bluuebunny/crossref_metadata_2025 huggingface dataset:
Formal (4+1) Cyclization of Ammonium Ylides with Vinylogous para-Quinone Methides
Authors: Waser Mario , Roiser Lukas , Zielke Katharina
Published: September 2018

The formal (4+1) cyclization between in situ generated achiral carbonyl-stabilized ammonium ylides and vinylogous p-quinone methides can be carried out under operationally simple conditions, leading to two different double bond regioisomers depending on the conditions used. Apart from these racemic approaches, a first proof-of-concept for enantioselective versions of these reactions was also obtained.
A Brief Survey on Six Basic and Reduced eHealth Indicators in Seven Countries in 2017
Authors: Haux Reinhold , Ammenwerth Elske , Koch Sabine , Lehmann Christoph , Park Hyeoun-Ae , Saranto Kaija , Wong C.
Published: September 2018

Background Holistic, ubiquitous support of patient-centered health care (eHealth) at all health care institutions and in patients' homes through information processing is increasingly supplementing institution-centered care. While eHealth indicators may measure the transition from institution-centered (e.g., hospital-centered) information processing to patient-centered information processing, collecting relevant and timely data for such indicators has been difficult.

Objectives This article aims to design some basic eHealth indicators, which are easily collected and measure how well information processing supports holistic patient-centered health care, and to evaluate penetrance of patient-centered health as measured by the indicators internationally via an expert survey.

Methods We identified six basic indicators that measure access of health care professionals, patients, and caregivers to the patient's health record data and the ability of providers, patients, and caregivers to add information in the patient's record. In a survey of international informatics experts, these indicators' penetrance were evaluated for Austria, Finland, Germany, Hong Kong, South Korea, Sweden, and the United States in the summer of 2017.

Results The eHealth status measured by the indicators varied significantly between these seven countries. In Finland, most practices measured by the indicators were fully implemented whereas in Germany only one practice was partially realized.

Conclusion Progress in the implementation of practices that support patient-centered care could mainly be observed in those countries where the “political will” focused on achieving patient-centered care as opposed to an emphasis on institution-centered care. The six eHealth indicators seem to be useful for measuring national progress in patient-centered care. Future work will extend the number of countries analyzed.
Chlorhexidine–Alcohol Compared with Povidone–Iodine Preoperative Skin Antisepsis for Cesarean Delivery: A Systematic Review and Meta-Analysis
Authors: Whitham Megan , El-Nashar Sherif , Clark Steven , Tolcher Mary
Published: September 2018

Objective To compare chlorhexidine–alcohol with povidone–iodine solutions for skin antisepsis prior to cesarean delivery for the prevention of surgical site infection.

Study Design Electronic databases MEDLINE, Embase, Scopus, and Clinicaltrials.gov were searched from inception to August 2017. Eligible studies included randomized controlled trials comparing chlorhexidine–alcohol with povidone–iodine skin preparation solutions for women undergoing cesarean delivery. The primary outcome was surgical site infection including superficial or deep wound infection. Meta-analysis was performed, and risk ratios (RRs) with 95% confidence interval (CI) were calculated using the Mantel–Haenszel random effects model. Statistical heterogeneity was assessed using Higgin's I
2.

Results Of 61 abstracts identified in the primary search, four studies (3,059 women) met the eligibility criteria. The risk of surgical site infection was significantly reduced with chlorhexidine–alcohol (RR: 0.72; 95% CI: 0.52–0.98). No heterogeneity across studies was observed with I
2 = 0%. Subgroup analysis of superficial infection only or deep infection only showed no statistically significant difference (RR: 0.76, 95% CI: 0.54–1.08; and RR: 0.50, 95% CI: 0.23–1.10, respectively).

Conclusion Preoperative skin cleansing prior to cesarean delivery with chlorhexidine–alcohol reduces surgical site infection as compared with povidone–iodine solutions.
Enhanced photoresponse of Ge/Si nanostructures by combining amorphous silicon deposition and annealing
Authors: Podolian A. , Nadtochiy A. , Korotchenkov O. , Romanyuk B. , Melnik V. , Popov V.
Published: September 2018

In order to inhibit high carrier recombination rates in Ge-on-Si nanostructures, GexSi1–x nanoislands were covered by a thin amorphous silicon layer via a low pressure CVD process. It is demonstrated that the surface photovoltage (SPV) signal in capped GexSi1–x/Si is increased by an order of magnitude compared to that of bare GexSi1–x islands, which can be due to the effective passivation of recombination centers at the a-Si/GexSi1–x interface. The effect is even more enhanced after subsequent annealing at 400 °C in an O2 ambient environment, with the signal increases ranging from 5 to 10 times. The observed increased photovoltage is accompanied by longer time decays in the SPV transients, being most increased after the annealing step. These results show that the photoexcited electron-hole pairs can be efficiently separated by the internal electric field at the a-Si/GexSi1–x/c-Si interfaces and can contribute to the photovoltage with decreasing recombination in GexSi1–x islands or at the interfaces. This work can facilitate the photovoltaic applications of Ge/Si heterostructures.
Impact of doping on bonding energy hierarchy and melting of phase change materials
Authors: Liu Jie , Wang Evan , Zhao Yunqi , Xu Xu , Moon Jeong-Sun , Anantram M. P.
Published: September 2018

