bluuebunny/crossref_metadata_2025 huggingface dataset:
Influenza
Authors: Jacquet Gabrielle , Dugas Andrea
Published: November 2017

Influenza is a viral syndrome caused by a highly contagious viral infection. It presents with acute fever, respiratory symptoms, rigors, malaise, myalgia, and/or fatigue. Substantial morbidity and mortality can result in susceptible populations, including patients who are at the extremes of age; have chronic medical conditions; or are immunocompromised, pregnant, reside in a nursing home, obese, or of Native American descent. Antiviral treatment is recommended for those requiring hospital admission, those with lower respiratory tract disease, and inpatient populations at high risk for complications. In addition to causing a viral pneumonia, influenza damages the respiratory epithelium. This increases the risk of bacterial coinfection, especially in those with severe illness, pneumonia, and otitis media. Preventive recommendations include vaccination for everyone over the age of 6 months, minimizing potential exposures, attention to respiratory and hand hygiene, adherence to standard precautions, and minimizing visitors for patients in isolation for influenza.
Viral Gastroenteritis
Authors: Tobar Ximena , Putman Shannon B.
Published: November 2017

Viral gastroenteritis is a diarrheal disease associated with nausea, vomiting, headache, abdominal cramping, myalgias, and low-grade fever. Stools are often described as watery, with bouts of diarrhea and emesis that can occur on an hourly basis. Blood or mucus in the stool is suggestive of a bacterial or parasitic process. Additionally, the presence of fecal leukocytes excludes viral infection, as it is suggestive of colonic inflammation. Treatment is mainly supportive with appropriate hydration, including oral rehydration and/or intravenous fluids, being the key intervention. Specific antiviral agents are not available. Prevention and control of spread are important issues for viral gastroenteritis. Hand washing alone may reduce the spread of infection. The use of alcohol-based hand sanitizers and daily disinfection of surfaces with quaternary ammonium wipes has reduced the spread of Norovirus and was found superior to handwashing alone.
Infectious Colitis
Authors: Scordino David
Published: November 2017

Infectious colitis is diarrhea with evidence of colonic inflammation by visualization (colonoscopy), history (blood or mucus in the stool), or laboratory evidence (high lactoferrin). Infectious colitis is associated with direct bacterial or indirect bacterial toxin invasion of the colonic mucosa, leading to toxicity, volume loss, hemorrhage, and colonic inflammation. The most important treatment is adequate hydration, but treatment also may include loperamide (useful in patients without fever or bloody stools) and antibiotics in individuals with evidence of colitis (although not for mild to moderate diarrhea without colitis). In any individual with diarrhea, address recent travel history, possible immunosuppression, the presence of blood or mucus in the stool, and any history of vomiting or severe abdominal pain. Therapy should be focused on maintaining adequate hydration and not missing potentially dangerous etiologies. Intravenous hydration can be used for those with moderate to severe dehydration with supplemental oral hydration solutions if discharge is possible.
Peritonitis
Authors: Rosenblatt Elizabeth
Published: November 2017

Peritonitis, or inflammation of the serosal membranes lining the abdominal cavity, is used predominately to describe primary peritonitis (spontaneous bacterial peritonitis [SBP]) and secondary peritonitis—two conditions with distinct pathophysiologies that require different diagnostic and therapeutic approaches. Tertiary peritonitis is characterized by persistent symptoms or signs of infection despite appropriate treatment of primary or secondary peritonitis. Patients undergoing peritoneal dialysis are at risk for catheter-associated peritonitis, which is sometimes considered an additional category of peritonitis. The most common manifestation of SBP is fever. In addition, patients often endure abdominal pain, general malaise, fatigue, and hepatic encephalopathy. One-third of patients with SBP develop renal dysfunction, which is an independent predictor of mortality. In patients with ascites and high clinical suspicion for infection, empiric antibiotic therapy should be started immediately following blood cultures and diagnostic paracentesis.
Diverticulitis
Authors: Kocher Bharati
Published: November 2017

Diverticular disease includes two conditions: diverticulosis and diverticulitis. Both involve saclike protrusions of the mucosal and submucosal walls, typically in the colon. Diverticulosis is the presence of multiple diverticula, which may or may not be symptomatic. Symptomatic diverticulosis presents with indistinct symptoms and, less commonly, with severe symptoms, such as slow bleeding (causing anemia) or rapid bleeding (causing frank hematochezia and even hemodynamic instability). Diverticulitis is acute or chronic inflammation of the diverticula, possibly leading to abscesses and even perforation. Classic diverticulitis includes fever, leukocytosis, and left-sided abdominal pain, with localized tenderness and guarding. Incidence of disease increases with age. CT is the gold standard for diagnosis, which rules out other abdominal pathology and detects any diverticular complications. An outpatient course of oral antibiotics is prescribed for uncomplicated diverticulitis in an immunocompetent patient. Indications for surgery are generalized peritonitis or large abscesses that cannot be drained.
Appendicitis
Authors: Scordino David
Published: November 2017

