bluuebunny/crossref_metadata_2025 huggingface dataset:
The future of drugs: recreational drug use and sexual health among gay and other men who have sex with men
Authors: Race Kane , Lea Toby , Murphy Dean , Pienaar Kiran
Published: October 2016

There are complex historical connections between sexual minoritisation and desires to chemically alter bodily experience. For gay men, drug and alcohol use can be a creative or experimental response to social marginalisation – and not necessarily a problematic one in every instance. Numerous studies have found that infection with HIV and other sexually transmissible infections (STIs) is more likely among gay and men who have sex with men (MSM) who use recreational drugs than those who do not, but the causal nature of these relations is uncertain. Sexualised drug use is associated with a range of other problems, including dependence, mental health issues, accident and overdose. A growing body of work in the Alcohol and Other Drugs (AOD) field demonstrates the action of drugs and their purported effects to be a product of their relations with various other actors, contexts and practices. Given these contingencies, it is impossible to predict the future of drugs or their effect on the sexual health of gay and MSM with any degree of certainty. This article outlines some of the conditions most likely to mediate such futures in the medium term. Public funding for lesbian, gay, bisexual, transgender and queer drug issues should not remain restricted to questions of HIV prevention and sexual health. It should be expanded to equip sexual health and AOD service providers with the cultural and sexual literacy to mitigate stigma and allow them to respond constructively to drug problems among sexual and gender minorities as a matter of priority.
What is the extent of repeat prescriptions for post-exposure prophylaxis for HIV after sexual exposure among men who have sex with men in the UK?
Authors: Llewellyn Carrie , Martin Harriet , Nixon Eileen
Published: October 2016

People who repeatedly present for post-exposure prophylaxis (PEP) for prevention of HIV following a high-risk sexual exposure are of concern according to the British HIV Association PEP guidelines. The aim of this audit was to determine the extent of repeat PEP prescriptions for men who have sex with men (MSM) by conducting a retrospective review of patient notes from a 5-year period at one genitourinary medicine clinic. Over the 5 years, 107 of 929 MSM (11.5%; 95% confidence interval: 9.45–13.55) received more than one PEP prescription (repeat range 1–8; mean = 3.3, s.d. = 1.44). Forty percent of these had received three or more PEP prescriptions. Seven of the 107 became HIV positive. Patients need to be offered and encouraged to take up behavioural risk reduction interventions at the time of each PEP prescription.
FOXA1 overexpression mediates endocrine resistance by altering the ER transcriptome and IL-8 expression in ER-positive breast cancer
Authors: Fu Xiaoyong , Jeselsohn Rinath , Pereira Resel , Hollingsworth Emporia F. , Creighton Chad J. , Li Fugen , Shea Martin , Nardone Agostina , De Angelis Carmine , Heiser Laura M. , Anur Pavana , Wang Nicholas , Grasso Catherine S. , Spellman Paul T. , Griffith Obi L. , Tsimelzon Anna , Gutierrez Carolina , Huang Shixia , Edwards Dean P. , Trivedi Meghana V. , Rimawi Mothaffar F. , Lopez-Terrada Dolores , Hilsenbeck Susan G. , Gray Joe W. , Brown Myles , Osborne C. Kent , Schiff Rachel
Published: October 2016

Significance

One of the mechanisms of endocrine resistance in estrogen receptor α (ER)-positive (+) breast cancer is the cross-talk between the ER and growth factor receptor pathways leading to altered ER activity and a reprogrammed ER-dependent transcriptome. However, key mediators of this ER-dependent transcriptional reprogramming remain elusive. Here we demonstrate that forkhead box protein A1 (FOXA1) up-regulation via gene amplification or overexpression contributes to endocrine resistance and increased invasiveness phenotypes by altering the ER-dependent transcriptome. We further show that IL-8, one of the top altered FOXA1/ER effectors, plays a key role in mediating these phenotypes and is a potential target to treat ER+/FOXA1-high breast cancer. Our findings provoke a new interplay of FOXA1 in the ER transcriptional program in endocrine-resistant breast cancer.
The grammatical potential of co-speech gesture
Authors: Kok Kasper
Published: October 2016

In recent years, consensus has been growing that certain co-speech gestures must be incorporated in grammatical theory. Contrary to traditional beliefs, gestural expression has been found to be systematic in various ways, to exhibit some degree of compositional structure and to be to a certain extent language-specific. Most current work on the gesture-grammar interface is, nonetheless, rather programmatic in character or lacks an appropriate theoretical framework. This paper shows that Functional Discourse Grammar (FDG) provides a promising model for understanding the grammar-gesture relationship in a more comprehensive and detailed way than has thus far been achieved. It first evaluates how a FDG perspective on language structure aligns with the ways gestures have been studied. Then it demonstrates that various types of co-speech manual gestures can be classified (perhaps even exhaustively) according to the pragmatic and semantic layers recognized in FDG. On the basis of this survey, a first sketch of a multi-channel (speech-gesture) version of FDG’s architecture is presented. Finally, some challenges are put forward that arise when taking the multimodal grammar enterprise seriously. Altogether, the content of this paper suggests that a multimodal perspective on grammar can be mutually beneficial for functionally oriented linguists and gesture researchers.
Russia as the other
Authors: Bolshakova Anastasia
Published: October 2016

