bluuebunny/crossref_metadata_2025 huggingface dataset:
Workforce Differentiation
Authors: Collings David G.
Published: October 2017

Historically, a key focus of human resource (HR) professionals was developing, implementing, and standardizing HR polices and processes to ensure employees perform in standardized ways. However, the utility of a standardized approach to HR practices has been increasingly questioned over recent decades. In this vein, formalized workforce-differentiation approaches to the segmentation of the workforce based on employees’ competence or the nature of roles performed to reflect differential potential to generate value has emerged as a central element of talent-management strategies. While earlier research on workforce differentiation identified individual talent as the locus of differentiation, more recently, the focus has shifted to strategic or pivotal jobs. This chapter reviews the emergence of workforce differentiation in the academic literature and charts key trends in this regard. The implications of a workforce-differentiation strategy for employees are also considered. The chapter concludes with a consideration of emerging trends and potential avenues for future study.
Virtual Teams
Authors: Maynard Michael Travis , Vartiainen Matti , Sanchez Diana
Published: October 2017

Given the proliferation of technology developments and the continued use of teams within organizations, it is not surprising to see an increasing use of virtual teams. In response, researchers are more closely examining factors that may affect virtual team performance. There have been several reviews that do a thorough job of providing the current state of the virtual team literature, as well as providing directions for future research in this area. However, within the current chapter, we leverage a framework from the talent-management literature to assess whether certain talent-management-related topics have been adequately considered within the virtual team literature. Within each section of the framework leveraged here, we outline what the virtual team research has discussed, as well as where future opportunities exist. Our contention is that by integrating thoughts from the talent-management literature, additional insights and gaps can be identified within the virtual team literature.
HR Metrics and Talent Analytics
Authors: Fink Alexis A. , Sturman Michael C.
Published: October 2017

Taking advantage of the history of research quantifying the effects of human resource (HR) practices, leveraging current advances in information systems and opportunities presented by big data, HR metrics and talent analytics present a renewed opportunity to help drive effective HR practices. HR metrics are operational measures, addressing how efficient, effective, and impactful an organization’s HR practices are. In contrast, talent analytics focus on decision points, guiding investment decisions. The chapter provides an overview of the historic roots and current practices around HR metrics and talent analytics. Through this, we explore the role, benefits, and risks of benchmarking and utility analyses as two common approaches to setting HR metrics. We discuss how current advances in research and practice make the use of HR metrics and talent analytics a greater business necessity. We conclude the chapter with a discussion on fostering talent analytics within organizations.
Introduction
Authors: Collings David G. , Mellahi Kamel , Cascio Wayne F.
Published: October 2017

This chapter serves as an introduction to the Oxford Handbook of Talent Management. The chapter provides a summary introduction to talent management and an overview of the content of the handbook. Specifically, we begin by considering how talent management is defined in the academic literature. Thereafter, we provide an overview of the key trends and debates in the talent management literature over the past decade and a half. We also point to some seminal research that is central to our understanding of talent management that has been omitted from a number of recent reviews of the field owing to broader theoretical framing. We conclude with an overview of the content of the handbook.
Talent Management in the Global Context
Authors: Khilji Shaista E. , Schular Randall S.
Published: October 2017

Talent-management research has primarily focused at the individual and organizational levels. While this work has added much value to the literature, we believe that shifting the focus to the macro context will further strengthen the field. This might include exploring country-level government activities that enhance a country’s talent levels; non-governmental initiatives to help various countries bolster their talent-management programs; global talent mobility; and knowledge transfer. To incorporate this focus more systematically, we present a conceptual framework for macro talent management. The framework draws our attention to the macro, global, and country context within which talent management occurs, as well illuminates its multiple processes and outcomes. We offer directions for future research and discuss implications for policy makers and companies.
Reconstructing Artificial Light in Ancient Greece
Authors: Moullou Dorina , Topalis Frangiskos V.
Published: October 2017

This chapter presents an overview of artificial lighting means and their efficiency in the performance of domestic nocturnal activities (except cult practices) in ancient Greece. Through experiments conducted in the Lighting Laboratory of the National Technical University of Athens, the optical properties of exact copies of ancient light sources are investigated. The experimental data are used to assess the sufficiency of light produced by the lighting devices, and to examine the resulting lighting conditions in relation to colour perception and domestic nocturnal activities. The results show that people in antiquity could move around and operate with relative ease at night. Most domestic nocturnal activities could be performed even by the light of a single lamp, provided that it was located relatively nearby. Activities involving colour discrimination, such as weaving, were the most difficult but not impossible to perform. Therefore, artificial light in antiquity could be both effective and economical.
Capturing the Complexity and Dynamics of Positive Human Health
Authors: Rush Jonathan , Ong Anthony D. , Hofer Scott M. , Horn John L.
Published: October 2017