The impact of doping on the bonding energy hierarchy and melting point of phase change material germanium telluride is studied. The underlying bonding energy decomposition is based on density functional theory calculations. It is shown that doping can influence the bonding energy hierarchy to lower the melting temperature and latent heat of fusion. Conversely, doping slightly increases the specific heat capacity. Nevertheless, doping induces a net reduction in energy consumption for the “reset” operation of phase change memory devices. This bonding energy analysis is three to four orders of magnitude more computationally efficient than the widely used ab initio molecular dynamics simulations. It is expected that this approach could be useful for next-generation high-throughput simulation-based phase change material design and optimization.
Investigation of multifilament MgB2 superconducting joint technique for development of MRI magnets
Authors: Yoo B. H. , Kim J. C. , Kim Y. G. , Hwang D. Y. , Lee J. H. , Lee H. G.
Published: September 2018

This study presents the investigation of superconducting joints fabricated using multifilament magnesium diboride (MgB2) wires for the development of persistent-current mode magnetic resonance imaging (MRI) magnets. The critical current of the jointed samples decreased with increasing cutting angle because the smaller cutting angle allowed greater exposure of the MgB2 filament, thereby increasing the contact area for the wire-bulk-wire connection. In addition, an appropriate pressing pressure (300 MPa) was necessary to establish the multifilament MgB2 joint without significant degradation of superconducting properties. The resistance of the optimal MgB2 joint, measured using the field-decay technique, was <1.5 × 10−14 Ω. Therefore, the proposed joint technique can be employed for developing multifilament MgB2 MRI magnets operating in the persistent-current mode.
Exchange-repulsion energy in QM/EFP
Authors: Viquez Rojas Claudia I. , Fine Jonathan , Slipchenko Lyudmila V.
Published: September 2018

The effective fragment potential (EFP) is a quantum mechanics (QM)-based model designed to accurately describe intermolecular interactions. Hybrid QM/EFP calculations combine quantum mechanical methods with an EFP embedding to study complex systems in which many-body effects are relevant. As in EFP-only calculations, non-bonded interactions between the QM region and EFP fragments are computed as a sum of electrostatic, polarization, dispersion, and exchange-repulsion energies. The exchange-repulsion term is a computational bottleneck of the EFP calculations. Here, we present a general procedure for computing the QM/EFP exchange-repulsion interactions based on one-electron contributions to the QM Hamiltonian, by using Gaussian functions to represent localized molecular orbitals of the effective fragments. The accuracy of the exchange-repulsion and total QM/EFP interaction energies is evaluated on a diverse set of dimers, including complexes from the S22 dataset of non-covalent interactions. In most cases, the QM/EFP energies are at least as accurate as corresponding EFP energies. A simple and computationally efficient form of the introduced QM/EFP exchange-repulsion term will facilitate further developments and applications of QM/EFP methods.
Enhanced thermoelectric properties of flexible aerosol-jet printed carbon nanotube-based nanocomposites
Authors: Ou Canlin , Sangle Abhijeet L. , Chalklen Thomas , Jing Qingshen , Narayan Vijay , Kar-Narayan Sohini
Published: September 2018

Aerosol-jet printing allows functional materials to be printed from inks with a wide range of viscosities and constituent particle sizes onto various substrates, including the printing of organic thermoelectric materials on flexible substrates for low-grade thermal energy harvesting. However, these materials typically suffer from relatively poor thermoelectric performance, compared to traditional inorganic counterparts, due to their low Seebeck coefficient, S, and electrical conductivity, σ. Here, we demonstrate a modified aerosol-jet printing technique that can simultaneously incorporate well-dispersed high-S Sb2Te3 nanoflakes and high-σ multi-walled carbon nanotubes (MWCNTs) providing good inter-particle connectivity to significantly enhance the thermoelectric performance of poly(3,4-ethylenedioxythiophene) polystyrene sulfonate structures on flexible polyimide substrates. A nominal loading fraction of 85 wt. % yielded a power factor of ∼41 μW/mK2, which is among the highest for printed organic-based structures. Rigorous flexing and fatigue tests were performed to confirm the robustness and stability of these aerosol-jet printed MWCNT-based thermoelectric nanocomposites.
Investigation of electronic structure and optical properties of thallium lead halides: First principle calculations
Authors: Mahmood Asad , Shi Gansehng , Sun Jing , Liu Jianjun
Published: September 2018

Using first principle calculations, we comprehend the electronic structure and optical constant of thallium lead halides TI3PbX5 (X = Cl, Br, I), which are viewed as potential materials for mid-infrared and near-infrared applications. The generalized gradient approximation function given by Perdew-Burke-Ernzerhof is used for geometry optimization and properties calculations. The calculated Mulliken charges are more positive for Pb than TI in the TI3PbCl5 system demonstrating a high electronic density contribution from the Pb-Cl bonds in contrast to the TI-Cl bonds. Similarly, the TI3PbCl5 configuration displays the smallest enthalpy value suggesting a more stable structure among different TI3PbX5 species studied in this work. The band gap value for TI3PbCl5 has been calculated as 3.52 eV, which decreases to 3.14 eV and 2.64 eV for the TI3PbBr5 and TI3PbI5, respectively. Additionally, the TI3PbI5 exhibits a high magnitude of real component of static dielectric function ε1(k) in contrast to TI3PbBr5 and TI3PbCl5. The optical absorption results display a redshift when TI3PbCl5 is doped with Br and I sequentially. These outcomes suggest that the concentration of halide elements can be adjusted to enhance the optical properties of TI3PbX5 for optoelectronic device applications.
Improved hydrogen adsorption of 5A molecular sieves by enhancing its thermal conductivity
Authors: Sun Nan , Zhang Quan-Ping , Yao Yong , Wen Ming , Sun Hao-Ran , Yang Wen-Bin , Zhou Yuan-Lin , Song Jiang-Feng , Luo De-Li
Published: September 2018

