bluuebunny/crossref_metadata_2025 huggingface dataset:
Inhibition of highly pathogenic PRRSV replication in MARC-145 cells by artificial microRNAs
Authors: Xiao Shuqi , Wang Qiwei , Gao Jintao , Wang Liangliang , He Zuyong , Mo Delin , Liu Xiaohong , Chen Yaosheng
Published: November 2011

Background

Highly pathogenic porcine reproductive and respiratory syndrome (HP-PRRS) has caused large economic losses in swine industry in recent years. However, current antiviral strategy could not effectively prevent and control this disease. In this research, five artificial microRNAs (amiRNAs) respectively targeted towards ORF5 (amirGP5-243, -370) and ORF6 (amirM-82, -217,-263) were designed and incorporated into a miRNA-based vector that mimics the backbone of murine miR-155 and permits high expression of amiRNAs in a GFP fused form mediated by RNA Pol II promoter CMV.

Results

It was found that amirGP5-370 could effectively inhibit H-PRRSV replication. The amirM-263-M-263, which was a dual pre-amiRNA expression cassette where two amirM-263s were chained, showed stronger virus inhibitory effects than single amirM-263. H-PRRSV replication was inhibited up to 120 hours in the MARC-145 cells which were stably transduced by recombinant lentiviruses (Lenti-amirGP5-370, -amirM-263-M-263). Additionally, efficacious dose of amirGP5-370 and amirM-263 expression did not trigger the innate interferon response.

Conclusions

Our study is the first attempt to suppress H-PRRSV replication in MARC-145 cells through vector-based and lentiviral mediated amiRNAs targeting GP5 or M proteins coding sequences of PRRSV, which indicated that artificial microRNAs and recombinant lentiviruses might be applied to be a new potent anti-PRRSV strategy.
How many lobes do you see?
Authors: Karangelis Dimos , Tagarakis Georgios I , Chlapoutakis Serapheim , Papadopoulos Dimitrios , Roubelakis Apostolos , Hevas Athanasios , Daskalopoulos Marios E , Tsantsaridou Angeliki , Lampoura Stefania , Tsilimingas Nikolaos B
Published: November 2011

Accessory fissures represent a variation of the normal lung anatomy. Incomplete development or even the absence of the major or minor fissures can lead to confusion in distinguishing adjacent lobes. This report aims to present a rare intraoperative finding of an anatomic malformation of the right lung in a 19-year old male patient with recurrent pneumothorax who underwent a surgical repair. An accessory fissure which was separating the superior segment of the lower lobe from the basal segments gave to the whole lung the unique image of a four-lobed one. A profound knowledge of the accessory fissures, even if they are incidentally discovered, is of pivotal importance for the thoracic surgeon and leads to optimal operative assessment and strategic planning.
Time-resolved in silico modeling of fine-tuned cAMP signaling in platelets: feedback loops, titrated phosphorylations and pharmacological modulation
Authors: Wangorsch Gaby , Butt Elke , Mark Regina , Hubertus Katharina , Geiger Jörg , Dandekar Thomas , Dittrich Marcus
Published: November 2011

Background

Hemostasis is a critical and active function of the blood mediated by platelets. Therefore, the prevention of pathological platelet aggregation is of great importance as well as of pharmaceutical and medical interest. Endogenous platelet inhibition is predominantly based on cyclic nucleotides (cAMP, cGMP) elevation and subsequent cyclic nucleotide-dependent protein kinase (PKA, PKG) activation. In turn, platelet phosphodiesterases (PDEs) and protein phosphatases counterbalance their activity. This main inhibitory pathway in human platelets is crucial for countervailing unwanted platelet activation. Consequently, the regulators of cyclic nucleotide signaling are of particular interest to pharmacology and therapeutics of atherothrombosis. Modeling of pharmacodynamics allows understanding this intricate signaling and supports the precise description of these pivotal targets for pharmacological modulation.

Results

We modeled dynamically concentration-dependent responses of pathway effectors (inhibitors, activators, drug combinations) to cyclic nucleotide signaling as well as to downstream signaling events and verified resulting model predictions by experimental data. Experiments with various cAMP affecting compounds including anti-platelet drugs and their combinations revealed a high fidelity, fine-tuned cAMP signaling in platelets without cross-talk to the cGMP pathway. The model and the data provide evidence for two independent feedback loops: PKA, which is activated by elevated cAMP levels in the platelet, subsequently inhibits adenylyl cyclase (AC) but as well activates PDE3. By multi-experiment fitting, we established a comprehensive dynamic model with one predictive, optimized and validated set of parameters. Different pharmacological conditions (inhibition, activation, drug combinations, permanent and transient perturbations) are successfully tested and simulated, including statistical validation and sensitivity analysis. Downstream cyclic nucleotide signaling events target different phosphorylation sites for cAMP- and cGMP-dependent protein kinases (PKA, PKG) in the vasodilator-stimulated phosphoprotein (VASP). VASP phosphorylation as well as cAMP levels resulting from different drug strengths and combined stimulants were quantitatively modeled. These predictions were again experimentally validated. High sensitivity of the signaling pathway at low concentrations is involved in a fine-tuned balance as well as stable activation of this inhibitory cyclic nucleotide pathway.