This chapter illustrates how recent advances in longitudinal methodology can be applied to diverse issues of interest to positive psychologists. The rules for doing research that can net the highest stakes in understanding are, to a considerable extent, the rules of design and measurement. The aim of the chapter is to describe how contemporary theories of well-being may be empirically evaluated using a variety of research designs and analytical techniques that can fully capture the complexity and dynamics of positive human health. Throughout, the chapter identifies unresolved methodological challenges associated with the measurement and analysis of between- and within-person phenomena and elaborates on the implications of these challenges for process research in positive psychology.
Delivering Justice
Authors: Abisaab Rula Jurdi
Published: October 2017

This article examines the relationship between the ‘urfi (monarchical/sultanic) and the shari‘a courts in the administration of justice in Safavid Iran. In particular, it considers the notion that there was a split between a sacred and a secular basis for justice in Safavid Iran. To prove that this is not the case, the article looks at the roles of the Shah, the sadr, the qazis, the shaykh al-Islam, and the divan-begi in administering justice during the period. It shows that legal roles and processes in the Safavid justice system unfolded within a religious framework, reflecting the interface between ideal stipulations and practical ends, and between public shari‘a -derived law and private monarchical law. This provides evidence that shari‘a and ‘urfi courts were interdependent and provided overlays of jurisdiction in Safavid Iran.
Freedom and Contingency
Authors: McDonough Jeffrey K.
Published: October 2017

This chapter attempts to clarify Leibniz’s theories of freedom and contingency by viewing them against the backdrop of his efforts to reengineer important philosophical concepts. In developing a concept of freedom, Leibniz is above all concerned to preserve divine and human responsibility (Section 1). His account of freedom requires him to reject necessitarianism, that is, the view that all things are absolutely necessary (Section 2). Leibniz therefore carves out two concepts of contingency. The first is centered on the thought that something may be contingent considered by itself – that is, per se – even if it is necessary in light of God’s goodness or will (Section 3). The second is centered on the thought that it may be possible to draw a distinction between contingent and necessary propositions in terms of logic alone (Section 4).
Between Pastness and Presentism
Authors: Stanton Cathy
Published: October 2017

This chapter traces the separation of preserved historical farm landscapes from working agriculture over the two-century history of industrial ascendancy, the dominance of fossil fuels after World War II, and the emergence of a for-profit/nonprofit and public/private divide within the increasingly revitalized world of small-scale farming. It argues that there are several benefits to public historians of aligning their work more closely with “local food” movement activities and activism and that these new alliances can make public history a more consequential participant in the broader civic project of understanding and adapting to many environmental and economic changes . The chapter presents examples of emerging projects that do seek to connect directly with food-movement goals, including through engagement with issues of social, environmental, and economic justice related to food production, access, and consumption.
History Museums and Identity
Authors: Filene Benjamin
Published: October 2017

In the nineteenth century, elites saw museums as a tool to shape a citizenry, to mold a national identity. Even as the New Social History of the 1960s pushed for a more inclusive history, the idea of a shared American identity remained largely intact. In the 1990s, however, museums started to think of identity as more multifaceted and fragmented. History became a collection of stories whose morals and even main characters varied according to one’s perspective. Exhibitions encouraged visitors to explore their individual identities, and ethnically specific museums emerged to reinforce particular community identities. Recent years have seen another shift: some museums see their job less as to reinforce visitors’ identities than to show how identity works—how it is continually negotiated by individuals, communities, and cultures.
Politics and Memory
Authors: Gößwald Udo
Published: October 2017

This chapter focuses on how German politics and society have approached the difficult history of a country that caused World War II and the extermination of millions of Jews during Nazi rule. Hope and memory or expectation and experience are introduced as two major theoretical categories that determine the degree of a successful historical reflection. The manifestations of memory in institutions of public history such as historical sites, monuments, and museums are discussed. The chapter analyzes the political interests that have determined memory politics in different phases of German postwar history. It reflects the attempts that have been made in literature or other forms of public history to integrate the subjective dimension into the perception of history. Facing the past is seen as an ongoing process in an open society in which diverse competitive narratives emerge and constantly reshape society’s cultural self-understanding.
In the Service of the State
Authors: Ashton Paul , Brahmantyo Kresno , Keaney Jaya
Published: October 2017

Public history in Indonesia today faces considerable challenges. Despite the downfall of the New Order regime, its nationalist history program and agenda remain powerful in the culture. Nowhere is this more apparent than in the construction and use of authorized monuments and memorials. Monuments and memorials are evocative and affective; they promote and perpetuate emotional bonds. Drawing on familiar materials and symbols, they are aimed at particular audiences in specific contexts, and they are intended to be efficacious. As objects with the potential to affect communities or whole societies, they are also contestable. This chapter draws on what are arguably two of the most prominent public monuments and memorials in Indonesia—the Sacred Pancasila Monument (Monumen Pancasila Sakti), which speaks primarily to an internal or domestic audience, and the memorial to the victims of the Bali bombing in Kuta, which is primarily aimed at an international audience.
The Kyoto School
Authors: Ōhashi Ryōsuke , Akitomi Katsuya
Published: October 2017

