bluuebunny/crossref_metadata_2025 huggingface dataset:
On the line
Authors: Danza Phyllis
Published: October 2018

This article defines the terms associated with bullying, identifies two types of bullying behaviors, and discusses anti-bullying strategies based on education and professional behaviors to eliminate incivility in nursing departments.
Does Incorporating a Measure of Clinical Workload Improve Workplace-Based Assessment Scores? Insights for Measurement Precision and Longitudinal Score Growth From Ten Pediatrics Residency Programs
Authors: Park Yoon Soo , Hicks Patricia J. , Carraccio Carol , Margolis Melissa , Schwartz Alan
Published: October 2018

Purpose

This study investigates the impact of incorporating observer-reported workload into workplace-based assessment (WBA) scores on (1) psychometric characteristics of WBA scores and (2) measuring changes in performance over time using workload-unadjusted versus workload-adjusted scores.

Method

Structured clinical observations and multisource feedback instruments were used to collect WBA data from first-year pediatrics residents at 10 residency programs between July 2016 and June 2017. Observers completed items in 8 subcompetencies associated with Pediatrics Milestones. Faculty and resident observers assessed workload using a sliding scale ranging from low to high; all item scores were rescaled to a 1–5 scale to facilitate analysis and interpretation. Workload-adjusted WBA scores were calculated at the item level using three different approaches, and aggregated for analysis at the competency level. Mixed-effects regression models were used to estimate variance components. Longitudinal growth curve analyses examined patterns of developmental score change over time.

Results

On average, participating residents (n = 252) were assessed 5.32 times (standard deviation = 3.79) by different raters during the data collection period. Adjusting for workload yielded better discrimination of learner performance, and higher reliability, reducing measurement error by 28%. Projections in reliability indicated needing up to twice the number of raters when workload-unadjusted scores were used. Longitudinal analysis showed an increase in scores over time, with significant interaction between workload and time; workload also increased significantly over time.

Conclusions

Incorporating a measure of observer-reported workload could improve the measurement properties and the ability to interpret WBA scores.
Prognostic Factors for Physical Functioning After Multidisciplinary Rehabilitation in Patients With Chronic Musculoskeletal Pain
Authors: Tseli Elena , Boersma Katja , Stålnacke Britt-Marie , Enthoven Paul , Gerdle Björn , Äng Björn O. , Grooten Wilhelmus J.A.
Published: October 2018

Objectives:

This systematic review aimed to identify and evaluate prognostic factors for long-term (≥6 mo) physical functioning in patients with chronic musculoskeletal pain following multidisciplinary rehabilitation (MDR).

Materials and Methods:

Electronic searches conducted in MEDLINE, PsycINFO, EMBASE, CINAHL, Web of Science, and Cochrane CENTRAL revealed 25 original research reports, published 1983-2016, (n=9436). Potential prognostic factors relating to initial pain and physical and psychological functioning were synthesized qualitatively and quantitatively in random effects meta-analyses. The level of evidence (LoE) was evaluated with Grading of Recommendations Assessment, Development and Evaluation (GRADE).

Results:

Pain-related factors (intensity and chronicity) were not associated with function/disability at long-term follow-up, odds ratio (OR)=0.84; 95% confidence interval (CI), 0.65-1.07 and OR=0.97; 95% CI, 0.93-1.00, respectively (moderate LoE). A better function at follow-up was predicted by Physical factors; higher levels of initial self-reported functioning, OR=1.07; 95% CI, 1.02-1.13 (low LoE), and Psychological factors; low initial levels of emotional distress, OR=0.77; 95% CI, 0.65-0.92, low levels of cognitive and behavioral risk factors, OR=0.85; 95% CI, 0.77-0.93 and high levels of protective cognitive and behavioral factors, OR=1.49; 95% CI, 1.17-1.90 (moderate LoE).

Discussion:

While pain intensity and long-term chronicity did not predict physical functioning in chronic pain patients after MDR, poor pretreatment physical and psychological functioning influenced the prognosis negatively. Thus, treatment should further target and optimize these modifiable factors and an increased focus on positive, psychological protective factors may perhaps provide an opening for yet untapped clinical gains.
Spinal Cord Stimulators
Authors: Malige Ajith , Sokunbi Gbolabo
Published: October 2018

Study Design.

A retrospective chart review.

Objective.

The aim of this study was to address and characterize the differences between pain relief obtained from the “trial” versus permanent stimulator in the acute postoperative period (less than 6 weeks).

Summary of Background Data.

After a short stimulator trial (typically less than 7 days), patients who report at least a 50% relief are set up for permanent spinal cord stimulator (SCS) placement. The literature has shown that a subset of patients develop tolerance to these stimulating therapies, often resulting in reduced efficacy of symptom relief as early as 2 years post-permanent implantation.

Methods.

Between the years of 2013 and 2017, 241 patient charts who underwent a successful trial and had a subsequent permanent SCS placed by a fellowship-trained surgeon through an open incision were reviewed. For each patient, demographic information, numerical rating system (NRS) pain scores, Oswestry Disability Index (ODI) scores, and opioid medication usage were recorded and stratified by time-period (before trial, after trial and before permanent placement, and after permanent SCS placement).

Results.

