bluuebunny/crossref_metadata_2025 huggingface dataset:
Elevated Lin28B expression is correlated with lymph node metastasis in oral squamous cell carcinomas
Authors: Lin Wei‐Tung , Shieh Tzong‐Ming , Yang Li‐Chiu , Wang Tung‐Yuan , Chou Ming‐Yung , Yu Cheng‐Chia
Published: February 2015

Background

Lymph node (LN) metastasis is the most common cause of oral squamous cell carcinoma (OSCC)‐related death. Searching the detailed molecular mechanisms involved LN metastasis in OSCC is still an open question.

Methods

Paired tissue samples from tumor (T) and adjacent non‐cancerous matched tissues (NCMT) parts, as well as LN metastatic lesions in patient with OSCC tissues were subjected to quantitative real‐time PCR analysis for the expression levels of Lin28B. Arecoline, a major areca nut alkaloid, was to explore whether expression of Lin28B could be changed dose dependent in oral epithelial cells. Control and Lin28B‐knockdown arecoline‐stimulated oral epithelial cells were subjected to migration/invasion/anchorage‐independent growth assay.

Results

Compared with NCMT samples from the same OSCC patient, the expression of Lin28B was increased in all of the tumor samples. A similar upregulation of Lin28B was also observed in LN metastatic when compared with local tumors. Arecoline treatment dose dependently induced Lin28B expression in SG and FaDu cells. Lentiviral‐mediated silencing Lin28B expression significantly attenuated arecoline‐induced oncogenicity including proliferation, migration, invasiveness, and anchorage‐independent growth in SG and FaDu cells.

Conclusions

Lin28B may be a useful biomarker and novel molecular target for LN metastasis OSCC patients' treatment.
Integrating oral health into pediatric nursing practice: Caring for kids where they live
Authors: Spurr Shelley , Bally Jill , Ogenchuk Marcella
Published: February 2015

Purpose

The purpose was to identify the factors influencing pediatric oral health and describe the Caring for Kids Where They Live program.

Conclusions

In North America, the burden of pediatric oral disease is significant. Despite evidence to this effect, oral health is an often‐neglected aspect of pediatric nursing care. The Caring for Kids Where They Live program has successfully integrated oral health into pediatric nursing care as evidenced by increased accessibility of health care, pathways for care, and disease prevention.

Practice Implications

Pediatric nurses can address oral health disparities by integrating an oral health assessment tool as well as interprofessional follow‐up and referral processes in practice.
Making personalized medicine more affordable
Authors: Aronson Naomi
Published: February 2015

Precision medicine holds promise to solve the conundrums of clinical care. Foremost is the well‐known but vexing problem of heterogeneity and the tyranny of the mean. Who will respond to a treatment? How can patients avoid the harms of treatments that will not work for them? And if we know who to treat, will that make care more efficient and less costly? But the converse can also be true: treatments become more expensive as the costs of development must be distributed across smaller populations. Next‐generation sequencing is making genetic testing radically cheaper. But the costs of medical tests also include false‐positive results, incidental findings, and the cascade of follow‐up. The affordability of precision medicine is intertwined with the broader issue of affordability of our healthcare system, and will require all stakeholders to assume stewardship for access and sustainability.
Trigeminal nerve paraesthesia from inferior alveolar nerve blocks: incidence and course
Authors: van der Sleen J.M. , Jaspers G.W. , de Lange J.
Published: February 2015

Aim

The aims of the present study were to assess the incidence of injection‐related injuries to the inferior alveolar nerve (IAN) and lingual nerve (LN) and identify the clinical course of injection‐related paraesthesia.

Material and methods

One thousand patients were included in this study. All patients received an alveolar nerve block. The patients were instructed orally and written to report any numb feelings in the IAN and LN area 24 h after administration of the local anaesthetic. Patients that responded were seen the next day for assessment.

Results and conclusions

In our group of 1000 mandibular blocks, there is no long‐term injury caused by applying the local anaesthetics. When there is no manipulation of the mandibular nerve during the procedure, there are no long‐term side effects of the mandibular block, and the paraesthesia is only temporary. The cause of the paraesthesia, however, remains unclear, and there is no prevention or treatment.
Novel Oral Anticoagulants for DC Cardioversion Procedures: Utilization and Clinical Outcomes Compared with Warfarin
Authors: COLEMAN COREY M. , KHALAF SHADEN , MOULD STEVEN , WAZNI OUSSAMA , KANJ MOHAMED , SALIBA WALID , CANTILLON DANIEL
Published: February 2015

Background

Novel oral anticoagulant (NOAC) agents dabigatran, rivaroxaban, and apixaban are increasingly utilized as thromboembolic prevention for patients with atrial fibrillation undergoing direct current cardioversion (DCCV) with post hoc analyses of clinical trials suggesting satisfactory safety and efficacy. This study characterizes utilization, effectiveness, and complications of NOAC agents for stroke prophylaxis in the setting of DCCV.

Methods

Comparison of warfarin and NOAC agents as periprocedural anticoagulation for DCCV procedures performed at Cleveland Clinic from January 2009 through December 2013. Variables of interest include utilization rates for each NOAC agent stratified by clinical parameters including CHADS2 score, and associated clinical outcomes including cerebrovascular accident (CVA), transient ischemic attack (TIA), peripheral arterial embolism (PAE), and bleeding events during 8 weeks of postprocedure follow‐up.