Appendicitis is caused by acute inflammation of the appendix (usually secondary to obstruction) and can result in perforation, leading to peritonitis, sepsis, and/or abscess formation. Symptomatology includes anorexia, nausea, vomiting, and periumbilical pain (later localizing to the right lower quadrant). Patients at the extremes of age and pregnant women may have atypical presentations and higher rates of perforation and complications. Most patients suspected of having appendicitis receive prompt surgical intervention (usually laparoscopic). Antibiotic therapy, initiated preoperatively, varies for perforated vs nonperforated appendicitis. In patients with evidence of a contained abscess, nonoperative therapy is considered, as abscess is evidence of a prolonged disease course (more than 5 days) prior to presentation. On imaging, patients may have a well-circumscribed abscess or phlegmon; if immediate surgical intervention is attempted, there is significant risk of morbidity due to adhesions to adjacent tissues.
Urinary Tract Infections in Women
Authors: Chanmugam Arjun S. , Scalabrini Gino
Published: November 2017

Urinary tract infections (UTIs) refer to a urine culture yielding a minimum of 100 to 10,000 bacteria units/mm of urine usually from a clean catch midstream sample. This can result from infection of the lower urinary tract involving the bladder (cystitis) or an infection of the upper urinary tract involving the kidneys (pyelonephritis). Uncomplicated UTIs occur in healthy, pre-menopausal, non-pregnant women with a normal urinary tract who have a high likelihood to respond favorably to treatment, but consider local antibiotic resistance patterns. Complicated UTIs occur in women with coexisting pathology, anatomical abnormality, underlying comorbidity, or immunocompromise. Untreated UTIs can progress to pyelonephritis and urosepsis. Asymptomatic bacteriuria for pregnant women can progress very quickly; pyelonephritis carries increased risk of perinatal and neonatal mortality. Pregnant patients should be treated with cephalexin, amoxicillin, or amoxicillin-clavulanic acid (avoiding fluoroquinolones).
Urethritis, Prostatitis, and Epididymitis
Authors: Putman Shannon B. , Chanmugam Arjun S.
Published: November 2017

Urethritis, prostatitis, and epididymitis are a constellation of diseases often caused by infections; they can result in dysuria, pain, urethral discharge, and fever. Male dysuria can be the presenting complaint in patients with urethritis, prostatitis, epididymitis, or cystitis. Urethritis is most frequently caused by sexually transmitted infection, including Neisseria gonorrhea, Chlamydia trachomatis, Mycoplasma genitalium, and Trichomonas vaginalis. Prostatitis has four classifications: acute bacterial, chronic bacterial, chronic prostatitis/chronic pelvic pain, and asymptomatic inflammatory prostatitis. Epididymitis is an inflammation of the epididymis, with or without infection lasting less than 6 weeks. Acute epididymitis usually involves the testicles, resulting in an epididymo-orchitis. Although trauma is one example of a noninfectious cause, infectious causes must be considered, especially gonorrhea and chlamydia. Treatment for these diseases is targeted antibiotics based on lab and culture results.
Infections of the Hand
Authors: Steiner Lisa A.
Published: November 2017

Hand infections can be delineated by type and location of infection, by a polymicrobial vs single microbial colonization, and by the type of organism. They are most often caused by superficial injury or trauma. Early identification and timely treatment can significantly improve the morbidity associated with hand infections. In addition to determining the source and mechanism of infection, it is important to identify tetanus immunization status, prior injury to the affected area, immune status, occupation, and hand dominance. Some hand infections (eg, paronychia, felon, herpetic whitlow, and cellulitis) can be treated in the emergency department and discharged with close follow-up. Deep space abscesses and infections caused by bite wounds involving tendons will require either observation, admission, or surgery depending on their severity. Take into account a patient’s comorbidities—diabetes, immunosuppression, injection drug use, inability to follow up for re-evaluation, and ability to fill antibiotic prescriptions—upon disposition.
West Nile Virus
Authors: Finn Matthew
Published: November 2017

West Nile virus (WNV) is a single-stranded RNA virus of the Flavivirus family that is transmitted via a mosquito vector, typically causing fever and capable of causing meningoencephalitis. Although mortality is low, it can lead to debilitating neuroinvasive disease in some patients. WNV is a leading cause of domestically-acquired arboviral disease and most commonly occurs in late August and early September. Consider WNV in otherwise unexplained cases of meningitis or encephalitis. Initial testing should consist of cerebrospinal fluid (CSF) analysis and West Nile immunoglobulin M enzyme-linked immunosorbent assay in serum and/or CSF. WNV is a nationally notifiable disease. Prevention remains the key to controlling this disease. Reducing the breeding grounds of the Culex mosquito and using insect repellant to prevent bites are two important strategies.
Infections in the HIV Patient
Authors: Henggeller Michelle
Published: November 2017

