bluuebunny/crossref_metadata_2025 huggingface dataset:
Uncommon resemblance
Authors: Lempert Michael
Published: June 2017

Research on manual gesture has been preoccupied with unconventionalized and conventionalized extremes. Homesigns developed spontaneously by deaf children unexposed to standardized sign languages have been used as a window onto more general socio-cognitive processes of semiotic systemization. Spontaneous, idiosyncratic gesticulation has been contrasted with shared, highly regimented “emblematic” or “quotable” gestures to reveal a cline of conventionalization. I direct attention here to the vast and relatively understudied middle ground in which manual gesture shows evidence of only partial conventionalization. Using a corpus of televised political debate data from a US presidential campaign cycle, I note, first, that there is nothing as coherent and systematized as a “register” of political gesture here. Focusing on gesture variation in precision-grip and index-finger-extended gestures of Barack Obama and Hillary Clinton, I identify form-functional “pragmatic affinities” among gestures that have not crystallized into stable types or classes. Dwelling on the specificities of gesture variation, with its mercurial forms and incomplete conventionalization, may allow us to appreciate the processual complexities of gestural enregisterment in social and historical life.
The challenge of film to innovation and entrepreneurship studies
Authors: Wood Martin , Glisovic Smiljana , Berkeley Leo
Published: June 2017

This commentary supplements the work of a creative practice research project that generates new ways of thinking about innovation and entrepreneurial processes. Our creative method, underwritten by the logic of sensation and presented in film format, operates as an alternative form of research in these fields, where results are normally conveyed in book or journal paper. Film-based research has developed distinctive qualitative, empirical and theoretical vocabularies that can expand the nature and range of evidence, argument and expression across the broad range of innovation and entrepreneurship studies. 600 Mills, the film that accompanies this paper, is available at https://doi.org/10.1080/08109028.2017.1336011.
The G protein–coupled receptor GPR31 promotes membrane association of KRAS
Authors: Fehrenbacher Nicole , Tojal da Silva Israel , Ramirez Craig , Zhou Yong , Cho Kwang-Jin , Kuchay Shafi , Shi Jie , Thomas Susan , Pagano Michele , Hancock John F. , Bar-Sagi Dafna , Philips Mark R.
Published: June 2017

The product of the KRAS oncogene, KRAS4B, promotes tumor growth when associated with the plasma membrane (PM). PM association is mediated, in part, by farnesylation of KRAS4B, but trafficking of nascent KRAS4B to the PM is incompletely understood. We performed a genome-wide screen to identify genes required for KRAS4B membrane association and identified a G protein–coupled receptor, GPR31. GPR31 associated with KRAS4B on cellular membranes in a farnesylation-dependent fashion, and retention of GPR31 on the endoplasmic reticulum inhibited delivery of KRAS4B to the PM. Silencing of GPR31 expression partially mislocalized KRAS4B, slowed the growth of KRAS-dependent tumor cells, and blocked KRAS-stimulated macropinocytosis. Our data suggest that GPR31 acts as a secretory pathway chaperone for KRAS4B.
Many parts make a whole: Calcium transients sum for slow waves
Authors: Sedwick Caitlin
Published: June 2017

New JGP study shows how calcium events drive long intestinal slow wave plateaus.
PAR proteins regulate maintenance-phase myosin dynamics duringCaenorhabditis eleganszygote polarization
Authors: Small Lawrence E. , Dawes Adriana T.
Published: June 2017

Establishment of anterior–posterior polarity in the Caenorhabditis elegans zygote requires two different processes: mechanical activity of the actin–myosin cortex and biochemical activity of partitioning-defective (PAR) proteins. Here we analyze how PARs regulate the behavior of the cortical motor protein nonmuscle myosin (NMY-2) to complement recent efforts that investigate how PARs regulate the Rho GTPase CDC-42, which in turn regulates the actin-myosin cortex. We find that PAR-3 and PAR-6 concentrate CDC-42–dependent NMY-2 in the anterior cortex, whereas PAR-2 inhibits CDC-42–dependent NMY-2 in the posterior domain by inhibiting PAR-3 and PAR-6. In addition, we find that PAR-1 and PAR-3 are necessary for inhibiting movement of NMY-2 across the cortex. PAR-1 protects NMY-2 from being moved across the cortex by forces likely originating in the cytoplasm. Meanwhile, PAR-3 stabilizes NMY-2 against PAR-2 and PAR-6 dynamics on the cortex. We find that PAR signaling fulfills two roles: localizing NMY-2 to the anterior cortex and preventing displacement of the polarized cortical actin–myosin network.
EDEN: evolutionary dynamics within environments
Authors: Münch Philipp C , Stecher Bärbel , McHardy Alice C
Published: June 2017

Metagenomics revolutionized the field of microbial ecology, giving access to Gb-sized datasets of microbial communities under natural conditions. This enables fine-grained analyses of the functions of community members, studies of their association with phenotypes and environments, as well as of their microevolution and adaptation to changing environmental conditions. However, phylogenetic methods for studying adaptation and evolutionary dynamics are not able to cope with big data. EDEN is the first software for the rapid detection of protein families and regions under positive selection, as well as their associated biological processes, from meta- and pangenome data. It provides an interactive result visualization for detailed comparative analyses.

