bluuebunny/crossref_metadata_2025 huggingface dataset:
Syphilis in Pregnancy: The Reality in a Public Hospital
Authors: Torres Rafael Garcia , Mendonça Ana Laura Neves , Montes Grazielle Cezarine , Manzan Jacqueline Jácome , Ribeiro João Ulisses , Paschoini Marina Carvalho
Published: February 2019

Objective: The present study assessed epidemiological and obstetrical data from pregnant women with syphilis at the Hospital de Clínicas of the Universidade Federal do Triângulo Mineiro (UFTM, in the Portuguese acronym), describing this disease during pregnancy and its vertical transmission for future healthcare actions.

Methods: Records from pregnant women who had been admitted to the Obstetrics Department of the Hospital de Clínicas of the UFTM and were diagnosed with syphilis between 2007 and 2016 were reviewed. A standardized form was used to collect epidemiological, obstetric data and outcomes of congenital infection. The present research has been authorized by the Ethics Committee of the institution.

Results: There were 268 women diagnosed with syphilis, with an average age of 23.6 years old. The majority of the patients were from Uberaba. Inadequate prenatal care was observed in 37.9% of the pregnant women. Only 34.2% of the patients completed the treatment according to the guidelines issued by the Ministry of Health of Brazil, and 19.8% of the partners of the patients underwent adequate syphilis treatment; 37 (13.8%) couples (patients and partners) underwent correct treatment. Regarding the obstetric outcomes, 4 (1.5%) patients had a miscarriage and 8 (3.4%) had fetal losses (from the fetal loss group, 7 had no adequate treatment); 61 (25.9%) patients had premature births – this prematurity has been significantly correlated to inadequate or incomplete treatment in 49 (27.9%) patients, compared with 12 (13.0%) patients with premature births and adequate treatment (p = 0.006). The average live newborn weight was 2,840 g; 25.3% had a birth weight < 2,500 g; 74.2% had congenital syphilis, a data with heavy correlation to inadequate or incomplete prenatal care, prematurity, and low birth weight.

Conclusion: Public awareness policies on adequate prenatal care, intensification of serological screening, and early treatment of syphilis are needed, considering the rise of cases diagnosed during gestation and its potentially preventable deleterious consequences related to congenital transmission.
Achieving Baby-Friendly Designation at a Large Metropolitan Center
Authors: Bruney Talitha , Campbell Deborah , Iyare Abieyuwa
Published: February 2019

Objective This study aimed to describe the journey of obtaining Baby-Friendly designation as a large metropolitan center in an urban city and review the initial patient-related outcomes.

Study Design Our medical center participated in the New York City Department of Health and Mental Hygiene Breastfeeding Hospital Collaborative from 2012 to 2017. Monthly meetings were held to monitor data, and audits conducted among prenatal sites and maternity units. This hospital collaborative was established to help facilities through the designation process.

Results Breastfeeding education in the prenatal setting was provided consistently at all outpatient sites. By 2017, 89.8% of patients had received appropriate education and support during their prenatal visits. There was a shift in feeding pattern from mostly formula feeding with some breastfeeding to primarily breastfeeding with fewer formula feeds. Baby-Friendly designation was achieved in June 2017 after a formal Baby-Friendly USA assessment.

Conclusion Since embarking on this journey, there has been a consistent increase in antenatal patient education and a paradigm shift from some breastfeeding to mostly breastfeeding among the mother–baby dyads which combination feed. Our hospital center has continued to successfully maintain the workflow changes implemented during the Baby-Friendly process.
Effects of heavy ion irradiation on Zr-2.5Nb pressure tube alloy. I. Orientation dependent mechanical response
Authors: Wang Qiang , Guo Ning , Long Fei , Daymond Mark R.
Published: February 2019

In this study, the orientation dependent hardness and creep properties of heavy ion irradiated Zr-2.5Nb pressure tube alloy are investigated by nanoindentation. The indentation tests are conducted along the axial direction (AD) and the transverse direction (TD) relative to the tube. TD samples demonstrate a dependence of the indentation size effect on irradiation damage, which is related to the decrease of the plastic zone size as irradiation damage increases. The hardness of AD and TD samples shows linear dependence on the square root of the irradiation damage density. The transition of the flow pattern from laminar to rotational flow happens in TD samples when the indentation is deeper than 1 μm; rotational flow is expected to be dominant after irradiation. AD samples exhibit laminar flow regardless of indentation depth or irradiation damage. The creep distance is increased for AD while it decreased for TD after irradiation. The creep process in the unirradiated materials and irradiated TD samples is found to be plasticity creep (dislocation glide plus climb). However, for AD samples, the mechanism is changed to power-law creep after 0.6 dpa irradiation. Both the hardness and creep results can be related to the anisotropic deformation mechanisms in the samples.
Local discontinuous Galerkin method for modeling the nonplanar structures (solitons and shocks) in an electronegative plasma
Authors: El-Tantawy S. A. , Aboelenen Tarek , Ismaeel Sherif M. E.
Published: February 2019