The hallmark of the human immunodeficiency virus (HIV) patient with a cluster of differentiation 4 (CD4) T lymphocyte count below 200 is the development of opportunistic infections. Although the use of antiretroviral therapy (ART) has decreased the incidence of these infections, they continue to be a major case of morbidity and mortality in the patient with HIV. These infections can be respiratory in nature and present with cough or shortness of breath: Pneumocystis pneumonia (PCP), tuberculosis (TB), aspergillosis, and coccidioidomycosis. Neurological infections, which can present with change in mental status, include toxoplasmosis encephalitis (TE), meningoencephalitis, John Cunningham (JC) virus, and progressive multifocal leukoencephalopathy (PML). Gastrointestinal infections, such as Cryptosporidium, present with abdominal pain and diarrhea. Viral changes can result from cytomegalovirus retinitis. Fever or nonspecific symptoms can result from disseminated Mycobacterium Avium complex disease, histoplasmosis, bartonellosis, and cytomegalovirus.
Infection in Travelers and Emigrants
Authors: Tenforde Mark
Published: November 2017

This chapter focuses on common travel-related health topics. International travel generally requires appropriate preparation, including careful consideration of vaccinations and prophylaxis. Common problems include systemic febrile illness, traveler’s diarrhea, and dermatoses. Acute malaria and dengue are common infections, but an organism is not identified in a significant number of patients. The etiology and risk of each disease varies by region of travel and travel-related activities. Traveler’s diarrhea affects an estimated 20% to 60% of people traveling to low-income countries and usually develops within the first few days of travel, lasting only about 5 days. Rehydration is the cornerstone of management. Emergency physicians should be aware of pre-travel recommendations and be prepared to diagnose and manage common travel-related infections. Comprehensive travel resources include the World Health Organization’s International Travel and Health and the US Centers for Disease Control and Prevention’s Health Information for International Travel.
Anthrax
Authors: Smith Rebecca
Published: November 2017

Anthrax spores are found in the soil in many parts of the world and usually cause disease in grazing animals. Human disease is typically seen in farmers, ranchers, and workers handling animal carcasses, hides, hair, and bones. In biologic warfare or terrorism, aerosolization of the spores has been considered as an effective route of mass dissemination. Clinical presentation depends on the route of exposure: cutaneous, ingestion, inhalation (or Woolsorter’s disease). Personal protective equipment and patient decontamination are important before addressing a potential exposure. Mass casualty incidents will likely cause a strain on resources and appropriate triage will be crucial. Cardiopulmonary monitoring may not be available for all patients and should be reserved for patients with a high suspicion for inhalational anthrax. The duration of antibiotic therapy for all suspected bioterrorism attacks is 60 days in order to adequately cover for possible delayed development of inhalational anthrax.
Plague
Authors: Anest Trisha , Scordino David
Published: November 2017

Plague has three distinct clinical forms. Bubonic plague may resemble many viral syndromes; a distinct feature is buboes. Buboes are swollen lymph nodes filled with multiplying bacteria. They form near the bacteria’s entry point into the bloodstream. Septicemic plague symptoms can include abdominal pain and shock, with bleeding into skin and internal organs. Tissue manifestations include fingers, toes, or other areas turning black and necrotic. Bubonic and septicemic forms are transmitted by flea bites or the handling of infected animals. Pneumonic plague is easily transmitted from human to human by the inhalation of infectious droplets. Pneumonic plague is often lethal, resulting in respiratory failure and shock. Antibiotic treatment should be started as soon as plague as suspected. A vaccine, which is no longer being manufactured, was effective against the bubonic plague but not pneumonic plague. Research is ongoing for a vaccine effective against pneumonic plague, the form most likely to be utilized as a biological weapon.
Tularemia
Authors: Gertz Alida
Published: November 2017

Tularemia, caused by the gram-negative coccobacillus Francisella tularensis, is an extremely infectious bacterial zoonosis. Symptoms depend on site of exposure; they can be nonspecific and may include fever, lymphadenopathy, ulcer or papule, and nausea/vomiting. Natural transmission occurs via small mammals, such as rabbits, or arthropod bites. IV or IM antibiotics are preferred over oral forms. Supportive care is also critical; some patients may require respiratory support. If used as a biological weapon, aerosolized F. tularensis would be the most likely route of transmission. Clinical symptoms would include those of pneumonic tularemia. In the event of a bioterrorist attack, oral administration antibiotics can be used, as the health care system may not be able to accommodate intravenous or intramuscular treatment. Antibiotic resistance should also be considered if patients deteriorate despite use of recommended antibiotics.
Antibiotic Resistance
Authors: Klein Eili Y.
Published: November 2017

Antibacterial resistance threatens the ability of physicians to treat infections, reversing medical gains and increasing the probability of morbidity and mortality in infected patients. Decreased antibiotic efficacy also threatens advanced surgical procedures dependent on antibiotic effectiveness, such as organ and prosthetic transplants. Even simple procedures consider antibiotic prophylaxis to be a standard means of controlling surgical site infections. Despite the link between increased antibiotic use and resistance, a large fraction of antimicrobial use is inappropriate, particularly for acute respiratory tract infections. Methicillin-resistant Staphylococcus aureus (MRSA) is the most significant antibiotic-resistant pathogen, but new pathogens such as carbapenem-resistant enterobacteriaceae (CRE) are increasing in clinical significance. Antibiotic use and resistance is rising rapidly in developing countries, particularly India, China, and various African countries. The inappropriate use of antibiotics must be reduced, and incentives for the development of new antibiotics should be increased.
Patient Care and Clinical Research in the 1920s
Authors: Fye W. Bruce
Published: November 2017