Results

Among 5,320 DCCV procedures, 673 (12.6%) cases were excluded due to inadequate follow‐up. Warfarin was utilized in 3,721 (80.1%), dabigatran in 719 (15.5%), rivaroxaban in 159 (3.4%), and apixaban in 48 (1.0%) with a steady increase in NOAC utilization from 2011 to 2013. There were low rates of CVA/TIA (warfarin: 0.97% vs NOAC 1.62%, P = 0.162) and bleeding (warfarin: 1.02% vs NOAC: 0.5%, P = 0.247) and no significant differences detected between agents. Higher CHADS2/CHA2DS2‐VASC scores were associated with thromboembolic and bleeding risk. Increasing age, chronic kidney disease, diabetes, coronary disease, and deep vein thrombosis/pulmonary embolism were associated with increased bleeding risk.

Conclusion

In a high‐volume, single‐center experience, NOAC utilization has grown to account for over a third of cardioversion procedures, and these agents appear safe and effective compared to warfarin with low rates of thromboembolic and bleeding complications.
Photosensitizing Activity of Endogenous Eye Lens Chromophores: An Attempt to Unravel Their Contributions to Photo‐Aging and Cataract Disease
Authors: Avila Felipe , Friguet Bertrand , Silva Eduardo
Published: February 2015

UVA‐visible light has been proposed as a risk factor in the photo‐aging of the human eye lens, as well as in the etiology of cataract disease. There is accumulating evidence indicating that photosensitizing reactions mediated by endogenous chromophores, which are generated during human eye lens aging, can play an important role in the generation of these processes. These reactions can lead to protein impairment by inducing non‐enzymatic post‐translational modifications such as protein oxidation and crosslinking. Although numerous chromophores have been characterized as both bound to human eye lens proteins and as unbound low‐molecular‐mass compounds, their contribution to eye lens photoaging and cataract disease is not completely understood. In this article we discuss the photochemical contribution of UV‐filters derived from tryptophan catabolism and advanced glycation end products (AGEs) to human eye lens aging and cataract disease. We also discuss the recently described photosensitizing capacity of chromophores derived from newly discovered glucose and ascorbate degradation as a parallel pathway to their role in AGEs generation.
The Poisson and the Biharmonic Equations in the Interior of a Convex Polygon
Authors: Dimakos  M. , Fokas  A. S.
Published: February 2015

A new method for analyzing linear elliptic partial differential equations in the interior of a convex polygon was developed in the late 1990s. This method does not rely on the classical approach of separation of variables and on the use of classical integral transforms and therefore is well suited for the investigation of the biharmonic equation. Here, we present a novel integral representation of the solution of the biharmonic equation in the interior of a convex polygon. This representation contains certain free parameters and therefore is more general than the one presented in [1]. For a given boundary value problem, by choosing these free parameters appropriately, one can obtain the simplest possible representation for the solution. This representation still involves certain unknown boundary values, thus for this formula to become effective it is necessary to characterize the unknown boundary values in terms of the given boundary conditions. This requires the investigation of certain relations refereed to as the global relations. A general approach for analyzing these relations is illustrated by solving several problems formulated in the interior of a semistrip. In addition, for completeness, similar results are presented for the Poisson equation by employing an integral representation for the Laplace equation which is more general than the one derived in the late 1990s.
Perioperative blood product administration and thromboembolic events in patients with treated polycythemia vera: a case‐control study
Authors: Weingarten Toby N. , Hofer Ryan E. , Ahle Barrett J. , Kemp Keri M. , Nkwonta Jacinta A. , Narr Bradly J. , Pardanani Animesh , Schroeder Darrell R. , Sprung Juraj
Published: February 2015

BACKGROUND

Patients with polycythemia vera (PV) have historically been considered to be at high risk for perioperative hemorrhagic and thromboembolic complications. However, no recent studies have compared these outcomes between treated PV patients and patients without PV undergoing similar procedures.

STUDY DESIGN AND METHODS

Patients with PV who underwent surgery with anesthesia from June 1, 2006, to May 31, 2011, were randomly matched (sex, age, type of surgical procedure, surgical year) at a ratio of 1:4 with control patients without PV. Conditional logistic regression analysis adjusting for surgical duration, preoperative hemoglobin, platelet count, and cardiovascular disease was used to assess the association between PV and blood product transfusions, thromboembolism, and other major cardiovascular and pulmonary complications.

RESULTS

Fifty‐six PV patients who underwent 79 surgeries were matched with 312 controls. During hospitalization, 35 (44.3%) and 82 (25.9%) PV and control patients, respectively, were transfused with blood products. PV patients were at increased risk for transfusion intraoperatively (odds ratio [OR], 4.35; 95% confidence interval [CI], 1.79‐10.57; p = 0.001) and during hospitalization (OR, 4.35; 95% CI, 1.84‐10.31; p < 0.001). The likelihood of thromboembolic complications and/or other major complications did not differ between the two study groups (thromboembolic—OR 1.53, 95% CI 0.39‐6.02, p = 0.540; other major complications—OR 2.15, 95% CI 0.93‐4.96, p = 0.073).

CONCLUSIONS

Medically managed PV patients had an increased likelihood of receiving blood products perioperatively. Given the low number of observed thromboembolic events, we cannot make definitive conclusions regarding the association between PV and thromboembolism.
A randomized noninferiority crossover trial of corrected count increments and bleeding in thrombocytopenic hematology patients receiving 2‐ to 5‐ versus 6‐ or 7‐day–stored platelets
Authors: MacLennan Sheila , Harding Kay , Llewelyn Charlotte , Choo Louise , Bakrania Lekha , Massey Edwin , Stanworth Simon , Pendry Kate , Williamson Lorna M.
Published: February 2015

BACKGROUND

Bacterial screening offers the possibility of extending platelet (PLT) storage to Day 7. We conducted a noninferiority, crossover trial comparing PLTs stored for 6 or 7 days versus 2 to 5 days.

