bluuebunny/crossref_metadata_2025 huggingface dataset:
Finding the Gaps: An Assessment of Concepts, Skills, and Employer Expectations for Plant Pathology Foundational Courses
Authors: Richter Brantlee Spakes , Poleatewich Anissa , Hayslett Maya , Stofer Kathryn
Published: April 2018

Foundational plant pathology courses, taught at the undergraduate level, serve students from a wide array of disciplines, and for most will be the only plant pathology course taken. This work examined the content, skills, and delivery modes of undergraduate plant pathology courses at a national scale, and assessed employer expectations for these courses and for students entering the workforce with degrees in plant science-related disciplines. While content knowledge coverage among plant pathology courses was generally consistent and aligned well with employers’ knowledge expectations, delivery modes and skill development components were more variable and less aligned. Significant gaps were found between skills expected by employers and those emphasized by instructors, particularly in the areas of general laboratory skills (e.g., media preparation, molecular techniques, microscopy, and competence with other lab equipment) and recognition of plant problems that are not caused by pathogens. Employers also emphasized the value of (and frequent lack of) critical soft skills, such as teamwork, adaptability, communication, writing, and critical thinking. Results of this study will provide a foundation for course and curriculum development and evaluations. Recommendations are also discussed for enhanced interactions among educators and employers outside of academia.
Downy Mildew: A Serious Disease Threat to Rose Health Worldwide
Authors: Salgado-Salazar Catalina , Shiskoff Nina , Daughtrey Margery , Palmer Cristi L. , Crouch Jo Anne
Published: April 2018

Peronospora sparsa is a downy mildew-causing oomycete that can infect roses, blackberries, and other members of the rose family. During the last 70 years, this disease has become a serious problem for rose growers in the U.S. and worldwide. While much is known about the disease and its treatment, including significant research on molecular identification methods, as well as environmental conditions conducive to disease and the fungicides used to prevent it, significant knowledge gaps remain in our basic comprehension of the pathogen’s biology. For example, the degree of genetic relatedness of pathogen isolates collected from rose, caneberries, and cherry laurel has never been examined, and the natural movement of genotypes from host to host is not known. Further work could be done to determine the differences in pathogen population structure over time (using herbarium specimens and fresh collections) or differences in pathogen population structure and pathogen environmental adaptation for specimens from different geographic regions. The oospore stage of the organism is poorly understood, both as to how it forms and whether it serves as an overwintering structure in nurseries and landscapes. In production greenhouses, the detection of the pathogen using infrared thermographic imaging and possible inhibition by ultraviolet light needs to be explored. Further work needs to be done on breeding using wild roses as new sources for resistance and using new methods such as marker assisted selection and RNAi technologies. As roses are one of the most economically important ornamental crops worldwide, a proper understanding of the disease cycle could allow for better use of cultural and chemical controls to manage rose downy mildew in landscapes and in greenhouse and nursery production areas.
Survey of Fusarium Species Associated with Fusarium Head Blight of Spring Wheat (Triticum aestivum) in Southeastern Idaho
Authors: Bissonnette Kaitlyn M. , Wharton Philip , Chen Jianli , Marshall Juliet M.
Published: April 2018

In Idaho, losses due to Fusarium head blight (FHB) of spring wheat (Triticum aestivum) have been infrequent and have historically been dominated by Fusarium culmorum (Wm. G. Sm.) Sacc. However, the incidence of FHB and deoxynivalenol-contaminated grain has increased in spring wheat in southeastern Idaho since 2009, indicating that other species of Fusarium may be contributing to disease. In 2011 and 2012, 17 spring wheat fields were scouted and sampled for FHB in southern Idaho. Contaminated grains were cultured, and putative Fusarium isolates were identified using species-specific polymerase chain reaction. In 2011, 87% of all recovered isolates were identified as F. graminearum, whereas only 13% were identified as F. culmorum. Of the isolates collected in 2012, 51% were identified as F. graminearum and 49% as F. culmorum. In both years, more F. graminearum isolates were recovered as compared to a survey conducted in 1984. Implementation of effective disease management practices will be necessary to minimize the establishment and spread of F. graminearum–responsible FHB in southeastern Idaho.
Back to Living
Authors: Randall Edin T. , Smith Kelly R. , Conroy Caitlin , Smith Allison M. , Sethna Navil , Logan Deirdre E.
Published: April 2018

Objectives:

To provide a descriptive account of long-term functioning (≥5 y posttreatment) among youth who completed intensive interdisciplinary pain treatment (IIPT) for pediatric chronic pain conditions.

Materials and Methods:

A total of 95 patients (mean age at follow-up=20.0 y) treated at least 5 years previously at a single IIPT program completed questionnaires assessing pain, functional disability, health care utilization, academic/career achievement, and quality of life. Data analyses focused on pain, functioning, and progress toward developmental goals at long-term follow-up.

Results:

The majority of respondents report significant reduction in pain compared with preadmission (P<0.001). Five years posttreatment, average functional disability scores were in the minimal range, with statistically significant decrease in functional disability from time of admission (P<0.001). Nearly 80% of respondents characterized themselves as having no functional difficulties at follow-up. Clinically significant improvement was established for both pain and function. Respondents generally reported developmentally appropriate status, with 89% graduating high school on schedule.