Using the hydrodynamic equations of cold inertial positive ions with the Maxwellian distribution for light negative ion and electron densities and the Poisson equation, the family of nonplanar (cylindrical and spherical) Korteweg-de Vries (KdV) equations, i.e., the KdV, modified KdV, and extended KdV (EKdV), are obtained for small but finite amplitude ion-acoustic waves. The nonplanar EKdV equation is used to analyze the time-dependent planar and nonplanar soliton and shock structures. It is well-known that the exact solutions of the family of nonplanar KdV equations are not possible. Therefore, a local discontinuous Galerkin (LDG) method is developed for solving the nonplanar EKdV equation numerically. According to this method, the initial and boundary conditions for the solitary and shock waves are accurately identified. The L2 stability of the LDG method is proved for the general nonlinear case. The existence regions for both solitary and shock excitations have been defined precisely depending on the laboratory plasma parameters. Moreover, the effects of the negative-ion temperature ratio and the negative ion concentration on the profiles of the nonlinear structures (solitons and shocks) are examined. The effect of the geometrical divergence on the pulse profile is also reported which indicates that the localized pulses deform as time goes on. Furthermore, it is found that the amplitude of cylindrical structures (solitons and shocks) is larger than that of planar ones but smaller than that of the spherical ones. Moreover, in cylindrical geometry, the nonlinear structures travel slower than in the spherical ones. The implications of our results agree with the experimental observations.
Waveform, spectrum, and energy of backward terahertz emission from two-color femtosecond laser induced microplasma
Authors: Ushakov A. A. , Panov N. A. , Chizhov P. A. , Shipilo D. E. , Bukin V. V. , Savel'ev A. B. , Garnov S. V. , Kosareva O. G.
Published: February 2019

We measured the key characteristics of the backward terahertz (THz) emission from a two-color femtosecond laser spark in air: waveform, spectrum, and energy. Through the controlled reflection of the forward THz pulse, we observed the backward and forward ones in the same waveform and hence directly evidenced the origin of the backward THz radiation from the plasma spark. The spectrum of the backward THz radiation is shifted to the low-frequency range as compared with the forward one. Measurements of the energy of the backward and forward THz pulses for different pump pulse energies provide their ratio to be ∼5.5%, which quantitatively agrees with the results of our numerical simulations. These results can be useful for the noninvasive monitoring of forward THz emission parameters by the backward one.
Single-layer transmissive metasurface for generating OAM vortex wave with homogeneous radiation based on the principle of Fabry-Perot cavity
Authors: Ma Lina , Chen Chang , Zhou Lingyun , Jiang Shan , Zhang Hualiang
Published: February 2019

In this paper, a single-layer transmissive metasurface (TMS) is designed to generate orbital angular momentum (OAM) vortex waves with homogeneous radiation at microwave frequencies (e.g., 10 GHz). A single-layer TMS with the thickness of 3 mm (0.1λ0) is designed by well connecting the phase shift range of two elemental TMS structures. Specifically, two TMS structures—meandering patch-double meandering rings and meandering patch-single meandering ring with the unit-cell size of 7.5 mm (0.25λ0)—are used together to achieve high transmission efficiency (>0.8) and a large phase coverage range (>360°). In order to address issues such as uneven circumferential radiation and posterior lobe radiation and further enhance the efficiency of the TMS, the modified principle of Fabry-Perot cavity (FPc) suited for realizing the TMS to generate OAM vortex waves is proposed, analyzed closely, and applied. Specifically, an improved rectangular microstrip antenna is employed as a feeding source and a double square ring array is used to construct the backplane. A prototype of the proposed TMS with a FPc is designed, simulated, manufactured, and measured. The simulated and experimental results agree well, which demonstrate the feasibility of the presented design methodology.
Interface effect of ultrathin W layer on spin-orbit torque in Ta/W/CoFeB multilayers
Authors: Li S. K. , Zhao X. T. , Liu W. , Song Y. H. , Liu L. , Zhao X. G. , Zhang Z. D.
Published: February 2019

The effect of an ultrathin W interlayer on the perpendicular magnetic anisotropy (PMA), spin orbit torque (SOT), and SOT-induced magnetization switching of Ta/CoFeB/MgO films has been investigated. Both the anisotropy energy density and the spin-torque efficiency are enhanced by inserting the ultrathin W interlayer. The results suggest that the large enhancement of the spin-torque efficiency originates from the increase in the interfacial spin transparency using a simplified drift-diffusion model. The minimum in-plane field required for SOT-induced complete switching is reduced to 12 Oe for the sample with the W interlayer, which is confirmed by polar Kerr microscopy. The reversed domain nucleation and propagation of the reversal processes have been observed by Kerr imaging. It is concluded that the ultrathin W interlayer increases the spin transmission and reduces the strength of the Dzyaloshinskii–Moriya interaction. Our result suggests that the interface modification is an efficient way to modulate the PMA and SOT.
Role of phonon coupling and non-equilibrium near the interface to interfacial thermal resistance: The multi-temperature model and thermal circuit
Authors: Lu Zexi , Shi Jingjing , Ruan Xiulin
Published: February 2019

