bluuebunny/crossref_metadata_2025 huggingface dataset:
Using Quality Improvement to Increase Access to Behavioral Health Care in Federally Qualified Health Centers
Authors: Maragakis Alexandros , Snipes Cassandra , Mazzucotelli Joseph , Duarte Charles
Published: November 2014

Objectives: Integrated care programs, in which behavioral health is integrated in primary care settings, have been widely implemented as solution to rising health care expenditures. A number of recommendations for implementation of integrated care have been published in the past decade; however, data regarding how to produce the most effective system are lacking. This may be because of the fact that existing integrated care programs do not institute quality improvement initiatives that could generate this needed data. Methods: A quality improvement program was instituted at an integrated Federally Qualified Health Center. As a result, productivity and no-show rates were analyzed for two psychology externs providing integrated care services. A process map was created to identify systematic methods to improve outcomes. Results: There were statistically significant increases to productivity increased and decreases no-show rates through systematic changes. Conclusion: This case study provides evidence that quality improvement systems in integrated care can result in systemic changes that improve access to care.
Bundled Payments for Elective Primary Total Knee Arthroplasty
Authors: Cram Peter , Lu Xin , Li Yue
Published: November 2014

Bundled payments have been proposed as a mechanism for restraining health care spending for total knee arthroplasty (TKA), but empirical data are limited. We used Medicare data to examine variation in payments for TKA during a window extending 30 days before to 90 days after TKA for 167 186 patients who underwent elective primary TKA in 2009. Mean Medicare payment was US$23 656. We found that 2.5% of patients incurred payments of >US$50 000 (0.2% >US$100 000). Payments were lower for men and for non-Hispanic whites but higher for patients with greater comorbidity. Episode-of-care payment for primary TKA varies substantially depending upon patient demographics and comorbidity. To the extent that similar patients tend to be clustered within hospitals, bundled payments could inadvertently cause financial harm to certain health systems while rewarding others.
Instituting Cultural Change at a Major Organization
Authors: Dulek Ronald E.
Published: November 2014

This article examines the development and implementation of a strategic cultural change program from a case study perspective. Initially, the article describes how the program was developed, including an explanation as to how a communication component was integrated into the program from inception. This integration helped reduce the anxiety that change programs traditionally initiate. Additionally, the article examines preliminary findings captured during the program’s implementation. These findings provide generalized insights about ways communication, strategy, and cultural change programs interact. As such, the findings provide real-world support that communication facilitates organizational change.
American and Brazilian Children With Primary Urolithiasis
Authors: Penido Maria Goretti Moreira Guimarães , Tavares Marcelo de Sousa , Guimarães Milena Maria Moreira , Srivastava Tarak , Alon Uri Saggie
Published: November 2014

Objectives. Considering the differences in location, socioeconomic background, and cultural background, the aim of this study was to try to identify possible factors associated with the increased incidence of urolithiasis by comparing American and Brazilian children with stones. Methods. Data of 222 American and 190 Brazilian children with urolithiasis were reviewed including age, gender, body mass index, imaging technique used (ultrasound and computed tomography), and 24-hour urine volume and chemistries. Results. There were no differences between age and gender at diagnosis. Brazilian children were leaner but in no population did obesity rate exceed that of the general population. Ultrasound was most commonly used to diagnose stones, even more so in Brazilians. Decreased urine flow was more common among Americans ( P = .004), hypercalciuria among Brazilians ( P = .001), and elevated Ca/citrate ratio among Americans ( P = .009). There were no differences between the groups in the frequency of hypocitraturia, hyperuricosuria, absorptive hyperoxaluria, and cystinuria. Conclusions. Despite some differences between the populations, the leading causes of urolithiasis among both were “oliguria,” hypercalciuria, and high Ca/citrate ratio. In neither country was obesity the reason for the increase in incidence of urolithiasis, nor was the use of computed tomography. The similarities between the 2 populations call for combining efforts in addressing the leading causes of pediatric urolithiasis.
Risk of Social Media for Teens in an Urban Setting
Authors: Knowles Megan , Lee Sara Hirschfeld , O’Riordan MaryAnn , Lazebnik Rina
Published: November 2014

Purpose. To describe the self-reported risky behaviors associated with adolescent social media use. Methods. Adolescents ages 13 to 21 years were recruited from a large, urban academic center to complete a written survey regarding social media use. Results are presented as frequencies and percentage; nominal variables were compared using χ2 analysis. Results. Almost all participants (93%) reported belonging to a social media site. The majority of adolescents (72%) access the Internet with a phone. Nearly half (49%) of participants accept friend requests from strangers, 42% send friend requests to strangers, and 55% of participants report meeting people from social media sites in person. Conclusion. Adolescents self-report engaging in a number of risky behaviors when they use social media. Teenagers’ use of social media is an additional behavior that requires attention and monitoring.
Size- and time-dependent alteration in metabolic activities of human hepatic cytochrome P450 isozymes by gold nanoparticles via microsomal coincubations
Authors: Ye Meiling , Tang Ling , Luo Mengjun , Zhou Jing , Guo Bin , Liu Yangyuan , Chen Bo
Published: November 2014

