bluuebunny/crossref_metadata_2025 huggingface dataset:
Molecular testing in metastatic colorectal adenocarcinoma cytology cell pellets
Authors: McHugh Kelsey E. , Dermawan Josephine K. , Cheng Yu‐Wei , Cruise Michael , Sohal Davendra P. S. , Reynolds Jordan P.
Published: July 2019

Background

Mutational status for KRAS, NRAS, and BRAF genes should be performed on all colorectal carcinoma (CRC) specimens in order to guide targeted therapy selection for metastatic disease. Mutations are typically assessed via polymerase chain reaction and/or next generation sequencing (NGS) on formalin‐fixed paraffin‐embedded tissues. With minimally invasive diagnostic methodologies, the cytology cell pellet obtained by fine‐needle aspiration (FNA) can serve as an alternative source of tumor deoxyribonucleic acid.

Methods

An electronic record review of the cytopathology files (CoPathPlus, Cerner Corp., North Kansas City, Missouri) from September 1, 2015 through December 31, 2018 was conducted. All cytology specimens obtained via FNA and diagnosed as metastatic CRC on which NGS was performed were included. NGS for KRAS, NRAS, and BRAF mutations using the AmpliSeq Cancer Hotspot Panel v2.0 kit (Thermo Fisher Scientific, Waltham, Massachusetts) was performed on cytology cell pellets.

Results

Forty‐eight cases were identified. Forty‐six of 48 specimens (96%) were adequate for molecular testing. Of those adequate specimens, proportion of malignant cells in the sample ranged from 5% to 95% (mean 46%). Twenty‐seven of 48 cases (56%) were positive for clinically relevant mutations. Twenty‐four of 27 cases (89%) were positive for KRAS mutations, with exon 2 most frequently involved (22/24 cases, 92%). Two of 27 cases (7%) were positive for NRAS mutations and one case (1/27, 4%) was positive for a BRAF mutation involving codon 594.

Conclusion

Mutational analysis performed on cytology cell pellets serves as a useful means of gathering clinically actionable information on tumor mutation status in metastatic CRC.
Drought‐Net rainfall shelters did not cause nondrought effects on photosynthesis for California central coast plants
Authors: Loik Michael E. , Lesage Josephine C. , Brown Timothy M. , Hastings Daniel O.
Published: July 2019

Rainfall interception shelters are frequently used to study the ecological consequences of drought. One common shelter design employs V‐shaped plastic troughs spaced on a supporting frame to intercept rainfall. Shading, reflection, and infrared radiation may alter the radiative environment under shelters in ways independent of their intended effect on soil moisture. We measured microclimate and several photosynthetic variables for watered, potted plants under rain‐out shelters and in open‐air, unsheltered plots. We tested whether the shelter infrastructure altered aboveground micrometeorology and photosynthesis for watered, potted plants of native Californian species: Elymus glaucus, Eriogonum latifolium, Mimulus aurantiacus, and Morella californica. We quantified the effects on photosynthesis in terms of light harvesting by photosystem II (PSII) and leaf‐level gas exchange on open‐air and shelter plots, the quantum yield of PSII for darkened leaves, dark respiration, and nocturnal stomatal conductance. The rain‐out shelter reduced daily integrated photosynthetically active radiation by 20%. Air temperature, leaf temperature, and leaf‐to‐air vapour pressure difference were not different under shelters compared with controls during the day. Likewise, there were no effects of shelters on net CO2 assimilation, stomatal conductance to water vapour (gs), internal leaf (CO2), or electron transport rate through PSII during the daytime. At night, Tair was 0.6°C higher under shelters, but there were no effects on dark respiration or stomatal conductance. Despite some differences in micrometeorology under rain‐out shelters compared with open‐air plots, there were little or no aboveground nondrought effects of the shelters on leaf‐level photosynthesis for watered, potted plants of these California native plant species.
Life history traits predict colonization and extinction lags of desert plant species since the Last Glacial Maximum
Authors: Butterfield Bradley J. , Holmgren Camille A. , Anderson R. Scott , Betancourt Julio L.
Published: July 2019

Variation in life‐history strategies can affect metapopulation dynamics and consequently the composition and diversity of communities. However, data sets that allow for the full range of species turnover from colonization to extinction over relevant time periods are limited. The late Quaternary record provides unique opportunities to explore the traits that may have influenced interspecific variation in responses to past climate warming, in particular the rate at which species colonized newly suitable habitat or went locally extinct from degrading habitat. We controlled for differences in species climate niches in order to predict expected colonization and extinction sequences recorded in packrat middens from 15 localities in the Mohave, Sonoran, and Chihuahuan deserts of North America. After accounting for temperature niche differences, we tested the hypotheses that dispersal syndrome (none, wind, vertebrate), growth form (herb, shrub, tree) and seed mass mediated variation in postglacial colonization lags among species, whereas clonality (clonal, non‐clonal), growth form, and seed mass affected extinction lags. Growth form and dispersal syndrome interactively affected colonization lags, where herbaceous species lacking long‐distance dispersal mechanisms exhibited lags that exceeded those of woody, wind or vertebrate‐dispersed species by an average of 2,000–5,000 yr. Growth form and seed mass interactively affected extinction lags, with very small‐seeded shrubs persisting for 4,000–8,000 yr longer than other functional groups. Taller, vertebrate‐dispersed plants have been shown in other studies to disperse farther than shorter plants without specialized dispersal mechanisms. We found that variation along this axis of dispersal syndromes resulted in dramatic differences in colonization rates in response to past climate change. Very small seeded shrubs may have a unique combination of long vegetative and seed bank lifetimes that may allow them to persist for long periods despite declines in habitat condition. This study indicates that readily measurable traits may help predict which species will be more or less sensitive to future climate change, and inform interventions that can stabilize and promote at‐risk populations.
Student Test Takers' and Teachers' Perceptions of the TOEFL Junior® Standard Test
Authors: Galikyan Irena , Madyarov Irshat , Gasparyan Rubina
Published: July 2019