The Mayo Clinic, recognized as a world center for comprehensive diagnosis and surgical therapy by World War I, became known for its research programs during the 1920s. Laboratories of experimental biochemistry and experimental surgery had already been established. In 1920 Will Mayo hired internist-pharmacologist Leonard Rowntree to build a hospital-based program of clinical research in Rochester, Minnesota. Rowntree assembled a group of internist-investigators that complemented internist Henry Plummer’s team of medical diagnosticians. Much of the research undertaken at Mayo focused on common clinical problems. The institution was among the first to study insulin therapy for diabetes. Steady growth of the multispecialty group practice led to the construction of a twenty-floor outpatient building that opened in 1928. In it, internist-diagnosticians were clustered in sections that reflected their interests in subspecialties, such as cardiology, gastroenterology, or hematology.
The Electrocardiograph and the Birth of Cardiology
Authors: Fye W. Bruce
Published: November 2017

The electrocardiograph, invented in Holland in 1902, was introduced into medical practice in the United States seven years later. The technology, which produced a tracing of the heart’s electrical activity, stimulated the development of cardiology as a specialty around World War I. The Mayo Clinic acquired an electrocardiograph in 1914. Fredrick Willius was a medical fellow when he was assigned to use it. Willius, who would become Mayo’s first cardiologist, used the technology to help evaluate patients and to conduct clinical research. Patient care was influenced by contemporary concepts of disease, such as the focal infection theory, and by an ever-expanding array of diagnostic tests that complemented history-taking and physical examinations. Willius participated in the establishment of the American Heart Association and played a leading role in organizing Minnesota’s first generation of heart specialists during the 1920s.
Surgeons Begin Trying to Treat Heart Disease
Authors: Fye W. Bruce
Published: November 2017

The development of heart surgery lagged behind operations on other organs. In the 1920s surgeons in Boston and in Europe attempted to open mitral valves that had become obstructed as a complication of rheumatic fever. Most of their patients died, and the operation was abandoned until after World War II. Operations to treat children with specific types of congenital heart disease were developed between 1938 and 1944. But these procedures involved the blood vessels outside the heart rather than structures within it. After the war, surgeons in Boston, Philadelphia, and London showed that it was safe to operate on patients with severe mitral stenosis. Without surgery, these individuals would die of heart failure. Mid-century optimism about the potential of treating patients with heart disease was fueled by the discovery of so-called miracle drugs, such as penicillin and cortisone (for which two Mayo staff members shared the Nobel Prize in 1950).
Coronary Angiography
Authors: Fye W. Bruce
Published: November 2017

Coronary angiography, injecting radiopaque contrast into the coronary arteries through a catheter, transformed the care of millions of patients and the careers of tens of thousands of cardiologists. As was typical of new diagnostic techniques, coronary angiography was the result of a series of technological innovations combined with contributions that many individuals had made over several years. But Mason Sones Jr. of the Cleveland Clinic was the main innovator and promoter of coronary angiography, which he described in a 1960 publication. At the time, there was no accepted surgical treatment for coronary heart disease, so very few cardiologists saw the need to refer their patients for this invasive catheter-based procedure. Sones and his colleagues at the Cleveland Clinic became tireless promoters of coronary angiography and of the Vineberg internal mammary artery implant operation as a treatment strategy for patients with coronary artery disease and angina pectoris.
Transforming Cardiac Catheters into Treatment Tools
Authors: Fye W. Bruce
Published: November 2017

Percutaneous transluminal coronary angioplasty (PTCA) transformed the cardiac catheter from a diagnostic tool into a treatment tool. The technology involved a special catheter fitted with a balloon near its tip that could be blown up to expand a narrowed coronary artery segment. For patients with angina, the procedure was an attractive alternative to coronary bypass surgery. Mayo cardiologists were among the first to adopt angioplasty and to call for controlled clinical trials to compare it to bypass surgery. Initially, cardiologists (who already performed coronary angiography) learned to perform PTCA informally. After attending one or more live demonstration courses, many began to perform angioplasty in their local hospitals. The philosophy in many contexts was “see one, do one.” By the mid-1980s, however, more rigorous training expectations were elaborated. Heart specialists who performed PTCA were described as “interventional cardiologists,” a phrase that acknowledged that this catheter-based treatment had immediate effects.
Seeing the Heart
Authors: Fye W. Bruce
Published: November 2017

During the 1960s and 1970s, new diagnostic technologies were developed that provided unique visual information about the heart’s structure and function. Echocardiography uses ultrasound to create moving images of the heart’s walls and valves. During the 1980s, advances in computer technology contributed to the development of new ultrasound techniques (such as two-dimensional echocardiography) that provided better visualization of the heart. Doppler echocardiography yielded physiological information that had been available previously only by performing cardiac catheterization. Mayo helped pioneer several echocardiography innovations, which it popularized in many publications and lectures. Another so-called noninvasive approach to imaging the heart involved the use of radioisotopes. Nuclear cardiology proved to be especially useful in evaluating patients with known or suspected coronary artery disease. The application of CT and MRI imaging to the heart lagged because it was difficult to apply these technologies to a moving organ.
Treating Heart Failure and Preventing Cardiovascular Disease
Authors: Fye W. Bruce
Published: November 2017

