bluuebunny/crossref_metadata_2025 huggingface dataset:
Trauma to the cardiovascular system
Authors: Akin Ibrahim , Nienaber Christoph A.
Published: March 2018

Trauma to the heart is most common cause of death after chest trauma, with a distinction between blunt and penetrating cardiac injuries. Both of these types of injury might be lethal and need detailed diagnosis and treatment. This chapter describes the aetiology, pathogenesis, clinical presentation, diagnostic procedures, and therapeutic management of traumatic rupture of the aorta, and the aetiology, pathogenesis, clinical features, and therapeutic management of trauma to the heart.
Introduction
Authors: Konstantinides Stavros V.
Published: March 2018

The chapters in this section review our current state of knowledge on venous thromboembolism (VTE), placing particular emphasis on integrating the recent advances in diagnostic and therapeutic modalities into a severity- and risk-adjusted management concept in accordance with the current European and other international guidelines. The progress in imaging techniques, interventional options, and pharmacological anticoagulation for VTE are reviewed, including specific reference to vulnerable conditions such as pregnancy and vulnerable patient groups such as those with cancer-related VTE. Beyond acute-phase treatment and early prognosis, the chapters in this section elaborate on the factors which may help to determine the optimal duration of anticoagulation after VTE as well as on the early detection and treatment of long-term sequelae such as chronic thromboembolic pulmonary hypertension.
Treatment: thrombolysis
Authors: Meyer Guy
Published: March 2018

According to recent guidelines, thrombolysis is considered as the standard of care in patients with high-risk pulmonary embolism. Although this recommendation is based on a limited level of evidence, these patients have a high risk of mortality justifying the increased risk of bleeding associated with thrombolytic therapy. Conversely, the role of thrombolytic therapy in intermediate-risk pulmonary embolism has been debated for many years but has been recently clarified by a large randomized trial and subsequent meta-analyses. In these patients, thrombolytic therapy is associated with a reduction in the combined endpoint of mortality and haemodynamic decompensation, but this is not paralleled by a decrease in overall mortality. In addition, the use of thrombolytic therapy in these patients is associated with a significant increase in major extracranial and intracranial bleeding. Thrombolytic therapy should thus be reserved for the few patients who experience haemodynamic worsening while receiving anticoagulant treatment. Although promising, the effectiveness of reduced dosages is not yet established and should be evaluated in further studies.
Treatment: catheter-based intervention and inferior vena cava filters
Authors: Winokur Ronald S. , Sista Akhilesh K.
Published: March 2018

Venous thromboembolism including pulmonary embolism and deep vein thrombosis leads to short- and long-term morbidity and in some cases mortality. Although treatment approaches vary among institutions based on local expertise, the employment of interventional techniques is of great interest. Several studies have shown clinical and physiological benefits from catheter-based techniques. However, these therapies are not without risk, especially with the use of powerful thrombolytic agents that increase the rate of bleeding. This chapter reviews the catheter-based techniques for the management of deep vein thrombosis and pulmonary embolism as well as the indications and complications of inferior vena cava filters.
Management of pulmonary embolism in patients with cancer
Authors: Ay Cihan , Posch Florian
Published: March 2018

Pulmonary embolism (PE) is a frequent complication in patients with cancer. Clinicians have to maintain a high index of suspicion to reduce the large proportion of PEs that remain undiagnosed in the cancer population. Thrombolysis is not a standard treatment for haemodynamically unstable patients with cancer-associated PE because the risk of haemorrhage can be excessive. Anticoagulation with a low-molecular-weight heparin (LMWH) for at least 6 months is the current standard of care for the treatment of cancer-associated PE, while vitamin K antagonists are a reasonable second choice for patients with contraindications against LMWH or a strong preference towards an oral agent. Although an indirect network meta-analysis suggests that non-vitamin K-dependent oral anticoagulants may be comparably efficacious and safe as LMWH for treating PE in cancer patients, these agents cannot be recommended as a standard first-line treatment at this time because a head-to-head comparison to the standard of care has not yet been reported. Anticoagulation beyond 6 months is an emerging concept; however, the patient population that may benefit from this intervention still needs to be defined. Guidance statements facilitate the management of challenging patients with brain metastases, unsuspected PE, thrombocytopenia, and recurrent PE.
Ischaemic heart disease in pregnancy
Authors: Maas Angela H. E. M.
Published: March 2018

Acute coronary syndromes during pregnancy are rare, but the number of affected women is increasing due to adverse lifestyle habits and a higher maternal age. The majority of acute coronary syndromes in pregnancy are related to atherosclerosis, whereas a spontaneous coronary artery dissection may occur in late pregnancy or puerperium. Treatment depends on the findings from coronary angiography in patients with ST elevation myocardial infarction and is similar to that in the acute coronary syndromes guidelines.
Hypertensive disorders
Authors: Cifkova Renata
Published: March 2018

Hypertensive disorders in pregnancy are the most common medical complications affecting about 10% of pregnancies worldwide. This chapter discusses the following topics: diagnosis of hypertension, definition and classification of hypertension in pregnancy, additional laboratory tests, management of hypertension in pregnancy, pharmacological management of hypertension in pregnancy, delivery induction, blood pressure postpartum and lactation, and prognosis after pregnancy.
Ethnicity and hypertension
Authors: Born Bert-Jan van den , Agyemang Charles
Published: March 2018