Discussion:

Results show long-term positive functioning among individuals who underwent intensive rehabilitation treatment for chronic pain as children or adolescents. Despite experiencing one or more pain flares at some point after treatment, most former IIPT patients report minimal to no ongoing functional disability, complete or partial resolution of pain symptoms, and developmentally appropriate progress toward goals (eg, school completion, independent living).
Dorsal Plating for Low and High-energy Lisfranc Injuries
Authors: Pyle Casey , Heinen Angela , Harris Thomas G.
Published: April 2018

Lisfranc injuries are uncommon but destabilizing injuries of the tarsometatarsal joint that are often missed on initial evaluation and have a high incidence of posttraumatic arthritis. These injuries can occur from low or high-energy mechanisms and feature unique characteristics. Open reduction and internal fixation is indicated in Lisfranc injuries that include a fracture component and different methods of fixation have been described. In this article, we present our operative techniques for open reduction and internal fixation of Lisfranc fractures using dorsal plating for both low and high-energy injuries.

Level of Evidence: Diagnostic Level 3. See Instructions for Authors for a complete description of levels of evidence.
Evidence for Efficacy of Treatment With the Anti-PD-1 Mab Nivolumab in Radiation and Multichemorefractory Advanced Penile Squamous Cell Carcinoma
Authors: Trafalis Dimitrios T. , Alifieris Constantinos E. , Kalantzis Anastasios , Verigos Kosmas E. , Vergadis Chrysovalantis , Sauvage Sébastien
Published: April 2018

Penile squamous cell carcinoma (PeSCC) is a rare tumor and advanced PeSCC is associated with poor survival due to the aggressiveness of the disease and lack of effective systemic therapies. We describe for the first time a case with advanced chemoradiation refractory PeSCC who had documented response to active immunotherapy with the immune checkpoint inhibitor, anti-programmed death-1 monoclonal antibody Nivolumab. The patient suffered from a poor prognosis human papillomavirus-negative PeSCC, with a somatic inactivation mutation of cyclin-dependent kinase inhibitor 2A (CDKN2A) gene in tumor cells, and treatment with Nivolumab resulted in a partial response to therapy and significant tumor shrinkage. Histology transitions and alterations in tumor-infiltrating cytotoxic CD8+ T-cell lymphocytes, programmed death ligand-1 expression on tumor cells and immune cells in tumor lesion biopsies pretreatment and posttreatment with Nivolumab were observed and described. In conclusion, in patients with metastatic PeSCC active immunotherapy combinations with an anti-programmed death-1/programmed death ligand-1 agent may be beneficial and further relative clinical studies are required.
Herpesvirus Infection in Infants with Gastroschisis
Authors: Francis Stephen S. , Wiemels Joseph L. , Yang Wei , Shaw Gary M.
Published: April 2018

Background:

Gastroschisis is a congenital malformation that has been shown to be more common in younger mothers and appears to be increasing in prevalence in the United States and elsewhere. Epidemiologic data suggest a potential role of infection and recent studies report an association between maternal antibodies to human herpesviruses (HHV) and development of gastroschisis.

Methods:

In this study, we examined newborn bloodspots from 50 children with gastroschisis and 50 healthy controls using a highly sensitive digital droplet polymerase chain reaction assay covering eight human herpesviruses [herpes simplex sirus 1/2, Epstein-Barr virus (HHV-4), cytomegalovirus (HHV-5), HHV-6A/B, HHV-7, and HHV-8], to examine the presence of herpesvirus DNA at birth, which would suggest in utero infection.

Results:

One control tested positive for low-level cytomegalovirus infection. We found no evidence of an association between herpesvirus DNA in neonatal blood spots taken at birth and gastroschisis.

Conclusions:

Our results do not support direct involvement of herpesviruses in the etiology of gastroschisis. However, there are several limitations in our study, most notably the known induction of this congenital malformation early in pregnancy and our analysis of blood taken at birth. Therefore, we cannot conclude that herpesviruses play no role in the etiology of gastroschisis and further research is needed to better define this relationship.
A behavioral economic analysis of the value-enhancing effects of nicotine and varenicline and the role of nicotinic acetylcholine receptors in male and female rats
Authors: Barrett Scott T. , Geary Trevor N. , Steiner Amy N. , Bevins Rick A.
Published: April 2018

Reinforcement value enhancement by nicotine of non-nicotine rewards is believed to partially motivate smoking behavior. Recently, we showed that the value-enhancing effects of nicotine are well characterized by reinforcer demand models and that the value-enhancing effects of the smoking-cessation aid bupropion (Zyban) are distinct from those of nicotine and differ between the sexes. The present study evaluated potential sex differences in the enhancement effects of nicotine and varenicline (Chantix) using a reinforcer demand methodology. The role of α4β2* and α7 nicotinic acetylcholine receptors (nAChRs) in the enhancing effects of nicotine and varenicline is also evaluated. Male and female rats (n=12/sex) were trained to lever press maintained by sensory reinforcement by visual stimulus (VS) presentations. Changes in the VS value following nicotine and varenicline administration were assessed using an established reinforcer demand approach. Subsequently, the effects of antagonism of α4β2* and α7 nAChRs on varenicline and nicotine-induced enhancement active lever-pressing were assessed using a progressive ratio schedule. Nicotine and varenicline enhanced VS demand equivalently between the sexes as evaluated by reinforcer demand. However, α4β2* receptor antagonism attenuated value enhancement by nicotine and varenicline in females, but only of nicotine in males.
Balance ability and posture in postmenopausal women with chronic pelvic pain
Authors: Fuentes-Márquez Pedro , Rodríguez-Torres Janet R. , Valenza Marie C. , Ortíz-Rubio Araceli , Ariza-Mateos María J. , Cabrera-Martos Irene
Published: April 2018

Objective:

The aim of the present study was to analyze balance ability and posture in postmenopausal women with chronic pelvic pain (CPP).