Interfacial thermal transport between two semi-infinite leads has been widely assumed to be independent from bulk transport in the two leads. However, here we show that due to the mismatch of phonon modal interfacial conductance and modal thermal conductivity, thermal interfacial transport is affected by the bulk thermal transport, and phonons near the interface can be driven into strong non-equilibrium, causing an additional resistance that is lumped into the interfacial resistance. This is captured using a multi-temperature model (MTM) that we introduce. Using thermal properties predicted from first-principles calculations and interfacial transmission coefficients predicted from the acoustic mismatch model, we present a case study of thermal transport across the Si-Ge interfaces using our MTM. The results show that phonon branches are in non-equilibrium near the interface due to energy re-distribution caused by different thermal properties of the materials and the corresponding transmission coefficients, and the overall interfacial thermal conductance is 5.4% smaller than the conventional prediction, due to the phonon non-equilibrium resistance. We present a thermal circuit to include this new resistance due to phonon-phonon coupling and non-equilibrium near the interfaces. The thermal circuit also shows that increasing the phonon-phonon coupling factor Gpp can reduce this resistance. Our MTM is a general and simple analytical approach expected to be useful for investigating the coupling between thermal transport across interfaces and in the bulk leads.
Spatial variation of meiofaunal tardigrades in a small tropical estuary (~6°S; Brazil)
Authors: Tilbert Sebastião , de Castro Francisco J. V. , Tavares Géssica , Nogueira Júnior Miodeli
Published: February 2019

Spatial variations and organism–sediment relationship are paramount subjects of soft-bottom ecology. However, these issues have been unexplored for most minor meiofaunal taxa such as tardigrades. In the present study, we explore this subject on a small tropical (~6°S) estuary. Total meiofaunal abundance ranged from 4 to 1036 individuals per 10cm2, averaging (mean±s.d.) 324.8±245.9 individuals per 10cm2. Nematodes dominated in both seasons, representing >70% of total abundance. Tardigrades were the second-most abundant taxon, representing 15% of the total and up to 71%. Tardigrades were represented by two species, Batillipes dandarae and B. pennaki, the latter dominating in the rainy season, and both with similar abundances in the dry season. Abundance of total meiofauna and both tardigrade species differed significantly (ANOVA; P<0.05) among stations and in the interaction between stations and seasons, but only B. dandarae varied seasonally, with higher values occurring in the dry season. The spatial variations observed were mostly related to differences in the sediment granulometry. Environmental explanatory variables explained 72.6% of the variance of dominant meiofaunal taxa in the Redundancy Analysis. Nematodes and ostracods were mostly associated with fine and very fine sands, both tardigrades with medium sand and oligochaetes with larger size-fractions of the sediment and organic matter. The data gathered here suggest that granulometry was the most important environmental factor in the meiofaunal spatial structure in tropical estuaries and both tardigrade species were closely associated with medium sand.
Agriculture and conservation: an oxymoron or a necessity?
Authors: Saunders Denis A.
Published: February 2019

This essay discusses two waves of settlement by Homo sapiens of continental Australia; the first over 60000 years ago, and the second less than 250 years ago. The failure of the second wave of Homo sapiens to understand the way the first wave had changed the biotic composition has led to major environmental problems.
Tracking the affective state of unseen persons
Authors: Chen Zhimin , Whitney David
Published: February 2019

Emotion recognition is an essential human ability critical for social functioning. It is widely assumed that identifying facial expression is the key to this, and models of emotion recognition have mainly focused on facial and bodily features in static, unnatural conditions. We developed a method called affective tracking to reveal and quantify the enormous contribution of visual context to affect (valence and arousal) perception. When characters’ faces and bodies were masked in silent videos, viewers inferred the affect of the invisible characters successfully and in high agreement based solely on visual context. We further show that the context is not only sufficient but also necessary to accurately perceive human affect over time, as it provides a substantial and unique contribution beyond the information available from face and body. Our method (which we have made publicly available) reveals that emotion recognition is, at its heart, an issue of context as much as it is about faces.
OAS-RNase L innate immune pathway mediates the cytotoxicity of a DNA-demethylating drug
Authors: Banerjee Shuvojit , Gusho Elona , Gaughan Christina , Dong Beihua , Gu Xiaorong , Holvey-Bates Elise , Talukdar Manisha , Li Yize , Weiss Susan R. , Sicheri Frank , Saunthararajah Yogen , Stark George R. , Silverman Robert H.
Published: February 2019

Significance

Drugs that cause epigenetic modification of DNA, such as 5-azacytidine (AZA), are used clinically to treat myelodysplastic syndromes and acute myeloid leukemia. In addition, AZA is being investigated for use against a range of different types of solid tumors, including lung and colorectal cancers. Treatment with AZA causes demethylation of DNA, thus increasing RNA synthesis, including the synthesis of double-stranded RNA, which is otherwise produced in virus-infected cells. We determined that cell death in response to AZA requires the antiviral enzyme RNase L. The results identify a drug target for enhancing the anticancer activity and reducing the toxicity of AZA and related drugs.
Par3 is essential for the establishment of planar cell polarity of inner ear hair cells
Authors: Landin Malt Andre , Dailey Zachary , Holbrook-Rasmussen Julia , Zheng Yuqiong , Hogan Arielle , Du Quansheng , Lu Xiaowei
Published: February 2019