This paper explores the construction of Russia as the Other in a major Western media source. For its theoretical framework, it draws on Stuart Hall’s conception of the representation of the Other through splitting. The study is based on the comparative analysis of the portrayal of Russia and the UK as host nations for two different Olympic Games inThe New York Times. In order to reduce researcher bias, the analysis is conducted using methods of corpus linguistics. Two specialized corpora were compiled: one on the run-up to the 2014 Sochi Olympics and the other to the 2012 London Olympics. Three topics of the typical pre-Olympic discourse are compared: security, construction, and protests. It is observed that these aspects are constructed in binary opposition in the coverage of the two Games, presenting Russia as the West’s constituting Other. The issue of the negative implications of such discourse is raised.
Acquisition of a rural variety
Authors: Roberts Julie
Published: October 2016

Glottal stop is a widely reported phenomenon in the United Kingdom, but it has been rarely studied in the United States. The current study follows up on work on this feature in a wide age range of speakers in Vermont. Currently the speakers comprise thirty-six children ages 2;6 to 5 from this same location. In addition to demonstrating that these children have acquired the phonological constraints, as well as the full range of allophones of /t/, the results provide a lens through which to explore other issues of language acquisition and language variation, most notably, the boundary between dialectal and developmental variation. In general, it is argued that sociolinguistically conditioned variation adds empirical as well as theoretical value to studies of phonetically and phonologically conditioned variation and acquisition of the phonological system by first language learners.
Global spread of chikungunya virus: a lesson for
Aedes
-transmitted arboviruses?
Authors: Santos C. N. D. dos , Dupont-Rouzeyrol M. , Sam I. C. , Roques P.
Published: October 2016

Chikungunya virus (CHIKV) is an arbovirus, transmitted by
Aedes aegypti
and
Ae. albopictus
, which causes epidemics of fever, rash and joint pains. First described in 1952 in Tanzania, CHIKV remained a relatively neglected tropical virus, despite causing sporadic outbreaks in Africa and Asia over the next few decades. However, since 2004, an epidemic lineage of the East/Central/South African (ECSA) genotype has arisen in East Africa and spread to cause unprecedented global outbreaks in the Indian Ocean islands, South and Southeast Asia, as well as autochthonous outbreaks in Europe. This spread was driven by mutations in the virus envelope proteins that improved the vectorial competence of
Ae. albopictus
, which is widely distributed in the affected areas, and which was previously considered a vector of secondary importance to
Ae. aegypti
. In 2011, the Asian lineage of CHIKV emerged to cause outbreaks in Pacific islands, before unexpectedly spreading to cause explosive epidemics in the Caribbean and Latin America, mainly via
Ae. aegypti
. The factors behind the global spread of previously niche arboviruses such as CHIKV and more recently Zika virus are complex, multifactorial and poorly understood. The implications on strained health services and economies are considerable, particularly as CHIKV is associated with long-term rheumatological disorders. However, with the increasing ease of global travel and the growing geographical distributions of
Aedes
mosquito vectors, we should expect further spread of exotic arboviruses to new populations who remain entirely immunologically naive.
Influence of Introduction History on Genetic Variation in Introduced Populations: A Case Study of Oregon Chub
Authors: DeHaan Patrick W. , Adams Brice A. , Scheerer Paul D. , Bangs Brian L.
Published: October 2016

Population introductions and reintroductions have become a common tool for conserving threatened species, but oftentimes introduced populations have reduced the genetic diversity compared with the source population they were founded from. Population introductions played an important role in the recovery of the Oregon Chub Oregonichthys crameri, a small floodplain minnow found in western Oregon. Unlike many introduction efforts, introduced populations of Oregon Chub were founded using large numbers of individuals (hundreds in many cases) and each population had a unique introduction history (e.g., number of founders, source populations selected, duration of the introduction effort). We used microsatellite loci to examine 13 introduced populations and their respective sources to evaluate how well the introduction program captured genetic diversity present in the wild populations. Genetic variation was reduced by roughly 25% in one introduced population, and three introduced populations showed evidence of a genetic bottleneck due to heterozygote excess. Populations introduced from multiple sources had greater genetic diversity than populations from a single source. When multiple source populations were used, all source populations contributed genetic material to the introduced population, though the proportional contribution from each source population varied. Using correlation analyses and general linear models, we explored the relationship between introduction history variables and genetic diversity. Our top-ranked models included genetic diversity in the source population, and this variable had the highest variable importance weight (0.999), but the number of founders and the number of source populations were also important. Overall, the Oregon Chub introduction program was highly successful at capturing the genetic variation observed in natural populations. Results of this study will be useful for planning future population introductions for Oregon Chub and other species of conservation concern.