STUDY DESIGN AND METHODS

Stable hematology patients were allocated to receive blocks of 2‐ to 5‐ and 6‐ or 7‐day PLTs in random order. The primary outcome was the proportion of successful transfusions during the first block, defined as a corrected count increment (CCI) of more than 4.5 at 8 to 24 hours posttransfusion.

RESULTS

Of 122 patients with an evaluable first block, 87 (71%) and 84 (69%) had successful transfusions after 2‐ to 5‐ and 6‐ or 7‐day PLTs of mean (SD) ages of 3.8 (1.0) and 6.4 (0.5) days, respectively. Six‐ or 7‐day PLTs were declared noninferior to 2‐ to 5‐day PLTs since the upper confidence interval (CI) limit was less than the predefined noninferiority margin of 10% (95% CI, −14.0% to 9.1%; p = 0.766). Logistic regression analysis gave an adjusted odds ratio of 0.86 (95% CI, 0.47‐1.58; p = 0.625). Mean (SD) 8‐ to 24‐hour CCIs were 9.4 (7.9) and 7.7 (7.1) after transfusion with 2‐ to 5‐ or 6‐ or 7‐day PLTs (95% CI, −3.31 to 0.03; p = 0.054). The proportions of days with bleeding scores of WHO Grade 2 or higher were 13% (38/297 days) and 11% (32/296 days; 95% CI, −3.2 to 7.2; p = 0.454). Median interval to next PLT transfusion (2 days) was unaffected (95% CI, −10.5 to 5.4; p = 0.531).

CONCLUSION

In hematology patients, there was no evidence that 6‐ or 7‐day PLTs were inferior to 2‐ to 5‐day PLTs, as measured by proportion of patients with successful transfusions, bleeding events, or interval to next transfusion.
Description of the Anatomy, Surgical Technique, and Outcome of Hemipelvectomy in 4 Dogs and 5 Cats
Authors: Barbur Laura A. , Coleman Kevin D. , Schmiedt Chad W. , Radlinsky MaryAnn G.
Published: February 2015

Objective

To provide (1) a comprehensive description of hemipelvectomy; and (2) report clinical application and outcome of hemipelvectomy in dogs and cats.

Study Design

Descriptive report and retrospective case series.

Animals

Dogs (n = 4) and 5 cats.

Methods

Cadaveric dissection was performed for imaging purposes using 4 mixed breed dogs euthanatized for reasons unrelated to this study. Medical records (2005–2012) were reviewed for dogs and cats that had hemipelvectomy. Data collected included signalment, body weight, body condition score, clinical presentation, diagnostic imaging findings, location and extent of tumor, definitive diagnosis, use of adjuvant therapy, ability to ambulate postoperatively, complications, and survival.

Results

The most common indication for hemipelvectomy in cats was injection site sarcoma (ISS) and in dogs, osteosarcoma or peripheral nerve sheath tumor (PNST). Complete tumor excision was achieved in 6 (67%) cases. Incomplete excision occurred in 2 dogs with lumbosacral PNST and 1 cat having a 2nd surgery for ISS. Complications included intraoperative hemorrhage (n = 2), postoperative soft tissue infection (2), and discharge from the incision site (1). All but 1 animal were ambulatory at the time of discharge. Hospitalization ranged from 1–10 days (median, 4 days). Survival after surgery was individually assessed.

Conclusion

With in‐depth anatomic familiarity, hemipelvectomy can be successful for excision of neoplastic lesions of the proximal aspect of the pelvic limb, with only minor complications.
Methods for species delimitation in bumblebees (Hymenoptera, Apidae, Bombus): towards an integrative approach
Authors: Lecocq Thomas , Dellicour Simon , Michez Denis , Dehon Manuel , Dewulf Alexandre , De Meulemeester Thibaut , Brasero Nicolas , Valterová Irena , Rasplus Jean‐Yves , Rasmont Pierre
Published: February 2015

Delimitation of closely related species is often hindered by the lack of discrete diagnostic morphological characters. This is exemplified in bumblebees (genus Bombus). There have been many attempts to clarify bumblebee taxonomy by using alternative features to discrete morphological characters such as wing shape, DNA, or eco‐chemical traits. Nevertheless each approach has its own limitations. Recent studies have used a multisource approach to gather different lines of speciation evidence in order to draw a strongly supported taxonomic hypothesis in bumblebees. Yet, the resulting taxonomic status is not independent of selected evidence and of consensus methodology (i.e. unanimous procedure, majority, different weighting of evidence). In this article, we compare taxonomic conclusions for a group of taxonomically doubtful species (the Bombus lapidarius‐group) obtained from the four commonly used lines of evidence for species delimitation in bumblebees (geometric morphometric of wing shape, genetic differentiation assessment, sequence‐based species delimitation methods and differentiation of cephalic labial gland secretions). We ultimately aim to assess the usefulness of these lines of evidence as components of an integrative decision framework to delimit bumblebee species. Our results show that analyses based on wing shape do not delineate any obvious cluster. In contrast, nuclear/mitochondrial, sequence‐based species delimitation methods, and analyses based on cephalic labial gland secretions are congruent with each other. This allows setting up an integrative decision framework to establish strongly supported species and subspecies status within bumblebees.
SonoelastographÄ±c assessment of the age-related changes of the Achilles tendon
Authors: Turan Aynur , Teber Mehmet Akif , Yakut Zeynep Ilerisoy , Unlu Havva Akmaz , Hekimoglu Baki
Published: February 2015