Availability and implementation

EDEN is available as a Docker installation under the GPL 3.0 license, allowing its use on common operating systems, at http://www.github.com/hzi-bifo/eden.

Contact

alice.mchardy@helmholtz-hzi.de

Supplementary information

Supplementary data are available at Bioinformatics online.
Logically-consistent hypothesis testing and the hexagon of oppositions
Authors: Stern Julio Michael , Izbicki Rafael , Esteves Luis Gustavo , Stern Rafael Bassi
Published: June 2017

Although logical consistency is desirable in scientific research, standard statistical hypothesis tests are typically logically inconsistent. To address this issue, previous work introduced agnostic hypothesis tests and proved that they can be logically consistent while retaining statistical optimality properties. This article characterizes the credal modalities in agnostic hypothesis tests and uses the hexagon of oppositions to explain the logical relations between these modalities. Geometric solids that are composed of hexagons of oppositions illustrate the conditions for these modalities to be logically consistent. Prisms composed of hexagons of oppositions show how the credal modalities obtained from two agnostic tests vary according to their threshold values. Nested hexagons of oppositions summarize logical relations between the credal modalities in these tests and prove new relations.
Discovery of H2O megamasers in obscured active galactic nuclei
Authors: Yamauchi Aya , Miyamoto Yusuke , Nakai Naomasa , Terashima Yuichi , Okumura Taishi , Zhou Bin , Taniguchi Kotomi , Kaneko Hiroyuki , Matsumoto Naoko , Salak Dragan , Nishimura Atsushi , Ueno Saeko
Published: June 2017

A new method to discover obscured active galactic nuclei (AGNs) by utilizing X-ray and infrared data has recently been developed. We carried out a survey of H2O maser emission toward 10 obscured AGNs with the Nobeyama 45 m telescope. We newly detected the maser emission with a signal-noise-ratio (SNR) of above 4 from two AGNs; NGC 1402 and NGC 7738. We also found a tentative detection with SNR > 3 in NGC 5037. The detection rate of 20% is higher than those of previous surveys (usually several percent).
Reactions to cytostatic agents in children
Authors: Cernadas Josefina R.
Published: June 2017

Purpose of review

The current review will focus on drug hypersensitivity reactions to chemotherapy specifically to those drugs most used in children. We know that potentially all chemotherapeutic agents can cause infusion reactions, generally defined as adverse drug reactions. Of these, some are Type A, defined as expected and described in the characteristics of the drug and others, and Type B, defined as unexpected reactions which cannot be explained by the known toxicity profile of the drug. When an unexpected reaction occurs, drugs we can refer as hypersensitivity reactions (HSRs). Some of these (HSRs) are allergic reactions as they have an underlying immunologic mechanism. In general, the cytotoxic agents most commonly associated with HSRs are the platinum salts derivatives, taxanes, pegylated liposomal doxorubicin, l-asparaginase, procarbazine, etoposide, bleomycin, and cytarabin.

Recent findings

HSRs may also occur in children with cancer, during the treatment with chemotherapeutic drugs. The most used drugs of this group in children to cause HSRs are: carboplatin, l-asparaginase, and methothrexate. The aim of this review is to summarize the incidence and the clinical features of HSRs occurring with these drugs in children.

The aim of this review is to summarize the incidence and the clinical features of HSRs occurring with these drugs in children. The current review will focus on the most involved drugs in children, the type of reactions, the mechanisms involved, and the best way to manage them.
Operative Treatment of 2-Part Surgical Neck Fracture of the Humerus: Intramedullary Nail Versus Locking Compression Plate With Technical Consideration
Authors: Lee Wonyong , Park Jun-Young , Chun Yong-Min
Published: June 2017

Objective:

To compare the outcomes of patients who underwent either open reduction internal fixation with a locking plate and screws or closed reduction internal fixation with an antegrade intramedullary nail (IMN) for displaced surgical neck fracture of the humerus.

Design:

Retrospective comparative study.

Setting:

Single institute, Level-I academic trauma center.

Patients and Intervention:

Sixty-nine patients with 2-part surgical neck fracture of the humerus underwent either an IMN (38 patients group A) or a locked plate fixation (31 patients group B).

Outcomes Measurement:

Pain on a visual analog scale, University of California Los Angeles (UCLA) Shoulder Score, American Shoulder and Elbow Surgeons (ASES) score, and active range of motion (ROM).

Results:

At the 2-year follow-up, there were no significant differences in the visual analog scale pain score (1.3 in group A; 0.9 in group B), ASES score (90.2 in group A; 91.9 in group B), and UCLA Shoulder Score (30.7 in group A; 31.8 in group B) between groups. Active ROM did not differ significantly between groups. There were 3 complications in the IMN group, 1 nonunion requiring autogenous iliac crest bone graft, and 2 cases of screw loosening.

Conclusions:

For displaced surgical neck fractures of the humerus, both IM nailing and locked plate fixation in patients yielded satisfactory outcomes at the 2-year follow-up with no significant differences in pain or ROM between groups.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
An Alternative Consent Process for Minimal Risk Research in the ICU*
Authors: Terry Melissa A. , Freedberg Daniel E. , Morris Marilyn C.
Published: June 2017

Objectives:

Seeking consent for minimal risk research in the ICU poses challenges, especially when the research is time-sensitive. Our aim was to determine the extent to which ICU patients or surrogates support a deferred consent process for a minimal risk study without the potential for direct benefit.