Conclusions

On the basis of experimental data, literature mining and database screening we established a dynamic in silico model of cyclic nucleotide signaling and probed its signaling sensitivity. Thoroughly validated, it successfully predicts drug combination effects on platelet function, including synergism, antagonism and regulatory loops.
Lulo cell line derived from Lutzomyia longipalpis (Diptera: Psychodidae): a novel model to assay Leishmania spp. and vector interaction
Authors: Côrtes Luzia MC , Silva Roger MM , Pereira Bernardo AS , Guerra Camila , Zapata Angela C , Bello Felio J , Finkelstein Léa C , Madeira Maria F , Brazil Reginaldo P , Côrte-Real Suzana , Alves Carlos R
Published: November 2011

Background

Leishmania (Vianna) braziliensis,Leishmania (Leishmania) amazonensis and Leishmania (Leishmania) chagasiare important parasites in the scenario of leishmaniasis in Brazil. During the life cycle of these parasites, the promastigote forms adhere to the midgut epithelial microvillii of phlebotomine insects to avoid being secreted along with digestive products. Lulo cells are a potential model that will help to understand the features of this adhesion phenomenon. Here, we analyze the interaction betweenLeishmaniaspp. promastigotes and Lulo cellsin vitro, specifically focusing on adhesion events occurring between threeLeishmaniaspecies and this cell line.

Methods

Confluent monolayers of Lulo cells were incubated with promastigotes and adhesion was assessed using both light microscopy and scanning electron microscopy.

Findings

The results indicate that species from the subgeneraLeishmaniaandVianniahave great potential to adhere to Lulo cells. The highest adherence rate was observed forL. (L.) chagasiafter 24 h of incubation with Lulo cells (27.3 ± 1.8% of cells with adhered promastigotes), followed byL. (L.) amazonensis(16.0 ± 0.7%) andL. (V.) braziliensis(3.0 ± 0.7%), both after 48 h. In the ultrastructural analysis, promastigote adherence was also assessed by scanning electron microscopy, showing that, for parasites from both subgenera, adhesion occurs by both the body and the flagellum. The interaction of Lulo cells withLeishmania (L.) chagasishowed the participation of cytoplasmic projections from the former closely associating the parasites with the cells.

Conclusions

We present evidence that Lulo cells can be useful in studies of insect-parasite interactions forLeishmaniaspecies.
AccrualNet: Addressing Low Accrual Via a Knowledge-Based, Community of Practice Platform
Authors: Massett Holly A. , Parreco Linda K. , Padberg Rose Mary , Richmond Ellen S. , Rienzo Marie E. , Leonard Colleen E. Ryan , Quesenbery Whitney , Killiam H. William , Johnson Lenora E. , Dilts David M.
Published: November 2011

AccrualNet represents a unique, centralized comprehensive-solution platform to systematically capture accrual knowledge for all stages of a clinical trial.
Antiemetics: American Society of Clinical Oncology Clinical Practice Guideline Update
Authors: Basch Ethan , Hesketh Paul J. , Kris Mark G. , Prestrud Ann Alexis , Temin Sarah , Lyman Gary H.
Published: November 2011

ASCO's update to its antiemetics guideline now includes an evaluation of evidence on complementary antiemetic therapy.
Enhanced Thecal Androgen Production Is Prenatally Programmed in an Ovine Model of Polycystic Ovary Syndrome
Authors: Hogg Kirsten , Young Julia M. , Oliver Elizabeth M. , Souza Carlos J. , McNeilly Alan S. , Duncan W. Colin
Published: November 2011

One of the hallmarks of polycystic ovary syndrome (PCOS) is increased ovarian androgen secretion that contributes to the ovarian, hormonal, and metabolic features of this condition. Thecal cells from women with PCOS have an enhanced capacity for androgen synthesis. To investigate whether this propensity is a potential cause, rather than a consequence, of PCOS, we used an ovine prenatal androgenization model of PCOS and assessed ewes at 11 months of age. Pregnant Scottish Greyface ewes were administered 100 mg testosterone propionate (TP) or vehicle control twice weekly from d 62 to 102 of gestation, and female offspring (TP = 9, control = 5) were studied. Prenatal TP exposure did not alter ovarian morphology or cyclicity, or plasma androgen, estrogen, and gonadotropin concentrations, at this stage. However, follicle function was reprogrammed in vivo with increased proportions of estrogenic follicles (P < 0.05) in the TP-exposed cohort. Furthermore, in vitro the thecal cells of follicles (>4 mm) secreted more LH-stimulated androstenedione after prenatal androgenization (P < 0.05), associated with increased basal expression of thecal StAR (P < 0.01), CYP11A (P < 0.05), HSD3B1 (P < 0.01), CYP17 (P < 0.05), and LHR (P < 0.05). This provides the first evidence of increased thecal androgenic capacity in the absence of a PCOS phenotype, suggesting a thecal defect induced during fetal life.
Dynamic Reserve Selection: Optimal Land Retention with Land-Price Feedbacks
Authors: Tóth Sándor F. , Haight Robert G. , Rogers Luke W.
Published: November 2011

