bluuebunny/crossref_metadata_2025 huggingface dataset:
A Comprehensive Approach to Pediatric Pneumonia: Relationship Between Standardization, Antimicrobial Stewardship, Clinical Testing, and Cost
Authors: Rutman Lori , Wright Davene R. , O'Callaghan James , Spencer Suzanne , Lion K. Casey , Kronman Matthew P. , Zhou Chuan , Mangione-Smith Rita
Published: November 2016

Objective:

In September 2012, our institution implemented an emergency department (ED) and inpatient pathway for community-acquired pneumonia (CAP) based on national guideline recommendations. The objective of this study was to determine the relationship between standardizing ED and inpatient care for CAP and antimicrobial stewardship, clinical testing, and cost.

Methods:

We used descriptive statistics, statistical process control, and interrupted time series analysis to analyze measures 12 months before and after implementation.

Results:

Six hundred thirty-two patients were included. We found an immediate sustained increase in narrow-spectrum antibiotic (ampicillin) use from a baseline of 8–54%. There was a shift toward more guideline-recommended diagnostic testing with an increase in blood cultures and respiratory viral testing among admitted patients (35–63% and 52–84%, respectively). We identified no significant change in ED chest radiography use, mean ED length of stay (LOS), percentage of CAP admissions, or mean inpatient LOS. Costs of care for admitted patients and for patients discharged from the ED were unchanged.

Conclusions:

Standardizing care for ED and inpatient management of CAP led to immediate and sustained improvements in antimicrobial stewardship and guideline-recommended testing without significantly affecting costs.
Process Mapping and Time Study to Improve Efficiency of New Procedure Implementation for High–Dose Rate Prostate Brachytherapy
Authors: Doyle Laura A. , Yondorf Menachem , Peng Cheng , Harrison Amy S. , Den Robert B.
Published: November 2016

New technologies and procedures have the potential to improve outcomes; however, initial implementation is often associated with a steep learning curve, decreased efficiency, and patient safety implications. Implementation of a real-time, ultrasound-based prostate high–dose rate brachytherapy procedure involved a multidisciplinary team composed of approximately 6–8 team members and numerous complex tasks. To characterize time spent on various aspects of the procedure and improve efficiency, the team developed a detailed process map, time study, and team debriefings. A benchmark was created based on an experienced institution which has performed >100 procedures annually. The process map was analyzed based on clinical tasks and treatment planning tasks. Over the course of 17 cases at a single institution, total procedure time ranged from 222 to 107 minutes. Implementation of the process map resulted in a reduction of total time by 52%. The implementation of a new procedure benefits from the integration and utilization of a process map. We were able to reduce procedure time significantly, which resulted in decreased time under general anesthesia, reduced risk of deep vein thrombosis, improved overall patient safety, patient throughput, and decreases in staffing demands.
Interprofessional Health Team Communication About Hospital Discharge
Authors: Bahr Sarah J. , Siclovan Danielle M. , Opper Kristi , Beiler Joseph , Bobay Kathleen L. , Weiss Marianne E.
Published: November 2016

The Consolidated Framework for Implementation Research guided formative evaluation of the implementation of a redesigned interprofessional team rounding process. The purpose of the redesigned process was to improve health team communication about hospital discharge. Themes emerging from interviews of patients, nurses, and providers revealed the inherent value and positive characteristics of the new process, but also workflow, team hierarchy, and process challenges to successful implementation. The evaluation identified actionable recommendations for modifying the implementation process.
Learning Style as a Predictor of First-Time NCLEX-RN Success
Authors: Lown Susan G. , Hawkins Lee Ann
Published: November 2016

Improving NCLEX-RN® pass rates remains a priority for nursing programs. Many programs collect learning style inventory data, yet few studies have looked at relationships between these data and NCLEX-RN pass/fail rates. Learning style preferences (visual, auditory, tactile, individual, group) and NCLEX pass/fail results were examined for 532 undergraduates in a Midwestern university. A significant correlation between preference for group learning and failure of the NCLEX was found (χ
2 = 5.99, P = .05).
Temporal Characteristics of Sodium Fluorescein in the Tear Meniscus
Authors: Markoulli Maria , Isa Nur Amalina M. D. , Papas Eric B.
Published: November 2016

Purpose

To observe the emission intensity profile of sodium fluorescein in the human tear film as a function of time and concentration.

Methods

Twenty-two participants with no dry eye signs or symptoms were randomly allocated to receive 1 μL of either a 2 or 10% concentration of fluorescein to one eye. Images of the inferior tear meniscus were captured at regular intervals over 30 minutes and the process repeated for the other eye with the alternate concentration. Fluorescence intensity was quantified on the basis of the grayscale pixel values in the tear meniscus images. The fluorescein-decay profile over time and between concentrations was determined.

Results

Peak fluorescence intensity was reached in 3.9 ± 3.0 and 8.7 ± 4.4 minutes after instillation for the 2 and 10% concentrations, respectively. The 10% concentration of fluorescein maintained its peak fluorescence intensity longer than the 2% concentration (about 9 and 2 minutes, respectively). The peak fluorescence intensity was not significantly different between the higher and lower concentrations (44 ± 37 vs. 38 ± 32 units, P = .22). For both concentrations, the observed intensity did not return to baseline levels by the end of the 30-minute observation time.