Significance

Planar cell polarity (PCP) signaling coordinates cell polarization along an axis orthogonal to its apical–basal axis and is essential for both tissue development and function. In inner ear sensory epithelia, intercellular and cell-intrinsic PCP signaling controls the orientation and V shape of hair bundles atop sensory hair cells essential for hearing. Here we demonstrate that the conserved PDZ-domain scaffold protein Par3 plays an essential role in establishing PCP of sensory hair cells. Genetic mosaic analysis indicates that Par3 has both cell-autonomous and cell-nonautonomous functions in kinocilium positioning and hair bundle orientation. Mechanistically, Par3 interacts with and regulates localization of Rac guanine nucleotide exchange factors Tiam1 and Trio to activate Rac GTPases, thereby mediating both intercellular and cell-intrinsic PCP signaling.
Deliberately misleading or unintentionally ambiguous?
Authors: Prażmo Ewelina
Published: February 2019

The present paper focuses on the use of deliberately misleading or unintentionally misinformative phrases related to the so called “Polish concentration camp” issue. This problem has been gaining increasing attention in the Polish media and political sphere. In the article I present the background of the problem including the current legal situation, as well as a linguistic analysis of a selection of problematic collocations. I attempt to maintain an objective stance and refrain from passing any emotional judgement on the issue, providing, at the same time, an in-depth analysis of the linguistic data. I frame the present paper within the cognitive linguistics methodology. I combineGilles Fauconnier and Mark Turner’s (2002)Conceptual Integration TheorywithKerstin Norén and Per Linell’s (2007)concept ofmeaning potentialsin order to account for the emergent and modifiable nature of meanings of complex expressions.
The dialects of control and connection in the study abroad homestay
Authors: Kinginger Celeste , Lee Sheng-Hsun
Published: February 2019

As in every conversation, negotiation for control and connection is at the heart of communication in the study abroad homestay. Finding a comfortable footing on the control-and-connection continua (i.e., closeness versus distance, and hierarchy versus equality) is both a product and a process of language learning in the homestay. Drawing on interviews of all parties and recordings of homestay interactions, we present the dialectical interplay of control and connection through analysis of conversational narratives recounted at Chinese homestay dinner tables. We recruitWertsch’s (1998)notion of mediated action to show how stories, as cultural tools, were employed by the hosts and students to construct moral injunctions and to cultivate closeness through mutual caring (guānxīn), affective gratification (qièyì), and attentiveness (tiēxīn). Findings of the study challenge assumptions about homestay communication as a power struggle only and underscore the importance of teaching students to appreciate the value of interpersonal exchange in homestay settings.
Variables affecting the maintenance of L2 proficiency and fluency four years post-study abroad
Authors: Huensch Amanda , Tracy-Ventura Nicole , Bridges Judith , Cuesta Medina Jhon A.
Published: February 2019

This study explored the attrition / maintenance of second language (L2) proficiency by examining longitudinally the oral skills of a group of L2 French and L2 Spanish participants (n = 33) four years after study abroad, and three years after completing an undergraduate degree in languages. Multiple regressions were conducted to determine the extent to which language contact / use and attained proficiency at the end of study abroad could predict changes in fluency and oral proficiency. Results demonstrated that those variables that improved significantly during study abroad (e.g., speech rate) were maintained four years later. The amount of target language contact / use played a role in maintenance of aspects of fluency such as speech rate and frequency of silent pauses, whereas proficiency attained at the end of study abroad played a role in the use of corrections. Both language contact / use and proficiency attained are important variables in the long-term maintenance of overall proficiency.
“Seriously, I came here to study English”
Authors: Kimura Daisuke
Published: February 2019

While English plays a prominent role in universities across the globe, study abroad research has rarely considered
English learning in non-Anglophone countries. This article presents a narrative case study of the experience of a Japanese
exchange student in Thailand whose primary purpose for study abroad was to improve his English. Grounded in the notion of
Individual Networks of Practice (Zappa-Hollman & Duff, 2015), the qualitative
analysis will focus on the participant’s evolving social networks and reported communication practices as mediated through
available subject positions and varying degrees of investment. Particularly, findings reveal the dissonance between his investment
in native speaker English and the reality of using English as a lingua franca, which decidedly influenced the student’s
(non-)participation in certain social groups and practices. Casting fresh light on globalization and language learning, the study
offers a unique contribution to the study abroad literature and suggests avenues for further research and education.
Superrational types
Authors: Tohmé Fernando A , Viglizzo Ignacio D
Published: February 2019

We present a formal analysis of Douglas Hofstadter’s concept of superrationality. We start by defining superrationally justifiable actions, and study them in symmetric games. We then model the beliefs of the players, in a way that leads them to different choices than the usual assumption of rationality by restricting the range of conceivable choices. These beliefs are captured in the formal notion of type drawn from epistemic game theory. The theory of coalgebras is used to frame type spaces and to account for the existence of some of them. We find conditions that guarantee superrational outcomes.
Evaluation of the Common Bed Bug, Cimex lectularius (Insecta: Hemiptera: Cimicidae) Susceptibility to λ-Cyhalothrin, Malathion, and Diazinon in Northeastern Iran
Authors: Berenji Fariba , Moshaverinia Ali , Jadidoleslami Abbas , Shamsian Aliakbar , Doggett Stephen L , Moghaddas Elham
Published: February 2019