Nano-sized particles are known to interfere with drug-metabolizing cytochrome P450 (CYP) enzymes, which can be anticipated to be a potential source of unintended adverse reactions, but the mechanisms underlying the inhibition are still not well understood. Herein we report a systematic investigation of the impacts of gold nanoparticles (AuNPs) on five major CYP isozymes under in vitro incubations of human liver microsomes (HLMs) with tannic acid (TA)-stabilized AuNPs in the size range of 5 to 100 nm. It is found that smaller AuNPs show more pronounced inhibitory effects on CYP2C9, CYP2C19, CYP2D6, and CYP3A4 in a dose-dependent manner, while 1A2 is the least susceptible to the AuNP inhibition. The size- and dose-dependent CYP-specific inhibition and the nonspecific drug-nanogold binding in the coincubation media can be significantly reduced by increasing the concentration ratio of microsomal proteins to AuNPs, probably via a noncompetitive mode. Remarkably, AuNPs are also found to exhibit a slow time-dependent inactivation of 2D6 and 3A4 in a β-nicotinamide adenine dinucleotide 2′-phosphate reduced tetrasodium salt hydrate (NADPH)-independent manner. During microsomal incubations, UV–vis spectroscopy, dynamic light scattering, and zeta-potential measurements were used to monitor the changes in particle properties under the miscellaneous AuNP/HLM/CYP dispersion system. An improved stability of AuNPs by mixing HLM with the gold nanocolloid reveals that the stabilization via AuNP-HLM interactions may occur on a faster time scale than the salt-induced nanoaggregation by incubation in phosphate buffer. The results suggest that the AuNP induced CYP inhibition can be partially attributed to its adhesion onto the enzymes to alter their structural conformations or onto the HLM membrane therefore impairing the integral membrane proteins. Additionally, AuNPs likely block the substrate pocket on the CYP surface, depending on both the particle characteristics and the structural diversity of the isozymes. These findings may represent additional mechanisms for the differential inhibitory effects arising from the coincubated AuNPs on the metabolic activities of the hepatic CYP isozymes.
Solvent-free fabrication of thermally conductive insulating epoxy composites with boron nitride nanoplatelets as fillers
Authors: Wang Zifeng , Fu Yuqiao , Meng Wenjun , Zhi Chunyi
Published: November 2014

A solvent-free method for the fabrication of thermally conductive epoxy-boron nitride (BN) nanoplatelet composite material is developed in this study. By this method, polymer composites with nearly any filler fractions can be easily fabricated. The maximum thermal conductivity reaches 5.24 W/mK, which is 1,600% improvement in comparison with that of pristine epoxy material. In addition, the as-fabricated samples exhibit excellent overall performances with great mechanical property and thermal stability well preserved.
Electrical conductivity of poly(3,4-ethylenedioxythiophene):p-toluene sulfonate films hybridized with reduced graphene oxide
Authors: Lee Jun-Taek , Choi Sul-Hwa , Kim Jin-Yeol
Published: November 2014

Reduced graphene oxide-poly(3,4-ethylenedioxythiophene):p-toluene sulfonate (rGO-PEDOT:PTS) hybrid electrode films were synthesized directly on a substrate by interfacial polymerization between an oxidizing solid layer and liquid droplets of 3,4-ethylenedioxythiophene (EDOT) produced by electrospraying. The EDOT reduced the graphene oxide by donating electrons during its transformation into PEDOT:PTS, and hybrid films consisting of rGO distributed in a matrix of PEDOT:PTS were obtained. These rGO-PEDOT:PTS hybrid films showed excellent electrical conductivities as high as 1,500 S/cm and a sheet resistance of 70 Ω sq-1. The conductivity values are up to 50% greater than those of films containing conductive PEDOT:PTS alone. These results confirm that highly conductive rGO-PEDOT:PTS hybrid films can potentially be used as organic transparent electrodes.
Designed nitrogen doping of few-layer graphene functionalized by selective oxygenic groups
Authors: Chen Ying , Xie Bingqiao , Ren Yingtao , Yu Mengying , Qu Yang , Xie Ting , Zhang Yong , Wu Yucheng
Published: November 2014

Few-layer nitrogen doped graphene was synthesized originating from graphene oxide functionalized by selective oxygenic functional groups (hydroxyl, carbonyl, carboxyl etc.) under hydrothermal conditions, respectively. Transmission electron microscopy (TEM) and atomic force microscopy (AFM) observation evidenced few-layer feature of the graphene oxide. X-ray diffraction (XRD) pattern confirmed phase structure of the graphene oxide and reduced graphene oxide. Nitrogen doping content and bonding configuration of the graphene was determined by X-ray photoelectron spectroscopy (XPS), which indicated that different oxygenic functional groups were evidently different in affecting the nitrogen doping process. Compared with other oxygenic groups, carboxyl group played a crucial role in the initial stage of nitrogen doping while hydroxyls exhibited more evident contribution to the doping process in the late stage of the reaction. Formation of graphitic-like nitrogen species was controlled by a synergistic effect of the involved oxygenic groups (e.g., -COOH, -OH, C-O-C, etc.). The doping mechanism of nitrogen in the graphene was scrutinized. The research in this work may not only contribute to the fundamental understandings of nitrogen doping within graphene but promote the development of producing novel graphene-based devices with designed surface functionalization.
Cardiac echo-lab productivity in times of economic austerity
Authors: Katsi Vasiliki K , Vrachatis Dimitrios A , Politi Anastasia , Papageorgiou Manto , Koumoulidis Anastasios , Vlasseros Ioannis , Vavuranakis Manolis , Tousoulis Dimitrios , Stefanadis Christodoulos , Kallikazaros Ioannis , Souliotis Kyriakos
Published: November 2014