Design:

Prospective cohort study.

Setting:

Five ICUs within a tertiary care hospital.

Patients:

Newly admitted ICU patients 18 years old or older.

Interventions:

We administered an eight-item verbal survey to patients or surrogates approached for consent to participate in a minimal risk, ICU-based study. The parent study involved noninvasive collection of biosamples and clinical data at the time of ICU admission and again 3 days later. If patients had capacity at the time of ICU admission, or if a surrogate was readily available, consent was sought prior to initial sample collection; otherwise, a waiver of consent was granted, and deferred consent was sought 3 days later. Quantitative and qualitative data were analyzed.

Measurements and Main Results:

One hundred fifty-seven individuals were approached for consent to participate in the parent study; none objected to the consent process. One hundred thirty-five of 157 (86%) competed the survey, including 94 who consented to the parent study and 41 who declined. Forty-four of 60 individuals (73%) approached for deferred consent responded positively to the question “Did we make the right choice in waiting until now to ask your consent?” three of 60 (5%) responded negatively, and 13 of 60 (22%) made a neutral or unrelated response. The most common reason given for endorsing the deferred consent process was the stress of the early ICU experience 25 of 44 (61%).

Conclusions:

Most patients and surrogates accept a deferred consent process for minimal risk research in the ICU. For appropriate ICU-based research, investigators and Institutional Review Boards should consider a deferred consent process if the subject lacks capacity and an appropriate surrogate is not readily available.
Extraskeletal Osteosarcoma
Authors: Paludo Jonas , Fritchie Karen , Haddox Candace L. , Rose Peter S. , Arndt Carola A.S. , Marks Randolph S. , Galanis Evanthia , Okuno Scott H. , Robinson Steven I.
Published: June 2017

Objectives:

Extraskeletal osteosarcoma (EO) is a malignant neoplasm that produces osteoid, bone, and chondroid material without direct attachment to bone or periosteum. Surgical resection is the mainstay of treatment; the role of chemotherapy is not well defined. Therefore, we evaluated the impact of chemotherapy in the survival of patients with EO.

Methods:

All EO patients seen at Mayo Clinic between 1990 and 2014 were assessed. Forty-three patients were included after all archived pathology slides were reviewed to confirm the diagnosis of EO.

Results:

Of 43 patients, 37 patients had localized disease and 6 patients had metastatic disease at diagnosis. Chemotherapy was used in 73% and 75% of patients, respectively. Chemotherapy was predominantly anthracycline based, and included platinum in 22 patients (84%).

Median overall survival (OS) and progression-free survival (PFS) were 50 months (95% confidence interval, 25-99), and 21 months (95% confidence interval, 13-not reached), respectively. There was a trend towards longer OS and PFS in patients who received chemotherapy. Those who received platinum-based therapy had remarkably prolonged OS (median, 182 vs. 18 mo; 5-year, 61% vs. 0%; P=0.01) and PFS (median, not reached vs. 10 mo; 5-year, 56% vs. 0%; P=0.005). Baseline characteristics were similar in the platinum and nonplatinum group.

In patients who received chemotherapy, relapse/recurrence rate was lower in the platinum-based group (41%) as opposed to the nonplatinum-based group (100%; P=0.02). In the neoadjuvant setting, the overall response rate of platinum-containing regimens was 27%.

Conclusions:

Our results suggest a clinical benefit when platinum-based chemotherapy is incorporated in the management of patients with EO. We plan to validate this further with an expanded multicenter analysis.
Local Application of Statins Significantly Reduced Hypertrophic Scarring in a Rabbit Ear Model
Authors: Jia Shengxian , Xie Ping , Hong Seok J. , Galiano Robert D. , Mustoe Thomas A.
Published: June 2017

Background:

We previously showed that intradermal injection of statins is a successful treatment for hypertrophic scarring. Topical application has many advantages over intradermal injection. In this study, we demonstrate the efficacy of topical statin treatment in reducing scar in our validated rabbit ear scar model.

Methods:

Twenty New Zealand White rabbits were divided into 2 study groups, with 6 rabbits receiving 10 μm pravastatin intradermally at postoperative days 15, 18, and 21, and 14 rabbits receiving 0.4%, 2%, and 10% simvastatin topical application at postoperative days 14–25. Four or 6 full-thickness circular dermal punches 7 mm in diameter were made on the ventral surface of the ear down to but not including the perichondrium. Specimens were collected at 28 days to evaluate the effects of statins on hypertrophic scarring.

Results:

Treatment with pravastatin intradermal administration significantly reduced scarring in terms of scar elevation index. Topical treatment with both medium- and high-dose simvastatin also significantly reduced scarring. High-dose simvastatin topical treatment showed a major effect in scar reduction but induced side effects of scaling, erythema, and epidermal hyperplasia, which were improved with coapplication of cholesterol. There is a dose response in scar reduction with low-, medium- and high-dose simvastatin topical treatment. High-dose simvastatin treatment significantly reduced the messenger ribonucleic acid (mRNA) expression of connective tissue growth factor, consistent with our previously published work on intradermally injected statins. More directly, high-dose simvastatin treatment also significantly reduced the mRNA expression of collagen 1A1.

