bluuebunny/crossref_metadata_2025 huggingface dataset:
Accuracy of fully automated right ventricular quantification software with 3D echocardiography: direct comparison with cardiac magnetic resonance and semi-automated quantification software
Authors: Otani Kyoko , Nabeshima Yosuke , Kitano Tetsuji , Takeuchi Masaaki
Published: August 2019

Aims

The aim of this study was to determine the accuracy and reproducibility of a novel, fully automated 3D echocardiography (3DE) right ventricular (RV) quantification software compared with cardiac magnetic resonance (CMR) and semi-automated 3DE RV quantification software.

Methods and results

RV volumes and the RV ejection fraction (RVEF) were measured using a fully automated software (Philips), a semi-automated software (TomTec), and CMR in 100 patients who had undergone both CMR and 3DE examinations on the same day. The feasibility of the fully automated software was 91%. Although the fully automated software, without any manual editing, significantly underestimated RV end-diastolic volume (bias: −12.6 mL, P < 0.001) and stroke volume (−5.1 mL, P < 0.001) compared with CMR, there were good correlations between the two modalities (r = 0.82 and 0.78). No significant differences in RVEF between the fully automated software and CMR were observed, and there was a fair correlation (r = 0.72). The RVEF determined by the semi-automated software was significantly larger than that by CMR or the fully automated software (P < 0.001). The fully automated software had a shorter analysis time compared with the semi-automated software (15 s vs. 120 s, P < 0.001) and had a good reproducibility.

Conclusion

A novel, fully automated 3DE RV quantification software underestimated RV volumes but successfully approximated RVEF when compared with CMR. No inferiority of this software was observed when compared with the semi-automated software. Rapid analysis and higher reproducibility also support the routine adoption of this method in the daily clinical workflow.
Improving Genetic Analysis of Corymbia citriodora subsp. variegata with Single- and Multiple-Trait Spatial-Competition Models
Authors: Hernández Mariano Agustín , López Juan Adolfo , Cappa Eduardo Pablo
Published: August 2019

Environmental heterogeneity and/or genetic and environmental competition were quantified on two growth traits, diameter at breast height and total height, and wood density in a progeny trial of Corymbia citriodora subsp. variegata. Three single-trait mixed models with random spatial and/or competition effects were compared to a standard analysis by analyzing fit, dispersion parameters, accuracy of breeding values, genetic gains, and ranking of trees. In addition, a multiple-trait spatial-competition model was fitted to estimate correlations among direct and indirect additive genetic effects, and to explore relations between traits. Single-trait analyses with spatial and/or competition effects outperformed the standard model. However, the performance of these models depended on the sensitivity of each trait to detect each effect. Direct–indirect genetic correlations from the multiple-trait spatial-competition model showed inverse and strong relations among growth traits and wood density, suggesting that growth traits can be affected by competition and environmental heterogeneity, but also wood density might be influenced by these effects. The approach proposed was useful to improve the genetic analysis of the species as well as to gain an understanding of the genetic relations between traits under the influence of environmental heterogeneity and competition.
Event-triggered Hꝏ control for NCS with time-delay and packet losses
Authors: Bai Jing , Wang Ying , Zhao Li-Ying
Published: August 2019

This paper is concerned with the discrete event-triggered dynamic output-feedback ${H}_{\infty }$ control problem for the uncertain networked control system, where the time-varying sampling, network-induced delay and packet losses are taken into account simultaneously. The random packet losses are described via the Bernoulli distribution. And then, the closed-loop system is modelled as an augmented time-delay system with interval time-varying delay. By using the Lyapunov stability theory and the augmented state space method, the sufficient conditions for the asymptotic stability of the closed-loop system are proposed in the form of linear matrix inequalities. At the same time, the design method of the ${H}_{\infty }$ controller is created. Finally, a numerical example is employed to illustrate the effectiveness of the proposed method.
Minimal Boundaries in Tonelli Lagrangian Systems
Authors: Asselle Luca , Benedetti Gabriele , Mazzucchelli Marco
Published: August 2019

We prove several new results concerning action minimizing periodic orbits of Tonelli Lagrangian systems on an oriented closed surface $M$. More specifically, we show that for every energy larger than the maximal energy of a constant orbit and smaller than or equal to the Mañé critical value of the universal abelian cover, the Lagrangian system admits a minimal boundary, that is, a global minimizer of the Lagrangian action on the space of smooth boundaries of open sets of $M$. We also extend the celebrated graph theorem of Mather in this context: in the tangent bundle $\textrm{T} M$, the union of the supports of all lifted minimal boundaries with a given energy projects injectively to the base $M$. Finally, we prove the existence of action minimizing simple periodic orbits on energies just above the Mañé critical value of the universal abelian cover. This provides in particular a class of nonreversible Finsler metrics on the two-sphere possessing infinitely many closed geodesics.
Influenza Vaccine Effectiveness in Preventing Hospitalizations in Older Patients With Chronic Obstructive Pulmonary Disease
Authors: Gershon Andrea S , Chung Hannah , Porter Joan , Campitelli Michael A , Buchan Sarah A , Schwartz Kevin L , Crowcroft Natasha S , Campigotto Aaron , Gubbay Jonathan B , Karnauchow Timothy , Katz Kevin , McGeer Allison J , McNally J Dayre , Richardson David C , Richardson Susan E , Rosella Laura C , Simor Andrew E , Smieja Marek , Zahariadis George , Kwong Jeffrey C
Published: August 2019

Background

Annual influenza immunization is recommended for people with chronic obstructive pulmonary disease (COPD) by all major COPD clinical practice guidelines. We sought to determine the seasonal influenza vaccine effectiveness (VE) against laboratory-confirmed influenza-associated hospitalizations among older adults with COPD.