Received November 9, 2015; accepted June 18, 2016 Published online October 7, 2016
Colonial Waterbird Predation on Lost River and Shortnose Suckers in the Upper Klamath Basin
Authors: Evans Allen F. , Hewitt David A. , Payton Quinn , Cramer Bradley M. , Collis Ken , Roby Daniel D.
Published: October 2016

We evaluated predation on Lost River Suckers Deltistes luxatus and Shortnose Suckers Chasmistes brevirostris by American white pelicans Pelecanus erythrorhynchos and double-crested cormorants Phalacrocorax auritus nesting at mixed-species colonies in the Upper Klamath Basin of Oregon and California during 2009–2014. Predation was evaluated by recovering (detecting) PIT tags from tagged fish on bird colonies and calculating minimum predation rates, as the percentage of available suckers consumed, adjusted for PIT tag detection probabilities but not deposition probabilities (i.e., probability an egested tag was deposited on- or off-colony). Results indicate that impacts of avian predation varied by sucker species, age-class (adult, juvenile), bird colony location, and year, demonstrating dynamic predator–prey interactions. Tagged suckers ranging in size from 72 to 730 mm were susceptible to cormorant or pelican predation; all but the largest Lost River Suckers were susceptible to bird predation. Minimum predation rate estimates ranged annually from <0.1% to 4.6% of the available PIT-tagged Lost River Suckers and from <0.1% to 4.2% of the available Shortnose Suckers, and predation rates were consistently higher on suckers in Clear Lake Reservoir, California, than on suckers in Upper Klamath Lake, Oregon. There was evidence that bird predation on juvenile suckers (species unknown) in Upper Klamath Lake was higher than on adult suckers in Upper Klamath Lake, where minimum predation rates ranged annually from 5.7% to 8.4% of available juveniles. Results suggest that avian predation is a factor limiting the recovery of populations of Lost River and Shortnose suckers, particularly juvenile suckers in Upper Klamath Lake and adult suckers in Clear Lake Reservoir. Additional research is needed to measure predator-specific PIT tag deposition probabilities (which, based on other published studies, could increase predation rates presented herein by a factor of roughly 2.0) and to better understand biotic and abiotic factors that regulate sucker susceptibility to bird predation.

Received January 19, 2016; accepted June 25, 2016 Published online October 7, 2016
Mapping Print, Connecting Cultures
Authors: Burrows Simon , Ensor Jason , Henningsgaard Per , Hiribarren Vincent
Published: October 2016

This article discusses the potential of ‘historical bibliometric’ methodologies for understanding past cultures and offers a vision for how historical bibliometric research might be conducted on a comparative and global scale. Drawing on conceptual work being undertaken at the Western Sydney University in order to further develop and extend the widely respected ‘French Book Trade in Enlightenment Europe’ (FBTEE) database project, it explores how historians might proceed to correlate, map, and analyse multiple spatially referenced data sets pertaining to the creation, publication, dissemination, ownership, consumption, reception, policing, and geographic setting of texts. While the authors recognise the many dangers and limitations inherent in reducing the cultural history of text to a set of statistical data, they observe that historians frequently use the production and circulation of texts as a useful proxy for understanding the circulation of ideas. Hence historical bibliometrics can provide measurable indicators of cultural resonance. The challenge, then, is to meaningfully integrate algorithmic abstractions with qualitative-based humanities research. This paper and the suite of projects it discusses seek to provide a way forward.
Soergel calculus
Authors: Elias Ben , Williamson Geordie
Published: October 2016

The monoidal category of Soergel bimodules is an incarnation of the Hecke category, a fundamental object in representation theory. We present this category by generators and relations, using the language of planar diagrammatics. We show that Libedinsky’s light leaves give a basis for morphism spaces and give a new proof and a generalization of Soergel’s classification of the indecomposable Soergel bimodules.
Quivers with relations for symmetrizable Cartan matrices III: Convolution algebras
Authors: Geiß Christof , Leclerc Bernard , Schröer Jan
Published: October 2016

We realize the enveloping algebra of the positive part of a semisimple complex Lie algebra as a convolution algebra of constructible functions on module varieties of some Iwanaga-Gorenstein algebras of dimension 1.
Behaviours of Atlantic herring and mackerel in a purse-seine net, observed using multibeam sonar
Authors: Tenningen Maria , Macaulay Gavin J. , Rieucau Guillaume , Peña Héctor , Korneliussen Rolf J.
Published: October 2016

To ensure efficient and sustainable purse-seine fisheries, the catch process must be monitored to better understand the reactions of fish to the gear. In this study, we monitored the behaviours of herring (Clupea harengus) and mackerel (Scomber scombrus) schools during purse-seine capture using a multibeam imaging sonar (Simrad MS70, 75–112 kHz) mounted on a research vessel. The fish behaviours differed between species and purse-seine sets. For both species, the acoustic volume backscattering coefficient increased as 0–80% of the seine was hauled aboard, indicating a corresponding increase in fish spatial density. This increase was significantly greater for herring than mackerel. As 0–40% of the seine was hauled aboard the fishing vessel, schools changed their spatial distribution and volume independent of seine hauling, while for some schools, depth and height decreased. The acoustic volume backscattering strength was up to 25 dB higher in the centre of the school than in the edges. The average lateral target strength was estimated for individual fish in the captured herring schools, and the effect of incident angle on the backscattering strength is considered.
Development and Validation of an HPLC-UV Assay for the Therapeutic Monitoring of the New Antiepileptic Drug Perampanel in Human Plasma
Authors: Franco Valentina , Marchiselli Roberto , Fattore Cinzia , Tartara Elena , De Sarro Giovambattista , Russo Emilio , Perucca Emilio
Published: October 2016

Background:

Perampanel, a new specific non-competitive α-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid receptor antagonist, has been recently approved in the United States and the European Union for the adjunctive treatment of focal seizures and primary generalized tonic–clonic seizures associated with idiopathic generalized epilepsy. A positive relationship between plasma perampanel concentration and improvement in seizure control has been identified in regulatory trials, suggesting that therapeutic drug monitoring could be useful in optimizing clinical response in patients with epilepsy treated with perampanel. The development of a simple and broadly applicable method for measuring plasma perampanel concentrations is desirable to permit the use of TDM for this drug in clinical practice.