Heart failure may result from coronary disease, valve disease, or hypertensive heart disease. The first effective pills to treat hypertension and fluid retention were introduced in the 1950s. Cardiac transplantation was first performed in a human in 1967. This radical approach to treat patients with so-called end-stage heart failure presented a series of problems, such as organ rejection and ethical issues surrounding the definition of death. The large gap between the number of patients who might benefit from transplantation and the number of available donor organs contributed to a costly and controversial program to develop an artificial heart. During the final third of the twentieth century, preventive cardiology gained momentum. The goal was to identify cardiac risk factors and to attempt to treat them. Controlled clinical trials became increasingly important in the evaluation of competing treatments. Organizations used trial results as raw materials to produce clinical practice guidelines.
Challenges and Opportunities Around the New Millennium
Authors: Fye W. Bruce
Published: November 2017

During the 1980s and 1990s, Mayo implemented strategies to confront increasing regional competition. Clinic leaders were concerned about the managed care movement and other factors causing uncertainty about the future of health care. The institution entered new markets in Florida and Arizona. Mayo re-emphasized its commitment to patient care at the same time it devoted additional resources to medical education and research. The Cardiovascular Division sought to enhance its national reputation by sponsoring more continuing medical education programs. To protect referral patterns, it established outreach programs that sent cardiologists and specialized diagnostic technologies (such as echocardiography) to sites in surrounding counties. Mayo has long been a leader in employing state-of-the-art heart care technologies. Increasingly, however, questions about the appropriate use of technologies have been raised. Mayo was an early adopter of the electronic medical record and the notion of empowering patients by providing information in several formats, including social media.
Acute Human Immunodeficiency Virus (HIV) Infection Presenting With Bilateral Interstitial Pneumonia: Case Report and Discussion of Potential HIV-Induced Interstitial Pneumonia
Authors: Peri Anna Maria , Alagna Laura , Trovati Serena , Sabbatini Francesca , Rona Roberto , Simonetti Francesco Roberto , Foresti Sergio , Migliorino Guglielmo Marco , Gori Andrea , Bandera Alessandra
Published: November 2017

A 50-year-old man was admitted to intensive care unit because of acute respiratory failure due interstitial pneumonia; after admission, a diagnosis of acute human immunodeficiency virus (HIV)-1 infection was made. Clinical and radiological improvement was observed only after introduction of antiretroviral treatment. We discuss the hypothesis of interstitial pneumonia induced by the acute HIV-1 infection.
Student Perceptions of Clinical Instructor Characteristics Affecting Clinical Experiences
Authors: Reising Deanna L. , James Breya , Morse Ben
Published: November 2017

AIM

The purpose of this study was to explore and describe students’ perceptions of clinical instructor characteristics that affect their clinical experiences.

BACKGROUND

Clinical instructors can have a profound impact on student clinical experiences, yet little is known about what clinical instructor characteristics promote and hinder quality clinical experiences from the student perspective.

METHOD

A multisite prospective, descriptive exploratory design was used.

RESULTS

Students ranked instructor knowledge and support as the highest desirable characteristics, followed by patience, creating challenges, enthusiasm, and organization. Emerging themes from the content analysis revealed that the ability of the instructor to convey knowledge, demonstrate professionalism, and exhibit enthusiasm and caring were key characteristics that influence the clinical experience.

CONCLUSION

Nurse educators can use the results of this study to target hiring and placing of desired characteristics of clinical instructors and to support mentoring programs that promote clinical teaching excellence.
Bilateral Sacral Ala Fractures Are Strongly Associated With Lumbopelvic Instability
Authors: Bishop Julius A. , Dangelmajer Sean , Corcoran-Schwartz Ian , Gardner Michael J. , Routt Milton L. Chip , Castillo Tiffany N.
Published: November 2017

Objectives:

To quantify the incidence of lumbopelvic instability in the setting of unilateral and bilateral sacral fractures and assess whether the presence of bilateral sacral fractures on axial imaging is a useful screening test for lumbopelvic instability.

Design:

Retrospective case series.

Setting:

Level I trauma center at an academic medical center.

Patients/Participants:

A hospital database was used to identify patients diagnosed with a sacral fracture by The International Classification of Diseases, Ninth Revision (ICD-9) code from 2000 to 2014.

Intervention:

Axial cross-sectional imaging was reviewed to confirm the presence of unilateral or bilateral sacral ala fractures. Sagittal reconstructions were scrutinized for a transverse fracture line separating the lumbar spine from the pelvis, which was used to define lumbopelvic instability.

Main Outcome Measurements:

The Roy-Camille classification system was applied to all identified cases of lumbopelvic instability.

