bluuebunny/crossref_metadata_2025 huggingface dataset:
Irrigation Water Quality Standards for Indirect Wastewater Reuse in Agriculture: A Contribution toward Sustainable Wastewater Reuse in South Korea
Authors: Jeong Hanseok , Kim Hakkwan , Jang Taeil
Published: April 2016

Climate change and the subsequent change in agricultural conditions increase the vulnerability of agricultural water use. Wastewater reuse is a common practice around the globe and is considered as an alternative water resource in a changing agricultural environment. Due to rapid urbanization, indirect wastewater reuse, which is the type of agricultural wastewater reuse that is predominantly practiced, will increase, and this can cause issues of unplanned reuse. Therefore, water quality standards are needed for the safe and sustainable practice of indirect wastewater reuse in agriculture. In this study, irrigation water quality criteria for wastewater reuse were discussed, and the standards and guidelines of various countries and organizations were reviewed to suggest preliminary standards for indirect wastewater reuse in South Korea. The proposed standards adopted a probabilistic consideration of practicality and classified the use of irrigation water into two categories: upland and rice paddy. The standards suggest guidelines for E. coli, electric conductivity (EC), turbidity, suspended solids (SS), biochemical oxygen demand (BOD), pH, odor, and trace elements. Through proposing the standards, this study attempts to combine features of both the conservative and liberal approaches, which in turn could suggest a new and sustainable practice of agricultural wastewater reuse.
Neural Stem Cells Restore Hair Growth through Activation of the Hair Follicle Niche
Authors: Hwang Insik , Choi Kyung-Ah , Park Hang-Soo , Jeong Hyesun , Kim Jeong-Ok , Seol Ki-Cheon , Kwon Han-Jin , Park In-Hyun , Hong Sunghoi
Published: April 2016

Several types of hair loss result from the inability of hair follicles to initiate the anagen phase of the hair regeneration cycle. Modulating signaling pathways in the hair follicle niche can stimulate entry into the anagen phase. Despite much effort, stem cell-based or pharmacological therapies to activate the hair follicle niche have not been successful. Here, we set out to test the effect of neural stem cell (NSC) extract on the hair follicle niche for hair regrowth. NSC extracts were applied to the immortalized cell lines HaCaT keratinocytes and dermal papilla cells (DPCs) and the shaven dorsal skin of mice. Treatment with NSC extract dramatically improved the growth of HaCaT keratinocytes and DPCs. In addition, NSC extract enhanced the hair growth of the shaven dorsal skin of mice. In order to determine the molecular signaling pathways regulated by NSCs, we evaluated the expression levels of multiple growth and signaling factors, such as insulin-like growth factor-1 (IGF-1), hepatocyte growth factor (HGF), keratinocyte growth factor (KGF), vascular endothelial growth factor (VEGF), transforming growth factor-β (TGF-β), and bone morphogenetic protein (BMP) family members. We found that treatment with an NSC extract enhanced hair growth by activating hair follicle niches via coregulation of TGF-β and BMP signaling pathways in the telogen phase. We also observed activation and differentiation of intrafollicular hair follicle stem cells, matrix cells, and extrafollicular DPCs in vivo and in vitro. We tested whether activation of growth factor pathways is a major effect of NSC treatment on hair growth by applying the growth factors to mouse skin. Combined growth factors, including TGF-β, significantly increased the hair shaft length and growth rate. DNA damage and cell death were not observed in skin cells of mice treated with the NSC extract for a prolonged period. Overall, our data demonstrate that NSC extract provides an effective approach for promoting hair growth by directly regulating hair follicle niches through TGF-β and BMP signaling pathways as well as induction of core growth factors.
Novel roles for well-known players: from tobacco mosaic virus pests to enzymatically active assemblies
Authors: Koch Claudia , Eber Fabian J , Azucena Carlos , Förste Alexander , Walheim Stefan , Schimmel Thomas , Bittner Alexander M , Jeske Holger , Gliemann Hartmut , Eiben Sabine , Geiger Fania C , Wege Christina
Published: April 2016

The rod-shaped nanoparticles of the widespread plant pathogen tobacco mosaic virus (TMV) have been a matter of intense debates and cutting-edge research for more than a hundred years. During the late 19th century, their behavior in filtration tests applied to the agent causing the 'plant mosaic disease' eventually led to the discrimination of viruses from bacteria. Thereafter, they promoted the development of biophysical cornerstone techniques such as electron microscopy and ultracentrifugation. Since the 1950s, the robust, helically arranged nucleoprotein complexes consisting of a single RNA and more than 2100 identical coat protein subunits have enabled molecular studies which have pioneered the understanding of viral replication and self-assembly, and elucidated major aspects of virus–host interplay, which can lead to agronomically relevant diseases. However, during the last decades, TMV has acquired a new reputation as a well-defined high-yield nanotemplate with multivalent protein surfaces, allowing for an ordered high-density presentation of multiple active molecules or synthetic compounds. Amino acid side chains exposed on the viral coat may be tailored genetically or biochemically to meet the demands for selective conjugation reactions, or to directly engineer novel functionality on TMV-derived nanosticks. The natural TMV size (length: 300 nm) in combination with functional ligands such as peptides, enzymes, dyes, drugs or inorganic materials is advantageous for applications ranging from biomedical imaging and therapy approaches over surface enlargement of battery electrodes to the immobilization of enzymes. TMV building blocks are also amenable to external control of in vitro assembly and re-organization into technically expedient new shapes or arrays, which bears a unique potential for the development of 'smart' functional 3D structures. Among those, materials designed for enzyme-based biodetection layouts, which are routinely applied, e.g., for monitoring blood sugar concentrations, might profit particularly from the presence of TMV rods: Their surfaces were recently shown to stabilize enzymatic activities upon repeated consecutive uses and over several weeks. This review gives the reader a ride through strikingly diverse achievements obtained with TMV-based particles, compares them to the progress with related viruses, and focuses on latest results revealing special advantages for enzyme-based biosensing formats, which might be of high interest for diagnostics employing 'systems-on-a-chip'.
Recent advances in C(sp3)–H bond functionalization via metal–carbene insertions
Authors: Wang Bo , Qiu Di , Zhang Yan , Wang Jianbo
Published: April 2016