Urban growth compromises open space and ecosystem functions. To mitigate the negative effects, some agencies use reserve selection models to identify conservation sites for purchase or retention. Existing models assume that conservation has no impact on nearby land prices. We propose a new integer program that relaxes this assumption via adaptive cost coefficients. Our model accounts for the two key land price feedbacks that arise in markets where conservation competes with development: the amenity premium and price increases driven by shifts in market equilibriums. We illustrate the mechanics of the proposed model in a real land retention context. The results suggest that in competitive land markets, the optimal conservation strategy during the initial phase of the retention effort might be to use available dollars to buy fewer parcels with smaller total area that are under high risk of development. We show that failure to capture the land-price feedbacks can lead to significant losses in biological conservation. The present study is the first to create a reserve selection model that captures the economic theory of competitive land markets in a dynamic framework, produces tangible, parcel-level conservation recommendations, and works on problems with thousands of potential site selection decisions and several planning periods.
Exact Simulation of Point Processes with Stochastic Intensities
Authors: Giesecke K. , Kakavand H. , Mousavi M.
Published: November 2011

Point processes with stochastic arrival intensities are ubiquitous in many areas, including finance, insurance, reliability, health care, and queuing. They can be simulated from a Poisson process by time scaling with the cumulative intensity. The paths of the cumulative intensity are often generated with a discretization method. However, discretization introduces bias into the simulation results. The magnitude of the bias is difficult to quantify. This paper develops a sampling method that eliminates the need to discretize the cumulative intensity. The method is based on a projection argument and leads to unbiased simulation estimators. It is exemplified for a point process whose intensity is a function of a jump-diffusion process and the point process itself. In this setting, the method facilitates the exact sampling of both the point process and the driving jump-diffusion process. Numerical experiments demonstrate the effectiveness of the method.
Find-and-Fetch Search on a Tree
Authors: Alpern Steve
Published: November 2011

We introduce a new type of search game called the “find-and-fetch” game F(Q, O). The Hider simply picks any point H in the network Q. The Searcher starts at time zero at a given point O of Q, moving at unit speed until he reaches H (finds the Hider). Then he returns at a given speed ρ along the shortest path back to O, arriving at time R, the payoff.

This models the problem faced in many types of search, including search-and-rescue problems and foraging problems of animals (where food must be found and returned to the lair). When Q is a binary tree, we derive optimal probabilities for the Searcher to branch at the nodes. These probabilities give a positive bias towards searching longer branches first. We show that the minimax value of the return time R (the game value of F(Q, O)) is μ + D/ρ, where μ is the total length of Q and D is the mean distance from the root O to the leaves (terminal nodes) of Q, where the mean is taken with respect to what is known as the equal branch density distribution. As ρ goes to infinity, our problem reduces to the search game model where the payoff is simply the time to reach the Hider, and our results tend to those obtained by Gal [Gal, S. 1979. Search games with mobile and immobile hider. SIAM J. Control Optim. 17(1) 99–122] and Anderson and Gal [Anderson, E. J., S. Gal. 1990. Search in a maze. Probab. Engrg. Inform. Sci. 4(3) 311–318] for that model. We also apply our return time formula μ + D/ρ to determine the ideal location for the root (lair or rescue center) O, assuming it can be moved. In the traditional “find only” model, the location of O does not matter.
Parameterized Supply Function Bidding: Equilibrium and Efficiency
Authors: Johari Ramesh , Tsitsiklis John N.
Published: November 2011

We consider a model where a finite number of producers compete to meet an infinitely divisible but inelastic demand for a product. Each firm is characterized by a production cost that is convex in the output produced, and firms act as profit maximizers. We consider a uniform price market design that uses supply function bidding: firms declare the amount they would supply at any positive price, and a single price is chosen to clear the market. We are interested in evaluating the impact of price-anticipating behavior both on the allocative efficiency of the market and on the prices seen at equilibrium. We show that by restricting the strategy space of the firms to parameterized supply functions, we can provide upper bounds on both the inflation of aggregate cost at the Nash equilibrium relative to the socially optimal level, as well as the markup of the Nash equilibrium price above the competitive level: as long as N > 2 firms are competing, these quantities are both upper bounded by 1 + 1/(N − 2). This result holds even in the presence of asymmetric cost structure across firms. We also discuss several extensions, generalizations, and related issues.
An Erratum on the Multiproduct Network Equilibrium Model
Authors: Wu Yunan , Cheng T. C. E.
Published: November 2011

We give examples to show that the necessary conditions of Theorem 2.1 and Theorem 3.4 in Cheng and Wu [Cheng, T. C. E., Y. N. Wu. 2006. A multiproduct, multicriterion supply-demand network equilibrium model. Oper. Res. 54(3) 544–554] for a multiproduct network equilibrium model may not hold.
Process Flexibility Revisited: The Graph Expander and Its Applications
Authors: Chou Mabel C. , Chua Geoffrey A. , Teo Chung-Piaw , Zheng Huan
Published: November 2011

We examine how to design a flexible process structure for a production system to match supply with demand more effectively. We argue that good flexible process structures are essentially highly connected graphs, and we use the concept of graph expansion (a measure of graph connectivity) to achieve various insights into this design problem. Whereas existing literature on process flexibility has focused on the expected performance of process structure, we analyze in this paper the worst-case performance of the flexible structure design problem under a more general setting, which encompasses a large class of objective functions. Chou et al. [Chou, M. C., G. Chua, C. P. Teo, H. Zheng. 2010. Design for process flexibility: Efficiency of the long chain and sparse structure. Oper. Res. 58(1) 43–58] showed the existence of a sparse process structure that performs nearly as well as the fully flexible system on average, but the approach using random sampling yields few insights into the nature of the process structure. We show that the ψ-expander structure, a variant of the graph expander structure (a highly connected but sparse graph) often used in communication networks, is within ϵ-optimality of the fully flexible system for all demand scenarios. Furthermore, the same expander structure works uniformly well for all objective functions in our class. Based on this insight, we derive design guidelines for general nonsymmetrical systems and develop a simple and easy-to-implement heuristic to design flexible process structures. Numerical results show that this simple heuristic performs well for a variety of numerical examples previously studied in the literature and compares favourably even with the best solutions obtained via extensive simulation and known demand distribution.
TECHNICAL NOTE—A Note on Profit Maximization and Monotonicity for Inbound Call Centers
Authors: Koole Ger , Pot Auke
Published: November 2011