Understanding the hydrogen adsorption of porous materials is crucial to the design of high-efficiency hydrogen isotope separation materials. Much importance has been attached to tailoring the structures of materials, while the thermal management during the adsorption is often ignored. Here, we have experimentally found that the hydrogen adsorption capacity of a 5A molecular sieve (5A) is improved by enhancing its thermal conductivity. It can be facilely achieved by constructing rich and firm thermally conductive networks by filling graphite. 5A with 30 wt. % graphite shows a high thermal conductivity of 0.97 W m−1 K−1 and a fast thermal response. Notably, it also displays an enhancement of 15.6 ml/g normalized hydrogen adsorption capacity compared to the neat 5A. This indicates that there is a close relationship between thermal conductivity and hydrogen adsorption. The above demonstrations show that thermal management plays a significant role in hydrogen adsorption and should be seriously considered for designing the materials of hydrogen isotope separation.
Droplet ski-jumping on an inclined macro-textured superhydrophobic surface
Authors: Regulagadda Kartik , Bakshi Shamit , Das Sarit Kumar
Published: September 2018

Rapid shedding of impinging water drops is crucial in a cold habitat for diverse reasons spanning from self-cleaning to thermal regulation in most plants, animals, and industrial applications as well. It was shown recently that deploying linear millimetric ridges on a superhydrophobic surface can reduce the contact time (for drops crashing normally) up to 50% compared to a flat surface. However, the contact time rises for drops impacting at an increasing offset to the structure. Counter-intuitively, we demonstrate a ski-jumping mechanism occurring only over a range of offsets from the macro-structure with a remarkable reduction in contact time (∼65%) during oblique impacts. Theoretically, the reduction can be as high as 80%. The flow hydrodynamics is very similar to the oblique impacts on a flat surface. However, the architecture of ridge allows the drop to rapidly fly away from the surface. This work provides new insight which can be useful for the design of surfaces with high water repellency.
Extensional vibration characteristics and screening of polarization charges in a ZnO piezoelectric semiconductor nanofiber
Authors: Wang Guolin , Liu Jinxi , Liu Xianglin , Feng Wenjie , Yang Jiashi
Published: September 2018

We study extensional vibrations of a ZnO piezoelectric semiconductor fiber driven by a time-harmonic end force. A theoretical analysis is performed using a one-dimensional model based on the phenomenological theory of piezoelectric semiconductors consisting of the equations of piezoelectricity coupled to the continuity equation of electrons. A series of resonance frequencies are identified. It is found that these frequencies are lower than those of the corresponding piezoelectric dielectric fiber because the mobile charges in the semiconductor screen the effective polarization charges and thus weaken the piezoelectric stiffening effect. Various electromechanical fields at resonances are calculated and examined. Numerical results show that the effective surface polarization charge plays a more dominant role than the effective body polarization charge. The mobile charges can screen the body polarization charges greatly, but not the surface polarization charges.
Overcoming Resistance in Clinical and Forensic Interviews
Authors: Place Codie J. , Meloy J. Reid
Published: September 2018

Reactance is one of the most common underlying causes of resistance. Reactance, a term coined by Brehm, is the reaction that occurs when a person feels their freedom of choice is threatened. Reactance can be especially troublesome for those attempting to gather information through interviews, such as mental health or law enforcement personnel. We explore resistance and reactance, and methods identified to ameliorate these phenomena when they arise during both clinical and forensic interviewing, such as the use of particular language construction, optimal eye contact, acknowledgment of resistance, providing limited and double-bind choices, and advancing the interview through affirmative comments.
Addressing Linguistic and Cultural Differences in the Forensic Interview
Authors: Barber Rioja V. , Rosenfeld B.
Published: September 2018

Given the increased cultural, linguistic and socioeconomic diversity of individuals undergoing legal proceedings, forensic mental health professionals around the world are often tasked with evaluating defendants who are drastically different from themselves. There appears to be a clear consensus that cultural competency should be a key component of both the training and practice of forensic mental health. However, despite the growing literature on multicultural assessment in clinical settings, there is little guidance on how to apply cultural competency principles to the area of forensic mental health assessment. This article reviews some of the challenges that arise during the forensic mental health interview with culturally diverse individuals. In addition, practice recommendations to mitigate some of these challenges are provided. Identified challenges and recommendations are organized around three stages: preparation for the interview (e.g., what type of knowledge about the defendant’s culture is needed beforehand, how to attain that knowledge, or whether and how to use translators), the initiation of the forensic interview (e.g., the effect of culture in the informed consent process), and the interviewing process itself (e.g., cultural challenges to developing rapport, and identification of mental status assessment domains that may be vulnerable to cultural influences).
The Szlenk index of 𝐿_{𝑝}(𝑋) and 𝐴_{𝑝}
Authors: Causey Ryan
Published: September 2018

