bluuebunny/crossref_metadata_2025 huggingface dataset:
Inoculant effects on the fermentation quality, chemical composition and saponin content of lucerne silage in a mixture with wheat bran or corn husk
Authors: Tian Jipeng , Na Risu , Yu Zhu , Liu Zhongkuan , Liu Zhenyu , Yu Yidong
Published: February 2018

This study evaluated the effects of lactic acid bacteria inoculants on the fermentation quality and chemical composition of lucerne silage (A), a mixture of lucerne and wheat bran (A+WB), and a mixture of lucerne and corn husk (A+CH). The application rates of wheat bran in A+WB or corn husk in A+CH were 10%, 15%, and 20% of the whole fresh material. These different materials were treated with distilled water (Control), Lactobacillus plantarum 1 (LAB1), L. plantarum 2 (LAB2), L. plantarum 8 (LAB8) or a commercial inoculant (LALMAND) at a rate of 106 CFU/g of fresh forage. As the application rate of the by-products increased, the dry matter, lactate, propionate, and neutral detergent fibre (after heat-stable amylase treatment) contents increased, and the pH and the acetate, ammonia nitrogen, crude protein, and non-fibre carbohydrate contents decreased. The A+WB showed better fermentation quality than A and A+CH. The inoculants had beneficial effects on the silages, but the effects varied. The results indicate that the use of LAB1, LAB2, or LAB8 was better with A, whereas LALMAND was preferable for use with A+WB or A+CH. The saponin content decreased during ensiling and was positively correlated with the pH and the acetate and ammonia nitrogen content but negatively correlated with the dry matter content. The increase in the application rate of by-products and the addition of LALMAND further decreased the saponin content. Overall, the combined effects of the inoculants, by-products, and different application rates improved the fermentation quality and chemical composition and led to greater a reduction of saponin in lucerne silage, but the selection of suitable types and application rates of by-products and inoculants is essential.
Progress in comprehending the phytate–phytase axis in chicken-meat production
Authors: Moss Amy F. , Liu Sonia Yun , Selle Peter H.
Published: February 2018

After an extended delay, the level of acceptance of exogenous phytases by the global chicken-meat industry is now almost complete. Contemporary bacterial phytases degrade phytate primarily in the gizzard. The extent of phytate degradation determines the extent to which phytate-bound phosphorus (P) is liberated; however, studies designed to investigate phytate degradation along the digestive tract have generated some confusing outcomes. This may be related to the reactivity of the phytate moiety, coupled with problems with inert dietary markers and perhaps a lack of complete and uniform extractions of phytate from digesta due to variations in digesta pH and phytate solubility. Quite recently, phytase was shown to have profound impacts on sodium (Na) digestibility coefficients in four segments of the small intestine. This has obvious implications for intestinal uptakes of glucose and amino acids via their respective Na+-dependent transport systems and it is possible that phytate and phytase have reciprocal impacts on ‘sodium pump’ (Na+, K+-ATPase) activity. It has been recently demonstrated unequivocally that phytase has the capacity to increase amino acid digestibility coefficients to the extent that phytase may generate a ‘proximal shift’ in the sites of amino acid absorption. The impact of phytase on starch digestibility is more equivocal and phytase responses may stem more from enhanced glucose absorption rather than starch digestion. The acceptance of phytase is hardly surprising, given its capacity to increase P utilisation coupled with numerous other positive influences that are still being properly realised.
Translation: universals or cognition?
Authors: Szymor Nina
Published: February 2018

This paper contributes to the ongoing debate on the existence of translation universals by investigating the use of aspect in modal contexts in translated and non-translated legal Polish and by analysing the observed differences with reference to insights from cognitive linguistics. Corpus analysis highlights significant distributional differences in the use of the two aspectual forms of Polish verbs (imperfective and perfective) in modal contexts. I argue that cognitive mechanisms called ‘chunking’ (Langacker 1988;Bybee 2006) and ‘entrenchment’ (Bybee 2010) underlie these differences. I show that what may at first glance seem as behaviour unique to the translation process, is in fact caused by general cognitive processes. The study has implications for both translation studies and cognitive linguistics: it offers support for the basic assumptions about the usage-based nature of linguistic knowledge and highlights the importance of taking these assumptions into consideration when investigating the translation process and translation universals.
Discrete topological complexity
Authors: Fernández-Ternero D. , Macías-Virgós E. , Minuz E. , Vilches J.
Published: February 2018

We introduce a notion of discrete topological complexity in the setting of simplicial complexes, using only the combinatorial structure of the complex and replacing the concept of homotopy by that of contiguous simplicial maps. We study the links of this new invariant with those of simplicial category and topological complexity.
Topologically weakly mixing polygonal billiards
Authors: Bobok Jozef , Troubetzkoy Serge
Published: February 2018

We show that in a typical polygon the billiard map as well as its associated subshift obtained by coding orbits by the sequence of sides they visit are topologically weakly mixing.
Classification of empty lattice 4-simplices of width larger than two
Authors: Iglesias-Valiño Óscar , Santos Francisco
Published: February 2018

A lattice

d
d

-simplex is the convex hull of

d
+
1

d+1

affinely independent integer points in

R

d

{\mathbb R}^d

. It is called empty if it contains no lattice point apart from its

d
+
1

d+1

vertices. The classification of empty

3
3

-simplices has been known since 1964 (White), based on the fact that they all have width one. But for dimension

4
4

no complete classification is known.