The present study attempts to offer insight into the volume, cost, and productivity of the operation of a cardiac echocardiographic laboratory (echo-lab) in a major public hospital of Greece and thus to contribute, on a practical level, to the widening of knowledge in the strategic field of secondary and tertiary healthcare management. The conducted research includes the basic step of the deployment of a primary data registry in the echo-lab and unfolds in three levels, i.e. the variability measurement of the quantity and cost of medical services provided to different patient populations, the assessment of operating costs and the development of productivity indexes. The results show that the mean costs of provision do change among distinct patient populations. The most important, from a financial standpoint, population cluster appears to be the one corresponding to outpatients. Productivity indices presented in this analysis constitute an essential piece of information which the public healthcare system is currently largely lacking, and which, combined with the pricing and the diagnosis-related group coding system of hospitals, can be used to improve efficiency in the management of secondary and tertiary care.
Accuracy of invasive arterial pressure monitoring in cardiovascular patients: an observational study
Authors: Romagnoli Stefano , Ricci Zaccaria , Quattrone Diego , Tofani Lorenzo , Tujjar Omar , Villa Gianluca , Romano Salvatore M , De Gaudio A Raffaele
Published: November 2014

Introduction

Critically ill patients and patients undergoing high-risk and major surgery, are instrumented with intra-arterial catheters and invasive blood pressure is considered the “gold standard” for arterial pressure monitoring. Nonetheless, artifacts due to inappropriate dynamic response of the fluid-filled monitoring systems may lead to clinically relevant differences between actual and displayed pressure values. We sought to analyze the incidence and causes of resonance/underdamping phenomena in patients undergoing major vascular and cardiac surgery.

Methods

Arterial pressures were measured invasively and, according to the fast-flush Gardner’s test, each patient was attributed to one of two groups depending on the presence (R-group) or absence (NR-group) of resonance/underdamping. Invasive pressure values were then compared with the non-invasive ones.

Results

A total of 11,610 pulses and 1,200 non-invasive blood pressure measurements were analyzed in 300 patients. Ninety-two out of 300 (30.7%) underdamping/resonance arterial signals were found. In these cases (R-group) systolic invasive blood pressure (IBP) average overestimation of non-invasive blood pressure (NIBP) was 28.5 (15.9) mmHg (P <0.0001) while in the NR-group the overestimation was 4.1(5.3) mmHg (P <0.0001). The mean IBP-NIBP difference in diastolic pressure in the R-group was −2.2 (10.6) mmHg and, in the NR-group −1.1 (5.8) mmHg. The mean arterial pressure difference was 7.4 (11.2) mmHg in the R-group and 2.3 (6.4) mmHg in the NR-group. A multivariate logistic regression identified five parameters independently associated with underdamping/resonance: polydistrectual arteriopathy (P =0.0023; OR = 2.82), history of arterial hypertension (P =0.0214; OR = 2.09), chronic obstructive pulmonary disease (P =0.198; OR = 2.61), arterial catheter diameter (20 vs. 18 gauge) (P <0.0001; OR = 0.35) and sedation (P =0.0131; OR = 0.5). The ROC curve for the maximal pressure–time ratio, showed an optimum selected cut-off point of 1.67 mmHg/msec with a specificity of 97% (95% CI: 95.13 to 99.47%) and a sensitivity of 77% (95% CI: 67.25 to 85.28%) and an area under the ROC curve by extended trapezoidal rule of 0.88.

Conclusion

Physicians should be aware of the possibility that IBP can be inaccurate in a consistent number of patients due to underdamping/resonance phenomena. NIBP measurement may help to confirm/exclude the presence of this artifact avoiding inappropriate treatments.
Levosimendan attenuates multiple organ injury and improves survival in peritonitis-induced septic shock: studies in a rat model
Authors: Tsao Cheng-Ming , Li Kai-Yi , Chen Shiu-Jen , Ka Shuk-Man , Liaw Wen-Jinn , Huang Hsieh-Chou , Wu Chin-Chen
Published: November 2014

Introduction

The aim of this study was to investigate the effects of levosimendan on rodent septic shock induced by cecal ligation and puncture (CLP).

Methods

Three hours after peritonitis-induced sepsis, male Wistar rats were randomly assigned to receive an intravenous infusion of levosimendan (1.2 μg/kg/min for 10 min and then 0.3 μg/kg/min for 6 h) or an equivalent volume of saline and vehicle (5% dextrose) solution.