Worldwide, large differences exist in the prevalence of hypertension and hypertension-related complications, both along geographic boundaries and between different ethnic groups. Urbanization and dietary changes have led to a genuine increase in hypertension prevalence in many low- and middle-income countries, whereas migration has been associated with disparities in hypertension prevalence, awareness, and control in different, large multi-ethnic populations in Europe and the United States. Depending on the geographic area and definition of ethnicity, results can be quite heterogeneous and are susceptible to generalization. However, data in both Europe and the United States consistently show higher prevalence rates of hypertension and hypertension-related complications in populations of West African descent. These ethnic differences in hypertension susceptibility may in part be attributable to quantitative differences in other risk factors such as obesity and dietary salt intake, but may also relate to differences in pathophysiological traits, particularly increased salt sensitivity and vascular contractility. This may also explain the better blood pressure-lowering potential of salt restriction and of pharmacological treatment with diuretics and calcium channel blocking agents, whereas renin–angiotensin system blockers and beta-blocking agents are in general less effective. The European Society of Hypertension/European Society of Cardiology Guidelines recommend to start with calcium channel blockers or a thiazide diuretic for the treatment of hypertension in sub-Saharan African populations if no other compelling indications are present, while there is a lack of evidence that ethnicity should influence the preference for particular blood pressure-lowering combinations. The realization that ethnic differences in hypertension prevalence and treatment response exist may help to increase our understanding of the complex pathophysiology of hypertension and improve strategies aimed at the selection and control of hypertensive patients with different ethnic background.
Sudden cardiac death in athletes: implications for pre-participation evaluation and safety in sport arenas
Authors: Guasch Eduard , Heidbuchel Hein , Mont Lluís
Published: March 2018

Physical activity is an invaluable tool to fight cardiovascular disease, but sudden death (SD) in athletes has catastrophic effects at an individual level, and also at a social level. Although the incidence of SD remains rather low in athletes (in the range of 0.5–2 events per 100,000 participants), there are some data suggesting that the risk could be higher in athletes than in sedentary individuals. A large study conducted in the Veneto region in Italy suggested that athletes are at an increased risk of SD; however, conflicting data has been published in Denmark and Israel. Most athletes who die suddenly present with a previously unknown cardiac condition, most commonly hypertrophic cardiomyopathy in American series or arrhythmogenic right ventricular cardiomyopathy in some European studies. Other causes of SD include coronary congenital abnormalities, valve disease, or commotio cordis. Based on these data, efforts have been undertaken to reduce the impact of SD in athletes. First, pre-participation screening programmes including a clinical history, physical examination, and an electrocardiogram aim for the early detection of cardiac conditions causing SD. Remarkably, concerns about the efficiency of such a protocol have been raised. Second, a quick response to a cardiac arrest may also save lives; training personnel in cardiac resuscitation and readily available automated external defibrillation equipment may critically influence outcomes in this situation.
Comprehensive geriatric assessment in cardiovascular disease
Authors: Schoenenberger Andreas W.
Published: March 2018

Comprehensive geriatric assessment (CGA) is an efficient and effective way for evaluating complex elderly patients and for planning improved care based on CGA findings. Based on these findings, a plan for geriatric management is developed, usually involving a multidisciplinary team. CGA has been shown to improve functional status as well as survival, while reducing healthcare utilization and costs. Therefore, CGA should be systematically performed in the growing population of older patients with cardiovascular diseases.
Degenerative cardiovascular disease in the elderly
Authors: Argulian Edgar
Published: March 2018

The ageing population represents a unique challenge for cardiovascular care. Ageing causes remodelling of the cardiovascular system and commonly results in distinct degenerative changes. Most of these degenerative changes have significant interactions with cardiovascular risk factors by either being a marker of disease burden or being exaggerated by co-morbid conditions. Also, age-related degenerative conditions have physiological and prognostic implications. This chapter discusses several common degenerative cardiovascular conditions in the elderly such as cardiac fibrosis, amyloidosis, mitral annular calcification, and aortic valve sclerosis. Some of these conditions (such as cardiac fibrosis and amyloidosis) are implicated in pathogenesis of heart failure with preserved ejection fraction. Others (such as mitral annular calcification and aortic valve sclerosis) do not typically cause any measurable physiological abnormality but have prognostic significance.
Decision-making and Heart Teams in valvular heart disease: the transcatheter aortic valve implantation team model
Authors: Abdelghani Mohammad , Makhdom Fahd , Piazza Nicolo
Published: March 2018

Benefits from transcatheter aortic valve implantation (TAVI) in the pivotal trials can be largely ascribed to the multidisciplinary decision-making and care, a process that can be executed only by an integrative team. The Heart Valve Team can include, in addition to interventional cardiologists with expertise in transcatheter valve interventions and cardiac surgeons with expertise in valve surgery, general clinical cardiologists, echocardiologists/cardiac imaging specialists, cardiac anaesthesiologists, intensivists, nurses, and/or social workers, among others. The main functions of this Team are assessment of a patient’s eligibility for TAVI, procedural planning, and setting a post-procedural extended care plan.
Aortic regurgitation
Authors: Tornos Mas Pilar , Lansac Emmanuel
Published: March 2018