Conclusions

The fluorescence intensity of fluorescein in a clinical setting varies with time such that both the onset and duration of maximum brightness are concentration dependent. At low concentration (2%), maximum brightness occurs almost immediately after instillation and lasts about 2 minutes. With a higher concentration (10%), the effective working window is delayed for about 7 to 8 minutes. Irrespective of initial concentration, observable fluorescence remains in the tear film beyond 30 minutes post-instillation.
Singing whales generate high levels of particle motion: implications for acoustic communication and hearing?
Authors: Mooney T. Aran , Kaplan Maxwell B. , Lammers Marc O.
Published: November 2016

Acoustic signals are fundamental to animal communication, and cetaceans are often considered bioacoustic specialists. Nearly all studies of their acoustic communication focus on sound pressure measurements, overlooking the particle motion components of their communication signals. Here we characterized the levels of acoustic particle velocity (and pressure) of song produced by humpback whales. We demonstrate that whales generate acoustic fields that include significant particle velocity components that are detectable over relatively long distances sufficient to play a role in acoustic communication. We show that these signals attenuate predictably in a manner similar to pressure and that direct particle velocity measurements can provide bearings to singing whales. Whales could potentially use such information to determine the distance of signalling animals. Additionally, the vibratory nature of particle velocity may stimulate bone conduction, a hearing modality found in other low-frequency specialized mammals, offering a parsimonious mechanism of acoustic energy transduction into the massive ossicles of whale ears. With substantial concerns regarding the effects of increasing anthropogenic ocean noise and major uncertainties surrounding mysticete hearing, these results highlight both an unexplored pathway that may be available for whale acoustic communication and the need to better understand the biological role of acoustic particle motion.
Maternal corticosterone exposure has transgenerational effects on grand-offspring
Authors: Khan Nicola , Peters Richard A. , Richardson Emily , Robert Kylie A.
Published: November 2016

The hormone fluctuations that an animal experiences during ovulation can have lifelong effects on developing offspring. These hormones may act as an adaptive mechanism, allowing offspring to be ‘pre-programmed’ to survive in an unstable environment. Here, we used a transgenerational approach to examine the effects of elevated maternal corticosterone (CORT) on the future reproductive success of female offspring. We show that female zebra finches (
Taeniopygia guttata
) exposed to embryonic CORT produce daughters that have equal reproductive success (clutch sizes, fertility, hatching success) compared with the daughters produced from untreated mothers, but their offspring had accelerated post-hatching growth rates and were significantly heavier by nutritional independence. Although there was no significant effect on primary offspring sex ratio, females from CORT-treated mothers produced significantly female-biased clutches by nutritional independence. To the best of our knowledge, this is the first record of a transgenerational sex ratio bias in response to elevated maternal CORT in any avian species.
Queen reproductive tract secretions enhance sperm motility in ants
Authors: Liberti Joanito , Baer Boris , Boomsma Jacobus J.
Published: November 2016

Queens ofAcromyrmexleaf-cutting ants store sperm of multiple males after a single mating flight, and never remate even though they may live for decades and lay tens of thousands of eggs. Sperm of different males are initially transferred to the bursa copulatrix and compete for access to the long-term storage organ of queens, but the factors determining storage success or failure have never been studied. We usedin vitroexperiments to show that reproductive tract secretions ofAcromyrmex echinatiorqueens increase sperm swimming performance by at least 50% without discriminating between sperm of brothers and unrelated males. Indiscriminate female-induced sperm chemokinesis makes the likelihood of storage directly dependent on initial sperm viability and thus provides a simple mechanism to secure maximal possible reproductive success of queens, provided that initial sperm motility is an accurate predictor of viability during later egg fertilization.
A new mechanism for spatial pattern formation via lateral and protrusion-mediated lateral signalling
Authors: Hadjivasiliou Zena , Hunter Ginger L. , Baum Buzz
Published: November 2016

Tissue organization and patterning are critical during development when genetically identical cells take on different fates. Lateral signalling plays an important role in this process by helping to generate self-organized spatial patterns in an otherwise uniform collection of cells. Recent data suggest that lateral signalling can be mediated both by junctional contacts between neighbouring cells and via cellular protrusions that allow non-neighbouring cells to interact with one another at a distance. However, it remains unclear precisely how signalling mediated by these distinct types of cell–cell contact can physically contribute to the generation of complex patterns without the assistance of diffusible morphogens or pre-patterns. To explore this question, in this work we develop a model of lateral signalling based on a single receptor/ligand pair as exemplified by Notch and Delta. We show that allowing the signalling kinetics to differ at junctional versus protrusion-mediated contacts, an assumption inspired by recent data which show that the cleavage of Notch in several systems requires both Delta binding and the application of mechanical force, permits individual cells to act to promote both lateral activation and lateral inhibition. Strikingly, under this model, in which Delta can sequester Notch, a variety of patterns resembling those typical of reaction–diffusion systems is observed, together with more unusual patterns that arise when we consider changes in signalling kinetics, and in the length and distribution of protrusions. Importantly, these patterns are self-organizing—so that local interactions drive tissue-scale patterning. Together, these data show that protrusions can, in principle, generate different types of patterns in addition to contributing to long-range signalling and to pattern refinement.
Predicting false lumen thrombosis in patient-specific models of aortic dissection
Authors: Menichini Claudia , Cheng Zhuo , Gibbs Richard G. J. , Xu Xiao Yun
Published: November 2016