The broad range of English language teaching and learning contexts present in the world today necessitates high quality assessment instruments that can provide reliable and meaningful information about learners' English proficiency levels to relevant stakeholders. The TOEFL Junior® tests were recently introduced by Educational Testing Service (ETS) to address the assessment needs of educators of young adolescent learners by providing necessary information on their English language proficiency. This study explores the perceptions of key stakeholders (202 student test takers and 9 teachers) of the TOEFL Junior Standard test in an English as a foreign language (EFL) context (an afterschool program in Armenia). The analysis of the data gathered through questionnaires provides insights into the perceptions of test users, suggesting that the test tasks were perceived to be developmentally appropriate for the student test takers and allowed them to demonstrate their English language abilities. The findings of the current study can serve as additional validity evidence for the TOEFL Junior Standard as they reflect the correspondence found between the test construct and test users' perceptions and, thus, support the validity argument for TOEFL Junior Standard score interpretation and use in EFL settings.
Miocene potassic and adakitic intrusions in eastern central Lhasa terrane, Tibet: Implications for origin and tectonic of postcollisional magmatism
Authors: Zhang Zhi , Li Guang Ming , Cao Hua Wen , Zhang Lin Kui , Huang Yong , Dong Sui–Liang , Lu Liu , Liu Yu Qi
Published: July 2019

Miocene postcollisional potassic and adakitic rocks are widely distributed in the southern Lhasa terrane and western central Lhasa terrane. However, coeval potassic and adakitic rocks in eastern central Lhasa terrane were rarely recognized, and their origins and formation mechanism remain controversial. In this paper, we provide new geochronological and geochemical data for the Miocene postcollisional potassic and adakitic intrusions exposed in the Qingdu area, eastern central Lhasa terrane, southern Tibet. The Qingdu Miocene intrusions consist of quartz monzonite porphyry and biotite granite with coeval zircon U–Pb ages of 14.1 Ma and 14.0 Ma, respectively. They have high SiO2 (67.98–75.32 wt.%), Al2O3 (14.13–14.78 wt.%), and K2O (4.06–6.18 wt.%) and low MgO (0.25–1.46 wt.%) contents. They are both enriched in light rare earth elements (LREEs) and depleted in heavy rare earth elements (HREEs), with high (La/Yb)N (25.37–42.32) ratios. The biotite granite samples have low Y (7.10–9.96 ppm) and Yb (0.61–0.85 ppm) contents, and high Sr (229–384 ppm) contents and high Sr/Y (30–41) ratios, which show adakitic geochemical characteristics, whereas the quartz monzonite porphyry samples show potassic geochemical characteristics. They display initial (87Sr/86Sr)i ratios of 0.7083–0.7103, εHf(t) values of −6.7 to −0.1, εNd(t) values of −8.96 to −7.44, (208Pb/204Pb)i ratios of 39.028–39.110, (207Pb/204Pb)i ratios of 15.662–15.684, and (206Pb/204Pb)i ratios of 18.541–18.577. These signatures indicate that both the potassic and adakitic intrusions are more likely to originate from partial melting of a thickened lower crust, which were mainly the products of the binary mixing between the juvenile and ancient crust components. Based on the spatial distributions and isotopic features of the postcollisional potassic and adakitic rocks in the Lhasa terrane, we suggest that the differences of the lower crustal composition played a crucial role in causing the geochemical variations of the Miocene postcollisional adakitic and potassic rocks in Lhasa terrane.
The collision‐related structures revealed in the northern Tarim Basin and their geological significance
Authors: Wen Lei , Li Cheng , Li Hong‐Hui , Liu Ya‐Lei , Li Yue‐Jun , Zhao Yan , Sun Xiang‐Can , Huang Tong‐Fei , Zhao Tian‐Yu , Gao Yan‐Yan , Shi Bin
Published: July 2019