In this chapter, the authors aim to provide an introduction to the Kyoto School of modern Japanese philosophy. The chapter begins with a historical overview of the formation of various images of the School. It then briefly examines the controversial political engagements of members of the School during the Pacific War. The central sections of the chapter introduce the main figures and ideas of the first, second, and third generations of the School. The chapter concludes with some reflections on how the School may contribute to a contemporary philosophical critique of technology and to a renewed dialogue between Eastern and Western traditions.
Philosophical Implications of the Japanese Language
Authors: Elberfeld Rolf
Published: October 2017

This chapter seeks to elucidate the philosophical implications of some distinctive traits of the grammar and word types of both Classical and Modern Japanese. It discusses in particular the emphasis on the predicate rather than the subject of the sentence, and hence on verbal processes rather than nominal substances, as well as the central role played by the “middle voice,” which expresses the spontaneous and natural unfolding of an occurrence rather than the activity or passivity of a subject. Such philosophical proclivities harbored in the Japanese language are explored by way of examining passages from the thirteenth-century Zen master Dōgen, the fourteenth-century classic Tsurezuregusa, and the twentieth-century philosopher Nishida Kitarō.
The impact of the Hall effect during cloud core collapse: Implications for circumstellar disk evolution
Authors: Tsukamoto Yusuke , Okuzumi Satoshi , Iwasaki Kazunari , Machida Masahiro N. , Inutsuka Shu-ichiro
Published: October 2017

We perform three-dimensional radiation non-ideal magnetohydrodynamics simulations and investigate the impact of the Hall effect on the angular momentum evolution in collapsing cloud cores in which the magnetic field B and angular momentum Jang are misaligned with each other. We find that the Hall effect noticeably changes the magnetic torques in the pseudo-disk, and strengthens and weakens the magnetic braking in cores with acute and obtuse relative angles between B and Jang, respectively. This suggests that the bimodal evolution of the disk size may occur in the early disk evolutionary phase even if B and Jang are randomly distributed. We show that a counter-rotating envelope forms in the upper envelope of the pseudo-disk in cloud cores with obtuse relative angles. We also find that a counter-rotating region forms at the midplane of the pseudo-disk in cloud cores with acute relative angles. The former and latter types of counter-rotating envelopes may be associated with young stellar objects with large (r ∼ 100 au) and small (r ≲ 10 au) disks, respectively.
Analgesia Nociception Index Monitoring During Supratentorial Craniotomy
Authors: Kommula Lakshman K. , Bansal Sonia , Umamaheswara Rao Ganne S.
Published: October 2017

Background:

Objective monitoring of pain during and after surgery has been elusive. Recently, Analgesia Nociception Index (ANI) monitor based on the high frequency component of heart rate variability has been launched into clinical practice. We monitored analgesia during craniotomy using ANI monitor and compared it with cardiovascular parameters and response entropy (RE) of entropy monitor.

Materials and Methods:

In 21 patients undergoing a craniotomy for a supratentorial lesion, we monitored ANI, heart rate (HR), mean arterial pressure (MAP), state entropy, and RE throughout the surgery. Also, ANI, hemodynamic variables and spectral entropy values were noted at the times of maximal stimulation, such as induction, intubation, head pin fixation, skin incision, craniotomy, durotomy, and skin closure. We also compared ANI with RE during administration of bolus doses of fentanyl.

Results:

There was an inverse correlation between ANI values and the hemodynamic changes. When the HR and MAP increased, ANI decreased suggesting a good correlation between hemodynamics and ANI values during the times of maximal stimulation. State entropy and RE did not change significantly in response to bolus doses of fentanyl administered during the course of surgery, while ANI increased significantly.

Conclusion:

In neurosurgical patients undergoing elective supratentorial craniotomy, ANI measures response to noxious stimuli with at least as much reliability as hemodynamic variables and changes in ANI parallel the changes in HR and MAP. ANI is superior to RE for measurement of response to noxious stimuli.
Transition to College and Adherence to Prescribed Attention Deficit Hyperactivity Disorder Medication
Authors: Gray Wendy N. , Kavookjian Jan , Shapiro Steven K. , Wagoner Scott T. , Schaefer Megan R. , Resmini Rawlinson Alana , Hinnant James B.
Published: October 2017

Objective:

As youth with attention deficit hyperactivity disorder (ADHD) transition to adulthood, they must learn how to manage their ADHD treatment independently. This may be challenging because many of the skills necessary to adhere to treatment (e.g., organization, planning) are impaired in those with ADHD. Using electronic monitoring, we examine trajectories of adherence to medication in a cohort of college students with ADHD. Further, we examine the effect of transitioning to college and executive functioning on adherence.

Methods:

Electronic monitors tracked adherence for 51 undergraduate students with ADHD across an academic semester. Multilevel modeling examined individual trajectories in monthly adherence and the role of transition status and self-reported executive functioning on these trajectories.

Results:

Overall, participants adhered to 53.53% of prescribed doses. Transition status predicted the linear slope in adherence (β = −8.95, standard error [SE] = 3.61, p < .05), with lower initial adherence among undergraduates transitioning to independence (34.17%) compared with post-transition undergraduates (67.63%; β = 33.46, SE = 8.00, p < .001). Adherence demonstrated a curvilinear change (β = −7.23, SE = 1.25, p < .001). It increased from the beginning of the semester to midterms before subsequently declining through the rest of the semester, including during final exams. Executive functioning did not predict adherence (β = −.10, SE = .02, p = .54).