Aortic dissection causes splitting of the aortic wall layers, allowing blood to enter a ‘false lumen’ (FL). For type B dissection, a significant predictor of patient outcomes is patency or thrombosis of the FL. Yet, no methods are currently available to assess the chances of FL thrombosis. In this study, we present a new computational model that is capable of predicting thrombus formation, growth and its effects on blood flow under physiological conditions. Predictions of thrombus formation and growth are based on fluid shear rate, residence time and platelet distribution, which are evaluated through convection–diffusion–reaction transport equations. The model is applied to a patient-specific type B dissection for which multiple follow-up scans are available. The predicted thrombus formation and growth patterns are in good qualitative agreement with clinical data, demonstrating the potential applicability of the model in predicting FL thrombosis for individual patients. Our results show that the extent and location of thrombosis are strongly influenced by aortic dissection geometry that may change over time. The high computational efficiency of our model makes it feasible for clinical applications. By predicting which aortic dissection patient is more likely to develop FL thrombosis, the model has great potential to be used as part of a clinical decision-making tool to assess the need for early endovascular intervention for individual dissection patients.
Cognitive ability and physical health: a Mendelian randomization study
Authors: Hagenaars Saskia P , Gale Catharine R , Deary Ian J , Harris Sarah E
Published: November 2016

Causes of the association between cognitive ability and health remain unknown, but may reflect a shared genetic aetiology. This study examines the causal genetic associations between cognitive ability and physical health. We carried out two-sample Mendelian randomization analyses using the inverse-variance weighted method to test for causality between later life cognitive ability, educational attainment (as a proxy for cognitive ability in youth), BMI, height, systolic blood pressure, coronary artery disease, and type 2 diabetes using data from six independent GWAS consortia and the UK Biobank sample (N = 112 151). BMI, systolic blood pressure, coronary artery disease and type 2 diabetes showed negative associations with cognitive ability; height was positively associated with cognitive ability. The analyses provided no evidence for casual associations from health to cognitive ability. In the other direction, higher educational attainment predicted lower BMI, systolic blood pressure, coronary artery disease, type 2 diabetes, and taller stature. The analyses indicated no causal association from educational attainment to physical health. The lack of evidence for causal associations between cognitive ability, educational attainment, and physical health could be explained by weak instrumental variables, poorly measured outcomes, or the small number of disease cases.
Determination of closed porosity in rocks by small-angle neutron scattering
Authors: Bahadur Jitendra , Medina Cristian R. , He Lilin , Melnichenko Yuri B. , Rupp John A. , Blach Tomasz P. , Mildner David F. R.
Published: November 2016

Small-angle neutron scattering (SANS) and ultra-small-angle neutron scattering (USANS) have been used to study a carbonate rock from a deep saline aquifer that is a potential candidate as a storage reservoir for CO2 sequestration. A new methodology is developed for estimating the fraction of accessible and inaccessible pore volume using SANS/USANS measurements. This method does not require the achievement of zero average contrast for the calculation of accessible and inaccessible pore volume fraction. The scattering intensity at high Q increases with increasing CO2 pressure, in contrast with the low-Q behaviour where the intensity decreases with increasing pressure. Data treatment for high-Q scattering at different pressures of CO2 is also introduced to explain this anomalous behaviour. The analysis shows that a significant proportion of the pore system consists of micropores (<20 Å) and that the majority (80%) of these micropores remain inaccessible to CO2 at reservoir pressures.
Optimizing the counting times for sample-in-container scattering experiments
Authors: Salmon Philip S. , Zeidler Anita , Fischer Henry E.
Published: November 2016

A method is given for choosing the relative counting times for the sample-in-container and empty container parts of a fixed-duration scattering experiment in order to minimize the statistical error on the container-corrected intensity. The method is applied to angular-dispersive diffraction experiments, and the effect on the fractional error of mis-estimating the relative run times is considered.
ContaMiner and ContaBase: a webserver and database for early identification of unwantedly crystallized protein contaminants
Authors: Hungler Arnaud , Momin Afaque , Diederichs Kay , Arold Stefan, T.
Published: November 2016