Given a Banach space

X
X

, a

w
∗

w^*

-compact subset of

X
∗

X^*

, and

1
>
p
>
∞

1>p>\infty

, we provide an optimal relationship between the Szlenk index of

K
K

and the Szlenk index of an associated subset of

L
p

(
X

)
∗

L_p(X)^*

. As an application, given a Banach space

X
X

, we prove an optimal estimate of the Szlenk index of

L
p

(
X
)

L_p(X)

in terms of the Szlenk index of

X
X

. This extends a result of Hájek and Schlumprecht to uncountable ordinals. More generally, given an operator

A
:
X
→
Y

A:X\to Y

, we provide an estimate of the Szlenk index of the “pointwise

A
A

” operator

A
p

:

L
p

(
X
)
→

L
p

(
Y
)

A_p:L_p(X)\to L_p(Y)

in terms of the Szlenk index of

A
A

.
Exponential map and normal form for cornered asymptotically hyperbolic metrics
Authors: McKeown Stephen
Published: September 2018

This paper considers asymptotically hyperbolic manifolds with a finite boundary intersecting the usual infinite boundary, cornered asymptotically hyperbolic manifolds, and proves a theorem of Cartan–Hadamard-type near infinity for the normal exponential map on the finite boundary. As a main application, a normal form for such manifolds at the corner is then constructed, analogous to the normal form for usual asymptotically hyperbolic manifolds and suited to studying geometry at the corner. The normal form is at the same time a submanifold normal form near the finite boundary and an asymptotically hyperbolic normal form near the infinite boundary.
smCounter2: an accurate low-frequency variant caller for targeted sequencing data with unique molecular identifiers
Authors: Xu Chang , Gu Xiujing , Padmanabhan Raghavendra , Wu Zhong , Peng Quan , DiCarlo John , Wang Yexun
Published: September 2018

Motivation

Low-frequency DNA mutations are often confounded with technical artifacts from sample preparation and sequencing. With unique molecular identifiers (UMIs), most of the sequencing errors can be corrected. However, errors before UMI tagging, such as DNA polymerase errors during end repair and the first PCR cycle, cannot be corrected with single-strand UMIs and impose fundamental limits to UMI-based variant calling.

Results

We developed smCounter2, a UMI-based variant caller for targeted sequencing data and an upgrade from the current version of smCounter. Compared to smCounter, smCounter2 features lower detection limit that decreases from 1 to 0.5%, better overall accuracy (particularly in non-coding regions), a consistent threshold that can be applied to both deep and shallow sequencing runs, and easier use via a Docker image and code for read pre-processing. We benchmarked smCounter2 against several state-of-the-art UMI-based variant calling methods using multiple datasets and demonstrated smCounter2’s superior performance in detecting somatic variants. At the core of smCounter2 is a statistical test to determine whether the allele frequency of the putative variant is significantly above the background error rate, which was carefully modeled using an independent dataset. The improved accuracy in non-coding regions was mainly achieved using novel repetitive region filters that were specifically designed for UMI data.

Availability and implementation

The entire pipeline is available at https://github.com/qiaseq/qiaseq-dna under MIT license.

Supplementary information

Supplementary data are available at Bioinformatics online.
Homological Projective Duality for Linear Systems with Base Locus
Authors: Carocci Francesca , Turčinović Zak
Published: September 2018

We show how blowing up varieties in base loci of linear systems gives a procedure for creating new homological projective duals from old. Starting with a homological projective (HP) dual pair $X,Y$ and smooth orthogonal linear sections $X_L,Y_L$, we prove that the blowup of $X$ in $X_L$ is naturally HP dual to $Y_L$. The result also holds true when $Y$ is a noncommutative variety or just a category. We extend the result to the case where the base locus $X_L$ is a multiple of a smooth variety and the universal hyperplane has rational singularities; here the HP dual is a weakly crepant categorical resolution of singularities of $Y_L$. Finally we give examples where, starting with a noncommutative $Y$, the above process nevertheless gives geometric HP duals.
Cognitive Function 3 and 12 Months After ICU Discharge—A Prospective Cohort Study
Authors: Estrup Stine , Kjer Cilia K. W. , Vilhelmsen Frederik , Poulsen Lone M. , Gøgenur Ismail , Mathiesen Ole
Published: September 2018

Objectives:

Studies have shown impaired cognitive function after ICU discharge. We aimed to describe long-term cognitive function in Danish ICU patients.

Design:

Prospective cohort study.

Setting:

Single-center ICU at Zealand University Hospital, Køge, Denmark.

Patients:

Adult patients admitted for over 24 hours.

Intervention:

Three and 12 months after discharge, the patients were visited at home and tested with the Repeatable Battery for the Assessment of Neuropsychological Status.

Measurements and Main Results:

We included 161 patients, 79 patients had a 3-month and 53 a 12-month follow-up visit. The primary reasons for not being visited at 3-month were death (44 patients), decline (26 patients), or transferal to another ICU (6 patients). Visited patients were median 67 years old (interquartile range, 59–73), had a median Acute Physiology and Chronic Health Evaluation score of 20 (interquartile range, 16–26), 58% were on a ventilator, and 30% were surgical patients. The mean Repeatable Battery for the Assessment of Neuropsychological Status score was 67 (sd, 21), compared with a normal value of 100 (15). A total of 57% had Repeatable Battery for the Assessment of Neuropsychological Status scores corresponding to moderate traumatic brain injury, 46% scored corresponding to light Alzheimer’s disease, and 73% corresponding to mild cognitive impairment. After 12 months, the Repeatable Battery for the Assessment of Neuropsychological Status was still reduced (71 [25]). We examined protective and risk factors using multiple linear regression and found protective effects of being employed before admission (p = 0.0005) or being admitted from a surgical ward (p = 0.019).