Aims: Tendons are crucial for optimal muscle force transfer and subject to changes with aging which may impair func- tional ability of elderly individuals. Achilles is the largest and the strongest tendon in the body; therefore it is an excellent site for the radiologic investigation of aging of tendons. Sonoelastography (SE) is a new ultrasound-based imaging technique that provides information on elastic properties and stiffness of tissues. The aim of our study was to investigate the age-related alterations in Achilles tendons using SE. Material and methods: Forty five geriatric (age≥ 65 years) and 42 young (age 18-40 years) healthy consecutive subjects were enrolled. Subjects with known history of metabolic or endocrine diseases, sports or traumatic injuries, peripheral vascular disorders were excluded. Both Achilles tendons were scanned with a real-time SE probe at a frequency of 6–15 MHz. Strains of Achilles tendons’ proximal, middle and distal parts were assessed semi-quantitatively with comparing a reference tissue. Results: Both SE methods -color coded evaluation and strain measurement- showed a re- markably stiffer tendon in the elderly subjects compared to young subjects in all thirds of Achilles tendons. In young subjects 84.9 % tendon thirds were blue, and 15.1% were green whereas, in elders 93.7% were blue and 6.3% were green (p=0.024). There was a significant correlation between age and stiffness of tendons assessed with strain indices. Conclusion: Our result showed increased tendon stiffness in elderly subjects which might be responsible for the high prevalence of Achilles tendi- nopathies observed in elderly subjects.
Assessment of fetal malformations in the first trimester of pregnancy by three-dimensional ultrasonography in the rendering mode. Pictorial essay.
Authors: Araujo Junior Edward , Rolo Liliam Cristine , Tonni Gabriele , Haeri Sina , Ruano Rodrigo
Published: February 2015

We present our experience in the contribution of three-dimensional ultrasonography, using the rendering mode, to the prenatal diagnosis of congenital anomalies including neurological defects (acrania/anencephaly, encephalocele, holoprosencephaly), facial anomalies (cyclopia and facial clefts), abdominal wall defects (omphalocele and gastroschisis) and defects of extremities (fetal muscle-skeletal dysplasias). Three-dimensional ultrasonography may contribute to improve the prenatal diagnosis with further revision of the fetal images, allowing a better prenatal counsel to the parents.
Ultrasound in Rheumatology: two decades of rapid development and evolving implementation
Authors: Naredo Esperanza
Published: February 2015

.
The use of ultrasonography in infantile hypertrophic pyloric stenosis: do the patientâ€™s age and weight affect pyloric size and pyloric ratio?
Authors: Ayaz Umit Yasar , Döğen Mehmet Ercüment , Dilli Alper , Ayaz Sevin , Api Arman
Published: February 2015

Aims: We aimed to obtain pyloric measurements of our patients with infantile hypertrophic pyloric stenosis (IHPS) using ultrasonography (US) and to evaluate the correlations between age, weight and pyloric size, pyloric ratio (PR). Material and methods: We designed a retrospective study including 20 term infants with surgically proven IHPS and studied the ultrasono- graphically obtained pyloric muscle thickness (PMT), pyloric diameter (width) (PD), pyloric length (PL) and PR (PMT/PD) to determine if there were statistically significant associations between patient age/weight and pyloric measurements. Results: The mean age of the infants was 38.7±17.3 days (range, 9–76 days) and their mean weight was 3688.5±772.7 g (range, 2810– 6000 g), at referral. Mean PMT was 4.98±1.04 mm (range, 3.5–6.8 mm). Mean PD was 14.04±2.39 mm (range, 10–18 mm). Mean PL was 22.16±4.02 mm (range, 16–31.5 mm) and mean PR was 0.35±0.04 (range, 0.29–0.42). The correlation between age and PMT (r=0.654, p0.05). Conclusions: The PMT and PD are age dependent parameters. The PR is age and weight independent and therefore, when combined with PMT, PD and PL, it can be useful in the diagnosis of IHPS in infants with early onset disease and/or in those with a lower weight.
Chemiexcitation of melanin derivatives induces DNA photoproducts long after UV exposure
Authors: Premi Sanjay , Wallisch Silvia , Mano Camila M. , Weiner Adam B. , Bacchiocchi Antonella , Wakamatsu Kazumasa , Bechara Etelvino J. H. , Halaban Ruth , Douki Thierry , Brash Douglas E.
Published: February 2015

The dark side of melanin exposed

Sun worshippers may have more to worry about than the DNA damage that occurs while they're relaxing on the beach. It seems that the DNA photoproducts responsible for cancer-causing mutations in skin cells continue to be generated for hours after sunlight exposure. Premi
et al.
find that a key mediator of this delayed damage is melanin, a pigment thought to protect against cancer (see the Perspective by Taylor). They propose a “chemiexcitation” model in which reactive oxygen and nitrogen species induced by ultraviolet light excite an electron in melanin fragments. This energy is then transferred to DNA, inducing the same damage as ultraviolet light, but in the dark. Conceivably, this energy could be dissipated by adding quenchers to sunscreens.