Conclusion:

Only half of all doses were taken as prescribed. Adolescents transitioning to independence demonstrated the lowest levels of adherence, suggesting that the transition to independence is a high-risk period for poor self-management of ADHD.
Prediction of N0 Irradiated Rectal Cancer Comparing MRI Before and After Preoperative Chemoradiotherapy
Authors: Pomerri Fabio , Crimì Filippo , Veronese Nicola , Perin Alessandro , Lacognata Carmelo , Bergamo Francesca , Boso Caterina , Maretto Isacco
Published: October 2017

BACKGROUND:

The prediction of lymph node status using MRI has an impact on the management of rectal cancer, both before and after preoperative chemoradiotherapy.

OBJECTIVE:

The purpose of this study was to maximize the negative predictive value and sensitivity of mesorectal lymph node imaging after chemoradiotherapy because postchemoradiation node-negative patients may be treated with rectum-sparing approaches.

DESIGN:

This was a retrospective study.

SETTINGS:

The study was conducted at a tertiary care hospital.

PATIENTS:

Sixty-four patients with locally advanced rectal cancer who underwent preoperative chemoradiotherapy and MRI for staging and the assessment of response were evaluated.

MAIN OUTCOME MEASURES:

The sums of the sizes of all mesorectal lymph nodes in each patient on both prechemoradiotherapy and postchemoradiotherapy imaging data sets were calculated to determine the lymph node global size reduction rates, taking these to be the outcomes of the histopathologic findings. Other included measures were interobserver agreement regarding the prediction of node status based on morphologic criteria and the diagnostic performance of contrast-enhanced images.

RESULTS:

Using a cutoff value of a 70% lymph node global size reduction rate with only 15 node-positive patients on histopathology, the sensitivity in the prediction of nodal status and negative predictive value were 93% (95% CI, 70.2%–98.8%) and 97% (95% CI, 82.9%–99.8%) for observer 1 and 100% (95% CI, 79.6%–100%) and 100% (95% CI, 62.9%–100%) for observer 2. The areas under the receiver operating characteristic curves for the 2 observers were 0.90 (95% CI, 0.82–0.98; p < 0.0001) for observer 1 and 0.65 (95% CI, 0.50–0.79; p = 0.08) for observer 2. The efficacy of the morphologic criteria and contrast-enhanced images in predicting node status was limited after chemoradiotherapy.

LIMITATIONS:

This study is limited by its small sample size and retrospective nature.

CONCLUSIONS:

Assessing the lymph node global size reduction rate value reduces the risk of undetected nodal metastases and may be helpful in better identifying suitable candidates for the local excision of early stage rectal cancer. See Video Abstract at http://links.lww.com/DCR/A412.
A Distal Resection Margin of ≤1 mm and Rectal Cancer Recurrence After Sphincter-Preserving Surgery: The Role of a Positive Distal Margin in Rectal Cancer Surgery
Authors: Zeng Wei-gen , Liu Meng-jia , Zhou Zhi-xiang , Wang Zhen-jun
Published: October 2017

BACKGROUND:

There is little information about the prognostic value of a microscopically positive distal margin in patients who have rectal cancer.

OBJECTIVE:

We aimed to investigate the influence of a distal margin of ≤1 mm on oncologic outcomes after sphincter-preserving resection for rectal cancer.

DESIGN:

This is a retrospective cohort study.

SETTINGS:

The study was conducted at 2 hospitals.

PATIENTS:

A total of 6574 patients underwent anterior resection for rectal cancer from January 1999 to December 2014; 97 (1.5%) patients with a distal margin of ≤1 mm were included in this study. For comparative analyses, patients were matched with 194 patients with a negative distal margin (>1 mm) according to sex, age, BMI, ASA score, neoadjuvant treatment, tumor location, and stage.

MAIN OUTCOME MEASURES:

The oncologic outcomes of the 2 groups were compared.

RESULTS:

Perineural and lymphovascular invasion rates were significantly higher in patients with a positive distal margin (54.6% vs 28.9%; 67.0% vs 42.8%; both p < 0.001) compared with to patients with negative distal margin. Comparison between microscopically positive and negative distal margin showed worse oncologic outcomes in patients with a microscopically positive distal margin, including 5-year local recurrence rate (24.1% vs 12.0%, p = 0.005); 5-year distant recurrence rate (35.5% vs 20.2%, p = 0.011); 5-year disease-free survival (45.5% vs 69.5%, p < 0.001); and 5-year OS (69.2% vs 79.7%, p = 0.004). Among the 97 patients with a microscopically positive distal margin, the 5-year disease-free survival rate was higher in patients who received adjuvant therapy (52.0% vs 30.7%, p = 0.089).

LIMITATIONS:

This is a retrospective study; bias may exist.