Haase and Ziegler (2000) enumerated all empty

4
4

-simplices up to determinant 1000 and based on their results conjectured that after determinant

179
179

all empty

4
4

-simplices have width one or two. We prove this conjecture as follows:

- We show that no empty

4
4

-simplex of width three or more can have a determinant greater than 5058, by combining the recent classification of hollow 3-polytopes (Averkov, Krümpelmann and Weltge, 2017) with general methods from the geometry of numbers.

- We continue the computations of Haase and Ziegler up to determinant 7600, and find that no new

4
4

-simplices of width larger than two arise.

In particular, we give the whole list of empty

4
4

-simplices of width larger than two, which is as computed by Haase and Ziegler: There is a single empty

4
4

-simplex of width four (of determinant 101), and 178 empty

4
4

-simplices of width three, with determinants ranging from 41 to 179.
Association of 24-Hour Blood Pressure With Urinary Sodium Excretion in Healthy Adults
Authors: van der Stouwe Jan Gerrit , Carmeli Cristian , Aeschbacher Stefanie , Schoen Tobias , Krisai Philipp , Wenger Giuditta , Ehret Georg , Ponte Belen , Pruijm Menno , Ackermann Daniel , Guessous Idris , Paccaud Fred , Pechère-Bertschi Antoinette , Vogt Bruno , Mohaupt Markus G , Martin Pierre-Yves , Burnier Michel , Risch Martin , Risch Lorenz , Bochud Murielle , Conen David
Published: February 2018

BACKGROUND

While the positive relationship between urinary sodium excretion and blood pressure (BP) is well established for middle-aged to elderly individuals using office BP, data are limited for younger individuals and ambulatory BP measurements.

METHODS

Our analysis included 2,899 individuals aged 18 to 90 years from 2 population-based studies (GAPP, Swiss Kidney Project on Genes in Hypertension [SKIPOGH]). Participants with prevalent cardiovascular disease, diabetes, or on BP-lowering treatment were excluded. In SKIPOGH, 24-hour urinary sodium excretion was used as a measure of sodium intake, while in GAPP it was calculated from fasting morning urinary samples using the Kawasaki formula. Multivariable linear regression models were used to assess the relationships of 24-hour urinary salt excretion with office and ambulatory BP measurements.

RESULTS

Mean age, ambulatory BP, sodium excretion, and estimated glomerular filtration rate in GAPP and SKIPOGH were 35 and 44 years, 123/78 and 118/77 mm Hg, 4.2 and 3.3 g/d, and 110 and 99 ml/min/1.73 m2, respectively. A weak linear association was observed between 24-hour ambulatory systolic BP and urinary sodium excretion (β (95% confidence interval [CI]) per 1 g increase in sodium excretion (0.33 % (0.09; 0.57); P = 0.008). No significant relationships were observed for 24-hour ambulatory diastolic BP (β (95% CI) (0.13 % (−0.15; 0.40) P = 0.37). When repeating the analyses in different age groups, all BP indices appeared to have stronger relationships in the older age groups (>40 years).

CONCLUSIONS

In these large cohorts of healthy adults, urinary sodium excretion was only weakly associated with systolic 24-hour ambulatory BP.
Arab American Cognitive Aging: Opportunities for Advancing Research on Alzheimer’s Disease Disparities
Authors: Ajrouch Kristine J , Zahodne Laura B , Antonucci Toni C
Published: February 2018

Background and Objectives

This article highlights the dearth of and need for research on Arab American cognitive aging. We propose that studying cognitive health issues among older Arab Americans provides an innovative opportunity to advance knowledge about causes and consequences of Alzheimer’s disease (AD) disparities and refine understanding of factors linked to immigrant health in the United States.

Research Design and Methods

Demographic information is provided on Arab Americans, who are on the cusp of being recognized by the U.S. government as a distinct ethnic group separate from whites. In the tradition of minority aging, we present a broad review of specific issues in the contemporary case of Arab Americans.

Results

We detail how including Arab Americans provides unique information on the importance of: (i) extending racial/ethnic group comparisons; (ii) linking social experiences to late-life cognitive health; and (iii) incorporating ethnic factors related to immigration and religion in the study of AD disparities.

Discussion and Implications

Studying Arab American cognitive aging provides an innovative opportunity to more fully delineate factors that create and sustain health disparities, with special insights into both causes and consequences.
Image Guidance for Ventricular Shunt Surgery: An Analysis of Ventricular Size and Proximal Revision Rates
Authors: Khan Nickalus R , DeCuypere Michael , Vaughn Brandy N , Klimo Paul
Published: February 2018

BACKGROUND

Image guidance is a promising technology that could lead to lower rates of premature shunt failure by decreasing the rate of inaccurate proximal catheter placement.

OBJECTIVE

To perform a detailed radiographic analysis of ventricular size using 3 well-described methods and compare proximal revision rates.

METHODS

Our shunt surgery research database was queried to identify procedures (new placement or revision) where frameless stereotactic electromagnetic neuronavigation was used (January 2010-June 2016). A randomly selected cohort of surgeries done without image guidance during the same time period served as the comparison group. A radiographic analysis utilizing the following indices was used to classify ventricular size: bifrontal, bicaudate, and frontal-occipital horn ratio. The primary outcome was shunt failure due specifically to proximal catheter malfunction at 90 and 180 days.

RESULTS

A total of 108 stereotactic and 95 free-hand cases were identified. Overall, there was no difference in ventricular size between the 2 groups. Neuronavigation yielded improved accuracy rates (73% grade 1; P < .001). Although there was no statistically significant difference in proximal revision rates when all patients were analyzed, there was a clinically beneficial reduction in the 90- and 180-day failure rates across all radiographic indices in children with small-to-moderate ventricular sizes when using image guidance.