Conclusions:

Topical simvastatin significantly reduces scar formation. The mechanism of efficacy for statin treatment through interference with connective tissue growth factor mRNA expression was confirmed.
Intracorneal Inlays for the Correction of Presbyopia
Authors: Binder Perry S.
Published: June 2017

The current nonsurgical approaches for the correction of presbyopia are spectacles or contact lenses or the use of pharmaceuticals to create an artificial pupil and/or to stimulate residual accommodation. Refractive surgical procedures use a monovision approach and/or a multifocal corneal laser ablation with or without the induction of negative spherical aberration to improve near vision. More recently, new surgical approaches include intracorneal inlays. Inlay approaches include increasing corneal curvature alone, implanting a multifocal inlay, or by implanting a small aperture device that functions as a pinhole to restore unaided near and intermediate visual acuity. This review presents an analysis of the history and development of the various inlay approaches designed to improve presbyopia. Unlike other refractive surgical approaches, these newer techniques are removable. Each has its advantages and disadvantages.
A Comparison of the Effects of Orthokeratology Lens, Medcall Lens, and Ordinary Frame Glasses on the Accommodative Response in Myopic Children
Authors: Han Xiaoxia , Xu Dongjun , Ge Weizhong , Wang Zhi , Li Xiaodong , Liu Weihua
Published: June 2017

Objective:

To observe and compare changes in accommodative response between myopic children wearing ordinary frame glasses (OFG), Mouldway orthokeratology lenses (M-OK), and medcall lenses (ML).

Methods:

A total of 240 myopic children were divided into three groups: OFG [n=90]; M-OK [n=90]; and ML [n=60]). The diopter, accommodative lag, and binocular accommodative facility before wearing glasses (T0) and 1-year after wearing glasses (T1) were compared among the three groups.

Results:

Commercially available software was used to perform statistical analysis, and the data were expressed as mean±SD. There were no significant differences among the three groups at T0. The accommodative lags in M-OK and ML at T1 were significantly lower than those at T0; this finding was most evident in M-OK. Although accommodative facility increased in all three groups, the increase was most evident in M-OK and ML.

Conclusion:

Mouldway orthokeratology lenses and ML can reduce the accommodative lag and increase the accommodative facility in myopic children. Compared with ML, M-OK showed considerably more marked effects to myopia progression in children.
Depth Profile Assessment of the Early Phase Deposition of Lysozyme on Soft Contact Lens Materials Using a Novel In Vitro Eye Model
Authors: Qiao Han , Phan Chau-Minh , Walther Hendrik , Subbaraman Lakshman N. , Jones Lyndon
Published: June 2017

Objective:

To characterize the location of fluorescently labeled lysozyme on commercial contact lenses (CLs) using an in vitro eye model that simulates tear volume, tear flow, air exposure, and mechanical wear.

Methods:

One commercially available conventional hydrogel CL material (etafilcon A) and three silicone hydrogel CL materials (balafilcon A, lotrafilcon B, and senofilcon A) were evaluated in this study. The CLs were mounted on the in vitro eye model and exposed to artificial tear fluid containing fluorescein isothiocyanate (FITC)-labeled lysozyme for 2 and 10 hrs. After these short incubation periods, circular discs were punched from the CLs at the center and periphery and were prepared for confocal laser scanning microscopy (CLSM). The CLSM captured a series of consecutive images spaced 5 μm apart, and the resulting images were rendered into two dimensional cross-sectional views of the CL. The mean fluorescence at each 5 μm slice was used to generate a histogram depicting the penetration of FITC-lysozyme into CLs.

Results:

For both incubation periods, the CLSM images and histogram of etafilcon A showed that FITC-lysozyme is more concentrated at the lens surface, with a moderate amount of deposition in the lens matrix. For balafilcon A, FITC-lysozyme was evenly distributed throughout the lens. For lotrafilcon B, there was a greater amount of FITC-lysozyme deposition on the surfaces of the lens versus the matrix. Senofilcon A had differential FITC-lysozyme distribution profiles depending on the location of the lens. At the lens periphery, FITC-lysozyme primarily deposited on the surface, whereas FITC-lysozyme was uniformly distributed at the center of the lens.

Conclusions:

With the use of a sophisticated in vitro eye model, the study revealed a complex deposition pattern of FITC-labeled lysozyme on various CL materials after short periods of exposure. An understanding of the early deposition pattern of lysozyme on different CL material may elucidate new insights into the processes behind CL discomfort.
Pseudomonas Aeruginosa Bacteremia in Patients With Hematologic Malignancies
Authors: Denham James Dustin , Nanjappa Sowmya , Greene John N.
Published: June 2017

Introduction

Pseudomonas aeruginosa is a gram-negative rod that is a major cause of bacteremia in patients with a hematologic malignancy. Neutropenia from induction chemotherapy is the main risk factor for P. aeruginosa bacteremia and sepsis in this population. We analyzed risk factors, antibiotic susceptibility patterns, and outcomes due to P. aeruginosa bacteremia in these patients from our institution and compared these with those of similar studies.