Methods

We conducted a test-negative study of influenza VE in community-dwelling older adults with COPD in Ontario, Canada using health administrative data and respiratory specimens collected from patients tested for influenza during the 2010–11 to 2015–16 influenza seasons. Influenza vaccination was ascertained from physician and pharmacist billing claims. Multivariable logistic regression was used to estimate the adjusted odds ratio of influenza vaccination in people with, compared to those without, laboratory-confirmed influenza.

Results

Receipt of seasonal influenza vaccine was associated with an adjusted 22% (95% confidence interval [CI], 15%–27%) reduction in laboratory-confirmed influenza-associated hospitalization. Adjustment for potential misclassification of vaccination status increased this to 43% (95% CI, 35%–52%). Vaccine effectiveness was not found to vary by patient- or influenza-related variables.

Conclusions

During the studied influenza seasons, influenza vaccination was at least modestly effective in reducing laboratory-confirmed influenza-associated hospitalizations in people with COPD. The imperfect effectiveness emphasizes the need for better influenza vaccines and other preventive strategies.
Associations Between Restrictive Fluid Management and Renal Function and Tissue Perfusion in Adults With Severe Falciparum Malaria: A Prospective Observational Study
Authors: Ishioka Haruhiko , Plewes Katherine , Pattnaik Rajyabardhan , Kingston Hugh W F , Leopold Stije J , Herdman M Trent , Mahanta Kishore , Mohanty Anita , Dey Chandan , Alam Shamsul , Srinamon Ketsanee , Mohanty Akshaya , Maude Richard J , White Nicholas J , Day Nicholas P J , Hossain Md Amir , Faiz Md Abul , Charunwatthana Prakaykaew , Mohanty Sanjib , Ghose Aniruddha , Dondorp Arjen M
Published: August 2019

Background

Liberal fluid resuscitation has proved harmful in adults with severe malaria, but the level of restriction has not been defined.

Methods

In a prospective observational study in adults with severe falciparum malaria, restrictive fluid management was provided at the discretion of the treating physician. The relationships between the volume of fluid and changes in renal function or tissue perfusion were evaluated.

Results

A total of 154 patients were studied, 41 (26.6%) of whom died. Median total fluid intake during the first 6 and 24 hours from enrollment was 3.3 (interquartile range [IQR], 1.8–5.1) mL/kg per hour and 2.2 (IQR, 1.6–3.2) mL/kg per hour, respectively. Total fluid intake at 6 hours was not correlated with changes in plasma creatinine at 24 hours (n = 116; rs = 0.16; P = .089) or lactate at 6 hours (n = 94; rs = −0.05; P = .660). Development of hypotensive shock or pulmonary edema within 24 hours after enrollment were not related to the volume of fluid administration.

Conclusions

Restrictive fluid management did not worsen kidney function and tissue perfusion in adult patients with severe falciparum malaria. We suggest crystalloid administration of 2–3 mL/kg per hour during the first 24 hours without bolus therapy, unless the patient is hypotensive.
Trends in hospital standardized mortality ratios for stroke in Japan between 2012 and 2016: a retrospective observational study
Authors: Amin Rebeka , Kitazawa Takefumi , Hatakeyama Yosuke , Matsumoto Kunichika , Fujita Shigeru , Seto Kanako , Hasegawa Tomonori
Published: August 2019

Objective

Stroke is one of the leading causes of death and disability, and imposes a major healthcare burden. The aim of this study was to determine the characteristics of hospital standardized mortality ratios (HSMRs) for stroke in Japan for the year 2012–16 to describe the trend.

Design

Retrospective observational study.

Setting

Data from the Japanese administrative database.

Participants

All hospital admissions for stroke were identified from diagnostic procedures combination (DPC) database from 2012 to 2016.

Main Outcome Measures

HSMR was calculated using the actual number of in-hospital deaths and expected deaths. To obtain the expected death number, a logistic regression model was developed to get the coefficient with a number of explanatory variables. Predictive accuracy of the logistic models was assessed using c-index and calibration was evaluated using the Hosmer–Lemeshow test.

Results

A total of 63 084 patients admitted for stroke from January 2012 to December 2016 were analyzed. HSMRs showed declining tendency over these 5 years, suggesting stroke-related mortality has been improving. While the HSMRs varied from year to year, a wide variation was also seen among the different hospitals in Japan. The proportion of hospitals with HSMR less than 100 increased from 41.0% in 2012 to 59.0% in 2016.

Conclusion

This study demonstrated that HSMR can be calculated using DPC data and found wide variation in HSMR of stroke among hospitals in Japan and enabled us to image the trend. By examining these trends, facilities, authorities and provinces can initiate designs that will ultimately lead to an upgraded healthcare delivery system.
Predicting emergency department orders with multilabel machine learning techniques and simulating effects on length of stay
Authors: Hunter-Zinck Haley S , Peck Jordan S , Strout Tania D , Gaehde Stephan A
Published: August 2019

Objective

Emergency departments (EDs) continue to pursue optimal patient flow without sacrificing quality of care. The speed with which a healthcare provider receives pertinent information, such as results from clinical orders, can impact flow. We seek to determine if clinical ordering behavior can be predicted at triage during an ED visit.