The common bed bug, Cimex lectularius (Linnaeus 1758), is a nocturnal blood-sucking ectoparasite of humans that is highly prevalent in the northeast of Iran. In recent years, the efficacy of those insecticides that have been frequently used to control bed bugs in Iran has not been studied. Due to frequent complaints about bed bug treatment failures in Mashhad city (northeastern Iran), this study assessed the susceptibility of C. lectularius collected from a student residence hall to Diazinon, Malathion, and λ-cyhalothrin. The desired concentrations of each insecticide were prepared in acetone, and bioassays were performed using insecticide-impregnated filter paper method. The concentration–response data were subjected to POLO-PC software and data were analyzed by the log-probit procedure. The LC50 values of Diazinon and λ-cyhalothrin for examined bed bugs were 1,337.40 and 2,022.36 ppm, respectively. Malathion at the highest concentration (10,000 ppm) did not exhibit any toxicity to examined C. lectularius. Comparing these results to the same previous studies showed that susceptibility of examined bed bugs to these insecticides has been highly decreased. This study revealed an occurrence of insecticide resistance in bed bug populations in northeastern Iran. It also suggests that Malathion, Diazinon, and λ-cyhalothrin are ineffective against bed bugs in this region.
Model independent expansion history from supernovae: Cosmology versus systematics
Authors: L’Huillier Benjamin , Shafieloo Arman , Linder Eric V , Kim Alex G
Published: February 2019

We examine the Pantheon supernovae distance data compilation in a model independent analysis to test the validity of cosmic history reconstructions beyond the concordance ΛCDM cosmology. Strong deviations are allowed by the data at z ≳ 1 in the reconstructed Hubble parameter, Om diagnostic, and dark energy equation of state. We explore three interpretations: 1) possibility of the true cosmology being far from ΛCDM, 2) supernovae property evolution, and 3) survey selection effects. The strong (and theoretically problematic) deviations at z ≳ 1 vanish and good consistency with ΛCDM is found with a simple Malmquist-like linear correction. The adjusted data is robust against the model independent iterative smoothing reconstruction. However, we caution that while by eye the original deviation from ΛCDM is striking, χ2 tests do not show the extra linear correction parameter is statistically significant, and a model-independent Gaussian Process regression does not find significant evidence for the need for correction at high-redshifts.
Combining timing characteristics with physical broad-band spectral modelling of black hole X-ray binary GX 339–4
Authors: Connors R M T , van Eijnatten D , Markoff S , Ceccobello C , Grinberg V , Heil L , Kantzas D , Lucchini M , Crumley P
Published: February 2019

GX 339–4 is a black hole X-ray binary that is a key focus of accretion studies, since it goes into outburst roughly every 2–3 yr. Tracking of its radio, infrared (IR), and X-ray flux during multiple outbursts reveals tight broad-band correlations. The radio emission originates in a compact, self-absorbed jet; however, the origin of the X-ray emission is still debated: jet base or corona? We fit 20 quasi-simultaneous radio, IR, optical, and X-ray observations of GX 339–4 covering three separate outbursts in 2005, 2007, 2010–2011, with a composite corona+jet model, where inverse Compton emission from both regions contributes to the X-ray emission. Using a recently proposed identifier of the X-ray variability properties known as power-spectral hue, we attempt to explain both the spectral and evolving timing characteristics, with the model. We find the X-ray spectra are best fit by inverse Compton scattering in a dominant hot corona (kTe ∼ hundreds of keV). However, radio and IR-optical constraints imply a non-negligible contribution from inverse Compton scattering off hotter electrons (kTe ≥ 511 keV) in the base of the jets, ranging from a few up to ∼50 per cent of the integrated 3–100 keV flux. We also find that the physical properties of the jet show interesting correlations with the shape of the broad-band X-ray variability of the source, posing intriguing suggestions for the connection between the jet and corona.
Concern About Falling Is Associated With Gait Speed, Independently From Physical and Cognitive Function
Authors: van Schooten Kimberley S , Freiberger Ellen , Sillevis Smitt Myriam , Keppner Veronika , Sieber Cornel , Lord Stephen R , Delbaere Kim
Published: February 2019

Background

Higher levels of concern about falling in older people have been associated with slower walking speed and an increased risk of falls. However, it is unclear whether this relationship is independent or confounded by other fall risk factors, such as physical and cognitive function.

Objective

The aim of this study was to examine the effects of concern about falling on gait speed, adjusted for physiological fall risk and cognitive function.

Design

This was an observational, cross-sectional study.

Methods

A total of 204 community-dwelling older people aged 70 years or older were recruited from 2 sites (Germany, n = 94; Australia, n = 110). Walking speed was measured over 6 m under 4 conditions: preferred speed, fast speed, speed while carrying a tray (functional dual task), and speed while answering a question (cognitive dual task). The Falls Efficacy Scale–International was used to assess concern about falling, the Physiological Profile Assessment was used to assess physiological fall risk, and the Digit Symbol Substitution Test and Trail Making Test were used to assess attention and executive function.