Methods

This is a retrospective chart review analyzing P. aeruginosa bacteremia in patients with hematologic malignancies.

Results

Between January 2012 and February 2016, a total of 71 patients met the requirements for inclusion in our study. The average age of study participants was 57.9 years. Of the 71 patients included, 43 (60.6%) were neutropenic at the time of positive blood culture, 28 (39.4%) were not neutropenic at the time of positive of blood culture, 23 (32.4%) developed either sepsis or severe sepsis during the course of their hospital stay, 8 (11.3%) developed septic shock, 10 (14.1%) required vasopressor administration, 8 (11.3%) required mechanical ventilation, and 6 (8.5%) required both vasopressor administration and mechanical ventilation.

Discussion

Our research reaffirms the general severity of P. aeruginosa infections. Ultimately, 9 of 71 patients died as a result of their infection, with a mortality rate of 12.7%. Individuals whose bacteremia progressed to septic shock were much more likely to die. The case fatality rate of septic shock was 62.5%. Our data are congruent with other research that finds advanced age to be a significant risk factor for mortality. Our study also found that individuals who received a bone marrow transplant before developing bacteremia were more likely to survive than individuals who did not receive a bone marrow transplant.
Microbiology of Acute Rhinosinusitis in Immunosuppressed Patients
Authors: Ito Christopher J. , Jackson Ryan S. , Castro-Borobio Manuel , Nanjappa Sowmya , Klinkova Olga , Phommachanh Viengsouk , Keeler Jarrod A. , Greene John N. , Padhya Tapan A. , Tabor Mark H.
Published: June 2017

Objective

The aim of this study was to identify causative organisms of acute rhinosinusitis in immunosuppressed patients by a retrospective chart review.

Methods

Records were reviewed usingInternational Classification of Disease, Ninth Editioncodes for inpatient treatment of acute sinusitis. Patients were included only if they had formal sinus cultures obtained and were immunosuppressed, either carrying a diagnosis of a hematologic malignancy or receiving chemotherapy. Demographics, underlying malignancy, and culture results were recorded.

Results

Records of 74 patients with 104 cultures were obtained. There were 43 males and 31 females. The mean age was 51. The most common primary diagnoses were leukemia (65%) and lymphoma (23%). Sixty cultures resulted in either no growth or growth of usual respiratory flora. Of the 44 positive cultures, 5 were polymicrobial, resulting in 61 organisms isolated in total. Bacteria cultured were 73% Gram positive, whereas 27% were Gram negative. The most common Gram-positive organisms cultured wereStaphylococcusspecies.Pseudomonasspecies were the predominant Gram-negative bacteria. Thirteen samples grew fungal organisms.

Conclusions

Medical management of sinusitis in an immunosuppressed patient seems to be adequate in most cases. Patients who fail to improve should undergo evaluation by an otolaryngologist to obtain cultures for directed antibiotic therapy. Infections byStaphylococcusspecies as well as quinolone- and cephalosporin-resistant Gram-negative organisms may be encountered, and clinicians should suspect their presence in patients with persistent disease and expand their antibiotic coverage appropriately.
Fecal Microbiota Transplant in Severe/Complicated Clostridium difficile Infection
Authors: Gundacker Nathan D. , Walker Jeremey B. , Rodriguez J. Martin , Morrow Casey D.
Published: June 2017

Clostridium difficile infection (CDI) is the most common hospital-acquired infection in the United States. Fecal microbiota transplant (FMT) has become a highly efficacious therapy for recurrent mild/moderate disease; however, the efficacy and optimal delivery method in severe/complicated disease is unknown. A retrospective chart review was performed for all FMT recipients at the University of Alabama at Birmingham. Those with severe/complicated disease were isolated and their clinical course documented via chart review and phone calls. Eight patients with severe/complicated CDI who received FMT via both lower and/or upper routes were documented. Six experienced eventual cure, 2 died, with 1 death attributed to CDI, the other to another nosocomial infection. Fecal microbiota transplant is a reasonable option and should be considered in patients who are not surgical candidates. If lower endoscopy is not possible, delivery of FMT via nasogastric tube should also be considered. More studies comparing the efficacy of these routes are needed.
Myroides Soft Tissue Infections
Authors: Alkiswany Doaa , Bush Larry M.
Published: June 2017

Previously classified as Flavobacterium odoratum, Myroides species, although not regular constituents of the normal endogenous human flora may occasionally cause clinical disease. Most infections follow either exposure to environmental sources or acquired nosocomially often linked to contaminated water. The bulk of nonhealthcare-associated infections involve skin and soft tissues resulting from a traumatic event frequently accompanied by bacteremia. Once considered to be “opportunistic pathogens,” infections with Myroides also occur in immunocompetent individuals. Their unanticipated involvement and inherent multidrug resistance often lead to treatment failures when empiric and practice guideline recommended antimicrobial regimens be administered. However, other than in specific circumstances, it remains in the best interest of “good practice,” antibiotic stewardship efforts, and patient care to adhere to evidence-based guidelines and avoid influences such as the case we present and anecdotal experiences suggesting that broad-spectrum empiric antibiotic prescribing is a prudent practice in the initial treatment of undefined skin and soft tissues.
Short-duration physical activity prevents the development of activity-induced hyperalgesia through opioid and serotoninergic mechanisms
Authors: Lima Lucas V. , DeSantana Josimari M. , Rasmussen Lynn A. , Sluka Kathleen A.
Published: June 2017