Materials and Methods

Using data available during triage, we trained multilabel machine learning classifiers to predict clinical orders placed during an ED visit. We benchmarked 4 classifiers with 2 multilabel learning frameworks that predict orders independently (binary relevance) or simultaneously (random k-labelsets). We evaluated algorithm performance, calculated variable importance, and conducted a simple simulation study to examine the effects of algorithm implementation on length of stay and cost.

Results

Aggregate performance across orders was highest when predicting orders independently with a multilayer perceptron (median F1 score = 0.56), but prediction frameworks that simultaneously predict orders for a visit enhanced predictive performance for correlated orders. Visit acuity was the most important predictor for most orders. Simulation results indicated that direct implementation of the model would increase ordering costs (from $21 to $45 per visit) but reduce length of stay (from 158 minutes to 151 minutes) over all visits.

Discussion

Simulated implementations of the predictive algorithm decreased length of stay but increased ordering costs. Optimal implementation of these predictions to reduce patient length of stay without incurring additional costs requires more exploration.

Conclusions

It is possible to predict common clinical orders placed during an ED visit with data available at triage.
Effect of supplementation of pelleted hazel (Corylus avellana) leaves on blood antioxidant activity, cellular immune response, and heart beat parameters in sheep1
Authors: Wang Shaopu , Giller Katrin , Hillmann Edna , Marquardt Svenja , Schwarm Angela
Published: August 2019

Hazel leaves (Corylus avellana) fed to sheep resulted in decreased methane emissions without negatively affecting feed intake and were found to have antioxidant properties in vitro. The objective of this study was to evaluate effects of hazel leaves, rich in tannins, on blood antioxidant activity, cellular immune response, and heart beat parameters in sheep. Four experimental pellets were produced by mixing alfalfa and hazel leaves in different proportions, including alfalfa alone as a control, 30% and 60% of hazel leaves, the latter also with 3.8% polyethylene glycol (PEG). Six adult, nonpregnant, nonlactating female sheep (71 ± 5.7 kg of body weight) were allocated to 4 treatments in a 6 × 4 crossover design with four 18-d periods. The diet consisted of experimental pellets and ryegrass-dominated hay (ratio 80% to 20% in dry matter), resulting in hazel leaf proportions of approximately 0%, 25%, and 50% in the total diet. Blood samples were collected at the end of each period to determine plasma total phenol concentration and markers of oxidative status as well as peripheral blood mononuclear cells (PBMC) activation and proliferation response in vitro. Heart rate (HR) and HR variability parameters were measured for 2 consecutive days in each period, during different activities (i.e., eating pellets or hay, or lying). Treatments were compared with multiple comparisons and contrast analysis was used to test for linear and quadratic relations. Compared with control, feeding a high dosage of hazel leaves enhanced (P = 0.006) the plasma total antioxidant capacity, which linearly (P = 0.016) increased with increasing level of hazel leaves in the diet. The total phenol concentration and activities of the antioxidant enzymes superoxide dismutase, catalase, and glutathione reductase in the plasma were not different (P ≥ 0.23) among the treatments; however, the latter slightly increased linearly (P = 0.047) with increasing hazel leaves proportion. No differences were observed in the activation and proliferation of PBMC among treatments. The HR decreased linearly (P ≤ 0.009) during pellet eating and lying and the root mean square of successive differences of interbeat intervals (RMSSD) increased linearly (P = 0.037) when lying with increasing level of hazel leaves in the diet. In conclusion, our findings indicate that hazel leaves are a promising supplement to improve oxidative status with no effect on cellular immune response and cardiac stress level of sheep.
Geostatistical Assessment of Frankliniella schultzei (Thysanoptera: Thripidae) Spatial Distribution in Commercial Watermelon Crops
Authors: Pereira Poliana Silvestre , Sarmento Renato Almeida , Lima Carlos Henrique Oliveira , Pinto Cleovan Barbosa , Silva Gerson Adriano , Dos Santos Gil Rodrigues , Picanço Marcelo Coutinho
Published: August 2019

Spatial distribution studies of insect pests make it possible to determine their colonization and dispersal patterns. Watermelon (Citrullus lanatus (Thunb.) Matsum. et Nakai) is among the most frequently consumed fruits in the world, and the common blossom thrips, Frankliniella schultzei (Trybom) (Thysanoptera: Thripidae), is one of the most important insect pests of this plant. The objective of this study was to determine the spatial distribution of F. schultzei in commercial watermelon crops using geostatistics. The studied F. schultzei populations presented an aggregated distribution. The colonization of thrips began at the borders of the crops, especially in the areas located in the opposite direction to that of the prevailing winds. The highest densities of thrips occurred in crops that had cucurbits in the surrounding areas. When monitoring for F. schultzei populations, greater attention should be given to sampling that part of the crop located in the opposite direction to that of the prevailing winds because this is where colonization begins. Even at low densities, the aggregation points of thrips in the crop should be located and controlled so that they do not cause damage. In sampling programs for F. schultzei, samples should be taken at distances greater than 9 m apart because this is the distance up to which densities of this species show spatial dependence. Planting watermelon crops close to other cucurbits should be avoided, as these alternate hosts may act as a source of infestation by this pest.
A wavenumber-domain iterative approach for 3D imaging of magnetic anomalies and gradients with depth constraints
Authors: Cui Yatong , Guo Lianghui
Published: August 2019