CONCLUSION

Electromagnetic neuronavigation results in more accurate placement of catheters, but did not result in an overall reduction in proximal shunt failure at 90 and 180 days after the index surgery. However, subgroup analysis suggests a clinically important benefit in those patients with harder to cannulate ventricles.
Learning Through Boundary Crossing: Professional Identity Formation of Pharmacists Transitioning to General Practice in the Netherlands
Authors: Hazen Ankie C.M. , de Groot Esther , de Bont Antoinette A. , de Vocht Simone , de Gier Johan J. , Bouvy Marcel L. , de Wit Niek J. , Zwart Dorien L.M.
Published: February 2018

Purpose

To unravel boundary crossing as it relates to professional identity formation in pharmacists transitioning from a community pharmacy to working as nondispensing clinical pharmacists in general practice, with the aim of optimizing their education.

Method

This was a multiple-case study, including two-stage interviews, peer feedback, and individual reflection, that collected data in 2014–2016 from eight clinical pharmacists working in general practice in the Netherlands. These pharmacists acted—without a workplace role model—as pharmaceutical care providers in general practices during a 15-month training program. In within-case and cross-case analysis, data were collected regarding pharmacists’ role development in practice and perceptions of learning processes, and examined through the lens of professional identity formation and boundary crossing.

Results

Analysis of data collected during and after the training program demonstrated that the clinical pharmacists who applied the learning mechanisms of reflection and transformation developed a patient-care-oriented professional identity. Some clinical pharmacists, who learned mainly through the mechanism of identification, did not integrate the new patient-care-oriented role into their professional identity. They felt that their workplace provided limited opportunities for reflection and transformation. Learning with peers on formal training days was seen as highly valuable for professional identity formation; it counterbalanced the lack of a role model in the workplace.

Conclusions

Professional identity formation in the transition from community pharmacist to clinical pharmacist in general practice benefited from reflective, on-the-job training. This permitted transformative, boundary-crossing learning with peers and supported professional identity formation oriented to providing practice-based pharmaceutical care.
Current Practices and Attitudes Regarding Use of Inhaled Nitric Oxide in the NICU
Authors: Kayton Allyson , Timoney Paula , Vargo Lyn , Perez Jose A.
Published: February 2018

Background:

Excessive supplemental oxygen exposure in the neonatal intensive care unit (NICU) can be associated with oxygen-related toxicities, which can lead to negative clinical consequences. Use of inhaled nitric oxide (iNO) can be a successful strategy for avoiding hyperoxia in the NICU. iNO selectively produces pulmonary vasodilation and has been shown to improve oxygenation parameters across the spectrum of disease severity, from mild to very severe, in neonates with hypoxic respiratory failure associated with persistent pulmonary hypertension of the newborn.

Purpose:

An online survey was conducted among members of the National Association of Neonatal Nurse Practitioners to gain insight into the level of understanding and knowledge among neonatal nurse practitioners (NNPs) about optimizing supplemental oxygen exposure and the use of iNO in the NICU setting.

Results:

Of 937 NNP respondents, 51% reported that their healthcare team typically waits until the fraction of inspired oxygen level is 0.9 or more before adding iNO in patients not responding to oxygen ventilation alone. Among respondents with 1 or more iNO-treated patients per month, only 35% reported they know the oxygenation index level at which iNO should be initiated. Less than 20% of NNPs reported perceived benefits associated with early initiation of iNO for preventing progression to use of extracorporeal membrane oxygenation or reducing the length of hospital stay, and about one-third of respondents reported they believe early iNO use minimizes hyperoxia.

Implications for Practice:

More education is needed for NNPs regarding the negative effects of oxidative stress in neonates.

Implications for Research:

Additional clinical trials investigating the most beneficial strategies for avoiding neonatal hyperoxia are warranted.
Characterization of Postinfusion Phenotypic Differences in Fresh Versus Cryopreserved TCR Engineered Adoptive Cell Therapy Products
Authors: Nowicki Theodore S. , Escuin-Ordinas Helena , Avramis Earl , Chmielowski Bartosz , Chodon Thinle , Berent-Maoz Beata , Wang Xiaoyan , Kaplan-Lefko Paula , Yang Lili , Baltimore David , Economou James S. , Ribas Antoni , Comin-Anduix Begoña
Published: February 2018

Adoptive cell therapy (ACT) consisting of genetically engineered T cells expressing tumor antigen-specific T-cell receptors displays robust initial antitumor activity, followed by loss of T-cell activity/persistence and frequent disease relapse. We characterized baseline and longitudinal T-cell phenotype variations resulting from different manufacturing and administration protocols in patients who received ACT. Patients with melanoma who enrolled in the F5-MART-1 clinical trial (NCT00910650) received infusions of MART-1 T-cell receptors transgenic T cells with MART-1 peptide-pulsed dendritic cell vaccination. Patients were divided into cohorts based on several manufacturing changes in the generation and administration of the transgenic T cells: decreasing ex vivo stimulation/expansion time, increased cell dose, and receiving fresh instead of cryopreserved cells. T-cell phenotypes were analyzed by flow cytometry at baseline and longitudinally in peripheral blood. Transgenic T cells with shorter ex vivo culture/expansion periods displayed significantly increased expression of markers associated with less differentiated naive/memory populations, as well as significantly decreased expression of the inhibitory receptor programmed death 1 (PD1). Patients receiving fresh infusions of transgenic cells demonstrated expansion of central memory T cells and delayed acquisition of PD1 expression compared with patients who received cryopreserved products. Freshly infused transgenic T cells showed persistence and expansion of naive and memory T-cell populations and delayed acquisition of PD1 expression, which correlated with this cohort’s superior persistence of transgenic cells and response to dendritic cell vaccines. These results may be useful in designing future ACT protocols.
Patient With 2 Hematologic Malignancies Presenting as Neurolymphomatosis
Authors: Daher Ahmad , Kamiya-Matsuoka Carlos , Woodman Karin
Published: February 2018