Regular physical activity prevents the development of chronic muscle pain through the modulation of central mechanisms that involve rostral ventromedial medulla (RVM). We tested if pharmacological blockade or genetic deletion of mu-opioid receptors in physically active mice modulates excitatory and inhibitory systems in the RVM in an activity-induced hyperalgesia model. We examined response frequency to mechanical stimulation of the paw, muscle withdrawal thresholds, and expression of phosphorylation of the NR1 subunit of the N-methyl-D-aspartate receptor (p-NR1) and serotonin transporter (SERT) in the RVM. Mice that had performed 5 days of voluntary wheel running prior to the induction of the model were compared with sedentary mice. Sedentary mice showed significant increases in mechanical paw withdrawal frequency and a reduction in muscle withdrawal threshold; wheel running prevented the increase in paw withdrawal frequency. Naloxone-treated and MOR−/− mice had increases in withdrawal frequency that were significantly greater than that in physically active control mice and similar to sedentary mice. Immunohistochemistry in the RVM showed increases in p-NR1 and SERT expression in sedentary mice 24 hours after the induction of the model. Wheel running prevented the increase in SERT, but not p-NR1. Physically active, naloxone-treated, and MOR−/− mice showed significant increases in SERT immunoreactivity when compared with wild-type physically active control mice. Blockade of SERT in the RVM in sedentary mice reversed the activity-induced hyperalgesia of the paw and muscle. These results suggest that analgesia induced by 5 days of wheel running is mediated by mu-opioid receptors through the modulation of SERT, but not p-NR1, in RVM.
Pain sensation in human osteoarthritic knee joints is strongly enhanced by diabetes mellitus
Authors: Eitner Annett , Pester Julia , Vogel Franziska , Marintschev Ivan , Lehmann Thomas , Hofmann Gunther O. , Schaible Hans-Georg
Published: June 2017

The major burden of knee joint osteoarthritis (OA) is pain. Since in elder patients diabetes mellitus is an important comorbidity of OA, we explored whether the presence of diabetes mellitus has a significant influence on pain intensity at the end stage of knee OA, and we aimed to identify factors possibly related to changes of pain intensity in diabetic patients. In 23 diabetic and 47 nondiabetic patients with OA undergoing total knee arthroplasty, we assessed the pain intensity before the operation using the “Knee Injury and Osteoarthritis Outcome Score”. Furthermore, synovial tissue, synovial fluid (SF), cartilage, and blood were obtained. We determined the synovitis score, the concentrations of prostaglandin E2 and interleukin-6 (IL-6) in the SF and serum, and of C-reactive protein and HbA1c and other metabolic parameters in the serum. We performed multivariate regression analyses to study the association of pain with several parameters. Diabetic patients had on average a higher Knee Injury and Osteoarthritis Outcome Score pain score than nondiabetic patients (P < 0.001). Knee joints from diabetic patients exhibited on average higher synovitis scores (P = 0.024) and higher concentrations of IL-6 in the SF (P = 0.003) than knee joints from nondiabetic patients. Multivariate regression analysis showed that patients with higher synovitis scores had more intense pain independent of all investigated confounders, and that the positive association between pain intensities and IL-6 levels was dependent on diabetes mellitus and/or synovitis. These data suggest that diabetes mellitus significantly increases pain intensity of knee OA, and that in diabetic patients higher pain intensities were determined by stronger synovitis.
An Effective Filter for Noise Removal in Magnetic Resonance Images Using Multilevel Fuzzy Reasoning Concept
Authors: Saxena Priyank , Kumar R. Sukesh
Published: June 2017

In this study, a novel 2-stage noise adaptive multilevel fuzzy reasoning–based filter is proposed as a postprocessing filtering technique for noise removal from magnetic resonance images. The edge detection stage uses multilevel fuzzy reasoning to handle uncertainty present in the local information introduced by noise. The image-smoothing stage uses a low-pass filter to retain the low-frequency information of the noisy image. Finally, the output of the edge-detection stage, and the smoothed noisy image are added together to form the noise-free image. The effectiveness of the proposed method in noise removal from MR images is evaluated in terms of visual quality of the image and image quality assessment metrics such as peak signal-to-noise ratio, mean square error, structural similarity index measurement, and image enhancement factor. Experimental results show that the proposed method removes noise more effectively from MR images without destroying finer details and coarser structures as compared with the other tested state-of-the-art methods.
Postural Investigation in Individuals With Human T cell lymphotropic virus-1-Associated Myelopathy/Tropical Spastic Paraparesis
Authors: Patricio Naiane Araujo , Macedo Maira Carvalho , Miranda Jose Garcia Vivas , Peña Norberto , Baptista Abrahao Fontes , Sa Katia Nunes
Published: June 2017