Solving the phase problem in protein X-ray crystallography relies heavily on the identity of the crystallized protein, especially when molecular replacement (MR) methods are used. Yet, it is not uncommon that a contaminant crystallizes instead of the protein of interest. Such contaminants may be proteins from the expression host organism, protein fusion tags or proteins added during the purification steps. Many contaminants co-purify easily, crystallize and give good diffraction data. Identification of contaminant crystals may take time, since the presence of the contaminant is unexpected and its identity unknown. A webserver (ContaMiner) and a contaminant database (ContaBase) have been established, to allow fast MR-based screening of crystallographic data against currently 62 known contaminants. The web-based ContaMiner (available at http://strube.cbrc.kaust.edu.sa/contaminer/) currently produces results in 5 min to 4 h. The program is also available in a github repository and can be installed locally. ContaMiner enables screening of novel crystals at synchrotron beamlines, and it would be valuable as a routine safety check for `crystallization and preliminary X-ray analysis' publications. Thus, in addition to potentially saving X-ray crystallographers much time and effort, ContaMiner might considerably lower the risk of publishing erroneous data.
Equality and diversity in democracy: how can we democratize inclusively?
Authors: Martinez Palacios Jone
Published: November 2016

Purpose

The purpose of this paper is to propose a theoretical framework for democratize inclusively through participatory and deliberative apparatus.

Design/methodology/approach

The paper draws on literature from inclusion in deliberation, gender in participation and intersectionality to critically analyze the democratic deepening. By bringing into dialogue with one another “the norm of parity of participation” (Fraser, 2006), “communicative democracy” (Young, 1993) and the “matrix of domination” (Collins, 1990) a response to one of the questions that has been put to European and North American thought in democracy since the 1960s is proposed: how is it possible to democratize inclusively?

Findings

The reproduction of domination through apparatuses for the extension of democracy is both possible and probable. So, to democratize inclusively, it is necessary to bring the theories on vertical and horizontal inclusion into dialogue with each other. With the aim of establishing a dialogue between the two, it is necessary to export complex thought regarding oppression and inequality into the design of deliberative and participatory apparatuses. For that, consider that designing democratization processes based on the fact that the intersectional experience of oppression is not an exception but rather an everyday occurrence allows participatory procedures to be made more inclusive.

Practical implications

This paper proposes a tool designed with a focus on dialogue among the norm of parity of participation, communicative democracy and the matrix of oppression, based on 11 direct questions for the inclusive design of deliberative or participatory procedures. Facilitators, experts and social agents involved in deliberative or participatory processes will be able to use this question-based instrument in their work.

Originality/value

This paper has applied value because it offers a conceptual key to the design of and thought about participatory inclusive processes. The originality of this approach lies in its shift away from partial analyses of horizontal and vertical inclusion. It is of use both to facilitators of participatory processes and educators and researchers concerned with democratization. It offers an instrument for working on reflexivity with regard to inclusion in democratic extension, based on a series of key questions that can be used as a checklist. In comparison with other forms of considering inclusion in democracy, the proposal considered includes complex thought on oppression based on the critique of simple identity, as well as on an intersectional perspective.
“Digital buddies”: parasocial interactions in social media
Authors: Yuksel Mujde , Labrecque Lauren I.
Published: November 2016

Purpose

This paper aims to focus its inquiries on the parasocial interactions (PSI) and relationships (PSR) consumers form with personae in online social media communities. The authors extend the marketing literature on parasocial interaction/relationship beyond brands by focusing on personal social media accounts (public student-athletes).

Design/methodology/approach

The authors adopt a grounded theory methodology (Glaser and Strauss, 2009) triangulating observational netnographic data (Kozinets, 2010) of 49 public student-athlete accounts on Twitter (34,500 tweets) with in-depth interviews. The findings emphasize that PSI/PSR occur not only from interactions with brands but also through personal accounts on social media platforms.

Findings

The investigation reveals that through such social media platforms, PSI/PSR influence consumers cognitively, affectively and behaviorally. In terms of cognition, the data suggest that PSI/PSR can influence opinion, interests, attention allocation and construction of relations, specifically through the availability of in-depth knowledge about the social media persona. Additionally, the research findings indicate that affect-laden messages from persona can alter emotion and mood, induce empathetic reactions and trigger inspiration, especially in relation to the shared interest of the online community of the social media account. Behaviorally, the findings suggest that personas’ messages can direct and inspire both online and offline actions through endorsed behavioral parasocial interactions.

Research limitations/implications

This research focused on one specific social media platform, Twitter. Twitter was specifically chosen, because it is a popular social media platform and allows non-reciprocal relationships. Although the authors feel that the findings would hold for other social media platforms, future research may be conducted to see if there are differences in PSI/PSR development on different types of networks. Additionally, the authors focused on a specific type of personal account, student-athletes. Future research may wish to extend beyond this population to other personal social media accounts, such as fashion bloggers, diy bloggers and others.

Originality/value

This research reveals that PSI/PSR can occur not only from interactions with brands but also through personal accounts on social media platforms. The findings give support for the value of brand spokespersons and brand ambassadors and suggest that brands should take careful consideration into who is chosen to represent the brand.
Mind in eBay, body in Macy’s
Authors: Banerjee Syagnik , Longstreet Phil
Published: November 2016

Purpose

With the ubiquitous diffusion of mobile-enabled internet, individuals are constantly immersed in both virtual and physical environments. While this causes distractions, lower attention spans and disasters such as texting while driving and walking, it also creates synergies and smoother navigational experiences. Technology developers, marketers and policy-makers are both concerned and intrigued to understand how to deploy these mobile technologies so as to optimize their disruptive impact. In this paper, the authors aim to develop a framework of dual consciousness to understand the potential causes and outcomes of individual’s simultaneous presence in physical and virtual worlds.