Of the 100 included patients, 60 were female; 60 patients had previous failed lumbar surgery (53%). Placement of trial stimulator (median = 4) decreased pain scores significantly more than permanent spinal cord stimulator did (median = 2) (P = 0.00). No significant difference was seen in ODI score difference between trial and initial scores (median = 4) and final and initial scores (median = 6) (P = 0.64). Finally, a significantly higher decrease in pain medication usage was seen after trial initiation (median = 0) versus after permanent spinal cord stimulator placement (median = 0) (P = 0.028). Twenty-two patients (22%) had reported complications, with 15 complaining of prolonged surgical site pain.

Conclusion.

Discrepancies observed in symptom alleviation between percutaneous trials and permanent placement in the acute 6-week postop period can have a significant effect on patient perceived outcomes. Understanding these issues will help in providing preoperative counseling and managing postoperative expectations.

Level of Evidence: 4
A meta-analysis of melanoma risk in industrial workers
Authors: Vujic Igor , Gandini Sara , Stanganelli Ignazio , Fierro Maria T. , Rappersberger Klemens , Sibilia Maria , Tosti Giulio , Ferrucci Pier F. , Caini Saverio , De Felici Maria B. , Pagliarello Calogero , Quaglino Pietro , Sanlorenzo Martina
Published: October 2018

Industrial workers are exposed to occupational pollutants, which may cause diseases such as cancer, but links to melanoma are not established. The identification of industry-related risk factors for melanoma incidence and mortality might be of importance for workers, health providers, and insurance companies. To assess melanoma incidence and mortality among oil/petroleum, chemical, and electrical industry workers. All studies reporting standardized mortality ratios (SMR) and/or standardized incidence ratios (SIR) of melanoma in workers employed in oil/petroleum, chemical, and electrical industries were included. Random-effect meta-analyses were carried out to summarize SIR and SMR for melanoma among oil/petroleum, chemical, and electrical industry workers. Heterogeneity was assessed using
χ

2 and I
2 statistics. Possible source bias and quality were assessed using the Strengthening the Reporting of Observational Studies in Epidemiology checklist and a modified version of the Newcastle–Ottawa scale. Of 1878 citations retrieved, we meta-analyzed 21, 6, and 9 studies for the oil/petroleum, electrical, and chemical industry, respectively. Oil/petroleum industry: summary standardized incidence ratio (SSIR)  = 1.23 [95% confidence interval (CI): 1.11–1.36, I
2 = 45%]; summary standardized mortality ratio (SSMR) = 1.02 (95% CI: 0.81–1.28, I
2 = 48%); subgroups: SSIRmales = 1.16 (95% CI: 1.01–1.32, I
2 = 15%), SSMRmales = 1.19 (95% CI: 1.00–1.42, I
2 = 20%). Electrical industry: SSIR = 1.00 (95% CI: 0.93–1.11, I
2 = 72%); SSMR = 1.16 (95% CI: 0.74–1.81, I
2 = 11%). Chemical industry: SSIR = 2.08 (95% CI: 0.47–9.24, I
2 = 73%); SSMR = 2.01 (95% CI: 1.09–3.72, I
2 = 33%). Our meta-analysis suggests a slightly increased risk of developing melanoma among oil/petroleum industry workers and an increased melanoma mortality among oil/petroleum and chemical industry workers. No increased risks were found among electrical industry workers.
A Stab in the Back: An Unusual Case of Cutaneous Neural Infiltration as a Manifestation of Chronic Lymphoproliferative Disorder of Natural Killer Cells
Authors: Ní Mhaolcatha Sarah , Flynn Aoibheann , Hayes Brian , O'Shea Derville , Bennett Mary , Fitzgibbon James
Published: October 2018

Chronic lymphoproliferative disorder of natural killer cells (CLPDNK) is a rare heterogenous indolent disorder comprising a persistent peripheral blood cell count of more than ≥2 × 109/L natural killer cells for over 6 months. We report an unusual case of cutaneous neural infiltration as a manifestation of CLPDNK. A 52-year-old woman with a background of CLPDNK was referred to dermatology with a painful rash primarily affecting her back. Skin biopsies revealed a neurotropic atypical lymphoid infiltration. Results of immunohistochemistry studies showed CD8, CD56, granzyme B, perforin positivity, and CD3 negativity in keeping with an atypical neurotropic lymphoid infiltrate consistent with cutaneous involvement by the patient's known CLPDNK. Cutaneous lesions and peripheral neuropathy in patients with CLPDNK have been reported; however, the involvement of cutaneous peripheral nerves as described in our case has not been reported before.
Spinal Ewing Sarcoma Metastatic to Bilateral Orbits
Authors: Chan Lawrence , Megalla Marez , Kim Jenna M. , Pointdujour-Lim Renelle
Published: October 2018

A 39-year-old woman with primary spinal Ewing sarcoma and known lung metastases presented with painless bilateral decreased visual acuity over a 1-month period. Examination revealed bilateral disc edema. MRI of the brain/orbits showed metastatic lesions to the dura and bilateral orbits. Venous sinus thrombosis extending to the jugular vein was also noted. To the authors' knowledge, this is the first case of bilateral orbital metastasis and papilledema secondary to Ewing sarcoma and related hypercoagulability.
Impact of Food and Drug Administration Approval of Vismodegib on Prevalence of Orbital Exenteration as a Necessary Surgical Treatment for Locally Advanced Periocular Basal Cell Carcinoma
Authors: Sagiv Oded , Ding Stephanie , Ferrarotto Renata , Glisson Bonnie , Altan Mehmet , Johnson Faye , Elamin Yasir , Thakar Sudip D. , Nagarajan Priyadharsini , Esmaeli Bita
Published: October 2018

Purpose:

To test the hypothesis that the US Food and Drug Administration approval of vismodegib in early 2012 has reduced the prevalence of orbital exenteration for locally advanced periocular basal cell carcinoma (BCC).