The South Tianshan on the southern margin of the Central Asian Orogenic Belt (CAOB) is a collisional orogenic belt between the Tarim continent and Ili‐Central Tianshan volcanic arc. The initial time of the collision remains debated, with proposed timing from Early Devonian to Middle Triassic. Almost all the previous studies on this collision were carried out within the South Tianshan Mountains, few within the related basins. End Permian–Triassic thrusts and Jurassic–Cretaceous normal faults were discovered in the northern Tarim Basin where is the southern piedmont of the South Tianshan Mountains after careful and systematic seismic interpretation. The end Permian–Triassic thrusts are constituted by both basement‐involved and thin‐skinned thrusts. They are likely seen as the syn‐collision compressional structures of the South Tianshan collisional orogen. The syn‐collision thrusts constitute the main faults in the study area. Consistent with the Triassic/Permian and Jurassic/Triassic unconformities, two thrusting phases occurred, at end Permian–beginning Triassic and end Triassic–beginning Jurassic, respectively. The Jurassic–Cretaceous normal faults usually arrange into stair‐step or graben‐horst structures in profile and en echelon normal fault zones horizontally. They are attributed as the results of the regional extensional stage in the CAOB. This regional extension stage provides a good constraint for the ending time of the collision between Tarim and Ili‐Central Tianshan blocks. The normal faulting time is revealed by normal fault growth indexes. According to these observed syn‐collision compressional and subsequent extension structures, it can be fairly inferred that the collision between Tarim and Ili‐Central Tianshan was initiated at end Permian, lasted through the Triassic and ceased at end Triassic, and then evolved into the Jurassic–Cretaceous extensional tectonic stage.
VEGFR‐2 is downregulated in sestamibi‐negative parathyroid adenomas
Authors: Erovic Boban M. , Goldstein David P. , Asa Sylvia L. , Janik Stefan , Mete Ozgur , Irish Jonathan C.
Published: July 2019

Background

The purpose of this study was to determine the expression profile of several biomarkers in sestamibi‐positive (n = 23) and sestamibi‐negative (n = 6) parathyroid adenomas.

Methods

A tissue microarray of parathyroid adenomas from 29 patients was constructed and slides were stained for several proteins involved in angiogenesis, inflammation, cell adhesion, cell cycle, apoptosis, and with markers of the sonic hedgehog, mTOR, Forkhead box O and WNT signal transduction pathways. Protein expression was determined using an image‐analysis software (Spectrum Plus©, 38 Aperio).

Results

Protein expression analysis revealed that the vascular endothelial growth factor receptor 2 (VEGFR2) score was significantly higher in the sestamibi‐positive cohort compared to sestamibi‐negative adenomas (P = .038). Other proteins were not differentially expressed between sestamibi‐positive and sestamibi‐negative adenomas.

Conclusion

It is hypothesized that VEGFR‐2 overexpression in parathyroid adenomas increases vascular permeability resulting in a higher uptake of sestamibi.
A numerical investigation of various phase change models on simulation of saturated film boiling heat transfer
Authors: Hosseini Seyed Amirreza , Kouhikamali Ramin
Published: July 2019

There is a great variety of two‐phase models in numerical simulations. The performance of each model complicates the numerical simulation of boiling. The challenge of the right choice of heat and mass transfer models makes this type of problem more complicated. In this research work, the volume of the fluid two‐phase model has been used to simulate the film boiling of saturated liquid. The geo‐reconstruction method also reconstructs the interface of two phases. The models of the sharp interface, Lee and Tanasawa have been employed among the available models for calculating the phase change rate and the source terms of the equations. The Numerical solver of the phase‐change is verified through the Stefan one‐dimensional vaporizing problem. Correct empirical coefficients used in both Lee and Tanasawa models are presented. Bubble detachment time, flow pattern, the periodic Nusselt number, and the bubble form have been investigated in all three phase change models. Two Berenson and Klimenko experimental correlations have been used for verification of Nusselt number derived from simulations. The Nusselt number shows a proper fit with the Klimenko's Nusselt number. Obtained Nusselt number demonstrates the Lee model is more precise than other phase change models in simulating of film boiling on the flat plate.
The gut microbiota at the intersection of bile acids and intestinal carcinogenesis: An old story, yet mesmerizing
Authors: Liu Tianyu , Song Xueli , Khan Samiullah , Li Yun , Guo Zixuan , Li Chuqiao , Wang Sinan , Dong Wenxiao , Liu Wentian , Wang Bangmao , Cao Hailong
Published: July 2019

The prevalence of colorectal cancer (CRC) has markedly increased worldwide in the last decade. Alterations of bile acid metabolism and gut microbiota have been reported to play vital roles in intestinal carcinogenesis. About trillions of bacteria have inhabited in the human gut and maintained the balance of host metabolism. Bile acids are one of numerous metabolites that are synthesized in the liver and further metabolized by the gut microbiota, and are essential in maintaining the normal gut microbiota and lipid digestion. Multiple receptors such as FXR, GPBAR1, PXR, CAR and VDR act as sensors of bile acids have been reported. In this review, we mainly discussed interplay between bile acid metabolism and gut microbiota in intestinal carcinogenesis. We then summarized the critical role of bile acids receptors involving in CRC, and also addressed the rationale of multiple interventions for CRC management by regulating bile acids–microbiota axis such as probiotics, metformin, ursodeoxycholic acid and fecal microbiota transplantation. Thus, by targeting the bile acids–microbiota axis may provide novel therapeutic modalities in CRC prevention and treatment.
Reflective Capacity: An Antidote to Structural Racism Cultivated Through Mental Health Consultation
Authors: Silverman Miriam E. , Hutchison Margaret S.
Published: July 2019