The recent development of intermolecular C–H insertion in the application of C(sp3)–H bond functionalizations, especially for light alkanes, is reviewed. The challenging problem of regioselectivity in C–H bond insertions has been tackled by the use of sterically bulky metal catalysts, such as metal porphyrins and silver(I) complexes. In some cases, high regioselectivity and enantioselectivity have been achieved in the C–H bond insertion of small alkanes. This review highlights the most recent accomplishments in this field.
Dissemination of Evidence-Based Practice to Directors of Nursing by an Outreach Campaign in Taiwan
Authors: Weng Yi-Hao , Chen Chiehfeng , Chen Kee-Hsin , Kuo Ken N. , Yang Chun-Yuh , Chiu Ya-Wen
Published: April 2016

Background:

Directors of nursing (DONs) have an important influence in the dissemination of evidence-based practice (EBP) in hospital settings. The current study examined how the knowledge, skills, and behaviors of DONs changed when EBP was implemented during a 5-year, nationwide promotional campaign providing EBP-related information resources and promotional activities in regional hospitals in Taiwan.

Method:

Cross-sectional questionnaire surveys for a nationwide representative sample of DONs were conducted in 2007, 2009, and 2011 to examine views related to EBP, including changes in beliefs, attitudes, knowledge, skills, behaviors, and barriers.

Results:

This study enrolled 267 DONs in 2007, 257 in 2009, and 287 in 2011. During the study period, DONs' EBP knowledge and skills increased, but their beliefs and attitudes did not significantly change. Furthermore, the use of Internet-based resources, including web portals, electronic textbooks, electronic journals, and evidence-based online databases, increased. Most barriers significantly declined after the intervention.

Conclusion:

DONs' knowledge, skills, and behaviors regarding EBP increased after the multifaceted intervention. The data suggest this outreach program is useful in disseminating EBP implementation to DONs.

J Contin Educ Nurs.2016;47(4):181–188.
Web-Based Assessment of Genomic Knowledge Among Practicing Nurses: A Validation Study
Authors: McCabe Margaret , Ward Linda D. , Ricciardi Catherine
Published: April 2016

Background:

Understanding foundational concepts of genetics and genomics is essential to contemporary nursing practice. The Genomic Nursing Concept Inventory (GNCI) is a research-based measure designed to assess nurses' knowledge of key genetic concepts. Developed and tested among nursing students, the GNCI needs to be validated with practicing nurses. A valid assessment of genetic–genomic knowledge among nurses is vital to support competency-based continuing education.

Method:

This study explored the feasibility of employing a Web-based version of the GNCI and tested its psychometric performance among a purposive sample of practicing nurses.

Results:

The psychometric features of the GNCI are described in terms of scale, subscale, and concept difficulty and internal consistency reliability; these values were in an acceptable range.

Conclusion:

This study represents a successful early step in testing the feasibility of using a Web-based version of the GNCI and validating the GNCI to measure genetic–genomic knowledge among practicing nurses.

J Contin Educ Nurs.
2016;47(4):189–196.
Sleep and Schizophrenia
Authors: Holbert Richard C. , Khurshid Khurshid A. , Averbuch Robert , Khawaja Imran S.
Published: April 2016

Schizophrenia is a chronic, disabling condition that significantly impacts social and occupational functioning. Sleep problems are common to the illness, but are often overlooked. Patients with schizophrenia often have a combination of subjective sleep complaints and objective findings on polysomnographic testing. As a group, people with schizophrenia have a higher prevalence of common sleep disorders. This article reviews sleep abnormalities and disorders in schizophrenia and provides an overview of treatment options.

[
Psychiatr Ann
. 2016;46(3):192–196.]
Electroconvulsive Therapy, Transcranial Magnetic Stimulation, and Deep Brain Stimulation in Treatment-Resistant Depression
Authors: Livingston Robin , Anandan Sharadamani , Moukaddam Nidal
Published: April 2016

Treatment-resistant depression (TRD) continues to challenge current therapeutic options, especially pharmacologic treatments often used as first-line management. Thus, multimodality treatments, including neurostimulation techniques, are sought for symptom improvement. Since the first use of electroconvulsive therapy (ECT), the field of neurostimulation has strived to find treatments that improve safety, efficacy, and the side-effect profile to provide relief for patients suffering from TRD. Development in neurostimulation is spurred by ongoing innovation in technology, but also by increasing awareness that TRD frequently requires multimodal approaches for optimal symptom relief. This article reviews the most recent advances in ECT, transcranial magnetic stimulation (TMS), and deep brain stimulation (DBS) for use in TRD. ECT, TMS, and DBS are all researched in the treatment of depression, with ECT and TMS having approval from the US Food and Drug Administration, but differ widely in techniques, protocols, and patient selection parameters. ECT has the most data backing efficacy, but needs ancillary support (anesthesia, support staff) for implementation, and considerable stigma still represents an obstacle to widespread use. TMS and DBS, although less efficacious than ECT, are gaining popularity and as additional knowledge is acquired in regards to ideal use, circumstances may allow for them to become mainstream treatments for TRD in the next decade.