Three-dimensional magnetic inversion, based on the least-square and regularization algorithm in the space domain, is an important tool for quantitative interpretation of magnetic data. However, the common 3D inversion approaches usually require great numbers of forward and inversion calculations and cause low efficiency for inverting large-scale data. Three-dimensional imaging is an alternate rapid tool for qualitative and quantitative interpretation of magnetic data. In this paper, we present a wavenumber-domain iterative approach for 3D imaging of magnetic anomalies and gradients, which could increase imaging efficiency and is suitable for rapidly imaging large-scale data. The wavenumber-domain formulas for forward modeling and imaging of total magnetic anomaly, three magnetic components, magnetic gradients and magnetic full-tensor gradients are deduced and provided. A depth-scale factor and the constraints of magnetic interface are included into the imaging formulas to enhance depth resolution. An iterative algorithm is adopted for the imaging to reduce the fitting error and improve the imaging accuracy. Tests on synthetic and real data from the Sichuan basin, China, verified the feasibility of the presented approaches.
Development and Validation of the Adolescent Insomnia Questionnaire
Authors: Bromberg Maggie H , de la Vega Rocio , Law Emily F , Zhou Chuan , Palermo Tonya M
Published: August 2019

Objective

Insomnia is a highly prevalent sleep disorder that is particularly common among adolescents with health conditions. We aimed to develop and validate a brief screening measure of insomnia in adolescents that can be used across clinical and community samples. We hypothesized that we would identify evidence supporting reliability, convergent/discriminant validity, and that we would determine preliminary clinical cutoff scores.

Methods

A team of experts in behavioral sleep medicine developed a 13-item brief screening measure of insomnia in adolescents (Adolescent Insomnia Questionnaire [AIQ]). We evaluated the psychometric properties of the AIQ in a sample of 315 youth (11–18 years old, Mean = 14.90, SD = 2.02; 64% female) who had chronic pain (n = 37), headache (n = 170), insomnia diagnosed by a sleep specialist (n = 22), or were otherwise healthy (n = 86).

Results

Using Exploratory and Confirmatory Factor Analysis, we identified three subscales consistent with major diagnostic criteria of insomnia. As expected, the measure showed strong reliability through high internal consistency (α =.91). We also found strong convergent validity through expected positive relationships between the AIQ and self-report measures of sleep disturbance, and divergent validity via weak relationships with parent-report of snoring. Results of receiver operating characteristic (ROC) identified a clinical cutoff score that may assist in clinical decision making.

Conclusions

We found that the AIQ has sound psychometric properties in a large heterogeneous sample of treatment-seeking youth and youth from the community. The AIQ can quickly screen adolescent insomnia and could address an important clinical need in identifying youth in need of insomnia treatment in pediatric practice settings.
Polymicrobial infection with Kluyvera species secondary to pressure necrosis of the hand, a case report
Authors: Metoyer Garyn T , Huff Scott , Johnson R Michael
Published: August 2019

Kluyvera is a rare infection in the upper extremity. Originally identified as an opportunistic pathogen, the virulence of Kluyvera has been debated. An elderly male presented with multiple pressure sores after being found down for an unknown time period. A hand abscess bacterial culture grew Kluyvera species as part of a polymicrobial infection. Despite multiple debridements, antibiotics and wound care, his clinical course ultimately was unsatisfactory and eventually fatal.
A national survey of the enteral feeding practices in Canadian neonatal intensive care units
Authors: Xu James Haiyang , Coo Helen , Fucile Sandra , Ng Eugene , Ting Joseph Y , Shah Prakesh S , Dow Kimberly ,   Canadian Neonatal Network Investigators
Published: August 2019

Aim

Nutrition affects the growth and neurodevelopmental outcomes of preterm infants, yet controversies exist about the optimal enteral feeding regime. The objective of this study was to compare enteral feeding guidelines in Canadian neonatal intensive care units (NICUs).

Method

The research team identified key enteral feeding practices of interest. Canadian Neonatal Network site investigators at 30 Level 3 NICUs were contacted to obtain a copy of their 2016 to 2017 feeding guidelines for infants who weighed less than 1,500 g at birth. Each guideline was reviewed to compare recommendations around the selected feeding practices.

Results

Five of the 30 NICUs did not have a feeding guideline. The other 25 NICUs used 22 different enteral feeding guidelines. The guidelines in 40% of those NICUs recommend commencing minimal enteral nutrition (MEN) within 24 hours of birth and maintaining that same feeding volume for 24 to 96 hours. In 40% of NICUs, the guideline recommended that MEN be initiated at a volume of 5 to 10 mL/kg/day for infants born at <1,000 g. Guidelines in all 25 NICUs recommend the use of bovine-based human milk fortifier (HMF), and in 56% of NICUs, it is recommended that HMF be initiated at a total fluid intake of 100 mL/kg/day. Guidelines in only 16% of NICUs recommended routine gastric residual checks. Donor milk and probiotics are used in 76% and 72% of the 25 NICUs, respectively.