Conclusions:

In this prospective cohort study of Danish ICU patients, we found significantly reduced cognitive function for intensive care patients 3 and 12 months after discharge.
Older Adults’ Experience Using Patient Portals in Communities
Authors: Son Hyojin , Nahm Eun-Shim
Published: September 2018

Patient portals can be beneficial for older adults who manage their own health. However, there is a lack of research on older adults’ experience using patient portals in the community. The aim of this study was to assess older adults’ perceived usability of patient portals they currently use. This was a secondary data analysis using selected baseline data from an online trial that tested the effects of a 3-week Theory-Based Patient Portal eLearning Program, and included 272 older adults recruited online. Data were analyzed using descriptive statistics and content analysis. Most participants owned patient portal accounts (n = 194 [71.3%]). Self-efficacy for using patient portals was relatively low (mean, 27.1; range, 0–40), and perceived usability of patient portals was also low (mean, 28.7; range, 6–42). The most-favored features of patient portals were review of medical information and eMessaging. The main difficulties in using patient portals were associated with login/access and specific portal functions. Managing multiple patient portals was a particular challenge for many participants. Findings from this study indicate the importance of providing proper levels of training and technical support to older adults to maximize use and improve outcomes of patient portal implementation.
Metoprolol and Nebivolol Prevent the Decline of the Redox Status of Low-Molecular-Weight Aminothiols in Blood Plasma of Rats During Acute Cerebral Ischemia
Authors: Ivanov Alexander Vladimirovich , Alexandrin Valery Vasil'evich , Paltsyn Alexander Alexandrovich , Virus Edward Danielevich , Nikiforova Ksenya Alexandrovna , Bulgakova Polina Olegovna , Sviridkina Nadezhda Borisovna , Appolonova Svetlana Alexandrovna , Kubatiev Aslan Amirkhanovich
Published: September 2018

Cerebral ischemia has previously been shown to cause a systemic decrease in levels of the reduced forms of low-molecular-weight aminothiols [cysteine (Cys), homocysteine (Hcy), and glutathione (GSH)] in blood plasma. In this study, we examined the effect of beta-adrenergic receptor (β-AR) antagonists metoprolol (Met) and nebivolol (Neb) on the redox status of these aminothiols during acute cerebral ischemia in rats. We used a model of global cerebral ischemia (bilateral occlusion of common carotid arteries with hypotension lasting for 10 minutes). The antagonists were injected 1 hour before surgery. Total and reduced Cys, Hcy, and GSH levels were measured 40 minutes after the start of reperfusion. Neb (0.4 and 4 mg/kg) and Met (8 and 40 mg/kg) treatment increased the levels of reduced aminothiols and the global methylation index in the hippocampus. The treatments also prevented any decrease in reduced aminothiol levels in blood plasma during ischemia. Although both of these drugs eliminated delayed postischemic hypoperfusion, only Neb reduced neuronal damage in the hippocampus. The results indicate an essential role of β1-AR blockage in the maintenance of redox homeostasis of aminothiols in the plasma and brain during acute cerebral ischemia.
Limited Impact of β-Adrenergic Receptor Activation on Left Ventricular Diastolic Function in Rat Models of Hypertensive Heart Disease
Authors: Bamaiyi Adamu J. , Norton Gavin R. , Peterson Vernice , Norman Glenda , Mojiminiyi Frank B. , Woodiwiss Angela J.
Published: September 2018

Background:

Hypertension is a major cause of left ventricular (LV) diastolic dysfunction. Although β-adrenergic receptor (β-AR) blockers are often used to manage hypertension, the impact of β-AR activation on LV lusitropic effects and hence filling pressures in the hypertensive heart with LV diastolic dysfunction is uncertain.

Methods:

Using tissue Doppler imaging and Speckle tracking software, we assessed LV function in isoflurane anesthetised spontaneously hypertensive (SHR) and Dahl salt-sensitive (DSS) rats before and after β-AR activation [isoproterenol (ISO) administration].

Results:

As compared to normotensive Wistar Kyoto control rats, or DSS rats not receiving NaCl in the drinking water, SHR and DSS rats receiving NaCl in the drinking water had a reduced myocardial relaxation as indexed by lateral wall e′ (early diastolic tissue velocity at the level of the mitral annulus) and an increased LV filling pressure as indexed by E/e′. However, LV ejection fraction and deformation and motion were preserved in both SHR and DSS rats. The administration of ISO resulted in a marked increase in ejection fraction and decrease in LV filling volumes in all groups, and an increase in e′ in SHR, but not DSS rats. However, after ISO administration, although E/e′ decreased in DSS rats in association with a reduced filling volume, E/e′ in SHR remained unchanged and SHR retained greater values than Wistar Kyoto control.

