bluuebunny/crossref_metadata_2025 huggingface dataset:
Mutations in AML: prognostic and therapeutic implications
Authors: DiNardo Courtney D. , Cortes Jorge E.
Published: December 2016

Acute myeloid leukemia (AML) is a heterogeneous hematologic malignancy characterized by the proliferation and aberrant differentiation of immature clonal myeloid cells. The prognosis of AML is variable, based on clinical features such as patient age, performance status, and comorbidities, as well as leukemia-specific genetic features including cytogenetics and molecular classification. The modern application of next-generation sequencing technology has uncovered marked heterogeneity and genomic complexity within AML, based on the presence or absence of cooperating mutations within functional categories such as epigenetic regulators, cell signaling and proliferation pathways, and master hematopoietic transcription factors. Although the treatment of AML has hitherto changed little in the past 40 years, the enhanced scientific understanding of AML pathophysiology and leukemogenesis has led to the recent development of multiple targeted and selective treatment approaches, and our increasing awareness of functional AML subsets will be evermore used to inform rational and personalized treatment strategies.
Autoimmune and other acquired neutropenias
Authors: Newburger Peter E.
Published: December 2016

This educational review addresses the diagnostic evaluation of patients for autoimmune and other forms of acquired neutropenia, including the futility of deconstructing the overlap of chronic “autoimmune,” “benign,” and “idiopathic” categories. Isolated neutropenias caused by infection, drugs, and immunologic disorders are also addressed. Discussion of management options emphasizes a conservative approach, with largely supportive care for these mostly benign and self-limited disorders.
Frontline therapy and role of high-dose consolidation in mantle cell lymphoma
Authors: Rule Simon
Published: December 2016

Mantle cell lymphoma (MCL) is a rare and aggressive form of non-Hodgkin lymphoma. It is predominantly a disease of older individuals, with a median age at presentation of ∼70 years. For the majority of patients, the management revolves around immuno-chemotherapy often followed by maintenance rituximab, and at relapse, a range of options are available. For the younger patient, it is possible to be more intensive with therapy, consolidate responses with high-dose procedures, and in a few there might be the prospect of a cure. The incorporation of high-dose cytarabine into the treatment algorithm has had a major impact on outcomes, with approximately half of the patients alive at 10 years whether an autologous stem cell transplant is adopted or not. Allogeneic transplantation produces some very durable responses in the relapsed setting and has a potential role up front in the highest-risk patients. However, with the advent of Bruton tyrosine kinase inhibitor and other highly effective nontraditional chemotherapeutic approaches, there is the potential for the management of this disease to change fundamentally over the next few years.
Cellular immune responses in red blood cell alloimmunization
Authors: Zimring James C. , Hudson Krystalyn E.
Published: December 2016

In excess of 340 blood group antigens have now been described that vary between individuals. Thus, any unit of blood that is nonautologous represents a significant dose of alloantigen. Most blood group antigens are proteins, which differ by a single amino acid between donors and recipients. Approximately 1 out of every 70 individuals are transfused each year (in the United States alone), which leads to antibody responses to red blood cell (RBC) alloantigens in some transfusion recipients. When alloantibodies are formed, in many cases, RBCs expressing the antigen in question can no longer be safely transfused. However, despite chronic transfusion, only 3% to 10% of recipients (in general) mount an alloantibody response. In some disease states, rates of alloimmunization are much higher (eg, sickle cell disease). For patients who become alloimmunized to multiple antigens, ongoing transfusion therapy becomes increasingly difficult or, in some cases, impossible. While alloantibodies are the ultimate immune effector of humoral alloimmunization, the cellular underpinnings of the immune system that lead to ultimate alloantibody production are complex, including antigen consumption, antigen processing, antigen presentation, T-cell biology, and B-cell biology. Moreover, these cellular processes differ to some extent with regard to transfused RBCs as compared with other better-studied immune barriers (eg, infectious disease, vaccines, and solid organ transplantation). The current work focuses on illustrating the current paradigm of humoral immunity, with a specific focus on particulars of RBC alloimmunization and recent advances in the understanding thereof.
Treatment of low-risk myelodysplastic syndromes
Authors: Santini Valeria
Published: December 2016

The majority of myelodysplastic syndrome (MDS) patients belong to the International Prognostic Scoring System (IPSS) and IPSS-revised (IPSS-R) lower-risk categories. Their precise diagnostics and prognostic stratification is often a challenge, but may ensure the optimization of therapy. The availability of diverse treatment options has significantly improved the quality of life and survival of this group of patients. Anemia is the most relevant cytopenia in terms of frequency and symptoms in lower-risk MDS, and may be treated successfully with erythropoietic stimulating agents, provided a careful selection is performed on the basis of IPSS-R, endogenous erythropoietin levels, and transfusion independence. Doses and duration of therapy of erythropoietic-stimulating agents (ESAs) are critical to determine efficacy. In case a patient fails ESA treatment, the available options may include lenalidomide (approved for del5q positive cases), hypomethylating agents, and a rather large number of experimental agents, whose clinical trials should be offered to a larger number of MDS patients. The choice for second-line treatment must take into account biologic, cytogenetic, and molecular-identified characteristics of individual patients, as well as frailty and comorbidities. Other cytopenias are less frequently presenting as isolated. Specific therapy for thrombocytopenia has been proposed in experimental clinical trials with thrombomimetic agents that have shown good efficacy, but raised some safety concern. Although neutropenia is targeted symptomatically with growth factor supportive care, the immunosuppressive treatments are indicated mainly for pancytopenic, hypoplastic lower-risk MDS; they are not widely used because of their toxicity, despite the fact that they may induce responses. Finally, hematopoietic stem cell transplant is the curative option also for lower-risk MDS and timing should be carefully evaluated, balancing toxicity and the possibility of survival advantage. Finally, even when considered suitable for lower-risk MDS, transplant application is limited to the rarer fit and younger MDS patient.
Myelofibrosis: to transplant or not to transplant?
Authors: Devlin Rebecca , Gupta Vikas
Published: December 2016