Science
, this issue p.
842
; see also p.
824
Black hole feedback in the luminous quasar PDS 456
Authors: Nardini E. , Reeves J. N. , Gofford J. , Harrison F. A. , Risaliti G. , Braito V. , Costa M. T. , Matzeu G. A. , Walton D. J. , Behar E. , Boggs S. E. , Christensen F. E. , Craig W. W. , Hailey C. J. , Matt G. , Miller J. M. , O’Brien P. T. , Stern D. , Turner T. J. , Ward M. J.
Published: February 2015

Finding the necessary negative feedback

The evolution of galaxies seems to be tied to the growth of the supermassive black holes at their centers, but it's not entirely clear why. Models have suggested a mechanism in which the growth of the black hole results in an outflow of gas that interrupts star formation. However, evidence for enough of this negative feedback has been lacking. Nardini
et al.
now see a signature in x-ray spectra of a strong persistent outflow in the quasar PDS 456. They estimate a broad solid angle spanned by the wind that enables a far greater impact on the host galaxy than narrower jet outflows.

Science
, this issue p.
860
Cope’s rule in the evolution of marine animals
Authors: Heim Noel A. , Knope Matthew L. , Schaal Ellen K. , Wang Steve C. , Payne Jonathan L.
Published: February 2015

Getting bigger all the time

In today's world, many animal species are large, with even larger species only recently extinct, but the first animals to evolve were tiny. Was this increase in size due to active selection or to some more random process? Heim
et al.
test the classic hypothesis known as Cope's rule, which posits that there is selection for increasing body size. They analyzed a data set that spans over 500 million years and includes more than 17,000 marine animal species. In support of Cope's rule, body volumes have increased by over five orders of magnitude since the first animals evolved. Furthermore, modeling suggests that such a massive increase could not have emerged from a random process.

Science
, this issue p.
867
Voxelated liquid crystal elastomers
Authors: Ware Taylor H. , McConney Michael E. , Wie Jeong Jae , Tondiglia Vincent P. , White Timothy J.
Published: February 2015

Making small actuators more effective

Liquid-crystal molecules orient locally in response to external fields. When long-chain liquid-crystalline molecules are crosslinked together, changes in local orientation can lead to significant volume changes. Ware
et al.
made efficient microactuators that can change their shape from flat to three-dimensional structures (see the Perspective by Verduzco). By patterning volume elements so that each has a different preferred alignment for the liquid-crystalline molecules, they could fine-tune the volume changes.

Science
, this issue p.
982
; see also p.
949
Full crop protection from an insect pest by expression of long double-stranded RNAs in plastids
Authors: Zhang Jiang , Khan Sher Afzal , Hasse Claudia , Ruf Stephanie , Heckel David G. , Bock Ralph
Published: February 2015

Bypassing a plant's defense for pest defense

Colorado potato beetles can skeletonize the leaves on a potato plant, devastating crop yields. Insecticides are increasingly useless as the beetle evolves resistance. Zhang
et al.
used RNA interference to take down this beetle (see the Perspective by Whyard). Success required shifting production of the double-stranded RNA to the plastids to evade the plant's own RNA management mechanisms. The insect's own RNA interference mechanisms then inactivated two everyday genes that the beetle can't do without.

Science
, this issue p.
991
; see also p.
950
Indo-European languages tied to herders
Authors: Balter Michael , Gibbons Ann
Published: February 2015

Ancient migration from the east shaped European genome and language.
The Siberian snow connection
Authors: Gramling Carolyn
Published: February 2015

Melting sea ice may have grabbed headlines, but one researcher suggests another link between the changing Arctic and midlatitude weather.
Line of attack
Authors: Neimark Jill
Published: February 2015

Christopher Korch is adding up the costs of contaminated cell lines.
Confining the state of light to a quantum manifold by engineered two-photon loss
Authors: Leghtas Z. , Touzard S. , Pop I. M. , Kou A. , Vlastakis B. , Petrenko A. , Sliwa K. M. , Narla A. , Shankar S. , Hatridge M. J. , Reagor M. , Frunzio L. , Schoelkopf R. J. , Mirrahimi M. , Devoret M. H.
Published: February 2015

A way to induce quantum stability

Dynamical systems, whether classical or quantum, usually require a method to stabilize performance and maintain the required state. For instance, communication between computers requires error correction codes to ensure that information is transferred correctly. In a quantum system, however, the very act of measuring it can perturb it. Leghtas
et al.
show that engineering the interaction between a quantum system and its environment can induce stability for the delicate quantum states, a process that could simplify quantum information processing.

Science
, this issue p.
853
Trapping a transition state in a computationally designed protein bottle
Authors: Pearson Aaron D. , Mills Jeremy H. , Song Yifan , Nasertorabi Fariborz , Han Gye Won , Baker David , Stevens Raymond C. , Schultz Peter G.
Published: February 2015

A transition state holds a pose

The transition state of a chemical transformation is inherently fleeting because the structure is high in energy. Nonetheless, Pearson
et al.
trapped a classical example of a bond rotation transition state using a modified protein (see the Perspective by Romney and Miller). The biphenyl molecule passes through an energy maximum when its rings rotate through a parallel position. A pocket within the editing domain of threonyl–transfer RNA synthetase was modified to stabilize parallel biphenyl rings, allowing further characterization of this normally transient structure.

Science
, this issue p.
863
; see also p.
829
Metal-free efficient photocatalyst for stable visible water splitting via a two-electron pathway
Authors: Liu Juan , Liu Yang , Liu Naiyun , Han Yuzhi , Zhang Xing , Huang Hui , Lifshitz Yeshayahu , Lee Shuit-Tong , Zhong Jun , Kang Zhenhui
Published: February 2015

An enduring catalyst built from carbon

Splitting water into its constituent elements, hydrogen and oxygen, generally requires the assistance of metal catalysts. Liu
et al.
now show that a metal-free hybrid material composed of carbon and nitrogen can promote this reaction all on its own, with the help of some visible light. The photocatalyst combines one material (C
3
N
4
) known to split water into hydrogen and peroxide with a second material (CDot) that breaks the peroxide down before it can damage the first. The robust stability of this hybrid bodes well for practical implementation of optimized analogs in solar energy storage schemes.

