bluuebunny/crossref_metadata_2025 huggingface dataset:
Trading Zones
Authors: Sandell Richard , Dodd Jocelyn , Jones Ceri
Published: October 2017

Because of the determined efforts of disability activists, public historians, and other scholars, the hidden history of disabled people is emerging in the public sphere. Although museums and other cultural institutions hold wide-ranging material in their collections that links to the lives of disabled people, its significance is often underresearched and poorly understood. Although disabled people desire greater visibility, like other groups who have been marginalized or misrepresented, they also want to be involved in the process and empowered to make decisions about their representation. Drawing on insights from research and experimental practice, we suggest that the idea of the “trading zone,” the creation of a space of exchange for collaborative and equitable dialogue, provides a way forward for disabled people to make their voices heard in the museum and for museum staff to confront and develop new ways of incorporating disability history into their collections and displays.
Sexuality and the Cities
Authors: Murphy Kevin , Pierce Jennifer , Urquhart Alex T.
Published: October 2017

The Twin Cities GLBT Oral History Project, launched in 2003, was a collective devoted to documenting and interpreting the formation of queer identities and politics in the Twin Cities through the collection of oral histories, through other forms of archival and ethnographic research, and via community-engaged collaborative public projects. This chapter examines the project’s formation and history as well as the challenges of working in an interdisciplinary group. Further, it highlights our decision to disavow identity politics in our research and writing and to deploy instead the queer analytics of the “politics of sexuality.” Finally, it considers the challenges of producing the volume Queer Twin Cities as one broadly accessible to multiple public audiences, even as it engaged with social and cultural theory, addressed controversial topics, and provoked debate about sexuality and politics.
Hemodynamic Instability and Cardiovascular Events After Traumatic Brain Injury Predict Outcome After Artifact Removal With Deep Belief Network Analysis
Authors: Kim Hakseung , Lee Seung-Bo , Son Yunsik , Czosnyka Marek , Kim Dong-Joo
Published: October 2017

Background:

Hemodynamic instability and cardiovascular events heavily affect the prognosis of traumatic brain injury. Physiological signals are monitored to detect these events. However, the signals are often riddled with faulty readings, which jeopardize the reliability of the clinical parameters obtained from the signals. A machine-learning model for the elimination of artifactual events shows promising results for improving signal quality. However, the actual impact of the improvements on the performance of the clinical parameters after the elimination of the artifacts is not well studied.

Materials and Methods:

The arterial blood pressure of 99 subjects with traumatic brain injury was continuously measured for 5 consecutive days, beginning on the day of admission. The machine-learning deep belief network was constructed to automatically identify and remove false incidences of hypotension, hypertension, bradycardia, tachycardia, and alterations in cerebral perfusion pressure (CPP).

Results:

The prevalences of hypotension and tachycardia were significantly reduced by 47.5% and 13.1%, respectively, after suppressing false incidents (P=0.01). Hypotension was particularly effective at predicting outcome favorability and mortality after artifact elimination (P=0.015 and 0.027, respectively). In addition, increased CPP was also statistically significant in predicting outcomes (P=0.02).

Conclusions:

The prevalence of false incidents due to signal artifacts can be significantly reduced using machine-learning. Some clinical events, such as hypotension and alterations in CPP, gain particularly high predictive capacity for patient outcomes after artifacts are eliminated from physiological signals.
New treatment paradigms in spondyloarthritis
Authors: van Mens Leonieke J.J. , van de Sande Marleen G.H. , Baeten Dominique L.P.
Published: October 2017

Purpose of review

The review presents the recent rapid expansion of therapeutical options in spondyloarthritis. Additionally, it focuses on the importance of additional questions raised by the growing therapeutic possibilities related to the optimal use of these drugs.

Recent findings

The emergence of new treatment options opens new avenues and opportunities for treating patients with nonresponse, contraindications, or intolerance for classic drugs. However, it becomes more relevant than ever to define not only drugs and treatment options but also treatment strategies. We address current literature and remaining questions on strategies such as early intervention, combination treatment, personalized medicine, and treat-to-target.

Not only the treatment as such, but also the treatment strategy is crucial to reveal the full therapeutic potential and benefit for patients. Whereas cautious but crucial steps have been taken in the last years to explore these aspects, related to timing and sequence of treatment (including combination treatments), stratified medicine approaches, and treat-to-target strategies, it is now time for full-scale investment in prospective strategy trials.
Prospective Trial Evaluating the Surgical Anastomosis at One-Year Colorectal Cancer Surveillance: CT Colonography Versus Optical Colonoscopy and Implications for Patient Care
Authors: Pickhardt Perry J. , Edwards Kristin , Bruining David H. , Gollub Marc , Kupfer Sonja , Lubner Sam J. , Kim David H. , Ross Eric , Keenan Eileen , Weinberg David S.
Published: October 2017

OBJECTIVE:

The aim of this study was to compare the accuracy of CT colonography versus optical colonoscopy for neoplastic involvement at the surgical anastomosis 1 year after curative-intent colorectal cancer resection.

DESIGN, SETTING, PATIENTS, AND INTERVENTIONS:

Two hundred one patients (mean age, 58.6 years; 117 men, 84 women) underwent same-day contrast-enhanced CT colonography and colonoscopy approximately 1 year (mean, 12.1 months; median, 11.9 months) after colorectal cancer resection as part of a prospective, multicenter trial. All patients enrolled were without clinical evidence of disease and considered low risk for recurrence (stage I–III).