Hematopoietic cell transplantation (HCT) is the only curative therapeutic modality for myelofibrosis (MF) at present. The optimal timing of HCT is not known in the presence of wider availability of less risky nontransplant therapies such as JAK 1/2 inhibitors. Careful review of patient, disease, and transplant-related factors is required in the appropriate selection of HCT vs the best available nontransplant therapies. We highlight some of the relevant issues and positioning of HCT in light of evolving data on JAK 1/2 inhibitors. The goal of this study is to provide the reader with updated evidence of HCT for MF, recognizing that knowledge in this area is limited by the absence of comparative studies between HCT and nontransplant therapies. Prospective studies are needed for better information on: the determination of optimal timing and conditioning regimens, the best way to integrate JAK inhibitors in the HCT protocols, and the impact of JAK inhibitors on graft-versus-host disease.
Ph-like acute lymphoblastic leukemia
Authors: Tran Thai Hoa , Loh Mignon L.
Published: December 2016

Philadelphia chromosome–like acute lymphoblastic leukemia (Ph-like ALL) is a newly identified high-risk (HR) B-lineage ALL subtype, accounting for ∼15% of children with National Cancer Institute–defined HR B-ALL. It occurs more frequently in adolescents and adults, having been reported in as much as 27% of young adults with ALL between 21 and 39 years of age. It exhibits adverse clinical features, confers a poor prognosis, and harbors a diverse range of genetic alterations that activate cytokine receptor genes and kinase signaling pathways, making it amenable to treatment with tyrosine kinase inhibitor (TKI) therapy. Multiple groups are currently conducting clinical trials to prospectively screen patients with Ph-like ALL and incorporate the relevant TKI for those harboring ABL-class gene rearrangements or those with JAK-STAT pathway alterations. The success of combinatorial treatment of TKI with chemotherapy in the setting of Ph-positive ALL suggests that this approach may similarly improve outcomes for patients with Ph-like ALL. Hence, Ph-like ALL illustrates the modern treatment paradigm of precision medicine and presents unique opportunities for harnessing international collaborations to further improve outcomes for patients with ALL.
Reversing vitamin K antagonists: making the old new again
Authors: Eichinger Sabine
Published: December 2016

Vitamin K antagonists (VKAs) are commonly used for the prevention and treatment of thrombotic disorders. The response to VKAs is highly variable due to their specific interaction with the vitamin K cycle, and hence interference with hepatic synthesis of vitamin K-dependent coagulation factors. Monitoring the anticoagulant effect of VKAs by assessing the patient’s international normalized ratio (INR) is essential because complications are closely related to the intensity of anticoagulation. Treatment with VKAs contains a substantial risk of bleeding with a high case fatality rate. Reversal of VKAs is required in case of bleeding or a supratherapeutic INR, but also prior to high-risk surgery or interventions. Choice of methods to reverse VKAs depends on whether or not the patient is bleeding or is in need of an urgent procedure, and has to be based on the pharmacokinetic and pharmacodynamic properties of the VKA. Reversal strategies include withholding the VKA, administration of vitamin K1, and substitution of vitamin K-dependent procoagulant factors, and need to be combined with measures according to general bleeding management.
What to do after the bleed: resuming anticoagulation after major bleeding
Authors: Witt Daniel M.
Published: December 2016

Resuming anticoagulation therapy after a potentially life-threatening bleeding complication evokes high anxiety levels among clinicians and patients trying to decide whether resuming oral anticoagulation to prevent devastating and potentially fatal thromboembolic events or discontinuing anticoagulation in hopes of reducing the risk of recurrent bleeding is best. The available evidence favors resumption of anticoagulation therapy for gastrointestinal tract bleeding and intracranial hemorrhage survivors, and it is reasonable to begin postbleeding decision making with resuming anticoagulation therapy as the default plan. After considering factors related to the index bleeding event, the underlying thromboembolic risk, and comorbid conditions, a decision to accept or modify the default plan can be made in collaboration with other care team members, the patient, and their caregivers. Although additional information is needed regarding the optimal timing of anticoagulation resumption, available evidence indicates that waiting ∼14 days may best balance the risk of recurrent bleeding, thromboembolism, and mortality after gastrointestinal tract bleeding. When to resume anticoagulation after intracranial hemorrhage is less clear, but most studies indicate that resumption within the first month of discharge is associated with better outcomes.
Sickle cell disease: an inherited thrombophilia
Authors: Wun Ted , Brunson Ann
Published: December 2016