Science
, this issue p.
970
An unexpected cost of sex
Authors: Alonzo Suzanne H.
Published: February 2015

Coevolution of male and female mosquitoes influences whether mosquitoes transmit human malaria

[Also see Report by

Mitchell
et al.

]
The dark side of sunlight and melanoma
Authors: Taylor John-Stephen
Published: February 2015

UV-initiated DNA photodamage in melanocytes is found to continue in the dark

[Also see Research Article by

Premi
et al.

]
Pancreas micromanages autophagy
Authors: Rutter Guy A.
Published: February 2015

Nutrient-sensing β cells degrade insulin when blood glucose is low

[Also see Report by

Goginashvili
et al.

]
Why science? Why AAAS?
Authors: Holt Rush D.
Published: February 2015

Among the various ways of thinking and knowing about the universe and ourselves, science is special. Asking questions that can be answered empirically and engaging in open communication so that others can collectively review and verify possible answers lead to the most reliable knowledge—a knowledge that is powerfully applicable in daily life. Science is, as physician and essayist Lewis Thomas wrote, the “shrewdest maneuver” for discovering the world. This grand and clever enterprise, while surely not removing all worldly woes, brings beauty, wonderfully fulfilling intellectual pleasure, and cultural enrichment. It can lead to improved human interaction, more constructive commerce, and a better quality of life. Science helps bring what I think is a deep human need—a sense of progress.
Draft Genome Sequence of the Cellulolytic Fungus Chaetomium globosum
Authors: Cuomo Christina A. , Untereiner Wendy A. , Ma Li-Jun , Grabherr Manfred , Birren Bruce W.
Published: February 2015

Chaetomium globosum is a filamentous fungus typically isolated from cellulosic substrates. This species also causes superficial infections of humans and, more rarely, can cause cerebral infections. Here, we report the genome sequence of C. globosum isolate CBS 148.51
,
which will facilitate the study and comparative analysis of this fungus.
Complete Genome Sequence of Enterotoxigenic Escherichia coli Siphophage Seurat
Authors: Doan Dung P. , Lessor Lauren E. , Hernandez Adriana C. , Kuty Everett Gabriel F.
Published: February 2015

Enterotoxigenic
Escherichia coli
(ETEC) is one of the leading causes of diarrhea in developing countries. Bacteriophage therapy has the potential to aid in the prevention and treatment of ETEC-related illness. To that end, we present here the complete genome of ETEC siphophage Seurat and describe its major features.
Whole-Genome Sequences of 12 Clinical Strains of Listeria monocytogenes
Authors: Cao Guojie , Zhang Jianmin , Xu Xuebin , Jin Huiming , Yang Xiaowei , Pan Haijian , Allard Marc , Brown Eric , Meng Jianghong
Published: February 2015

Listeria monocytogenes
is a foodborne pathogen of global concern due to the high mortality rate among immunocompromised patients. Whole-genome sequences of 12 strains of
L. monocytogenes
from humans were reported. The availability of these genomes should provide useful information on the evolutionary history and genetic diversity of
L. monocytogenes
.
Improving smoking cessation policy by assessing user demand for an inpatient smoking cessation service in adult psychiatric wards
Authors: Liu Kathy , Creamer Andrew
Published: February 2015

Smoking rates are higher among people with mental health conditions compared to the general population. Smoking reduces physical, mental and financial well-being, and interacts with psychotropic drugs. An inpatient admission provides an opportunity to engage and support smokers in smoking cessation. Compliance with Trust/NICE smoking cessation guidelines was assessed in two inpatient wards, and a questionnaire evaluated user demand for an inpatient smoking cessation service. A need for improved documentation of smoking status to identify and treat smokers routinely was revealed.

A new electronic health form was designed and introduced, and a clear pathway for onward referrals was developed. This intervention preceded the introduction of the Trust-wide smoke free policy from October 2014. The intervention doubled rates of documentation of smoking status, cessation advice and offer of NRT/referral. There were large differences between the two wards, highlighting the need for a tailored approach.
THE POTENTIAL FOR NURSE INDEPENDENT PRESCRIBING BY THE CLINICAL NURSE SPECIALIST IN PALLIATIVE CARE IN THE COMMUNITY; ATTITUDES AND EXPERIENCES OF GENERAL PRACTITIONERS
Authors: McGleish Elaine , Sivell Stephanie , Nelson Annmarie
Published: February 2015

Introduction

Nurse Independent Prescribing (NIP) has the potential to enhance patient care and the practice of palliative care in the community. Medical prescribing in the community is the key responsibility of the General Practitioner (GP); however, many GPs see palliative care patients infrequently. Conversely, community Clinical Nurse Specialists (CNSs) are key workers in the delivery of specialist palliative care, often working autonomously and are arguably better positioned to respond quickly to patients' needs. In practice there is some resistance to NIP and little research into the views of GPs towards NIP in palliative care in the community.

Aim

To explore GPs' attitudes and experiences towards NIP in palliative care in order to identify the barriers, benefits and support available, and thus inform future practice.

Methods

Semi-structured interviews were undertaken with ten GPs in one local health board in Wales. Interviews were audio recorded and transcribed verbatim. Data were analysed using thematic analysis.

Results

Four major themes were generated from the data: (i) impact of nurse prescribing; (ii) prescribing practices; (iii) communication; (iv) education. Overall attitudes towards NIP were positive with eight of the GPs having experience of NIP. Identified benefits included: time-saving for CNSs and patients; greater autonomy for CNSs; improved working relationships between GPs and CNSs.