Effecting a paradigm shift from “reproductive health” to “reproductive justice” within the perinatal field requires changes simultaneously at the levels of the individual healthcare provider and the system of care. The Infant‐Parent Program at the University of California, San Francisco (UCSF) has extended its pioneering infant and early childhood mental health consultation to perinatal service systems applying an infant mental health approach to programs caring for expecting and new parents. In partnership with two nursing programs, UCSF consultants direct their efforts at supporting reflective practice capacities and use‐of‐self in patient–provider relationships. Both nursing programs serve vulnerable groups of expectant and new parents who grapple with challenges to health and well‐being stemming from structural racism. As reflective capacities are supported within the consultation case conferences, providers spontaneously identify the need for tools to effectively address issues of race, class, and culture and to combat structural racism throughout the healthcare system. Policies and procedures that uphold structural racism cease to be tolerable to providers who bring their full selves to the work that they are trained to do. Using these nurse consultation partnerships as organizational case studies, this article describes a range of challenges that arise for providers and delineates steps to effective engagement toward reproductive justice.
Design and Preclinical Development of TransCon PTH, an Investigational Sustained-Release PTH Replacement Therapy for Hypoparathyroidism
Authors: Holten-Andersen Lars , Pihl Susanne , Rasmussen Caroline E , Zettler Joachim , Maitro Guillaume , Baron Julia , Heinig Stefan , Hoffmann Eric , Wegge Thomas , Krusch Mathias , Faltinger Frank , Killian Steffen , Sprogoe Kennett , Karpf David B , Breinholt Vibeke Miller , Cleemann Felix
Published: July 2019

Hypoparathyroidism (HP) is a condition of parathyroid hormone (PTH) deficiency leading to abnormal calcium and phosphate metabolism. The mainstay of therapy consists of vitamin D and calcium supplements, as well as adjunct Natpara (PTH(1-84)). However, neither therapy optimally controls urinary calcium (uCa) or significantly reduces the incidence of hypercalcemia and hypocalcemia. TransCon PTH, a sustained-release prodrug of PTH(1-34) in development for the treatment of HP, was designed to overcome these limitations. To determine the pharmacokinetics and pharmacodynamics of TransCon PTH, single and repeat s.c. dose studies were performed in rats and monkeys. TransCon PTH demonstrated a half-life of 28 and 34 hours in rats and monkeys, respectively. After repeated dosing, an infusion-like profile of the released PTH, characterized by low peak-to-trough levels, was obtained in both species. In intact rats and monkeys, daily subcutaneous administration of TransCon PTH was associated with increases in serum calcium (sCa) levels and decreases in serum phosphate levels (sP). In monkeys, at a single dose of TransCon PTH that increased sCa levels within the normal range, a concurrent decrease in uCa excretion was observed. In 4-week repeat-dose studies in intact rats and monkeys, uCa excretion was comparable to controls across all dose levels despite increases in sCa levels. Further, in a rat model of HP, TransCon PTH normalized sCa and sP levels 24 hours per day. This was in contrast to only transient trends toward normalization of sCa and sP levels with an up to 6-fold higher molar dose of PTH(1-84). After repeated dosing to HP rats, uCa excretion transiently increased, corresponding to increases in sCa above normal range, but at the end of the treatment period, uCa excretion was generally comparable to sham controls. TransCon PTH was well tolerated and the observed pharmacokinetics and pharmacodynamics were in line with the expected action of physiological replacement of PTH. © 2019 American Society for Bone and Mineral Research.
A loop involving NRF2, miR‐29b‐1‐5p and AKT, regulates cell fate of MDA‐MB‐231 triple‐negative breast cancer cells
Authors: De Blasio Anna , Di Fiore Riccardo , Pratelli Giovanni , Drago‐Ferrante Rosa , Saliba Christian , Baldacchino Shawn , Grech Godfrey , Scerri Christian , Vento Renza , Tesoriere Giovanni
Published: July 2019

The present study shows that nuclear factor erythroid 2‐related factor 2 (NRF2) and miR‐29b‐1‐5p are two opposite forces which could regulate the fate of MDA‐MB‐231 cells, the most studied triple‐negative breast cancer (TNBC) cell line. We show that NRF2 activation stimulates cell growth and markedly reduces reactive oxygen species (ROS) generation, whereas miR‐29b‐1‐5p overexpression increases ROS generation and reduces cell proliferation. Moreover, NRF2 downregulates miR‐29b‐1‐5p expression, whereas miR‐29b‐1‐5p overexpression decreases p‐AKT and p‐NRF2. Furthermore, miR‐29b‐1‐5p overexpression induces both inhibition of DNA N‐methyltransferases (DNMT1, DNMT3A, and DNMT3B) expression and re‐expression of HIN1, RASSF1A and CCND2. Conversely, NRF2 activation induces opposite effects. We also show that parthenolide, a naturally occurring small molecule, induces the expression of miR‐29b‐1‐5p which could suppress NRF2 activation via AKT inhibition. Overall, this study uncovers a novel NRF2/miR‐29b‐1‐5p/AKT regulatory loop that can regulate the fate (life/death) of MDA‐MB‐231 cells and suggests this loop as therapeutic target for TNBC.
Can Anthropologists Contribute to Road Construction? Insights from Southwest China
Authors: He Jun , He Ming
Published: July 2019

This paper documents the contributions of anthropologists in the improvement of road construction in Yunnan Province of Southwest China. It argues that the involvement of social scientists in road planning can make important contributions to a people‐centred approach, advocate for cultural embeddedness and meet local needs, all of which help to avoid local conflict while promoting local ethnic culture. The policy implication drawn from this research calls for placing social sustainability at the forefront of the institutionalizing of multi‐stakeholder involvement in infrastructure development. © 2019 John Wiley & Sons, Ltd.
A Meta‐Analysis of the Relationship between Curiosity and Creativity
Authors: Schutte Nicola S. , Malouff John M.
Published: July 2019