Methods:

A high-performance liquid chromatographic method with ultraviolet detection for the quantitative determination of perampanel in small aliquots of human plasma (200 μL) has been developed and validated. Sample preparation involves a simple precipitation step followed by solvent evaporation. High-performance liquid chromatographic separation is achieved on 2 reverse-phase monolithic columns in sequence connected to an ultraviolet detector (320 nm), using as mobile phase water/acetonitrile (60:40 vol/vol) mixed with 1 mL/L phosphoric acid, at a flow rate of 1.5 mL/min. Promethazine hydrochloride is used as internal standard.

Results:

Calibration curves were linear over a perampanel concentration range of 25–1000 ng/mL, with correlation coefficients equal or greater than 0.998 ± 0.001 and a limit of quantitation set at 25 ng/mL. Intra- and inter-day coefficients of variation did not exceed 7.4%, and the accuracy ranged from 96.4% to 113.3%. No interference was observed from commonly coprescribed drugs.

Conclusions:

The present assay is simple, specific, and cost effective with performance characteristics suitable for TDM use.
Cutaneous Leishmaniasis Successfully Treated by Liposomal Amphotericin B
Authors: Shah Niel N. , Nanjappa Sowmya , Messina Jane I. , Greene John N.
Published: October 2016

Leishmaniasis is a group of vector-borne diseases, caused by a group of protozoa belonging to the genus Leishmania. It is usually transmitted by sandfly vectors. There are 2 types of leishmaniasis: visceral and cutaneous. We report a case of cutaneous leishmaniasis in a young male caused by Leishmania panamensis. We also discuss the clinical features, diagnostic tools, differential diagnosis, and management options for cutaneous leishmaniasis.
Factors Associated With Antidepressant Dosing in Asia
Authors: Rajaratnam Kamini , Xiang Yu-Tao , Tripathi Adarsh , Chiu Helen Fung Kum , Si Tian-Mei , Chee Kok-Yoon , Avasthi Ajit , Grover Sandeep , Chong Mian-Yoon , Kuga Hironori , Kanba Shigenobu , He Yan-Ling , Lee Min-Soo , Yang Shu-Yu , Udomratn Pichet , Kallivayalil Roy Abraham , Tanra Andi J. , Maramis Margarita , Shen Winston Wu-Dien , Sartorius Norman , Kua Ee-Heok , Tan Chay-Hoon , Mahendran Rathi , Shinfuku Naotaka , Sum Min Yi , Baldessarini Ross J. , Sim Kang
Published: October 2016

In this study, we sought to examine factors associated with dosing of antidepressants (ADs) in Asia. Based on reported data and clinical experience, we hypothesized that doses of ADs would be associated with demographic and clinical factors and would increase over time. This cross-sectional, pharmacoepidemiological study analyzed data collected within the Research Study on Asian Psychotropic Prescription Pattern for Antidepressants from 4164 participants in 10 Asian countries, using univariate and multivariate methods. The AD doses varied by twofold among countries (highest in PR China and RO Korea, lowest in Singapore and Indonesia), and averaged 124 (120–129) mg/d imipramine-equivalents. Average daily doses increased by 12% between 2004 and 2013. Doses were significantly higher among hospitalized patients and ranked by diagnosis: major depression > anxiety disorders > bipolar disorder, but were not associated with private/public or psychiatric/general-medical settings, nor with age, sex, or cotreatment with a mood stabilizer. In multivariate modeling, AD-dose remained significantly associated with major depressive disorder and being hospitalized. Doses of ADs have increased somewhat in Asia and were higher when used for major depression or anxiety disorders than for bipolar depression and for hospitalized psychiatric patients.
Subjective Versus Objective Weight Gain During Acute Treatment With Second-Generation Antipsychotics in Schizophrenia and Bipolar Disorder
Authors: Gao Keming , Fang Fang , Wang Zuowei , Calabrese Joseph R.
Published: October 2016

Objectives

To compare objective and subjective weight gain of second-generation antipsychotics in schizophrenia and bipolar disorder.

Methods

English-language literature published and cited in PubMed (MEDLINE) from January 1966 to December 2015 was searched with the keywords antipsychotic, atypical antipsychotic, or generic/brand name of atypical antipsychotics, and schizophrenia, bipolar disorder, bipolar mania, or bipolar depression, and safety, tolerability, weight gain, and randomized, placebo-controlled clinical trials. The absolute risk increases and the numbers needed to treat to harm (NNH) for ≥7% weight gain (objective) and self-report weight gain (subjective) were estimated.

Results

In schizophrenia, the NNH for 7% or greater weight gain ranged from 5 to 62, and the NNH for self-reported weight gain was from 11 to −224. The ratio of self-reported NNH to 7% or greater NNH was from 1.5 to 8.0. In bipolar mania, the NNH for 7% or greater weight gain ranged from 7 to −101 and the NNH for self-reported weight gain was from 13 to 84. The ratio of self-reported NNH to 7% or greater NNH was from 0.9 to 2.5. In bipolar depression, the NNH for 7% or greater weight gain ranged from 5 to 69, and the NNH for self-reported weight gain was from 8 to 17. The ratio of self-reported NNH to 7% or greater NNH was 1.2 to 1.6.