MAIN OUTCOME MEASURES:

Suspected neoplastic lesions within 5 cm of the colonic anastomosis were recorded at CT colonography, with subsequent colonoscopy performed for the same, with segmental unblinding of colonography findings. Anastomotic region biopsy or polypectomy was performed at the endoscopist’s discretion.

RESULTS:

None of the 201 patients had intraluminal anastomotic cancer recurrence or advanced neoplasia (or metachronous cancers). CT colonography detected extramural perianastomotic recurrence in 2 patients (1.0%); neither was detected at colonoscopy. Only 2 patients (1.0%; 2/201) were called positive at CT colonography for intraluminal anastomotic nondiminutive lesions (7- to 8-mm polyps), which were confirmed at colonoscopy but nonneoplastic at histopathology. At optical colonoscopy, the anastomosis was deemed abnormal and/or biopsied in 10.0% (20/201), yielding only 1 nondiminutive benign neoplasm (7-mm tubular adenoma).

LIMITATIONS:

The lack of luminal cancer recurrence in our lower-risk cohort precludes assessment of sensitivity for detection, rendering the study underpowered in this regard. Potential cost savings of combined CT/CT colonography over the standard CT/colonoscopy approach were not assessed.

CONCLUSIONS:

Relevant intraluminal anastomotic pathology appears to be very uncommon 1 year after colorectal cancer resection in lower-risk cohorts. Unlike colonoscopy, diagnostic contrast-enhanced CT colonography effectively evaluates both the intra- and extraluminal aspects of the anastomosis. See Video Abstract at http://links.lww.com/DCR/A471.
Retained Needle Following Transanal Hemorrhoidal Dearterialization
Authors: Celentano Valerio , Banerjee Anjan , Luvisetto Federico , Naqvi Syed , Khan Jim
Published: October 2017

INTRODUCTION:

A needle was retained during transanal hemorrhoidal dearterialization. This rare complication has not been described before.

TECHNIQUE:

A spinal needle was inserted from the perianal skin to localize the retained foreign body that was located at 7 cm from the anal margin. A decision was made to proceed to intersphincteric dissection, and a 3-cm incision was made in the perianal skin from 2 to 4 o’clock. Deep pararectal dissection continued, and the needle was eventually found lying in the muscular layer, parallel to the plane of the dissection.

RESULTS:

The needle was retrieved intact, and repeat x-ray confirmed that no foreign body was retained. The patient made an uneventful recovery and was discharged home on postoperative day 1 with a 5-day course of oral antibiotics; she was examined in clinic 4 weeks following surgery and reported significant symptomatic improvement with no perianal pain or rectal bleeding. No anal fistula was found on the examination.

CONCLUSIONS:

X-ray guidance is a helpful adjunct to facilitate 3-dimensional localization. Intersphincteric dissection is a reliable alternative to the transanal approach, particularly when the needle cannot be seen arising from the mucosa or felt on palpation. Repeated attempts to palpate the needle should be avoided, because there is a potential risk of displacing it deeper or higher, making retrieval more difficult.
Keratoconus Progression in Patients With Allergy and Elevated Surface Matrix Metalloproteinase 9 Point-of-Care Test
Authors: Mazzotta Cosimo , Traversi Claudio , Mellace Pierfrancesco , Bagaglia Simone A. , Zuccarini Silvio , Mencucci Rita , Jacob Soosan
Published: October 2017

Purpose:

To assess keratoconus (KC) progression in patients with allergies who also tested positive to surface matrix metalloproteinase 9 (MMP-9) point-of-care test.

Methods:

Prospective comparative study including 100 stage I–II keratoconic patients, mean age 16.7±4.6 years. All patients underwent an anamnestic questionnaire for concomitant allergic diseases and were screened with the MMP-9 point-of-care test. Patients were divided into two groups: patients KC with allergies (KC AL) and patients KC without allergies (KC NAL). Severity of allergy was established by papillary subtarsal response grade and KC progression assessed by Scheimpflug corneal tomography, corrected distance visual acuity (CDVA) measurement in a 12-month follow-up.

Results:

The KC AL group included 52 patients and the KC NAL group 48. In the KC AL group, 42/52 of patients (81%) were positive to MMP-9 point-of-care test versus two positive patients in the KC NAL group (4%). The KC AL group data showed a statistically significant decrease of average CDVA, from 0.155±0.11 to 0.301±0.2 logarithm of the minimum angle of resolution (P<0.005) at 12 months; Kmax value increased significantly, from 50.2 D±2.7 to 55.2 D±1.9 on average. The KC NAL group revealed a slight KC progression without statistically significant changes. Pearson correlation test showed a high correlation between Kmax worsening and severity of PSR in the KC AL group.