Conclusion

This study revealed substantial variability in recommended feeding practices for very low birth weight infants, underscoring the need to establish a national feeding guideline for this vulnerable group.
Bearing the White Man’s Burden: American Empire and the Origin of Public Administration
Authors: Roberts Alasdair
Published: August 2019

There is an overlooked chapter in the history of American public administration: the experiment with colonial administration in the two decades following the Spanish-American War. Several scholars now identified as pioneers of American public administration were actively engaged in this project. They studied European empires closely to determine how the new American dependencies should be governed. This work was guided by beliefs about racial superiority and the duty of civilized nations to improve uncivilized peoples through colonization. This episode of administrative history provides insight into how American academics thought about race and public administration in the early decades of the twentieth century, both overseas and within the United States. It compels a reassessment of our understandings about their commitment to democracy, and about the supposed differences between American and European public administration at that time.
Neural signatures of child cognitive emotion regulation are bolstered by parental social regulation in two cultures
Authors: Myruski Sarah , Birk Samantha , Karasawa Mayumi , Kamikubo Aya , Kazama Midori , Hirabayashi Hidemi , Dennis-Tiwary Tracy
Published: August 2019

Caregiver impact on the efficacy of cognitive emotion regulation (ER; i.e. reappraisal) during childhood is poorly understood, particularly across cultures. We tested the hypothesis that in children from Japan and the USA, a neurocognitive signature of effective reappraisal, the late positive potential (LPP), will be bolstered by cognitive scaffolding by parents, and explored whether the two cultures differed in whether mere physical proximity of parents provides similar benefit. Five-to-seven-year-olds (N = 116; nJapan = 58; nUSA = 58) completed a directed reappraisal task (EEG-recorded) in one of three contexts: (i) parent-scaffolding, (ii) parent-present and (iii) parent-absent. Across cultures, those in the parent-scaffolding group and parent-present group showed effective reappraisal via the LPP relative to those in the parent-absent group. Results suggest that scaffolding is an effective method through which parents in these two cultures buttress child ER, and even parental passive proximity appears to have a meaningful effect on child ER across cultures.
Conservation and divergence of ancestral AGAMOUS/SEEDSTICK subfamily genes from the basal angiosperm Magnolia wufengensis
Authors: Ma Jiang , Deng Shixin , Jia Zhongkui , Sang Ziyang , Zhu Zhonglong , Zhou Chao , Ma Lvyi , Chen Faju
Published: August 2019

AGAMOUS/SEEDSTICK (AG/STK) subfamily genes play crucial roles in the reproductive development of plants. However, most of our current knowledge of AG/STK subfamily genes is restricted to core eudicots and grasses, and the knowledge of ancestral exon–intron structures, expression patterns, protein–protein interaction patterns and functions of AG/STK subfamily genes remains unclear. To determine these, we isolated AG/STK subfamily genes (MawuAG1, MawuAG2 and MawuSTK) from a woody basal angiosperm Magnolia wufengensis (Magnoliaceae). MawuSTK arose from the gene duplication event occurring before the diversification of extant angiosperms, and MawuAG1 and MawuAG2 may result from a gene duplication event occurring before the divergence of Magnoliaceae and Lauraceae. Gene duplication led to apparent diversification in their expression and interaction patterns. It revealed that expression in both stamens and carpels likely represents the ancestral expression profiles of AG lineage genes, and expression of STK-like genes in stamens may have been lost soon after the appearance of the STK lineage. Moreover, AG/STK subfamily proteins may have immediately established interactions with the SEPALLATA (SEP) subfamily proteins following the emergence of the SEP subfamily; however, their interactions with the APETALA1/FRUITFULL subfamily proteins or themselves differ from those found in monocots and basal and core eudicots. MawuAG1 plays highly conserved roles in the determinacy of stamen, carpel and ovule identity, while gene duplication contributed to the functional diversification of MawuAG2 and MawuSTK. In addition, we investigated the evolutionary history of exon–intron structural changes of the AG/STK subfamily, and a novel splice-acceptor mode (GUU-AU) and the convergent evolution of N-terminal extension in the euAG and PLE subclades were revealed for the first time. These results further advance our understanding of ancestral AG/STK subfamily genes in terms of phylogeny, exon–intron structures, expression and interaction patterns, and functions, and provide strong evidence for the significance of gene duplication in the expansion and evolution of the AG/STK subfamily.
A conditional mouse model of complex II deficiency manifesting as Leigh‐like syndrome
Authors: Khazal Fatimah Al , Holte Molly Nelson , Bolon Brad , White Thomas A. , LeBrasseur Nathan , III L. James Maher
Published: August 2019