Conclusions

NIP is an evolving area of clinical practice enhancing the nursing role. This study demonstrates evidence of support from GPs; effective collaborative working between GPs and CNSs will be fundamental to successful implementation of NIP in palliative care.
TEACHING PALLIATIVE CARE (PC) TO MEDICAL STUDENTS; ARE WE DEVELOPING SAFE PRACTITIONERS?
Authors: Walker Steven , Gishen Faye , Lodge Philip , Wee Bee
Published: February 2015

Introduction

Appropriate training is essential to ensure PC is safely practised1. A proportion of newly qualified doctors report that undergraduate teaching has not adequately prepared them to manage PC patients.2Little is known about how PC training is delivered across UK medical schools3. Addressing this requires key data; one group likely to have an overview are the responsible PC educational leads.

Aim(s) and method(s)

To undertake a comprehensive review of PC teaching across UK medical schools by means of an anonymised, multifactorial questionnaire of educational leads.

A 40-point questionnaire was developed using SurveyMonkey® and sent to PC educational leads at all 30 UK medical schools. This study received ethical approval.

Results

The response was 100%. PC teaching occurred in all institutions. In 20 (67%), there was a formal PC component. Teaching around last days of life, death and bereavement was mandatory. Training in other areas (e.g. emergencies) was sometimes optional. Teaching was generally ‘integrated’ (15 respondents) and/or ‘formed a module’ within a larger course (17 respondents) and generally occurred in the final 2 years. A student selected component was offered by 27 (90%).

Most respondents were positive about their courses which, in general, were well supported locally, personally satisfying and highly rated by students.

Concerns included:

Limited student placements (20, 66%).

Restricted opportunity to visit a hospice and observe MDT care (10, 33%)

Insufficient teachers (22, 73%)

Insufficient funding (10, 33%)

Variability in teaching (15, 50%)

Whether courses prepared doctors to care for PC patients (9, 30%) delivered quality training (5, 17%) and fulfilled GMC requirements (2, 7%).

Conclusions

PC training for medical students in the UK continues to evolve with greater integration into the curriculum and the wider use of learning assessment. There is, however, variability, which has the potential to affect patient safety, with a minority of medical schools offering limited teaching and patient contact.
WHAT DO INFORMAL CARERS WANT TO LEARN ABOUT BREATHLESSNESS IN ADVANCED DISEASE AND HOW DO THEY WANT TO LEARN IT?
Authors: Penfold C , Ewing G , Gilligan D , Mahadeva R , Booth S , Benson J , Burkin J , Howson S , Lovick R , Todd C , Farquhar M
Published: February 2015

Introduction

Breathlessness is a distressing, disabling symptom of advanced disease with considerable impact on informal carers. We know that carers experience anxiety, isolation, restriction of activity, lack of support and powerlessness. Despite this knowledge the evidence-base for educational interventions to support informal carers and enhance their caregiving capacity is limited.

Aim(s) and method(s)

To identify informal carer preferences for learning content and delivery modes of an educational intervention for carers on breathlessness in advanced disease. In-depth interviews with a purposive sample of 24 patient-carer dyads from two disease groups (cancer and COPD) to facilitate exploration of similarities and differences in education needs and preferences for differing disease trajectories. Analysed using a Framework approach.

Results

There was a notable degree of overlap in content and delivery-mode preferences among informal carers across the two disease trajectories. Five areas of learning were salient for carers: understanding breathlessness (causes and experience); managing anxiety and panic; helpful and safe levels of activity; maintaining quality of life; and, knowing what to expect in the future. Intervention delivery-mode preferences included face-to-face group learning incorporating clinical-practitioner expertise and a supportive element through sharing experiences, ‘work-arounds’ and useful tips with peers. Carers generally wanted to learn with their patient so short sessions, not too early in the day, in venues accessible for breathless patients were important practical considerations.

Conclusions

An evidence-based educational intervention needs to be broad in scope, incorporating both clinical-practitioner expertise and peer experience. It should also be flexible to accommodate a variety of delivery-mode preferences and personalised content.
ADAPTATION, FACE AND CONTENT VALIDATION OF A PALLIATIVE CARE NEEDS ASSESSMENT TOOL FOR PEOPLE WITH INTERSTITIAL LUNG DISEASE
Authors: Reigada C , Bajwah S , Ross J , Boland J , Wells A , Yorke J , Grande G , Hart S , Currow D , Papadopoulos T , Macleod U , Johnson M
Published: February 2015

Introduction

Interstitial lung disease (ILD) is a non-malignant progressive disease which causes breathlessness, cough, fatigue, psycho-social, financial and spiritual distress; difficult for patients and their family carers. The Needs Assessment Tool: Progressive Disease (NAT:PD-C) was developed as an “aide-memoire” to help clinicians identify a range of palliative care needs in people with cancer, and their carers, in daily practice. We have adapted this tool for people with ILD.

Aim(s) and method(s)

Our aim was to adapt, and then test face and content validity of the adapted version.

The NAT:PD-C was adapted for people with ILD using data from a systematic review of the literature and previously completed qualitative interviews. Focus groups were held (patients [N=7], carers [N=3], clinicians [N=8] followed by an Expert Consensus Group to discuss face and content validity of the NAT:PD-ILD. The Expert Group also discussed issues regarding implementation in practice. The discussion was audio and video-recorded, and cognitive mapping was used. Data was analysed following the principles of inductive theory building. Further validation and reliability testing is ongoing. We present the preliminary results of the face/content validation.