Methods:

This study includes a sample of 48 women with CPP recruited from the Gynecology Service of Virgen de las Nieves and San Cecilio Hospitals in Granada (Spain) and 48 healthy control women matched with respect to age and anthropometric characteristics. Outcome variables collected included: balance ability (Mini-Balance Evaluation Systems Test and Timed Up an Go Test) and posture (photogrammetry and Spinal Mouse).

Results:

Significant differences were found in all Mini Best Test subscales: total (P < 0.001), anticipatory (P = 0.002), reactive postural control (P < 0.001), sensory orientation (P < 0.001), and dynamic gait (P < 0.001), and all Timed Up and Go test subscales: alone (P < 0.001), with manual (P = 0.002) and cognitive task (P = 0.030). Significant differences were also found on spinal cervical angles with a forward head posture in women with CPP; global spine alignment exhibited more deviation in the women with CPP (P < 0.001); and a higher percentage of women with CPP (58%) presented with increased thoracic kyphosis and lumbar lordosis. Cohen's d was used to calculate the effect size. Some subscales of balance and posture tests showed a large effect size (d ≥0.8), indicating a more consistent result.

Conclusions:

Women with CPP presented poor balance including anticipatory, reactive postural control, sensory orientation, dynamic gait, and dual task-related conditions. Posture showed higher values on the dorsal angle and lower sacral inclination, less spine alignment, and a more prevalent posture with increased kyphosis and lumbar lordosis.
A Novel Laryngeal Preservation Technique following Total Glossectomy with Hyoid Bone Resection
Authors: Kurosawa Koreyuki , Imai Takayuki , Matsumoto Ko , Asada Yukinori , Katoh Kengo , Matsuura Kazuto , Goto Takahiro
Published: April 2018

Despite the recent progress of chemotherapy and sophisticated radiotherapy, surgery still remains the most reliable treatment for advanced tongue cancers in terms of survival. The major disadvantage of this treatment is that it should sacrifice the quality of patients’ life. When the tongue cancer is so advanced as to involve the hyoid bone, which is considered a functional part of the larynx, radical operation needs to resect both the entire tongue and the larynx and the hyoid bone en bloc to prevent aspiration pneumonia. As a result of total laryngectomy, the patients will suffer significant disabilities: aphonia and the loss of deglutition that limits the oral intake to only liquid or pasty food. With this clinical background, we have been contriving to overcome these significant surgical shortcomings by conducting larynx-preserving operation. In this case report, we present our newly devised surgical method which consists of free-flap transfer with a combination of laryngeal suspension and a novel reconstructive technique, that is, epiglottis suspension, which enabled favorable swallowing function without aspiration and allowed a sufficiently wide airway for breathing. The operation worked quite successfully for the patient’s quality of life. We believe this novel surgical method would serve as a larynx-preservation treatment for locally advanced tongue cancers with hyoid bone invasion.
Corneal Stiffness and Its Relationship With Other Corneal Biomechanical and Nonbiomechanical Parameters in Myopic Eyes of Chinese Patients
Authors: Zhang Yaohua , Wang Yan , Li Liuyang , Dou Rui , Wu Wenjing , Wu Di , Jhanji Vishal
Published: April 2018

Purpose:

To investigate corneal stiffness and analyze its possible influence on other corneal biomechanical and nonbiomechanical parameters in myopic eyes of Chinese patients.

Methods:

A total of 387 healthy (right) myopic eyes were included in this study. Corneal visualization Scheimpflug technology was used to measure the corneal stiffness parameter at the first applanation (SP-A1), deformation amplitude ratio at 1.0 and at 2.0 mm, biomechanically corrected intraocular pressure (bIOP), and corneal deformation parameters during the first applanation (A1: A1-time, A1-length, and A1-velocity), second applanation (A2; A2-time, A2-length, and A2-velocity), and highest concavity (HC; HC-time, HC-radius, HC deformation amplitude, and HC peak distance). The Pentacam was used to evaluate central corneal thickness, mean corneal curvature (Km), anterior corneal central elevation, and corneal asphericity (Q value) of the anterior cornea.

Results:

The mean SP-A1 and bIOP values were 90.46 ± 15.39 mm Hg/mm and 13.5 ± 1.85 mm Hg, respectively. The SP-A1 increased with age (β = 0.41 [95% CI, 0.28%–0.54%]; P < 0.0001). Corneal stiffness was positively correlated with central corneal thickness, uncorrected intraocular pressure, and bIOP and was also significantly correlated with all corneal deformation parameters (P < 0.05), except A1-length, HC-time, and HC peak distance. Corneal stiffness was negatively correlated with central corneal elevation of the anterior surface (r = −0.124, P = 0.014) and mean corneal curvature (r = −0.114, P = 0.025) and positively correlated with the Q value of the anterior surface (r = 0.109, P = 0.032).

Conclusions:

Corneal stiffness increased with age. Stronger corneal stiffness may be related to flattening of the cornea and higher intraocular pressure.
Management of Stenotrophomonas maltophilia Infections in Critically Ill Children
Authors: Tokatly Latzer Itay , Paret Gideon , Rubinstein Marina , Keller Nathan , Barkai Galia , Pessach Itai M.
Published: April 2018

Background:

Stenotrophomonas maltophilia is a life-threatening nosocomial pathogen with profound multidrug-resistant attributes. It is associated with high mortality, particularly in immunocompromised patients. Data on therapy for S. maltophilia infections are scarce, especially in children hospitalized in intensive care settings (pediatric intensive care unit).