Peripheral nervous system damage from hematologic malignancies is related to neoplastic cells infiltration of peripheral nerves or to monoclonal antibody production cross-reacting with peripheral nerves' antigens. Neurolymphomatosis (NL), a rare manifestation of hematologic malignancies, occurs when malignant cells invade the peripheral nerves leading to various manifestations. Here, we report a case of NL with 2 hematologic malignancies in a 79-year-old woman presenting with lower extremity pain/weakness. Investigation revealed anemia, IgM kappa monoclonal gammopathy, and elevated anti-MAG titer. Electrodiagnostic studies were consistent with mononeuropathy multiplex while imaging suggested malignancy in her ovaries and right S1 nerve root. Bone marrow and ovarian biopsies revealed chronic myelomonocytic leukemia, Waldenstrom macroglobulinemia, and diffuse large B-cell lymphoma. She received standard chemotherapy resulting in radiographic resolution of disease and symptomatic relief. NL can precede the diagnosis of hematologic malignancy but its symptoms are not easily identifiable, whereas management depends on the treatment of the underlying tumor.
Mitochondrial DNA Deletions With Low-Level Heteroplasmy in Adult-Onset Myopathy
Authors: Leung Doris G. , Cohen Julie S. , Michelle Elizabeth Harlan , Bai Renkui , Mammen Andrew L. , Christopher-Stine Lisa
Published: February 2018

We report the cases of 2 patients who presented to our Myositis Center with myalgias and elevated creatine kinase levels. Muscle biopsy showed pathological features consistent with mitochondrial myopathy. In both cases, a single large deletion in mitochondrial DNA at low-level heteroplasmy was identified by next-generation sequencing in muscle tissue. In 1 case, the deletion was identified in muscle tissue but not blood. In both cases, the deletion was only identified on next-generation sequencing of muscle mitochondrial DNA and missed on array comparative genome hybridization testing. These cases demonstrate that next-generation sequencing of mitochondrial DNA in muscle tissue is the most sensitive method of molecular diagnosis for mitochondrial myopathy due to mitochondrial DNA deletions.
A Systematic Review of Exercise Training in Patients With Cardiac Implantable Devices
Authors: Alswyan Afnan Hamad , Liberato Ana Carolina Sauer , Dougherty Cynthia M.
Published: February 2018

Purpose:

This systematic review identified exercise-based intervention studies in patients with cardiac implantable devices (CIDs): implantable cardioverter defibrillator (ICD), cardiac resynchronization pacemaker or defibrillator (cardiac resynchronization therapy [CRT]), or ventricular assist device (VAD) and assessed evidence for the safety and efficacy of exercise-based interventions alone or in combination with psychoeducational components.

Methods:

PubMed, EMBASE, CINAHL Plus, Web of Science, Cochrane, and PEDro databases were searched from database inception to September 2016. Data were extracted and validity was assessed by 2 reviewers. Study quality was evaluated using the JADAD scale for randomized controlled trials. A total of 3991 articles for all CIDs (ICD: 1015; pacemaker: 1630; and VAD: 1346) were screened for relevance. Subsequently, 24 full-text articles (ICD: 14; CRT: 4; and VAD: 6) were deemed eligible for this review.

Results:

Studies of aerobic exercise training demonstrated an average increase in peak oxygen uptake of 2.61 mL/kg/min, (ICD = 2.43, VAD = 2.2, and CRT = 3.2 mL/kg/min). These incremental increases were statistically significant when compared with the usual care or other comparison groups. Adverse event rates were very low at 1.1% to 2.2% for all CIDs.

Conclusion:

Exercise interventions tested to date in the CID population (ICD, CRT, and VAD) indicate that exercise training at moderate to high intensity is safe and effective in improving cardiopulmonary outcomes without adverse events. Future investigations should include a more diverse sample of participants, designs that include translation of exercise to routine practice, the destination therapy VAD population, and measurement of costs and patient-centered outcomes.
INTRAVITREAL INJECTION OF PROPRANOLOL FOR THE TREATMENT OF RETINAL CAPILLARY HEMANGIOMA IN A CASE OF VON HIPPEL–LINDAU
Authors: Karimi Saeed , Nikkhah Homayoun , Ahmadieh Hamid , Safi Sare
Published: February 2018

Purpose:

The purpose of this study was to evaluate the safety and efficacy of intravitreal propranolol for the management of retinal capillary hemangioma in a patient with Von Hippel–Lindau.

Methods:

Two intravitreal injections of 50 μg/0.05 mL propranolol were administered 6 weeks apart in the left eye of a 26-year-old patient with bilateral multiple retinal capillary hemangiomas. Safety and response to therapy were evaluated using electroretinogram, fluorescein angiography, and measurement of visual acuity. Laser photocoagulation was performed in the right eye.

Results:

One month after the second intravitreal injection of propranolol, fluorescein leakage decreased from the tumors located on the optic nerve head and in the inferonasal retinal periphery. Reduction of the retinal capillary hemangioma vascularity and enhancement of its fibrosis associated with the attenuation of the feeder vessel were also observed. Ophthalmic examination showed no adverse effect except for a mild transient vitreous haziness after each injection. Electroretinogram performed 4 weeks after the first injection revealed no retinal toxicity.