We consider an inbound call center with a fixed reward per call and communication and agent costs. By controlling the number of lines and the number of agents, we can maximize the profit. Abandonments are included in our performance model. Monotonicity results for the maximization problem are obtained, which lead to an efficient optimization procedure. We give a counterexample to the concavity in the number of agents, which is equivalent to saying that the law of diminishing returns does not hold. Numerical results are given.
A Comparative Study of Interventions for Delaying The Initiation of Sexual Intercourse Among Latino And Black Youth
Authors: Guilamo‐Ramos Vincent , Jaccard James , Dittus Patricia , Bouris Alida , Gonzalez Bernardo , Casillas Eileen , Banspach Stephen
Published: November 2011

CONTEXT: Latino and black adolescents are disproportionately affected by STDs, including HIV, and unintended pregnancies. Few parent‐based interventions have targeted these youth, focused on early adolescence and had high participation rates.

METHODS: Between 2003 and 2009, a randomized clinical trial was conducted with 2,016 Latino and black mother‐adolescent dyads in New York City. Adolescents were eligible if they were in grade 6 or 7. Dyads were assigned to one of three conditions: a parent‐based intervention, Families Talking Together (FTT); an adolescent‐only intervention, Making a Difference! (MAD); or a combined FTT+MAD intervention. Respondents completed questionnaires at baseline and 12 months later. Single‐degree‐of‐freedom contrasts and logistic regression analysis were used to evaluate differences in outcomes by intervention.

RESULTS: The proportion of youth who reported ever having engaged in vaginal intercourse increased over the study period by eight percentage points among those in the MAD group, five points in the FTT group and three points in the combined group; the differences among these increases were not statistically significant. Adolescents in the two FTT groups were significantly more likely than those in the MAD group to indicate that their mother had talked to them about not having intercourse (79% vs. 68%). They also scored higher than youth in the MAD group on measures of communication and perceived maternal attributes, and lower on activities that might lead to risky behaviors.

CONCLUSIONS: The proportions of adolescents who initiated intercourse during the study period were not significantly different across groups, implying that the interventions were comparable. Findings suggest that FTT may have led to improved parenting behaviors.
Evaluation of Flufenacet plus Metribuzin Mixtures for Control of Italian Ryegrass in Winter Wheat
Authors: Koepke-Hill Rebecca M. , Armel Gregory R. , Bradley Kevin W. , Bailey William A. , Wilson Henry P. , Hines Thomas E.
Published: November 2011

Field studies were conducted to compare the effectiveness of PRE and POST applications of a prepackaged mixture of flufenacet plus metribuzin with that of diclofop for winter wheat tolerance and control of Italian ryegrass. Additional studies investigated the effectiveness of reduced rates of flufenacet plus metribuzin applied POST to Italian ryegrass when wheat was in the spike stage. All PRE and POST applications of flufenacet plus metribuzin produced similar or greater injury to wheat and more consistent control of Italian ryegrass than PRE or POST applications of diclofop. PRE applications of flufenacet plus metribuzin controlled Italian ryegrass 73 to 77%, whereas POST applications controlled Italian ryegrass 77 to 99%. PRE applications of diclofop controlled Italian ryegrass 57%; POST application controlled Italian ryegrass 78%. Wheat injury from flufenacet plus metribuzin applications varied with application rate, cultivar, and year of application.
Effects of Soil vs. Foliar Application of Amicarbazone on Annual Bluegrass (Poa annua)
Authors: Perry D. H. , McElroy J. S. , Walker R. H.
Published: November 2011

Amicarbazone is a photosystem II (PSII) inhibiting herbicide of the triazolinone herbicide family. Greenhouse experiments were conducted to compare the effects of amicarbazone and atrazine on annual bluegrass control and quantum yield (ΦPSII) when applied at three treatment placements (soil-only, foliage-only, and foliage + soil). Herbicide rates for amicarbazone and atrazine were 0.53 and 2.25 kg ha−1, respectively. Amicarbazone applied soil-only and foliage + soil controlled annual bluegrass 57 and 59%, respectively, 1 wk after treatment (WAT). Atrazine applied to foliage + soil controlled annual bluegrass 48% at 1 WAT. All soil-only and foliage + soil treatments were similar 2 WAT. Foliage-only application of amicarbazone provided significantly less control than other amicarbazone treatments throughout the study. Amicarbazone applied soil-only and foliage + soil controlled annual bluegrass 100% at 3 WAT. Soil-only and foliage + soil applications of atrazine and amicarbazone had similar reductions in quantum yield (ΦPSII) at 1 to 3 WAT. Foliar-applied amicarbazone reduced ΦPSII 78, 84, and 86% at 1, 2, and 3 WAT, respectively. The rapid reduction in annual bluegrass ΦPSII and the increase in control resulting from soil contact of amicarbazone indicate root exposure of amicarbazone is beneficial for annual bluegrass control.
Effects of Planting Pattern and Cultivar on Weed and Crop Growth in Aerobic Rice System
Authors: Mahajan Gulshan , Chauhan Bhagirath S.
Published: November 2011