Conclusions:

The study demonstrated a statistically significant progression of KC in patients with concomitant allergies, positive to MMP-9 point-of-care test versus negative. A high correlation between severity of allergy and KC progression was documented.
Bezlotoxumab
Authors: Whitaker Andrea , Cosimi Reese A. , Reveles Kelly R. , Evoy Kirk E.
Published: October 2017

The purpose was to review the pharmacology, safety, and efficacy of bezlotoxumab (Zinplava; Merck Sharp & Dohme Corp, Whitehouse Station, NJ) as a novel therapy for prevention of recurrent Clostridium difficile infection (CDI). MEDLINE was searched (1946 to February 2017) using the terms bezlotoxumab, MK6072, MBL-CDB1, and MDX-1388. Additional studies were identified through searching FDA.gov, clinicaltrials.gov, and review of reference lists. Studies included were randomized control trials in English language on bezlotoxumab for recurrent CDI. Animal studies were excluded. Three randomized control trials were identified evaluating bezlotoxumab in adults receiving standard of care therapy for CDI. The primary outcome evaluated in all trials was CDI recurrence. A phase II trial found the combination of bezlotoxumab-actoxumab compared with placebo decreased CDI recurrence at 84 days (7% vs 25%, P < 0.001). Two similar, yet independent phase III trials evaluated recurrent CDI at 12 weeks. Results were consistent between the 2 trials and pooled analysis displayed a reduction in CDI recurrence in the bezlotoxumab group (absolute difference, −10.1%; 95% confidence interval, −14 to −6; P < 0.001) and the bezlotoxumab-actoxumab group (absolute difference, −11.5%; 95% confidence interval, −15.2 to −7.2; P < 0.001) compared with placebo. Initial and sustained clinical cure rates were similar between bezlotoxumab, bezlotoxumab-actoxumab, and placebo. Overall, the adverse effects associated with bezlotoxumab were similar to placebo, with diarrhea, nausea, pyrexia, and headache having a higher occurrence than placebo. In conclusion, bezlotoxumab is safe and effective at reducing CDI recurrence and the use of bezlotoxumab should be considered in patients who are at highest risk for CDI.
Evaluation of Antimicrobial Therapy Duration for Hospital-Acquired Pneumonia Treatment
Authors: Petite Sarah E. , Nguyen Khang
Published: October 2017

Background

The Infectious Diseases Society of America recommends a 7-day duration of antimicrobial therapy for hospital-acquired pneumonia (HAP); however, this recommendation is based on low-quality evidence. This recommendation is supported by evidence from ventilator-associated pneumonia clinical trials. Use of guideline-recommended antimicrobial durations is variable in clinical practice owing to the lack of literature available.

Methods

This was a retrospective, cohort, single-center study. Adult patients admitted with a diagnosis of HAP and received at least 72 hours of antimicrobial therapy were included. The primary outcome was day 7 clinical stability in patients treated with standard (≤7 days) compared with extended (>7 days) duration antimicrobial therapy. Secondary outcomes included hospital and intensive care unit length of stay (LOS), 30-day mortality, and 30-day hospital readmission rates.

Results

Fifty-three patient encounters were identified. Thirty-two patients (60.4%) received standard duration (6 [4.5–7] days) antimicrobial therapy, and 21 patients (39.6%) received extended duration (14 [11–14] days) antimicrobial therapy (P < 0.001). There were no statistically significant differences between groups with respect to day 7 clinical stability (62.5% vs 47.6%; P = 0.29), hospital LOS (9 [7–16] days vs 12 [7.5–24] days; P = 0.29), intensive care unit LOS (5 [3.5–9.5] days vs 5 [3–20] days; P = 0.62), 30-day mortality (3.1% vs 9.5%; P = 0.56), or 30-day readmission rates (21.9% vs 38.1%; P = 0.2).

Conclusions

No differences were observed in clinical outcomes between antimicrobial treatment groups. Guideline-recommended durations of antimicrobial therapy should be used in patients with HAP.
Long-term Complications and Surgical Failures After Ossiculoplasty
Authors: Cox Matthew D. , Page Joshua Cody , Trinidade Aaron , Dornhoffer John L.
Published: October 2017

Objective:

To study long-term complications after ossiculoplasty.

Study Design:

Case series with chart review.

Setting:

Tertiary care referral center otology practice.

Patients:

One hundred ninety-five patients (18–88 yr of age) undergoing ossiculoplasty with tympanoplasty or tympanomastoidectomy using cartilage tympanic membrane grafts, retrograde mastoidectomy with canal wall reconstruction, or mastoid obliteration techniques between July 1998 and July 2012. The studied patients all had at least 3 years of clinical follow-up.

Outcome Measures:

Incidence of long-term complications, including need for revision surgery, need for secondary ventilation tube placement, recurrence of conductive hearing loss (and related etiologies), recurrent cholesteatoma, and delayed graft failure (recurrent tympanic membrane perforation).

Results:

Long-term complications were observed in 10.3% (20/195) of patients. 8.2% (16/195) required revision surgery, 10.2% (17/195) required secondary ventilation tube placement, 3.6% (7/195) experienced recurrence of conductive hearing loss, 4.1% (8/195) had delayed failure of tympanic membrane graft, and 1.5% (3/195) had recurrence of cholesteatoma. Recurrence of conductive hearing loss was caused by the displacement of prosthesis in 3 of 7 patients and extensive scar tissue formation without prosthesis displacement in 4 of 7 patients. Seventy-two percent obtained a postoperative pure-tone average - air-bone gap  < 20 dB. Forty-eight percent (93/195) obtained a hearing result worse than expected based on the ossiculoplasty outcome parameter staging index.

Conclusion:

Long-term complications are a significant consideration in all the patients undergoing ossiculoplasty. Our data suggest that tobacco smoking, Eustachian tube dysfunction, and an unexpectedly poor hearing result on the first postoperative audiogram are all important risk factors for the development of significant complications.
Otology at the Academy of Gondishapur 200–600 CE
Authors: Ruben Robert J.
Published: October 2017

Objective:

To investigate the way in which otology was practiced at the Academy of Gondishapur in ancient Persia from 200 to 600 CE.