The objective of this article is to determine the accuracy of a new videogrammetry software (CvMob; Federal University of Bahia [UFBA] - Salvador, Bahia, Brazil) in 2-dimensional evaluation of the posture of individuals with Human T cell lymphotropic virus-1-associated myelopathy/tropical spastic paraparesis. A diagnostic accuracy study was used in which survey participants underwent computerized postural analysis through Postural Assessment Software (SAPO; University of São Paulo [USP], Brazil) Software (gold standard) and CvMob. On the final sample with 53 participants, there was a high correlation (r > 0.800, P < .001) between the 2 systems in all angles analyzed. However, receiver operating characteristic curve confirmed that ankle angle evaluation is discrepant between the 2 methods. Angles evaluated by CvMob are accurate for postural diagnosis and are strongly correlated with the absolute values of SAPO, except for the ankle angle.
Clinical/Biomedical Quality Management System
Authors: Tomaino Kelsea , Ngoie Jean
Published: June 2017

This article discusses the process and importance of a clinical engineering quality management system (QMS). The goal is to guarantee that the Clinical Engineering Department delivers their services at a consistent level with a high degree of effectiveness. Before the creation of the QMS, there were inconsistencies in service delivery in our organization. This was due to the fact that technologists performed service and maintenance based on their own experience and guidance from manufacturer service manuals.

The QMS at Niagara Health is developed by implementing standardized general and specific device procedures and checklists. These fit into a clinical engineering quality manual. The written procedures and checklists are then loaded onto a mobile application to be used by technologists at any time or place.

The implementation of a QMS is important for any department or organization regardless of specialty. It promotes quality, consistency, and accuracy in the delivery of service. It ensures that individuals are performing their duties in the same way across the department or organization. The mobile application is a component of the QMS that provides the Clinical Engineering Department of Niagara Health with a tool to enhance the quality system. It allows users to access all quality documents at anytime and anywhere.

As equipment, processes, and procedures are the same across the healthcare system, the long-term goal is to share this mobile application with other hospitals, as well as to use it as a quality management document control and audit tool for clinical engineering–related activities.
Antipsychotic Use Among Adult Outpatients and Venous Thromboembolic Disease
Authors: Ferraris Augusto , Szmulewicz Alejandro G. , Vazquez Fernando J. , Vollmer William M. , Angriman Federico
Published: June 2017

Background

Treatment with antipsychotic (AP) agents is associated with incident thromboembolic events. However, the underpinnings of this association remain unknown. We sought to evaluate the effect of AP agents—categorized by their metabolic/sedative and hyperprolactinemia adverse effect profile—on the risk of venous thromboembolic disease during long-term follow-up.

Methods

A retrospective cohort study of adult patients initiating AP treatment for the first time was conducted. Primary outcome was defined as the time to venous thromboembolism (VTE) (either deep venous thrombosis or acute pulmonary embolism). Antipsychotic agents were categorized by their risk (high vs low) of either drug-induced (a) sedation/metabolic adverse event or (b) hyperprolactinemia. We used a propensity score–adjusted Cox proportional hazards model to control for confounding.

Findings

One thousand eight patients (mean age, 72.4 y) were followed for a median of 36 months. Incident VTE occurred in 6.25% of patients, corresponding to an incidence rate of 184 cases per 10,000 person-years. We found no difference in the hazard of VTE during follow-up between high- and low-risk groups (hazard ratio, 1.23 [95% confidence interval, 0.74–2.04] for drug-induced sedation/metabolic adverse event risk categories, and hazard ratio 0.81 [95% confidence interval, 0.50–1.35] for high versus low hyperprolactinemia risk).

Conclusions

These results suggest that the risk of thromboembolic events in older adults who started AP treatment for the first time does not seem to be related to these drugs' risk of either sedation/metabolic adverse events or hyperprolactinemia. However, VTE remains a common problem in this subgroup of patients.
The Spectrum of General Surgery Interventions in Pediatric Patients with Ventricular Assist Devices
Authors: Kamel Fady , Buchholz Holger , Dicken Bryan , Conway Jennifer
Published: June 2017

Ventricular assist devices (VADs) have positively impacted the management of heart failure. However, they come with a range of complications. Although general surgical complications have been assessed in adults with VADs, there is no study to date that has assessed general surgery intervention in the pediatric population. Fifty-two patients who received VADs from 2005 to 2015 at the Stollery Children’s Hospital were assessed for general surgery intervention and anticoagulation status at the time of intervention. Eighteen patients (35%) had general surgery intervention; there were 21 nonemergency procedures and six emergency procedures performed. For nonemergency procedures, 89% of patients had anticoagulation held within 24 hours of surgery and 84% had anticoagulation resumed within 4 hours postoperatively. Antiplatelet therapy was not held perioperatively. In both emergency and nonemergency procedures, anticoagulation status was not a factor in the success of the procedure. This study shows that it is safe to have general surgery intervention on the same admission as a VAD implant provided an appropriate interdisciplinary healthcare team is involved with the perioperative management of the patient.
Population-based Cancer Screening
Authors: Benito Llucia , Espinosa Jose , Binefa Gemma , Vidal Carmen , Lluch María Teresa , Puig Montse , Fernandez Maria , Padrol Isabel , García Montse
Published: June 2017

Background:

European guidelines for the quality of screening programs for breast and colorectal cancer describe process, structure, and outcome indicators. However, none of them specifically evaluate coordination and continuity of care during the cancer screening process.