Design/methodology/approach

A careful review of past academic literature on behavior, as well as media reports of incidents of disruptions, led the authors to construct a 2 × 2 framework depicting behaviors that indicated high-low consciousness in physical, as well as virtual worlds.

Findings

In dual environments, individuals either dissociate from one of the environments or integrate both environments. While the former is driven by the multiplicity of irrelevant roles and goals, oblivion of relevant roles, perception of group norms and performance of practiced routine tasks, the latter is driven by strong executive control processes, focused singular goals and usage of the virtual environment to reinforce their physical tasks. The most affected parties are retailers, service providers, digital marketers and social media marketers.

Originality/value

Most prior research in interactive marketing examine effects of online stimuli on online behavior. This paper identifies the noise created by physical context on clicks as well as the interference created by virtual stimuli on physical purchases and service experiences.
Reconceptualizing the notion of relations underlying performance measurement models
Authors: Islam Syrus
Published: November 2016

Purpose

The purpose of this paper is to reconceptualize the notion of relations underlying performance measurement models (PMMs) and explicate the ample exciting research opportunities that this reconceptualized viewpoint offers.

Design/methodology/approach

This is a conceptual paper, which primarily builds on and extends the contemporary research that challenges the traditional viewpoint that cause-and-effect relations are a necessary element of every PMM.

Findings

The reconceptualized viewpoint suggests that a PMM can be built on any combination of cause-and-effect, finality and logical relations, as opposed to only cause-and-effect relations. This paper presents several exciting research opportunities that the reconceptualized perspective offers.

Originality/value

The different types of relations underlying PMMs and their appropriate validation techniques are a relatively novel concept and also, a complex phenomenon which has received very limited attention in the accounting literature. This paper extends this nascent literature by outlining the research implications of this novel concept.
An ethical perspective on performance measurement in the public sector
Authors: Narayan Anil K.
Published: November 2016

Purpose

The purpose of this paper is to provide an ethical perspective that goes beyond best practice in performance measurement systems in the public sector to help minimise unintended and unethical effects.

Design/methodology/approach

The paper draws on the ethical concepts of bounded ethicality, ethical blind spots and ethical fading to help illuminate the dark side of performance measurement in public sector organisations.

Findings

An understanding of the psychological tendencies that create unethical behaviours will assist compliance with ethics and morality and is a way forward towards minimising the unintended consequences of performance measurement in the public sector.

Practical implications

The findings will assist public sector managers by providing a greater understanding of why so many unethical acts occur and how to overcome ethical failures in the design and use of performance measurement systems.

Originality/value

The study adds value by contributing to performance measurement literature on the need to recognise the limitations of the human mind and innate psychological processes that make people systematically and unknowingly engage in unethical behaviour. The ethical concepts proposed in this paper go beyond the best practice notions of performance measurement and extend the toolkit of performance measurement techniques in the public sector.
The governance of inter-firm co-development projects in an open innovation setting
Authors: Biswas Sharlene , Akroyd Chris
Published: November 2016

Purpose

The purpose of this paper is to examine the governance of inter-firm co-development in an open innovation setting and show how a stage-gate product development process can be used to support this relationship.

Design/methodology/approach

The authors adopt a qualitative case-study approach informed by ethnomethodology. Data were obtained via semi-structured interviews and document analysis.

Findings

They found that in an open innovation setting – where the producing partner relies on a research partner for all product development activities – a stage-gate product development process can act as a governance mechanism, as it enables the development of trust and cooperation which supports the co-development relationship.

Research limitations/implications

The implication of this finding is that a stage-gate process can be a flexible governance mechanism, which can adapt over time in relation to the needs of the co-development partners in an open innovation setting. This also lays the groundwork for future research to explore the applicability of this tool in other settings, e.g. outsourcing arrangements as well as help guide the design and implementation of future governance mechanisms.

Originality/value

In the context of accounting research, this paper helps practitioners and academics understand how a stage-gate process can be used as a governance mechanism to manage and control co-development projects in an open innovation setting.
Mycobacterium smegmatis is a suitable cell factory for the production of steroidic synthons
Authors: Galán Beatriz , Uhía Iria , García‐Fernández Esther , Martínez Igor , Bahíllo Esther , de la Fuente Juan L. , Barredo José L. , Fernández‐Cabezón Lorena , García José L.
Published: November 2016