Evaluation of aortic regurgitation requires consideration of valve morphology, mechanism and severity of regurgitation and assessment of aortic dilatation. In asymptomatic patients with severe aortic regurgitation, follow-up of symptomatic status and LV size and function is mandatory. The strongest indication for valve surgery is the presence of symptoms and/or the documentation of LVEF <50% and/or end-systolic diameter =50 mm. In patients with dilated aorta, definition of aortic pathology and accurate measurements of aortic diameters are crucial. Surgery is recommended whenever aortic dilation is = 55 mm or = 50 mm in patients with bicuspid aortic valves and Marfan syndrome or =45 mm when additional risk factors are present. For patients who have an indication for valve surgery, an aortic diameter of ≥45 mm is considered to indicate concomitant surgery of the aorta. Aortic valve repair and valve-sparing aortic surgery instead of aortic valve replacement should be considered in selected cases in experienced centres.
Prosthetic valves
Authors: Iung Bernard , Sjögren Johan
Published: March 2018

Prosthetic valve replacement is the most frequent valvular surgery. The choice between a mechanical prosthesis and a bioprosthesis should not overstress the role of age, and should take into account in particular the wishes of the informed patient. Patients with a mechanical prosthesis require lifelong treatment using VKA with a target INR adapted to the prosthesis and patient characteristics, while non-vitamin K antagonist oral anticoagulants are contra-indicated. The association of low-dose aspirin is restricted to selected patients with a mechanical prosthesis who have atherosclerosis or recurrent embolism. The post-operative period is at risk of thromboembolism and bleeding and requires increased awareness on the monitoring of anticoagulant therapy. The management of anticoagulant therapy during non-cardiac surgery should be adapted to the type of surgery. Minor procedures generally do not require interruption of anticoagulation. Dual antiplatelet therapy is recommended after transcatheter aortic valve implantation but ongoing trials will probably refine antithrombotic regimen.
Management during non-cardiac surgery
Authors: Holm Johan , Iung Bernard
Published: March 2018

The risk of cardiovascular complications in patients undergoing non-cardiac surgery depends risk on the type of non-cardiac surgery, classified into 3 groups, and the type and severity of valvular disease. The risk of complications is highest in aortic stenosis In symptomatic patients, aortic stenosis should be treated before non-cardiac surgery, while asymptomatic patients with severe aortic stenosis can undergo elective non-cardiac surgery. In symptomatic patients with mitral stenosis, percutaneous mitral commissurotomy should be attempted before high-risk non-cardiac surgery. In asymptomatic patients with severe regurgitation and preserved left ventricular systolic function, non-cardiac surgery can be performed safely. In patients with mechanical prosthesis, the main problem is the adaptation of the modalites of anticoagulant therapy.
Management during pregnancy
Authors: Holm Johan , Iung Bernard
Published: March 2018

Physiologic haemodynamic changes during pregnancy carry a risk of cardiac complications in women with valvular disease. Mitral stenosis with valve area <1.5 cm² is poorly tolerated and percutaneous mitral commissurotomy is needed during pregnancy if symptoms persist under medical therapy. The risk of complications is lower with aortic stenosis when women were asymptomatic before pregnancy with preserved left ventricular function. Chronic regurgitations are generally well tolerated, even when severe, provided left ventricular systolic function is preserved. Surgery under cardiopulmonary bypass should be avoided during pregnancy due to the fetal risk. There is a high risk of thromboembolic complications during pregnancy in women with a mechanical prosthesis, leading to maternal mortality between 1-4%. The choice of the modalities of anticoagulant therapy should weigh fetal and maternal risks after careful patient information. Given its complexity and risks, the management of pregnant patients with valvular disease should be performed in multidisciplinary cardiac-obstetric team.
General aspects
Authors: Mazzolai Lucia
Published: March 2018

Thorough clinical history and physical examination are key steps in PADs management. Beyond the diagnosis of LEAD, ABI is also a strong marker for CV events. The management of PADs includes all interventions to address specific arterial symptoms as well as general CV risk prevention. Best medical therapy includes CV risk factor management, including optimal pharmacological therapy as well as non-pharmacological measures such as smoking cessation, healthy diet, weight loss and regular physical exercise.
Proximal Parent Vessel Tapering is Associated With Aneurysm at the Middle Cerebral Artery Bifurcation
Authors: Lauric Alexandra , Greim-Kuczewski Kilian , Antonov Alexei , Dardik Gabriel , Magida Jane K , Hippelheuser James E , Kono Kenichi , Malek Adel M
Published: March 2018

BACKGROUND

Cerebral aneurysm initiation and evolution have been linked to hemodynamic and morphological factors. Stenotic morphology upstream to a bifurcation can alter hemodynamic patterns and lead to destructive vessel wall remodeling and aneurysm initiation. The effect of more subtle proximal variations in vessel diameter on bifurcation aneurysm development has not been evaluated.

OBJECTIVE

To investigate whether vessel tapering is associated with aneurysmal presence at the middle cerebral artery (MCA) bifurcation.

METHODS

Bilateral catheter three-dimensional rotational angiographic datasets from 33 patients with unilateral unruptured MCA aneurysms and 44 datasets from healthy patients were analyzed. Equidistant cross-sectional cuts were generated along the MCA M1 segment with cross-sectional area measurement using edge-detection filtering. Relative tapering of the M1 segment was evaluated as the TaperingRatio. Computational fluid dynamics (CFD) simulations were performed on bilateral patient models and parametric MCAs of constant and tapered inflow vessel.