[
Psychiatr Ann
. 2016;46(4):240–246.]
Medical Decision-Making Capacity in Depression
Authors: Ostermeyer Britta , Flores Araceli , Dukes Charles , Shah Asim A.
Published: April 2016

Ensuring that patients have decision-making capacity has become even more essential in today's autonomous, patient-centered health care settings. Depression is a common condition, with 1 in 6 Americans suffering from it sometime during their lifetime, and it can impair decision-making capacity in some patients. A patient's decisional appreciation ability can be impaired in depression, and the depression-related cognitive deficits can impede executive function, reasoning, working memory, information processing, and learning. Depressed mood and anhedonia itself can decrease the patient's motivation and interest in self-preservation. This article reviews the clinician's medical-legal framework related to patients' decision-making capacity, reviews the literature on depression and impaired decision-making capacity, and provides information on psychologic tests commonly employed in capacity evaluations in depression.[Psychiatr Ann. 2016;46(4):247–252.]
Complementary and Alternative Medicine in Autism: The Question of Omega-3
Authors: Posar Annio , Visconti Paola
Published: April 2016

The use of complementary and alternative medicine is widespread among children with autism spectrum disorder (ASD), but methodologically rigorous studies are still necessary to establish its effects. In this article, we address the role of omega-3 in the treatment of ASD, reviewing the relevant literature highlighted by searches of PubMed from 1949 to the present. According to the criteria of evidence-based medicine (ie, randomized clinical trials), the data do not support the effectiveness of omega-3 treatment in children with ASD. However, based on anecdotal experiences and on nonrandomized trials, we cannot exclude that there might be a subset of people with ASD who do respond to this type of approach. We propose a series of questions to be answered by future studies to clarify the possible role of omega-3 in the treatment of ASD.

[
Pediatr Ann
. 2016;45(3):e103–e107.]
Approach to the Underperforming Athlete
Authors: Solomon Mary L. , Weiss Kelly Amanda K.
Published: April 2016

Children and adolescents who participate in intense sports training may face physical and psychologic stresses. The pediatric health care provider can play an important role in monitoring an athlete's preparation by obtaining a proper sports history, assessing sleep hygiene, discussing nutrition and hydration guidelines, and evaluating physiologic causes of fatigue. Educating parents and athletes on the potential risks of high-intensity training, inadequate rest and sleep, and a poor diet may improve the athlete's performance and prevent symptoms of overtraining syndrome. Infectious mononucleosis must also be considered a cause of fatigue among adolescents. The signs and symptoms of overtraining and burnout are discussed in this article.

[
Pediatr Ann
. 2016;45(3):e91–e96.]
Amenorrhea in the Female Athlete: What to Do and When to Worry
Authors: Berz Kate , McCambridge Teri
Published: April 2016

Functional hypothalamic amenorrhea is a diagnosis of exclusion that is common in female athletes, particularly those participating in aesthetic sports (ballet, other dance genres, figure skating, and gymnastics) and endurance sports (cross-country running). Although common, it should be considered abnormal even in the high-level elite athlete. Amenorrhea in combination with low energy availability and low bone density is labeled “the Female Athlete Triad.” Studies have demonstrated numerous long-term consequences of athletes suffering from all or a portion of this triad, including increased rate of musculoskeletal injuries, stress fractures, abnormal lipid profiles, endothelial dysfunction, potential irreversible bone loss, depression, anxiety, low self- esteem, and increased mortality. This article provides the clinician with the tools to evaluate an athlete with secondary amenorrhea, reviews the recommended treatment options for affected athletes, and discusses when to return to the activity in an effort to facilitate “healthy” participation.[Pediatr Ann. 2016;45(3):e97–e102.]
Legg-Calvé-Perthes Disease
Authors: Divi Srikanth N. , Bielski Robert J.
Published: April 2016

Legg-Calve-Perthes disease (LCPD) is the insidious onset of idiopathic avascular necrosis of the hip in the pediatric population. The disease encompasses a wide spectrum of pathology, from mild with no long-term sequelae to severe with permanent degenerative change of the hip joint. A pediatric patient with hip pathology may initially only present with knee or thigh pain, thus obligating the clinician to maintain awareness about the hip during examination. Common physical examination findings include deficits in hip abduction and internal rotation, along with Trendelenburg gait in late stages. Plain radiographs demonstrate changes in the anterolateral aspect of the femoral head, sometimes only seen on the frog lateral X-ray in early stages. Treatment options aim to restore range of motion and maintain adequate coverage of the femoral head. When appropriate, surgery is used to reorient the femoral head or pelvis to maintain coverage.