Curiosity, the desire to know, may be associated with creativity, which involves generating ideas that are novel and valuable. This meta‐analytic investigation consolidated the results of studies of the association between curiosity and creativity. Across 10 studies, which included 2,692 individuals, there was a significant association between more curiosity and greater creativity (weighted effect size r = .41, 95% CI [.27, .54], p = .0001). For studies examining the association of the exploration dimension of curiosity with creativity, the weighted effect size was r = .48, 95% CI [.09, .74], while for studies examining the deprivation sensitivity dimension of curiosity with creativity the weighted effect size was r = .20, 95% CI [.10, .29]. The association of self‐report measures of curiosity with self‐reports of creativity was r = .52, 95% CI [.40, .62], while the association of self‐report measures of curiosity with rated creativity was r = .16, 95% CI [.10, .22]. These meta‐analytic results are congruent with some theoretical assumptions regarding curiosity and creativity and can be a foundation for efforts to facilitate creativity.
Grounding Neuro‐Informed Practice in a Humanistic Framework: A Response to Wilkinson
Authors: BEESON ERIC T. , MILLER RAISSA M.
Published: July 2019

Wilkinson (2018) opened an important dialogue about the role of neuroscience in counseling. In this article, the authors extend this dialogue with additional literature to show that neuroscience has meaningfully informed counseling practice and is compatible with humanistic principles.
Cocreative Counseling
Authors: TUDOR KEITH
Published: July 2019

This article articulates a number of qualities that characterize a cocreative approach to counseling. Informed by his work with Graeme Summers in transactional analysis, the author reviews the literature on cocreativity in counseling and psychotherapy in both humanistic and psychoanalytic/psychodynamic traditions. Despite their somewhat separate development, the ideas within these 2 traditions together contribute to the elaboration and understanding of cocreative therapeutic relating.
Effects of an electronic medication management system on pharmacists’ work in a paediatric hospital
Authors: Baysari Melissa T. , Hardie Rae‐Anne , Barclay Peter , Westbrook Johanna I.
Published: July 2019

Background

Many studies have explored the effect of electronic medication management systems (EMMS) on doctors’ and nurses’ work, but few have focused specifically on pharmacists’ work.

Aim

This study examined how implementation of a commercial EMMS affected the work of pharmacists in an Australian paediatric hospital. In particular, the study investigated whether any pharmacy tasks changed or were eliminated, or whether new tasks emerged following EMMS introduction.

Methods

Two rounds of semistructured interviews with pharmacists, one 4 months and the other 1 year after EMMS implementation, were conducted. In total, 17 pharmacists were interviewed, comprising inpatient, outpatient and oncology pharmacists, as well as pharmacy managers.

Results

EMMS implementation eliminated a small number of tasks, changed some tasks and created many new work tasks for pharmacists. These new tasks included helping doctors and nurses to use the EMMS, duplicated data entry and the review of additional information. Pharmacists held the view that their workload had increased and that additional pharmacists were necessary to cope with the new work requirements associated with the EMMS. Some problems were perceived to be the result of implementation of a US‐designed EMMS that did not fully support Australian pharmacy workflows.

Conclusion

Implementation of an EMMS in a paediatric hospital affected pharmacists’ work in a variety of ways, predominately by introducing new tasks. Anticipating how workflows will change with EMMS implementation is challenging. Undertaking regular reviews of workflow and planning for an increased burden on pharmacy staff is likely to improve the transition from paper to electronic medication management.
Quality pharmaceutical care in the neonatal intensive care unit: identification of essential pharmacy services and key performance indicators for the Australian setting
Authors: Krzyżaniak Natalia , Pawłowska Iga , Bajorek Beata
Published: July 2019

Background

When considering subspecialties of clinical pharmacy practice such as the neonatal intensive care unit (NICU), no key performance indicators (KPIs) or practice standards have been published by national or international pharmacy organisations.

Aim

The aims of this study were to identify: (1) a list of essential pharmacist roles that should be performed in the NICU; and (2) a set of clinical pharmacy KPIs that can be used to benchmark the quality of pharmaceutical care provided to patients in Australian NICU settings.

Methods

A modified Delphi technique was used to send 65 indicators and 30 proposed roles to an expert panel of doctors, pharmacists and nurses. The indicators and roles were compiled from a previously conducted literature review. An online survey sent in two consecutive Delphi rounds in August and September 2017 asked experts to rank the indicators and roles against specific criteria.

Results

Fifteen healthcare professionals from Australia participated as expert panellists. Overall, 75% consensus was reached for 31 indicators and 23 roles by Australian panellists. Experts particularly valued the following roles: pharmacists being a source of medication information (100%; median = 1.00), assisting in off‐label prescribing (100%; median = 1.00), documenting medication errors (100%; median = 1.00), medication chart review (100%; median = 1.00) and writing medication protocols for the NICU (100%; median = 1.00).

Conclusion

Further investigations are needed to formalise a set of NICU‐specific clinical pharmacy KPIs and a practice model to form the foundations of national and international standardised practice guidelines for this subspecialty.
Management of behavioural emergencies: a prospective observational study in Australian emergency departments
Authors: Yap Celene Y. L. , Taylor David McD. , Kong David C. M. , Knott Jonathan C. , Taylor Simone E. , Graudins Andis , Keijzers Gerben , Kulawickrama Sanjeewa , Thom Ogilvie , Lawton Luke , Furyk Jeremy , Finucci Daniel , Holdgate Anna , Watkins Gina , Jordan Peter
Published: July 2019

Background

Behavioural emergencies (BEs) are complex situations in the emergency department (ED) setting. Treatment decisions always must be made within a limited time and are based on incomplete patient data. As a result of the urgency and complexity, patients often are exposed to increased risk of harm.