Method:

The pertinent literature, using German and English translations of Latin, Greek, Arabic, and Sanskrit documents, was identified and reviewed through the indices of available books and through a PDF search for the following topics: auricle, deaf, deafness, dizziness, ear, hearing, medicine, otitis, pinna, punishment—ear, speech, surgery, vertigo, and voice.

Results:

The medical school at the Academy of Gondishapur followed the medical and surgical practices of Greece and Rome and, in the 6th century, incorporated those from India as detailed in the Shutra Samhita. This shutra, which originated during the first millennium BCE, detailed many interventions, among which one of the most unusual was the use of a pedicle cheek flap to restore the pinnae. The use of the pedicle flap for pinna restoration appears not have been reported in literature again until 1931, by Jacque Joseph.

Conclusion:

During the period of late antiquity, medical knowledge of both the east and west was preserved and taught in Persia. Among surgical interventions used during the first millennium BCE in India, knowledge of which passed, through the shutra, to the Sasanian Empire in the 6th century CE, was use of the pedicle cheek flap for pinna reconstruction. Even as late as the Renaissance, the pedicle flap was not known to surgeons in the West, and a pedicle flap, though not a cheek flap, was first incorporated into Western medical practice during the 1930s.
The crashing patient: hemodynamic collapse
Authors: Gidwani Hitesh , Gómez Hernando
Published: October 2017

Purpose of review

Rapid restoration of tissue perfusion and oxygenation are the main goals in the resuscitation of a patient with circulatory collapse. This review will focus on providing an evidence based framework of the technological and conceptual advances in the evaluation and management of the patient with cardiovascular collapse.

Recent findings

The initial approach to the patient in cardiovascular collapse continues to be based on the Ventilate–Infuse–Pump rule. Point of care ultrasound is the preferred modality for the initial evaluation of undifferentiated shock, providing information to narrow the differential diagnosis, to assess fluid responsiveness and to evaluate the response to therapy. After the initial phase of resuscitative fluid administration, which focuses on re-establishing a mean arterial pressure to 65 mmHg, the use of dynamic parameters to assess preload responsiveness such as the passive leg raise test, stroke volume variation, pulse pressure variation and collapsibility of the inferior vena cava in mechanically ventilated patients is recommended.

The crashing patient remains a clinical challenge. Using an integrated approach with bedside ultrasound, dynamic parameters for the evaluation of fluid responsiveness and surrogates of evaluation of tissue perfusion have made the assessment of the patient in shock faster, safer and more physiologic.
Recollections of Emotional Abuse and Neglect in Childhood as Risk Factors for Depressive Disorders and the Need for Psychotherapy in Adult Life
Authors: Neumann Eva
Published: October 2017

Theoretical and empirical works have pointed out that depression comes along with adverse interpersonal experiences in childhood and adult life. The purpose of this study was to explore whether past and current experiences differ in their relevance for depression. A clinical group of 80 psychotherapy patients diagnosed with a depressive disorder was contrasted with a control group of 111 nondepressed patients from somatic facilities. Child abuse, neglect, and adult attachment dimensions were measured with self-report scales. Depression was correlated with emotional abuse, neglect, and attachment anxiety. However, solely emotional abuse and neglect significantly predicted the probability to be in the group of depressed patients, whereas attachment anxiety did not contribute to this prediction. The findings reveal that childhood variables, namely, recollections of emotional traumas, are more closely associated with depression than representations of adult attachment bonds and therefore need special attention in the psychotherapeutic treatment of depressive disorders.
Comparison of Nursing Student and Instructor Preferences for Block and Nonblock Clinical Models
Authors: Rohatinsky Noelle , Chachula Kathryn , Sedgwick Monique , Press Madeline M. , Compton Roslyn M. , Lane Brenda
Published: October 2017

Clinical experiences are the hallmark of prelicensure nursing programs and assist students with applying nursing theory into practice. The literature is limited with respect to nursing student and instructor preferences for type of clinical model to facilitate student learning. This article explores these perceptions in the nursing programs of 5 universities located in 4 Western Canadian provinces. Findings support the use of both nonblock and block clinical models throughout nursing education programs.
Educational Model to Increase the Number and Diversity of RN to BSN Graduates From a Resource-Limited Rural Community
Authors: Hawkins Janice E. , Wiles Lynn L. , Karlowicz Karen , Tufts Kimberly Adams
Published: October 2017

Increasing the number of BSN-prepared nurses at the bedside is directly linked to improved health care outcomes. However, employers are challenged to find enough BSN graduates to meet workforce demands. This article presents an educational model that uses evidence-based practices to increase enrollment, retention, and graduation rates of RN students in a BSN program (RN-BSN) in a resource limited rural community. This exemplar may equip nurse educators with strategies to adopt in their own communities.
Substance Use Disorder Among Nurses
Authors: Stewart Dina M. , Mueller Christine A.
Published: October 2017

Substance use disorder (SUD) among nurses is a serious practice issue that poses a significant risk to patients and nurses. However, the topic of SUD is inadequately addressed in nursing education. A comprehensive education strategy was implemented and evaluated in 2 prelicensure nursing programs to improve nursing students’ knowledge, skills, and attitudes about SUD among nurses.
A Retrospective Analysis of Nursing Students’ Clinical Experience in an All-Male Maximum Security Prison
Authors: Bouchaud Mary T. , Brooks Madeline , Swan Beth Ann
Published: October 2017