Conclusion:

Intravitreal propranolol showed a therapeutic effect on retinal capillary hemangioma with no short-term adverse effects except a mild transient inflammatory response in a patient with Von Hippel–Lindau.
Long-Term Clinical and Computed Tomography Angiographic Follow-Up after Totally Endoscopic Coronary Artery Bypass Grafting
Authors: Stastny Lukas , Kofler Markus , Dumfarth Julia , Basaran Alim , Wiedemann Dominik , Schachner Thomas , Feuchtner Gudrun , Bonatti Johannes , Bonaros Nikolaos
Published: February 2018

Objective

Totally endoscopic coronary artery bypass grafting was shown to be feasible and safe, with excellent clinical and angiographic mid-term results. Data on long-term outcome are lacking. Therefore, we aimed to investigate the long-term rate of major adverse cardiac and cerebrovascular events and left internal mammary artery patency rate in patients undergoing arrested heart totally endoscopic coronary artery bypass grafting.

Methods

From 2001 to 2012, a total of 208 arrested heart-totally endoscopic coronary artery bypass grafting patients were prospectively included. Mean ± SD age was 58.8 ± 9.4 years, and mean ± SD Society of Thoracic Surgeons score was 0.5 ± 0.5%. Major adverse cardiac and cerebrovascular events were defined as a composite of death, myocardial infarction, stroke, re-percutaneous coronary intervention, re-coronary artery bypass graft, and target vessel revascularization. Left internal mammary artery patency was assessed using cardiac computed tomography and depicted according to the established Fitzgibbon classification. Mean ± SD follow-up was 6.9 ± 2.3 years.

Results

At 1, 5, and 10 years, survival rate was 100%, 98.3%, and 95.8%, respectively. The freedom from clinical events at 1, 5, and 10 years were major adverse cardiac and cerebrovascular events (93.5%, 85.9%, and 83.0%), myocardial infarction (99.0%, 97.4%, and 95.9%), target vessel revascularization (96.0%, 94.3%, and 91.7%), re-percutaneous coronary intervention (94.5%, 91.6%, and 84.2%), and re-coronary artery bypass graft (100%, 99.5%, and 99.5%), respectively. Left internal mammary artery patency rate at 1, 5, and 10 years was 100%, 94.9%, and 88.1%, respectively.

Conclusions

Arrested heart-totally endoscopic coronary artery bypass grafting shows excellent clinical long-term results with a left internal mammary artery patency rate comparable with conventional coronary artery bypass graft at 10 years after surgery.
Perspectives on voice treatment for unilateral vocal fold paralysis
Authors: Walton Chloe , Carding Paul , Flanagan Kieran
Published: February 2018

Purpose of review

Unilateral vocal fold paralysis (UVFP) is a common cause of neurogenic dysphonia resulting in glottal insufficiency. To restore glottal sufficiency and reduce the presenting dysphonia, treatment involving either surgical intervention, voice therapy or a combination of the two is typically provided. Currently, there is no consensus for the most effective voice treatment for UVFP. This results in an inability to compare current studies, and a lack of treatment effectiveness for the management of UVFP. This study aims to review the most recent literature for the management of dysphonia due to UVFP to establish the current evidence base for voice treatment options.

Recent findings

There was found to be a lack of consistency in the rationale, selection and timing of the surgical intervention and/or voice therapy being provided for patients with UVFP.

Further consensus is required for the rationale and selection of voice treatment prescriptions for the management of UVFP in order to improve treatment effectiveness and voice outcomes in patients with UVFP.
Novel therapeutics for bronchopulmonary dysplasia
Authors: Strueby Lannae , Thébaud Bernard
Published: February 2018

Purpose of review

This review provides a concise summary of recent literature pertaining to emerging therapies for bronchopulmonary dysplasia (BPD). To provide context for the presented therapies, a brief overview of recently proposed changes to the definition of BPD and the concept of expanded respiratory outcomes is included.

Recent findings

New or redefined respiratory outcomes are required to improve accuracy in evaluating new therapies and correlating results with long-term clinical outcomes of importance. Dexamethasone is no longer the only steroid-based therapy showing promise for impacting BPD. Early trials indicate hydrocortisone, inhaled budesonide, and a budesonide-surfactant combination may be of benefit to preterm infants. Additionally, simple approaches like increasing utilization of mother's own milk may deserve more emphasis. Of significant interest is the traction stem cell therapies are acquiring as one of the more anticipated treatments for BPD. A new preclinical meta-analysis demonstrates the benefits of mesenchymal stromal cell therapy in animal models while the results of early clinical trials remain eagerly awaited.

BPD continues to be the most frequently occurring significant morbidity for extremely preterm infants, yet highly effective therapies remain elusive. Promising new treatments are on the horizon, but only continued efforts to complete well-designed clinical trials will determine the true impact of these emerging therapies.
Recurrent Abdominal Pain in Children
Authors: Abbott Rebecca A. , Martin Alice E. , Newlove‐Delgado Tamsin V. , Bethel Alison , Whear Rebecca S. , Thompson Coon Jo , Logan Stuart
Published: February 2018

Objectives:

Between 4% and 25% of school‐aged children complain of recurrent abdominal pain (RAP) severe enough to interfere with their daily activities.

Methods:

We carried out a systematic review of randomised controlled trials (RCTs) in eleven databases and 2 trials registries from inception to June 2016. An update search was run in November 2017. All screening was performed by 2 independent reviewers. Included studies were appraised using the Cochrane risk of bias tool and the evidence assessed using GRADE. We included any dietary, pharmacological or psychosocial intervention for RAP, defined by Apley or an abdominal pain‐related functional gastrointestinal disorder, as defined by the Rome III criteria, in children and adolescents.