Aim

The aim of this paper is to describe the prescribing patterns and adverse events (AEs) associated with parenteral sedation for the management of BEs in Australian EDs.

Methods

Ten Australian EDs enrolled a convenience sample of adult patients (aged ≥18 years) requiring parenteral sedative medication for BEs. Data were collected prospectively between March 2015 and April 2017 using a designated case report form.

Results

In all, 564 cases were enrolled in this study. Incomplete cases (n = 17; 3%) were excluded. Of the 547 remaining cases, 63% were male and the median age was 34 years (range 18–95 years). Approximately half the patients (n = 230; 42.1%) required mechanical restraint and parenteral sedation to manage their BEs. Intramuscular monotherapy was administered in most cases (n = 390; 71.3%). The main sedative medications used as monotherapy were droperidol (n = 381; 69.7%), midazolam (n = 54; 9.9%) and olanzapine (n = 26; 4.8%). The most common combination therapy was midazolam + droperidol (n = 36; 6.6%). The incidence of AEs from sedative administration was 13.5%. No deaths or irreversible AEs were reported.

Conclusions

Overall, the participating EDs provided safe pharmacological management for BEs. AEs following parenteral sedation are common, although serious AEs are rare. Because all patients receiving parenteral sedation for BEs are at risk of AEs, ongoing monitoring of vital signs after parenteral sedation should be a standard protocol in all EDs.
Opioids, the pharmacist and the junior doctor: reducing prescribing error
Authors: Sheehan Dale C. , Lee Avril P. , Young Mary L. , Werkmeister Benjamin J. , Thwaites John H.
Published: July 2019

Aim

This pharmacy and medicine collaborative project investigated the effectiveness of teaching and learning strategies to enhance opioid prescribing by junior doctors in their first year of practice. A key strategy tested was that of pharmacists engaging with junior doctors on the ward to coach and develop their prescribing skills.

Data Sources

An evaluation research framework was implemented that went beyond collecting reaction and self‐reported learning to include impact on patient outcomes. Pre‐ and postintervention prescribing audits were undertaken to identify changes in prescribing practice over the period of the intervention.

Results

Learner reaction feedback was extremely positive for all facets of the intervention. Coaching by the ward pharmacists was recognised and valued. As predicted, there was no significant change in knowledge of the pharmacology and use of opioids but there was a reduction of dose errors, from 54% pre‐intervention to 7% post‐intervention.

Conclusion

While this is a small targeted intervention, we appear to have made a contribution to patient safety through enhanced prescribing practice. The programme has highlighted the potential for further development of the medical–pharmacy relationship as a true teaching and learning partnership. The context of a hospital ward offers unparalleled opportunities to promote learning and develop team‐based understandings.
Separation of prescribing and dispensing in Malaysia: public perception of pharmacists’ roles and agreement towards a separation policy
Authors: Loo Jason S. E. , Lo Eva M. Y. , Mai Chun Wai , Gan Pou Wee , Lee E‐Lyn , Tiong John Jeh Lung
Published: July 2019

Background

Full separation of prescribing and dispensing remains a subject of heated debate in Malaysia. Understanding public perception on the issue in order to garner public support is crucial in efforts to enact a change in policy.

Aim

This study assessed public perception of the separation of prescribing and dispensing in Malaysia within the context of the public's knowledge of the professional roles of pharmacists, awareness of the issue and the current healthcare system.

Methods

This cross‐sectional study used a validated self‐administered questionnaire, which was administered to random members of the public. Descriptive and inferential statistics were used to analyse the data.

Results

In all, 495 respondents participated in the study (response rate 61.9%). Most respondents were aware of pharmacists’ roles in educating patients (84.6%), checking prescriptions (65.9%) and dispensing medicines (85.1%). Most respondents (86.7%) agreed that pharmacists were more knowledgeable than physicians regarding medications and were aware that separation of prescribing and dispensing occurs in other developed countries (67.5%) and the public sector (70.9%). Approximately half of all respondents (52.5%) agreed that full separation of prescribing and dispensing should be implemented, with a higher level of agreement observed among respondents who were younger (68.0%), had tertiary education (69.8%), had a background in health sciences (71.7%) or were aware of the policy being practiced elsewhere (76.3%). However, only 28.5% of all respondents agreed that Malaysia was ready to implement a separation policy. This low level of agreement was consistent across all respondent groups except pharmacists, of which a slight majority (53.7%) agreed.

Conclusions

Approximately half the respondents agreed that full separation of prescribing should be implemented, but a significantly smaller proportion agreed that the country is ready to implement a separation system.
Emergency medicine pharmacy practice in Australia: a national survey
Authors: Roman Cristina P. , Dooley Michael J. , Mitra Biswadev
Published: July 2019

Background

Emergency medicine (EM) clinical pharmacy is a rapidly growing area of practice. The purpose of this study was to describe current EM pharmacy services in Australia, specifically the number of clinical pharmacy services, services provided within the emergency department (ED), working hours and the qualifications of pharmacists practising in the ED.