CONCLUSIONS:

A distal margin of 1 mm is associated with worse oncologic results. Our data indicate the importance of achieving a clear distal margin in the surgical treatment of rectal cancer. Adjuvant therapy should be used in these patients to reduce recurrence. See Video Abstract at http://links.lww.com/DCR/A408.
The Role of Hereditary Factors in Ovarian Carcinoma
Authors: SCHRADER KASMINTAN A.
Published: October 2017

Cancer is a disease of the genome, in which mutations in particular genes and pathways give rise to tissue-specific genotype-phenotype correlations. In tumors associated with hereditary cancer syndromes, a person is generally born with the first mutation relevant to the development of their cancer. In this chapter we will discuss the genes that have been associated with germline mutations that confer a moderate to high risk for ovarian carcinoma.
Ultrafast Track Robotic-Assisted Minimally Invasive Coronary Artery Surgical Revascularization
Authors: Tarola Christopher L. , Al-Amodi Hussein A. , Balasubramanian Sankar , Fox Stephanie A. , Harle Christopher C. , Iglesias Ivan , Sridhar Kumar , Teefy Patrick J. , Chu Michael W.A. , Kiaii Bob B.
Published: October 2017

Objective

Contemporary anesthetic techniques have enabled shorter sedation and early extubation in off-pump and minimally invasive coronary artery bypass (CABG) surgery. Robotic-assisted CABG represents the optimal surgical approach for ultrafast track anesthesia, with patients able to bypass the cardiac surgical intensive care unit with recovery in the postanesthesia care unit (PACU) and inpatient ward.

Methods

In-hospital postoperative outcomes from ninety patients who underwent either elective or urgent robotically-assisted CABG at our institution were reviewed. These patients were carefully selected by a multidisciplinary team to undergo fast-track anesthesia: extubation in the operating room, 4-hour recovery in the postanesthesia care unit and transfer to the inpatient ward. Intrathecal, paravertebral local, and patient-controlled anesthesia techniques were used to facilitate transition to oral analgesics.

Results

Average patient age was 61 ± 9 years. Sixty-six patients (73%) were male. Seventy cases were elective, and 20 patients required urgent revascularization. All patients underwent intraoperative angiography after graft construction, which revealed Fitzgibbon class A grafts. There were no in-hospital mortalities. One patient required re-exploration for bleeding, through the same minimally invasive incision, did not require conversion to sternotomy for bleeding, and was transferred to the intensive care unit postexploration for bleeding for standard postoperative care. Postoperative complications were limited to one superficial wound infection. The mean hospital length of stay was 3.5 ± 1.17 days.

Conclusions

In patients undergoing robotic-assisted CABG, ultrafasttrack cardiac surgery with immediate postprocedure extubation and transfer to the inpatient ward has been demonstrated to be safe with no increase in perioperative morbidity or mortality. It requires a dedicated heart team with a carefully selected group of patients. Avoiding cardiac surgical intensive care unit expedites recovery, with possible avoidance of infection and early discharge from hospital.
Minimally Invasive Mitral Valve Annuloplasty with Realignment of Both Papillary Muscles for Correction of Type IIIb Functional Mitral Regurgitation
Authors: Girdauskas Evaldas , Conradi Lenard , Karolina Harmel Eva , Reichenspurner Hermann
Published: October 2017

Objective

Pathophysiological background of type IIIb functional mitral regurgitation (FMR) is a progressively increasing distance between papillary muscle tips and mitral annular plane. Standard surgical treatment of such FMR by means of undersized mitral annuloplasty is associated with a high recurrence rate.

Methods

We propose a modified subannular maneuver to correct type IIIb FMR while combining undersized annuloplasty with a controlled realignment of both papillary muscles, thereby fixing the distance between mitral annular plane and papillary muscle tips. The differences of this subannular maneuver as compared with the previously published techniques are the following: (1) controlled realignment of both papillary muscles, (2) fixation of the papillary muscles to mitral annulus distance on an annuloplasty ring, and (3) application in a three-dimensional endoscopic minithoracotomy setting.

Results

We describe a surgical technique of minimally invasive mitral valve repair performed due to severe type IIIb FMR, which includes a modified subannular maneuver to realign both papillary muscles. Preliminary results of the first 10 patients who underwent this procedure at our institution are presented. There was no in-hospital mortality and follow-up echocardiography (mean ± SD echocardiographic follow-up = 10 ± 6 months) demonstrated stable functional results.

Conclusions

Our initial experience indicates that adding of this subannular maneuver to the standard annuloplasty and thereby fixing the distance between papillary muscles and mitral annular plane have a potential to improve results of surgical FMR treatment.
Nocardia nova Tenosynovitis and Abscess After a Remote Gunshot Wound
Authors: Linder Kathleen A. , Herc Erica S. , Kauffman Carol A.
Published: October 2017

Nocardia nova is a less commonly isolated Nocardia species that was formerly classified as belonging to the Nocardia asteroides complex. This organism is a rare cause of primary cutaneous nocardiosis. We report a case of N. nova flexor tenosynovitis and abscess involving the right forearm after a remote inoculation injury.
Pneumocystis Pneumonia and Acute Pulmonary Embolism in Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome
Authors: Olanipekun Titilope , Effoe Valery S. , Medhane Kimberly A. , Fransua Mesfin
Published: October 2017