[
Pediatr Ann
. 2016;45(4):e144–e149.]
Efficacy of Ba Duan Jin in Improving Balance: A Study in Chinese Community-Dwelling Older Adults
Authors: Liu Xiao-yun , Gao Jing , Yin Bing-xiang , Yang Xiang-yu , Bai Ding-xi
Published: April 2016

The current quasiexperimental study was intended to determine the efficacy of Ba Duan Jin (translation: eight-section brocade) in improving balance ability of Chinese community-dwelling older adults. The trial group (
n
= 47) engaged in a Ba Duan Jin exercise program for 12 weeks, whereas the control group (
n
= 48) participated in a 12-week walking exercise program. After the intervention, participants' balance ability was evaluated using the Timed Up and Go Test (TUGT), One Leg Standing Test (OLST), Berg Balance Scale (BBS), and Modified Falls Efficacy Scale (MFES). Ba Duan Jin was associated with increased TUGT and OLST scores at Week 6 with continuous increases reported through Week 12. Ba Duan Jin was also associated with increased BBS and MFES scores at Week 12. Ba Duan Jin may be an effective means for improving balance ability in Chinese community-dwelling older adults. [
Journal of Gerontological Nursing, 42
(5), 38–46.]
Group Cohesion in a Formal Exercise Program Composed of Predominantly Older Men
Authors: Daniels Steven , Wilke Nancy , Ertl Kristyn , Fletcher Kathlyn , Whittle Jeff
Published: April 2016

Individuals reporting high group cohesion are less likely to discontinue participation in group exercise programs. A validated measure of group cohesion, the Physical Activity Group Environment Questionnaire (PAGEQ), is untested in older men. The PAGEQ was administered to, and questions about demographics and frequency and duration of participation were asked of, the Walk A Mile or More (WAMM) exercise group, which was composed of U.S. military Veterans. Forty participants (mean age = 62 years, 77.5% male) completed surveys. Cronbach's alpha for the overall PAGEQ was 0.976. Although no significant relationship was found between group cohesion scores and frequency of attending WAMM sessions, there was a trend for individuals who had participated for a longer time to report more group cohesiveness, particularly regarding the task (i.e., exercise) itself. The PAGEQ was easily administered and internally consistent in this group of older men, and provides a useful benchmark for future gerontological researchers. [
Journal of Gerontological Nursing
,
42
(8), 18–23.]
Functional and Existential Tasks of Family Caregiving for End-of-Life, Hospitalized Older Adults
Authors: Cohen Chaim Charles , Auslander Gail , Dror Yossi Freier , Breuer Gabriel S.
Published: April 2016

The current study examined how functional and existential coping factors are related to the sense of self-benefit among end-of-life (EOL) family caregivers caring for hospitalized older adults. A convenience sample of 92 family caregivers was interviewed in two Israeli hospitals using a structured questionnaire based on Pearlin's stress process model. Findings show that engagement in EOL existential tasks and motivations, such as life review, spirituality, multigenerational family relationships, and preparation for death, acted as a coping resource and was positively related with caregivers' sense of self-benefit. However, functional caregiving did not act as a significant stressor, as it was weakly related to care-givers' sense of self-benefit. Findings discuss the importance of training health professionals to recognize and discuss existential concerns with EOL family caregivers. [
Journal of Gerontological Nursing, 42
(7), 55–64.]
Hand Dominance and Common Hand Conditions
Authors: Lutsky Kevin , Kim Nayoung , Medina Juana , Maltenfort Mitchell , Beredjiklian Pedro K.
Published: April 2016

The goals of this study were to (1) assess how frequently patients present for evaluation of common hand disorders in relation to hand dominance and (2) evaluate the effect of hand dominance on function in patients with these conditions. The authors hypothesized that (1) the majority of patients who seek evaluation would have a condition that affects the dominant hand, and (2) disability scores would be worse if the dominant hand is involved. They retrospectively reviewed the records of consecutive patients who presented for treatment to their institution with unilateral symptoms of 5 common disorders of the hand: carpal tunnel syndrome (CTS), de Quervain's tenosynovitis (DEQ), lateral epicondylitis (LE), hand osteoarthritis (OA), and trigger finger (TF). The authors assessed the effect of diagnosis and hand dominance on Disabilities of the Arm, Shoulder and Hand (DASH) scores. The study group comprised 1029 patients (379 men and 650 women) with a mean age of 59.5 years. Ninety percent were right-hand dominant. The dominant and nondominant hands were affected with relatively equal frequency for CTS, DEQ, OA, and TF (range, 45%–53%). Patients with LE had a significantly higher incidence of dominant hand involvement. Men had lower DASH scores than women by an average of 7.9 points, and DASH scores were significantly but slightly higher for the overall group (3.2 points) when the dominant side was affected. Men with LE and women with TF and OA had significantly higher DASH scores when their dominant extremity was affected. Common hand disorders such as CTS, DEQ, OA, and TF affect the dominant and nondominant hands in roughly equivalent proportions, whereas LE is more common on the dominant side. Dominant hand involvement results in significantly worse DASH scores, although the magnitude of this is relatively small. Women have significantly higher DASH scores than men for the conditions evaluated. [
Orthopedics.
2016; 39(3):e444–e448.]
Femoral Nerve Block Versus Long-Acting Wound Infiltration in Total Knee Arthroplasty
Authors: Emerson Roger H. , Barrington John W. , Olugbode Oluseun , Lovald Scott , Watson Heather , Ong Kevin
Published: April 2016