Results:

One thousand five hundred twenty-six patients were diagnosed with sacral fractures by the ICD-9 code. Four hundred ninety had adequate axial and sagittal cross-sectional imaging. Four hundred forty-three of these patients had unilateral sacral ala fractures, and none of these were associated with lumbopelvic instability. Forty-seven patients had bilateral sacral ala fractures, and 41 of these (87%) had a transverse component indicating some degree of lumbopelvic instability. The presence of bilateral sacral fractures was 100% sensitive and 99% specific for lumbopelvic instability. Among fractures with lumbopelvic instability, 27 (66%) were Roy-Camille type 1, 11 (27%) were type 2, and 3 (7%) were type 3.

Conclusions:

Bilateral sacral ala fractures are strongly associated with lumbopelvic instability and can be used as a very sensitive and specific screening tool. All patients with bilateral sacral fractures on axial computed tomography or magnetic resonance imaging should have close assessment of the sagittal plane images to evaluate for this pathology.

Level of Evidence:

Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Transfusion of Red Blood Cells Stored More Than 28 Days is Associated With Increased Morbidity Following Spine Surgery
Authors: Purvis Taylor E. , Goodwin C. Rory , Molina Camilo A. , Frank Steven M. , Sciubba Daniel M.
Published: November 2017

Study Design.

A retrospective study.

Objective.

The aim of this study was to describe the association between storage duration of packed red blood cells (PRBCs) and perioperative adverse events in patients undergoing spine surgery at a tertiary care center.

Summary of Background Data.

Despite retrospective studies that have shown that longer PRBC storage duration worsens patient outcomes, randomized clinical trials have found no difference in outcomes. However, no studies have examined the impact of giving the oldest blood (28 days old or more) on morbidity within spine surgery.

Methods.

The surgical administrative database at our institution was queried for patients transfused with PRBCs who underwent spine surgery between December 4, 2008, and June 26, 2015. Patients undergoing spinal fusion, tumor-related surgeries, and other identified spine surgeries were included. Patients were divided into two groups on the basis of storage duration of blood transfused: exclusively ≤28 days’ storage or exclusively >28 days’ storage. The primary outcome was composite in-hospital morbidity, which included (1) infection, (2) thrombotic event, (3) renal injury, (4) respiratory event, and/or (5) ischemic event.

Results.

In total, 1141 patients who received a transfusion were included for analysis in this retrospective study; 710 were transfused exclusively with PRBCs ≤28 days’ storage and 431 exclusively with PRBCs >28 days’ storage. Perioperative complications occurred in 119 patients (10.4%). Patients who received blood stored for >28 days had higher odds of developing any one complication [odds ratio (OR) = 1.82; 95% confidence interval (95% CI), 1.20–2.74; P = 0.005] even after adjusting for competing perioperative risk factors.

Conclusion.

Blood stored for >28 days is independently associated with higher odds of developing perioperative complications in patients transfused during spinal surgery. Our results suggest that blood storage duration may be an appropriate parameter to consider when developing institutional transfusion guidelines that seek to optimize patient outcomes.

Level of Evidence: 3
Immunomodulation of Human Mesenchymal Stem/Stromal Cells in Intervertebral Disc Degeneration
Authors: Teixeira Graciosa Q. , Pereira Catarina Leite , Ferreira Joana R. , Maia André F. , Gomez-Lazaro Maria , Barbosa Mário A. , Neidlinger-Wilke Cornelia , Goncalves Raquel M.
Published: November 2017

Study Design.

Ex vivo experimental study.

Objective.

To investigate the effect of proinflammatory/degenerative intervertebral disc (IVD) microenvironment on the regenerative and immunomodulatory behavior of mesenchymal stem/stromal cells (MSCs), using an ex vivo model from bovine origin.

Summary of Background Data.

Low back pain is a cause of disability worldwide, most frequently associated with IVD degeneration and inflammation, and characterized by increased levels of inflammatory mediators, often disregarded. MSC-based therapies to low back pain have been advocated, but the involvement of inflammation in IVD remodeling mechanism, promoted by MSCs has not yet been explored.

Methods.

Bovine IVD organ cultures of nucleus pulposus punches were stimulated with needle puncture and culture medium supplementation with 10 ng/mL of interleukin (IL)-1β, to induce a proinflammatory/degenerative environment, as previously established. Human bone marrow–derived MSCs were cultured on top of transwells, placed above nucleus pulposus punches, for up to 16 days. MSCs were analyzed by screening cell viability/apoptosis, metabolic activity, migration, and inflammatory cytokines production in response to the proinflammatory environment. IVD extracellular matrix (ECM) remodeling, gene expression profile of IVD cells, and inflammatory cytokine profile in the presence of MSCs in basal versus proinflammatory conditions were also evaluated.

Results.

Proinflammatory/degenerative IVD conditions did not affect MSCs viability, but promoted cell migration, while increasing IL-6, IL-8, monocyte chemoattractant protein-1, and prostaglandin E2 and reducing transforming growth factor-β1 production by MSCs. MSCs did not stimulate ECM production (namely type II collagen or aggrecan) in neither basal nor inflammatory conditions, instead MSCs downregulated bovine proinflammatory IL-6, IL-8, and TNF-α gene expression levels in IL-1β-stimulated IVDs.

Conclusion.

The present study provides evidence for an immunomodulatory paracrine effect of MSCs in degenerated IVD without an apparent effect in ECM remodeling, and suggest an MSCs mechanism-of-action dependent on a cytokine feedback loop.