Conclusions:

The hypertensive heart is characterized by reductions in myocardial relaxation and increases in filling pressures, but β-AR activation may fail to improve myocardial relaxation and when this occurs, it does not reduce LV filling pressures.
Uncharted Waters: Developing Mental Health Services for Survivors of Domestic Human Sex Trafficking
Authors: Judge Abigail M.
Published: September 2018

In recent years, heightened attention has been paid to commercial sexual exploitation, including domestic human sex trafficking (HST), with mental health concerns named the most dominant health concern among survivors. Human sex trafficking is associated with significant and long-term mental health consequences. Research to date has emphasized ways to identify survivors in health care settings. Once identified, however, few specialized services are available to help survivors exit and recover. The current services infrastructure for HST has been compared to the disjointed social response to intimate partner violence before the women’s movement helped develop a system of battered women’s shelters. Although research has highlighted the need for a multidisciplinary and interagency response to HST, including mental health care, best practices have not yet been formulated. Furthermore, available services are fragmented across sectors. With psychology and psychiatry taking tentative steps to develop services for HST survivors, this article identifies six principles to help avoid a fragmented and potentially retraumatizing clinical and systemic response. The overarching goal is to design services that are flexible, accessible, trauma informed, survivor driven, responsive to stages of change, multidisciplinary, and enduring, especially given the centrality of healthy attachments and community in trauma recovery. Principles are derived from the limited available research on HST services and from examples of efficacious interventions for patient groups with similar characteristics. The discussion is also informed by composite clinical vignettes from a specialized clinic for adult survivors of HST, housed in a major teaching hospital. Finally, practice recommendations and strategies for building interdisciplinary collaborations are discussed.
Assessment of Users' Needs and Expectations Toward Clinical Practice Guidelines to Support the Rehabilitation of Adults With Moderate to Severe Traumatic Brain Injury
Authors: Lamontagne Marie-Eve , Bayley Mark Theodore , Marshall Shawn , Kua Ailene , Marier-Deschênes Pascale , Allaire Anne-Sophie , Schmouth Marie-Eve , Kagan Corinne , Truchon Catherine , Swaine Bonnie
Published: September 2018

Objective:

Stakeholder engagement in clinical practice guideline (CPG) creation is thought to increase relevance of CPGs and facilitate their implementation. The objectives were to survey stakeholders involved in the care of adults with traumatic brain injury (TBI) regarding general perceptions of CPGs, key elements to be included, and needs and expectations about format and implementation strategy.

Settings:

Hospitals and inpatient and outpatient rehabilitation facilities providing services to persons with TBI.

Participants:

Stakeholders identified as primary end users of the CPG: clinicians, hospital leaders, health system managers, and funders in Quebec and Ontario (Canada).

Design:

Cross-sectional online survey conducted between May and September 2014.

Results:

In total, 332 individuals expressed their needs and expectations. Despite positive perceptions of CPGs, only a small proportion of respondents used them. Intensity and frequency of interventions, behaviors disorders and cognitive function impairment, and social participation and community life were important subjects to cover in the CPG. Finally, respondents asked for specific recommendations including a ranking of recommendations based on level of underlying evidence.

Conclusion:

Respondents have important expectations toward a CPG. We anticipate that early and meaningful engagement of end users could facilitate CPG implementation.
Reducing Phlebotomy Utilization With Education and Changes to Computerized Provider Order Entry
Authors: Breen Christopher , Maguire Kevin , Bansal Amit , Russin Stanley , West Sara , Dayal Anju , Berger Andrea , Olson Jordan , Hohmuth Benjamin
Published: September 2018

Introduction:

Daily phlebotomy is often a standard procedure in hospitalized patients. Recently, this practice has begun receiving attention as a potential target for efforts focused on eliminating overuse. Several organizations have published their efforts in this arena. Interventions have included education, feedback, and changes to computerized provider order entry (CPOE) but have yielded mixed results.

Methods:

A quality improvement initiative to reduce the utilization of daily phlebotomy was conducted at a 505-bed Academic Medical Center. This project involved a combination of educational interventions and changes to CPOE. The primary end point evaluated was the daily performance of complete blood counts (CBCs) and basic metabolic profiles (BMPs) on medical and surgery units relative to the corresponding hospital census.

Results:

Over the course of this project from August 1, 2013, to September 23, 2016, there was a 15.2% reduction in CBCs (p < .001 for linear trend) and 13.1% reduction in BMPs.

Discussion:

Our results suggest that layering multimodal interventions that involve both “hard-wired” changes to CPOE and education and performance feedback can result in decreased utilization of phlebotomy.
A prediction model for successful anticoagulation in cirrhotic portal vein thrombosis
Authors: Rodriguez-Castro Kryssia I. , Vitale Alessandro , Fadin Mariangela , Shalaby Sarah , Zerbinati Patrizia , Sartori Maria Teresa , Landi Stefano , Pettinari Irene , Piscaglia Fabio , Han Guohong , Burra Patrizia , Simioni Paolo , Senzolo Marco
Published: September 2018

Background and objective

Portal vein thrombosis (PVT) is a common complication in cirrhosis, and when complete, it increases morbidity and mortality in liver transplant candidates. The aim of the study was to assess the hemostatic status, as well as clinical characteristics of thrombus and patients, as predictors of therapeutic efficacy of anticoagulation for the treatment of PVT in cirrhotics.