Conclusions

Subjective reporting underestimated the risk of antipsychotic-related weight gain compared with objectively measured weight change. Self-awareness of antipsychotic-related weight gain was lower in patients with schizophrenia than in patients with bipolar disorder. Measuring weight change during antipsychotic treatment should be a routine practice.
Psoas abscess: aetiological and clinical review
Authors: Kumar Satish
Published: October 2016

Psoas muscle abscess is a rare infection that presents a diagnostic challenge to the physician and requires a high index of suspicion. A series of five patients with psoas abscess were diagnosed over a period in a tertiary care hospital. In this series, three of the five cases had primary psoas abscess in which Staphylococcus aureus was identified to be the causative agent. The other two patients had secondary psoas abscess associated with the spinal tuberculosis. Predisposing factors in these patients included diabetes mellitus, malnutrition, haematoma in the psoas muscle following trauma and HIV infection. The most common presenting complaints were fever, low back or flank pain with radiation to the lower limb.
Concept-Based Curriculum
Authors: Hendricks Susan M. , Wangerin Virginia
Published: October 2016

Many nursing educators have considered the implementation of a concept-based curriculum, with active, conceptual teaching and learning strategies, which offers a way to respond to the overwhelming content saturation in many nursing curricula. However, barriers abound, including faculty concerns about loss of control, changing faculty role and identity, and fear of failure. This article clarifies these legitimate barriers and offers practical strategies for success in curriculum change.
A Narrative Review of How Sleep-Related Breathing Disorders and Cardiovascular Diseases Are Linked
Authors: Moon Chooza , Phelan Cynthia H. , Lauver Diane R. , Bratzke Lisa C.
Published: October 2016

Purpose/Objectives:

Sleep-related breathing disorders (SRBDs), including obstructive sleep apnea and central sleep apnea, are common among patients with cardiovascular disease (CVD), but clinicians often do not pay enough attention to SRBDs. The purpose of this narrative review is to update advanced practice registered nurses on the literature focusing on the relationship between SRBDs and CVD (eg, hypertension, heart failure, coronary artery disease, arrhythmias, and stroke) and on treatments that can improve SRBDs in patients with CVD.

Description of the Project:

We conducted an electronic search of the literature published between 1980 and 2016 from PubMed, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Academic Search Premier, and related health resource Web sites to address the aims of this study.

Outcomes:

Fifty-six primary research articles (42 observational studies and 14 experimental and quasi-experimental studies) were selected based on our study aims and inclusion criteria. The studies revealed that individuals with CVD are at a greater risk for SRBDs and that SRBDs can worsen CVD. The findings from the studies also suggest that positive airway treatment could improve both SRBDs and CVD.

Conclusions:

This review found a close relationship between SRBDs and CVD. Advanced practice registered nurses are in key positions to identify and help patients manage SRBDs. In particular, advanced practice registered nurses can educate staff and establish standards of practice to improve outcomes for patients with CVD.
Improving Effectiveness and Satisfaction of an Electronic Charting System in Taiwan
Authors: Hsieh Hsiao-Yen , Henker Richard , Ren Dianxu , Chien Wan-Yi , Chang Jia-Ping , Chen Lifan , Tuite Patricia K.
Published: October 2016

Purpose/Objectives:

An efficient but comprehensive documentation system is essential for reducing nursing workload and ensuring adequate time for direct patient care. A “focus” is a nursing diagnosis or patient problem. The purpose of this project is to review and revise the focuses in the electronic charting system and to develop new focuses for documentation of clinical pathways. In addition, this project evaluated the impact of these changes on time required for documentation and nurse satisfaction.

Background/Rationale:

In 2012, a large hospital in Taiwan implemented a self-developed electronic charting system that had 217 focuses in the database. Staff reported low job satisfaction and too much time on documentation. Three major issues were identified, including repetitious and redundant documentation, incorrect templates, and an incomprehensive database.

Description:

A clinical nurse specialist devised quality improvement project was implemented on one 50-bed surgical unit. Forty-one focuses were revised and 13 new focuses were developed for clinical pathways. The implementation of new focus templates enhanced evidence-based practice and prevented redundant documentation. Focus templates also incorporated nursing policies and/or patient education materials. Two outcome indicators, time spent documenting and nurse satisfaction, were evaluated 3 months after implementation.

Outcomes:

Documentation time decreased by 60% (from 138.5 to 55.8 hours) per week. The median documentation time per patient per day decreased from 18.4 minutes to 9.3 minutes. Average scores for satisfaction in usability, content, functionality, and effectiveness were increased.

Conclusion:

Evidence-based focus templates used for documentation can reduce documentation time and increase nurse satisfaction. Clinical nurse specialists play an important role in leading the development of quality improvement projects while improving work efficiency.
Viral Pneumonias in Forensic Autopsies
Authors: Daş Taner , Sargan Aytül , Yağmur Gülhan , Yildirim Muzaffer , Topal Cumhur Selçuk , Gürler Ahmet Selçuk , Asliyüksek Hizir , Arslan Murat Nihat , Özdemirel Rifat
Published: October 2016