Prisons provide an ideal learning experience to prepare prelicensure students with the knowledge and skill set needed for practice in the 21st century. Beginning descriptive evidence demonstrates that correctional health is an innovative community resource to educate nursing students in today’s changing model of health care delivery and practice. This article shares results from a retrospective analysis of the perceptions and experiences of nursing students during their community clinical rotation in an all-male maximum security prison.
Opportunities for the Advanced Practice Nurse to Enhance Hypertension Knowledge and Self-management Among African American Women
Authors: Jones Lenette M. , Rosemberg Marie-Anne S. , Wright Kathy D.
Published: October 2017

Purpose:

Despite increased awareness and the advent of methods to manage the disease, hypertension is poorly controlled among African American women. This study explored hypertension knowledge and blood pressure in a sample of African American women.

Design:

A descriptive, cross-sectional design was used to collect survey data on hypertension knowledge.

Methods:

African American women attending a church conference were invited to complete a questionnaire, which included the Check Your High Blood Pressure Prevention IQ survey, and had their blood pressures measured.

Results:

Of the 151 women who participated, 62% were diagnosed with hypertension. Many of the women, even those not diagnosed with hypertension, had elevated blood pressures. Although the average scores showed that the women scored well on the survey, there were 4 items on the survey that a percentage of the women had difficulty with: questions about (1) stress as a cause of hypertension, (2) symptoms associated with high blood pressure, (3) whether hypertension could be cured, and (4) the amount of exercise needed to help reduce blood pressure.

Conclusion:

Despite efforts to increase awareness and control of hypertension, considerable misconceptions about the disease were found in this sample of African American women. To improve self-management of hypertension among this group, advanced practice nurses need to directly address these misconceptions.
Reliability and Validity of the Turkish Version of the Moral Competence Scale for Public Health Nurses
Authors: Yildiz Esra , Güdücü Tüfekci Fatma
Published: October 2017

Background:

Moral competencies must be improved in nursing area practice. To evaluate the moral competence seems necessary for nurses.

Aim:

The aims of this study are to adapt and evaluate the psychometric properties of the moral competence questionnaire for public health nurses in Turkey.

Method:

The moral competence scale was translated into Turkish by a skilled translator, after which it was back-translated into English by another translator. We then administered the Turkish version of the moral competence scale to 138 public health nurses working in family and public health centers in Erzurum, a city in eastern Turkey. We analyzed the data using factor analysis and Cronbach’s α.

Results:

Three factors were extracted, which together explained a total of 67.50% of the variance. The Cronbach’s α values were .83, .91, .87, and .88 for factors 1, 2, and 3 and for the whole scale, respectively.

Conclusion:

The Turkish version of the moral competence scale for public health nurses is a valid and reliable assessment tool.
Process of Transition for Congenital Heart Patients
Authors: Habibi Hajar , Emmanuel Yaso , Chung Natali
Published: October 2017

Purpose:

The aim of this article is to provide an overview of our nurse-led transition clinic provided to congenital heart disease patients moving from pediatric into adult care setting.

Description of the Service:

Nurse-led transition clinic was analyzed at various stages of young adult care from an early stage of 12 to 14 years to entering adult setting at 16 years or older.

Methods:

Overview of current transition service for young adults being transferred from pediatric into adult services highlights the integral role of clinical nurse specialist as a coordinator of care.

Results:

The result of the service overview indicates that nurse-led transition service enables patients to build on their knowledge. This is achieved by providing them time and the opportunities to develop an understanding of their condition and the attitudes required to engage with the adult care setting as indicated in the psychology questionnaire from transition day.

Conclusion:

A nurse-led transition clinic enhances long-term care of patients by supporting the young adults and their family/carer through the transition and transfer of the care to promote the young adult’s understanding of their condition and to prevent any lost to follow-up.
Impact of patient information leaflets on pain medication intake behavior: a pilot study
Authors: Schmitz Julia , Kamping Sandra , Wiegratz Janine , Müller Maike , Stork Jan , Colloca Luana , Flor Herta , Klinger Regine
Published: October 2017

Introduction:

Patient information leaflets on pain medication primarily list side effects while positive effects and action mechanisms remain underrepresented. Nocebo research has shown that negative instructions can lower analgesic effects.

Objectives:

Research on information leaflets and their influence on mood, memory of side effects, and intake behavior of healthy participants is needed.

Methods:

To determine the ratio of positive to negative phrases, 18 information leaflets of common, over-the-market analgesics were examined of which 1 was selected. In a randomized, controlled study design, 18 healthy participants read this leaflet while 18 control group participants read a matched, neutral leaflet of an electrical device. Collected data concerned the recall of positive and negative contents, mood, anxiety, and the willingness to buy and take the drug.

Results:

All examined leaflets listed significantly more side effects than positive effects (t17 = 5.82, P < 0.01). After reading the analgesic leaflet, participants showed a trend towards more negative mood (F
1,34 = 3.78, P = 0.06, ηp
2 = 0.1), a lower intention to buy [χ2 (1, n = 36) = 12.5, P < 0.01], a higher unwillingness to take the medication [χ2 (1, n = 36) = 7.2, P < 0.01], and even a greater recall for side effects than positive effects (t17 = 7.47, P < 0.01).