Results:

We included 55 RCTs, involving 3572 children with RAP (21 dietary, 15 pharmacological, 19 psychosocial, and 1 multiarm). We found probiotic diets, cognitive‐behavioural therapy (CBT) and hypnotherapy were reported to reduce pain in the short‐term and there is some evidence of medium term effectiveness. There was insufficient evidence of effectiveness for all other dietary interventions and psychosocial therapies. There was no robust evidence of effectiveness for pharmacological interventions.

Conclusions:

Overall the evidence base for treatment decisions is poor. These data suggest that probiotics, CBT, and hypnotherapy could be considered as part of holistic management of children with RAP. The evidence regarding relative effectiveness of different strains of probiotics is currently insufficient to guide clinical practice. The lack of evidence of effectiveness for any drug suggests that there is little justification for their use outside of well‐conducted clinical trials. There is an urgent need for high‐quality RCTs to provide evidence to guide management of this common condition.
Medium‐term Outcome of Laparoscopic Kasai Portoenterostomy for Biliary Atresia With 49 Cases
Authors: Li Yanan , Xiang Bo , Wu Yang , Wang Chuan , Wang Qi , Zhao Yiyang , Chen Siyuan , Ji Yi , Xu Zhicheng
Published: February 2018

Objective:

The aim of this study was to evaluate the mid‐term results of laparoscopic Kasai portoenterostomy (LKPE) for biliary atresia (BA) at our hospital.

Methods:

From May 2009 to May 2012, the charts of infants with BA who underwent LKPE were reviewed retrospectively. The clearance of jaundice (CJ) as well as 3‐year, and 5‐year survival with native liver (SNL) rates were analyzed and compared with those after open Kasai portoenterostomy (OKPE).

Results:

Forty‐nine patients with BA who underwent LKPE were assigned to group A, and 40 patients with BA who underwent OKPE were assigned to group B. All patients in both groups had type III non‐syndromic BA, and the LKPE and OKPE procedures were performed by 2 different surgical teams at our hospital. After median follow‐up periods of 77 months in group A and 79 months in group B, the CJ and 3‐ and 5‐year SNL rates were 61.2%, 55.1%, and 36.7% in group A, and 45.0%, 37.5%, and 25.0% in group B, respectively. The difference of CJ between group A and group B was not significant. The Kaplan‐Meier method analysis showed that the difference in SNL between group A and group B was not significant either.

Conclusions:

LKPE for patients with BA was a technically feasible and alternative procedure to OKPE. The 3‐ and 5‐year SNL rates after LKPE were not different compared to those after OKPE.
Posterior Reversible Encephalopathy Syndrome
Authors: Sundin Courtney Stanley , Johnson Michelle Laurane
Published: February 2018

Posterior reversible encephalopathy syndrome (PRES) is a newly defined syndrome; therefore, this transient clinical condition is not well known and probably underdiagnosed. It develops quickly with symptoms that are usually indistinguishable from eclampsia. Nurses need to be knowledgeable and aware of identifying symptoms and appropriate treatment. The condition is thought to share pathophysiology with eclampsia, and it is suggested that endothelial dysfunction combined with hypertension causes disruption in the blood brain barrier resulting in cerebral edema. Seizures develop secondary to cerebral edema, and mark later stages of the disease. Treatment is aimed at reducing blood pressure (BP) with antihypertensive therapy and seizure control with magnesium sulfate. When PRES is treated early, symptoms typically disappear within a few days and imaging studies normalize in several weeks. Permanent brain damage can occur if diagnosis and treatment are delayed. If PRES is suspected, thorough focused assessments and increased communication among the healthcare team are essential for patient care. When pregnant or postpartum women present with elevated BP accompanied with neurologic symptoms, imaging studies should be considered. An exemplar case is presented of a woman with normal prenatal course that is complicated by rapidly developing preeclampsia, eclampsia, and PRES.
A Tool to Identify Key Behaviors and Attributes of High-Performing Nurses
Authors: Cain Linda B. , Cronin Sherill Nones , Nelson Debbie , Meredith Darla A. , Newman Karen Profitt , Rudolf Steven
Published: February 2018

OBJECTIVE

The purpose of this project was to identify key behaviors and attributes that distinguish high-performing nurses to develop a tool for employment screening, staff development, and performance management.

BACKGROUND

Selecting nurses who will complement an organization's mission and philosophy is a key step toward achieving quality and safety goals, ensuring patient and family satisfaction, and improving retention rates and overall costs.

METHODS

Focus group methodology was used to determine perceptions of high-performing nurses' behaviors and attributes. Content analysis of the meeting transcripts was performed to aggregate data into categories and items.

RESULTS

Following several phases of testing with various groups, a 16-item scale has been developed.

CONCLUSIONS

This tool has received positive ratings from nurse managers currently using it to interview nurse applicants who best “fit” into the organization's nursing culture. Results will be monitored over time including hiring decisions, preceptor ratings, and retention rates.
Continuous Improvement and Employee Engagement, Part 2
Authors: Maurer Marsha , Browall Pamela , Phelan Cynthia , Sanchez Sandra , Sulmonte Kimberlyann , Wandel Jane , Wang Allison
Published: February 2018

A daily management system (DMS) can be used to implement continuous quality improvement and advance employee engagement. It can empower staff to identify problems in the care environment that impact quality or work flow and to address them on a daily basis. Through a DMS, improvement becomes the work of everyone, every day. The authors of this 2-part series describe their work to develop a DMS. Part 2 describes the implementation and outcomes of the program.
Examination of Behavioral, Social, and Environmental Contextual Influences on Sexually Transmitted Infections in At Risk, Urban, Adolescents, and Young Adults
Authors: Boyer Cherrie B. , Santiago Rivera Olga J. , Chiaramonte Danielle M. , Ellen Jonathan M.
Published: February 2018

Background

Despite the large body of extant literature on sexually transmitted infections (STIs) in adolescents and young adults (AYAs), more research on social and environmental contextual factors is needed. Also, further examination of STI indicators by gender remains a critical area of research focus.