Methods:

A retrospective chart review of pediatric patients with isolates of S. maltophilia hospitalized over a 5-year period in 2 pediatric intensive care units.

Results:

Thirty-one patients and 91 isolates from blood, respiratory secretions and soft tissues were identified and reviewed. The overall incidence of S. maltophilia infections increased during the study period (P = 0.003). The all-cause crude mortality was 61%, and the attributed mortality was approximately 16%. Risk factors associated with mortality included longer hospitalization before infection (P = 0.002), septic shock (P = 0.003), mechanical ventilation (P = 0.004), an indwelling central vein catheter (P = 0.03) and prior use of steroids (P = 0.04) and carbapenems (P = 0.004). On multivariate analysis, mortality was associated with mechanical ventilation (P = 0.02) and preinfection hospitalization days (P = 0.01). Combination treatment of trimethoprim and sulfamethoxazole, ciprofloxacin and/or minocycline significantly extended survival time (P < 0.001). The method of treatment did not significantly affect the interval between S. maltophilia isolation to resolution of infection (P = 0.200).

Conclusions:

Combinations of trimethoprim and sulfamethoxazole, ciprofloxacin and minocycline are proposed for pediatric intensive care unit patients harboring S. maltophilia. Meticulous evaluation of central vascular access and prior treatment with carbapenems are indicated, especially for mechanically ventilated and septic children.
Cardiac and Pulmonary Cystic Echinococcosis With Massive Obstruction of the Pulmonary Vessel System in a 16-Year-Old Girl
Authors: Kohlmaier Benno , Trobisch Andreas , Pfurtscheller Klaus , Knez Igor , Klepetko Walter , Pilhatsch Alexander , Schweintzger Sabrina , Zenz Werner
Published: April 2018

We describe herein the management of a 16-year-old girl with cystic echinococcosis of the right ventricle and massive obstruction of the pulmonary vessel system by parasitic metastatic dissemination. After resection of the cardiac cyst, pulmonary thromboendarterectomy was performed to remove parts of the obstructive parasitic material. The treatment reduced the elevated pulmonary arterial pressure, improving the patient’s overall condition.
Epidemiology of Otitis Media With Otorrhea Among Bangladeshi Children
Authors: Naziat Hakka , Saha Senjuti , Islam Maksuda , Saha Shampa , Uddin Mohammad J. , Hussain Manzoor , Luby Stephen P. , Darmstadt Gary L. , Whitney Cynthia G. , Gessner Bradford D. , Saha Samir K.
Published: April 2018

Background:

Otitis media (OM) poses a high disease burden on Bangladeshi children, but little is known about its etiologies. We conducted a surveillance study in the largest pediatric hospital to characterize pathogens responsible for OM.

Methods:

In the outpatient ear–nose–throat department of Dhaka Shishu Hospital, which serves 0 to 18-year-old children, we collected ear swabs from OM children with otorrhea from April 2014 to March 2015. We cultured all specimens for bacterial pathogens and assessed serotype and antimicrobial susceptibility of Streptococcus pneumoniae (Spn) and Haemophilus influenzae (Hi) isolates.

Results:

We recorded 1111 OM episodes; 88% (981/1111) involved otorrhea, and we collected samples from 91% (891/981) of these children. Fifty-one percent (452/891) were culture positive (contaminants excluded), with Hi (21%, 187/891) and Spn (18%, 164/891) most commonly detected. Overall, 45 distinct single and mixed pathogens were revealed. Dominant pneumococcal serotypes were 19A, 19F, 3 and 14; 98% of Hi isolates were nontypeable. Pneumococcal conjugate vaccine (PCV)10 and PCV10 + 6A serotypes accounted for 8% and 9% of all OM and 46% and 49% of pneumococcus-positive cases, respectively, and were more likely to be nonsusceptible to at least 1 antibiotic (erythromycin and/or trimethoprim-sulfamethoxazole) than nonvaccine serotypes (91% vs. 77%). Staphylococcus aureus (9%, 83/891) and Pseudomonas aeruginosa (4%, 38/891) were also found.

Conclusions:

Nontypeable Hi (NTHi) and Spn are predominant causes of OM in Bangladesh. PCV10, introduced in March 2015, is likely to reduce pneumococcal and overall OM burden. Data collected post-PCV10 will provide comprehensive insight into the effects of this vaccine on these pathogens.
Amniotic Band Syndrome: A Review of 2 Cases
Authors: Madan Siddharth , Chaudhuri Zia
Published: April 2018

Amniotic band syndrome is a rare congenital disorder caused by entrapment of fetal parts (usually a limb or digits) in fibrous amniotic bands while in utero that presents with complex multisystem anomalies. The authors report 2 children with amniotic band syndrome who presented to the ophthalmic unit of the authors’ pediatric hospital. One of them presented with telecanthus, syndactyly, amputated toes, and unilateral epiphora diagnosed as congenital nasolacrimal duct obstruction. She was managed conservatively with lacrimal sac massage and provided with refractive correction while she simultaneously underwent multiple surgeries for correction of clubfoot and craniosynostosis. The second patient presented with cleft lip, cleft palate, multiple constriction bands in upper limbs and fingers with unilateral microphthalmos, microcornea, typical iris coloboma, and retinochoroidal coloboma, very similar to a case reported in literature. These 2 cases provide an overview of the clinical spectrum of ophthalmic manifestations along with their staged optimum rehabilitation.
A Prospective Randomized Comparative Clinical Trial to Analyze Pain and Surgical Outcomes Between Frontal Nerve Blocks and Subconjunctival Anesthesia for Conjunctival Mullerectomy Resection
Authors: Zatezalo Chad C. , Tavakoli Mehdi , Ayala-Haedo Juan , Callaway Natalia F. , Ko Marcus J. , Anagnostopoulos Apostolos G. , Vanner Elizabeth A. , Lee Wendy W.
Published: April 2018