Patients and methods

Patients with cirrhosis consecutively treated for PVT with enoxaparin were enrolled. All patients underwent evaluation of coagulation status and thrombophilia screening. Thrombus characteristics and extension were evaluated at baseline and during follow-up. Anticoagulation was continued until recanalization or up to 12 months. Variables correlated with the response to anticoagulation were used to create a predictive score that was validated in an external multicenter cohort.

Results

A total of 65 patients were included and had partial PVT in most cases (72%). Treatment with enoxaparin resulted in an overall response rate of 66% (43/65) after a median time of 4.4 months and 76% (33/43) within the first 6 months. At multivariate analysis, efficacy of anticoagulation correlated with the severity of liver disease, complete verus partial PVT, age of the thrombus, and time interval from treatment start (<6 months). The areas under the curve of the statistical model for predicting the response to anticoagulation were 0.84 and 0.76 for the training (n=65) and validation (n=60) cohorts, respectively.

Conclusion

Early diagnosis and early treatment are key factors for the successful management of PVT in cirrhosis, so that screening of PVT and prompt start of anticoagulant treatment should be mandatory.
Iron deficiency anemia in gastric cancer: a Canadian retrospective review
Authors: Tang Grace H. , Hart Rachel , Sholzberg Michelle , Brezden-Masley Christine
Published: September 2018

Background

Gastric cancer is highly prevalent amongst men and women. Previous studies have described the high prevalence of iron deficiency anemia (IDA) in gastrointestinal cancer patients, but few have focused on the gastric cancer population. We aimed to determine the point prevalence of patients with gastric cancer who developed IDA and chemotherapy-induced anemia, and to identify types and frequencies of IDA therapies.

Patients and methods

A retrospective review was carried out for 126 gastric cancer patients from 2006 to 2016 at St Michael’s Hospital, Toronto, Canada. Patient demographics, laboratory (ferritin, iron parameters) and clinical data regarding IDA were reviewed. IDA was defined as transferrin saturation less than 20%, ferritin less than 100 μg/l, and hemoglobin less than 130 g/l in men and less than 120 g/l in women.

Results

Of the 126 patients with gastric cancer identified (median age 70, interquartile range: 59–77), 64.3% were men. Only 18.3% of patients had a self-reported history of IDA, 40% had IDA at the time of gastric cancer diagnosis, and 58.7% were anemic. A total of 77 patients received chemotherapy, and of these, 54.2% developed chemotherapy-induced anemia. At the final follow-up, 21.4% of patients were diagnosed with IDA along their treatment course, and 79.4% were anemic. Red blood cell transfusions were most frequently prescribed (48.4%; median: 4 U; interquartile range: 2–6), compared with oral (31.8%) or intravenous iron (16.7%) therapy.

Conclusion

The point prevalence of IDA was high in our gastric cancer patients despite inconsistent screening for IDA. Our findings indicate the need for a consistent diagnostic and therapeutic approach to IDA in this vulnerable patient population.
Acquired Pure Red Cell Aplasia and Acquired Amegakaryocytic Thrombocytopenia Associated With Clonal Expansion of T-Cell Large Granular Lymphocytes in a Patient With Lipopolysaccharide-responsive Beige-like Anchor (LRBA) Protein Deficiency
Authors: Rajpurkar Madhvi , Buck Steven , Lafferty Jennifer , Wakeling Erin , Ravindranath Yaddanapudi , Savaşan Süreyya
Published: September 2018

Acquired pure red cell aplasia and acquired amegakaryocytic thrombocytopenic purpura are rare in children. Similarly, clonal expansion of T-cell large granular lymphocytes is infrequently seen in pediatrics. Lipopolysaccharide-responsive beige-like anchor (LRBA) protein deficiency is a recently described immunodeficiency syndrome that has been associated with inflammatory bowel disease and autoimmune phenomena such as Evans syndrome. Here, we describe a patient with LRBA deficiency who developed acquired pure red cell aplasia and acquired amegakaryocytic thrombocytopenic purpura associated with expansion of clonal T-cell large granular lymphocytes. This has not been described in the literature previously and adds to the knowledge on the spectrum of manifestations of LRBA deficiency.
Systems Addressing Frail Elders (SAFE) Care
Authors: Ansryan Lianna Z. , Aronow Harriet Udin , Coleman Bernice , Haus Flora , Ward Cathy Rodgers , Sanchez-Rico Gloria , Berwald Peggy , LeQuire Barbara , Bolton Linda Burnes
Published: September 2018

Systems Addressing Frail Elders (SAFE) Care is an interprofessional team-based program, which was developed and evaluated in a cluster randomized controlled trial. Results of this trial included reduced length of stay and complications for patients. This article describes a successful partnership across 4 Magnet hospitals in the dissemination of the model. A 2-year sequential implementation process was completed, with an approach of adoption, adaptation, and abandonment. The model was successfully implemented at each participating Magnet hospital. Implementation included capacity building, organizational change, and process implementation.
Applying a Balm
Authors: Mahon Margaret M. , Barker Karen L.
Published: September 2018

Moral distress occurs when a nurse knows the right action but is impeded from taking that right action because of institutional constraints. Caring for patients who are dying might evoke distress, including moral distress. The distress from a difficult clinical situation is likely to permeate other areas of practice. In this article, 2 cases are used as a means to distinguish moral distress from other distress arising from clinical situations. Opportunities to alleviate distress include increasing knowledge, improved communication, enhanced collaboration, and development of institutional supports.
Leading the Charge
Authors: Brown Tyo Mirinda , Gundlach Molly , Brennan Cheryl , Esdale Laurie , Knight Autumn , Provencher Sarah , Tardy Kathleen
Published: September 2018