Results

The levosimendan-treated CLP animals had significantly higher arterial pressure and lower biochemical indices of liver and kidney dysfunction compared to the CLP animals (P < 0.05). Plasma interleukin-1β, nitric oxide and organ superoxide levels in the levosimendan-treated CLP group were less than those in CLP rats treated with vehicle (P < 0.05). In addition, the inducible nitric oxide synthase (iNOS) in lung and caspase-3 expressions in spleen were significantly lower in the levosimendan-treated CLP group (P < 0.05). The administration of CLP rats with levosimendan was associated with significantly higher survival (61.9% vs. 40% at 18 h after CLP, P < 0.05). At postmortem examination, the histological changes and neutrophil filtration index in liver and lung were significantly attenuated in the levosimendan-treated CLP group (vs. CLP group, P < 0.05).

Conclusions

In this clinically relevant model of septic shock induced by fecal peritonitis, the administration of levosimendan had beneficial effects on haemodynamic variables, liver and kidney dysfunction, and metabolic acidosis. (1) Lower levels of interleukin-1β, nitric oxide and superoxide, (2) attenuation of iNOS and caspase-3 expressions, and (3) decreases of neutrophil infiltration by levosimendan in peritonitis-induced sepsis animals suggest that anti-inflammation and anti-apoptosis effects of levosimendan contribute to prolonged survival.
Determining the mechanisms underlying augmented renal drug clearance in the critically ill: use of exogenous marker compounds
Authors: Udy Andrew A , Jarrett Paul , Stuart Janine , Lassig-Smith Melissa , Starr Therese , Dunlop Rachel , Wallis Steven C , Roberts Jason A , Lipman Jeffrey
Published: November 2014

Introduction

The aim of this study was to explore changes in glomerular filtration (GFR) and renal tubular function in critically ill patients at risk of augmented renal clearance (ARC), using exogenous marker compounds.

Methods

This prospective, observational pharmacokinetic (PK) study was performed in a university-affiliated, tertiary-level, adult intensive care unit (ICU). Patients aged less than or equal to 60 years, manifesting a systemic inflammatory response, with an expected ICU length of stay more than 24 hours, no evidence of acute renal impairment (plasma creatinine concentration <120 μmol/L) and no history of chronic kidney disease or renal replacement therapy were eligible for inclusion. The following study markers were administered concurrently: sinistrin 2,500 mg (Inutest; Laevosan, Linz, Austria), p-aminohippuric acid (PAH) 440 mg (4% p-aminohippuric acid sodium salt; CFM Oskar Tropitzsch, Marktredwitz, Germany), rac-pindolol 5 or 15 mg (Barbloc; Alphapharm, Millers Point, NSW, Australia) and fluconazole 100 mg (Diflucan; Pfizer Australia Pty Ltd, West Ryde, NSW, Australia). Plasma concentrations were then measured at 5, 10, 15, 30, 60 and 120 minutes and 4, 6, 12 and 24 hours post-administration. Non-compartmental PK analysis was used to quantify GFR, tubular secretion and tubular reabsorption.

Results

Twenty patients were included in the study. Marker administration was well tolerated, with no adverse events reported. Sinistrin clearance as a marker of GFR was significantly elevated (mean, 180 (95% confidence interval (CI), 141 to 219) ml/min) and correlated well with creatinine clearance (r =0.70, P <0.01). Net tubular secretion of PAH, a marker of tubular anion secretion, was also elevated (mean, 428 (95% CI, 306 to 550) ml/min), as was net tubular reabsorption of fluconazole (mean, 135 (95% CI, 100 to 169) ml/min). Net tubular secretion of (S)- and (R)-pinodolol, a marker of tubular cation secretion, was impaired.

Conclusions

In critically ill patients at risk of ARC, significant alterations in glomerular filtration, renal tubular secretion and tubular reabsorption are apparent. This has implications for accurate dosing of renally eliminated drugs.
Decision support tool for differential diagnosis of Acute Respiratory Distress Syndrome (ARDS) vs Cardiogenic Pulmonary Edema (CPE): a prospective validation and meta-analysis
Authors: Schmickl Christopher N , Pannu Sonal , Al-Qadi Mazen O , Alsara Anas , Kashyap Rahul , Dhokarh Rajanigandha , Herasevich Vitaly , Gajic Ognjen
Published: November 2014

Introduction

We recently presented a prediction score providing decision support with the often-challenging early differential diagnosis of acute lung injury (ALI) vs cardiogenic pulmonary edema (CPE). To facilitate clinical adoption, our objective was to prospectively validate its performance in an independent cohort.

Methods

Over 9 months, adult patients consecutively admitted to any intensive care unit of a tertiary-care center developing acute pulmonary edema were identified in real-time using validated electronic surveillance. For eligible patients, predictors were abstracted from medical records within 48 hours of the alert. Post-hoc expert review blinded to the prediction score established gold standard diagnosis.