A number of pharmaceutical steroid synthons are currently produced through the microbial side‐chain cleavage of natural sterols as an alternative to multi‐step chemical synthesis. Industrially, these synthons have been usually produced through fermentative processes using environmental isolated microorganisms or their conventional mutants. Mycobacterium smegmatis mc2155 is a model organism for tuberculosis studies which uses cholesterol as the sole carbon and energy source for growth, as other mycobacterial strains. Nevertheless, this property has not been exploited for the industrial production of steroidic synthons. Taking advantage of our knowledge on the cholesterol degradation pathway of M. smegmatis mc2155 we have demonstrated that the MSMEG_6039 (kshB1) and MSMEG_5941 (kstD1) genes encoding a reductase component of the 3‐ketosteroid 9α‐hydroxylase (KshAB) and a ketosteroid Δ1‐dehydrogenase (KstD), respectively, are indispensable enzymes for the central metabolism of cholesterol. Therefore, we have constructed a MSMEG_6039 (kshB1) gene deletion mutant of M. smegmatis MS6039 that transforms efficiently natural sterols (e.g. cholesterol and phytosterols) into 1,4‐androstadiene‐3,17‐dione. In addition, we have demonstrated that a double deletion mutant M. smegmatis MS6039‐5941 [ΔMSMEG_6039 (ΔkshB1) and ΔMSMEG_5941 (ΔkstD1)] transforms natural sterols into 4‐androstene‐3,17‐dione with high yields. These findings suggest that the catabolism of cholesterol in M. smegmatis mc2155 is easy to handle and equally efficient for sterol transformation than other industrial strains, paving the way for valuating this strain as a suitable industrial cell factory to develop à la carte metabolic engineering strategies for the industrial production of pharmaceutical steroids.
Homocysteine, Alcoholism, and Its Potential Epigenetic Mechanism
Authors: Kamat Pradip K. , Mallonee Carissa J. , George Akash K. , Tyagi Suresh C. , Tyagi Neetu
Published: November 2016

Alcohol is the most socially accepted addictive drug. Alcohol consumption is associated with some health problems such as neurological, cognitive, behavioral deficits, cancer, heart, and liver disease. Mechanisms of alcohol‐induced toxicity are presently not yet clear. One of the mechanisms underlying alcohol toxicity has to do with its interaction with amino acid homocysteine (Hcy), which has been linked with brain neurotoxicity. Elevated Hcy impairs with various physiological mechanisms in the body, especially metabolic pathways. Hcy metabolism is predominantly controlled by epigenetic regulation such asDNAmethylation, histone modifications, and acetylation. An alteration in these processes leads to epigenetic modification. Therefore, in this review, we summarize the role of Hcy metabolism abnormalities in alcohol‐induced toxicity with epigenetic adaptation and their influences on cerebrovascular pathology.
Deficits in Access to Reward Are Associated with College Student Alcohol Use Disorder
Authors: Joyner Keanan J. , Pickover Alison M. , Soltis Kathryn E. , Dennhardt Ashley A. , Martens Matthew P. , Murphy James G.
Published: November 2016

Background

Reward deprivation has been implicated in major depressive disorder and severe substance abuse, but its potential relation to alcohol use disorder (AUD) symptoms in non‐treatment‐seeking young adult drinkers is less clear. Depression is often comorbid with alcohol misuse, so relations of AUD with reward deprivation might be due in part to the presence of depressive symptoms in young adults. Behavioral economic theory views addiction as a state that is related in part to deficits in drug‐free rewards, and therefore requires an investigation into whether reward deprivation has a direct relation to alcohol misuse that is, at least partially, independent of mood.

Methods

This study evaluates the contribution of 2 facets of reward deprivation (reward availability and experience) to alcohol use, AUD symptoms, and depression in a sample of young adult heavy episodic drinkers. Data were collected from 392 undergraduates (60.4% female, 85.1% Caucasian) who reported recent heavy drinking (83.7% with at least 1 AUD symptom).

Results

Low reward availability (environmental suppression) was significantly associated with both DSM‐5 AUD symptoms and alcohol‐related problems after controlling for age, gender, depressive symptomatology, and drinking level.

Conclusions

This study provides support for behavioral economic models that emphasize reward deprivation as a unique risk factor for AUD that is independent of mood and drinking level. Limited access to natural rewards may be a risk and/or maintaining factor for AUD symptoms in college student drinkers.
A review of a national training initiative to increase provider use of MAT to address the opioid epidemic
Authors: Levin Frances R. , Bisaga Adam , Sullivan Maria A. , Williams Arthur Robin , Cates‐Wessel Kathryn
Published: November 2016

Background and Objectives

The Providers’ Clinical Support System for Medication Assisted Treatment (PCSS‐MAT) initiative focuses on training and mentoring health professionals in the treatment of opioid use disorders (OUD) using pharmacological strategies. Led by the American Academy of Addiction Psychiatry (AAAP), PCSS‐MAT is a consortium representing four of the five national professional organizations authorized by DATA 2,000—AAAP, American Osteopathic Academy of Addiction Medicine, American Psychiatric Association, and American Society of Addiction Medicine. DATA organizations are authorized to train physicians to prescribe buprenorphine for OUD treatment. The primary aim of PCSS‐MAT is to substantially increase evidence‐based practices with medications for OUD.

Methods

This review describes the development of PCSS‐MAT, an ongoing national initiative funded by the Substance Abuse and Mental Health Services Administration (SAMHSA), to address the training needs posed by this critical public health problem. Core initiatives include: (1) Training and mentoring activities for primary care physicians; (2) Outreach to multidisciplinary professional organizations, (3) Creating a resource portal for families, patients, and communities for OUD treatment.