Activation of the hemostatic system occurs in patients with sickle cell disease. The extent to which this activation contributes to sickle cell pathophysiology is uncertain. Clinical trials of anticoagulants or platelet inhibitors have demonstrated the ability to decrease biomarkers of hemostatic activation, but this has generally not resulted in improvement in clinically relevant outcomes. Venous thromboembolism (VTE: deep venous thrombosis and pulmonary embolism) has been until recently an underappreciated complication of sickle cell disease, with incident event and recurrence rates consistent with a strong thrombophilia. There is no strong evidence that management should differ than for other patients with VTE, with the possible exception that secondary prophylaxis be extended regardless of provocation, given the persistent strong thrombophilic state.
What is the role of an extended half-life product in immune tolerance induction in a patient with severe hemophilia A and high-titer inhibitors?
Authors: Janbain Maissaa , Pipe Steven
Published: December 2016

A 10-year-old boy presents with a history of severe hemophilia A and high-titer inhibitor that had failed high-dose immune tolerance induction (ITI) with a recombinant factor VIII (rFVIII) product and a plasma-derived FVIII product. You are asked by his mother whether he should be tried on ITI with an extended half-life product, in particular, consideration of a rFVIIIFc concentrate.
What have we learned from large population studies of von Willebrand disease?
Authors: Montgomery Robert R. , Flood Veronica H.
Published: December 2016

Von Willebrand factor (VWF) is a critical regulator of hemostatic processes, including collagen binding, platelet adhesion, and platelet aggregation. It also serves as a carrier protein to normalize plasma factor VIII synthesis, release, and survival. While VWF protein measurements by immunoassay are reasonably comparable between institutions, the measurement of VWF ristocetin cofactor activity (VWF:RCo) has significant variability. Other tests of VWF function, including collagen binding or platelet glycoprotein IIb-IIIa binding, are not universally available, yet these functional defects may cause major bleeding even with normal VWF antigen (VWF:Ag) and VWF:RCo assays. This results in both the overdiagnosis and underdiagnosis of VWD. Newer assays of VWF function (using recombinant glycoprotein Ib rather than whole platelets) have been developed that may improve interlaboratory variability. Some of these tests are not uniformly available and may not be licensed in the United States. Large longitudinal studies of VWF in von Willebrand disease (VWD) patients are not available. Patients are sometimes diagnosed with a single diagnostic VWF panel. Plasma VWF levels increase with age, but it is not clear if this results in less bleeding or whether different normal ranges should be used to identify age-related decreases in VWF. In order to quantitatively compare bleeding symptoms in VWD patients and normal individuals, recent studies in the European Union, Canada, United Kingdom, Holland, and the United States have used semiquantitative bleeding assessment tools (BATs). Even with careful centralized testing, including functional assays of VWF, addition of a BAT does not solve all of the problems with VWD diagnosis. No matter where the line is drawn for diagnosis of VWD, VWF is still a continuous variable. Thus, VWD can be a severe hemorrhagic disease requiring frequent treatment or a mild condition that may not be clinically relevant. As will be discussed by Dr. Goodeve in her presentation, genetics has helped us to diagnose type 2 functional variants of VWD but has not been helpful for the many patients who are at the interface of normal and low VWF and carry the possible diagnosis of type 1 VWD. The hematologist’s management of patients with reduced levels of VWF still requires both the art and science of clinical medicine.
New treatment approaches to von Willebrand disease
Authors: Lavin Michelle , O’Donnell James S.
Published: December 2016

von Willebrand disease (VWD) is the commonest inherited bleeding disorder and results from either a quantitative or qualitative deficiency in the plasma glycoprotein von Willebrand factor (VWF). Recent large cohort studies have significantly enhanced our understanding of the molecular mechanisms involved in the pathogenesis of VWD. In contrast, however, there have been relatively few advances in the therapeutic options available for the treatment of bleeding in patients with VWD. Established treatment options include tranexamic acid, 1-deamino-8-d-arginine vasopressin (DDAVP), and plasma-derived VWF concentrates. In addition, a recombinant VWF has also recently been developed. In this review, we focus on how recent insights into the clinical and molecular aspects underpinning VWD are already beginning to influence treatment in the clinic. For example, a number of different bleeding assessment tools (BATs) have been developed to objectively assess bleeding symptoms in patients with VWD. Interestingly, however, these BAT scores may also have an important role to play in predicting bleeding risk in VWD. Furthermore, recent studies have demonstrated that enhanced VWF clearance plays a critical role in the etiology of both type 1 and type 2 VWD. These findings have direct translational relevance with respect to the use of DDAVP in patients with VWD. As understanding of the mechanisms involved in VWD pathogenesis continues to advance, novel treatment options are likely to emerge. Critically, however, large adequately powered and stratified clinical trials will be required to address the outstanding questions that remain regarding VWD treatment optimization.
Biologic vs physiologic age in the transplant candidate
Authors: Artz Andrew S.
Published: December 2016