Results

Of 1,516 patients identified by electronic surveillance, data were abstracted for 249 patients (93% within 48 hours of disease onset), of which expert review (kappa 0.93) classified 72 as ALI, 73 as CPE and excluded 104 as “other”. With an area under the curve (AUC) of 0.81 (95% confidence interval =0.73 to 0.88) the prediction score showed similar discrimination as in prior cohorts (development AUC = 0.81, P = 0.91; retrospective validation AUC = 0.80, P = 0.92). Hosmer-Lemeshow test was significant (P = 0.01), but across eight previously defined score ranges probabilities of ALI vs CPE were the same as in the development cohort (P = 0.60). Results were the same when comparing acute respiratory distress syndrome (ARDS, Berlin definition) vs CPE.

Conclusion

The clinical prediction score reliably differentiates ARDS/ALI vs CPE. Pooled results provide precise estimates of the score’s performance which can be used to screen patient populations or to assess the probability of ALI/ARDS vs CPE in specific patients. The score may thus facilitate early inclusion into research studies and expedite prompt treatment.
Prophylactic intra-aortic balloon counterpulsation in cardiac surgery: it is time for clear evidence
Authors: Grieshaber Philippe , Niemann Bernd , Roth Peter , Böning Andreas
Published: November 2014

In the previous issue of Critical Care, Yu and colleagues report increased morbidity and mortality in patients after myocardial infarction undergoing prophylactic intra-aortic balloon pump support before coronary artery bypass graft surgery. The impact of prophylactic intra-aortic balloon pump implantation before coronary artery bypass graft therapy still is controversially debated. However, Yu and colleagues emphasize further discussion and substantiate the need for a prospective randomized controlled trial on this subject.
Neurally adjusted non-invasive ventilation in patients with chronic obstructive pulmonary disease: does patient–ventilator synchrony matter?
Authors: Nava Stefano , Pisani Lara
Published: November 2014

Patient–ventilator interaction represents an important clinical challenge during non-invasive ventilation (NIV). Doorduin and colleagues’ study shows that non-invasive neurally adjusted ventilatory assist (NAVA) improves patient–ventilator interaction compared with pressure support ventilation in patients with chronic obstructive pulmonary disease. There is no doubt nowadays that NAVA is the most effective mode of improving the synchrony between patient and machine, but the key question for the clinicians is whether or not this will make a difference to the patient’s outcome. The results of the study still do not clarify this issue because of the very low clinically important dyssynchrony, like wasted efforts, in the population studied. Air leaks play an important role in determining patient–ventilator interaction and therefore NIV success or failure. Apart from the use of a dedicated NIV ventilator or specific modes of ventilation like NAVA, the clinicians should be aware that the choice of interface, the humidification system and the appropriate sedation are key factors in improving patient–ventilator synchrony.
Gary Becker’s early work on human capital – collaborations and distinctiveness
Authors: Teixeira Pedro Nuno
Published: November 2014

ᅟ

In a prolific and illustrious career, the late Gary Becker (1930–2014) developed what he would later call "the economic approach to human behaviour". One of the most significant strands of that research was that which focused on human capital, occuping a significant part of his career, especially in his early years. In this paper we will focus on Becker’s early work in human capital up to the publication of his book in 1964, a period that laid the foundations for his career and in which he tested the possibilities of (and the resistance to) this economic approach to human behaviour. We will explore the context in which the book was developed and the interactions with other people that were laying the foundations for human capital research, namely those working at the Chicago and Columbia Departments of Economics.

JEL codes

B2; B3; I2; J3
Remittances, savings and return migration under uncertainty
Authors: Delpierre Matthieu , Verheyden Bertrand
Published: November 2014

Recent empirical evidence links migrant remittances, savings and return migration, and stresses the inaccuracy of return migration plans. This paper presents a model of endogenous remittances, savings and return decisions under uncertainty. In our framework, migrants make remittance and saving decisions at an early stage of migration, when their long term economic performance in the host country is still uncertain. Over time, information about professional prospects is acquired, and conditionally on past decisions, migrants adjust their return plans. We show that when migrants expect large gains from migration and face relatively low wage risks in the host country, they tend to remit less, save more and are less likely to return migrate. These results are in line with recent empirical evidence and provide a rationale for the support by relatives in the sending country of low-skill, illegal migration.

JEL codesD13; D80; JE
Remote control system of disaster response robot with passive sub-crawlers considering falling down avoidance
Authors: Suzuki Soichiro , Hasegawa Satoshi , Okugawa Masayuki
Published: November 2014

This paper describes a remote control system for a crawler-type mobile robot with passive sub-crawlers. This system has a great advantage because it utilizes an essential compliant mechanism that allows the angle of the sub-crawlers to be adapted to the shape of the road surface. Its operation is extremely simple, and it is only necessary to control the movement direction and driving speed in comparison with the case of controlling active sub-crawlers. However, a robot with passive sub-crawlers cannot recover from a situation in which it is stuck. The operator must select a traversable route for unknown rough terrain using only the information obtained from camera images and some sensor data from the robot. In this study, a remote control system for a crawler robot with passive sub-crawlers was developed based on a warning system. This system evaluates the currently selected route by calculating the stabilization for the robot when falling down in the roll and pitch directions. Experimental results obtained using a prototype crawler robot with passive sub-crawlers demonstrated the effectiveness of the proposed system.
CCM proteins control endothelial β1 integrin dependent response to shear stress
Authors: Macek Jilkova Zuzana , Lisowska Justyna , Manet Sandra , Verdier Claude , Deplano Valerie , Geindreau Christian , Faurobert Eva , Albigès-Rizo Corinne , Duperray Alain
Published: November 2014