RESULTS

MCA leading to aneurysms had significantly lower TaperingRatio (0.88 ± 0.15) compared to contralateral (1.00 ± 0.16, P = .002) and healthy MCAs (1.00 ± 0.15, P > .001, area under the curve = 0.73), which showed little to no tapering. CFD simulations showed that vessel tapering leads to flow acceleration with higher wall shear stress (WSS) and WSS gradients at the bifurcation apex.

CONCLUSION

Aneurysmal but not contralateral or control MCA M1 segments demonstrate a previously undescribed progressive distal tapering phenomenon. This upstream vessel narrowing leads to flow acceleration that accentuates WSS and spatial gradients at the bifurcation apex, a pattern previously shown to favor aneurysm initiation and progression.
Recent HIV Risk Behavior and Partnership Type Predict PrEP Adherence in Men Who Have Sex with Men
Authors: Blumenthal Jill , Jain Sonia , Dube Michael , Sun Xiaoying , Ellorin Eric , Hoenigl Martin , Corado Katya , Moore David , Morris Sheldon ,   California Collaborative Treatment Group
Published: March 2018

Background

Individuals engaging in higher risk behavior are often more adherent to PrEP but it is unclear if partnership type itself affects PrEP adherence. We examined the effect of recent HIV risk behaviors and partnership type on PrEP adherence in men who have sex with men (MSM) taking PrEP.

Methods

CCTG 595 is a 48-week PrEP demonstration study of 398 HIV− at-risk MSM. At baseline and week 48, HIV risk score was estimated as the probability of seroconversion over the next year based on number of condomless anal sex acts with HIV+/unknown partners in the last month and any STI diagnosed at study visit. HIV risk score was categorized as low (<0.12), moderate (0.12−0.59) and high (>0.59) risk based on population seroconversion probabilities. Partnership type was assigned as no/single HIV− partner, single HIV+ partner, or multiple partners of any serostatus in the past 3 months. PrEP adherence was estimated by intracellular tenofovir-diphosphate (TFV-DP) levels as a continuous variable at week 48. Statistical methods included McNemar’s test, Wilcoxon rank-sum test, and linear regression model where appropriate.

Results

Of 313 MSM who completed week 48, there was no significant change in HIV risk category from baseline to week 48 (low: 44 to 42%; moderate: 27 to 24%; high: 28 to 34%; P = 0.25). There was a significant change in partnership type, with the proportion of those with no or single HIV− partnerships increasing (1 to 9%, P < 0.001). In univariate analysis, moderate and high-risk groups had higher TFV-DP levels than the low-risk group at week 48 (P = 0.018). Participants with no/single HIV− partner had significantly lower TFV-DP levels than those with one HIV+ partner or multiple partners (P = 0.007). In a multivariable linear regression model, only low-risk partnerships remained significant where no/single HIV− partnerships were associated with lower TFV-DP levels (mean difference = −344fmol/punch [−617, −71], P = 0.014).

Conclusion

Although there was a shift in partnership type towards lower risk partnerships, objective HIV risk behavior remained stable over time. Individuals with higher HIV risk behaviors and risk partnerships had higher TFV-DP levels suggesting maintained strong motivation for PrEP adherence. Thus, recent sexual risk behavior and partnership type may be important predictors of PrEP adherence in MSM.

Disclosures

All authors: No reported disclosures.
Immunogenicity and Safety of a Candidate Subunit Adjuvanted Herpes Zoster Vaccine in Adults with Solid Tumors Vaccinated Before or During Immunosuppressive Chemotherapy Treatment: A Phase II/III, Randomized Clinical Trial
Authors: Vink Peter ,   the Zoster-028 Study Group
Published: March 2018

Background

No herpes zoster (HZ) vaccine for immunosuppressed individuals is currently available. GSK’s candidate HZ vaccine containing recombinant varicella zoster virus glycoprotein E (gE) subunit and AS01B Adjuvant System (HZ/su) showed >90% efficacy for HZ prevention in immunocompetent adults aged ≥50 years. The HZ incidence in individuals with solid tumors (ST) receiving immunosuppressive chemotherapy (chemo) is estimated as 3–4 times higher than in the overall US population (3.2/1000 person-years). We present HZ/su immunogenicity and safety in ST adults aged ≥18 years.

Methods

In this phase II/III, observer-blind, multicenter study (NCT01798056), ST adults received 2 doses of HZ/su or placebo intramuscularly 1–2 months apart and were randomized 4:4:1:1 to receive a first dose 8–30 days (D) pre-chemo (HZ/su – HZ/su-PreC group, placebo – Pl-PreC) or on chemo start (±1 D) (HZ/su-OnC, Pl-OnC). Vaccine response rates (VRRs) and geometric means (GMs)/means were evaluated for gE humoral immune and gE-specific CD4+ cell-mediated immune (CMI) responses 1 month (M2) and 12 months (M13) post-dose 2. Solicited adverse events (AEs) were recorded for 7 D and unsolicited and medically-attended AEs (MAEs) for 30 D post each dose. Potential immune-mediated diseases (pIMDs) and serious AEs (SAEs) were recorded until study end.