Results

Higher levels of concern about falling were associated with slower gait speed. Following adjustment for age, history of falls, and female sex, and further adjustment for physical and cognitive function, the association between concern about falling and walking speed remained significant, with a considerable effect size (standardized β = 0.18 ± 0.08; P = .037).

Limitations

The use of walking speed as a sole measure of gait was a limitation of this study.

Conclusions

Gait speed, especially under dual-task conditions, was affected by concern about falling. Concern about falling was the strongest predictor of gait speed under all 4 conditions and should be included in routine geriatric assessments.
Hyperbaric Oxygen Therapy for Second-Degree Burn Healing: An Experimental Study in Rabbits
Authors: Hatibie Mendy J. , Islam Andi A. , Hatta Mochammad , Moenadjat Yefta , Susilo Rudy H. , Rendy Leo
Published: February 2019

BACKGROUND:

The wound healing process includes inflammation, proliferation, and remodelling phases, the main features of which are inflammation, neoangiogenesis, and epithelialization. Hyperbaric oxygen therapy (HBOT) is one modality postulated to improve wound healing. The objective of this study was to determine whether HBOT could improve selected features of burn wound healing in an experimental rabbit model.

METHODS:

Researchers conducted an experimental study with 36 rabbits given second-degree burns. Subjects were separated into two groups: a control group (n = 18) and an intervention group that was given HBOT at 2.4 atmospheres absolute for 6 days (n = 18). The main outcome measure was wound healing.

RESULTS:

Compared with the control group, the HBOT group showed more robust inflammatory cells (P = .025) and epithelialization (P = .024), but no significant difference in angiogenesis (P = .442).

CONCLUSIONS:

The authors conclude that HBOT may improve second-degree burn healing by increasing inflammatory cell migration and re-epithelialization.
Reexamining the Literature on Terminal Ulcers, SCALE, Skin Failure, and Unavoidable Pressure Injuries
Authors: Ayello Elizabeth A. , Levine Jeffrey M. , Langemo Diane , Kennedy-Evans Karen Lou , Brennan Mary R. , Gary Sibbald R.
Published: February 2019

This article synthesizes the literature regarding the concepts of “terminal” skin injuries that are found in patients at the end of life, including Kennedy terminal ulcers, Skin Changes At Life’s End, Trombley-Brennan terminal tissue injuries, and skin failure. Also included is a discussion of avoidable and unavoidable pressure injuries as defined and differentiated by the Centers for Medicare & Medicaid Services and the National Pressure Ulcer Advisory Panel. To help clarify the controversy among these terms, a unifying concept of “skin failure” that may occur with an acute illness, chronic illness, or as part of the dying process is proposed. This proposed concept of skin failure is etiologically different than a pressure injury, although pressure injury and skin failure can occur concomitantly. These proposed concepts require further research and validated diagnostic criteria. Consensus around appropriate terminology is essential to reduce confusion among stakeholders and ensure appropriate patient care.

GENERAL PURPOSE:

To synthesize the literature regarding skin injuries that are found in patients at the end of life and to clarify the terms used to describe these conditions.

TARGET AUDIENCE:

This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.

LEARNING OBJECTIVES/OUTCOMES:

After completing this continuing education activity, you should be better able to:1. Define the terms used to describe pressure injuries and skin changes at the end of life.2. Discuss the concept of skin failure as applied to end-of-life skin injuries and implications for practice.
Specialty certification and clinical flexibility
Authors: Peterson Eric D. , Hussaini Sobia Shariff , Murfin Melissa , Smith Benjamin J. , Polansky Maura , Klingler Amy M. , Peterson Phyllis R. , Mast Jane , Wright Karen A.
Published: February 2019

The ability for PAs to easily move from one specialty to another without additional formal training is a unique feature of the profession that is valued by PAs and their employers. Specialty certification has been viewed as a threat to this flexibility, yet 73% of PAs are in specialty practice. How can the desire to preserve flexibility be balanced against the desire of specialized PAs to distinguish themselves in their chosen specialty? This article reviews the issue of specialty certification in the context of contemporary PA practice and concludes that although specialty certification remains a threat to the flexibility of the PA model, it may be appropriate in some situations. In particular, specialty certification may be appropriate as a means for promotion within healthcare systems so long as it is not used as a requirement for entry into specialty practice, credentialing, or third-party reimbursement. A portfolio model may give stakeholders an alternative way to assess the experience and competencies of PAs in specialty practice areas.
Nursing Schools Add Diversity Directors to Faculty
Authors: Kritz Fran
Published: February 2019

The goal is to recruit and retain minority students and promote cultural sensitivity.
Life-Threatening Bleeding and Deaths from Synthetic Cannabinoids
Authors: Zolot Joan
Published: February 2019

‘Fake weed’ containing rat poison raises alarm.
Over-The-Counter Asthma Inhaler Returns to the Market
Authors: Aschenbrenner Diane S.
Published: February 2019

The Primatene Mist inhaler has returned to the market as an over-the-counter treatment for mild, intermittent asthma.