Hemodynamic shear stress from blood flow on the endothelium critically regulates vascular function in many physiological and pathological situations. Endothelial cells adapt to shear stress by remodeling their cytoskeletal components and subsequently by changing their shape and orientation. We demonstrate that β1 integrin activation is critically controlled during the mechanoresponse of endothelial cells to shear stress. Indeed, we show that overexpression of the CCM complex, an inhibitor of β1 integrin activation, blocks endothelial actin rearrangement and cell reorientation in response to shear stress similarly to β1 integrin silencing. Conversely, depletion of CCM2 protein leads to an elongated “shear-stress-like” phenotype even in the absence of flow. Taken together, our findings reveal the existence of a balance between positive extracellular and negative intracellular signals, i.e. shear stress and CCM complex, for the control of β1 integrin activation and subsequent adaptation of vascular endothelial cells to mechanostimulation by fluid shear stress.
Slow-cycling stem cells in hydra contribute to head regeneration
Authors: Govindasamy Niraimathi , Murthy Supriya , Ghanekar Yashoda
Published: November 2014

Adult stem cells face the challenge of maintaining tissue homeostasis by self-renewal while maintaining their proliferation potential over the lifetime of an organism. Continuous proliferation can cause genotoxic/metabolic stress that can compromise the genomic integrity of stem cells. To prevent stem cell exhaustion, highly proliferative adult tissues maintain a pool of quiescent stem cells that divide only in response to injury and thus remain protected from genotoxic stress. Hydra is a remarkable organism with highly proliferative stem cells and ability to regenerate at whole animal level. Intriguingly, hydra does not display consequences of high proliferation, such as senescence or tumour formation. In this study, we investigate if hydra harbours a pool of slow-cycling stem cells that could help prevent undesirable consequences of continuous proliferation. Hydra were pulsed with the thymidine analogue 5-ethynyl-2′-deoxyuridine (EdU) and then chased in the absence of EdU to monitor the presence of EdU-retaining cells. A significant number of undifferentiated cells of all three lineages in hydra retained EdU for about 8–10 cell cycles, indicating that these cells did not enter cell cycle. These label-retaining cells were resistant to hydroxyurea treatment and were predominantly in the G2 phase of cell cycle. Most significantly, similar to mammalian quiescent stem cells, these cells rapidly entered cell division during head regeneration. This study shows for the first time that, contrary to current beliefs, cells in hydra display heterogeneity in their cell cycle potential and the slow-cycling cells in this population enter cell cycle during head regeneration. These results suggest an early evolution of slow-cycling stem cells in multicellular animals.
Mate choice and body pattern variations in the Crown Butterfly fish Chaetodon paucifasciatus (Chaetodontidae)
Authors: Levy Keren , Lerner Amit , Shashar Nadav
Published: November 2014

Mate choice is an important ecological behavior in fish, and is often based on visual cues of body patterns. The Crown Butterfly fish Chaetodon paucifasciatus (Chaetodontidae) is a monogamist, territorial species; it swims in close proximity to its partner throughout most of its life. This species is characterized by a pattern of 6–8 vertical black stripes on a white background, on both sides of its body. Our aim was to define spatial features (variations) in body patterns by evaluating the level of dissimilarity between both sides of each individual fish, and the level of dissimilarity between patterns of different individuals. In addition, we tested whether the fish are attracted to or reject specific features of the body patterns. Features were defined and counted using photographs of body patterns. Attraction to or rejection of specific features were tested behaviorally using a dual-choice experiment of video animations of individuals swimming over a coral-reef background. We found that the patterns of each fish and sides of the body were no less dissimilar, compared intraspecificly to other fish, and that each side pattern was unique and distinguishable. Variations in the patterns occurred mostly in the last three posterior stripes. Individuals were mainly attracted to conspecifics with multiple crossing patterns (two or more consecutive crossings), and rejected patterns with holes. Our results suggest that in this species the unique body pattern of each fish is used for conspecific identification of mates and intruders.
McArdle disease does not affect skeletal muscle fibre type profiles in humans
Authors: Kohn Tertius Abraham , Noakes Timothy David , Rae Dale Elizabeth , Rubio Juan Carlos , Santalla Alfredo , Nogales-Gadea Gisela , Pinós Tomas , Martín Miguel A. , Arenas Joaquin , Lucia Alejandro
Published: November 2014