Conclusion:

Reading the patient information leaflets can increase fear and lower the intention to buy and the willingness to take a pain medication.
Association Between Cardiac Surgery and Mortality Among Patients With Infective Endocarditis Complicated by Sepsis and Septic Shock
Authors: Krajinovic Vladimir , Ivancic Stipe , Gezman Petar , Barsic Bruno
Published: October 2017

Background:

Sepsis and septic shock are common presentations of infective endocarditis (IE), but little is known about clinical characteristics in this group of patients, use of surgical treatment, and their associations with outcome. We sought to determine the influence of cardiac surgery (CS) on the outcome of patients with IE in different stages of sepsis severity.

Methods:

Two hundred ninety four patients with definite IE native or prosthetic valve IE admitted between 2000 and 2011. Prospective evaluation using multivariable logistic regression to evaluate clinical characteristics and outcomes (in-hospital and 1-year mortality) in surgically and medically treated patients stratified by severity of sepsis and using new Sepsis-3 definitions.

Results:

The presence of sepsis or septic shock during IE showed a statistical relationship with increased in-hospital mortality (odds ratio [OR] 8.915, P < 0.001 and OR 35.969, P < 0.001, respectively) after adjusting for other risk factors of poor outcomes (neurological complications, congestive heart failure, and Staphylococcus aureus IE). Surgical treatment had a positive influence on in-hospital mortality in patients with sepsis or septic shock and IE (OR 5.157, P < 0.001) as well as on 1-year survival (hazard ratio 3.092, P < 0.001).

Conclusions:

The presence of sepsis or septic shock as defined in Sepsis-3 definitions is associated with unfavorable outcomes in patients with IE. Surgical treatment has a positive effect on outcomes (in-hospital mortality and 1-year survival) in patients with IE and sepsis or septic shock.
Is Inappropriate Response to Cosyntropin Stimulation Test an Indication of Corticosteroid Resistance in Septic Shock?
Authors: Hyvernat Hervé , Doyen Denis , Barel Rémy , Kaidomar Michel , Goubaux Bernard , Pradier Christian , Panaïa-Ferrari Patricia , Dellamonica Jean , Bernardin Gilles
Published: October 2017

We recently published a comparison of two hydrocortisone dosage regimens in patients with septic shock. We compare the results conferred by the two regimens as a function of the response to cosyntropin stimulation test (CST). Patients with septic shock were treated by one of two hydrocortisone regimens: either a 50-mg intravenous bolus every 6 h during 7 days (200 mg group; n = 49), or a 100-mg initial bolus followed by a continuous infusion of 300 mg daily for 5 days (300 mg group; n = 50). Nonresponders was defined as a CST response of 9 μg/dL or less. Nonresponders had more severe septic shock, greater fluid resuscitation needs, and greater vasopressor dependence than responders. When analyzed only as a function of CST results, there was no difference in survival between responders and nonresponders. However, analyses crossing CST results and the treatment regimens showed that patients who were responders and in the 300 mg group had significantly less intensive care unit mortality compared with responders in the 200 mg group (respective mortality of 24% vs. 55% [relative risk 0.43, 95% confidence interval, 0.20 to 0.94, P = 0.018]). Multivariate analysis identified baseline blood cortisol as an independent prognostic factor for 28-day mortality in all groups (hazard ratio 1.002, 95% confidence interval, 1.001 to 1.002, P ≤ 0.0001). The results suggest that in patients who respond to CST, hydrocortisone can provide a dose-dependent benefit. In contrast, nonresponse may indicate corticosteroid resistance. This heterogeneity of response to hydrocortisone may explain the difficulties encountered when trying to demonstrate its benefit in septic shock.
Selective LPS Adsorption Using Polymyxin B-Immobilized Fiber Cartridges in Sepsis Patients Following Cardiac Surgery
Authors: Yaroustovsky Michael , Abramyan Marina , Komardina Ekaterina , Nazarova Helen , Popov Dmitrii , Plyushch Marina , Soldatkina Alina , Rogalskaya Ekaterina
Published: October 2017

Sepsis remains the leading cause of morbidity and mortality in intensive care units. The extracorporeal therapy in the complex treatment of sepsis seems to be the most promising direction. The aim of this study was to assess the safety and effectiveness of selective endotoxin adsorption on the basis of the analysis of our own experience with the intensive therapy for sepsis in adult cardiac surgical patients. Our single-center study included 143 patients with sepsis. One hundred and three adult patients received lipopolysaccharide adsorption procedures using Toraymyxin-PMX-20R columns. The historical control group included 30 adult patients received only conservative therapy, and 10 children (6.2–14 kg) received hemoperfusion with Toraymyxin-PMX-0.5R. After the lipopolysaccharide-adsorption course, we noted improving of the hemodynamic and respiratory parameters. A favorable effect of hemoperfusion was a decrease procalcitonin and endotoxin activity assay, expressed by changes of leukocytosis, a normalization of body temperature. The 28-day survival was 53% in the study group and 30% in the control group (P = 0.037). The 28-day survival of children who received selective hemoperfusion was 90%. Our own experience with the use of selective hemoperfusion in a fairly large group of cardiovascular patients with sepsis showed the safety and efficacy of these procedures.
Clinical and Oculographic Analysis of Inferior Oblique Myokymia
Authors: Jang Ji-Yeong , Jeon Hyeshin , Choi Seo-Young , Choi Jae-Hwan , Choi Kwang-Dong
Published: October 2017

