewarded with sucrose, or differential conditioning, in which one odour (the same aldehyde) was similarly rewarded and another odour (an aldehyde differing in carbon-chain length) was punished with quinine. The response to the trained odours and generalization to other aldehydes were assessed. We show that olfactory similarity, rather than being immutable, varies with the conditioning procedure. Compared with absolute conditioning, differential conditioning enhances olfactory discrimination. This improvement is best described by a multiplicative interaction between two independent processes, the excitatory and inhibitory generalization gradients induced by the rewarded and the punished odour, respectively. We show that olfactory similarity is dramatically shaped by an individual's perceptual experience and suggest a new hypothesis for the nature of stimulus interactions underlying experience-dependent changes in perceptual similarity.
Interactions between demography, genetics, and landscape connectivity increase extinction probability for a small population of large carnivores in a major metropolitan area
Authors: Benson John F. , Mahoney Peter J. , Sikich Jeff A. , Serieys Laurel E. K. , Pollinger John P. , Ernest Holly B. , Riley Seth P. D.
Published: August 2016

The extinction vortex is a theoretical model describing the process by which extinction risk is elevated in small, isolated populations owing to interactions between environmental, demographic, and genetic factors. However, empirical demonstrations of these interactions have been elusive. We modelled the dynamics of a small mountain lion population isolated by anthropogenic barriers in greater Los Angeles, California, to evaluate the influence of demographic, genetic, and landscape factors on extinction probability. The population exhibited strong survival and reproduction, and the model predicted stable median population growth and a 15% probability of extinction over 50 years in the absence of inbreeding depression. However, our model also predicted the population will lose 40–57% of its heterozygosity in 50 years. When we reduced demographic parameters proportional to reductions documented in another wild population of mountain lions that experienced inbreeding depression, extinction probability rose to 99.7%. Simulating greater landscape connectivity by increasing immigration to greater than or equal to one migrant per generation appears sufficient to largely maintain genetic diversity and reduce extinction probability. We provide empirical support for the central tenet of the extinction vortex as interactions between genetics and demography greatly increased extinction probability relative to the risk from demographic and environmental stochasticity alone. Our modelling approach realistically integrates demographic and genetic data to provide a comprehensive assessment of factors threatening small populations.