Severe immunosuppression and the presence of opportunistic infections in human immunodeficiency virus/acquired immunodeficiency syndrome are strongly associated with incidence of venous thromboembolism especially deep venous thrombosis and pulmonary embolism (PE). The co-occurrence of 2 diseases with similar clinical presentation can pose diagnostic and treatment challenges. We describe the case of a 54-year-old male, with no significant past medical history who presented with complaints of a 6-week history of shortness of breath. He was diagnosed with human immunodeficiency virus 1 infection with a CD4 count of 121 cells/μL and severe Pneumocystis jirovecii pneumonia. After 5 days of treatment without significant improvement, we obtained a computed tomography pulmonary angiogram, which showed concurrent acute PE. His clinical condition improved with anticoagulation therapy. Clinicians need to have a high index of suspicion and consider PE in the differential diagnosis of dyspnea and hypoxemia, particularly when P. jirovecii pneumonia infection or other acquired immunodeficiency syndrome defining illnesses are suspected.
Enhancing Care of Aged and Dying Prisoners: Is e-Learning a Feasible Approach?
Authors: Loeb Susan J. , Penrod Janice , Myers Valerie H. , Baney Brenda L. , Strickfaden Sophia M. , Kitt-Lewis Erin , Wion Rachel K.
Published: October 2017

Background

Prisons and jails are facing sharply increased demands in caring for aged and dying inmates. Our Toolkit for Enhancing End-of-life Care in Prisons effectively addressed end-of-life (EOL) care; however, geriatric content was limited, and the product was not formatted for broad dissemination. Prior research adapted best practices in EOL care and aging; but, delivery methods lacked emerging technology-focused learning and interactivity.

Purposes

Our purposes were to uncover current training approaches and preferences and to ascertain the technological capacity of correctional settings to deliver computer-based and other e-learning training.

Methods

An environmental scan was conducted with 11 participants from U.S. prisons and jails to ensure proper fit, in terms of content and technology capacity, between an envisioned computer-based training product and correctional settings.

Results

Environmental scan findings focused on content of training, desirable qualities of training, prominence of “homegrown” products, and feasibility of commercial e-learning.

Conclusions/Implications

This study identified qualities of training programs to adopt and pitfalls to avoid and revealed technology-related issues to be mindful of when designing computer-based training for correctional settings, and participants spontaneously expressed an interest in geriatrics and EOL training using this learning modality as long as training allowed for tailoring of materials.
STRC Deletion is a Frequent Cause of Slight to Moderate Congenital Hearing Impairment in the Czech Republic
Authors: Plevova Pavlina , Paprskarova Martina , Tvrda Petra , Turska Petra , Slavkovsky Rastislav , Mrazkova Eva
Published: October 2017

Objective:

This study aimed to clarify the molecular epidemiology of hearing loss by identifying the responsible genes in patients without GJB2 mutations.

Study Design:

Prospective genetic study.

Setting:

Tertiary referral hospital.

Patients:

Fifty one patients with bilateral sensorineural hearing loss, 20 men, and 31 women, mean age 24.9 years, range 3 to 64 years, from 49 families. GJB2 and deltaGJB6-D13S1830 mutations were excluded previously.

Intervention:

Diagnostic. Sixty-nine genes reported to be causative of hearing loss were analyzed. Sequence capture technology, next-generation sequencing, and multiplex ligation-dependent probe amplification (MLPA) were used. Coverage of STRC was screened in Integrative Genomics Viewer software.

Main Outcome Measure:

Identification of causal pathogenic mutations in genes related to deafness.

Results:

Five families (10%) had recessive STRC deletions or mutations. Five unrelated patients (10%) had recessive mutations in TMPRSS3, USH2A, PCDH15, LOXHD1, and MYO15A. Three families (6%) had autosomal dominant mutations in MYO6A, KCNQ4, and SIX1. One family (2%) had an X-linked POU3F4 mutation. Thus, we identified the cause of hearing loss in 28% of the families studied.

Conclusions:

Following GJB2, STRC was the second most frequently mutated gene in patients from the Czech Republic with hearing loss. To decrease the cost of testing, we recommend STRC deletion screening with MLPA before next-generation sequencing. The existence of a pseudogene and polymorphic STRC regions can lead to false-positive or false-negative results when copy number variation analysis is based on next-generation sequencing data.
Cochlear Dysfunction is not Common in Human Meningioma of the Internal Auditory Canal
Authors: Landegger Lukas D. , Lee Jong D. , Linthicum Fred H. , Stankovic Konstantina M.
Published: October 2017

Hypothesis:

Cochlear dysfunction is not common in human meningioma of the internal auditory canal.

Background:

Meningiomas arising from the cerebellopontine angle and internal auditory canal typically cause hearing loss. Cochlear dysfunction is known to contribute to sensorineural hearing loss induced by vestibular schwannoma, the most common tumor of the internal auditory canal. Detailed cochlear histopathology in meningioma has not been reported.

Methods:

Retrospective analysis of cochlear histopathology in five unoperated and five operated meningiomas of the internal auditory canal identified after screening human temporal bone collections from three academic medical centers.