Purpose:

Conjunctival Müller’s muscle resection (CMMR) is a posterior approach surgical technique to correct blepharoptosis. The purpose of this study is to compare patient-reported pain scores and surgical outcomes for patients who received 2 different anesthetic techniques during CMMR, frontal nerve block and subconjunctival injection.

Methods:

A prospective randomized comparative clinical trial enrolled 33 CMMR subjects from one tertiary eye center. Patients undergoing unilateral CMMR were randomized to receive either frontal nerve block or subconjunctival injection. For patients undergoing bilateral CMMR, each side was randomized to one of the injection techniques. Upper eyelid margin reflex distance was measured and recorded for each eye before and after surgery. Patients’ pain scores were quantified using the Wong Baker Pain Scale. Subjects quantified their pain during, immediately after, 12 and 24 hours after surgery.

Results:

Twenty-four bilateral and 9 unilateral cases were enrolled in the study. Twenty-two (92%) subjects were female, and the mean patient age was 69 ± 12 years. The mean margin reflex distance was 1.1 mm preoperatively, which increased to 3.5 and 3.6 mm 2 months postoperatively in frontal nerve block and subconjunctival injection groups, respectively (p value <0.0001). Both paired and nonpaired analyses demonstrated no significant difference in the pain score reported by the patients or the surgical outcomes between the 2 anesthesia techniques at any time during or after the surgery. There were no anesthetic-related complications.

Conclusion:

There was no statistically significant difference in pain scores or surgical outcomes in patients receiving frontal nerve block compared with those receiving subconjunctival injection during CMMR surgery.
Herpes Zoster Ophthalmicus With Orbital Findings Preceding Skin Rash
Authors: Chiang Elizabeth , Bajric Jasmina , Harris Gerald J.
Published: April 2018

The authors describe 2 patients who presented with orbital findings and later developed vesicular lesions that were positive for varicella zoster virus and consistent with Herpes Zoster ophthalmicus. One case is the first to involve dacryoadenitis and orbital myositis preceding disseminated Herpes Zoster. In the other case, a patient developed zoster orbital syndrome leading to elevated intraocular pressure, loss of vision, and afferent pupillary defect. Canthotomy and cantholysis were required to restore vision. In both cases, the orbital syndrome developed prior to the vesicular rash. These cases highlight the need to consider Herpes Zoster ophthalmicus in patients with orbital syndrome not responding to conventional treatment.
A Meta-ethnography of Out-of-Hospital Cardiac Arrest Survivors’ Meanings on Life and Death
Authors: Aristidou Maria , Vouzavali Fotini , Karanikola Maria N. , Lambrinou Ekaterini , Papathanassoglou Elizabeth
Published: April 2018

Background:

Although out-of-hospital cardiac arrest (OHCA) survivors’ physiological outcomes have been addressed, less is known on the holistic needs of individuals after OHCA, which hinders our ability to prioritize care around what really matters to survivors.

Aim:

The aim of this study was to interpretatively synthesize qualitative findings on OHCA survivors’ perceptions and meanings of life and death and existential issues.

Methods:

We used a meta-ethnographic synthesis of published qualitative studies addressing the experiences of OHCA survivors based on a systematic literature search (CINAHL, PsycINFO, Scopus, PubMed). Studies were selected based on predefined inclusion/exclusion criteria. The identified studies were subjected to a quality appraisal based on the Critical Appraisal Skills Programme.

Results:

Based on eligibility criteria, 6 phenomenological studies were included, of overall medium to high quality. One core theme, “the reality of death,” and 4 main themes were identified: “redefining existence”; “revaluing death”; “being familiar with, yet oblivious of death”; and “living consciously.” Emerging from the realization of death, the themes appeared to describe a gradual progression toward living consciously.

Conclusions:

An existential trajectory and a need for meaning are central in the experience of OHCA survivors. When existential issues are not addressed, the ongoing suffering may interfere with survivors’ recovery and quality of life. Future research needs to address specific needs and ways to support survivors’ meaning-making.
Etiology of Sudden Cardiac Arrest and Death in US Competitive Athletes: A 2-Year Prospective Surveillance Study
Authors: Peterson Danielle F. , Siebert David M. , Kucera Kristen L. , Thomas Leah Cox , Maleszewski Joseph J. , Lopez-Anderson Martha , Suchsland Monica Z. , Harmon Kimberly G. , Drezner Jonathan A.
Published: April 2018

Objective:

To determine the etiology of sudden cardiac arrest and death (SCA/D) in competitive athletes through a prospective national surveillance program.

Design:

Sudden cardiac arrest and death cases in middle school, high school, college, and professional athletes were identified from July 2014 to June 2016 through traditional and social media searches, reporting to the National Center for Catastrophic Sports Injury Research, communication with state and national high school associations, review of the Parent Heart Watch database, and search of student-athlete deaths on the NCAA Resolutions List. Autopsy reports and medical records were reviewed by a multidisciplinary panel to determine the underlying cause.