Hematopoietic cell transplantation (HCT) remains a cornerstone of treatment of many hematologic malignancies but transplant-associated morbidity and mortality limit application to older patients. Biologic or chronologic age barriers to HCT have fallen, because patients in their 8th decade of life comprise the group with the greatest rise in transplant use over the past decade. Evaluating physiologic age or general health in older transplant candidates requires a systematic approach inclusive of functional and comorbidity assessment, which typically is accomplished through geriatric assessment (GA). GA incorporates measures of comorbidity, function, nutrition, social support, and other health-related domains to better describe physiologic age. Older allogeneic transplant patients have a surprisingly high prevalence of vulnerabilities by GA prior to transplant, and significant comorbidity or functional limitations heighten the risks of transplant-related mortality. Ultimately, incorporation of physiologic age can improve estimates of nondisease life expectancy, prognostic survival after HCT, and inform HCT candidacy. Future research on the optimal tools to characterize physiologic age and appropriate interventions in the context of transplant are needed.
The College Science Learning Cycle: An Instructional Model for Reformed Teaching
Authors: Withers Michelle
Published: December 2016

Finding the time for developing or locating new class materials is one of the biggest barriers for instructors reforming their teaching approaches. Even instructors who have taken part in training workshops may feel overwhelmed by the task of transforming passive lecture content to engaging learning activities. Learning cycles have been instrumental in helping K–12 science teachers design effective instruction for decades. This paper introduces the College Science Learning Cycle adapted from the popular Biological Sciences Curriculum Study 5E to help science, technology, engineering, and mathematics faculty develop course materials to support active, student-centered teaching approaches in their classrooms. The learning cycle is embedded in backward design, a learning outcomes–oriented instructional design approach, and is accompanied by resources and examples to help faculty transform their teaching in a time-efficient manner.
Undertreatment of people with major depressive disorder in 21 countries
Authors: Thornicroft Graham , Chatterji Somnath , Evans-Lacko Sara , Gruber Michael , Sampson Nancy , Aguilar-Gaxiola Sergio , Al-Hamzawi Ali , Alonso Jordi , Andrade Laura , Borges Guilherme , Bruffaerts Ronny , Bunting Brendan , de Almeida Jose Miguel Caldas , Florescu Silvia , de Girolamo Giovanni , Gureje Oye , Haro Josep Maria , He Yanling , Hinkov Hristo , Karam Elie , Kawakami Norito , Lee Sing , Navarro-Mateu Fernando , Piazza Marina , Posada-Villa Jose , de Galvis Yolanda Torres , Kessler Ronald C.
Published: December 2016

Background

Major depressive disorder (MDD) is a leading cause of disability worldwide.

Aims

To examine the: (a) 12-month prevalence of DSM-IV MDD; (b) proportion aware that they have a problem needing treatment and who want care; (c) proportion of the latter receiving treatment; and (d) proportion of such treatment meeting minimal standards.

Method

Representative community household surveys from 21 countries as part of the World Health Organization World Mental Health Surveys.

Results

Of 51 547 respondents, 4.6% met 12-month criteria for DSM-IV MDD and of these 56.7% reported needing treatment. Among those who recognised their need for treatment, most (71.1%) made at least one visit to a service provider. Among those who received treatment, only 41.0% received treatment that met minimal standards. This resulted in only 16.5% of all individuals with 12-month MDD receiving minimally adequate treatment.

Conclusions

Only a minority of participants with MDD received minimally adequate treatment: 1 in 5 people in high-income and 1 in 27 in low-/lower-middle-income countries. Scaling up care for MDD requires fundamental transformations in community education and outreach, supply of treatment and quality of services.
Type 3 Deiodinase Role on Central Thyroid Hormone Action Affects the Leptin-Melanocortin System and Circadian Activity
Authors: Wu Zhaofei , Martinez M. Elena , St. Germain Donald L. , Hernandez Arturo
Published: December 2016

The role of thyroid hormones (THs) in the central regulation of energy balance is increasingly appreciated. Mice lacking the type 3 deiodinase (DIO3), which inactivates TH, have decreased circulating TH levels relative to control mice as a result of defects in the hypothalamic-pituitary-thyroid axis. However, we have shown that the TH status of the adult Dio3−/− brain is opposite that of the serum, exhibiting enhanced levels of TH action. Because the brain, particularly the hypothalamus, harbors important circuitries that regulate metabolism, we aimed to examine the energy balance phenotype of Dio3−/− mice and determine whether it is associated with hypothalamic abnormalities. Here we show that Dio3−/− mice of both sexes exhibit decreased adiposity, reduced brown and white adipocyte size, and enhanced fat loss in response to triiodothyronine (T3) treatment. They also exhibit increased TH action in the hypothalamus, with abnormal expression and T3 sensitivity of genes integral to the leptin-melanocortin system, including Agrp, Npy, Pomc, and Mc4r. The normal to elevated serum levels of leptin, and elevated and repressed expression of Agrp and Pomc, respectively, suggest a profile of leptin resistance. Interestingly, Dio3−/− mice also display elevated locomotor activity and increased energy expenditure. This occurs in association with expanded nighttime activity periods, suggesting a disrupted circadian rhythm. We conclude that DIO3-mediated regulation of TH action in the central nervous system influences multiple critical determinants of energy balance. Those influences may partially compensate each other, with the result likely contributing to the decreased adiposity observed in Dio3−/− mice.
Anesthetic Considerations for Patients With Congenital Central Hypoventilation Syndrome: A Systematic Review of the Literature
Authors: Basu Saptashree M. , Chung Frances F. , AbdelHakim Shireen F. , Wong Jean
Published: December 2016