This article describes best practice recommendations in program development for a nurse residency program. This registered nurse residency program is the first in New England to acquire the American Nurses Credentialing Center’s Practice Transition Accreditation. Best practices identified in this effort include (a) use of a quality improvement analyst for data trending, (b) inclusion of an off-shift nurse educator, (c) use of evidence-based practice, (d) a standardized preceptor program, and (e) appropriate evaluation instruments. New graduate nurse satisfaction increased and turnover decreased after program implementation.
The Kansas Nurse Leader Residency Program
Authors: Peltzer Jill N. , Shen Qiuhua , Pierce Janet , Selig Brian , Hober Christine , Carlton Elizabeth , Teel Cynthia
Published: September 2018

As nurses engage as partners in addressing complex healthcare issues, it is increasingly important to develop nurse leaders. Many nurses need expanded knowledge and training to lead change. The purpose of this article is to describe an innovative statewide nurse leadership residency program to prepare new nurse leaders in four specialty areas. Suggestions are offered for continued advancement of leadership training for RNs across specialty roles and settings.
nCounter NanoString Assay Shows Variable Concordance With Immunohistochemistry-based Algorithms in Classifying Cases of Diffuse Large B-Cell Lymphoma According to the Cell-of-Origin
Authors: Saad Ali G. , Grada Zakaria , Bishop Barbara , Abulsayen Hend , Hassan Mohamed , Firpo-Betancourt Adolfo , Teruya-Feldstein Julie , Fraig Mostafa , El Jamal Siraj M.
Published: September 2018

Classifying diffuse large B-cell lymphoma (DLBCL) according to the cell-of-origin (COO) was first proposed using gene expression profiling; accordingly, DLBCL is classified into germinal-center B-cell type and activated B-cell type. Immunohistochemistry (IHC)-based classification using different algorithms is used widely due to the ability to use formalin-fixed paraffin-embedded tissue. Recently, newer techniques using RNA expression from formalin-fixed paraffin-embedded were introduced including the nCounter NanoString platform assay. In this brief report, we study the degree of concordance between the NanoString assay and 6 commonly utilized IHC-based algorithms to classify DLBCL cases by COO. Stains for CD10, BCL2, BCL6, FOXP-1, MUM-1, and LOM2 were used to classify a cohort of DLBCL by COO according to the respective IHC-algorithms. Then, RNA was extracted from the same cases for NanoString assay classification. The degree of concordance was calculated between the NanoString classification and each IHC-algorithm as well as among the different IHC-algorithm themselves. The concordance in COO classification of DLBCL between NanonoString assay and IHC-based algorithms is variable depending on the used IHC-algorithm; the highest concordance is seen with the Visco algorithm (κ=0.69; P=0.001). Therefore, discrepancies between the recently introduced NanoString assay and the commonly utilized IHC-algorithms are expected to some extent and should be taken into consideration when interpreting conflicting results.
Implementation and Effectiveness of an Online Responsible Vendor Training Program for Recreational Marijuana Stores in Colorado, Oregon, and Washington State
Authors: Buller David B. , Woodall W. Gill , Saltz Robert , Grayson Andrew , Buller Mary Klein
Published: September 2018

Context:

Six US states have implemented retail sales of recreational marijuana. Training in responsible sales practices has been effective in the alcohol market. An online responsible marijuana vendor (RMV) training was produced and implemented with stores in a randomized trial.

Program:

An online RMV training was developed through meetings with state regulators and local law enforcement personnel, curriculum standards published by the Colorado Marijuana Enforcement Division in May 2015, interviews with recreational marijuana store personnel (n = 15), and usability testing of a prototype training with store personnel (n = 19) in Colorado and Washington State. The training contained 5 modules: state laws and regulations, ID checking, health effects of marijuana, customer service practices including recognizing intoxicated patrons, and rules of the trade.

Implementation:

A randomized controlled trial testing the training enrolled a random sample of state-licensed retail recreational marijuana stores (n = 225) in Colorado, Oregon, and Washington State. In total, 125 stores were randomly assigned to receive the RMV training. A total of 420 store employees completed the online training between June 2017 and February 2018 (43.5% female, 88.4% younger than 40 years, and 74.1% non-Hispanic white).

Evaluation:

Responses to posttraining surveys showed that most trainees found the training user-friendly (78.4%), were satisfied (68.8%), and would recommend it to another employee (91.1%). The training improved trainees' ability to check IDs (pretraining mean = 3.91 [SD = 1.36], posttraining mean = 4.58 [SD = 0.66], t
387,388 = 8.68, P < .001) and their confidence to use the state's inventory tracking system (pretraining mean = 2.52 [SD = 0.65], posttraining mean = 2.85 [SD = 0.39], t
387, 388 = 10.89, P < .001) and spot intoxicated customers (pretraining mean = 2.79 [SD = 0.41], posttraining mean = 2.94 [SD = 0.25], t
387,388 = 6.87, P < .001).

Discussion:

Online RMV training was acceptable to retail recreational marijuana personnel and potentially improved responsible sales practices. Responsible vendor training has been successful under certain conditions in the alcohol market and should be considered for the recreational marijuana market.