Setting and Participants:

US competitive athletes with SCA/D.

Main Outcome Measures:

Etiology of SCA/D.

Results:

A total of 179 cases of SCA/D were identified (74 arrests with survival, 105 deaths): average age 16.6 years (range 11-29), 149 (83.2%) men, 94 (52.5%) whites, and 54 (30.2%) African American. One hundred seventeen (65.4%) had an adjudicated diagnosis, including 83 deaths and 34 survivors. The most common etiologies included hypertrophic cardiomyopathy (19, 16.2%), coronary artery anomalies (16, 13.7%), idiopathic left ventricular hypertrophy/possible cardiomyopathy (13, 11.1%), autopsy-negative sudden unexplained death (8, 6.8%), Wolff-Parkinson-White (8, 6.8%), and long QT syndrome (7, 6.0%). Hypertrophic cardiomyopathy was more common in male basketball (23.3%), football (25%), and African American athletes (30.3%). An estimated 56.4% of cases would likely demonstrate abnormalities on an electrocardiogram.

Conclusions:

The etiology of SCA/D in competitive athletes involves a wide range of clinical disorders. More robust reporting mechanisms, standardized autopsy protocols, and accurate etiology data are needed to better inform prevention strategies.
Online Clinical Post Conference
Authors: Hannans Jaime
Published: April 2018

Clinical post conference (CPC) is a strategy for peer learning and reflective discourse after clinical experiences. Reflective and experiential learning practices are essential in nursing education to develop students' critical thinking. Innovative approaches to structure asynchronous online CPC using VoiceThread offer time for student reflection, while retaining the value of facial cues, tone, and peer-peer connections occurring during traditional face-to-face CPC.
Comparison of Algorithms to Triage Patients to Express Care in a Sexually Transmitted Disease Clinic
Authors: Chambers Laura C. , Manhart Lisa E. , Katz David A. , Golden Matthew R. , Barbee Lindley A. , Dombrowski Julia C.
Published: April 2018

Background

The ideal approach to triaging sexually transmitted disease (STD) clinic patients between testing-only express visits and standard visits with clinician evaluation is uncertain.

Methods

In this cross-sectional study, we used classification and regression tree analysis to develop and validate the optimal algorithm for predicting which patients need a standard visit with clinician assessment (i.e., to maximize correct triage). Using electronic medical record data, we defined patients as needing a standard visit if they reported STD symptoms, received any empiric treatment, or were diagnosed as having an infection or syndrome at the same visit. We considered 11 potential predictors for requiring medical evaluation collected via computer-assisted self-interview when constructing the optimized algorithm. We compared test characteristics of the optimized algorithm, the Public Health–Seattle and King County STD Clinic's current 13-component algorithm, and a simple 2-component algorithm including only presence of symptoms and contact to STD.

Results

From October 2010 to June 2015, 18,653 unique patients completed a computer-assisted self-interview. In the validation samples, the optimized, current, and simple algorithms appropriately triaged 90%, 85%, and 89% of patients, respectively. The optimized algorithm had lower sensitivity for identifying patients needing standard visits (men, 94%; women, 93%) compared with the current algorithm (men, 95%; women, 98%), as did the simple algorithm (men, 91%; women, 93%). The optimized, current, and simple algorithms triaged 31%, 23%, and 33% of patients to express visits, respectively.

Conclusions

The overall performance of the statistically optimized algorithm did not differ meaningfully from a simple 2-component algorithm. In contrast, the current algorithm had the highest sensitivity but lowest overall performance.
Shear Wave Elastography Improves Specificity of Ultrasound for Parotid Nodules
Authors: Liu Guangqing , Wu Size , Liang Xian , Cui Xiaojing , Zuo Dongshen
Published: April 2018

Objectives

This study aimed to determine the performance of Virtual Touch tissue quantification (VTQ) technique in the differential evaluation of parotid gland nodules.

Methods

Acoustic radiation force impulse VTQ technique was used to determine the shear wave velocity (SWV) of 76 patients with parotid nodules and 30 subjects with normal parotid gland. These nodules were assigned to benign and malignant nodules according to histopathology, measurements of SWV were compared, a cutoff point for benign and malignant nodules was obtained with reference to receiver-operating characteristic curve, and relevant sensitivity and specificity were evaluated.

Results

There were 61 of 76 patients with benign parotid nodules and 15 of 76 patients with malignant nodules. The SWV of the malignant nodules was higher than the SWV of the benign nodules, and the SWV of the benign and malignant nodules was higher than the normal parotid glands. There were significant differences between benign and malignant nodules as well as normal parotid glands in terms of the age and SWV of the nodules (all P < 0.001). The area under the curve is 0.893, the cutoff is 2.445 m/s, and the sensitivity and specificity are 80.0% and 91.8%, respectively.