Results

All sections (“red flags” for high risk patients; priority referral; patient wellbeing; ability of carer to provide care; carer wellbeing) of the tool were felt to be important. Some symptoms (voice, mucous and mobility) were added by patients. Clinicians identified training needs about “Spiritual or existential concerns”. Carers highlighted the need for support for themselves.

Conclusion(s)

The NAT:PD-ILD appears to have face and content validity and the content and structure reflected the experience of all groups.

*This research was funding by Marie Curie Care Cancer Research UK.
PILOTING A NEW APPROACH TO IDENTIFYING, ASSESSING AND SUPPORTING CARERS OF PEOPLE WITH PALLIATIVE CARE NEEDS IN PRIMARY CARE
Authors: Carduff E , Highet G , Finucane A , Kendall M , Jarvis A , Harrison N , Greenacre J , Murray SA
Published: February 2015

Introduction

UK general practices are incentivised to “have a protocol for the identification of carers and a mechanism for referral for social services assessment”. This is rarely done systematically and very few carers of patients with palliative care needs are identified. Thus they fail to receive support.

Aim(s) and method(s)

To model and pilot a systematic approach to identifying, assessing and supporting carers of people with palliative care needs in primary care.

Four general practices which varied in size were recruited to pilot a theoretically modelled intervention for 12 months. Each practice nominated a carer liaison to lead on carer identification and support.

Results

The practices varied in size from 5840 to 10832 patients. 83 carers were identified across the 4 practices via registers; illness (12), palliative care (12), carer (11); advanced care plans (12) or opportunistically (28) at GP appointments or at home. 7 carers self-identified. There were 55 female and 28 male carers. Overall, 81 carers received the intervention and 25 returned the Carer Support Needs Assessment Tool (CSNAT). On average carers each identified 4/14 areas of need. 11 carers received a follow up call from the practice to discuss support. 12 carers were also referred for support.

Conclusion(s)

The findings suggest that the new approach to identifying and supporting carers was feasible, but had to be embraced by the whole practice. Carers did not tend to self-identify, nor ask for help. Practices need to be motivated and equipped with information about local carer support and take measures to empower carers to self-identify.
RELATIVES' PREFERRED PLACE OF CARE AT THE END-OF-LIFE: IMPLICATIONS FOR PALLIATIVE CARE IN THE FUTURE
Authors: Woodman C , Baillie J , Sivell S
Published: February 2015

Introduction

Government policy stresses the need to include patients and relatives in decisions surrounding place of end-of-life care. Relatives play an important role in providing care at the end-of-life, therefore understanding their preferences is essential. While systematic reviews have explored patients' perspectives and demonstrated preference for home care, no such review considers relatives' preferences alone.

Aim(s) and method(s)

The aim of this study was to systematically review and synthesise the qualitative literature exploring relatives' perspectives on preferred place of care for their relatives at the end-of-life. Ten databases were searched up until January 2014 and relevant studies were appraised for quality. The included studies (n=18) were thematically synthesised.

Results

Relatives reported involvement in decisions surrounding place of end-of-life care, but described experiencing expectations from patients and healthcare professionals to provide care at home. Home was relatives' preferred place of care: other locations of care were infrequently considered. Care at home was facilitated by resilience, positive family relationships and appreciation of the caregiving role. Caring for relatives impacted positively on families as they were able to demonstrate their love, but also led to feelings of loneliness. Relatives felt they had failed if the patient did not die at home.

Conclusion(s)

Appropriate support mechanisms for patients and relatives are needed if end-of-life care at home is to be achieved. To improve patients' and relatives' experiences of end-of-life care, equitable support and real options for place of care are needed. Patients' and relatives' preferences need to be considered when forming future practice guidelines and policies.
USE OF APREPITANT AS AN ANTIEMETIC IN CYSTIC FIBROSIS PATIENTS
Authors: Jamali A , Harrison M , Bilton D , Simmonds N , Ross J
Published: February 2015

Introduction

Aprepitant is a NK1 receptor antagonist licensed for treatment of nausea and vomiting (n&v) associated with emetogenic chemotherapy. There are case reports of use for n&v post-operatively or secondary to diabetic gastroparesis. There is no published evidence in patients with cystic fibrosis (CF).

Tigecycline is used in treatment of Non-Tuberulosis Mycobacteria in CF. However uncontrolled n&v can result in dose reduction, interruption or discontinuation, and treatment failure.

Aims

To evaluate the efficiacy and side-effects of aprepitant (added to domperidone and ondansetron) in CF patients requiring tigecycline treatment.

Methods

Retrospective and prospective audits (studies) were conducted with case note review of consecutive CF patients receiving IV tigecycline, using a standardised proforma. Consecutive admissions for IV tigecycline therapy were consented and commenced on aprepitant 80mg OD for the first five days of tigecycline therapy. They completed daily n&v and side-effect diaries.

Results

16 case notes were evaluated retrospectively and 10 patients prospectively audited.

Aprepitant was likely to have contributed to reduction in n&v in 17/26 (65%) cases. 9/10 (90%) patients in prospective audit completed the full course/dose of tigecycline.

8/26 (31%) cases reported mild side-effects (headache (3), hiccups, dyspepsia (2), abdominal pain, atrial tachycardia); all resolved on continuing aprepitant or persisted despite stopping aprepitant.

Conclusion(s)

Aprepitant was well tolerated and appeared to be effective for a number of CF patients. Ongoing work will further evaluate the benefit of aprepitant in this population and inform clinical guidelines for management of n&v in CF patients.