The administration technique for this revised product is different from that of the original drug. The inhaler is now approved for use in people ages 12 and older.
New Warning for the Multiple Sclerosis Drug Alemtuzumab
Authors: Aschenbrenner Diane S.
Published: February 2019

The Food and Drug Administration has added a black box warning for alemtuzumab (Lemtrada) stating that the drug, used in the treatment of relapsing multiple sclerosis, may cause ischemic and hemorrhagic stroke and cervicocephalic arterial dissection, rare but serious adverse effects.

Nurses should teach patients prescribed this medication to recognize and seek emergency medical care if they develop any signs or symptoms of stroke.
Early Symptoms may Help Identify Patients at High Risk for Psychosis
Authors: Rosenberg Karen
Published: February 2019

According to this study:

Suicidal behavior and certain other nonspecific symptoms are associated with a subsequent diagnosis of psychosis and can help primary care providers identify patients at risk for this condition.

Primary care consultations tend to occur more frequently in the five years before diagnosis.
The Nursing Voice on the Global Stage
Authors: Burton Erica
Published: February 2019

Nursing is influencing global health policy and aligning with global health priorities.
To Recruit More Men, Rebrand Nursing as ‘Masculine’? Or Just Stop Oversimplifying the Profession
Authors: Kuehnert Paul
Published: February 2019

Updated several times a week with posts by a wide variety of authors, AJN's blog Off the Charts allows us to provide more timely—and often more personal—perspectives on professional, policy, and clinical issues. Best of the Blog will be a regular column to draw the attention of AJN readers to posts we think deserve a wider audience. To read more, please visit: www.ajnoffthecharts.com.
Considering toxicology
Authors: Quail M. Thomas
Published: February 2019

Toxicology is an interesting and specialized branch of medicine. This article examines the parallels between nursing and working as a specialist in poison information, offering a different career path for eligible nurses.
Holding the line against workplace violence
Authors: Toon Molly F. , Weaver Christy , Frasier Nora , Brown Kristie L.
Published: February 2019

As caregivers, nurses often dismiss violent patient interactions as “just part of the job.” This article addresses this misconception, differentiates between two types of violence present in healthcare settings, and stresses the importance of reporting and evaluating violent acts to plan mitigation strategies.
Advancing the Biosocial Perspective in the Clinical Training Environment: Surmounting the Barriers and Constructing the Framework
Authors: Taira Breena R. , Hsieh Dennis
Published: February 2019

Calls for integrating the biosocial perspective into medical education are abundant. The core curricula of most of health professions education, however, have yet to fully integrate this concept. In this Invited Commentary, the authors describe barriers to implementation—the lack of a shared vocabulary, core curriculum, and clinical metrics—and propose a framework for implementing curricula in social medicine and structural competence. Advancing the biosocial perspective necessitates concerted efforts to link classroom training in social medicine to the clinical training environment by implementing tools to identify and address structural vulnerability in the clinical setting. Creating clinical metrics that value health outcomes instead of processes will enable educators to model clinical practice that integrates the social determinants of health as a core component. Finally, formalizing and emphasizing social medicine in graduate medical education will reinforce and solidify the importance of the biosocial perspective in the future clinical practice of our trainees.
Using Interactive Learning Modules to Teach Value-Based Health Care to Health Professions Trainees Across the United States
Authors: Moriates Christopher , Valencia Victoria , Stamets Sara , Joo Joseph , MacClements Jonathan , Wilkerson LuAnn , Nelson Elizabeth A. , Bozic Kevin , Cox Susan M.
Published: February 2019

Problem

Despite prominent calls to incorporate value-based health care (VBHC) into medical education, there is still a global need for robust programs to teach VBHC concepts throughout health professions training.

Approach

In June 2017, Dell Medical School released the first collection (three modules) of a set of free interactive online learning modules, which aim to teach the basic foundations of VBHC to health professions learners at any stage of training and can be incorporated across diverse educational settings. These modules were designed by an interprofessional team based on principles of cognitive engagement for active learning.

Outcomes

From June 2017 to September 2018, the website received 130,098 pageviews from 8,546 unique users (2,072 registered users), representing 45 states in the United States and 10 foreign countries. As of October 15, 2018, 568 (27%) of registered users completed modules 1–3. Five-hundred thirty-five of these users completed a survey (94% response rate). Nearly all (484/535; 90%) reported overall satisfaction with the curriculum, 522/535 (98%) agreed “after completing the modules, I can define value in health care,” and 520/535 (97%) agreed “after completing the modules, I can provide examples of low- and high-value care.” Second-year Dell Medical School students reported that they have incorporated value into their clinical clerkships (e.g., by discussing VBHC with peers [43/45; 96%]) as a result of completing the modules.