Results

185 subjects (65 HZ/su-PreC, 78 Pl-PreC, 22 HZ/su-OnC, 20 Pl-OnC) were included in the according-to-protocol (ATP) cohort for humoral immunogenicity and 58 (27 HZ/su-PreC, 31 Pl-PreC) in the ATP sub-cohort for CMI. The most common ST were breast tumors (54% HZ/su, 49% placebo), followed by colorectal, lung, then other. Humoral and CMI VRRs were higher in HZ/su than Pl groups at M2 and M13. GM concentration (GMC) was highest at M2 in HZ/su-PreC. M13 GMCs were similar in the HZ/su-PreC and HZ/su-OnC groups (Table 1). The frequency of local solicited AEs was higher in HZ/su than Pl groups (Table 2); that of general solicited, unsolicited AEs, MAEs and SAEs was similar among groups (Table 3). 1 pIMD (Pl-OnC) and 23 fatal SAEs were reported. No SAE was considered vaccine-related by investigators.

Conclusion

HZ/su was highly immunogenic in ST adults receiving chemo. No safety concerns were raised.

Funding

GlaxoSmithKline Biologicals SA

Disclosures

P. Vink, GSK group of companies: Employee, Salary and stock options and stock granted
Causal Conditions Supporting Antibiotic Stewardship Information Dashboards
Authors: Kean Jacob , Butler Jorie , Bunker Lisa , Goetz Matthew , Glassman Peter , Jones Makoto , Graber Christopher , Madaras-Kelly Karl , Samore Matthew , Weir Charlene ,   The Veterans Affairs Antimicrobial Use Learning Collaborative
Published: March 2018

Background

Antibiotic stewardship is key to minimizing antibiotic resistance. To assist antibiotic stewards in dissecting population-level antibiotic use patterns, our study group developed a dashboard that displays consolidated patterns, supports data exploration, and compares facility-level antibiotic use to others. We report fuzzy set qualitative comparative analyses (QCA) of interviews designed to elicit user experiences to uncover different combinations of causal conditions supporting dashboard use.

Methods

Dashboards were iteratively designed based upon longitudinal feedback from stewards. Views include antibiotic use stratified by diagnoses and duration of therapy. Eight VAMCs, each with 0.5 to 2.0 FTE stewards, used the dashboard. One to 2 stewards from each site were interviewed using a structured script that focused on: 1) structure (i.e., program FTE) and functions of the local stewardship program; 2) critical incident or usage story; and 3) perceived knowledge and efficacy.

Results

Qualitative codes were developed from the interviews and were scaled in a fuzzy logic framework (i.e., between 0 and 1) to reflect the degree to which the qualitative theme was present in the stewardship program at participating clinical sites. The scaling was assigned using prior knowledge external to the data. The most parsimonious QCA solution identified just the absence of program structure (program FTE) a sufficient causal configuration to the frequency of dashboard use (coverage = 0.612, consistency = 0.813). Intermediate solutions added stewardship activities, dashboard self-efficacy, and trust in the data (coverage = 0.502, consistency = 0.952) as sufficient conditions. The coverage for both solutions exceeded 0.75, which was the lower bound of acceptability.

Conclusion

The dashboard may be successfully integrated into institutions based on the complicated interplay between program structure (e.g., # FTE) and dashboard self-efficacy, experience with data-activities, and trust of population data. Incorporating user-centered design of dashboards supports the development of fully functional teams and has the potential for important population health impact.

Disclosures

All authors: No reported disclosures.
Probiotics to Reduce Clostridium difficile Infection: Clinical Experience in a Tertiary Care Center
Authors: Box Maggie , Ortwine Kristine ,   Scripps Antimicrobial Stewardship Program
Published: March 2018

Background

There is conflicting clinical data regarding the efficacy of probiotics to prevent Clostridium difficile infection (CDI). The goal of this study is to compare rates of hospital acquired Clostridium difficile infection (HA-CDI) among patients receiving antibiotics with or without concomitant administration of probiotics.

Methods

This retrospective, cohort study compares hospitalized patients who received antibiotics alone vs. antibiotics plus a multi-strain probiotic preparation of lactobacillus over a six month time period. Probiotics were given at the discretion of the physician. The primary outcome was incidence in HA-CDI (defined as onset after hospital day three) between groups.

Results

A total of 1,576 patients met selection criteria, with 927 patients receiving antibiotics alone and 649 patients receiving antibiotics plus probiotics. HA-CDI rates were 0.9% and 1.8% (P = 0.16), respectively. In a subgroup analysis of patients in the antibiotic only group, patients who received similar antibiotic exposure as the probiotics group (n = 284) had no difference in rates of HA-CDI (1.8% vs. 1.8%; P = 1.0).

Conclusion

Probiotic administration did not decrease rates of HA-CDI in our institution. We recommend prioritizing resources to other CDI reduction measures such as decreasing antibiotic exposure and preventing transmission.