Weeds are a major biotic constraint to aerobic rice production in Asia. Research is needed on the effects of cultural practices on weed management in aerobic rice, including techniques such as planting pattern and competitive cultivars. Field experiments were conducted in Punjab, India, in the wet seasons of 2008 and 2009 to study the growth of weeds and two rice cultivars [PR 115 and Punjab (P.) Mehak 1] in relation to planting pattern (uniform rows [23-cm row spacing] and paired rows [15-, 30-, and 15-cm row spacings]) under aerobic conditions. Junglerice and rice flatsedge were the dominant weed species during the early stages of the crop, while Chinese sprangletop and large crabgrass were the predominant species during flowering stage of the crop. Weed dry matter was not affected by planting pattern of P. Mehak 1; however, for PR 115, weed dry matter was greater in rice grown in uniform rows (244 g m−2) than in paired rows (183 g m−2). Planting patterns did not affect weed-free crop growth and yield, but weeds tended to be more abundant in the uniform planting system, particularly under cultivar PR 115. Consequently, this cultivar grew and yielded better under the paired rows when weeds were present. The cultivar PR 115 had greater yield potential than P. Mehak 1, but growth and productivity of P. Mehak 1 were unaffected by the planting patterns, suggesting better competitive ability against weeds than PR 115. The results imply that yield of some aerobic rice cultivars may be improved by exploring competitiveness of rice cultivars through paired row planting patterns. There is a need to study plasticity changes for cultivars which respond with more competiveness in paired rows. The identified traits could be useful as selection criteria for screening weed-competitive cultivars in paired row pattern.
Epidermolysis Bullosa: Pathophysiology and Nursing Care
Authors: Gannon Barbara
Published: November 2011

Epidermolysis bullosa (EB) is defined as a group of skin disorders that presents as blistering of the skin in varying degrees of severity. Most cases are inherited, but rare cases may be acquired. There are three main types: simplex, junctional, and dystrophic. The dermal-epidermal junction of the newborn skin is a vital area of attachment. Any defects in the components that comprise this junction can lead to fragility of the skin. EB diagnosis and testing can be performed both prenatally and postnatally. There is no cure for EB. Treatment revolves around supportive care and prevention of complications.The NICU nurse plays an important role on the multidisciplinary team as primary caregiver to the infant and educator to the family.
Pathophysiology and Current Management of Necrotizing Enterocolitis
Authors: Horton Kelly
Published: November 2011

NECROTIZING ENTEROCOLITIS (NEC) is a common and life-threatening gastrointestinal (GI) emergency in the low birth weight infant.1,2Characterized by necrosis, which often leads to perforation of the GI tract, NEC can be a deadly disease.3According to Israel, NEC is a disease of the immature intestinal mucosal barrier in the premature population.4
Holding the Very Low Birth Weight Infant: Skin-to-Skin Techniques
Authors: Kledzik Theresa
Published: November 2011

Skin-to-skin holding has been reported as a valuable intervention for preterm infants for over a decade. However, many neonatal intensive care units are not practicing this therapy and cite lack of protocols and techniques as a barrier. This article describes in detail the nursing considerations and techniques involved to successfully implement skin-to-skin holding for very low birth weight, technology-dependent infants. NICU protocols can be derived from this article.
What Goes Around Comes Around?
Authors: Askin Debbie Fraser
Published: November 2011

“WHAT GOES AROUND comes around,” isn’t that the old saying? Others use phrases like “what’s old is new and what’s new is old” to describe the cyclical patterns we see in life. You know—bell bottoms and belly buttons come and go, short hair, long hair, horned-rim glasses or not. We are always hearing of new trends that really aren’t new at all and in some ways, can make us feel really quite old.
Parents and Professionals in the NICU: Communication within the Context of Ethical Decision Making—An Integrative Review
Authors: Ward Frances
Published: November 2011

Communication between parents and professionals in the NICU is a necessary part of collaborative decision making in the provision of family-centered care. Decisions with ethical components, those regarding treatment plans or neonatal research enrollment, need to be made conjointly with parents and health care professionals. This article reviews the present state of knowledge of how parents’ input can be facilitated in regard to decisions made about their children. Research studies involving decisions made with ethical components in the NICU since the advent of the Baby Doe regulations reveal parents’ frustration with communication practices, their need for control of information, and the trust in their children’s health care providers that is required to best facilitate their input into ethical decisions made about their children.
Extinguishing the Flames of Manager Burnout with CPR
Authors: Simons Sherri Lee
Published: November 2011

YEARS AGO, OLD TIMEX WATCH advertisements had the slogan, “It takes a licking and keeps on ticking.” In these ads, the watches were submitted to dramatic abuse but, in the end, still worked.1 With sufficient attention to self-preservation and renewal, nurse managers can be like Timex watches. The alternative may be burnout and the loss of a good manager.
Early Enteral Feeding for the Very Low Birth Weight Infant: The Development and Impact of a Research-Based Guideline
Authors: Smith Joan Renaud
Published: November 2011