Next Steps

Future plans for the curriculum include the release of additional modules, more robust knowledge assessment, and an expanded learning platform that allows for further community engagement.
Clinical Updates in Women’s Health Care Summary: Evaluation and Management of Lipid Disorders
Authors: Christopher Bridgette A. , Pagidipati Neha J.
Published: February 2019

Cardiovascular disease (CVD) remains the leading cause of mortality for women, and only a small percentage of women have optimally managed risk factors. One of the strongest risk factors for CVD is an increased lipid level. Many women seek primary care from obstetrician–gynecologists who often identify and provide initial management of dyslipidemia in these women. Thus, it is imperative that obstetrician–gynecologists become familiar with the identification and treatment of women with dyslipidemia to minimize their future risk of CVD. This monograph provides a brief primer on the epidemiology, pathophysiology, diagnosis, and management of dyslipidemia in women, as it pertains to CVD risk.
What Is in the Myopathy Literature?
Authors: Lacomis David , Abdel-Hamid Hoda Z.
Published: February 2019

We review the development of exon 51 skipping therapy with eteplirsen for Duchenne muscular dystrophy, including the recent report of long-term, sustained dystrophin production. Studies of the late-life health profile of patients with Duchenne muscular dystrophy, early detection of left ventricular systolic dysfunction, and caregiver burden are also covered. A study of skeletal muscle magnetic resonance imaging in dysferlinopathies provides an extensive, detailed map of the involved muscles and consistency across phenotypes. Regarding the category of autoimmune myopathies, we discuss an article on the clinical and laboratory features associated with PM/Scl antibodies in comparison with other autoimmune myopathy subgroups. Finally, the overall increase in mortality in inflammatory myopathies is highlighted in a recent report from Sweden.
Melanoma With Loss of BAP1 Expression in Patients With No Family History of BAP1-Associated Cancer Susceptibility Syndrome: A Case Series
Authors: Aung Phyu P. , Nagarajan Priyadharsini , Tetzlaff Michael T. , Curry Jonathan L. , Tang Guilin , Abdullaev Zied , Pack Svetlana D. , Ivan Doina , Prieto Victor G. , Torres-Cabala Carlos A.
Published: February 2019

The presence of multiple BAP1-negative melanocytic neoplasms is a hallmark of familial cancer susceptibility syndrome caused by germline mutations in BAP1. Melanocytic tumors lacking BAP1 expression may also present as sporadic lesions in patients lacking a germline BAP1 mutation. Here, we report histomorphologic and clinical characteristics of cutaneous melanomas with loss of BAP1 expression in 4 patients with no known history of BAP1-associated cancer susceptibility syndrome. The lesions were nodular melanomas composed predominantly of intradermal large epithelioid (Spitzoid) melanocytes with nuclear pseudoinclusions as well as scattered multinucleated cells, arising in association with a typical intradermal nevus. Of the 4 patients, only 1 had recurrence. This patient had multiple recurrences with in-transit and regional lymph node metastases. To the best of our knowledge, this is the first reported series of cutaneous melanomas with loss of BAP1 expression arising in patients without a family history of cancer.
Alterations of acoustic features of 50 kHz vocalizations by nicotine and phencyclidine in rats
Authors: Swalve Natashia , Mulholland Michele M. , Li Ming
Published: February 2019

Ultrasonic vocalizations are widely used to examine affective states in rats, yet relatively few studies explore the acoustic features of vocalizations, especially in relation to drug exposure, and no studies have explored alterations in acoustic features over time. The goal of this study was to examine nicotine- and phencyclidine-induced alterations of bandwidth, duration, and frequency of 50 kHz vocalizations. The minimum and maximum frequency, bandwidth, and duration of calls were examined after 7 days of daily subcutaneous administration of phencyclidine (2.0 mg/kg) and nicotine (0.2 and 0.4 mg/kg) in male Sprague-Dawley rats. Bandwidth was significantly decreased in rats treated with both nicotine (0.2 and 0.4 mg/kg) and phencyclidine. Maximum frequency was lowest on the first day of exposure compared with all other days and was not altered by drug exposure. Call duration was not affected by time or drug exposure. These findings suggest the importance of studying alterations in acoustic features in time, especially those induced by drug exposure.
Animal models of post-traumatic stress disorder and novel treatment targets
Authors: Aspesi Dario , Pinna Graziano
Published: February 2019

Understanding the neurobiological basis of post-traumatic stress disorder (PTSD) is fundamental to accurately diagnose this neuropathology and offer appropriate treatment options to patients. The lack of pharmacological effects, too often observed with the most currently used drugs, the selective serotonin reuptake inhibitors (SSRIs), makes even more urgent the discovery of new pharmacological approaches. Reliable animal models of PTSD are difficult to establish because of the present limited understanding of the PTSD heterogeneity and of the influence of various environmental factors that trigger the disorder in humans. We summarize knowledge on the most frequently investigated animal models of PTSD, focusing on both their behavioral and neurobiological features. Most of them can reproduce not only behavioral endophenotypes, including anxiety-like behaviors or fear-related avoidance, but also neurobiological alterations, such as glucocorticoid receptor hypersensitivity or amygdala hyperactivity. Among the various models analyzed, we focus on the social isolation mouse model, which reproduces some deficits observed in humans with PTSD, such as abnormal neurosteroid biosynthesis, changes in GABAAreceptor subunit expression and lack of pharmacological response to benzodiazepines. Neurosteroid biosynthesis and its interaction with the endocannabinoid system are altered in PTSD and are promising neuronal targets to discover novel PTSD agents. In this regard, we discuss pharmacological interventions and we highlight exciting new developments in the fields of research for novel reliable PTSD biomarkers that may enable precise diagnosis of the disorder and more successful pharmacological treatments for PTSD patients.