Objectives:

The aim of this study was to identify and adapt care quality indicators related to the coordination and continuity of the cancer screening process to assess nursing care in cancer screening programs.

Methods:

The indicators proposed in this study were selected in 2 phases. The first consisted of a literature review, and the second was made by consensus of an expert group. An electronic literature search was conducted, through June 2016. From a total of 225 articles retrieved, 14 studies met inclusion criteria, and these 14 documents were delivered to the group of experts for evaluation and to propose a final list of agreed-upon indicators.

Results:

The group of experts selected 7 indicators: adequacy and waiting time derivation of participants, delivery and availability of the report of the process, understanding professionals involved in the process, and satisfaction and understanding of participants.

Conclusions:

These indicators should help identify areas for improvement and measure the outcome of coordination and continuity of care.

Implications for Practice:

The results provided a common set of indicators to evaluate the coordination and continuity of care for cancer screening and to consequently assess the contribution of nursing care in cancer screening programs. The identification and adaptation of these quality indicators will help to identify areas for improvement and measure the effect of coordination and continuity of care.
A New Resource for STD Clinical Providers: The Sexually Transmitted Diseases Clinical Consultation Network
Authors: Caragol Laura A. , Wendel Karen A. , Anderson Teri S. , Burnside Helen C. , Finkenbinder Allison , Fitch John D. , Kelley Destiny H. , Stewart Terry W. , Thrun Mark , Rietmeijer Cornelis A.
Published: June 2017

An online consultation tool, the Sexually Transmitted Diseases Clinical Consultation Network is a new resource for sexually transmitted disease clinicians and clinic managers. An initial evaluation shows that most requests (29%) were from medical doctors, followed by nurse practitioners (22%). Syphilis queries comprised 39% of consults followed by gonorrhea (12%) and chlamydia (11%).
The Number of Interviews Needed to Yield New Syphilis and Human Immunodeficiency Virus Cases Among Partners of People Diagnosed With Syphilis, North Carolina, 2015
Authors: Samoff Erika , Cope Anna B. , Maxwell Jason , Thomas Francina , Mobley Victoria L.
Published: June 2017

Objective

Compare syphilis investigation yield among patient groups using number needed to interview.

Goal

To increase investigation efficiency.

Study Design

Retrospective review of North Carolina 2015 syphilis investigations, using the number of cases needed to interview (NNTI) and the total number of cases and contacts needed to interview (TNTI) to compare yield of new syphilis and human immunodeficiency virus diagnoses between patient groups.

Results

We reviewed 1646 early syphilis cases and 2181 contacts; these yielded 241 new syphilis cases (NNTI, 6.9; TNTI, 16.4) and 38 new human immunodeficiency virus cases (NNTI, 43). Interviews of women (prevalence difference [PD] = 6%, 95% confidence interval [CI], 12–16), patients <30 years old (PD = 5%, 95% CI, 1–8), and patients with titer >1:16 (PD = 5%, 95% CI, 1–9) yielded more new syphilis cases in our adjusted model; no other patient factors increased investigation yield.

Conclusions

The NNTI and TNTI are useful measures of efficiency. Prioritizing early syphilis investigation by gender, rapid plasmin reagin titer, and age provides small increases in efficiency; no other factors increased efficiency.
Self-Reported Use of Mouthwash and Pharyngeal Gonorrhoea Detection by Nucleic Acid Amplification Test
Authors: Chow Eric P.F. , Walker Sandra , Read Tim R.H. , Chen Marcus Y. , Bradshaw Catriona S. , Fairley Christopher K.
Published: June 2017

Background

Use of alcohol-containing mouthwash has been found to have an inhibitory effect against pharyngeal gonorrhoea. The aim of this study was to investigate the association between self-reported mouthwash use and pharyngeal gonorrhoea detection among men who have sex with men (MSM).

Methods

A cross-sectional survey was conducted between March 23, 2015, and June 30, 2015 among MSM attending the Melbourne Sexual Health Centre in Australia. Men who have sex with men were invited to complete a short questionnaire on mouthwash use and they were also tested for pharyngeal gonorrhoea by nucleic acid amplification test. Multivariate logistic regression was performed to examine the association between mouthwash use and pharyngeal gonorrhoea detection.

Results

Of the 823 MSM, pharyngeal gonorrhoea detection decreased significantly with increasing age group (≤24 years, 14.5%; 25–34 years, 10.7%; ≥35 years, 6.0%; p
trend = 0.003). The proportion reporting daily use of mouthwash increased significantly with increasing age group (from 10.1% to 14.5% to 19.8%; p
trend = 0.005). However, there was no significant association between pharyngeal gonorrhoea detection and daily use of mouthwash after adjusting for age, number of male sexual partners, human immunodeficiency virus status, and type of mouthwash use.

Conclusions

Although the proportion of daily use of mouthwash increased with age, and pharyngeal gonorrhoea detection decreased with age, the association between self-reported mouthwash use and pharyngeal gonorrhoea detection by nucleic acid amplification test was not statistically significant.