Providing optimal nutrition for the very low birth weight (VLBW) infant is critical during the neonatal period. Evidence-based practice guidelines are essential in managing these fragile infants. Putting scientific research into daily clinical practice may be arduous at times, however. A multidisciplinary team of health care providers successfully established a practical feeding guideline for a 52-bed, teaching-affiliated, Level III neonatal intensive care unit in St. Louis. This guideline identifies human milk as the recommended source of nutrition for the VLBW infant, a suggestion that has significantly affected lactation services in the unit. This article describes the process of developing, implementing, and evaluating a feeding guideline based on current research and describes the impact on lactation rates of having such a guideline in place within the unit.
The Neonatal Respiratory Pump: A Developmental Challenge with Physiologic Limitations
Authors: Greenspan Jay , Miller Thomas , Shaffer Thomas
Published: November 2011

Newborn lungs are particularly susceptible to pathophysiology. Respiratory distress commonly brings infants to the intensive care nursery. Premature birth compromises the infant’s ability to respond to early lung dysfunction because of the reduced functional reserve available at younger gestational ages. The respiratory pump consists of respiratory musculature and the chest wall. The respiratory pump is the physiologic “machine” that responds to lung pathology. From gestation onward, components of the pump undergo developmental changes that influence its compensatory ability in the neonate. Careful observation of the synchrony of the chest wall and abdomen during spontaneous breathing efforts assists the caretaker in detecting respiratory compromise and impending respiratory failure. Noninvasive monitoring of respiratory patterns is a valuable tool for the neonatal caregiver, who must understand the developmental changes in the respiratory pump and be able to identify an infant’s ineffective responses to lung pathophysiology.
Pneumothorax in the Neonate: Assessment and Diagnosis
Authors: Kirby Cindy , Trotter Carol
Published: November 2011

PNEUMOTHORAX OCCURS MORE often in the neonatal period than at any other time of life.1 It can happen spontaneously, secondary to mechanical ventilation, as a complication following certain procedures, or as a result of pneumonia or aspiration.2 The frequency of spontaneous pneumothorax is approximately 1 percent of all live births.1 Horbar and colleagues reported data on 118,448 very low birth weight newborns (410–1,500 gm) followed through the Vermont Oxford Network from 1991 to 1999. They documented an increasing risk for pneumothorax with time. Rates of pneumothorax for neonates with birth weights of 501–750 gm were as high as 14 percent in 1999.3 The following case study summarizes the course of a neonate with a recurrent tension pneumothorax.
Elevated Sound Levels within a Busy NICU
Authors: Krueger Charlene , Wall Susan , Parker Leslie , Nealis Rose
Published: November 2011

Purpose:Elevated sound levels in the NICU may contribute to undesirable physiologic and behavioral effects in preterm infants. This study describes sound levels in a busy NICU in the southeastern U.S. and compares the findings with recommended NICU noise level standards.

Design:NICU sound levels were recorded continuously at nine different locations within the NICU. Hourly measurements of loudness equivalent (Leq) sound level, sound level exceeded 10 percent of the time (L10), and maximum sound level (Lmax) were determined.

Sample:Sound levels were sampled from nine different locations within the NICU.

Main Outcome Variable:Sound levels are described using the hourly, A-weighted Leq, L10, and Lmax.

Results:The overall average hourly Leq (M = 60.44 dB, range = 55–68 dB), L10(M = 59.26 dB, range = 55–66 dB), and Lmax (M = 78.39, range = 69–93 dB) were often above the recommended sound levels (hourly Leq <50 dB, L10 <55 dB, and 1-second Lmax <70 dB). In addition, certain times of day, such as 6–7 AM and 10 AM–12 noon, were noisier than other times of day.
Embracing Bioethics in Neonatal Intensive Care, Part II: Case Histories in Neonatal Ethics
Authors: Purdy Isabell , Wadhwani Rita
Published: November 2011

Ethical treatment dilemmas are not new to the NICU. With technologic advances over the past 20 years, NICU care has developed rapidly, and survival rates have improved for some of the tiniest and most critically ill infants. In guiding clinical practice, however, standards in evidenced-based medicine have often superseded standards in evidence-based ethics. Neonatal nurses attain a more in-depth understanding of the clinical significance of the four principles of bioethics: autonomy, nonmaleficence, beneficence, and justice. Case studies illustrate the principles discussed.
Letters
Authors: Mundy Cynthia
Published: November 2011

As a current Doctorate of Nursing Practice (DNP) student at the Medical College of Georgia (pilot program) and a neonatal nurse practitioner, I was disturbed by the editorial in the July/August 2005 edition of Neonatal Network® entitled “Yet Another Degree for the Nursing Profession,” and would like to express a different point of view.
Neonatal ECMO: Current Controversies and Trends
Authors: Ford Jesse
Published: November 2011