Disclosures

All authors: No reported disclosures.
Molecular clouds in the NGC 6334 and NGC 6357 region: Evidence for a 100 pc-scale cloud–cloud collision triggering the Galactic mini-starbursts
Authors: Fukui Yasuo , Kohno Mikito , Yokoyama Keiko , Torii Kazufumi , Hattori Yusuke , Sano Hidetoshi , Nishimura Atsushi , Ohama Akio , Yamamoto Hiroaki , Tachihara Kengo
Published: March 2018

We carried out new CO (J = 1–0, 2–1, and 3–2) observations with NANTEN2 and ASTE in the region of the twin Galactic mini-starbursts NGC 6334 and NGC 6357. We detected two velocity molecular components of 12 km s−1 velocity separation, which is continuous over 3° along the plane. In NGC 6334 the two components show similar two-peaked intensity distributions toward the young H ii regions and are linked by a bridge feature. In NGC 6357 we found spatially complementary distribution between the two velocity components as well as a bridge feature in velocity. Based on these results we hypothesize that the two clouds in the two regions collided with each other in the past few Myr and triggered the formation of the starbursts over ∼ 100 pc. We suggest that the formation of the starbursts happened toward the collisional region of extent ∼ 10 pc with initial high molecular column densities. For NGC 6334 we present a scenario which includes spatial variation of the colliding epoch due to non-uniform cloud separation. The scenario possibly explains the apparent age differences among the young O stars in NGC 6334, which range from 104 yr to 106 yr; the latest collision happened within 105 yr toward the youngest stars in NGC 6334 I(N) and I which exhibit molecular outflows without H ii regions. For NGC 6357 the O stars were formed a few Myr ago, and the cloud dispersal by the O stars is significant. We conclude that cloud–cloud collision offers a possible explanation of the mini-starburst over a 100 pc scale.
A perfect storm in a sunny economy: a political economy approach to the crisis in Spain
Authors: Buendía Luis
Published: March 2018

Although Spain’s economy was seen as a miracle during the most recent expansive phase (for its labour market outcomes in terms of job growth, among other things), the economy’s development during those years suffered from severe problems that deserve attention. This became more relevant in a context like the current one, where there is no consensus around which economic policies might lead the country back onto a stable growth path. Using a systemic approach in which we analyse the growth model, the role of Spain in the European division of labour, the financial sector, the labour market, the public sector, and the distribution of income, we contend that, in contrast with several narratives concerning the crisis in Spain: (i) the ‘living-beyond-our-means’ discourse is not true; and (ii) certain political and economic aspects, usually missing in those narratives, are essential to understanding the recent evolution of Spain.
A 67-year-old man with odynophagia and neck pain
Authors: Fenn DJ , Howard Brittany , Hoxworth Joseph , Sommers Annjanette
Published: March 2018

Acute calcific longus colli tendinitis is a benign and self-limiting inflammatory disease that rarely requires aggressive intervention. However, clinicians may be unfamiliar with this condition, and it can easily be misdiagnosed for a deep neck abscess or tumor resulting in unnecessary and invasive procedures. This article describes a patient who presented to the ED with progressive odynophagia and neck pain.
Attention Health Care Leaders: Literature Review Deems Baccalaureate Nurses Improve Patient Outcomes
Authors: O’Brien Deborah , Knowlton Mary , Whichello Ramona
Published: March 2018

AIM

This review of studies conducted since the 2011 publication of the Institute of Medicine (IOM) report “The Future of Nursing: Leading Change, Advancing Health” evaluates the current state of evidence showing an association between an increased ratio of BSN-prepared nursing staff and improved patient outcomes.

BACKGROUND

The IOM established a nationwide goal to increase the number of BSN nurses to 80 percent by 2020 to meet the challenges seen in today’s health care environment.

METHOD

The literature search included a five-year (2011-2016) span following the initial release of the IOM report.

RESULTS

Mortality, failure to rescue, and readmission rates all decrease as the proportion of BSN nurses is increased in a nursing staffing ratio.

CONCLUSION

It is the recommendation of this project that nurse leaders and organizations support the findings of this literature review and the IOM BSN recommendation.
Simulation to Prepare Graduate Nursing Students for Clinical Faculty Role
Authors: Forcina Hill Jill M. , Woodley Lisa , Goodwin Megan
Published: March 2018

Limited clinical sites and faculty to teach graduate students to be undergraduate clinical faculty have led to the exploration of innovative teaching strategies. This article describes and evaluates a simulation experience to supplement didactic learning about best clinical teaching practices within a graduate nursing course. Scenarios were created to simulate complex teaching situations with a patient, an undergraduate nursing student, and a clinical faculty member. Evaluations were positive regarding knowledge, performance, self-confidence, critical thinking, and satisfaction. Results of this project support the use of simulation in the preparation of graduate nursing students to become clinical faculty.
SPIRONOLACTONE AS A THERAPEUTIC ALTERNATIVE FOR THE BULLOUS VARIANT OF CENTRAL SEROUS CHORIORETINOPATHY
Authors: Ramos-Yau Eva C. , Muñoz-Domínguez Ediberto , Contreras-Mérida Silvia P. , Valencia-Londoño Luis M.
Published: March 2018

Purpose:

To report a case of the bullous variant of central serous chorioretinopathy successfully treated with spironolactone, a mineralocorticoid receptor antagonist.

Methods:

Case report of a patient including fluorescein angiography, optical coherence tomography, and color fundus photography.

Results:

Initially managed as a multifocal choroiditis, the use of oral and peribulbar corticoids worsened the serous retinal detachment. Taking in consideration this response, she was then diagnosed with a bullous variant of central serous chorioretinopathy and treated with 50 mg of spironolactone per day. Resolution of the serous retinal detachment, decrease in choroidal thickness on optical coherence tomography, and absence of leaks in fluorescein angiography was achieved 2 months posterior to the first dose of oral spironolactone.