Lower respiratory infections are commonly due to viruses and are the third largest cause of death. Respiratory tract viruses have a tendency to target the specific regions in the lung and can harm the host via direct effect of the virus and the host's inflammatory response. In this study, relationships between morphologic changes in the lung and the viral agent type isolated in the lung by the polymerase chain reaction technique were investigated. This study was performed retrospectively at 113 autopsy cases in the Council of Forensic Medicine in Istanbul. Slides from the lung tissues diagnosed as interstitial pneumonia and detected viral agent in polymerase chain reaction were evaluated and reviewed under light microscope by 2 pathologists simultaneously according to predetermined bronchiolar, alveolar, and interstitial findings. Alveolar findings were detected in 108 cases (95.6%), whereas interstitial and bronchiolar findings were detected in 91 (80.5%) and 38 (33.6%) cases, respectively. Intra-alveolar edema was the most common alveolar finding. Some findings such as multinucleated syncytial cells and smudge cells can aid the search for etiologic agent. Interstitial inflammation was the most common histopathologic finding in the lung in viral infections and the most prominent clue to viral infections in the lung histopathologically without discrimination of viral agent type.
Urine KIM-1 as a Potential Biomarker of Acute Renal Injury After Circulatory Collapse in Children
Authors: Assadi Farahnak , Sharbaf Fatemeh Ghane
Published: October 2016

Objectives

Serum creatinine (SCr) is a late marker of acute kidney injury (AKI) due to the lag time between initiating injury and loss of function. We assessed the ability of urinary interleukin-18 (IL-18), kidney injury molecule-1 (KIM-1), and neutrophil gelatinase-associated lipocalin (NGAL) to predict AKI in critically ill children with circulatory collapse.

Methods

Serum creatinine, estimated creatinine clearance (eCrCL), urine IL-18, KIM-1, and NGAL values were measured in 86 children with circulatory collapse on the day of admission, and the results were compared with those obtained 6 days later. Acute kidney injury was defined as a decrease in eCrCL of greater than 25% within the first 48 hours of enrollment. Areas under the curve (AUC) for receiver operating characteristic curve were calculated for the early detection of AKI.

Results

Mean SCr concentration did not differ significantly during the first 6 days of hospital admission. In contrast, mean urine concentrations of IL-18, KIM-1, and NGAL rose significantly from day of admission to the sixth day of hospital stay (P < 0.001). Urinary KIM-1 emerged as having the strongest performance for the early detection of AKI, followed by NGAL, IL-18, and eCrCL. Urinary KIM-1 displayed the highest AUC of 0.81 (95% confidence interval [CI], 0.76-0.93; P < 0.001) for the early detection of AKI after circulatory collapse, followed by NGAL (0.77% CI, 0.70–0.84) and IL-18 (0.69% CI, 0.48–0.64).

Conclusions

Of a panel of 3 promising urinary biomarkers, KIM-1 demonstrated the best performance in predicting AKI in children with circulatory collapse before a change in SCr or eCrCL becomes apparent.
The Utility of Head Computed Tomography in the Evaluation of Apparent Life-Threatening Event
Authors: Stark Wayne , Rominger Annie , Warkentine Fred , Caperell Kerry
Published: October 2016

Objective

This study aimed to evaluate the diagnostic utility of empiric head computed tomography (CT) in apparent life threatening event (ALTE).

Methods

This was a retrospective chart review of children younger than 12 months presenting to an urban pediatric hospital and its suburban satellite for an ALTE from October 2009 to December 2012. The ALTE cases were identified as having had a diagnosis of ALTE (International Classification of Diseases, 9th Revision 799.82) or as having had a constellation of studies performed consistent with our institutional protocol for ALTE evaluation. Exclusion criteria were known trauma and cases lacking an identifiable ALTE feature on review.

Results

There were 631 cases identified, of which 617 met inclusion and exclusion criteria. Of those, 537 had a head CT performed. Five patients were identified with clinically important head CT findings: a case of congenital toxoplasmosis, a case of intraventricular hemorrhage, and 3 cases of nonaccidental trauma (NAT). One of the NAT patients had a bruise on his forehead; the other patients had no historical, physical examination, and other laboratory or radiologic findings to raise concern for significant finding on head CT. The rate of clinically significant findings and occult clinically significant findings was 5/537 (0.93%) (95% confidence interval, 0.30%–2.16%; number needed to treat = 108) and 4/537 (0.75%) (95% confidence interval, 0.20%–1.90%; number needed to treat = 135), respectively.

Conclusions

The rate of clinically important head CT findings in ALTE evaluation was relatively rare, at 0.93%. Given the severe consequences of missing these cases, these data establish a role for empiric head CT in the evaluation of ALTE.
Implementation of a 2-Day Simulation-Based Course to Prepare Medical Graduates on Their First Year of Residency
Authors: Bragard Isabelle , Seghaye Marie-Christine , Farhat Nesrine , Solowianiuk Marie , Saliba Mariane , Etienne Anne-Marie , Schumacher Katharina
Published: October 2016

Objectives

Residents beginning their specialization in pediatrics and emergency medicine (EM) are rapidly involved in oncall duties. Early acquisition of crisis resource management by novice residents is essential for patient safety, but traditional training may be insufficient. Our aim was to investigate the impact of a 2-day simulation-based course on residents to manage pediatric and neonatal patients.

Methods

First year residents participated in the course. They completed two questionnaires concerning perceived stress and self-efficacy in technical skills (TSs) and non-TSs (NTSs) at 3 times: before (T0), after (T1), and 6 weeks after the course (T2).