Congenital central hypoventilation syndrome (CCHS) is a form of sleep-disordered breathing characterized by a diminished drive to breathe during sleep, despite progressive hypercapnia and hypoxia. The condition results from mutations in the paired-like homeobox 2B (PHOX2B) gene. The aim of this review was to conduct a systematic search of the current data on CCHS as it relates to perioperative considerations and to discuss the classification, prevalence, pathophysiology, presentation, genetics, and management of the condition. A systematic search of Medline, EMBASE, Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials was done up to October 2015. The results were limited to human studies published in the English language. Study titles and abstracts were screened to identify studies relating to CCHS relevant to anesthetic care. All study designs including randomized controlled trials, observational studies, case reports, or case series were included. The searches yielded 165 articles, of which 45 were relevant to perioperative considerations. There were 15 relevant case reports categorized as pertaining to the following: (1) novel presentations of the condition after sedation/anesthesia; (2) anesthetic techniques used in patients with established CCHS; and (3) patients with CCHS who experienced anesthetic complications. Review of the case reports showed that patients ranged from neonates up to 59 years of age. Novel presentations of the disease after sedation or anesthesia for minor procedures often led to diagnosis. The sequelae of undiagnosed CCHS led to complications, such as hypoxia, desaturations, apneas, seizures, unplanned intensive care admissions, prolonged hospital stays, and long-term tracheostomies. There appeared to be few postoperative complications in patients with known CCHS. Anesthesiologists need to be aware of undiagnosed late-onset CCHS and include this condition in the differential diagnosis of patients with unexplained postoperative respiratory depression. Anesthetic techniques should minimize the use of agents that further depress respiration postprocedure and ensure adequate monitoring to detect postoperative apneas.
Implications of Perioperative Team Setups for Operating Room Management Decisions
Authors: Doll Dietrich , Kauf Peter , Wieferich Katharina , Schiffer Ralf , Luedi Markus M.
Published: December 2016

BACKGROUND:

Team performance has been studied extensively in the perioperative setting, but the managerial impact of interprofessional team performance remains unclear. We hypothesized that the interplay between anesthesiologists and surgeons would affect operating room turnaround times, and teams that worked together over time would become more efficient.

METHODS:

We analyzed 13,632 surgical cases at our hospital that involved 64 surgeons and 48 anesthesiologists. We detrended and adjusted the data for potential confounders including age, American Society of Anesthesiologists physical status, and surgical list (scheduled cases of specific surgical specialties). The surgical lists were categorized as ear, nose, and throat surgery; trauma surgery; general surgery; and gynecology. We assessed the relationship between turnaround times and assignment of different anesthesiologists to specific surgeons using a Monte Carlo simulation.

RESULTS:

We found significant differences in team performances among the different surgical lists but no team learning. We constructed managerial decision tables for the assignment of anesthesiologists to specific surgeons at our hospital. We defined a decision algorithm based on these tables. Our analysis indicated that had this algorithm been used in staffing the operating room for the surgical cases represented in our data, median turnaround times would have a reduction potential of 6.8% (95% confidence interval 6.3% to 7.1%).

CONCLUSIONS:

A surgeon is usually predefined for scheduled surgeries (surgical list). Allocation of the right anesthesiologist to a list and to a surgeon can affect the team performance; thus, this assignment has managerial implications regarding the operating room efficiency affecting turnaround times and thus potentially overutilized time of a list at our hospital.
Retromer- and WASH-dependent sorting of nutrient transporters requires a multivalent interaction network with ANKRD50
Authors: Kvainickas Arunas , Orgaz Ana Jimenez , Nägele Heike , Diedrich Britta , Heesom Kate J. , Dengjel Jörn , Cullen Peter J. , Steinberg Florian
Published: December 2016

Retromer and the associated actin-polymerizing WASH complex are essential for the endocytic recycling of a wide range of integral membrane proteins. A hereditary Parkinson's-disease-causing point mutation (D620N) in the retromer subunit VPS35 perturbs retromer's association with the WASH complex and also with the uncharacterized protein ankyrin-repeat-domain-containing protein 50 (ANKRD50). Here, we firmly establish ANKRD50 as a new and essential component of the SNX27–retromer–WASH super complex. Depletion of ANKRD50 in HeLa or U2OS cells phenocopied the loss of endosome-to-cell-surface recycling of multiple transmembrane proteins seen upon suppression of SNX27, retromer or WASH-complex components. Mass-spectrometry-based quantification of the cell surface proteome of ANKRD50-depleted cells identified amino acid transporters of the SLC1A family, among them SLC1A4, as additional cargo molecules that depend on ANKRD50 and retromer for their endocytic recycling. Mechanistically, we show that ANKRD50 simultaneously engages multiple parts of the SNX27–retromer–WASH complex machinery in a direct and co-operative interaction network that is needed to efficiently recycle the nutrient transporters GLUT1 (also known as SLC2A1) and SLC1A4, and potentially many other surface proteins.
Meditative music listening to reduce state anxiety in patients during the uptake phase before positron emission tomography (PET) scans
Authors: Lee Wen-Li , Sung Huei-Chuan , Liu Shu-Hsin , Chang Shu-Min
Published: November 2016