Multimodal wound infiltration analgesic techniques have attracted growing interest for applications in total knee arthroplasty (TKA). A benefit of using wound infiltration instead of femoral nerve block (FNB) in a multimodal pain control regimen is the limitation of muscle strength impairment to the surgical area, which will focus the pain control effort and may provide the opportunity for easier rehabilitation and earlier discharge from the hospital. The current study directly compares patients undergoing TKA who are given a continuous FNB with those who were administered an injection of liposomal bupivacaine infiltration. The study cohort included 36 patients with osteoarthritis who were treated with a continuous FNB (OnQ pump; I-Flow, Lake Forest, California), and 36 patients who were administered an injection for liposome bupivacaine infiltration (EXPAREL; Pacira Pharmaceuticals, Inc, Parsippany, New Jersey) for postoperative pain analgesia. The average number of narcotic doses and the total number of narcotics consumed was greater in the FNB group (
P
<.001). Average visual analog scale pain scores trended higher for patients in the FNB group (2.29 vs 1.93) overall and for each day postoperatively up to day 5, although the overall difference was not significant in this study sample (
P
=.115). The results of the current study support the conclusion that long-acting liposome bupivacaine infiltration gives comparable postoperative analgesia compared with a continuous FNB, but with significantly less narcotic medication. [
Orthopedics.
2016; 39(3):e449–e455.]
Surgical Management of Proximal Humeral Fractures: The Emerging Role of Reverse Total Shoulder Arthroplasty
Authors: Cvetanovich Gregory L. , Frank Rachel M. , Chalmers Peter N. , Verma Nikhil N. , Nicholson Gregory P. , Romeo Anthony A.
Published: April 2016

Acute proximal humeral fractures are common injuries in elderly patients. These fractures can lead to significant pain and functional loss. Nonoperative treatment offers high rates of satisfactory function and pain relief in the majority of fractures, particularly in elderly patients. Open reduction and internal fixation, closed reduction and percutaneous pinning, and hemiarthroplasty are used for treating displaced proximal humeral fractures, depending on patient and fracture characteristics. Recently, reverse total shoulder arthroplasty has gained popularity for treatment of complex proximal humeral fractures due to a rapid recovery of active elevation and activities of daily living function. Although complications remain a concern, early results of reverse total shoulder arthroplasty for proximal humeral fractures have been promising. Future comparative outcome studies are needed to define the indications for reverse total shoulder arthroplasty instead of nonoperative and other operative options. Optimal treatment of proximal humeral fractures requires clinical judgment based on fracture characteristics, bone quality, patient factors, and surgeon experience with the array of available techniques. [
Orthopedics.
2016; 39(3):e465–e473.]
Ipsilateral Nonvascularized Autograft and Periosteal Repair for the Treatment of Pediatric Tumors of the Distal Fibula
Authors: Yeung Caleb M. , Lozano-Calderón Santiago A. , Allar Benjamin , Naqvi Manahil , Gebhardt Mark C. , Anderson Megan E.
Published: April 2016

Resection of the distal fibula is used to treat malignant or benign locally aggressive tumors involving this region. Current reconstructive techniques are limited by undesirable functional deficits. The authors present a part-retrospective and part-prospective case-comparison of 2 patient groups (study and control) treated for malignant or benign locally aggressive primary bone tumors of the distal fibula. Patients in the study group underwent a novel surgical technique involving distal transportation of the ipsilateral proximal portion of the fibula after periosteal dissection and osteotomy with subsequent proximal periosteal reconstruction. Patients in the control group underwent other limb-salvage or amputation procedures. Patients were evaluated at follow-up appointments for oncologic, radiographic, and functional outcomes. The groups had similar demographic and perioperative data. Operative time was longer in the study group. Radiographic union occurred in 75% of the study group vs 50% of the control group. Musculoskeletal Tumor Society scores were similar between groups. According to American Foot and Ankle scores, activity limitations and support requirements were greater in the study group; according to Foot and Ankle Disability Index scores, patients in the control group reported more difficulty with squatting. All patients in the study group were without recurrence at follow-up. One patient in the control group had recurrence of disease. Complications occurred in 3 of 4 study group patients and in all control group patients. With the authors' technique for distal fibular reconstruction involving transporting the ipsilateral remaining proximal fibula as a nonvascularized autograft, the regenerative capability of the periosteum allows for restoration of the proximal fibula, preserving osseous stock. [
Orthopedics.
2016; 39(4):e687–e694.]
Chronic Antiplatelet Use Associated With Increased Blood Loss in Lumbar Spinal Surgery Despite Adherence to Protocols
Authors: McCunniff Peter T. , Young Ernest S. , Ahmadinia Kasra , Kusin David J. , Ahn Uri M. , Ahn Nicholas U.
Published: April 2016