Methods

Experienced EM clinical pharmacists in collaboration with an emergency physician developed an online survey that was sent electronically to Australian hospital directors of pharmacy. The survey questions related to hospital demographics, EM pharmacy clinical service and EM pharmacist working hours, level of staffing and qualifications.

Results

Between 4 November 2016 and 9 December 2016, 57 hospitals completed some or all of the survey from the 248 emails sent (response rate = 23%). Thirty‐five of 57 hospitals (61%) identified having a dedicated EM pharmacy service, and 11 of 35 hospitals (31%) indicated a 7‐day EM pharmacy service. All hospitals with a dedicated EM pharmacy service were involved in medication reconciliation, discharge counselling and clinical consultation for ED patients. Nine of 34 hospital responses (26.5%) indicated that the EM pharmacist was involved during resuscitation (stroke callouts, cardiopulmonary arrest and/or trauma) during weekdays. Two hospitals also provided this service on weekends.

Conclusion

Current clinical activities of EM pharmacists appear to be based on traditional areas of practice, but also include emerging roles of participation during resuscitation.
Role of the pharmacist in suicide prevention: primely positioned to intervene
Authors: Kassir Hiba , Eaton Heather , Ferguson Monika , Procter Nicholas Gerard
Published: July 2019

Suicide prevention is a global public health priority with approximately 800,000 people dying by suicide each year. As health professionals, pharmacists with further education can play an important role in suicide prevention as front‐line responders and gatekeepers. However, few studies have focused on pharmacists as gatekeepers in suicide prevention. This report discusses studies that focus on the pharmacist's role, gaining knowledge, reshaping attitudes and increasing confidence to engage with members of the public in suicide prevention.
Association Between Shame and Posttraumatic Stress Disorder: A Meta‐Analysis
Authors: López‐Castro Teresa , Saraiya Tanya , Zumberg‐Smith Kathryn , Dambreville Naomi
Published: July 2019

Posttraumatic stress disorder (PTSD) is a complex condition with affective components that extend beyond fear and anxiety. The emotion of shame has long been considered critical in the relation between trauma exposure and PTSD symptoms. Yet, to date, no meta‐analytic synthesis of the empirical association between shame and PTSD has been conducted. To address this gap, the current study summarized the magnitude of the association between shame and PTSD symptoms after trauma exposure. A systematic literature search yielded 624 publications, which were screened for inclusion criteria (individuals exposed to a Criterion A trauma, and PTSD and shame assessed using validated measures of each construct). In total, 25 studies employing 3,663 participants met full eligibility criteria. A random‐effects meta‐analysis revealed a significant moderate association between shame and posttraumatic stress symptoms,r= .49, 95% CI [0.43, 0.55],p< .001. Moderator analyses were not completed due to the absence of between‐study heterogeneity. Publication bias analyses revealed minimal bias, determined by small attenuation after the superimposition of weight functions. The results underscore that across a diverse set of populations, shame is characteristic for many individuals with PTSD and that it warrants a central role in understanding the affective structure of PTSD. Highlighting shame as an important clinical target may help improve the efficacy of established treatments. Future research examining shame's interaction with other negative emotions and PTSD symptomology is recommended.
Salivary Carcinosarcoma: An Extremely Rare and Highly Aggressive Malignancy
Authors: Gupta Avigeet , Koochakzadeh Sina , Neskey David M. , Nguyen Shaun A. , Lentsch Eric J.
Published: July 2019

Objectives/Hypothesis

Carcinosarcomas represent a rare entity of mixed malignant tumors of the salivary gland with limited evidence regarding management strategies. We aim to demonstrate the incidence, prognostic factors, and conduct a survival analysis for this aggressive malignancy.

Study Design

Retrospective database review.

Methods

The Surveillance, Epidemiology, and End Results database was queried for all cases of major salivary carcinosarcoma and its incidence from 1973 to 2015 to identify 66 patients.

Results

The incidence of this tumor was 0.02 cases per 1 million, with a rising number of absolute cases in the past 2 decades. The parotid gland was the most common site (78.8%) of involvement. The 5‐year overall survival was 37% and 5‐year disease‐specific survival was 62%. Surgery was most common management strategy (95.5%), with total parotidectomy and facial nerve sacrifice procedures for those with parotid disease. Radiotherapy was commonly performed (75.8%) and chemotherapy use was rare (18.2%). Patients with distant metastasis had a greater than threefold increase in mortality, and those with total parotidectomy surgery had decreased mortality.

Conclusions

Carcinosarcomas of major salivary glands are extremely rare and highly aggressive tumors. We recommend prompt surgical management and postoperative radiation for this tumor with a poor prognosis.

Level of Evidence

NA

Laryngoscope, 130:E335–E339, 2020
Efficacy of the mini‐meatoplasty
Authors: Varadarajan Varun V. , Antonelli Patrick J.
Published: July 2019

Objectives

The lateral meatoplasty is a well‐described technique for widening the lateral external auditory meatus. After bony canalplasty, the external auditory meatus may need to be enlarged to accommodate an expanded tympanic ring. In this study, we introduce a novel meatoplasty technique for use during canalplasty and describe its efficacy in widening the external auditory meatus.

Methods

Patients undergoing at least 180‐degree bony canalplasty and mini‐meatoplasty at a tertiary care facility were enrolled. Meatus diameter was measured before and after mini‐meatoplasty using Shea aural speculums and Hegar dilators.