Results

Educational outreach to providers addresses the needs of patients with OUD and common co‐occurring psychiatric and medical disorders.

Discussion and Conclusions

The overall scope of PCSS‐MAT is to increase access to evidence‐based treatment of substance use disorders as a public health priority. Recently enacted legislation requires office‐based opioid treatment programs to offer all Food and Drug Administration‐approved (FDA) forms of MAT.

Scientific Significance

Working with health care providers to effectively deliver MAT is key to integrating behavioral and physical medicine. (Am J Addict 2016;25:603–609)
Effects of an alveolar recruitment manoeuvre guided by lung ultrasound on anaesthesia‐induced atelectasis in infants: a randomised, controlled trial
Authors: Song I.‐K. , Kim E.‐H. , Lee J.‐H. , Ro S. , Kim H.‐S. , Kim J.‐T.
Published: November 2016

Atelectasis occurs in the majority of children undergoing general anaesthesia. Lung ultrasound has shown reliable sensitivity and specificity for diagnosing anaesthesia‐induced atelectasis. We assessed the effects of a recruitment manoeuvre on atelectasis using lung ultrasound in infants undergoing general anaesthesia. Forty infants, randomly allocated to either a recruitment manoeuvre group or a control group, received volume‐controlled ventilation with 5 cmH2O positive end‐expiratory pressure. Lung ultrasound examination was performed twice in each patient, the first a minute after starting mechanical ventilation of the lungs and the second at the end of surgery. Patients in the recruitment manoeuvre group received ultrasound‐guided recruitment manoeuvres after each lung ultrasound examination. The incidence of significant anaesthesia‐induced atelectasis at the second lung ultrasound examination was less in the recruitment manoeuvre group compared with the control group (25% vs. 80%; p = 0.001; odds ratio (OR) 0.083; 95% confidence interval (CI): 0.019–0.370). The median (IQR[range]) lung ultrasound scores for consolidation and B‐lines on the second examination were lower in the recruitment manoeuvre group compared with the control group; 6.0 (3.0–9.3 [0.0–14.0]) vs. 13.5 (11.0–16.5 [8.0–23.0]); p < 0.001 and 6.5 (3.0–12.0 [0.0–28.0]) vs. 15.0 (10.8–20.5 [7.0–28.0]); p < 0.001, respectively. The lung ultrasound scores for consolidation on the first and second examinations showed a negative correlation with age (r = −0.340, p = 0.008; r = −0.380, p = 0.003). We conclude that ultrasound‐guided recruitment manoeuvres with positive end‐expiratory pressure proved useful in reducing the incidence of anaesthesia‐induced atelectasis in infants, although 5 cmH2O positive end‐expiratory pressure alone was not sufficient to eliminate it. In addition, the younger the patient, the more susceptible they were to atelectasis.
Mycobacterium ulcerans in the Daintree 2009–2015 and the mini‐epidemic of 2011
Authors: Steffen Christina M. , Freeborn Helen
Published: November 2016

Background

Mycobacterium ulcerans infection (Buruli ulcer) is the third most common mycobacterial disease in humans, with presentations ranging from self‐limiting skin nodules and ulcers to aggressive infiltrative infections with extensive oedema, fat and skin necrosis. The two foci in Australia are in Victoria and Far North Queensland. We present the 2009–2015 case series for the Queensland focus with special reference to the 2011 spike of 64 cases.

Methods

This case series is based on a combination of prospectively and retrospectively collected data on 95 confirmed cases of M. ulcerans between 2009 and 2015 from the endemic area, consisting of 88 Category 1 lesions (single lesion less than 5 cm), three Category 2 (5–15 cm plaques) and four Category 3 (one multiple lesions, three oedematous infection).

Results

Eighty‐nine patients underwent surgery. Thirty‐two patients received antibiotics. Management details for three patients were unavailable. Recurrent disease was identified in six patients (6%).

Conclusion

Mycobacterium ulcerans infection (Buruli ulcer) is an endemic but uncommon infection in Far North Queensland with usually fewer than 10 cases per year. Small ulcers predominate. Most were excised and antibiotic treatment was frequently adjuvant rather than therapeutic. The 64 cases in 2011 was unexpected, not duplicated subsequently, and may relate to local climatic variations. Local awareness of the disease facilitated early presentation and diagnosis in most cases, enabling timely treatment while lesions were small and easily managed.
Prospective comparison of return of bowel function after left versus right colectomy
Authors: Yuan Lance , O'Grady Gregory , Milne Tony , Jaung Rebekah , Vather Ryash , Bissett Ian P.
Published: November 2016

Background

Passage of flatus and stool represents a key milestone in recovery after colonic resections. Colorectal surgeons may hold varied expectations regarding recovery rates after left‐ versus right‐sided colectomies, but there is currently little evidence to inform post‐operative care. This study prospectively compared gut function recovery after left‐ versus right‐sided resections.