Methods

Anonymous survey data were collected using audio computer-assisted self-interviews in community venues in urban, low-income, STI prevalent, US neighborhoods to reach AYAs, aged 12 to 24 years. Conventional descriptive statistics, bivariate analysis, and multiple logistical regression models were used to assess indicators of a self-reported lifetime prevalence of STIs.

Results

Participants (N = 1540) were on average 20.6 years; 57.2% were women, the majority were racial and ethnic minorities (92%), and almost half (49.2%) identified as sexual minorities. Nearly one third (32.%) had 1 or more STIs. As expected, gender differences were identified. For AYA men, being African American/Black, moving residences more than 4 times since kindergarten, and having a history of human immunodeficiency virus testing were each positively associated with STIs. Also, those who strongly disagreed that many young people in their community exchanged sex for money had a significantly lower likelihood of having an STI. For AYA women, exchanging sex for drugs or money, lacking money, which prevented activities, and using marijuana were each associated with STIs.

Conclusions

This research extends our understanding of social and environmental contextual influences on AYAs’ risk for STIs. It highlights differences in risk exposures that are distinctly different for AYA women and men, suggesting the need for tailored interventions to address their unique economic needs and social challenges.
Nonadherence to National Guidelines for Antibiotic Treatment of Uncomplicated Gonorrhea in China: Results From a Nationwide Survey
Authors: Han Yan , Yin Yue-Ping , Zhou Ying , Liu Jing-Wei , Zhou Ke , Liu Hong-Ye , Yi Fei , Chen Xiang-Sheng
Published: February 2018

Background

Provider adherence to the national treatment guidelines for gonorrhea is critical to assuring effective treatment. It is also an important means of limiting antibiotic overuse, which can lead to development of resistant bacteria. The Chinese treatment guidelines recommend the monotherapy with ceftriaxone or spectinomycin in accordance with the World Health Organization guidelines for treatment of uncomplicated gonorrhea. We evaluated adherence to the guidelines among treatment providers in China.

Methods

The study was a nationwide cross-sectional study. In each of the 6 geographic regions in China, at least 1 province was selected. In each selected province, cities with elevated incidence of reported gonorrhea were purposively selected. Using a questionnaire, 2121 physicians recruited from 512 different categories and levels of health sectors from July to September 2017 were investigated.

Results

Of the participants, more than 99% diagnosed gonorrhea using one of the laboratory tests including Gram stain, culture, nucleic acid amplification test, or other tests. Culture was the predominant assay of the choice for the diagnosis. Of the 1890 physicians who provided information on prescription behaviors, 62.2% were not adherent to the regimens for treatment of uncomplicated gonorrhea recommended by the National Sexually Transmitted Disease (STD) Treatment Guidelines (National STD Guidelines). Physicians working in the areas located in Northern China (adjusted odds ratio [AOR], 3.06; 95% confidence intervals [CIs], 1.77–5.31), in general hospitals or departments of urology (AOR, 1.54; 95% CIs, 1.08–2.19), diagnosing more cases in the past 6 months (AOR, 1.82; 95% CIs, 1.25–2.67), or unfamiliar with the treatment regimens in the National STD Guidelines (AOR, 3.48; 95% CIs, 2.76–4.37) were significantly more likely to be nonadherent to the National STD Guidelines.

Conclusions

It can be concluded from our study that nonadherence to the national guidelines and empirical treatment with high doses of ceftriaxone occurred frequently in China. Further studies on the impacts of the empirical treatment on antimicrobial resistance of gonorrhea are needed.
HIV Infection Is Not Associated With Aortic Stiffness. Traditional Cardiovascular Risk Factors Are the Main Determinants—Cross-sectional Results of INI-ELSA-BRASIL
Authors: Moreira Rodrigo C. , Mill José G. , Grinsztejn Beatriz , Veloso Valdilea , Fonseca Maria de Jesus , Griep Rosane H. , Bensenor Isabela , Cardoso Sandra W. , Lotufo Paulo , Chor Dora , Pacheco Antonio G. ,   for the INI ELSA BRASIL
Published: February 2018

Introduction:

Aortic stiffness measured by carotid-femoral pulse wave velocity (cf-PWV) is a marker of subclinical atherosclerosis. We propose to assess whether HIV infection is associated with arterial stiffness and their determinants in HIV-infected subjects.

Methods:

We compared data from an HIV cohort (644 patients, HIV+) in Rio de Janeiro with 2 groups: 105 HIV-negative (HIV−) individuals and 14,873 participants of the ELSA-Brasil study. We used multivariable linear regression to investigate factors associated with cf-PWV and whether HIV was independently associated with aortic stiffness and propensity score weighting to control for imbalances between groups.