Conclusions

Acoustic radiation force impulse VTQ technique can determine the stiffness of parotid nodules in general, its ability to distinct malignant from benign nodular nodule is still not strong, and overlay of SWV of VTQ between benign and malignant nodules is the main impedance to set cutoff point.
Comparison of Prognostic Accuracy of the quick Sepsis-Related Organ Failure Assessment between Short- & Long-term Mortality in Patients Presenting Outside of The Intensive Care Unit - A Systematic Review & Meta-analysis
Authors: TAN TOH LEONG , Tang Ying Jing , Ching Ling Jing , Abdullah Noraidatulakma , Neoh Hui-min
Published: April 2018

Objective: In year 2016, quick Sepsis-Related Organ Failure Assessment (qSOFA) was introduced as a better sepsis screening tool compared to systemic inflammatory response syndrome (SIRS). The purpose of this systematic review and meta-analysis is to evaluate the ability of the qSOFA in predicting short- and long-term mortality among patients outside the intensive care unit setting. Method: Studies reporting on the qSOFA and mortality from MEDLINE (published between 1946 and 15th December 2017) and SCOPUS (published before 15th December 2017). Hand-checking of the references of relevant articles was carried out. Studies were included if they involved inclusion of patients presenting to the ED; usage of Sepsis-3 definition with suspected infection; usage of qSOFA score for mortality prognostication; and written in English. Study details, patient demographics, qSOFA scores, short-term (<30 days) and long-term (≥30 days) mortality were extracted. Two reviewers conducted all reviews and data extraction independently. Results and Discussion: A total of 39 studies met the selection criteria for full text review and only 36 studies were inclided. Data on qSOFA scores and mortality rate were extracted from 36 studies from 15 countries. The pooled odds ratio was 5.5 and 4.7 for short-term and long-term mortality respectively. The overall pooled sensitivity and specificity for the qSOFA was 48% and 85% for short-term mortality and 32% and 92% for long-term mortality, respectively. Studies reporting on short-term mortality were heterogeneous (Tau=24%, I2=94%, P<0.001), while long-term mortality studies were homogenous (Tau=0%, I2<0.001, P=0.52). The factors contributing to heterogeneity may be wide age group, various clinical settings, variation in the timing of qSOFA scoring, and broad range of clinical diagnosis and criteria. There was no publication bias for short-term mortality analysis. Conclusion: qSOFA score showed a poor sensitivity but moderate specificity for both short and long-term mortality prediction in patients with suspected infection. qSOFA score may be a cost-effective tool for sepsis prognostication outside of the ICU setting.
A SoxB gene acts as an anterior gap gene and regulates posterior segment addition in the spiderParasteatoda tepidariorum
Authors: Paese Christian L. B. , Schoenauer Anna , Leite Daniel J. , Russell Steven , McGregor Alistair P.
Published: April 2018

The Sox gene family encode a set of highly conserved HMG domain transcription factors that regulate many key processes during metazoan embryogenesis. In insects, the SoxB geneDichaeteis the only Sox gene known to be involved in embryonic segmentation. To determine if similar mechanisms are used in other arthropods, we investigated the role of Sox genes during segmentation in the spiderParasteatoda tepidariorum. WhileDichaetedoes not appear to be involved in spider segmentation, RNAi knockdown of the closely relatedSox21b-1gene results in a gap like phenotype in the developing prosoma and also perturbs the sequential addition of opisthosomal segments. We show that this is in part due to a role forSox21b-1in regulating the expression ofWnt8and influencing Delta-Notch signalling during the formation of the segment addition zone. Thus, we have found that two different mechanisms for segmentation in a non-mandibulate arthropod are regulated by a Group B Sox gene. Our work provides new insights into the function of an important and conserved gene family across arthropods, and the evolution of the regulation of segmentation in these animals.
Screening of FDA-approved Drugs and Identification of Novel Lassa Virus Entry Inhibitors
Authors: Wang Peilin , Liu Yang , Zhang Guangshun , Wang Shaobo , Guo Jiao , Cao Junyuan , Jia Xiaoying , Zhang Leike , Xiao Gengfu , Wang Wei
Published: April 2018

Lassa virus (LASV) belongs to the Mammarenavirus genus (family Arenaviridae) and causes severe hemorrhagic fever in humans. At present, there are no Food and Drug Administration (FDA)-approved drugs or vaccines specific for LASV. Herein, high-throughput screening of an FDA-approved drug library was performed against LASV entry using a pseudo-type virus enveloping LASV glycoproteins. Two hit drugs, lacidipine and phenothrin, were identified as LASV entry inhibitors in the micromolar range. A mechanistic study revealed that both drugs inhibited LASV entry by blocking low-pH-induced membrane fusion. Moreover, lacidipine irreversibly bound to the LASV glycoprotein complex (GPC), resulting in virucidal activity. Adaptive mutant analyses demonstrated that replacement of T40, located in the ectodomain of the stable-signal peptide (SSP), with lysine (K) conferred LASV resistance to lacidipine without apparent loss of the viral growth profile. Furthermore, lacidipine showed antiviral activity and specificity against both LASV and the Guanarito virus (GTOV), which is also a category A new world arenavirus. Drug-resistant variants indicate that the V36M in ectodomain of SSP mutant and V436A in the transmembrane domain of GP2 mutant conferred GTOV resistance to lacidipine, suggesting that lacidipine might act via a novel mechanism other than calcium inhibition. This study shows that both lacidipine and phenothrin are candidates for LASV therapy, and the membrane-proximal external region of the GPC might provide an entry-targeted platform for inhibitors.
Diverse Mechanisms of Resistance in Carbapenem-Resistant Enterobacteriaceae at a Health Care System in Silicon Valley, California
Authors: Senchyna Fiona , Gaur Rajiv , Sandlund Johanna , Truong Cynthia , Tremintin Guillaume , Küeltz Dietmar , Gomez Carlos A. , Tamburini Fiona B. , Andermann Tessa , Bhatt Ami , Tickler Isabella , Watz Nancy , Budvytiene Indre , Shi Gongyi , Tenover Fred C. , Banaei Niaz
Published: April 2018