A 63-year-old man experienced transient vertical oscillopsia lasting several seconds for 2 months. Examination disclosed paroxysmal excyclotorsion of the right eye, spontaneously or triggered by adduction. Eye movements using 3D video-oculography showed intermittent, monocular phasic movements which consisted of excyclotorsion of the right eye mixed with a small amount of supraduction and abduction, and a tonic movement with excyclotorsion and slight elevation. Orbital and brain MRI was unremarkable. Administration of oxcarbazepine markedly decreased the severity and frequency of the episodes. The oculographic characteristics in our patient may indicate that inferior oblique myokymia may be attributed to aberrant, spontaneous discharges in the inferior oblique motor unit.
Laughter-Induced Transient Vision Loss in a Patient With Silent Sinus Syndrome
Authors: Reggie Sara N. , Kalyam Krishna , Holds John B. , Chung Sophia M.
Published: October 2017

Background:

To report a patient with silent sinus syndrome (SSS) who experienced transient ipsilateral monocular vision loss during intense laughter.

Methods:

Case report.

Results:

Our patient's transient vision loss completely resolved after maxillary sinus decompression and during 7 months of follow-up.

Conclusions:

Although the precise mechanism of our patient's vision loss remains undetermined, we suspect that the vascular supply to the eye and/or the optic nerve was compromised as the result of the combination of laughter (causing Valsalva maneuver and increased intrathoracic pressure) and SSS.
International Consensus Statement on the Clinical and Therapeutic Management of Leber Hereditary Optic Neuropathy
Authors: Carelli Valerio , Carbonelli Michele , de Coo Irenaeus F. , Kawasaki Aki , Klopstock Thomas , Lagrèze Wolf A. , La Morgia Chiara , Newman Nancy J. , Orssaud Christophe , Pott Jan Willem R. , Sadun Alfredo A. , van Everdingen Judith , Vignal-Clermont Catherine , Votruba Marcela , Yu-Wai-Man Patrick , Barboni Piero
Published: October 2017

Leber hereditary optic neuropathy (LHON) is currently estimated as the most frequent mitochondrial disease (1 in 27,000–45,000). Its molecular pathogenesis and natural history is now fairly well understood. LHON also is the first mitochondrial disease for which a treatment has been approved (idebenone–Raxone, Santhera Pharmaceuticals) by the European Medicine Agency, under exceptional circumstances because of the rarity and severity of the disease. However, what remains unclear includes the optimal target population, timing, dose, and frequency of administration of idebenone in LHON due to lack of accepted definitions, criteria, and general guidelines for the clinical management of LHON. To address these issues, a consensus conference with a panel of experts from Europe and North America was held in Milan, Italy, in 2016. The intent was to provide expert consensus statements for the clinical and therapeutic management of LHON based on the currently available evidence. We report the conclusions of this conference, providing the guidelines for clinical and therapeutic management of LHON.
Linking nitrogen load to the structure and function of wetland soil and rhizosphere microbial communities
Authors: Hester Eric R , Harpenslager Sarah F. , van Diggelen Josepha MH , Lamers Leon L , Jetten Mike SM , Lüke Claudia , Lücker Sebastian , Welte Cornelia U
Published: October 2017

Wetland ecosystems are important reservoirs of biodiversity and significantly contribute to emissions of the greenhouse gases CO2, N2O and CH4. High anthropogenic nitrogen (N) inputs from agriculture and fossil fuel combustion have been recognized as a severe threat to biodiversity and ecosystem functioning such as control of greenhouse gas emissions. Therefore it is important to understand how increased N input into pristine wetlands affects the composition and activity of micro-organisms, especially in interaction with dominant wetland plants. In a series of incubations analyzed over 90 days, we disentangle the effects of N fertilization on the microbial community in bulk soil and the rhizosphere ofJuncus acutiflorus, a common and abundant graminoid wetland plant. We observed an increase in greenhouse gas emissions when N is increased in incubations withJ. acutiflorus, changing the system from a greenhouse gas sink to a source. Using 16S rRNA amplicon sequencing and metagenomics, we determined that the bacterial orders Opitutales, Subgroup-6 Acidobacteria and Sphingobacteriales significantly responded to high N availability and we hypothesize that these groups are contributing to the increased greenhouse gas emissions. These results indicated that increased N input leads to shifts in microbial activity within the rhizosphere, severely altering N cycling dynamics. Our study provides a framework for connecting environmental conditions of wetland bulk and rhizosphere soil to the structure and metabolic output of microbial communities.
Ixodes scapularisdoes not harbor a stable midgut microbiome
Authors: Ross Benjamin D. , Hayes Beth , Radey Matthew C. , Lee Xia , Josek Tanya , Bjork Jenna , Neitzel David , Paskewitz Susan , Chou Seemay , Mougous Joseph D.
Published: October 2017