Extracorporeal membrane oxygenation (ECMO), a technique for providing life support to patients with cardiac and/or respiratory dysfunction, allows the heart and lungs to “rest.” The neonatal respiratory population has been a major benefactor of ECMO since 1982. Its use for neonatal respiratory disease increased dramatically until the past few years, when the number of neonatal respiratory ECMO cases began a downward trend. Fewer patients with persistent pulmonary hypertension of the newborn (PPHN), meconium aspiration syndrome, respiratory distress syndrome, or sepsis are requiring ECMO support as frequently as in the past. Many attribute this decline to the newer respiratory therapies—mainly, surfactant, high-frequency oscillatory ventilation, and inhaled nitric oxide. Neonates who continue to require ECMO today are sicker than the historic norm and have more complicated and lengthy ECMO runs. Patients with congenital diaphragmatic hernia, PPHN, and sepsis remain the most consistent in their representation among ECMO recipients within this author’s institution, suggesting that the newer respiratory therapies have not had the same impact on these patients’ needs for ECMO support. Better guidelines for determining which patients would benefit from earlier inititation of ECMO are needed.
A Protocol for the Use of Amorphous Hydrogel to Support Wound Healing in Neonatal Patients: An Adjunct to Nursing Skin Care
Authors: Cisler-Cahill Lorna
Published: November 2011

The care registered nurses offer makes a critical difference in the quality and cost-effectiveness of patient outcomes. The prevention and treatment of alterations in skin integrity remain primary nurse-sensitive quality indicators. Although wound prevention is a primary goal for nurses, iatrogenic wounds do occur. Neonatal patients are at greater risk for alterations in skin integrity because of the fragile nature of their skin. When skin breakdown occurs, nurses must have knowledge of effective treatment alternatives. The purpose of this article is to describe the use of a collaborative practice protocol to introduce and document patient outcomes with the use of amorphous hydrogel as a treatment modality for iatrogenic neonatal wounds. All hospitals collect data on the quality of patient care, and it has been known for some time that registered nurses can make a critical difference in the quality of patient care and the effectiveness of patient outcomes. The American Nurses Association has identified ten specific quality measures that are impacted by nursing care. Referred to as nurse-sensitive quality indicators, these measures include the maintenance of skin integrity.1
More than a Case Study
Authors: Franklin Sara
Published: November 2011

THE DAY FINALLY ARRIVES. As she rises this morning, she feels a tightening in her swollen belly. She quickly realizes that today will be the day she delivers her twins. She calls her husband and shares with him her conflicting feelings of excitement and anxiety—for she is aware that her babies will be born six weeks early.
When Health Professionals Become NICU Parents
Authors: Dockerty John , Dockerty Joanne
Published: November 2011

TWO YEARS AGO WE BECAME THE parents of an extremely premature baby, born 14 weeks early. As she spent her first 16 weeks in the newborn intensive care unit, we lived through one of the most difficult periods of our lives. Our situation was both helped and hindered by our occupations as health professionals.
Considerations for Implementation of a Neonatal Kangaroo Care Protocol
Authors: DiMenna Lisa
Published: November 2011

Kangaroo care (KC) is skin-to-skin contact between an infant and parent, where the infant is usually held chest- to-chest in an upright prone position. It is a very simple, beneficial developmental intervention for both baby and parent, as demonstrated in the literature, but many parents and health care professionals are not aware of KC, its benefits, or how to perform it. The purpose of this article is (1) to inform health care professionals about the research literature on KC and its benefits and (2) to develop a list of evidence-based KC guidelines for the use of all infants and their parents. Increased knowledge of and education on KC for healthcare providers should lead to increased, routine use of this beneficial intervention.
Neonatal Abstinence Syndrome: Reconstructing the Evidence
Authors: Marcellus Lenora
Published: November 2011

Neonatal abstinence syndrome (NAS) is the term used to describe the presence of withdrawal symptoms in neonates exposed prenatally to opiates. Much of what is known about NAS is based on the biomedical model of illness. There is less consideration of the social, historical, and political influences on knowledge development about the NAS phenomenon. Social construction presents an alternate framework within which to consider the diagnosis of NAS and on which to strengthen theoretical foundations, expand research programs, and improve practice.
Transient Myeloproliferative Disorder Associated with Trisomy 21
Authors: Kruger Branda
Published: November 2011

Transient myeloproliferative disorder (TMD) is a spontaneously resolving condition affecting infants born with trisomy 21 syndrome. Although TMD is rather rare among infants with trisomy 21, its ramifications can become severe enough that neonatal nurses should be aware of the condition, its manifestations, and its management. The spectrum of TMD presentation ranges from subtle blastemia in an otherwise healthy infant to severe, life-threatening expression of the disease. TMD may be a precursor to congenital leukemia—thus, the importance of nurses’ becoming aware of this condition. This article addresses the pathology of TMD, case reports in the literature, potential complications of the disorder, and nursing implications. A case study of an infant with dermatologic manifestations of TMD is presented, including history, differential diagnoses, treatment, and follow-up.
Handbook of Neonatal Intensive Care (6th Edition)
Authors: Merenstein Gerald , Gardner Sandra
Published: November 2011

Handbook of Neonatal Intensive Care (6th Edition) is a comprehensive, well-written clinical reference book that remains a cornerstone reference for the neonatal nurse. The sixth edition continues to provide an inclusive reference for the neonatal intensive multidisciplinary care team, from staff nurses to house staff and entry-level neonatal nurse practitioners. There are a few distractions in this professional and quality reference book, including some figures that are dated, if not antiquated, and the occasional noteworthy spelling error.
Newborn Screening: A Literature Review
Authors: Kayton Allyson
Published: November 2011