Carbapenem-resistant Enterobacteriaceae (CRE) are emerging as a major health threat in North America. The mechanism of resistance to carbapenems has therapeutic and public health implications. We comprehensively characterized the underlying mechanisms of carbapenem resistance in CRE isolates recovered between 2013 and 2016 at a health system in Northern California. Genotypic methods were used to detect carbapenemases and plasmid-encoded cephalosporinases, and mass spectrometry was used to quantify relative porin levels for OmpC and OmpF and their analogs. MICs for imipenem-relebactam, meropenem-vaborbactam, ceftazidime-avibactam, and ceftolozane-tazobactam were measured. Whole genome sequencing was used for strain typing. A carbapenemase gene encoding blaOXA-48 like, blaNDM, blaKPC, blaSME, blaIMP, and blaVIM was detected in 38.7% (24/62) of CRE isolates. Porin levels was down at least 2-fold in 91.9% (57/62) of isolates. Including carbapenemase genes and porin loss, the mechanism of resistance was identified in 95.2% (59/62) of CRE isolates. Of the carbapenemase gene-positive isolates, blaKPC -positive isolates were 100% susceptible to ceftazidime-avibactam, meropenem-vaborbactam, and imipenem-relebactam; blaOXA-48 like-positive isolates were 100% susceptible to ceftazidime-avibactam; and blaSME-positive isolates were 100% susceptible to meropenem-vaborbactam and ceftolozane-tazobactam. 100% (38/38), 92.1% (35/38), 89.5% (34/38), and 31.6% (12/38) of carbapenemase gene-negative CRE isolates were susceptible to ceftazidime-avibactam, meropenem-vaborbactam, imipenem-relebactam, and ceftolozane-tazobactam, respectively. None of the CRE strains were genetically identical. In conclusion, at this health system in Silicon Valley, carbapenemase-producing CRE occurred sporadically and were mediated by diverse mechanisms. Nucleic acid testing for blaOXA-48 like, blaNDM, blaKPC, blaIMP, and blaVIM was sufficient to distinguish between carbapenemase-producing and non-producing CRE and accurately predicted susceptibility to ceftazidime-avibactam, meropenem-vaborbactam and imipenem-relebactam.
Improved CD4 T-cell profile and inflammatory levels in HIV-infected subjects on maraviroc-containing therapy is associated with better responsiveness to HBV vaccination
Authors: Herrero-Fernéndez Inés , Rosado-Sánchez Isaac , Genebat Miguel , Tarancón-Díez Laura , Rodríguez-Méndez María Mar , Pozo-Balado María Mar , Lozano Carmen , Ruiz-Mateos Ezequiel , Leal Manuel , Pacheco Yolanda M.
Published: April 2018

Introduction

We previously found that a maraviroc-containing combined antiretroviral therapy (MVC-cART) was associated with a better response to the Hepatitis B Virus (HBV) vaccine in HIV-infected subjects younger than 50 years old. We aimed here to extend our previous analysis including immunological parameters related to inflammation, T-cell and dendritic cell (DC) subsets phenotype and to explore the impact of MVC-cART on these parameters.

Methods

We analyzed baseline samples of vaccinated subjects under 50 years old (n=41). We characterized CD4 T-cells according to the distribution of their maturational subsets and the expression of activation, senescence and prone-to-apoptosis markers; we also quantified Treg-cells and main DC subsets. Linear regressions were performed to determine the impact of these variables on the magnitude of vaccine response. Binary logistic regressions were explored to analyze the impact of MVC-cART on immunological parameters. Correlations with the time of MVC exposure were also explored.

Results

MVC-cART remained independently associated with HBV-vaccine responsiveness even after adjusting by immunological variables. The %CD4+CD25hiFoxP3+ki67+ and %pDCs were also independently associated. Moreover, HIV-infected subjects on MVC-containing therapy prior to vaccination showed lower inflammatory levels, activated CD4 T-cells and frequency of Treg cells and higher frequency of recent thymic emigrants.

Conclusion

Treg-cell levels negatively impacted the HBV-vaccine response, whereas higher pDCs levels and a MVC-cART prior to vaccination were associated with better responsiveness. These factors together with the improved phenotypic CD4 T-cell profile and the lower inflammatory levels found in subjects with a MVC-cART prior HBV vaccination could contribute to their enhanced vaccine response.
Label-free visualization of type IV pili dynamics by interferometric scattering microscopy
Authors: Tala Lorenzo , Fineberg Adam , Kukura Philipp , Persat Alexandre
Published: April 2018

Type IV pili (TFP) are slender objects that assemble by polymerization and secretion of protein subunits from bacterial cell surfaces. The mechanisms by which these surface structures of microscopic length and molecular diameter modulate the physical interaction of bacteria with their environment, however, remains poorly understood largely due to limitations in our ability to monitor and characterize the dynamics of individual TFP. Here, we demonstrate that interferometric scattering microscopy (iSCAT) enables label-free and dynamic visualization of TFP in intact cells of the opportunistic pathogenPseudomonas aeruginosa. As a result, we can directly monitor extension, attachment and retraction events on millisecond timescale and nanometer length scale in three dimensions. These capabilities allow us to observe thatP. aeruginosais able to crawl against the direction of flow using short TFP filaments. Also, careful observation show that TFP retract rapidly after surface attachment, suggesting thatP. aeruginosasenses contact of the pilus tip with the solid substrate. These results illustrate the power of iSCAT for the label-free visualization of small, dynamic microbial extracellular structures.