Objective:

This study examines the effects of listening to meditative music on state anxiety and heart rate variability (HRV) of patients during the uptake phase before positron emission tomography (PET) scans.

Methods:

A two-group randomized experimental design was used. Eligible patients were randomly assigned to either the experimental or control group. All patients received baseline assessments of state anxiety using Spielberger State-Trait Anxiety Inventory (STAI-S) and HRV before receiving an intravenous injection of radiopharmaceutical fluorine-18 fludeoxyglucose in the uptake room. The experimental group (n = 35) listened individually to 30 min of meditative music, integrating Chinese “Chi” and western frequency resonation in the uptake room. The control group (n = 37) lay on bed quietly for 40 min in the uptake room without music. All patients were assessed for their anxiety level and HRV again, before receiving PET scanning as post-test.

Results:

The results indicated that patients in the experimental group showed a significant reduction in state anxiety and heart rate, and increase on high frequency norm of HRV (p < 0.001). There was a statistically significant reduction on anxiety level (p < 0.001), heart rate (p < 0.001) and high frequency norm (p = 0.001) in the experimental group compared with those of the control group.

Conclusion:

Listening to meditative music as a non-invasive and cost-effective strategy can help maximize efforts to promote comfort and relaxation for patients awaiting stressful procedures, such as PET scans. Meditative music can be effective in alleviating state anxiety of patients during the uptake phase before PET scans.

Advances in knowledge:

The study provides scientific evidence of the effects of listening to meditative music for reducing state anxiety in patients during the uptake phase before PET scans. It may have the potential to lower the risk of unwanted false-positive fluorine-18 fludeoxyglucose uptake in normal organs and to further improve image quality and image interpretation. Listening to meditative music is a safe and inexpensive intervention which can be incorporated into routine procedures to reduce anxiety of patients undergoing PET scans.
New iteration process for a general class of contractive mappings
Authors: Mogbademu Adesanmi Alao
Published: December 2016

Let K be a closed convex subset of X, and let T : K → K be a self-mapping with the set FT of fixed points such that ‖Tx − ρ‖ ≤ δ‖x − ρ‖ for all x ∈ K, ρ ∈ FT and some δ ∈ (0, 1). We introduce a new iteration process called Picard-hybrid iteration and show that this iteration process converges to the unique fixed point of T. It is also shown that our iteration process converges more rapidly than the Picard–Mann and Picard iteration processes. Our result improves a recent result of S. H. Khan and some other results.
On φ-pseudo symmetric LP-Sasakian manifolds with respect to quarter-symmetric non-metric connections
Authors: Dey Santu , Bhattacharyya Arindam
Published: December 2016

The object of the present paper is to study φ-pseudo symmetric and φ-pseudo Ricci symmetric LP-Sasakian manifolds with respect to Levi–Civita connections and quarter-symmetric non-metric connections. We obtain a necessary and sufficient condition for a φ-pseudo symmetric LP-Sasakian manifold with respect to a quarter symmetric non-metric connection to be φ-pseudo symmetric LP-Sasakian manifold with respect to a Levi–Civita connection.
Autocommunicative meaning-making in online communication of the Estonian extreme right
Authors: Madisson Mari-Liis , Ventsel Andreas
Published: December 2016

This article analyses the online communication of the Estonian extreme right that appears to be characterized by an echo-chamber effect as well as enclosed and hermetic meaning-making. The discussion mainly relies on the theoretical frameworks offered by semiotics of culture.One of the aims of the article is to widen the scope of understanding of autocommunicative processes that are usually related to learning, insight and innovation. The article shows the conditions in which autocommunicative processes result in closed interactions, based on reproducing stereotypes and redundant content. We detect antithetical meaning-making, an orientation towards normative (“correct”) texts and the prevalence of phatic communication as the main dominants that guide closed autocommunication. Such communication leads to polarization of dissimilar views and hinders dialogue. Our case study focuses on the discussion that arose in the context of the European Refugee Crisis that started in spring 2015.
From paradigm to environment: The foreign rhythm and punctual catalysis of culture
Authors: Basso Fossali Pierluigi
Published: December 2016