Methods:

Following institutional review board approval, the authors reviewed clinical and pathological data of patients with locally advanced periocular BCC (T4 per the eyelid carcinoma classification in the 8th edition of the AJCC Cancer Staging Manual) treated by the senior author during 2006–2018. Patients were grouped into those who were treated before February 2012 (“before vismodegib approval”) and those who presented later (“after vismodegib approval”).

Results:

Forty-two patients with locally advanced periocular BCC were treated during the study period, of whom 31 were men. The median age at presentation was 66 years (range, 43–90). Twenty-two patients had T4a and 20 had T4b tumors. Thirteen patients were treated before and 29 were treated after vismodegib approval. The 2 groups did not differ in age distribution (p = 0.164), sex distribution (p = 0.270), prevalence of recurrent tumor at presentation (p = 0.317), or duration of treatment with vismodegib (p = 0.605). Orbital exenteration was significantly more prevalent in patients treated before vismodegib approval than after (46% vs. 10%, p = 0.016), and vismodegib treatment was significantly more prevalent in patients treated after vismodegib approval than before (when vismodegib was given in clinical trials; 69% vs. 23%, p = 0.008). There was a trend toward more patients retaining their eyes at last follow-up in patients treated after vismodegib approval (83% vs. 54%, p = 0.066).

Conclusions:

The prevalence of orbital exenteration as a necessary surgical procedure in patients with a locally advanced periocular BCC has fallen since the Food and Drug Administration approval of vismodegib. Although vismodegib is not specifically approved for organ-sparing, it has changed the authors’ practice and enabled eye preservation in patients with locally advanced periocular BCC, who would otherwise require an orbital exenteration.
Disseminated Mycobacterium haemophilum Infection and Pneumocystis jirovecii Pneumonia in a Patient Receiving Immunosuppressive Therapy
Authors: Dalia Yoseph , Fahmy Joseph , Khoncarly Sarah , Moore Tyler L. , Myers Joseph P.
Published: October 2018

A 53-year-old woman with mixed connective tissue disease and rheumatoid arthritis on successive treatment regimens consisting of rituximab then adalimumab + prednisone then azathioprine + hydroxychloroquine + prednisone developed multiple tender upper and lower extremity skin lesions followed shortly by dry cough and shortness of breath. Skin biopsy and blood cultures eventually revealed Mycobacterium haemophilum, and transbronchial lung biopsy and bronchial washings revealed Pneumocystis jirovecii pneumonia. The patient was treated with endotracheal intubation, clarithromycin/rifampin/ciprofloxacin, and trimethoprim-sulfamethoxazole and survived, gradually returning to baseline state after hospital course during which she was intubated for 17 days. She survived but continues on lower-dose azathioprine and prednisone for her mixed connective tissue disease and rheumatoid arthritis. We conducted a strict review of the literature for all patients with disseminated M. haemophilum infection and looked for concurrent opportunistic infections. There was only one other patient with concurrent disseminated M. haemophilum infection and P. jirovecii pneumonia. Three patients were diagnosed as having P. jirovecii before having a diagnosis of disseminated M. haemophilum infection. Other concurrent opportunistic infections found were herpesvirus-8–associated Kaposi sarcoma and disseminated histoplasmosis. As physicians become more aware of M. haemophilum and as diagnostic techniques improve and become more widely available, we may see more disseminated M. haemophilum infections and associated opportunistic infections.
Value of Nursing Objective Structured Clinical Examinations
Authors: Goh Hongli Sam , Zhang Hui , Lee Chen Na , Wu Xi Vivien , Wang Wenru
Published: October 2018

Background

Objective structured clinical examinations (OSCEs) have been used globally in medical education and touted as the “gold standard” for competence-based assessments. However, the value of OSCEs in nursing education has not been extensively evaluated.

Purposes

This review aims to report the global trends in nursing OSCEs; evaluate their validity, reliability, acceptability, and costs; and present the characteristics of validated nursing OSCEs.

Methods

This is a scoping review involving a systematic search in 7 electronic databases.

Results

A total of 204 studies, published between 1982 and 2018, were included in the review. We found that nursing OSCEs were extensively used across various nursing specialties in 33 countries and confirmed their validity, reliability, and acceptability in nursing education.