Results

Nineteen patients were enrolled. Mean preoperative speculum size was 6.1 mm (range 3.5–7.5 mm). All postoperative speculum sizes were 8 mm (P < .0001). Mean preoperative and postoperative Hegar dilator sizes were 10.6 mm (range 7–14 mm) and 16.2 mm (range 13–19 mm), respectively (P < .0001). The mean increase in aural speculum and Hegar dilator sizes were 1.9 mm (range 0.5–3.5 mm) and 5.7 mm (range 3–10 mm), respectively (P < .0001).

Conclusions

The mini‐meatoplasty is a novel and effective technique for widening the external auditory meatus after bony canalplasty.

Level of Evidence

4

Laryngoscope, 130:1294–1298, 2020
Management strategies for recurrent acute rhinosinusitis
Authors: Lin Jiahui , Kacker Ashutosh
Published: July 2019

Background

Management of patients with recurrent acute rhinosinusitis (RARS) is often challenging, and robust data in the literature is scant. The aim of this study is to better characterize the current treatment strategies for RARS used by otolaryngologists.

Methods

An online survey sent to all members of the American Rhinologic Society in a 1 month period evaluated demographics, practice characteristics, and management strategies for patients with RARS, subdivided into those with (RARSwD) and without (RARSsD) septal deviation. Eighty‐eight practicing members responded, of whom 41% were fellowship‐trained rhinologists.

Results

For most cases of RARSsD, 61% of otolaryngologists would primarily use medical management. Most would wait until patients had experienced 4–5 episodes to perform balloon sinuplasty (80%) or formal sinus surgery (79%). The sinus surgery procedure of choice was limited sinus surgery (62%). For RARSwD, 52% primarily chose medical management. Most would wait until patients had experienced 4–5 episodes to perform balloon sinuplasty (80%) or formal sinus surgery (78%). Nearly all fellowship‐trained rhinologists (97%) would perform limited sinus surgery with septoplasty for RARSwD, compared to only 70% of other otolaryngologists who would do so and 24% who would perform complete sinus surgery with septoplasty. While 89% of practitioners in private practice would wait to perform balloon sinuplasty until patients had experienced 4–5 episodes, only 68% of those in academia would wait this long and 23% would do so after only 1–3 episodes.

Conclusions

Treatment of patients with RARS is complex, and the differences in strategies employed between groups of otolaryngologists may reflect their training backgrounds and different patient populations.

Level of Evidence

V
Closing the oxygen mass balance in shallow coastal ecosystems
Authors: Long Matthew H. , Rheuban Jennie E. , McCorkle Daniel C. , Burdige David J. , Zimmerman Richard C.
Published: July 2019

The oxygen concentration in marine ecosystems is influenced by production and consumption in the water column and fluxes across both the atmosphere–water and benthic–water boundaries. Each of these fluxes has the potential to be significant in shallow ecosystems due to high fluxes and low water volumes. This study evaluated the contributions of these three fluxes to the oxygen budget in two contrasting ecosystems, a Zostera marina (eelgrass) meadow in Virginia, U.S.A., and a coral reef in Bermuda. Benthic oxygen fluxes were evaluated by eddy covariance. Water column oxygen production and consumption were measured using an automated water incubation system. Atmosphere–water oxygen fluxes were estimated by parameterizations based on wind speed or turbulent kinetic energy dissipation rates. We observed significant contributions of both benthic fluxes and water column processes to the oxygen mass balance, despite the often‐assumed dominance of the benthic communities. Water column rates accounted for 45% and 58% of the total oxygen rate, and benthic fluxes accounted for 23% and 39% of the total oxygen rate in the shallow (~ 1.5 m) eelgrass meadow and deeper (~ 7.5 m) reef site, respectively. Atmosphere–water fluxes were a minor component at the deeper reef site (3%) but a major component at the shallow eelgrass meadow (32%), driven by diel changes in the sign and strength of atmosphere–water gradient. When summed, the measured benthic, atmosphere–water, and water column rates predicted, with 85–90% confidence, the observed time rate of change of oxygen in the water column and provided an accurate, high temporal resolution closure of the oxygen mass balance.
Effect of Solvent on Segregated Network Morphology in Elastomer Composites for Tunable Piezoresistivity
Authors: Sang Zhen , Guo Haochen , Ke Kai , Manas‐Zloczower Ica
Published: July 2019

Flexible, light‐weight, and wearable electronics have significant potential for the development of Internet of Things. Flexible sensors with tunable piezoresistive properties are in high demand for various practical applications. Herein, different morphology thermoplastic polyurethane (TPU)/ carbon nanostructure (CNS) composites with segregated network are obtained by swelling the TPU powders using various solvents. The better solvent for TPU, dimethylformamide (DMF), renders the composites with 0.7 wt% CNS stronger polymer‐filler interactions, resulting in significantly improved piezoresistive sensitivity at strain larger than 150%. Also the gauge factors (GFs) for these composites are 9.7 in the range 0–60% strain and 19.3 for 60–100% strain. In contrast, the composites with ethanol (EtOH) and tetrahydrofuran (THF) which swell less the TPU show delayed increase in piezoresistivity and GFs of 2.2 and 3.5 for strain up to 100%, respectively, suggesting potential applications for stretchable conductors.