There are conflicting reports regarding postoperative bleeding risks associated with discontinuation of antiplatelet therapy at least 7 days preoperatively. Most of the studies in the spine literature are based on surveys or anecdotal evidence. The majority of surgeons discontinue therapy 7 days preoperatively, but this varies widely from 5 to 21 days. The purpose of this retrospective study was to assess whether chronic antiplatelet use is associated with increased intraoperative blood loss, need for transfusion, and perioperative complications. Of 454 patients who underwent elective lumbar spinal surgery, 85 were on antiplatelet therapy and 369 were not. All patients stopped antiplatelet therapy at least 7 days preoperatively with approval from their cardiologist or primary care provider. Multiple regression analysis was performed and corrected for age, sex, antiplatelet therapy, number of levels decompressed/fused/instrumented, preoperative hematocrit, and postoperative hematocrit. Results showed that preoperative antiplatelet therapy, despite at least 7 days of discontinuation, is a statistically significant predictor (
P
=.04) of increased intraoperative blood loss. Blood transfusion was not associated with antiplatelet use but was associated with the number of levels fused, age, and low preoperative hematocrit (all
P
<.01). There were no recorded complications in either group. The authors conclude that antiplatelet therapy is associated with an increased risk of intraoperative blood loss in spine patients despite discontinuation at least 7 days preoperatively, but the clinical significance of this is unclear given the lack of association with blood transfusions and perioperative complications. [
Orthopedics.
2016; 39(4):e695–e700.]
Analysis of Internet Information on Lateral Lumbar Interbody Fusion
Authors: Belayneh Rebekah , Mesfin Addisu
Published: April 2016

Lateral lumbar interbody fusion (LLIF) is a surgical technique that is being increasingly used. The authors' objective was to examine information on the Internet pertaining to the LLIF technique. An analysis was conducted of publicly accessible websites pertaining to LLIF. The following search engines were used: Google (
www.google.com
), Bing (
www.bing.com
), and Yahoo (
www.yahoo.com
). DuckDuckGo (
www.duckduckgo.com
) was an additional search engine used due to its emphasis on generating accurate and consistent results while protecting searchers' privacy and reducing advertisements. The top 35 websites providing information on LLIF from the 4 search engines were identified. A total of 140 websites were evaluated. Each web-site was categorized based on authorship (academic, private, medical industry, insurance company, other) and content of information. Using the search term
lateral lumbar interbody fusion
, 174,000 Google results, 112,000 Yahoo results, and 112,000 Bing results were obtained. DuckDuckGo does not display the number of results found for a search. From the top 140 websites collected from each website, 78 unique websites were identified. Websites were authored by a private medical group in 46.2% of the cases, an academic medical group in 26.9% of the cases, and the biomedical industry in 5.1% of the cases. Sixty-eight percent of websites reported indications, and 24.4% reported contraindications. Benefits of LLIF were reported by 69.2% of websites. Thirty-six percent of websites reported complications of LLIF. Overall, the quality of information regarding LLIF on the Internet is poor. Spine surgeons and spine societies can assist in improving the quality of the information on the Internet regarding LLIF. [
Orthopedics.
2016; 39(4):e701–e707.]
Association Between Serum Relaxin and Subsequent Shoulder Instability
Authors: Owens Brett D. , Cameron Kenneth L. , Clifton Kari B. , Svoboda Steven J. , Wolf Jennifer Moriatis
Published: April 2016

Ligamentous laxity correlates with shoulder instability. Relaxin is a hormone that has been linked to laxity in the knee and has been shown to be a risk factor for anterior cruciate ligament (ACL) injury. This study prospectively evaluated the association between relaxin and acute shoulder instability. A prospective cohort study of 1050 young athletes was performed between 2006 and 2010. The authors conducted a nested case-control analysis within this cohort to evaluate the association between preinjury serum relaxin concentration and the likelihood of subsequent shoulder instability. The study compared 53 patients who had shoulder instability and 53 control subjects who were matched for sex, age, height, and weight. The serum relaxin concentration in preinjury baseline samples was tested with enzyme-linked immunosorbent assay analysis in duplicate. Independent
t
tests were performed to identify differences in mean serum relaxin concentration between patients with shoulder instability and uninjured control subjects. Logistic regression was used to evaluate whether preinjury baseline serum relaxin concentration was associated with the subsequent likelihood of shoulder instability. Of the 53 patients with instability, 13 (25%) had a detectable serum relaxin concentration compared with 9 (17%) of uninjured control subjects (
P
=.34). Mean serum relaxin concentration in the injury group was 3.69±1.78 pg/mL and 2.20±0.97 pg/mL in uninjured control subjects (
P
=.02). Increased serum relaxin concentration was associated with the subsequent likelihood of acute shoulder instability. Subjects were 2.18 times (odds ratio, 2.18; 95% confidence interval, 1.01–4.76) more likely to have acute shoulder instability during the follow-up period for every 1-pg/mL increase in serum relaxin concentration at baseline. The findings suggest that serum relaxin concentration is associated with a risk of subsequent shoulder instability in young athletes. Further research on the role of relaxin in shoulder instability is warranted. [
Orthopedics.
2016; 39(4):e724–e728.]
The Effect of Mechanical Varus on Anterior Cruciate Ligament and Lateral Collateral Ligament Stress: Finite Element Analyses
Authors: Hinckel Betina B. , Demange Marco K. , Gobbi Riccardo G. , Pécora José Ricardo , Camanho Gilberto Luis
Published: April 2016