Conclusions

This review confirms the value of OSCEs in nursing education and presents the underlying characteristics of validated nursing OSCE designs.
Pediatric Bilateral Facial Paralysis
Authors: Wong Kei , Sequeira Sophia , Bechtel Kirsten
Published: October 2018

Pediatric bilateral facial nerve paralysis (FNP) is a rare condition, representing less than 2% of all cases of FNP. The differential diagnosis of FNP is extensive (ranging from infectious, traumatic, neurologic, to idiopathic) and often can present as a diagnostic challenge. In contrast to unilateral presentation, bilateral FNP presents as a manifestation of serious systemic conditions, including meningitis (infectious and neoplastic), brain stem encephalitis, Guillain-Barre syndrome, sarcoidosis, Lyme disease, human immunodeficiency virus infection, leukemia, and vasculitis. In the evaluation of a child who presents with bilateral FNP, history plays the utmost role in the diagnosis. A history of rash consistent with erythema chronicum migrans, recent tick exposure, or travel to a Lyme disease–endemic area is highly suggestive that the facial paralysis is a result of Lyme disease. It is also important to recognize that Lyme disease is emerging as the most common infectious etiology of bilateral FNP in the pediatric population. In this case report, we describe a 16-year-old boy who presented to the emergency department with complaints of headache and bilateral FNP, an unusual presentation of Lyme disease.
The Disturbed Function of Neutrophils at the Early Stage of Fat Grafting Impairs Long-Term Fat Graft Retention
Authors: Liu Kaiyang , Cai Junrong , Li Hongjin , Feng Jingwei , Feng Chuanbo , Lu Feng
Published: October 2018

Background:

Fat grafting is a popular soft-tissue filler method; however, the mechanism of its survival and regeneration is still not fully understood. Neutrophils are the frontier inflammatory cells and closely associated with tissue regeneration. To understand the role of neutrophils in fat graft retention, we adopted neutrophil depletion and up-regulation models.

Methods:

Mouse inguinal fat (approximately 200 mg) was transferred autologously. The anti-mouse Ly6G antibody and lipopolysaccharides were used in the mouse fat grafting model for neutrophil depletion or activation, respectively. We examined the blood and graft stromal vascular fraction by fluorescence-activated cell sorting in manipulation/control groups. Graft weight, vascularization, and secreted factors were also compared.

Results:

There was a significant reduction/increase of neutrophil counts in the circulation and the transferred fat before day 7 with Ly6G antibody/lipopolysaccharides treatment. Early depletion of neutrophils resulted in incompetent angiogenesis and eventually a poor retention rate (27 ± 8 percent) compared with control (51 ± 10 percent; p < 0.05), whereas up-regulated neutrophils increased the inflammation and reactive oxygen species level, leading to tissue damage and poor retention rate (20 ± 9 percent) compared with control (51 ± 10 percent; p < 0.05). Enhanced macrophage infiltration could be found in both neutrophil depletion and up-regulation groups after week 4.

Conclusions:

Undisturbed neutrophil function is the key to initiating downstream responses of macrophage infiltration, stimulating vessel formation, and regulating inflammation level; thus, it exerts a great impact on the long-term retention rate. Disturbed neutrophil function, either enhanced or weakened, can lead to impaired fat graft retention.
Creation of Clitoral Hood and Labia Minora in Penile Inversion Vaginoplasty in Circumcised and Uncircumcised Transwomen
Authors: Opsomer Dries , Gast Katherine M. , Ramaut Lisa , De Wolf Edward , Claes Karel , Sommeling Casper , Monstrey Stan
Published: October 2018

Gender dysphoria, the incongruence between anatomical sex and gender identity, is estimated to affect 1 percent of the population. Creation of a feminine vulva with labia minora remains a technical challenge for surgeons, especially in circumcised patients. The authors present the technique developed by the senior author (S.M.) that uses prepuce skin in uncircumcised patients or distal shaft skin in circumcised patients for creation of both clitoral hood and labia minora. A retrospective case review was conducted of all penile inversion vaginoplasties performed by the senior author between 2014 and 2016. Patient characteristics, history of circumcision, and revision surgery were recorded. Surgical technique to create and inset the neoclitoris and labia minora in a single-stage penile inversion vaginoplasty is described in detail. A total of 161 penile inversion vaginoplasty operations were performed. Creation of labia minora and clitoral hood was achieved in all patients, with 4.3 percent undergoing an early intervention for bleeding or dehiscence and 5.6 percent requiring late revision surgery for diverted urinary stream. Average length of follow-up was 29 months. Age, hormonal therapy time, body mass index, smoking, and diabetes were the investigated risk factors for postoperative complications, but no significant correlations were found. All patients met the standards of care set forth by the World Professional Association for Transgender Health. Creation of the clitoral hood and labia minora during penile inversion vaginoplasty is achievable in both circumcised and uncircumcised patients, with good aesthetic results and a low revision surgery rate.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Anatomy of the Superficial Fascia System of the Breast: A Comprehensive Theory of Breast Fascial Anatomy
Authors: Rehnke Robert D. , Groening Rachel M. , Van Buskirk Eric R. , Clarke John M.
Published: October 2018

Background:

It has been two centuries since Petrus Camper identified superficial fascia and over 175 years since Sir Astley Cooper wrote his book on the anatomy of the breast. In the 1990s, Ted Lockwood taught us the importance of the superficial fascia layers in body contouring procedures he pioneered. These descriptions, however, fail to explain the three-dimensional fascial system in the breast. The authors set out to discover and describe a theory of superficial fascia structures responsible for breast shape.