Leigh syndrome embodies degenerative disorders with a collection of symptoms secondary to inborn errors of metabolism. Combinations of hypomorphic and loss‐of‐function alleles in many genes have been shown to result in Leigh syndrome. Interestingly, deficiency for the tricarboxylic acid cycle enzyme succinate dehydrogenase (SDH) can lead to Leigh‐like syndrome in some circumstances and to cancer (paraganglioma, renal cell carcinoma, gastrointestinal stromal tumor) in others. In our experiments originally intended to create an inducible whole‐body SDH‐loss mouse model of tumorigenesis, we generated a condition reminiscent of Leigh‐like syndrome that is lethal to mice within 4 wk. Remarkably, as has been shown for other mitochondrial diseases, chronic hypoxia offers substantial protection to mice from this condition after systemic SDH loss, allowing survival in the context of profoundly impaired oxidative metabolism.—Al Khazal, F., Holte, M. N., Bolon, B., White, T. A., LeBrasseur, N., Maher, L. J. III. A conditional mouse model of complex II deficiency manifesting as Leigh‐like syndrome. FASEB J. 33, 13189–13201 (2019). www.fasebj.org
Enhanced mTOR complex 1 signaling attenuates diabetic cardiac injury in OVE26 mice
Authors: Xu Xianmin , Kobayashi Satoru , Timm Derek , Huang Yuan , Zhao Fengyi , Shou Weinian , Liang Qiangrong
Published: August 2019

The protein kinase mechanistic target of rapamycin (mTOR) performs diverse cellular functions through 2 distinct multiprotein complexes, mTOR complex (mTORC)1 and 2. Numerous studies using rapamycin, an mTORC1 inhibitor, have implicated a role for mTORC1 in several types of heart disease. People with diabetes are more susceptible to heart failure. mTORC1 activity is increased in the diabetic heart, but its functional significance remains controversial. To investigate the role of mTORC1 in the diabetic heart, we crossed OVE26 type 1 diabetic mice with transgenic mice expressing a constitutively active mTOR (mTORca) or kinase‐dead mTOR (mTORkd) in the heart. The expression of mTORca or mTORkd affected only mTORC1 but not mTORC2 activities, with corresponding changes in the activities of autophagy, a cellular degradation pathway negatively regulated by mTORC1. Diabetic cardiac damage in OVE26 mice was dramatically reduced by mTORca but exacerbated by mTORkd expression as assessed by changes in cardiac function, oxidative stress, and myocyte apoptosis. These findings demonstrated that the enhanced mTORC1 signaling in the OVE26 diabetic heart was an adaptive response that limited cardiac dysfunction, suggesting that manipulations that enhance mTORC1 activity may reduce diabetic cardiac injury, in sharp contrast to the results previously obtained with rapamycin.—Xu, X., Kobayashi, S., Timm, D., Huang, Y., Zhao, F., Shou, W., Liang, Q. Enhanced mTOR complex 1 signaling attenuates diabetic cardiac injury in OVE26 mice. FASEB J. 33, 12800–12811 (2019). www.fasebj.org
The neuronal oxygen‐sensing pathway controls postnatal vascularization of the murine brain
Authors: Nasyrov Emil , Nolan Karen A. , Wenger Roland H. , Marti Hugo H. , Kunze Reiner
Published: August 2019

The contribution of neurons to growth and refinement of the microvasculature during postnatal brain development is only partially understood. Tissue hypoxia is the physiologic stimulus for angiogenesis by enhancing angiogenic mediators partly through activation of hypoxia‐inducible factors (HIFs). Hence, we investigated the HIF oxygen‐sensing pathway in postmitotic neurons for physiologic angiogenesis in the murine forebrain during postnatal development by using mice lacking the HIF suppressing enzyme prolyl‐4‐hydroxylase domain (PHD)2 and/or HIF‐1/2α in postmitotic neurons. Perinatal activation or inactivation of the HIF pathway in neurons inversely modulated brain vascularization, including endothelial cell number and proliferation, density of total and perfused microvessels, and vascular branching. Accordingly, several angiogenesis‐related genes were up‐regulated in vivo and in primary neurons derived from PHD2‐deficient mice. Among them, only VEGF and adrenomedullin (Adm) promoted angiogenic sprouting of brain endothelial cells. VEGF and Adm additively enhanced endothelial sprouting through activation of multiple pathways. PHD2 deficiency in neurons caused HIF‐α stabilization and increased VEGF mRNA levels not only in neurons but unexpectedly also in astrocytes, suggesting a new mechanism of neuron‐to‐astrocyte signaling. Collectively, our results identify the PHD‐HIF pathway in neurons as an important determinant for vascularization of the brain during postnatal development.—Nasyrov, E., Nolan, K. A., Wenger, R. H., Marti, H. H., Kunze, R. The neuronal oxygen‐sensing pathway controls postnatal vascularization of the murine brain. FASEB J. 33, 12812–12824 (2019). www.fasebj.org
The Use of Tai-Chi to Reduce Anxiety Among Nursing Students Undergoing Simulation
Authors: Mulcahy Angela , Holland Brian , Gosselin Kevin , Pittman Alison
Published: August 2019

This study sought to examine tai-chi as an anxiety-reducing method to increase self-efficacy and improve performance among baccalaureate nursing students experiencing a patient care simulation. The sample included 63 nursing students enrolled in a traditional or second-degree nursing program. The study used a randomized control group pretest-posttest design. Students in the experimental group experienced significant reductions in cognitive and somatic anxiety, along with an increase in self-efficacy and improved performance. Tai-chi can be an effective technique to reduce anxiety and improve self-efficacy and performance among nursing students in simulations.
Partnering for Success: Development and Implementation of an Interprofessional Community-Academic Navigation Program
Authors: Testut Tammy A.
Published: August 2019