Conclusion:

We suggest the use of mineralocorticoid receptor antagonists, such as spironolactone, as a therapeutic alternative to more aggressive available treatments for the bullous variant of central serous chorioretinopathy.
Hotspotting
Authors: Zomorodi Meg , Odom Trish , Askew Naomi C. , Leonard Christina R. , Sanders Kimberly A. , Thompson Daniel
Published: March 2018

The purpose of this article is to describe a service learning opportunity where interprofessional teams of students worked together to address patients’ social determinants of health through home visits. This article describes this process, known as “hotspotting,” and presents the development of this project, including collaboration with a local home health agency, recruiting of students, and weekly team meetings for debriefing. Evaluation data, barriers with implementation, and next steps for sustainability are also discussed.
Integrating Climate Change Into Nursing Curricula
Authors: McDermott-Levy Ruth , Jackman-Murphy Kathryn P. , Leffers Jeanne M. , Jordan Lisa
Published: March 2018

Climate change is a significant threat to human health across the life cycle. Nurses play an important role in mitigation, adaptation, and resilience to climate change. The use of health care resources, air quality and extreme heat, mental health, and natural disasters are major content areas across undergraduate nursing curricula that influence or are influenced by climate change. Teaching strategies and resources are offered to prepare nursing students to address climate change and human health.
Discharge Patterns for Ischemic and Hemorrhagic Stroke Patients Going From Acute Care Hospitals to Inpatient and Skilled Nursing Rehabilitation
Authors: Hong Ickpyo , Karmarkar Amol , Chan Winston , Kuo Yong-Fang , Mallinson Trudy , Ottenbacher Kenneth J. , Goodwin James S. , Andersen Clark R. , Reistetter Timothy A.
Published: March 2018

Objective

The aim of the study was to explore variation in acute care use of inpatient rehabilitation facilities and skilled nursing facilities rehabilitation after ischemic and hemorrhagic stroke.

Design

A secondary analysis of Medicare claims data linked to inpatient rehabilitation facilities and skilled nursing facilities assessment files (2013–2014) was performed.

Results

The sample included 122,084 stroke patients discharged to inpatient or skilled nursing facilities from 3677 acute hospitals. Of the acute hospitals, 3649 discharged patients with an ischemic stroke (range = 1–402 patients/hospital, median = 15) compared with 1832 acute hospitals that discharged patients with hemorrhagic events (range = 1–73 patients/hospital, median = 4). The intraclass correlation coefficient examined variation in discharge settings attributed to acute hospitals (ischemic intraclass correlation coefficient = 0.318, hemorrhagic intraclass correlation coefficient = 0.176). Patients older than 85 yrs and those with greater numbers of co-morbid conditions were more likely to discharge to skilled nursing facilities. Comparison of self-care and mobility across stroke type suggests that patients with ischemic stroke have higher functional abilities at admission.

Conclusions

This study suggests demographic and clinical differences among stroke patients admitted for postacute rehabilitation at inpatient rehabilitation facilities and skilled nursing facilities settings. Furthermore, examination of variation in ischemic and hemorrhagic stroke discharges suggests acute facility-level differences and indicates a need for careful consideration of patient and facility factors when comparing the effectiveness of inpatient rehabilitation facilities and skilled nursing facilities rehabilitation.
Enhancement of Meditation Analgesia by Opioid Antagonist in Experienced Meditators
Authors: May Lisa M. , Kosek Peter , Zeidan Fadel , Berkman Elliot T.
Published: March 2018

Objective

Studies have consistently shown that long-term meditation practice is associated with reduced pain, but the neural mechanisms by which long-term meditation practice reduces pain remain unclear. This study tested endogenous opioid involvement in meditation analgesia associated with long-term meditation practice.

Methods

Electrical pain was induced with randomized, double-blind, cross-over administration of the opioid antagonist naloxone (0.15-mg/kg bolus dose, then 0.2-mg/kg per hour infusion dose) with 32 healthy, experienced meditation practitioners and a standardized open monitoring meditation.

Results

Under saline, pain ratings were significantly lower during meditation (pain intensity: 6.41 ± 1.32; pain unpleasantness: 3.98 ± 2.17) than at baseline (pain intensity: 6.86 ±1.04, t(31) = 2.476, p = .019, Cohen's d = 0.46; pain unpleasantness: 4.96 ±1.75, t(31) = 3.746, p = .001, Cohen's d = 0.68), confirming the presence of meditation analgesia. Comparing saline and naloxone revealed significantly lower pain intensity (t(31) = 3.12, p = .004, d = 0.56), and pain unpleasantness (t(31) = 3.47, p = .002, d = 0.62), during meditation under naloxone (pain intensity: 5.53 ± 1.54; pain unpleasantness: 2.95 ± 1.88) than under saline (pain intensity: 6.41 ± 1.32; pain unpleasantness: 3.98 ± 2.17). Naloxone not only failed to eliminate meditation analgesia but also made meditation analgesia stronger.