Methods:

The nature of the superficial fascia system that surrounds the breast and its attachments to the chest were studied in 12 cadaver breast dissections and in clinical cases of both cosmetic and reconstructive breast procedures.

Results:

The authors found a three-dimensional, closed system of fascia and fat surrounding the corpus mammae, which attaches to the skin by means of specialized vertical cutaneous ligaments, or Cooper ligaments, and which attaches to the chest wall by means of a three-dimensional zone of adherence at the breast’s periphery.

Conclusions:

The breast is shaped by a three-dimensional, fibrofatty fascial system. Two layers of this system surround the corpus mammae and fuse together around it, and anchor it to the chest wall in a structure we have called the circummammary ligament.
Clinical, Economic, and Organizational Impact of the Clinical Pharmacist in an Orthopedic and Trauma Surgery Department
Authors: Renaudin Pierre , Coste Annabelle , Audurier Yohan , Berbis Julie , Canovas François , Jalabert Anne , Castet-Nicolas Audrey , Mercier Gregoire , Villiet Maxime , Dagneaux Louis , Breuker Cyril
Published: October 2018

Aim

The aim of this study was to evaluate the clinical, economic, and organizational impact of clinical pharmacist services added to an adult orthopedic and trauma surgery unit in a university hospital.

Methods

This was a prospective, observational study performed from January to February 2017. All pharmacists’ interventions were documented, and their clinical, economic, and organizational impact and the probability of adverse drug events (ADEs) were assessed using the clinical, economic and organizational scale three-dimensional scale. An expert panel composed of three clinical pharmacists, one surgeon and one anesthetist classified the pharmacist intervention. The potential clinical impact was determined through a consensus by the expert panel. Cost avoidance was calculated for serious ADEs with a major impact by avoiding an additional cost of €4912 per event and taking into account the probability of ADE occurrence.

Results

The pharmacists performed 1014 interventions for 28 days with a 95.3% acceptance rate by prescribers. Thirty-nine interventions were rated to have a major clinical impact (3.8%). The organizational impact was estimated favorable for 856 (84.4%) pharmacist interventions. Cost avoidance was estimated at €24,364, and the indirect costs benefit was estimated at €11,864 during the study. The cost-benefit ratio of the clinical pharmacist intervention was €1.94 in savings for every €1 invested.

Conclusions

Clinical pharmacist services in an orthopedic and trauma surgery department have the potential to improve patient outcomes and avoid healthcare costs. Furthermore, the presence of a pharmacist in surgical units allows for communication between the unit and the pharmacy, which produces better fluidity and improves the quality of care.
The Las Vegas mass shooting: An analysis of blood component administration and blood bank donations
Authors: Lozada M. James , Cai Stephanie , Li Marissa , Davidson Stephanie Lynne , Nix Justin , Ramsey Glenn
Published: October 2018

BACKGROUND

The deadliest mass shooting in modern United States history occurred on October 1, 2017, in Las Vegas, killing 58 and overwhelming hospitals with more than 600 injured. The scope of the tragedy offers insight into medical demands, which may help guide preparedness for future mass shooting incidents.

METHODS

Retrospective, deidentified, health care institution–provided data from all hospitals and blood banks providing care to Las Vegas shooting victims were gathered. Study authors independently reviewed all data and cross-referenced it for verification. Main outcomes and measures include the number of victims requiring hospital and intensive care admission, the amount and types of blood components transfused during the first 24 hours, and the amount of blood donated to local blood banks following the Las Vegas mass shooting.

RESULTS

Two hundred twenty patients required hospital admission, 68 of them to critical care. Nearly 500 blood components were transfused during the first 24 hours in a red blood cell–to–plasma–to–platelet ratio of 1:0.54:0.81. Public citizens donated almost 800 units of blood immediately after the shooting; greater than 17% of this donated blood went unused.

CONCLUSIONS

The amount of blood components transfused per patient admitted was similar in magnitude to other mass casualty events, and available blood supply met patient demand. The public call for blood donors was not necessary to meet immediate demand and led to resource waste. Preparation for future mass shooting incidents should include training the community in hemorrhage control, encouraging routine blood donation, and avoiding public calls for blood donation unless approved by local blood suppliers.

LEVEL OF EVIDENCE

Therapeutic study, level V.
Evaluation of Pain in the Cognitively Impaired Patient in the Emergency Department
Authors: Davis Philip , Tucker Paula
Published: October 2018

The Research to Practice column is intended to improve the research critique skills of the advanced practice registered nurse and the emergency nurse, and to assist with the translation of research into practice. For each column, a topic and a research study are selected. The stage is set with a case presentation. The research article is then reviewed and critiqued, and the findings are discussed in relation to the case presented. In the current column, we examine the findings of A. Agit et al. (2018) from their article titled “An Iceberg Phenomenon in Dementia: Pain.”
Pulmonary Arterial Hypertension Emergency Complications and Evaluation
Authors: Hohsfield Robin , Archer-Chicko Christine , Housten Traci , Harris Nolley Stephanie
Published: October 2018