Newborn screening is the largest genetic testing effort for newborns in the U.S. Its purpose is to identify newborns who are at risk for metabolic, endocrine, or hematologic disorders. A review of the literature was conducted to determine the benefits of newborn screening; specimen collection timing and handling; ethical considerations of screening; as well as current practices regarding consent, notification of results, and follow-up procedures. The use of tandem mass spectrometry for expanded newborn screening and postmortem diagnosis of unexplained infant death was also reviewed. This article is intended to educate health care providers in the areas of controversy that surround the U.S. newborn screening program, with the hope of encouraging further research in this important area of newborn care.
The Chasm in Neonatal Outcomes in Relation to Time of Birth in Lebanon
Authors: Badr Lina Kurdahi , Abdallah Bahia , Balian Sossi , Tamim Hala , Hawari Mirvat
Published: November 2011

Purpose:The purpose of this study was to investigate the relationship between the time of birth and the mortality and morbidity of infants admitted to neonatal intensive care units.

Design:This prospective, cohort study examined the records of women and infants admitted to the NICUs of four hospitals in Beirut, Lebanon, between July 1, 2002, and June 30, 2003. The hospitals selected were university affiliated and had a large number of deliveries (5,152 total for the year 2002–2003).

Main Outcome Variables:Neonatal mortality and morbidity for infants admitted to the NICU were evaluated in relation to time of birth.

Results:For the whole sample, mortality was higher for infants born during the night shift than for those born during the day shift. Mortality, morbidity, and brain asphyxia rates were also higher for infants born during the night shift and admitted to the NICU. Maternal risk factors and delivery complications were not consistently higher on the night shift.
Use of the Six Sigma Methodology to Reduce Incidence of Breast Milk Administration Errors in the NICU
Authors: Drenckpohl Douglas , Bowers Laura , Cooper Hoa
Published: November 2011

Breast milk is the optimal source of nutrition for infants. According to research, neonates fed breast milk have a reduced risk of sepsis, increased feeding tolerance, a decreased incidence of necrotizing enterocolitis, and better neurodevelopmental outcomes. Unfortunately, researchers have not identified practices to reduce or eliminate the risk for errors in breast milk administration. This article discusses the potential hazards of incorrect administration of breast milk. It then describes how the tertiary care center at Children’s Hospital of Illinois implemented a policy utilizing six sigma quality improvement methodologies to improve breast milk administration. Since implementation of this policy, the NICU at our hospital has reduced the risk of breast milk administration errors to less than 3.4 mistakes per million opportunities.
Use of the Duotron Transporter High Frequency Ventilator During Neonatal Transport
Authors: Honey Gina , Bleak Tammy , Karp Tracy , MacRitchie Amy , Null, Donald
Published: November 2011

In the past, transport of neonates with severe respiratory failure was hampered by the lack of an appropriate transport ventilator capable of providing high frequency ventilation (HFV). This article reports on the experiences of the Intermountain Health Care Life Flight Program in selecting a high frequency ventilator and preparing the transport team members for its use. Once the use of the Duotron ventilator was initiated, pre- and posttransport data were collected for the first 134 neonates requiring HFV on transport. Analysis of the data determined that 96 percent of the infants were successfully transported using the Duotron ventilator. Inspired oxygen requirements stayed the same or improved in the majority of intubated patients for whom comparison data were available. Ventilation and acid-base balance improved. Although HFV has been a common therapy in neonatal care for some time, its adoption for use during transport required modification and considerable education for transport team members.
Effect of Environmental Changes on Noise in the NICU
Authors: Brandon Debra , Ryan Donna , Barnes Angel
Published: November 2011

Purpose:To evaluate the effect of changes in the NICU environment on sound levels.

Design:A prospective quasi-experimental design evaluated sound levels in a 43-bed NICU. Decibel levels were monitored utilizing a data-logging dosimeter for 24 hours weekly over 12 months. Sound levels were also measured inside four different incubator models.

Sample:Forty-four 24-hour decibel recordings were obtained in one of eight randomly selected four-bed pods. In addition, a single 1-hour recording was obtained in four different models of vacant incubators.

Main Outcome Variable:Ambient sound levels.

Results:Decibel levels were analyzed to identify changes in noise levels following alterations in the NICU environment. Installation of motion-sensing motorized paper towel holders significantly increased levels at beds closest to the towel dispensers, as did the trial of a new communication system. Decibel levels in four different incubators revealed varying noise levels. This study suggests that all environmental changes must be monitored to ensure that they reduce rather than increase noise levels.
Retinopathy of Prematurity: The Disease Process, Classifications, Screening, Treatment, and Outcomes
Authors: Harrell Sallie Nash , Brandon Debra Huffman
Published: November 2011

Retinopathy of prematurity (ROP) is the cessation of normal eye development and subsequent abnormal vessel growth that occurs exclusively in premature infants. ROP was first discovered in the 1940s and was for two decades the leading cause of blindness in children. Currently, the disease causes about 500 new cases of blindness per year. The severity of the disease increases with decreasing gestational age. The pathogenesis of ROP involves disruption of normal retinal vascularization. Vessel endothelial growth factor, insulin-like growth factor, and oxygen play important roles in its development. ROP is classified using an international classification system that provides direction for screening and treatment of premature infants. Examinations are performed by ophthalmologists, who identify the scope of vascularization, the degree of abnormal vessel growth, and the amount of the eye that is affected. Treatment modalities include cryosurgery and laser photocoagulation. Long-term outcomes include both structural and functional vision problems.