Patients suffering from glycogen storage disease V (McArdle disease) were shown to have higher surface electrical activity in their skeletal muscles when exercising at the same intensity as their healthy counterparts, indicating more muscle fibre recruitment. To explain this phenomenon, this study investigated whether muscle fibre type is shifted towards a predominance in type I fibres as a consequence of the disease. Muscle biopsies from the Biceps brachii (BB) (n = 9) or Vastus lateralis (VL) (n = 8) were collected over a 13-year period from male and female patients diagnosed with McArdle disease, analysed for myosin heavy chain (MHC) isoform content using SDS-PAGE, and compared to healthy controls (BB: n = 3; VL: n = 10). All three isoforms were expressed and no difference in isoform expression in VL was found between the McArdle patients and healthy controls (MHC I: 33±19% vs. 43±7%; MHC IIa: 52±9% vs. 40±7%; MHC IIx: 15±18% vs. 17±9%). Similarly, the BB isoform content was also not different between the two groups (MHC I: 33±14% vs. 30±11%; MHC IIa: 46±17% vs. 39±5%; MHC IIx: 21±13% vs. 31±14%). In conclusion, fibre type distribution does not seem to explain the higher surface EMG in McArdle patients. Future studies need to investigate muscle fibre size and contractility of McArdle patients.
Subcellular optogenetics – controlling signaling and single-cell behavior
Authors: Karunarathne W. K. Ajith , O'Neill Patrick R. , Gautam Narasimhan
Published: November 2014

Variation in signaling activity across a cell plays a crucial role in processes such as cell migration. Signaling activity specific to organelles within a cell also likely plays a key role in regulating cellular functions. To understand how such spatially confined signaling within a cell regulates cell behavior, tools that exert experimental control over subcellular signaling activity are required. Here, we discuss the advantages of using optogenetic approaches to achieve this control. We focus on a set of optical triggers that allow subcellular control over signaling through the activation of G-protein-coupled receptors (GPCRs), receptor tyrosine kinases and downstream signaling proteins, as well as those that inhibit endogenous signaling proteins. We also discuss the specific insights with regard to signaling and cell behavior that these subcellular optogenetic approaches can provide.
Module 1. Creating a nutritious and balanced diet for adults and children
Authors: More Judy
Published: November 2014

Overview

This learning module identifies the five food groups and explains how to combine the groups to provide a nutritious and balanced diet for adults and children from 1 year of age. The module discusses practical evidence and research on limiting salt, sugar and saturated fat intakes, as well as highlighting solutions to overcome the challenges in feeding children of different ages.
Module 3. The importance of relationship building in supporting families
Authors: Bidmead Christine
Published: November 2014

Overview

This learning module concentrates on describing how health visitors work with families to provide support. It provides an overview of family support skills with self-assessment to consolidate your learning and help you achieve the stated learning outcomes. It includes a detailed introduction to an understanding of the complexity of health visiting relational skills involved in providing family support. Further reading and practical experiential training is recommended to gain greater proficiency in the use of the skills discussed.
Module 4. The prevention, treatment and management of nappy rash in newborns and infants
Authors: Oshikanlu Ruth , Edwards Janet
Published: November 2014

Overview

This learning module focuses on the aetiology, prevention and treatment of nappy rash in newborns and infants. The module discusses evidence and research on nappy rash, including recommendations for the ideal barrier treatment. It also highlights the role of the health visitor in supporting parents with practical advice in managing nappy rash.
Module 9. Leadership in health visiting
Authors: Wallbank Sonya , Buttigieg Margaret
Published: November 2014

Overview

This learning module is concerned with the issue of leadership in the NHS and in particular what health visitors can do to develop their leadership skills at this vital time for their profession. Present coalition government policy emphasises the importance of clinical leadership and of the service being led by clinicians. But in practice, what does this mean? And how can individual practitioners develop their leadership skills in the changing NHS environment when the need for exemplary leadership in the NHS is greater than ever?
Pharmacological management of extrapyramidal side-effects
Authors: Keogh Brian , Lynch Aileen , Doyle Louise
Published: November 2014

Overview

This module will give a brief overview of typical and atypical antipsychotic drugs and their modes of action. The pharmacological management of extrapyramidal side-effects will be discussed in detail. Nursing considerations when administering antipsychotic drugs will also be outlined. The module will conclude by summarizing the key points.
Module 6. The effective management of contraception
Authors: Robinson Gina M
Published: November 2014

Overview

This module concentrates on the methods commonly used in the management of contraception. The module contains an overview of currently available methods in different age groups, with self-assessments to consolidate your learning and help you achieve the stated learning outcomes. The module provides a detailed introduction to the topic. Further reading is recommended to gain a greater understanding of the management of contraception.
Module 8. The Management of Type 2 Diabetes: Pharmacological Options
Authors: Meetoo Danny
Published: November 2014

Overview

This module focuses on a selection of commonly prescribed oral hypoglycaemic agents (OHAs) in the management of Type 2 diabetes mellitus (T2DM). The module contains an overview of the global incidence of diabetes, followed by an introduction to glucose homeostasis, pathophysiology, and clinical interventions in the management of patients with T2DM. The module provides a detailed introduction to the topic. Further reading is recommended to gain a greater understanding of the burden of T2DM on both patients and NHS resources.
Module 4. Pharmacological Management of Chronic Kidney Disease
Authors: Johnston Sheila , Noble Helen
Published: November 2014