Pulmonary hypertension (PH) complicates common diseases and can lead to worsening symptoms and increased mortality. A specific group of PH, pulmonary arterial hypertension (PAH), World Health Organization Group 1, may present to the emergency department (ED). We review common ED presentations of patients with PAH such as cardiac arrest/sudden death, right ventricular failure, syncope, hypoxemic respiratory failure, arrhythmias, hemoptysis, pulmonary embolism, chest pain/left main compression syndrome, infection, and considerations for PAH medication administration. We include a case study to illustrate a real example with a positive outcome, and an algorithm for evaluating and triaging patients with PAH in the ED. The ability to recognize, triage, and communicate changes in PAH disease status in a multidisciplinary team approach between the patient, family, specialty pharmacy, and specialized health care providers such as the PH team, is essential for ED providers who are evaluating and treating patients with PAH.
Herpes Zoster in the Emergency Department
Authors: Martinez Nicole , Arts Serena
Published: October 2018

An estimated one million cases of herpes zoster are reported in the United States annually. Although most cases of herpes zoster are self-limiting and require little interventions, some occurrences can result in potentially debilitating and/or life-threatening outcomes. The purpose of this article is to discuss the incidence, potential complications, treatment, and preventive measures of herpes zoster. A case report is utilized to emphasize the importance of a thorough evaluation and consideration of complications.
Feeding the disparities: the geography and trends of breastfeeding in the United States
Authors: Garnier Romain , Bento Ana I. , Rohani Pejman , Omer Saad B. , Bansal Shweta
Published: October 2018

There is scientific consensus on the importance of breastfeeding for the present and future health of newborns, in high- and low-income settings alike. In the United States, improving breast milk access is a public health priority but analysis of secular trends are largely lacking. Here, we used data from the National Immunization Survey of the CDC, collected between 2003 and 2016, to illustrate the temporal trends and the spatial heterogeneity in breastfeeding. We also considered the effect sizes of two key determinants of breastfeeding rates. We show that, while access to breast milk both at birth and at 6 months old has steadily increased over the past decade, large spatial disparities still remain at the state level. We also find that, since 2009, the proportion of households below the poverty level has become the strongest predictor of breastfeeding rates. We argue that, because variations in breastfeeding rates are associated with socio-economic factors, public health policies advocating for breastfeeding are still needed in particular in underserved communities. This is key to reducing longer term health disparities in the U.S., and more generally in high-income countries.
Bidirectional effects of anxiety and anorexia nervosa: A Mendelian randomization study
Authors: Lloyd E Caitlin , Sallis Hannah , Verplanken Bas , Haase Anne M , Munafò Marcus R
Published: October 2018

Objectives

To assess bidirectional effects of anxiety and anorexia nervosa (AN) phenotypes. Design Two-sample Mendelian randomization.

Setting

Genome-wide association study (GWAS) summary statistics from the Psychiatric Genomics Consortium (PGC), analysis of the UK Biobank sample, and Anxiety Neuro Genetics Study (ANGST) consortium.

Participants

European descent participants from the PGC (n = 14,477), UK Biobank (n = 348,219), and ANGST consortium (n = 17,310, and n = 18,186).

Main outcome measures

AN diagnosis, worry, anxiety disorder pathology (case-control and quantitative phenotypes).

Results

We found evidence of a moderate genetic correlation between worry and AN (Rg = 0.36, SE = 0.05, p < 0.001), and the Mendelian randomization analysis supported a causal influence of worry on AN (OR = 2.14, 95% CI: 1.18 to 3.90, p = 0.01). There was no clear evidence for a causal effect of AN on worry in this study (B = −0.01, 95% CI: −0.03 to 0.02, p = 0.55). There was no robust evidence for a causal influence of anxiety disorders on AN (for case-control anxiety disorder phenotype: OR = 1.02, 95% CI: 0.69, 1.50, p = 0.922; for quantitative anxiety disorder phenotype: OR = 4.26, 95% CI: 0.49, 36.69, p = 0.187). There was no robust evidence for a causal effect of AN on anxiety disorders (for case control anxiety disorder phenotype: OR = 1.00, 95% CI: 0.72, 1.38, p = 0.981; for quantitative anxiety disorder phenotype: B = 0.01, 95% CI: −0.06, 0.6=09, p = 0,761). AN and anxiety disorder phenotypes were not genetically correlated (for case-control anxiety disorder phenotype: Rg = 0.10, se = 0.17, p = .56; for quantitative anxiety disorder phenotype: Rg = 0.12, SE = 0.17, p = 0.47).

Conclusions

Findings support a role for worry in AN development, highlighting a potential target of future AN prevention efforts. Mechanisms underlying the association should be a focus of future investigation. The relatively small sample sizes of anxiety disorder and AN GWASs may have limited power to detect causal effects; these associations should be studied further.
Risk aversion in macaques in a freely moving patch-leaving foraging task
Authors: Eisenreich B. R , Hayden Benjamin Y.
Published: October 2018

Animals, including humans, are risk-averse in most contexts. A major exception is the rhesus macaque (Macaca mulatta), which is robustly risk-seeking. Macaques‘ unique preferences may reflect their unique evolutionary history. Alternatively, they may derive from elements of task design associated with the demands of physiological recording, the source of nearly all macaque risk preference data. To disambiguate these possibilities we assessed macaques’ risk attitudes in a somewhat more naturalistic environment: subjects foraged at four feeding stations in a large enclosure. Stations (i.e. patches) provided either stochastically or non-stochastically depleting rewards. Subjects’ patch residence times were longer at safe than at risky stations, indicating a preference for safe options. This preference was not attributable to a win-stay-lose-shift heuristic. These findings highlight the lability of risk attitudes in macaques and support the hypothesis that observed differences between macaques and other species are ephemeral, not evolved.
Global biogeography of Tetragnatha spiders reveals multiple colonization of the Caribbean
Authors: Čandek Klemen , Agnarsson Ingi , Binford Greta J. , Kuntner Matjaž
Published: October 2018