Results:

While some dysfunction of all analyzed cochlear cell types was identified, a predominant or exclusive loss of hair cells was not observed in any meningioma. Only 14.3% of temporal bones showed significantly more hair cell damage on the side of the tumor when compared with the contralateral ear; cochlear neuronal damage was more prevalent in meningiomas. The incidence of hydrops, perilymphatic precipitate, or endolymphatic precipitate was low.

Conclusions:

Substantial cochlear damage in human meningioma of the internal auditory canal is not common. This may explain the anecdotal hearing improvement observed after surgical resection of meningioma. Our findings underline the importance of developing therapeutic strategies to prevent cochlear neuronal degeneration due to tumors of the internal auditory canal.
Clozapine-induced agranulocytosis/granulocytopenia: mechanisms and monitoring
Authors: Wiciński Michał , Węclewicz Mateusz M.
Published: October 2017

Purpose of review

Clozapine-induced agranulocytosis/granulocytopenia (CIAG) is an uncommon condition, but potentially fatal in consequences. The pathogenesis, despite multiple experiments, is not fully elucidated. The current theory suggests reactive oxygen species – nitrenium ion as the most important factor of CIAG. In this review, mechanism and monitoring of CIAG will be discussed.

Recent findings

The mechanism of CIAG seems to have an autoimmune background, rather than toxic. Clozapine has a high potential to undergo biochemical activation to nitrenium ion. The role of the primary metabolite of clozapine – N-desmethylclozapine – is in decline. Nitrenium ion is mainly synthesized by CYP3A4, CYP2D6, and myeloperoxidase system in leukocytes. An important component of CIAG pathogenesis is genetic aberration in human leukocyte antigen genes, and also genes associated with apoptosis and ubiquitination. Clozapine monitoring regimes differ between countries. US-derived clozapine Risk Evaluation and Mitigation Strategy is the most tolerant in the aspect of blood parameter thresholds. Therefore, it provides the opportunities for physician to continue the treatment and also to rechallenge the drug after the episode of CIAG.

Each patient with the episode of CIAG should be assessed individually, with special attention to risk factors and drug–drug interactions. Upon that, the decision about clozapine rechallenge or withdrawal should be made.
Improving Nurse Competencies for Using Evidence in Practice
Authors: Olson DaiWai M. , Rogers Jennifer , Miller Corinne , Martin Karen , Granger Bradi B.
Published: October 2017

Nursing professional development practitioners are in a key position to use tools that foster nurses’ interpretation of research findings for increased use of evidence in practice. An online course was developed to teach statistics as language. The feasibility and efficacy of this “Language of Data” program were examined in a pilot study with a convenience sample from inpatient settings. Recognition and interpretation of statistical symbols significantly improved after the intervention. Knowledge, confidence, and accuracy also improved. The Language of Data program may be used by nursing professional development practitioners to improve nurses’ adoption of evidence-based practice by furthering their ability to translate science.
Clinical Nurse Specialist-Driven Practice Change
Authors: Derby Kelly M. , Hartung Natalie A. , Wolf Sherry L. , Zak Heather L. , Evenson Laura K.
Published: October 2017

Purpose

The purpose of this project was to standardize vital sign (VS) monitoring throughout a patient’s stay in the hospital, including at admission, following transitions to different levels of care, reassessment of abnormal VS results, daily monitoring, and before dismissal. The population of focus was adult general and progressive care patients.

Description of the Project

Standards for VS monitoring, documentation, and provider notification were established. Unit routines, nursing procedural guidelines, and order sets were updated with the new standards. Nursing staff received Web-based education. Compliance with the new standards was monitored monthly, and data were shared with nursing leadership. Leadership reviewed the data with nursing staff to identify opportunities and recognize achievements.

Outcomes

Overall, improvement in VS documentation was achieved. Continued opportunities exist for monitoring and reassessment of a full set of VSs after an abnormal result.

Conclusion

Establishing a minimum standard of VS frequency and documentation allows for all healthcare providers to trend and monitor a patient’s clinical status. Variability in patient care can be diminished by establishing minimum standards of VS monitoring.
Transitioning Into Practice
Authors: Bath Jennifer , Lucas Amy , Ward Cynthia W.
Published: October 2017

Purpose/Objectives:

The purposes of this article are to explore the shared experiences and feelings of clinical nurse specialists (CNSs) who were new to the role and to identify strategies that were helpful in making the transition.

Description of Project/Program:

Transitioning to a CNS role may be challenging and emotional, causing fear or anxiety. The authors reflected on their experiences of transitioning into CNS practice.

Outcome:

Reflection on the literature led to advice and helpful strategies for new CNSs as they transition into practice.