Results:

From 15,860 participants, cf-PWV was obtained in 15,622 (98.5%). Median age was 51 (interquartile range 45–58), 44.41 (35.73, 54.72), and 43.60 (36.01, 50.79) years (P < 0.001), and median cf-PWV (m/s; interquartile range) was 9.0 (8.10, 10.20), 8.70 (7.90, 10.20), and 8.48 (7.66, 9.40) for ELSA-Brasil, HIV− and HIV+, respectively (P < 0.001). In the final weighted multivariable models, HIV group was not associated with cf-PWV when compared either with ELSA-Brasil [β = −0.05; 95% confidence interval (CI) = −0.23; P = 0.12; P = 0.52] or with the HIV- groups (β = 0.10; 95% CI = −0.10; 0, 31; P = 0.32). Traditional risk factors were associated with higher cf-PWV levels in the HIV+ group, particularly waist-to-hip ratio (β = 0.20; 95% CI = 0.10; 0.30; P < 0.001, result per one SD change).

Conclusions:

HIV infection was not associated with higher aortic stiffness according to our study. In HIV-infected subjects, the stiffness of large arteries is mainly associated with traditional risk factors and not to the HIV infection per se.
Pharmacokinetics and Pharmacodynamics of Tenofovir Reduced-Glycerin 1% Gel in the Rectal and Vaginal Compartments in Women: A Cross-Compartmental Study With Directly Observed Dosing
Authors: Justman Jessica E. , Nair Gonasagrie (Lulu) , Hendrix Craig W. , Piper Jeanna M. , Marzinke Mark A. , Dai James Y. , Pan Zhenyu , Galaska Beth , Levy Lisa , Schwartz Jill L. , Balar Bhavna , Kunjara Na Ayudhya Ratiya P. , Mushamiri Ivy , McGowan Ian , Dezzutti Charlene S. ,   for the MTN-014 Study Team
Published: February 2018

Background:

Evidence is lacking regarding whether vaginal pre-exposure prophylaxis with topical tenofovir (TFV) reduces the risk of rectal HIV acquisition.

Setting:

Bronx, NY.

Methods:

MTN-014 was a phase 1, cross-over, randomized sequence trial comparing the cross-compartment pharmacokinetics and pharmacodynamics of daily TFV reduced-glycerin 1% gel after 14 days each of rectal and vaginal application, with directly observed dosing and a 6-week washout period between phases.

Results:

Fourteen HIV-uninfected women enrolled; 91% of doses were observed and 13 women completed all study procedures. TFV and TFV diphosphate (TFV-DP) were detected in most samples collected from the dosing compartment. After vaginal dosing, TFV was detected in 10/14 samples of rectal fluid (RF) (median 4.4 ng/sponge) and 1/13 rectal tissue samples (0.2 ng/mg); TFV-DP was detected in 2/13 rectal tissue samples at 59.8 and 76.5 fmol/mg. After rectal dosing, TFV was detected in 9/14 samples of vaginal fluid (median 1.1 ng/swab) and in 6/14 vaginal tissue samples (median below limit of quantification); TFV-DP was detected in 3/14 vaginal tissue samples at 17.3, 87.6, and 77.1 fmol/mg. Neither cervicovaginal lavage fluid nor RF collected 24 hours after rectal or vaginal dosing resulted in a statistically significant suppression of viral replication.

Conclusions:

In this study of 14 days each of vaginal and rectal application of TFV reduced-glycerin 1% gel, we found only a small degree of cross-compartment distribution of TFV in RF and vaginal fluids and no pharmacodynamic activity in ex vivo testing. Although high TFV concentrations in the dosing compartment may be protective, low cross-compartment tissue concentrations are not likely to be protective.
HIV Risk Among Adolescent Girls and Young Women in Age-Disparate Partnerships: Evidence From KwaZulu-Natal, South Africa
Authors: Maughan-Brown Brendan , George Gavin , Beckett Sean , Evans Meredith , Lewis Lara , Cawood Cherie , Khanyile David , Kharsany Ayesha B. M.
Published: February 2018

Background:

Evidence on the role of age-disparate partnerships in high HIV-infection rates among young women in sub-Saharan Africa remains inconclusive. This study examined the HIV-infection risk associated with age-disparate partnerships among 15- to 24-year-old women in a hyperendemic setting in South Africa.

Methods:

Face-to-face questionnaire, and laboratory HIV and viral load data were collected during 2014–2015 among a representative sample (15–49 years old) in KwaZulu-Natal. The association between age-disparate partnerships (age difference ≥5 years) and HIV status among 15- to 24-year-old women (N = 1459) was assessed using multiple logistic regression analyses. Data from the male sample on all on-going partnerships (N = 1229) involving 15- to 24-year-old women were used to assess whether young women's age-disparate male partners were more likely to have a viral load ≥1000 copies per milliliter, a marker of HIV-infection risk.

Results:

Women reporting an age disparity in any of their 3 most recent partnerships were more likely to test HIV positive compared to women with only age-similar partners [adjusted odds ratio (aOR): 1.58, 95% confidence interval (CI): 1.20 to 2.09, P < 0.01]. Among partnerships men reported with 15- to 24-year-old women, the age-disparate male partners were more likely to be HIV positive and have a viral load ≥1000 copies per milliliter (aOR: 2.05, 95% CI: 1.30 to 3.24, P < 0.01) compared with age-similar partners. Results were similar for each category of age disparity: partners 5–9 years older (aOR: 2.01, 95% CI: 1.18 to 3.43, P = 0.010) and those ≥10 years older (aOR: 2.17, 95% CI: 1.01–4.66, P = 0.048).

Conclusions:

Results indicate that age-disparate partnerships increase young women's HIV risk, although conclusive evidence was not ascertained. Interventions addressing risk from age-disparate sexual partnering, including expanding antiretroviral treatment among older partners, may help to reduce HIV incidence among young women.