Organismal variation in dispersal ability can directly affect levels of gene flow amongst populations, therefore importantly shaping species distributions and species richness patterns. The intermediate dispersal model of biogeography (IDM) predicts that in island systems, species diversity of those lineages with an intermediate dispersal potential is the highest. We broadly test this prediction, focusing on ‘four-jawed spiders’ (genus Tetragnatha) of the Caribbean archipelago. First, we report on original sampling of this globally distributed genus with numerous widespread as well as endemic species. We then reconstruct multiple Tetragnatha phylogenies from roughly 300 individuals delineated into 54 putative species. Our results support the monophyly of the four-jawed spiders but reject the monophyly of those lineages that reach the Caribbean, where we find low levels of endemism yet high diversity within Tetragnatha. The chronogram detects a potential early overwater colonization of the Caribbean, and in combination with reconstructed biogeographic history, refutes the possibility of ancient vicariant origins of Caribbean Tetragnatha as well as the GAARlandia land-bridge scenario. Instead, biogeographic results hypothesize multiple colonization events to, and from the Caribbean since mid-Eocene to late-Miocene. Tetragnatha seems unique among the arachnids explored so far in comprising some species that are excellent dispersers, and others that are not, perhaps having secondarily lost this dispersal propensity. A direct test of the IDM would require consideration of three categories of dispersers. However, four-jawed spiders do not fit one of these three a priori definitions, but rather represent a more complex combination of attributes of a ‘dynamic disperser’.
The Ca2+-activated Cl− current ensures robust and reliable signal amplification in vertebrate olfactory receptor neurons
Authors: Reisert Johannes , Reingruber Jürgen
Published: October 2018

Activation of most primary sensory neurons results in transduction currents that are carried by cations. One notable exception is the vertebrate olfactory receptor neuron (ORN), where the transduction current is carried largely by the anion Cl−. However, it remains unclear why ORNs use an anionic current for signal amplification. We have sought to provide clarification on this topic by studying the so far neglected dynamics of Na+, Ca2+, K+ and Cl− in the small space of olfactory cilia during an odorant response. Using computational modeling and simulations we compared the outcomes of signal amplification based on either Cl− or Na+ currents. We found that amplification produced by Na+ influx instead of a Cl− efflux is problematic due to several reasons: First, the Na+ current amplitude varies greatly depending on mucosal ion concentration changes. Second, a Na+ current leads to a large increase in the ciliary Na+ concentration during an odorant response. This increase inhibits and even reverses Ca2+ clearance by Na+/Ca2+/K+ exchange, which is essential for response termination. Finally, a Na+ current increases the ciliary osmotic pressure, which could cause swelling to damage the cilia. By contrast, a transduction pathway based on Cl− efflux circumvents these problems and renders the odorant response robust and reliable.
Activation of SEDS-PBP cell wall synthases by an essential regulator of bacterial division
Authors: Lariviere Patrick J. , Mahone Christopher R. , Santiago-Collazo Gustavo , Howell Matthew , Daitch Allison K. , Zeinert Rilee , Chien Peter , Brown Pamela J. B. , Goley Erin D.
Published: October 2018

Bacterial growth and division require insertion of new peptidoglycan (PG) into the existing cell wall by PG synthase enzymes. Emerging evidence suggests that many PG synthases require activation to function, however it is unclear how activation of division-specific PG synthases occurs. The FtsZ cytoskeleton has been implicated as a regulator of PG synthesis during division, but the mechanisms through which it acts are unknown. Here we show that FzlA, an essential regulator of constriction inCaulobacter crescentus, links FtsZ to PG synthesis to promote division. We find that hyperactive mutants of the PG synthases FtsW and FtsI specifically renderfzlA, but not other division genes, non-essential. However, FzlA is still required to maintain proper constriction rate and efficiency in a hyperactive PG synthase background. Intriguingly, loss offzlAin the presence of hyperactivated FtsWI causes cells to rotate about the division plane during constriction and sensitizes cells to cell wall-specific antibiotics. We demonstrate that FzlA-dependent signaling to division-specific PG synthesis is conserved in another α-proteobacterium,Agrobacterium tumefaciens.These data establish that FzlA links FtsZ to cell wall remodeling, serving both to activate and spatially orient PG synthesis during division. Overall, our findings support the paradigm that activation of SEDS-PBP PG synthases is a broadly conserved requirement for bacterial morphogenesis.
Efficiency of island homing by sea turtles under multimodal navigating strategies
Authors: Painter K. J. , Plochocka A. Z.
Published: October 2018