Methods

Prospective data were analysed from 94 consecutive patients undergoing elective colorectal resections with primary anastomosis at Auckland City Hospital. Patients having ileostomies were excluded. Primary analysis compared time to first bowel motion between left‐ versus right‐sided resections, excluding patients who developed prolonged post‐operative ileus, while secondary analyses compared length of stay, rates of prolonged ileus and other complications.

Results

Analysis included 42 patients with left‐sided and 52 with right‐sided resections. No significant differences were observed for complications (P = 0.1), length of stay (P = 0.9) or development of prolonged ileus (P = 0.2). Rate of return of bowel function was faster in patients after left‐sided resections (median 2.5 versus 4 days; P = 0.03 by Log‐rank (Mantel–Cox) test), when patients with prolonged post‐operative ileus were excluded. An association was also identified between length of bowel resected and time to recovery of bowel function for right‐sided (P = 0.02) but not left‐sided resections (P = 0.9).

Conclusion

This study shows that for patients who do not progress to prolonged ileus, those with left‐sided resections experience faster return of bowel function when compared with those having right‐sided resections. The reason for this finding is currently unknown and deserves further attention.
Short‐term results of microhook ab interno trabeculotomy, a novel minimally invasive glaucoma surgery in Japanese eyes: initial case series
Authors: Tanito Masaki , Sano Ichiya , Ikeda Yoshifumi , Fujihara Etsuko
Published: November 2016

Purpose

To report the first early postoperative results and safety profile after microhook ab interno trabeculotomy (μLOT).

Methods

This initial retrospective observational case series included 24 consecutive glaucomatous eyes of 17 Japanese patients (7 men, 10 women; mean age ± standard deviation, 66.7 ± 17.9 years) who underwent μLOT. The trabeculotomy extent, surgical time, perioperative complications, interventions for complications and additional glaucoma surgeries during the follow‐up for more than 3 months were collected by reviewing the medical and surgical records. The intraocular pressure (IOP), numbers of antiglaucoma medications, logarithm of the minimum angle of resolution visual acuity (VA), anterior chamber (AC) flare and corneal endothelial cell density (CECD) were compared preoperatively and postoperatively.

Results

The trabecular meshwork was incised for a mean of 3.6 ± 0.5 clock hours temporally, 3.7 ± 0.5 clock hours nasally and total 7.3 ± 0.6 clock hours during the 6.2 ± 1.6‐min surgery. The mean preoperative IOP of 25.9 ± 14.3 mmHg and number of antiglaucoma medication of 3.3 ± 1.0 decreased significantly (p = 0.0002 and p = 0.005, respectively) to 14.7 ± 3.6 mmHg and 2.8 ± 0.8 at the final visit at 188.6 ± 68.8 days postoperatively. Compared with preoperatively, the final VA, AC flare and CECD did not change significantly. Hyphema with niveau formation (nine eyes, 38%) and washout of hyphema (two eyes, 8%) were the most common postoperative complication and intervention, respectively. At the final visit, 19 eyes (79%) achieved successful IOP control of 18 mmHg or less and a 15% reduction or greater.

Conclusion

Microhook trabeculotomy normalizes the IOP during the early postoperative period in patients with glaucoma.
Comparison of corneal measurements in keratoconus using swept‐source optical coherence tomography and combined Placido–Scheimpflug imaging
Authors: Chan Tommy C. Y. , Biswas Sayantan , Yu Marco , Jhanji Vishal
Published: November 2016

Purpose

The aim of this study was to provide a comprehensive comparison of reliability of corneal topographic measurements in keratoconic eyes using swept‐source optical coherence tomography (OCT) and a combined Placido–Scheimpflug imaging.

Methods

A total of 30 eyes of 30 patients were included. The mean age was 31.2 ± 8.4 years. Two consecutive topographic measurements were obtained for one eye of each patient using swept‐source OCT (CASIA) and combined Placido–Scheimpflug imaging (TMS‐5). Test–retest reliability of CASIA and TMS‐5 measurements including central corneal thickness (CCT) and thinnest corneal thickness (TCT), keratometry at steep (Ks) and flat (Kf) axes, average keratometry (Avg K), cylinder, and, best‐fit spheres (BFS) of the anterior and posterior corneal surfaces were evaluated.

Results

There was no systematic or scaling bias in any parameter in both devices. Systematic differences between CASIA and TMS‐5 were found in posterior corneal Kf, Avg K and BFS, CCT and TCT (p ≤ 0.002); scaling differences between CASIA and TMS‐5 were also found in CCT and TCT (p ≤ 0.002). Both machines illustrated adequate reliability. Intraclass correlation coefficients (ICC) ≥0.952 was recorded for all parameters measured with CASIA and ICC ≥ 0.914 was recorded for all parameters on TMS‐5. CASIA showed significantly higher ICCs in CCT and TCT, and posterior corneal BFS (p < 0.001).

Conclusions

This study showed significant differences in posterior corneal surface and corneal thickness measurements between swept‐source OCT and combined Placido–Scheimpflug imaging in eyes with keratoconus. Swept‐source OCT might be preferred over Placido–Scheimpflug imaging owing to better repeatability of measurements.