Results

Eleven pediatric and 5 EM residents participated. At T0, stress about “communicating with parents” (P = 0.022) and “coordinating the team” (P = .037) was significantly higher among pediatric compared with EM residents; self-efficacy was not different between the specialities. After training, perceived stress about “managing a critical ill child” and perceived stress total significantly decreased among EM residents, whereas it remained the same among pediatricians (respectively, P = 0.001 and P = 0.016). Regarding self-efficacy, it had significantly increased in both groups (P < 0.001). Specifically, the increase in TSs self-efficacy was significant after the training (p = .008) and after 6 weeks (p < .001), and the increase in NTs self-efficacy was only significant after 6 weeks (P = 0.014).

Conclusions

Our course improved perceived stress, TSs, and NTSs self-efficacy of residents. This encourages us to formalize this as a prerequisite for admission to the pediatric and EM residency.
Improved Team Performance During Pediatric Resuscitations After Rapid Cycle Deliberate Practice Compared With Traditional Debriefing
Authors: Lemke Daniel S. , Fielder Elaine K. , Hsu Deborah C. , Doughty Cara B.
Published: October 2016

Introduction

Simulation-based medical education (SBME) improves medical knowledge compared with no intervention. In traditional SBME, more time is spent debriefing than practicing skills. Rapid cycle deliberate practice (RCDP) simulation allows learners to practice skills repetitively, receive brief interspersed feedback, and has been shown to improve individual performance of resuscitation skills in simulation; it has not been compared with traditional simulation methods.

Objective

The aim of the study was to compare traditional and RCDP SBME.

Methods

Four pediatric resuscitation cases (3 for teaching and 1 for testing) were developed. For the RCDP arm, traditional cases were deconstructed into sequences of progressively difficult rounds. The last RCDP round served as the traditional arm scenario.

Learners received 1 type of instruction on 2 separate days. Pretest and posttest performance during simulation were video recorded and scored using the Simulation Team Assessment Tool; satisfaction surveys were collected.

Results

Pretest team performance was similar in both groups. Simulation Team Assessment Tool score improvement for RCDP was 7.2% (95% confidence interval, 3.4% to 11%) and traditional was 0.8% (95% confidence interval, −11% to 13%). The difference in improvement of the human factors subscore was statistically significant; RCDP improved 10.2% and traditional improved 1.7% (P = 0.013). The RCDP technique was well received by learners but caused fatigue.

Conclusions

This pilot study showed a trend toward greater improvement in team performance and significantly greater improvement for human factors with RCDP compared with traditional simulation. Future studies comparing RCDP with other methods are needed to identify best practices and applications of RCDP, including which learners and learning objectives are best suited to RCDP.
Identification of an epidermal keratinocyte AMPA glutamate receptor involved in dermatopathies associated with sensory abnormalities
Authors: Cabañero David , Irie Takeshi , Celorrio Marta , Trousdale Christopher , Owens David M. , Virley David , Albrecht Phillip J. , Caterina Michael J. , Rice Frank L. , Morón Jose A.
Published: October 2016

Introduction: Epidermal keratinocytes are increasingly recognized as active participants in the sensory transduction of itch and pain, processes known to involve primary afferent glutamatergic neurons. However, the role of keratinocyte glutamate signaling in sensory functioning is not fully understood. Here, we present the observation of α-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid–type glutamate receptors (AMPARs) in epidermal keratinocytes.

Methods: Immunohistochemical and in situ hybridization analyses were conducted to assess the expression of AMPAR subunits in epidermal keratinocytes in mouse and human skin samples, and in organotypic cultures of human keratinocytes. In addition, reverse transcription PCR further confirmed the expression of GluA4-containing AMPAR in epidermal keratinocytes.

Results: We found prominent immunolabeling for the GluA4 subunit of AMPAR in keratinocytes of glabrous and hairy skin of mouse epidermis, as well as in human epidermal keratinocytes. Reverse transcription PCR confirmed Gria4 transcript expression in epidermal mouse keratinocytes. In addition, expression of GRIA4 mRNA was confirmed in epidermal human keratinocytes by in situ hybridization. Immunohistochemical studies conducted in human skin biopsies from patients with atopic dermatitis and postherpetic neuralgia demonstrate that keratinocyte expression of GluA4 can be altered under pathological conditions. Moreover, a decrease of GluA4 expression was observed in organotypic cultures of human keratinocytes after direct application of algogenic agents.

Conclusion: We provide evidence that GluA4-containing AMPARs are expressed in epidermal keratinocytes, that human pruritic and painful dermatopathologies have alterations in the keratinocyte expression levels of GluA4-containing AMPAR, and that itch- and pain-producing substances can directly regulate their production in keratinocytes.
New and emerging therapies for Clostridium difficile infection
Authors: Martin Jessica , Wilcox Mark
Published: October 2016

Purpose of review

Clostridium difficile infection has attained high prominence given its prevalence and impacts on patients and healthcare institutions. Multiple new approaches to the prevention and treatment of C. difficile infection (CDI) are undergoing clinical trials.

Recent findings

Bezlotoxumab is a monoclonal antibody against toxin B that has successfully completed phase III studies, demonstrating a significant reduction in recurrent CDI when given with standard of care antibiotics. Antibiotics under development include cadazolid and ridinilazole, whereas surotomycin has had disappointing phase III results. Multiple live biotherapeutics are being developed, including freeze thawed and encapsulated versions of faecal microbiota transplantation to improve the practicality of treating patients with recurrent CDI. Alternatives to faecal microbiota transplantation, that aim to improve safety, including a microbial suspension, RBX2660, and a complex spore formulation, SER-109, have progressed to phase II studies. A nontoxigenic C. difficile strain has also shown promise to prevent recurrent CDI. In addition, three C. difficile vaccines have progressed to phase II/III clinical trials.