A dot in the vastness of the Atlantic, Ascension Island remains a lifelong goal for the green sea turtles that hatched there, returning as adults every three or four years to nest. This navigating puzzle was brought to the scientific community’s attention by Charles Darwin and remains a topic of considerable speculation. Various cues have been suggested, with orientation to geomagnetic field elements and following odour plumes to their island source among the most compelling. Via a comprehensivein silicoinvestigation we test the hypothesis that multimodal cue following, in which turtles utilise multiple guidance cues, is the most effective strategy. Specifically, we combine agent-based and continuous-level modelling to simulate displaced virtual turtles as they attempt to return to the island. Our analysis shows how population homing efficiency improves as the number of utilised cues is increased, even under “extreme” scenarios where the overall strength of navigating information decreases. Beyond the paradigm case of green turtles returning to Ascension Island, we believe this could commonly apply throughout animal navigation.
Bacterial contribution to genesis of the novel germ line determinantoskar
Authors: Blondel Leo , Jones Tamsin E. M. , Extavour Cassandra G.
Published: October 2018

New cellular functions and developmental processes can evolve by modifying existing genes or creating novel genes. Novel genes can arise not only via duplication or mutation but also by acquiring foreign DNA, also called horizontal gene transfer (HGT). Here we show that HGT likely contributed to the creation of a novel gene indispensable for reproduction in some insects. Long considered a novel gene with unknown origin,oskarhas evolved to fulfil a crucial role in insect germ cell formation. Our analysis of over 100 insect Oskar sequences suggests that Oskar arose de novoviafusion of eukaryotic and prokaryotic sequences. This work shows that highly unusual gene origin processes can give rise to novel genes that can facilitate evolution of novel developmental mechanisms.

One Sentence Summary

Our research shows that gene origin processes often considered highly unusual, including HGT and de novo coding region evolution, can give rise to novel genes that can both participate in pre-existing gene regulatory networks, and also facilitate the evolution of novel developmental mechanisms.
3-D navigation – A core driver of brain plasticity in video game interventions
Authors: Kühn Simone , Becker Maxi , Gallinat Jürgen
Published: October 2018

Recent evidence has repeatedly shown that 3D platform video game training leads to substantial brain structural plasticity in hippocampus, prefrontal cortex and cerebellum. However, a great disadvantage of using complex video game interventions is the difficulty to attribute the observed effects to specific game mechanics.

In order to address this caveat, we conducted a longitudinal training study in which 40 participants were randomly assigned to train with a 3D platformer game or a 2D platformer game. The main difference between the two games lies within their affordance for spatial exploration. After a training phase of two months, we observed extended brain structural increases in the 3D in comparison to the 2D condition in bilateral prefrontal areas, hippocampus/ entorhinal cortex as well as precuneus and the temporal lobe. In the reverse contrast an increase in bilateral caudate nucleus was observed.

The results demonstrate a crucial role of 3D spatial navigation for widespread brain plasticity effects within a two-months training setup. Given the vast complexity of video games, spatial navigation seems to play an outstanding role in structural plasticity. Since prefrontal, temporal and hippocampal volume deficits are prominent risk factors for several psychiatric disorders, daily navigation habits (outdoor movement, using GPS devices etc.) have to be considered in future mental disorders prevention research.
Golden Mutagenesis: An efficient multi-sitesaturation mutagenesis approach by Golden Gate cloning with automated primer design
Authors: Püllmann Pascal , Ulpinnis Chris , Marillonnet Sylvestre , Gruetzner Ramona , Neumann Steffen , Weissenborn Martin J.
Published: October 2018

Site-directed methods for the generation of genetic diversity are essential tools in the field of directed enzyme evolution. The Golden Gate cloning technique has been proven to be an efficient tool for a variety of cloning setups. The utilization of restriction enzymes which cut outside of their recognition domain allows the assembly of multiple gene fragments obtained by PCR amplification without altering the open reading frame of the reconstituted gene. We have developed a protocol, termed Golden Muta-genesis that allows the rapid, straightforward, reliable and inexpensive construction of mutagenesis libraries. One to five amino acid positions within a coding sequence could be altered simultaneously using a protocol which can be performed within one day. To facilitate the implementation of this technique, a software library and web application for automated primer design and for the graphical evaluation of the randomization success based on the sequencing results was developed. This allows facile primer design and application of Golden Mutagenesis also for laboratories, which are not specialized in molecular biology.
Subcortical theta oscillations alternate with high amplitude neocortical population within synchronized states
Authors: Krull Erin Munro , Sakata Shuzo , Toyoizumi Taro
Published: October 2018

Synchronized states are marked by large-amplitude low-frequency oscillations in the cortex. These states can be seen during quiet waking or slow-wave sleep. Within synchronized states, previous studies have noted a plethora of different types of activity, including delta oscillations (0.5-4 Hz) and slow oscillations (<1 Hz) in the cortex and large- and small-irregular activity in the hippocampus. However, it is not still fully characterized how neural populations contribute to the synchronized state. Here we apply independent component analysis (ICA) to parse which populations are involved in different kinds of cortical activity, and find two populations that alternate throughout synchronized states. One population broadly affects cortical deep layers, and is associated with larger amplitude slower cortical activity. The other population exhibits theta-frequency oscillations that are not easily observed in raw field potential recordings. These theta oscillations apparently come from below the cortex, suggesting hippocampal origin, and are associated with smaller amplitude faster cortical activity. Relative involvement of these two alternating populations may indicate different modes of operation within synchronized states.