Overview

This module focuses on a selection of drugs commonly used in the management of chronic kidney disease. The module includes some case studies, a short overview of management, and self-assessments to test whether you have achieved your learning outcomes. Although further reading is recommended, this module can be taken as a stand-alone introduction to the topic.
Module 5. Pharmacological Management of Dyspepsia
Authors: Griffiths Helen
Published: November 2014

Overview

This module concentrates on the drugs commonly used in the management of dyspepsia. The module contains an overview of dyspepsia and its pharmacological management, with self-assessments to consolidate your learning and help you achieve the stated learning outcomes. The module provides a detailed introduction to the topic. Further reading is recommended to gain a greater understanding of the burden of dyspepsia on both patients and NHS resources.
Module 9. Conservative Management of Stage 5 Chronic Kidney Disease
Authors: Johnston Sheila , Noble Helen
Published: November 2014

Overview

This continuing professional development (CPD) module focuses on a selection of drugs commonly used in the conservative management (CM) of stage 5 chronic kidney disease (CKD). The module contains an overview of CKD, focusing on stage 5 CKD, and includes some case studies, a short overview of the management of the condition, and self-assessments to test if you have achieved your learning outcomes. Although some further reading is recommended, this module can be taken as a stand-alone introduction to the topic.
Module 10. Calculation skills for nurse prescribers
Authors: Wright Kerri
Published: November 2014

Overview

This module concentrates on common drug calculations used in the day-to-day life of a nurse prescriber. The module explains why good calculation skills are important in the context of medicines management. The topics discussed include: medicine strengths, units of measurements, divided dosages, dosage per weight, and calculations involving electronic devices, among others. Self-assessments to consolidate your learning and help you achieve the stated learning outcomes are included. The module provides a detailed introduction to the topic. Further reading is recommended to gain a greater understanding of drug calculations.
Module 11. The Pharmacological Management of Incontinence
Authors: Mangnall Joanne , Lakin Stuart
Published: November 2014

Overview

This module concentrates on the drugs commonly used in the management of incontinence. The module contains an overview of urinary and faecal incontinence and their pharmacological management, with self-assessments to consolidate your learning and help you achieve the stated learning outcomes. The module provides a detailed introduction to the topic. Further reading is recommended to gain a greater understanding of the complexity of incontinence on patients, and how its management can be a challenge for health professionals on a daily basis.
Module 15. Statins and their role in the prevention of cardiovascular disease
Authors: O'Donovan Kate
Published: November 2014

Overview

The purpose of this module to enhance your understanding of statins in the primary and secondary prevention of cardiovascular disease. Insight into statins—their indications, pharmacology, potential for drug interactions, and adverse effects—promotes the optimal care of patients prescribed these medications.

This module provides a concise overview of statins in clinical practice and offers a selection of reflective activities and multiple choice questions for self-assessment that will help readers achieve the learning outcomes specified.
Module 17. The effective management of contraception
Authors: Robinson Gina M
Published: November 2014

Overview

This module is focused on commonly used contraceptive methods. The module contains an overview of currently available methods in different age groups, with self-assessments to consolidate your learning and help you achieve the stated learning outcomes. The module provides a detailed introduction to the topic. Further reading is recommended to gain a greater understanding of the management of contraception.
Module 12. Achieving concordance in the treatment of bipolar disorder
Authors: Gray Richard , Brown Ellie
Published: November 2014

Overview

This module has a focus on ways of supporting patients with bipolar disorder to achieve greater adherence and ‘concordance’ in the use of their medications. The module contains an overview of the presentation and assessment of bipolar disorder and its pharmacological management, and a discussion of approaches that may empower patients to use their medications more effectively. The module provides a detailed introduction to the topic with self-assessments to consolidate your learning and help you achieve the stated learning outcomes. Further reading is recommended to gain a greater understanding.
Module 21. Adult asthma
Authors: Scullion Jane , Holmes Steve
Published: November 2014

Overview

The purpose of this continuing professional development module is to outline and discuss asthma in adults. There will be an introduction to the diagnosis of asthma, an examination of the aetiology and triggers, and a discussion of the monitoring and management of asthma in adults, including an overview of pharmacotherapy. Multiple choice questions are provided for self-assessment to help you achieve the learning outcomes.
Module 22. Conservative Management of Stage 5 Chronic Kidney Disease–An Update
Authors: Johnston Sheila , Noble Helen
Published: November 2014

Overview

This continuing professional development (CPD) module focuses on a selection of drugs commonly used in the conservative management (CM) of stage 5 chronic kidney disease (CKD). The module contains an overview of CKD, focusing on stage 5 CKD, and includes some case studies, a short overview of the management of the condition, and self-assessments to test if you have achieved your learning outcomes. Although some further reading is recommended, this module can be taken as a stand-alone introduction to the topic.
Module 19. Pharmacological management of incontinence
Authors: Mangnall Joanne , Lakin Stuart
Published: November 2014

Overview

This module concentrates on the drugs commonly used in the management of incontinence. The module contains an overview of urinary and faecal incontinence and their pharmacological management, with self-assessments to consolidate your learning and help you achieve the stated learning outcomes. The module provides a detailed introduction to the topic. Further reading is recommended to gain a greater understanding of the complexity of incontinence and how its management can be a challenge for health professionals on a daily basis.