Level of Evidence: 5
Anesthesia and Young Brains
Authors: Hall Keeley , Derouin Anne
Published: November 2017

Millions of children undergo anesthesia each year, and although some surgeries are medically necessary, the possible neurocognitive benefits of delaying elective surgeries in young pediatric patients need to be discussed between families and healthcare professionals as repeated or prolonged exposure to anesthesia in children less than 3 years old may negatively affect brain development. Nurses must be aware of the U.S. Food and Drug Administration recommendation and evolving research as they serve a key role in educating and supporting families through the perioperative process. This article discusses the recent U.S. Food and Drug Administration statement recommendations and its implications in clinical practice.
Selective Filopodia Adhesion Ensures Robust Cell Matching in theDrosophilaHeart
Authors: Zhang Shaobo , Amourda Christopher , Saunders Timothy E.
Published: November 2017

The ability to form specific cell-cell connections within complex cellular environments is critical for multicellular organisms. However, the underlying mechanisms of cell matching that instruct these connections remain elusive. Here, we explore the dynamic regulation of matching processes utilizingDrosophilacardiogenesis. During embryonic heart formation, cardioblasts (CBs) form precise contacts with their partners after long-range migration. We find that CB matching is highly robust at the boundaries between distinct CB subtypes. Filopodia in these CB subtypes have different binding affinities. We identify the adhesion molecules Fasciclin III (Fas3) and Ten-m as having complementary differential expression in CBs. Altering Fas3 expression influences the CB filopodia selective binding activities and CB matching. In contrast to single knockouts, loss of both Fas3 and Ten-m dramatically impairs CB alignment. We propose that differential expression of adhesion molecules mediates selective filopodia binding, and these molecules work in concert to instruct precise and robust cell matching.
Dietary and behavioral inferences from dental pathology and non-masticatory wear on dentitions from a British medieval town
Authors: Towle Ian , Davenport Carole , Irish Joel D. , De Groote Isabelle
Published: November 2017

Dental pathology and wear data can provide valuable insights into diet, cultural practices, and the health of populations. In this study, various dental pathologies and types of wear were recorded for 41 individuals (914 permanent teeth), excavated from the medieval cemetery of St. Owens Church in Southgate Street, Gloucester. Teeth were studied macroscopically with a 10x hand lens to confirm the presence of specific pathologies. Relatively high rates of antemortem chipping on the anterior teeth, and the presence of maxillary central incisor notches, suggested that the Gloucester population commonly used their teeth for non-masticatory activities. Abscessing and antemortem tooth loss fell within previously reported ranges for British medieval sites (2.6% and 6% respectively). However, the sample exhibits extremely high levels of carious lesions and calculus. Nearly 24% of teeth have at least one carious lesion, and the presence of calculus was recorded in 74% of teeth within the sample. Overall caries frequency is similar to sites from later time periods. This frequency may reflect Gloucester’s location as a large port town. Remains from the same area, but the earlier Roman period, also shows high rates of both caries and calculus, suggesting a continuation of consuming certain cariogenic foods is likely.
Glutamatergic drive along the septo-temporal axis of hippocampus boosts prelimbic oscillations in the neonatal mouse
Authors: Ahlbeck Joachim , Song Lingzhen , Chini Mattia , Candela Antonio , Bitzenhofer Sebastian H. , Hanganu-Opatz Ileana L.
Published: November 2017

The long-range coupling within prefrontal-hippocampal networks that account for cognitive performance emerges early in life. The discontinuous hippocampal theta bursts have been proposed to drive the generation of neonatal prefrontal oscillations, yet the cellular substrate of these early interactions is still unresolved. Here, we selectively target optogenetic manipulation of glutamatergic projection neurons in the CA1 area of either dorsal or intermediate/ventral hippocampus at neonatal age to elucidate their contribution to the emergence of prefrontal oscillatory entrainment. We show that despite stronger theta and ripples power in dorsal hippocampus, the prefrontal cortex is mainly coupled with intermediate/ventral hippocampus by phase-locking of neuronal firing via dense direct axonal projections. Theta band-confined activation by light of pyramidal neurons in intermediate/ventral but not dorsal CA1 that were transfected by in utero electroporation with high-efficiency channelrhodopsin boosts prefrontal oscillations. Our data causally elucidates the cellular origin of the long-range coupling in the developing brain.