The current study analyzed changes in anterior cruciate ligament (ACL) and lateral collateral ligament stress as a result of mechanical varus. In an exploratory pilot study, progressive mechanical varus was introduced to a male finite element model of the lower limb at different knee flexion angles. Nine situations were analyzed (combinations of 0°, 30°, and 60° knee flexion and 0°, 5°, and 10° varus). The ACL stress was measured via changes in section force, von Mises stress, and fiber stress. Lateral collateral ligament stress was measured via changes in section force. For all 3 measures of the ACL, maximum stress values were found in extension, stress decreased with flexion, and the effect of varus introduction was most significant at 30° flexion. With 60° flexion, varus introduction produced a decrease in section force and von Mises stress and a small increase in fiber stress. In all situations and stress measures except fiber stress at 60° flexion, stress was concentrated at the posterolateral bundle. For the lateral collateral ligament, the introduction of 5° and 10° varus caused an increase in section force at all degrees of flexion. Stress in the ligament decreased with flexion. Mechanical varus of less than 10° was responsible for increased ACL stress, particularly at 0° and 30° knee flexion, and for increased lateral collateral ligament stress at all degrees of flexion. Stress was mostly concentrated on the posterolateral bundle of the ACL. [
Orthopedics.
2016; 39(4):e729–e736.]
Closed Reduction and Percutaneous Fixation of Calcaneal Fractures in Children
Authors: Feng Yongzeng , Yu Yang , Shui Xiaolong , Ying Xiaozhou , Cai Leyi , Hong Jianjun
Published: April 2016

Open reduction and internal fixation has been widely used to treat displaced intra-articular calcaneus fractures in children. However, the complications of surgical trauma and the wound created through the extended lateral approach cannot be ignored. This study analyzed the outcomes of displaced intra-articular calcaneal fractures in children treated with closed reduction and percutaneous fixation. Medical records of pediatric patients who had displaced intra-articular calcaneus fractures and underwent closed reduction and percutaneous fixation at the study institution between January 2008 and January 2013 were reviewed. Preoperative radiographs and computed tomography scans were used to evaluate and classify the fractures. Clinical outcomes and radiographic findings were assessed at postoperative follow-up. The study included 14 displaced intra-articular calcaneal fractures in 11 patients (7 boys and 4 girls). Mean patient age was 11.18 years (range, 6–16 years), and average follow-up time was 42.8 months postoperatively (range, 12–72 months). There were 6 tongue-type fractures and 8 joint depression-type fractures, based on the Essex-Lopresti classification, and there were 11 type II and 3 type III fractures, based on the Sanders classification. Average Böhler angle was 8.00° (range, −5° to 18°) preoperatively and 30.79° (range, 26° to 40°) postoperatively (
P
<.001). Average subjective American Orthopaedic Foot and Ankle Society hindfoot score was 65.7 (range, 52–68). No patients had wound breakdown or infection. In the treatment of displaced intra-articular calcaneal fractures in pediatric patients, closed reduction and percutaneous fixation achieved good outcomes, with few complications. [
Orthopedics.
2016; 39(4):e744–e748.]
History of Nocturia May Guide Urinary Catheterization for Total Joint Arthroplasty
Authors: Rana Sumit , Woolson Steven T. , Giori Nicholas J.
Published: April 2016

Urinary tract infection is a common complication after total knee arthroplasty (TKA) and can be related to urethral catheterization. This study attempted to determine whether nocturia could be used as an indicator of risk for postoperative urinary retention to limit the need for prophylactic catheterization in men undergoing TKA. A retrospective study was performed in a consecutive series of men undergoing TKA at a single Veterans Affairs medical center. Patients reporting 0 episodes or 1 episode of nocturia per night were not catheterized prophylactically, and patients reporting 2 or more episodes of nocturia each night were catheterized preoperatively. Of 100 consecutive patients, 51 reported no more than 1 episode of nocturia and did not undergo preoperative catheterization. Of these patients, 10 required 1 postoperative straight catheterization for urinary retention. In the 49 patients who were catheterized prophylactically, all catheters were removed on postoperative day 1. Only 1 of these patients required reinsertion of a catheter. No patient in either group was discharged with a catheter or had a urinary tract infection. Previously, the authors' standard protocol was to use a prophylactic urinary catheter for all men after TKA. In this 100-patient cohort, with this new protocol, 41 patients were not catheterized at all and 10 patients had only 1 straight catheterization. In this study, the frequency of nocturia in men undergoing TKA was an effective screening tool that safely reduced the need for an indwelling catheter in 51% of patients. [
Orthopedics.
2016; 39(4):e749–e752.]
Nursing Students' Perceptions of a Hearing Voices Simulation and Role-Play: Preparation for Mental Health Clinical Practice
Authors: Fossen Peggy , Stoeckel Pamella Rae
Published: April 2016

Background:

Baccalaureate nursing students experience anxiety before working with patients with mental illness who hear voices. A hearing voices simulation and role-play was proposed as an approach to preparing students for clinical practice.

Method:

A qualitative interpretive phenomenological method was used to determine students' perceptions of the simulation experience before their first mental health clinical rotation.

Results:

Through the experience of the Walking in the Shoes of Patients activity, written student surveys revealed themes of Reflecting on Past Experiences, Developing Changed Perspectives, and Different Approaches to Care.