Lotman and Barthes created two different critically oriented semiotic traditions. Both of them wen t through an evolution in their thought, moving from systematic organization to living transformations in cultural systems. This allowed them to carry out a bilateral critique of codes and identities in favour of either anonymous hybridity (Lotman) or neutrality (Barthes), where heterogeneity becomes a principle of creative “disorder”. Though quite different as regards their theoretical production, both scholars meet in their refusal to turn descriptive practices (studium) into a model of any other form of behaviour, considering that the determination of textual or institutional perimetres is not always clear. In short, Barthes and Lotman anticipated current research trends on the semiotics of practices; Barthes because of a sort of self-reflexion on the behaviour of the interpreter in front of an object, and Lotman through his analytic interest in attitudes and ways of living.Barthes’s view on writing essentially reaches Lotman’s conception of culture as a “collective person”: we are looking for traces of breathing in the life of signs. More precisely, we can assert that, in the view of both scholars, inscribing speech events in history problematizes the dynamic and asynchronous relation between the structural frame of a culture and its textual heritage. The rhythm of fashion is not a side topic in their research, but, rather, it is the clearest exemplification of a dialectic between structural projection from the outside and local introjection of forms, depending on the conditions that make a difference.
Critique of ideology or/and analysis of culture? Barthes and Lotman on secondary semiotic systems
Authors: Monticelli Daniele
Published: December 2016

The article compares Roland Barthes’s and Juri Lotman’s notions of ‘second-order semiological systems’ [systemes sémiologique seconds] and ‘secondary modelling systems’ [вторичные моделирующие системы]. It investigates the shared presuppositions of the two theories and their important divergences from each other, explaining them in terms of the opposite strategic roles that the notions of ‘ideology’ and ‘culture’ play in the work of Barthes and Lotman, respectively. The immersion of secondary modelling systems in culture as a “system of systems” characterized by internal heterogeneity, allows Lotman to evidence their positive creative potential: the result of the tensions arising from cultural systemic plurality and heterogeneity may coincide with the emergence of new, unpredictable meanings in translation. The context of Barthes’s second-order semiological systems is instead provided by highly homogeneous ideological frames that appropriate the signs of the first-order system and make them into forms for significations which confirm, reproduce and transmit previously existing information generated by hegemonic social and cultural discourses. The article shows how these differences resurface and, partially, fade away in the theories of the text that Barthes and Lotman elaborated in the 1970s. The discussion is concluded by some remarks on the possible topicality of Barthes’s and Lotman’s approaches for contemporary semiotics and the humanities in general.
Coordinating Interdependencies in Online Communities: A Study of an Open Source Software Project
Authors: Lindberg Aron , Berente Nicholas , Gaskin James , Lyytinen Kalle
Published: December 2016

To manage work interdependencies, online communities draw on a variety of arm’s length coordination mechanisms offered by information technology platforms and associated practices. However, “unresolved interdependencies” remain that cannot be addressed by such arm’s length mechanisms. These interdependencies reflect, for example, unidentified or emerging knowledge-based dependencies between the community members or unaccounted relationships between ongoing community tasks. At the same time, online communities cannot resort to hierarchical coordination mechanisms such as incentives or command structures to address such interdependencies. So, how do they manage such interdependencies? To address this question, we conduct an exploratory, theory-generating case study involving qualitative and computational analyses of development activities within an open source software community: Rubinius. We analyze the ongoing management of interdependencies within the community and find that unresolved interdependencies are associated with alternatively structured sequences of activities, which we define as routines. In particular, we observe that two distinct classes of interdependencies—development and developer interdependencies—are associated with alternative forms of routine variation. We identify two generalized routine components—direct implementation and knowledge integration, which address these two distinct classes of unresolved interdependencies. In particular, direct implementation deals with development interdependencies within the code that are not already coordinated through modular interfaces, while knowledge integration resolves unaccounted interdependencies between developers. We conclude with implications for research into organizing principles for online communities and note the significance of our findings for the study of coordination in organization studies in general.
Withdrawing medical treatment: implications of the Bland case
Authors: Tribe Diana , Korgaonkar Gill
Published: November 2016

The question of whether it is possible to withdraw a feeding system from a patient who is in a persistent vegetative state raises serious legal and ethical issues which have recently been discussed in the High Court. This article discusses the issues and the Court's conclusions in this particular case.
The community care White Paper: a nursing perspective
Authors: Caldock Kerry
Published: November 2016

There is widespread confusion among nurses over the implications of the Department of Health's (1989a) community care White Paper; in addition, a lack of agreement over recent policy has been identified. This article presents the results of a questionnaire examining this issue and emphasizes the need for further research.
Prevention of falls among older people at home
Authors: Williams Meinir Wyn , Nolan Mike
Published: November 2016

The high incidence of falls among older people and the subsequent high rates of potentially preventable morbidity and mortality highlight the need for early identification of risk factors. This article discusses the major contributory factors and the role of community nurses in accident prevention assessment of older people.
Dimensions of nursing knowledge in wound care
Authors: Guilding Lucy
Published: November 2016

There is continuing debate as to whether nursing is an art or a science. This seems to be further fuelled by discussion about whether nursing is a profession. If nursing could be called a research-based science, would it become a recognized profession and be taken more seriously? This article relates the art/science debate to the teaching of wound care in clinical practice.
The nursing way of death
Authors: Castledine George
Published: November 2016