Hard ticks of the order Ixodidae serve as vectors for numerous human pathogens, including the causative agent of Lyme DiseaseBorrelia burgdorferi. Tick-associated microbes can influence pathogen colonization, offering the potential to inhibit disease transmission through engineering of the tick microbiota. Here, we investigate whetherB. burgdorferiencounters abundant bacteria within the midgut of wild adultIxodes scapularis, its primary vector. Through the use of controlled sequencing methods and confocal microscopy, we find that the majority of field-collected adultI. scapularisharbor limited internal microbial communities that are dominated by endosymbionts. A minority ofI. scapularisticks harbor abundant midgut bacteria and lackB. burgdorferi. We find that the lack of a stable resident midgut microbiota is not restricted toI. scapularissince extension of our studies toI. pacificus, Amblyomma maculatum, andDermacentorspp showed similar patterns. Finally, bioinformatic examination of theB. burgdorferigenome revealed the absence of genes encoding known interbacterial interaction pathways, a feature unique to theBorreliagenus within the phylumSpirochaetes. Our results suggest that reduced selective pressure from limited microbial populations within ticks may have facilitated the evolutionary loss of genes encoding interbacterial competition pathways fromBorrelia.
Evolving building blocks of rhythm: How human cognition creates music via cultural transmission
Authors: Ravignani Andrea , Thompson Bill , Grossi Thomas , Delgado Tania , Kirby Simon
Published: October 2017

Musical rhythm, in all its cross-cultural diversity, exhibits several commonalities across world cultures. Traditionally, music research has been split in two fields. Some scientists focused on musicality, namely the human biocognitive predispositions for music, with an emphasis on cross-cultural similarities. Other scholars investigated music, seen as cultural product, focusing on the large variation in world musical cultures. Recent experiments found deep connections between music and musicality, reconciling these opposing views. Here we address the question of how individual cognitive biases affect the process of cultural evolution of music. Data from two experiments is analyzed using two different, complementary techniques. In the experiments, participants hear drumming patterns and imitate them. These patterns are then given to the same or another participant to imitate. The structure of these - initially random - patterns is tracked down to later experimental ‘generations’. Frequentist statistics show how participants’ biases are amplified by cultural transmission, making drumming patterns more structured. Structure is achieved faster than in transmission within, rather than between, participants. A Bayesian model approximates the motif structures participants learned and created. Overall, our data and model show that individual biases for musicality play a central role in shaping cultural transmission of musical rhythm.
When less is more: Enhanced statistical learning of non-adjacent dependencies after disruption of bilateral DLPFC
Authors: Ambrus Géza Gergely , Vékony Teodóra , Janacsek Karolina , Trimborn Anna B. C. , Kovács Gyula , Nemeth Dezso
Published: October 2017

Brain networks related to human learning can interact in cooperative but also competitive ways to optimize performance. The investigation of such interactive processes is rare in research on learning and memory. Previous studies have shown that manipulations reducing the engagement of prefrontal cortical areas could lead to improved statistical learning performance. However, no study has investigated how disruption of the dorsolateral prefrontal cortex (DLPFC) affects the acquisition and consolidation of non-adjacent second-order dependencies. The present study aimed to test the role of the DLPFC, more specifically, the Brodmann 9 area in implicit temporal statistical learning of non-adjacent dependencies. We applied 1 Hz inhibitory transcranial magnetic stimulation or sham stimulation over both the left and right DLPFC intermittently during the learning. The DLPFC-stimulated group showed better performance compared to the sham group after a 24-hour consolidation period. This finding suggests that the disruption of DLPFC during learning induces qualitative changes in the consolidation of non-adjacent statistical regularities. A possible mechanism behind this result is that the stimulation of the DLPFC promotes a shift to model-free learning by weakening the access to model-based processes.
Swarmer cell development of the bacteriumProteus mirabilisrequires the conserved ECA biosynthesis gene,rffG
Authors: Little Kristin , Tipping Murray J. , Gibbs Karine A.
Published: October 2017

Individual cells of the bacteriumProteus mirabiliscan elongate up to 40-fold on surfaces before engaging in a cooperative surface-based motility termed swarming. How cells regulate this dramatic morphological remodeling remains an open question. In this paper, we move forward the understanding of this regulation by demonstrating thatP. mirabilisrequires the generffGfor swarmer cell elongation and subsequent swarm motility. TherffGgene encodes a protein homologous to the dTDP-glucose 4,6 dehydratase protein ofEscherichia coli, which contributes to Enterobacterial Common Antigen biosynthesis. Here we characterize therffGgene inP. mirabilis, demonstrating that it is required for the production of large lipopolysaccharide-linked moieties necessary for wild-type cell envelope integrity. We show that absence of therffGgene induces several stress-responsive pathways including those controlled by the transcriptional regulators RpoS, CaiF, and RcsB. We further show that inrffG-deficient cells, suppression of the Rcs phosphorelay, via loss of RcsB, is sufficient to induce cell elongation and swarm motility. However, loss of RcsB does not rescue cell envelope integrity defects and instead results in abnormally shaped cells, including cells producing more than two poles. We conclude that a RcsB-mediated response acts to suppress emergence of shape defects in cell envelope-compromised cells, suggesting an additional role for RcsB in maintaining cell morphology under stress conditions. We further propose that the composition of the cell envelope acts as a checkpoint before cells initiate swarmer cell elongation and motility.

Importance statement

P. mirabilisswarm motility has been implicated in pathogenesis. We have found that cells deploy multiple uncharacterized strategies to handle cell envelope stress beyond the Rcs phosphorelay when attempting to engage in swarm motility. While RcsB is known to directly inhibit the master transcriptional regulator for swarming, we have shown an additional role for RcsB in protecting cell morphology. These data support a growing appreciation that the Rcs phosphorelay is a multi-functional regulator of cell morphology in addition to its role in microbial stress responses. These data also strengthen the paradigm that outer membrane composition is a crucial checkpoint for modulating entry into swarm motility. Furthermore, therffG-dependent moieties provide a novel, attractive target for potential antimicrobials.