The diverse approaches to treating and preventing CDI offer substantial promise that new treatment options will soon emerge, particular ones that reduce the risk of recurrences.
The hepatitis D satellite virus of hepatitis B virus: half-opening a new era to control viral infection?
Authors: Abeywickrama-Samarakoon Natali , Cortay Jean-Claude , Dény Paul
Published: October 2016

Purpose of review

To highlight new concepts and therapeutic approaches concerning hepatitis D virus (HDV) infection.

Recent findings

Common receptor for hepatitis B virus (HBV) and HDV has been elucidated, deciphering of HDV replication is still in progress, preliminary results of phase II proof-of-concept clinical assays for entry inhibitors and cellular farnesyl transferase inhibitors are now available.

Hepatitis D infection remains a severe acute and chronic liver illness with the only currently approved therapy (Peg-αIFN) achieving disappointingly low rates of sustained viral response and clinical improvement. Both sodium taurocolate cotransporting polypeptide and heparan sulphate glypican 5 are important for viral adsorption. Preliminary results of 6 months treatment with a subcutaneous HBV PreS1-derived myristoyled peptide as an entry inhibitor indicates an encouraging short-term response with low side-effects. In addition, the short-term use of oral farnesyl transferase inhibitors induces a log10 reduction of viral RNA in almost all treated patients, but is associated with gastrointestinal upset and weight loss (especially using 200 mg/day). Encouraging results are being reported using intravenous phosphorothioate nucleic acid polymers both in terms of HBV surface antigens (HBsAg) and HDV-RNA decline; interestingly, in some patients with a strong HBsAg decline, the appearance of anti-hepatitis Bs antibodies might suggest clinical end-point improvement.
Does nutrition support have a role in managing cancer cachexia?
Authors: Laviano Alessandro , Di Lazzaro Giraldi Gianluca , Koverech Angela
Published: October 2016

Purpose of review

Cachexia is a negative prognostic factor in cancer patients. The pathogenesis is related to a variable combination of reduced food intake and metabolic changes. However, whether nutritional support may contribute to effectively prevent and treat cachexia remains a debated issue.

Recent findings

Consistent evidence demonstrates that anabolic windows of opportunity occur during the clinical trajectory of cancer patients. Also, the use of specific nutrients, namely omega-3 fatty acids, may enhance the efficacy of nutritional support when tumor-driven inflammatory response is high. Of greater interest, it is now becoming clearer that the use of nutritional support at key time points in the clinical journey of cancer patients (i.e., perioperative period) may extend its clinical benefits beyond those on nutritional status.

Nutritional support plays a role in managing cancer cachexia, when it is timely delivered, when it provides adequate amounts of calories and proteins, and when it is part of a concurrent palliative care approach. Specific nutrients, that is, omega-3 fatty acids, may help in those cancer patients with high-inflammatory response, and may also contribute to positively influence long-term clinical outcomes.
Cauda Equina Conduction Time Determined by F-Waves in Normal Subjects and Patients With Neurogenic Intermittent Claudication Caused by Lumbar Spinal Stenosis
Authors: Imajo Yasuaki , Kanchiku Tsukasa , Suzuki Hidenori , Funaba Masahiro , Nishida Norihiro , Fujimoto Kazuhiro , Taguchi Toshihiko
Published: October 2016

Purpose:

Lumbar spinal stenosis typically presents with neurogenic intermittent claudication. The aim of this study was to investigate cauda equina conduction time (CECT) in patients with neurogenic intermittent claudication caused by lumbar spinal stenosis and its relationship with age and body height in normal subjects.

Methods:

The study included 172 normal subjects (group C) (mean age 44.1 ± 16.6 years; mean height 163.7 ± 8.9 cm). Forty-seven patients (group L) (mean age 71.3 ± 8.7 years; mean height 158.8 ± 11.2 cm) underwent surgery because of neurogenic intermittent claudication in cauda equina type of lumbar spinal stenosis. Motor-evoked potentials from the abductor hallucis were recorded. Magnetic stimulation was delivered at the S1 spinous process. Compound muscle action potentials (CMAPs) and F-waves were also recorded after supramaximal electric stimulation of tibial nerves. The peripheral motor conduction time (PMCT) was calculated from the latencies of CMAPs and F-waves as follows: (CMAPs + F-waves − 1)/2. The CECT was calculated by subtracting the onset latency of the motor-evoked potentials from PMCT.

Results:

The mean values for F-wave latencies, motor-evoked potential latencies, and CECT were 44.5 ± 3.3, 20.6 ± 1.8, and 3.4 ± 0.8 milliseconds, respectively. F-wave and motor-evoked potential latencies showed significant positive linear correlations with age and body height. However, no significant correlation was found between CECT and age (P = 0.43) or body height (P = 0.26). Mean CECT was 5.7 ± 1.5 in group L. There was a significant difference between groups C and L (P < 0.05).

Conclusions:

The CECT value of normal subjects was 3.4 ± 0.8 milliseconds regardless of age and body height. We suggest that CECT may be a useful factor to consider when evaluating patients with neurogenic intermittent claudication.