Highlights

Neonatal theta bursts, sharp waves and ripples vary along septo-temporal axis

Hippocampal activity times prefrontal oscillations via direct axonal projections

Selective hippocampal targeting along septo-temporal axis causes precise firing

Light stimulation of hippocampal neurons at 8 Hz boosts prefrontal oscillations
Combinatorial appraisal of transition states for in situ pair distribution function analysis
Authors: Olds Daniel , Peterson Peter F. , Crawford Michael K. , Neilson James R. , Wang Hsiu-Wen , Whitfield Pamela S. , Page Katharine
Published: November 2017

In situ total scattering measurements are increasingly utilized to follow atomic and nanoscale structural details of phase transitions and other transient processes in materials. This contribution presents an automated method and associated tool set to analyze series of diffraction and pair distribution function data with a linear combination of end-member states. It is demonstrated that the combinatorial appraisal of transition states (CATS) software tracks phase changes, relative phase fractions and length scales of interest in experimental data series. It is further demonstrated, using a series of local structure data simulations, that the misfit of such a model can reveal details of phase aggregation and growth related to the pair distribution function's sensitivity to interphase correlations. CATS may be applied to quantitative evaluation of many transient processes, including amorphous-to-crystalline phase transitions, the evolution of solid-solution behaviors, the precipitation and growth of aggregates, and other atomic to nanoscale details of crystallization and phase transformation phenomena.
The mediating effects of ego-resilience in the relationship between organizational support and resistance to change
Authors: Ferreira Aristides Isidoro , Cardoso Carla , Braun Timo
Published: November 2017

Purpose

This study drew upon conservation of resources and organizational support theory to develop a deeper understanding of the antecedents of affective and behavioral reactions to change processes. The purpose of this paper is to construct a theoretical framework based on previous findings of change management research to suggest that the relationship between organizational support and resistance to change is mediated by ego-resilience. This framework was then validated empirically.

Design/methodology/approach

To test this model, the mediation relationship was examined using regression analysis with bootstrapping. The sample consisted of 323 employees from private and public organizations.

Findings

The results confirmed that the relationship between organizational support and affective and behavioral reactions to imposed change is mediated by ego-resilience. The theoretical model was thus validated for use in future research.

Research limitations/implications

This study’s findings have implications for organizations regarding how managers guide their employees through change processes. The research’s limitations arise from the use of convenience non-probability sampling and cross-sectional, self-reported data, which only allow for a tentative generalizability of the results.

Originality/value

The findings show that organizational change processes are affected by factors on both the individual (i.e. ego-resilience) and organizational level (i.e. organizational support). This study’s results thus provide empirical support for the conclusion that ego-resilience mediates the indirect relationship between organizational support and employees’ resistance to change.
Business model design and firm performance
Authors: Gerdoçi Blendi , Bortoluzzi Guido , Dibra Sidita
Published: November 2017

Purpose

The purpose of this paper is to contribute to the literature on business model (BM) design by deepening the relationship between BM design themes and performance in a sample of firms based in a developing country. In particular, the authors deepen the relationship between business model novelty (BMN), business model efficiency (BME), the trade-off between novelty and efficiency – that the authors call BM ambidexterity – and performance.

Design/methodology/approach

Data are drawn from a sample of 107 manufacturing and service firms based in a developing country (Albania). Hierarchical regression is used to assess the impact on firm performance from the two BM design themes and their interaction.

Findings

The authors find novelty-centred BM design is significantly related to firm performance while efficiency-centred design has no direct effect on performance. However, the authors also find that BME positively moderates the relationship between BMN and firm performance.

Research limitations/implications

The relationship between BM design and firm performance can be better understood if contextualised. In the paper, the authors find that different types of BM designs have different impacts on the performance of firms based in a developing economy. While novelty matters, quite surprisingly the authors find no support for efficiency. Additionally, the authors find the interaction between the two design themes (BM ambidexterity) to have a positive impact on firm performance.

Practical implications

The surveyed firms based in a developing economy appear to benefit from novelty-centred BM designs. Efficiency-centred designs have a more ambiguous role: while efficiency alone seems not to pay off, an efficient BM design may facilitate the market exploitation of a novel design.

Originality/value

This study responds to a precise call for additional quantitative empirical studies on the relationship between BM and performance. The study also contributes to an emerging stream of research focused on BM ambidexterity.
Internship-related learning outcomes and their influential factors
Authors: Nghia Tran Le Huu , My Duyen Nguyen Thi
Published: November 2017

Purpose

The purpose of this paper is to explore the experiences of Tourism and Hospitality interns in Vietnam to identify dimensions of internship-related learning outcomes and factors influencing these learning outcomes.

Design/methodology/approach

In total, 12 in-depth interviews were conducted with 12 interns to identify the dimensions of internship-related learning outcomes. Following the interview, an online survey, which was designed based on the results of content analysis of the interviews, was used to collect data from 319 interns from ten Vietnamese universities. Exploratory factor analysis, descriptive statistical analysis, independent samples t-tests, and one-way ANOVA tests were used to find answers to the research issues.

Findings

Qualitative and quantitative analysis showed that from the students’ perspective, internships helped them consolidate the existing knowledge and skills, further develop relevant professional skills, shape their career paths, and change their learning attitudes and behaviors. The analysis also indicated that student engagement and the extent to which they are involved in tasks during the internships could influence the learning outcomes they gained from the internships.

Research limitations/implications

This study completely relied on students’ perceptions and ratings.

Practical implications

The study findings indicate that universities need to pay greater attention to student engagement. By encouraging collaboration between interns and their mentors and organizing activities for interns to utilize their knowledge, universities will improve students’ learning experience during the internship.

Originality/value

This mixed-method study expands our understanding about internship-related learning outcomes and influential factors using the perspectives of interns in a developing country. It has important implications for higher education institutions and students to improve the effectiveness of internships.