Conclusions

Long-term meditation practice does not rely on endogenous opioids to reduce pain. Naloxone's blockade of opioid receptors enhanced meditation analgesia; pain ratings during meditation were significantly lower under naloxone than under saline. Possible biological mechanisms by which naloxone-induced opioid receptor blockade enhances meditation analgesia are discussed.
Rapid recalibration of speech perception after experiencing the McGurk illusion
Authors: Lüttke Claudia S. , Pérez-Bellido Alexis , de Lange Floris P.
Published: March 2018

The human brain can quickly adapt to changes in the environment. One example is phonetic recalibration: a speech sound is interpreted differently depending on the visual speech and this interpretation persists in the absence of visual information. Here, we examined the mechanisms of phonetic recalibration. Participants categorized the auditory syllables /aba/ and /ada/, which were sometimes preceded by the so-called McGurk stimuli (in which an /aba/ sound, due to visual /aga/ input, is often perceived as ‘ada’). We found that only one trial of exposure to the McGurk illusion was sufficient to induce a recalibration effect, i.e. an auditory /aba/ stimulus was subsequently more often perceived as ‘ada’. Furthermore, phonetic recalibration took place only when auditory and visual inputs were integrated to ‘ada’ (McGurk illusion). Moreover, this recalibration depended on the sensory similarity between the preceding and current auditory stimulus. Finally, signal detection theoretical analysis showed that McGurk-induced phonetic recalibration resulted in both a criterion shift towards /ada/ and a reduced sensitivity to distinguish between /aba/ and /ada/ sounds. The current study shows that phonetic recalibration is dependent on the perceptual integration of audiovisual information and leads to a perceptual shift in phoneme categorization.
Phylogeny, biogeography and diversification patterns of side-necked turtles (Testudines: Pleurodira)
Authors: Ferreira Gabriel S. , Bronzati Mario , Langer Max C. , Sterli Juliana
Published: March 2018

Pleurodires or side-necked turtles are today restricted to freshwater environments of South America, Africa–Madagascar and Australia, but in the past they were distributed much more broadly, being found also on Eurasia, India and North America, and marine environments. Two hypotheses were proposed to explain this distribution; in the first, vicariance would have shaped the current geographical distribution and, in the second, extinctions constrained a previously widespread distribution. Here, we aim to reconstruct pleurodiran biogeographic history and diversification patterns based on a new phylogenetic hypothesis recovered from the analysis of the largest morphological dataset yet compiled for the lineage, testing which biogeographical process prevailed during its evolutionary history. The resulting topology generally agrees with previous hypotheses of the group and shows that most diversification shifts were related to the exploration of new niches, e.g. littoral or marine radiations. In addition, as other turtles, pleurodires do not seem to have been much affected by either the Cretaceous–Palaeogene or the Eocene–Oligocene mass extinctions. The biogeographic analyses highlight the predominance of both anagenetic and cladogenetic dispersal events and support the importance of transoceanic dispersals as a more common driver of area changes than previously thought, agreeing with previous studies with other non-turtle lineages.
Kin discrimination via odour in the cooperatively breeding banded mongoose
Authors: Mitchell J. , Kyabulima S. , Businge R. , Cant M. A. , Nichols H. J.
Published: March 2018

Kin discrimination is often beneficial for group-living animals as it aids in inbreeding avoidance and providing nepotistic help. In mammals, the use of olfactory cues in kin discrimination is widespread and may occur through learning the scents of individuals that are likely to be relatives, or by assessing genetic relatedness directly through assessing odour similarity (phenotype matching). We use scent presentations to investigate these possibilities in a wild population of the banded mongooseMungos mungo, a cooperative breeder in which inbreeding risk is high and females breed communally, disrupting behavioural cues to kinship. We find that adults show heightened behavioural responses to unfamiliar (extra-group) scents than to familiar (within-group) scents. Interestingly, we found that responses to familiar odours, but not unfamiliar odours, varied with relatedness. This suggests that banded mongooses are either able to use an effective behavioural rule to identify likely relatives from within their group, or that phenotype matching is used in the context of within-group kin recognition but not extra-group kin recognition. In other cooperative breeders, familiarity is used within the group and phenotype matching may be used to identify unfamiliar kin. However, for the banded mongoose this pattern may be reversed, most likely due to their unusual breeding system which disrupts within-group behavioural cues to kinship.
Pressure-induced enhancement in the thermoelectric properties of monolayer and bilayer SnSe
2
Authors: Zou Daifeng , Yu Chuanbin , Li Yuhao , Ou Yun , Gao Yongyi
Published: March 2018

The electronic structures of monolayer and bilayer SnSe
2
under pressure were investigated by using first-principles calculations including van der Waals interactions. For monolayer SnSe
2
, the variation of electronic structure under pressure is controlled by pressure-dependent lattice parameters. For bilayer SnSe
2
, the changes in electronic structure under pressure are dominated by intralayer and interlayer atomic interactions. The
n
-type thermoelectric properties of monolayer and bilayer SnSe
2
under pressure were calculated on the basis of the semi-classical Boltzmann transport theory. It was found that the electrical conductivity of monolayer and bilayer SnSe
2
can be enhanced under pressure, and such dependence can be attributed to the pressure-induced changes of the Se–Sn antibonding states in conduction band. Finally, the doping dependence of power factors of
n
-type monolayer and bilayer SnSe
2
at three different pressures were estimated, and the results unveiled that thermoelectric performance of
n
-type monolayer and bilayer SnSe
2
can be improved by applying external pressure. This study benefits to understand the nature of the transport properties for monolayer and bilayer SnSe
2
under pressure, and it offers valuable insight for designing high-performance thermoelectric few-layered SnSe
2
through strain engineering induced by external pressure.