Sacred Heart University College of Nursing and Western Connecticut Healthcare Network developed an innovative community/academic partnership program known as iCAN (Interprofessional Community-Academic Navigation). The goal was to navigate services for some of the most vulnerable clients in the community. Challenges are inevitable within any partnership, but the team combated challenges and created a successful collaborative student program. Increased awareness into social determinants of health as well as improved client navigation to community services are among the powerful outcomes of this productive partnership.
High Readmission Rates and Mental Distress 1 yr After Ablation for Atrial Fibrillation or Atrial Flutter
Authors: Risom Signe Stelling , Zwisler Ann-Dorthe , Thygesen Lau Caspar , Svendsen Jesper Hastrup , Berg Selina Kikkenborg
Published: August 2019

Purpose:

Today, catheter ablation is a widely used treatment for atrial fibrillation (AF) and atrial flutter (AFL). Knowledge on long-term patient-reported outcomes and readmissions is lacking and is warranted to plan optimal follow-up care. Objectives were to describe patient-reported outcomes including perceived health, quality of life, anxiety, depression, and physical activity compared with an age- and sex-matched reference population without longstanding disease; readmissions and mortality; and factors associated with suboptimal patient-reported outcomes.

Methods:

A nationwide cross-sectional survey mailed to 627 adults 6 to 12 mo after ablation for AF or AFL including; Short Form-36 (SF-36), HeartQoL, Hospital Anxiety Depression Scale, and questions about physical activity. Readmission rates and mortality were obtained and regression analyses were performed.

Results:

Comparing the patient group (response rate: 74%, n = 462) with an age- and sex-matched reference population with no long-lasting disease, differences were found in all subscales of SF-36 and leisure-time physical activity in favor of the reference group (P < .001). Within 1 yr, 411 patients (59%) were readmitted and the total number of readmissions was 1167. Altogether, 227 (33%) patients were electively readmitted and 330 (48%) were acutely readmitted. Ten patients (1.4%) died. Age > 59 yr, female sex, high comorbidity, and readmission were associated with low physical health, low perceived health, and low quality of life.

Conclusions:

Patients treated for AF or AFL experienced decreased mental and physical health and high readmission rates 6 to 12 mo following catheter ablation. Closer multidisciplinary follow-up or cardiac rehabilitation after ablation for AF or AFL may be needed.
Imaging Biomarkers for Dry Eye Disease
Authors: Villani Edoardo , Bonsignore Francesco , Cantalamessa Elisa , Serafino Massimiliano , Nucci Paolo
Published: August 2019

The clinical, scientific, economic, and regulatory impact of validated biomarkers and surrogate endpoints has the potential to revolutionize the approach to ocular surface diseases. At present, there is a growing interest in developing biomarkers for dry eye disease, and other ocular surface disorders and imaging are of the most promising approaches to this issue. Among the several and constantly evolving imaging technologies, some tools that are aimed to assess tear film stability and volume, meibomian gland morphology and function, and ocular surface microanatomy are now supported by a good body of evidence. To date, clinical trials on ocular surface diseases have slowly started incorporating imaging biomarkers for disease diagnosis and stratification and as surrogate endpoints. Major efforts are still needed, mainly aimed to improve automatic acquisition and quantitative analysis, standardization (standard operating procedures, normative databases etc.), and validation of imaging biomarkers.
Intrasession Repeatability of the Contact Angle Measured Using the Captive Bubble Method and Agreement Assessed Between Different Analysis Software Programs
Authors: Sanchez Irene , Carmona Francisco Javier , Gonzalez-Puertas Sara , Valiente Angela , Martin Raul
Published: August 2019

Objectives:

The material biocompatibility of hydrogel and silicone hydrogel (SiHy) contact lens (CL) is of paramount importance in CL wear because a decrease in CL wettability reduces wearer comfort and increases wearer dropout. The aim of this study is to report on the repeatability and agreement between two different software programs that measure the contact angle with the captive bubble method in marketed CLs, which will help to translate this information into clinical practice.

Methods:

The contact angle of 23 different CLs was measured with the captive bubble method using 2 software programs: FTÅ200 and ImageJ. Three consecutive measurements were conducted for each CL. Reproducibility, repeatability, and agreement values were calculated according to the British Standards Institute and the International Organization for Standardization.

Results:

All methods showed good repeatability values in both CL materials (coefficient of variation <1.51%, Sw <2.26°, intraclass correlation coefficient >0.89, and the range of limits of agreement was between 7.22° and 7.57°). Higher concordance was achieved between the spherical and nonspherical options when using FTÅ200 software than when using ImageJ software. Statistically significant differences (P<0.05) between the 2 software programs were found, and they ranged between 5° and 10°.

Conclusions:

The captive bubble method showed great repeatability in measuring the contact angle in marketed CLs with both software programs (FTÅ200 and ImageJ) assessed in this study. However, differences in the measured contact angles suggest that these techniques are not interchangeable. Therefore, standardization is recommended for contact angle measurement in hydrogel CL materials to facilitate comparisons, to improve clinical use of this information, and to analyze their impact in CL user comfort.
A Comparison of Dressing Techniques for Presurgical Closure of Myelomeningocele in the Neonate
Authors: Cartwright Cathy C. , Igbaseimokumo Usiakimi , Olsen Steven
Published: August 2019