After all the recent hype and discussions surrounding the final stages of dying, it is perhaps pertinent to ask: ‘Is there a natural process of death?’
Ethical and legal issues in suicide
Authors: Davis Judi E
Published: November 2016

Nurse-patient encounters are influenced by the law and by morality. These frequently overlap and hold certain principles in common, such as justice and rights. Despite such close connections, the law and morality do not necessarily correspond. The difficulty in and complexity of reaching the right and just decision in the healthcare setting often highlight this.
Telephone triage: a step forward for nursing practice?
Authors: Glasper Edward Alan
Published: November 2016

The rapid pace of technological advancement, the shift from tertiary to primary medical care and the emphasis on self-care have all been reflected in the developments that have occurred within nursing practice. The recently published document The Scope of Professional Practice (UKCC, 1992) addresses the extending dynamic nature of nursing, midwifery and health visiting.
Holistic care following a palliative Hartmann's procedure
Authors: Webb Hannah
Published: November 2016

Care study

Alan, a terminally ill patient, underwent a palliative Hartmann's procedure for recurrent colorectal cancer. He recovered well from the surgery; his wound was clean with no evidence of infection, although he complained of some pain. A stoma therapist helped Alan come to terms, both physically and emotionally, with the presence of his stoma. On his fifth postoperative day his urinary catheter was removed and he was able to micturate without complication. His wound sutures were removed 5 days later. Alan kept up a positive self-image throughout and appeared to have few psychological problems with regard to his newly formed stoma. However, towards the end of his hospital stay, he expressed concern as to how he would cope on release. Alan was encouraged to maintain his roles of father and husband; he was as yet undecided about returning to work. To ensure continued help at home, he was referred to the home care team at his local hospice.
How to be successful when applying for a postregistration course: 3
Authors: Fish Jane
Published: November 2016

Most interview candidates are nervous; thorough preparation should raise confidence and help minimize anxiety. This article outlines the possible responses to questions that are commonly asked at interviews for places on postregistration courses.
Purposeful activity as an indicator of quality in the care of elderly patients
Authors: Perkins Glenys , Nolan Mike
Published: November 2016

Standards of physical care on continuing care wards have improved but psychosocial care remains generally poor. Purposeful activity is central to the quality of care of patients on respite and continuing care wards and nurses must take greater responsibility for its provision.
Non-sterile dressings and infection risk
Authors: Carter L.
Published: December 2016

A study of the use of non-sterile materials in an intensive therapy unit, with an analysis of the associated infection risk
Vascularised muscle — an aid to bone union
Authors: Lester R.
Published: December 2016

The treatment of a young man whose fractured leg would not heal and had become infected is described
The role of the specialist nurse in wound care
Authors: Flanagan M.
Published: December 2016

An examination of the benefits for both patients and hospital budgets of appointing a clinical nurse specialist in the management of wounds
From the journals
Authors: Lawrence J.C. , Whiston R.J. , Roberts G. P. , Melhuish J.M. , Banks V.
Published: December 2016

Donor site healing under alginate and porcine xenografts

Assessing varicose veins

Regulating tumour necrosis factor-α production

The uses of video image analysis

Pressure sores and nutrition
From the journals
Authors: Roberts G.P.
Published: December 2016

Treating skin defects with cultured epithelium

Using rTNF on tumour patients

The fluid handling properties of alginate dressings

Retroperitoneal necrotising fasciitis

Pilonidal sinus surgery
Comparing Sorbsan and polynoxylin/Melolin dressings after toenail removal
Authors: Smith J.
Published: December 2016

An assessment of two dressings used in the treatment of the toenail bed, comparing healing rates and complications reported
A comparison of sub-bandage pressures produced by experienced and inexperienced bandagers
Authors: Logan R.A. , Thomas S. , Harding E.F. , Collyer G.J.
Published: December 2016

An investigation of the relative importance of bandage design, experience of bandager and size of limb on sub-bandage pressures
Pilonidal sinus disease
Authors: Berry D.P.
Published: December 2016

A guide to the incidence, aetiology and treatment of sacrococcygeal pilonidal disease
Measuring leg ulcers by colour-coded structured light
Authors: Plassmann P. , Jones B.F.
Published: December 2016

A non-contact semi-automatic leg ulcer measurement and management system is described. Besides measuring the area of an ulcer, it can also evaluate its volume by calculating the difference between the virtual reconstruction of the former healthy skin and the actual measured surface. An adequate representation of a real ulcer is created in a PC memory using a structured light scanning system with simultaneously projected stripes of colour-coded light. The method is fast and reliable and capable of evaluating area and volume with an uncertainty of 5% of the total size. Means of ulcer classification, healing time forecast and patient data management may also be included in the system
Letters
Authors: Ruckley C.V. , Hughes A. , Banks V.A. , Vaidya G.
Published: December 2016

COMPRESSION BANDAGING

USING ALCOHOL SWABS BEFORE INJECTIONS

CORRECT USE OF PEGASUS AIRWAVE SYSTEM

OMIDERM DRESSING
Treating a patient with a sacral pressure sore
Authors: Mack R.
Published: December 2016

The successful treatment of a large sacral pressure sore with calcium sodium alginate dressings is described