Conclusion:

The hearing voices simulation provided students with a greater understanding of the experience of hearing voices, and the role-play helped students to gain personal insight into patients' behaviors and practice skills learned in preparation for their first mental health clinical experience. [J Nurs Educ.2016;55(4):203–208.]
Teaching a Systems Approach: An Innovative Quality Improvement Project
Authors: Hamrin Vanya , Vick Rose , Brame Cynthia , Simmons Megan , Smith Letizia , Vanderhoef Dawn
Published: April 2016

Background:

Nurse practitioners are required to navigate complex health care systems. Quality improvement (QI) projects provide the opportunity for nurse practitioner students to learn systems knowledge and improve health care outcomes in patient populations. A gap in the literature exists around how to systematically teach, apply, and measure QI curricular objectives at the master's level.

Method:

Six faculty evaluated the QI project for the psychiatric nurse practitioner master's program by identifying the most challenging QI concepts for students to apply, revising their teaching strategies to address gaps, and retrospectively evaluating the outcomes of these curriculum changes by comparing student outcomes before and after the curricular changes.

Results:

A significant difference was noted on QI project performance between students in the 2014 and 2015 graduating classes, measured by the scores earned on students' final papers (
t
[92] = 1.66,
p
= .05,
d
= .34,
r
2
= .0289).

Conclusion:

Theoretical principles of adult and cooperative learning were used to inform curricular changes to enhance student's acquisition of QI skills. [
J Nurs Educ.
2016;55(4):209–214.]
A Mixed-Methods Study of Prelicensure Nursing Students Changing Answers on Multiple Choice Examinations
Authors: George Tracy P. , Muller M. Annie , Bartz Jeremiah D.
Published: April 2016

Background:

Students often question whether changing answers on multiple choice examinations correlates with an increase or decrease in their grades.

Method:

In a mixed-methods study, 135 prelicensure nursing students were surveyed. The answer response forms were reviewed for erasures. Qualitative data were obtained through content analysis of two questions. Quantitative analysis was performed to explore the relationships among students' self-reported grade performance, test-anxiety levels, and how often they changed answers.

Results:

The themes of Risk, Careless Mistakes, Adequate Preparation, Instinct, and Cues From the Test were identified when students were asked their opinion on changing answers. The themes of Indecisiveness, Test Review, and Rationale emerged when students were asked why they changed answers. Students who reported being somewhat anxious had a greater tendency to change answers. Answers were changed from incorrect to correct 55.6% of the time.

Conclusion:

On average, changing answers resulted in a moderate increase in test scores. [
J Nurs Educ.
2016;55(4):220–223.]
Clinical Management of Orbital Rhabdomyosarcoma in a Referral Center in Spain
Authors: Bravo-Ljubetic Luciano , Peralta-Calvo Jesús , Larrañaga-Fragoso Paula , Pascual Nuria Olivier , Pastora-Salvador Natalia , Gomez Jose Abelairas
Published: April 2016

Purpose:

To review the systemic and ocular outcomes and long-term status of ocular rhabdomyosarcoma in pediatric patients in a tertiary center in Spain.

Methods:

All patients younger than 18 years who were diagnosed as having ocular rhabdomyosarcoma and treated between 1982 and 2011 at La Paz University Hospital, Madrid, Spain, were included. Clinical presentation, management, complications, and ocular and systemic outcomes were reviewed.

Results:

The mean age at presentation was 8 years (range: 3 months to 12.5 years). In all cases, the rhabdomyosarcoma was located primarily in the orbit. Treatment included surgical debulking and various regimens of chemotherapy and radiotherapy. All of the patients underwent surgical biopsy for diagnosis confirmation. Orbital exenteration was performed in 4 cases (28%). Twelve patients received radiotherapy. The long-term visual outcomes of the 10 patients who maintained their globe was as follows: best corrected visual acuity 20/20 to 20/40 in 6 patients (60%), 20/50 to 20/100 in 2 patients (20%), and 20/200 to no light perception in 2 patients (20%). Intraocular complications (primarily cataracts: 50%) were present in 7 patients (70%), ocular surface lesions occurred in 6 patients (60%), and orbital sequelae were found in 8 patients (80%). Local tumor recurrence was detected in 5 patients (35%) and distant metastasis occurred in 2 patients (14%). Tumor-related death occurred in 1 patient (7%).

Conclusions:

Orbital rhabdomyosarcoma has an excellent prognosis; nevertheless, local complications are common, including surgery-related complications. To minimize them, initial surgical planning based on individual patient characteristics and an accurate diagnosis of relapses is mandatory. The clinical presentation, management, and long-term ocular and systemic outcomes are comparable with other series published to date.

[
J Pediatr Ophthalmol Strabismus
. 2016;53(2):119–126.]
Reflective Prompts to Guide Termination of the Psychiatric Clinical Student Nursing Experience
Authors: Hubbard Grace B.
Published: April 2016

The average length of stay on psychiatric inpatient units has decreased in the past 40 years from 24.9 to 7.2 days. Inpatient psychiatric nurses are challenged to meet the standards and scope of practice despite the changing circumstances of their work environment. The amount of time student nurses spend with a given patient has been affected by changes in acute psychiatric inpatient care and decreased length of stay; however, opportunities exist for effective termination of the nurse–client relationship. Facilitation of students' awareness and understanding of the dynamics inherent in the termination process is an important teaching task for psychiatric nursing clinical instructors. In the current article, a clinically focused learning activity using structured prompts to guide and promote psychiatric nursing students' experiences with the process of termination is described and teaching strategies are discussed. [
Journal of Psychosocial Nursing and Mental Health Services
,
54
(4), 38–43.]