BACKGROUND: Myelomeningoceles are routinely closed surgically within 24 to 48 hours after birth; the defect and exposed placode must be protected from further damage from excoriation and contamination until surgery. PURPOSE: Two methods to keep the defect moist and clean are used at our large Midwestern children's hospital: the occlusive and the drip. There was no agreement between the neonatal and neurosurgical teams as to which technique was superior, hence the need for a formal evaluation. METHODS: A prospective, randomized trial was conducted to compare the ease of nursing care, cost of supplies, neonatal temperature, and moisture of the placode at the time of closure in neonates with a myelomeningocele. RESULTS: Nurses categorized the occlusive group as easy care (100%) compared with 60% for the drip group, although the difference was not statistically significant (P = .18). The mean temperatures of the 2 groups before surgery were identical (36.9°C) in both groups. The cost of the drip was 6 times higher than that of the occlusive technique. The placode was assessed as moist in all 13 cases (100%). CONCLUSION: The occlusive technique was easier to care for by all the nurses and was 6 times more cost effective. Both methods kept the placode moist and did not affect the temperature of the baby.
Lithium-Induced Neurotoxicity: A Case Study
Authors: Schneider Melissa A. , Smith Sonya S.
Published: August 2019

BACKGROUND

In patients presenting with neurological deficits, identifying the cause can be challenging.

METHODS

This case study discusses a condition that is not commonly seen.

DISCUSSION

Although lithium toxicity syndrome is not as familiar as other causes of neurological issues, this should be considered for any patient who presents with unexplained neurological deficits and a history of taking this medication.

CONCLUSION

If toxicity is not recognized early, the patient can be left with irreversible neurological symptoms, also known as syndrome of irreversible lithium-effectuated neurotoxicity, which impacts quality of life or can even cause death.
Mothers' Experiences Interacting with Infants after Traumatic Childbirth
Authors: Beck Cheryl Tatano , Watson Sue
Published: August 2019

Purpose:

The purpose of this study is to describe experiences of mothers interacting with their infants after traumatic childbirth.

Study Design and Methods:

A descriptive phenomenological method guided by Dahlberg, Dahlberg, and Nystrom's reflective lifeworld research was used. Women were recruited through Trauma and Birth Stress (TABS), a charitable trust in New Zealand, whose mission is to provide support for women who have experienced traumatic childbirth. Data were collected via an electronic survey. Women were asked to describe how their traumatic births affected their caring for and interactions with their infants and any other children they may have.

Results:

Eighteen women representing six countries across the globe participated. Four constituents of mothers' experiences interacting with their infants after traumatic births were identified: feelings of numbness and detachment, crying and anger, distressing cognitive changes, and limited outside social interactions.

Clinical Implications:

To help women struggling with the aftermath of their traumatic birth, nurses first need to identify them. Clinicians need to be attentive to symptoms such as a withdrawn, dazed look, and appearing distanced from their infants. Prior to hospital discharge after childbirth, women should be given opportunities to share their perceptions of their birth to determine if they view it as traumatic. Interventions should be started as soon as possible in this fragile mother–infant dyad to prevent long-term consequences.
Monitoring Procedural Pain and Distress in a Child With Rett Syndrome: A Case Report
Authors: Swiggum Mary , Grant Lisa
Published: August 2019

Background and Purpose:

Whole body vibration training is a viable option for children with Rett syndrome; however, the positioning requirements and intense vibration may be interpreted as pain.

Case:

A 13-year-old girl with a diagnosis of Rett syndrome, Stage IV, participated. The Individualized Numeric Rating Scale was developed in collaboration with the caregiver and scored by a physical therapist and student physical therapists during 16 sessions of whole body vibration training.

Outcomes:

The therapist and students reached 100% agreement on the Individualized Numeric Rating Scale ratings and successfully provided distractions to prevent pain and distress from reaching a level 5 out of 10 for 139 of 144 sessions.

Conclusion:

This is the first case in the literature to demonstrate use of the Individualized Numeric Rating Scale with a child who is nonverbal during a potentially painful physical therapy procedure.
Comprehensive Three-Dimensional Technology Strategies for Autologous Free Fat Graft in Parry-Romberg Syndrome
Authors: Kim Min Ji , Jeong Woo Shik , Jeon Dong Nyuk , Choi Jong Woo , Kim Don Han
Published: August 2019

Autologous free fat graft is a widely accepted method of facial contour restoration in Parry-Romberg syndrome (PRS); however, complex and unpredictable facial anatomy can render this surgery extremely challenging. The integration of 3-dimensional (3D) technology strategies as a method to enhance surgical aesthetic outcomes has been demonstrated.

A retrospective chart review was performed for PRS with autologous, free fat graft between 2016 and 2017. Based on 3D volumetric facial analysis and presurgical simulation, a 3D printed fat graft guide was produced. Surgical outcomes were analyzed by volumetric measurements of the upper, middle, and lower face segments.

A total of 9 patients were included in the study. Their upper and middle facial volumes before and after the procedures showed statistically significant volume augmentation (upper face, P = 0.004; middle face, P = 0.002) 6 months postoperatively (T1). Facial asymmetry was also statistically significantly corrected (middle face P = 0.012; lower face P = 0.025) at 1 year after the procedure (T2).

The advantageous application of 3D comprehensive technology for aesthetic improvements in patients with PRS with autologous, free fat graft treatment has been demonstrated. Precise preoperative planning based on simulations and postoperative 3D volumetric analyses can help adequately predict fat graft strategies.