Conclusion:

The strategies identified can be used to develop a structured orientation that may ease the transition into the CNS role.
Gonococcal and Chlamydial Cases of Pelvic Inflammatory Disease at 2 Canadian Sexually Transmitted Infection Clinics, 2004 to 2014: A Retrospective Cross-sectional Review
Authors: Chen Justin Z. , Gratrix Jennifer , Smyczek Petra , Parker Penny , Read Ron , Singh Ameeta E.
Published: October 2017

One hundred thirteen patients with gonococcal and chlamydial pelvic inflammatory disease were reviewed at 2 Canadian sexually transmitted infection clinics. Most patients (81%) with pelvic inflammatory disease were diagnosed as having chlamydia alone. Three treatment failures were seen in patients treated with ofloxacin.
Building Professionalism Through Management Training: New England Public Health Training Center's Low-Cost, High-Impact Model
Authors: MacVarish Kathleen , Kenefick Hope , Fidler Anne , Cohen Bradley , Orellana Yuri , Todd Karla
Published: October 2017

Context:

Evolving practices, accreditation, and priorities established in Public Health 3.0 are adding to the long-identified need for management training among public health practitioners.

Program:

The New England Public Health Training Center is addressing this need with a flexible, open-source, 16-topic training program. The program is designed to build competencies for current and future managers, preparing them for their day-to-day tasks and for the kinds of adaptation suggested by Public Health 3.0 advocates.

Implementation:

The training program uses live expert instructors for 10 webinars and 2 in-person trainings. Experts have also created the content for multiple self-paced E-Learnings that trainees undertake in addition to the instructor-led sessions. A webinar platform with breakout rooms and an advanced learning management system allows for online discussion and mentor interaction. The course has now been offered, evaluated, and modified 3 times, and the materials are available for noncommercial use by the public health community.

Evaluation:

Using the Kirkpatrick training evaluation model, the recent cohort was satisfied (87.5%) with the training, reported identifying actions to apply information learned to their work (85.8%), and experienced statistically significant knowledge gains. Earlier trainees reported work-related behavior change.

Discussion:

Management training offers the hope of increasing professionalism; creating better, more effective workplaces and programs; and preparing practitioners for an evolving public health landscape. Early results indicate that NEPHTC's program, Managing Effectively in Today's Public Health Environment, is a useful tool in realizing that hope.
Simulation-Based Education Enhances Patient Safety Behaviors During Central Venous Catheter Placement
Authors: Jagneaux Tonya , Caffery Terrell S. , Musso Mandi Wilkes , Long Ann C. , Zatarain Lauren , Stopa Erik , Freeman Nathan , Quin Cara Cantelli , Jones Glenn N.
Published: October 2017

Objective

We describe the effect of simulation-based education on residents’ adherence to protocols for and performance of central venous access.

Methods

Internal medicine and emergency medicine residents underwent a central venous access course that included a lecture, video presentation, readings, and simulation demonstrations presented by faculty. Baseline data were collected before the course was initiated. After a skills session where they rehearsed their ultrasound-guided central venous access skills, residents were evaluated using a procedural checklist and written knowledge exam. Residents also completed questionnaires regarding confidence in performing ultrasound-guided central venous access and opinions about the training course.

Results

Residents demonstrated significant improvement on the written knowledge exam (P < 0.0001) and Standard Protocol Checklist (P < 0.0001) after the training course. Training improved a number of patient safety elements, including adherence to sterile technique, transparent dressing, discarding sharps, and ordering postprocedure x-rays. However, a number of residents failed to wash their hands, prepare with chlorhexidine, drape the patient using a sterile technique, anesthetize the site, and perform a preprocedure time-out. Significant improvement in procedural skills was also noted for reduction in skin-to-vein time (P < 0.003) as well as a reduction in number of residents who punctured the carotid artery (P < 0.02).

Conclusions

Simulation-based education significantly improved residents’ knowledge and procedural skills along with their confidence. Adherence to the protocol also improved. This study illustrates that simulation-based education can improve patient safety through training and protocols.
Regulation of Electroconvulsive Therapy
Authors: Livingston Robin , Wu Chester , Mu Kathy , Coffey M. Justin
Published: October 2017

Objectives

The goal of this study was to systematically review current US state laws on electroconvulsive therapy (ECT) in order to provide a comprehensive resource to educate practitioners, potential patients, and lawmakers.

Methods

Individual state legislative Web sites were searched by 2 independent authors using the following search terms: “electroconvulsive therapy,” “convulsive therapy,” “electroconvulsant therapy,” “electroshock therapy,” and “shock therapy” from March 2017 to May 2017. All sections of state law pertaining to ECT were reviewed, and pertinent data regarding consent, age restrictions, treatment limitations, required reporting, defined qualified professionals, fees, and other information were extracted.

Results

State regulation on ECT widely varied from none to stringent requirements. There were 6 states without any laws pertaining to ECT. California, Illinois, Massachusetts, Missouri, New York, South Dakota, Tennessee, and Texas were noted to be the most regulatory on ECT.

Conclusions

There are no US national laws on ECT leaving individual state governments to regulate treatment. Whereas some states have detailed restrictions on use, other states have no regulation at all. This variation applies to multiple areas of ECT practice, including who can receive ECT, who can provide informed consent, who can prescribe or perform ECT, and what administrative requirements (eg, fees, reporting) must be met by ECT practitioners. Knowledge of these state laws will help providers not only to be aware of their own state's regulations, but also to have a general awareness of what other states mandate for better patient care and utilization of ECT.